Making and Keeping Making and Keeping ConnectionsConnections

Jean M Clinton B.Mus MD FRCP(C)Jean M Clinton B.Mus MD FRCP(C)McMaster University and Children’s HospitalMcMaster University and Children’s Hospital

Voices for ChildrenVoices for Children

October 16 2007

The Health and creativity of a community is renewed each

generation through its children.

The family, community, or society that understands and values its children thrives---the society that does not is

destined to fail

www.childtrauma.org

UNICEF REPORT CARD 2007UNICEF REPORT CARD 2007

““The true measure of a nation’s standing is The true measure of a nation’s standing is how well it attends to its children-their health how well it attends to its children-their health and safety, their material security, their and safety, their material security, their education and socialization, and their sense education and socialization, and their sense of being loved, valued and included in the of being loved, valued and included in the families and societies into which they are families and societies into which they are born.”born.”

Unicef Innocenti Report 2007

CanadaCanada

Material Well BeingMaterial Well Being Health and SafetyHealth and Safety Educational Well beingEducational Well being Family and Peer Family and Peer

RelationshipsRelationships Behaviours and RisksBehaviours and Risks Subjective well beingSubjective well being

OverallOverall

6 SWEDEN 16 SWEDEN 1 13 SWEDEN 113 SWEDEN 1 2 BELGIUM 12 BELGIUM 1 18 ITALY18 ITALY 1 1

17 SWEDEN 117 SWEDEN 1 15 NETHERLANDS 115 NETHERLANDS 1

12/2112/21

Unicef Innocenti Report 2007

The Long Reach of Early The Long Reach of Early ChildhoodChildhood

Early Years Study 2Early Years Study 2

CHAPTER 1CHAPTER 1

ExperienceExperience

Experiences in early life Experiences in early life

activate gene expression activate gene expression

and result in and result in

the formation of the formation of

critical pathways and processes.critical pathways and processes.

Adult-child interactionAdult-child interaction

SoundSoundVisionVision

TouchTouchSmellSmell

ProprioceptionProprioception

TasteTaste

‘‘Sensitive periods’ in early Sensitive periods’ in early brain developmentbrain development

Binocular vision

0 1 2 3 7654

High

Low

Years

Habitual ways of respondingLanguageEmotional

controlSymbolPeer social skillsRelative quantity

Central auditory system

CECD

EpigeneticsEpigenetics

Each person has an individualized Each person has an individualized genetic code.genetic code.

To be expressed, it must be To be expressed, it must be activated. activated.

Genes need nurturing. Genes need nurturing.

High School Diploma by

Level of Aggression

at Age 5

0

20

40

60

80

Never Low High Chronic

Level of Aggression

75.8%

%

62.5%

27.5%

3.3%

It takes a Child to Raise a It takes a Child to Raise a VillageVillage

EYS2EYS2

Chapter 2Chapter 2

FamiliesFamilies

Families are the basic social units of human societies. Families are the basic social units of human societies.

Monitoring developmentMonitoring development

Longitudinal surveys & Longitudinal surveys &

birth cohort studies birth cohort studies

allow researchers & allow researchers &

policy makers policy makers

to monitor to monitor

childrenchildren’’s development.s development.

Receptive Vocabulary, Age 5 Receptive Vocabulary, Age 5 (NLSCY, 2002-03)(NLSCY, 2002-03)

Source: Thomas, 2006

85

90

95

100

105

110

Low Low - Moderate Moderate High

¼¼ of children of children

¼¼ of Canada of Canada’’s s children children between birth between birth to ageto age  6 are 6 are experiencing experiencing some learning some learning or behavioural or behavioural difficulty. difficulty.

