Is Canadian Index the key to standard child development measures?

One of the achievements of the small but growing band of public health prevention experts – among them Australia’s own Fiona Stanley – has been to bring the terms and tools of epidemiology, so fundamental to effective strategy and service design, into more common parlance among politicians and policy makers.

The Australian Early Development Index, which Stanley adapted from work in Canada and has since pioneered, is an example of how that campaign of persuasion is progressing. A truly collaborative project involving universities, government, private investors and communities across Australia, it is beginning to bear fruit after three years of trials.

The original Early Development Index (EDI) was the brainchild of Magdalena Janus and the late Dan Offord at the Offord Centre for Child Studies [1] at McMaster University in Ontario. Reliability and validity of the instrument were confirmed by several studies on over 16,000 children and it has since been used to assess over quarter of a million young Canadians.

EDI and its Australian successor (AEDI) are practical tools for generating high quality local epidemiology. They provide a community-level measure of development across five domains: language and cognitive skills; emotional maturity; physical health and well-being; communication skills and general knowledge, and social competence. The instrument is completed by teachers who answer 100 questions on behalf of the children in their care.

The strength of EDI and AEDI lies in their potential for combining local evidence on children's well being with epidemiology relating to levels of social cohesion, and in the process galvanising a local population into finding ways to improve their children's health and development.

Building on Fiona Stanley's application of Canadian methods in Perth, Western Australia, the Centre for Community Child Health [2] in Melbourne, the Australian Council for Educational Research [3] and experts at Murdoch and other Australian universities undertook further tests of the reliability and validity. Their work was closely linked to a longitudinal study of Australian children, known as Growing Up in Australia [4].

AEDI is now being implemented in 60 communities. To be able to participate, a community must commit itself to the project and appoint a local co-ordinator to engage with schools and encourage people to use the results. Co-ordinators build on existing community coalitions or forge new ones by engaging key stakeholders in early childhood development.

The Australian version of EDI is web-based, and is supposed to take no more than 20 minutes for teachers to complete. Survey results suggest that they enjoy the process…

Another striking feature of AEDI is the presentation of results. Good examples are available on the AEDI project website [5]. Because the same instrument is used similarly in every participating community, it is possible to make meaningful comparisons. If the process is repeated regularly, the data should also give a reasonable indication of health and development time trends.

Like those in Canada, the results in Australia show significant variations in well-being across communities. Some but not all differences can be explained by socio-demographics. Children in affluent communities also suffer impairments to their health and development; the data can make service provision appear very poorly targeted.

In Australia the key to success will be the extent to which communities act on results. Evidence from the Canadian province of British Columbia suggests that EDI generated many new community initiatives. There was an inevitable bias towards parenting programs, but also much useful attention paid to child health and literacy.

Some European governments are watching how EDI and AEDI develop to see if they reap benefits in child outcomes. But it is already clear that high quality evidence and community engagement are potential partners not antagonists in the struggle to improve prevention and early intervention activity.