Social Risk IndexSocial Risk Index

9 comprehensive indicators of social 9 comprehensive indicators of social riskrisk

those with rate higher than the national those with rate higher than the national average = contributing to the overall average = contributing to the overall riskrisk

zero (0), indicating no social riskzero (0), indicating no social risk nine (9) indicating the highest risknine (9) indicating the highest risk

S4 Student Performance by SES Group S4 Student Performance by SES Group Language Arts Standards Test 2001/02Language Arts Standards Test 2001/02

Pass/Fail rates of test writers 17/18 year olds who should have written

N=221

121

98276

31

75%83%

92%87%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Low Low-Mid Middle High

SES

27%

52%

65%

77%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Low Low-Mid Middle High

SES

Withdrawn

In Grade 11(S3) or lower

In Grade 12(S4), but noLA Test Mark

Drop Course,Absent,Exempt, Incomplete

Fail

Pass

N=349

N=36

N=402

N=192

How are Children Doing?How are Children Doing?

Chapter 3Chapter 3

The EDI has Predictive Validity! The EDI has Predictive Validity! (more than we want)(more than we want)

# of Vulnerabilities % Failing the FSA % Not ‘Successful’

Numeracy

0 7.5 12.31 11.8 22.22-3 18.7 33.84-5 27.5 55.6

Reading0 13.6 17.81 26.7 33.92-3 29.5 43.14-5 48.4 68.3

(EDI) (Grade 4) (Grade 4)

Year 2003 2006

Floreat 47.22% 14.3%Wembley 47.11% 11.8%

AEDI S.Australia

06-11606-116

Decrease in the % of vulnerable children as a result of improved ECD in South Australia

CHAOSCHAOS

EYS2EYS2

Chapter 4Chapter 4

Top level:Top level:

Early interventi

on

Early interventi

onHealth Health

Social services

Education

Education

Family support

Provincial/stateProvincial/state

Local school

authorities

Local school

authorities

Public health

Munici-palities

Community

services

Parks and

recreation

Local authorityLocal authorityMiddle level:Middle level:

Bottom level: Bottom level:

Early identification and intervention

Kindergarten

Public Health

Family support

s

CommunityCommunity programsprograms

Child care

Preschools

Local school

authorities

Public health

Munici-palities

Community services

Parks & recreati

on

Early interventio

n

Health Social services

Education

Family support

Chaos

Child care

Parenting

centres Children’s mental health centres

Kindergartens

Thinking big, starting smallThinking big, starting small

ECD: the 1ECD: the 1stst tier of human tier of human developmentdevelopment

Start in local communitiesStart in local communities

Thinking bigThinking big…… starting small starting small

Communities need Communities need more than opportunities more than opportunities

to create a collective vision; to create a collective vision; they need they need

the mandate & resourcesthe mandate & resources

to realize itto realize it. .

Investing in Early Childhood Investing in Early Childhood DevelopmentDevelopment

Chapter 6Chapter 6

Early Child Development & Parenting Early Child Development & Parenting CentresCentres

Parentalparticipation

Resources for

families

Full-day, full-year options

Nutrition

Problem-basedplay

Pre- andpost-natalsupports

5.063.78

7.14

17.07

0

5

10

15

20

Rat

io o

f be

nefits

to

cost

Elmira PEIP(age 15)

CarolinaAbecedarian

(age 21)

Chicago CPCs(age 21)

PerryPreschool (age 40)

Sources: Karoly et al. (1998), Masse & Barnett (2002), Reynolds et al. (2002), Schweinhart et al. (2004)

Exceptional Returns on Investment:Exceptional Returns on Investment:Long-Term Benefit-Cost Ratios for Four Exemplary Long-Term Benefit-Cost Ratios for Four Exemplary ECD ProgramsECD Programs

Up to 16% rate of return on

investment in ECD, compared

to the highly touted 6% rate of return of the

U.S. stock market (1871-

1998)Sources: Lynch (2004),

Rolnick & Grunewald (2003)

Rates of Return to Human Development Investment Across all Ages

Pre-school Programs

School

Job Training

ReturnPer

$Invested

R

2

4

6

8

0 6 18Age

Pre-School School Post School

03-07403-074

Carneiro, Heckman, Human Capital Policy, 2003

OECD Report, 2004OECD Report, 2004

Source: Starting Strong ll: Early Childhood Education and Care; September 2006

Importance of RelationshipsImportance of Relationships

""Human beings of all ages are happiest Human beings of all ages are happiest and able to deploy their talents to best and able to deploy their talents to best advantage" when they experience advantage" when they experience trusted otherstrusted others as "standing behind as "standing behind them." them."

Bowlby, 1973Bowlby, 1973

Our Biological Unit of SurvivalOur Biological Unit of Survival“The Clan”“The Clan”

We are WIRED to connect.We are WIRED to connect.

We are unavoidably inter-dependant on We are unavoidably inter-dependant on each othereach other

YETYET

..www.childtrauma.org

The Relational Landscape is The Relational Landscape is changing.changing.

Children have fewer emotional, Children have fewer emotional, social and cognitive interactions social and cognitive interactions

with fewer peoplewith fewer people

www.childtrauma.org

POVERTY OF POVERTY OF RELATIONSHIPSRELATIONSHIPS

The compartmentalizing of our culture has The compartmentalizing of our culture has resulted in material wealth yet poverty of resulted in material wealth yet poverty of

social and emotional opportunity.social and emotional opportunity.

Modernity’s Paradox

www.childtrauma.org Hertzman and Keating

Robert Putnam-Bowling AloneRobert Putnam-Bowling Alone

Social CapitalSocial Capital

““Defined as a resource-that stems from Defined as a resource-that stems from participation in certain social networks-that participation in certain social networks-that possess specific characteristics-which open possess specific characteristics-which open up access to resources of varying value.up access to resources of varying value.

Collective EfficacyCollective Efficacy A fusion of shared willingness of residents to intervene A fusion of shared willingness of residents to intervene

and social trust, shared sense of common values and a and social trust, shared sense of common values and a sense of engagement and ownership of public space.” sense of engagement and ownership of public space.”

CE was found to affect crime rates more than factors CE was found to affect crime rates more than factors typically associated with crime like poverty, typically associated with crime like poverty, unemployment or discrimination. Resulted in unemployment or discrimination. Resulted in dramatically lower crime rates among communities with dramatically lower crime rates among communities with similar demographics.similar demographics.

DR Felton EarlsDR Felton Earls

Broken Windows or Collective Broken Windows or Collective EfficacyEfficacy

Physical and social disorder in a Physical and social disorder in a neighbourhood lead to increased crime, if neighbourhood lead to increased crime, if

one broken window or aggressive squeegee one broken window or aggressive squeegee man is allowed to remain in a man is allowed to remain in a

neighbourhood, bigger acts of disorderly neighbourhood, bigger acts of disorderly behaviour will follow.behaviour will follow.

In the year of our Lord 2007In the year of our Lord 2007

Bowling AloneBowling Alone

National Family Dinner DayNational Family Dinner Day

Spending more time studies….Spending more time studies….

If not our culture , then whose?If not our culture , then whose?

CLINTON

Individual Brain and BiologicalDevelopment, Genetics, Age, Sex

Family, Cultural, Economic, & Social Environment

Family Health Status and Dwelling Environment

Residential Community Health Status and Cultural, Economic, Service & Social Environments

Regional Health Status and Ecological, Economic, Policy, Political & Social Environments

National Health Status, Ecological, Economic, Policy, Political & Social Environments

Global Ecological, Corporate/Economic, Policy, Political & Social Environments

Civil SocietyECD Services

and Programs

Relational Community (Tribe, Religion, etc.)Health Status, Cultural Environment and Socioeconomic Status & Resources

Institutional/historical time

Many things we need can wait. The child Many things we need can wait. The child cannot. Now is the time his bones are being cannot. Now is the time his bones are being formed, his blood is being made, his mind is formed, his blood is being made, his mind is being developed. To him we cannot say being developed. To him we cannot say tomorrow, his name is today. tomorrow, his name is today.

~Gabriela Mistral~Gabriela Mistral