From October 26-28, CEI and our partners were delighted to participate in the inaugural conference of the Centre for Holistic Initiatives for Learning and Development (CHILD) in Singapore. The theme was “Emerging Issues & Advances in Early Childhood: Knowledge + Collaboration = Transformation.”
The Centre for Holistic Initiatives for Learning and Development (CHILD) is a Singaporean initiative established under the umbrella of the NUS Yong Loo Lin School of Medicine (NUS Medicine) with a generous endowment from the Lien Foundation. CHILD's core strategic partners are Centre for Evidence and Implementation (CEI) and A*STAR's Singapore Institute for Clinical Sciences (SICS).
CHILD combines expertise in translational research, early childhood development, and implementation science to address gaps in systems and services in Singapore. Leading local and international practitioners, policymakers, and researchers came together at the event to share insights and stimulate discussion about how to support young children to thrive and reach their full potential. There were several key themes, which are explored in brief below. Further insight, including some session threads, can be found on Twitter at #CHILDBC2022.
Theme 1: Early intervention is critical and extends to areas where systems may not yet be adequately supporting families and caregivers
Intervening early – in some cases, even in the pre-conception period – to support children and families is vital, and many of the conference presentations reinforced this. Keynote speaker Professor Philip Fisher of the Graduate School of Education at Stanford University framed his talk by sharing what is known about children’s neurological development in the early years of life and the well-established, high returns to early childhood education.
What happens in the early years affects lifelong health, learning, and behaviour. Professor Philip Fisher
Researchers conducting cohort studies, such as Dr Anne Rifkin-Graboi, Head of Infancy and Early Childhood Research, OER Centre for Research in Child Development at the National Institute of Education; Professor Melissa Wake of Murdoch Children's Research Institute and Scientific Director of Generation Victoria, Dr Jonathan Huang, Principal Investigator at A*STAR Singapore Institute for Clinical Sciences (SICS); and Dr Cai Shirong, Principal Investigator for Translational Neuroscience at A*STAR SICS, further underscored the importance of early intervention in diverse areas such as sleep and caregiving that can drive children’s outcomes later in life.
Several discussions focused on the issue of the need to shift to models that support effective screening and more rapid response to identified issues. These developments could advance opportunities for early intervention and improve long-term child health. Professor Jerry Chan, Director, SingHealth Duke-NUS Maternal and Child Health Research Institute, described a “golden thread approach” to transforming maternal and child health through HELMS, which supports screening and interventions from the pre-conception to post-natal periods for women. “Interventions need to be applied pre-conception to create the best impact, as most risks are accrued before pregnancy,” he said.
Professor Lynn Kemp, Director of the Translational Research and Social Innovation (TReSI) group in the School of Nursing and Midwifery, and academic leader of the Centre for Transforming early Education and Child Health (TeEACH) at Western Sydney University described her team’s work to develop more sensitive tools that can be used to assess risk factors for children even during pregnancy. Dr Pony Chew, Senior Research Specialist at the National Council on Social Service (NCSS) in Singapore emphasised the importance of screening for childhood adversities and responding with interventions that support children to build self-regulation skills.
There is also a need to adapt for context and culture. Associate Professor Shefaly Shorey of the Alice Lee Centre for Nursing Studies at the Yong Loo Lin School of Medicine, National University of Singapore described her research on the Supportive Parenting App and the lessons learned about supporting new parents. A key insight from her work is that fathers do not feel like they are being included and can be better engaged and empowered as parents in the context of early childhood interventions. “In Singapore, fathers are seen as lamp posts,” Dr Shorey noted – and this needs to change.
Finally, numerous speakers discussed the importance of early intervention not just in screening and supporting the mother-child dyad but ensuring programs also address the important roles that fathers and other caregivers play in child development. Much discussion focused on the need for systemic change. While screening and interventions for issues such as maternal mental health and physical health exist in varying degrees across sectors, what is missing is the holistic approach to targeting the family unit, not the individual.
Theme 2: Supporting holistic child development requires collaboration across institutions, disciplines, and sectors Showing a complex system map for child obesity, Professor Melissa Wake of Murdoch Children's Research Institute and Scientific Director of Generation Victoria emphasized that factors affecting children's developmental outcomes, even in discrete areas like nutrition, are inter-related and multifaceted, and that single interventions are likely insufficient.
A key conference theme was that our current systems for responding holistically to meet children’s needs are compromised by the systemic silos. The importance of collaboration and building partnerships was emphasised by many speakers, including in a panel featuring Ms Ng Mie Ling, Assistant Chief Executive Officer, Early Childhood Development Agency Singapore; Ms Ang Bee Lian, Senior Director-Professional Corporate Development Group and Director-General of Social Welfare, Ministry of Social and Family Development Singapore; and Ms Vasuki Utravathy, Director, School Health and Outreach, Health Promotion Board Singapore. All three called for breaking down barriers between disciplines and sectors to accelerate evidence into policy and practice. They wished to make evidence available more quickly for policymakers, to use the language of people on the ground for evidence communication, and to narrow the gap between researchers and policymakers. Because “we really live in different worlds,” concluded Ms Ng.
In a fireside chat, Ms Rahayu Mahzam, Senior Parliamentary Secretary, Ministry of Health and Ministry of Law Singapore and Ms Sun Xueling, Minister of State, Ministry of Social and Family Development and Ministry of Home Affairs Singapore, emphasised that this push for collaboration must recognise and address the differing ways that agencies and actors understand the issues. Agencies have different degrees of maturity in understanding and varying appetites of how much they want to respond to key topics, which affects collaboration.
We see the importance of coming together… [and] we already are starting to use common language… Everyone is coming on board. How do we make sure that interfaces meaningfully? – Ms Rahayu Mahzam
A panel moderated by CEI Director Dr Cheryl Seah further elaborated on this theme of “Partnerships in Practice” and featured Ms Seah Yang Hee, Deputy CEO & Group Director (Service Planning & Funding) at National Council of Social Service; Dr Sylvia Choo Senior Consultant (Department of Child Development), KK Women’s and Children’s Hospital; and Adjunct Associate Professor Chong Shang Chee, Head & Senior Consultant Paediatrician, Child Development Unit, Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital
Theme 3: Implementing effective and scalable solutions to the challenges we currently face is possible. But we must listen to the voices of families, contextualise programs, and respond to communities.
While we have a number of effective and scalable solutions that work for children and families, several speakers addressed the need to contextualise and adapt these solutions to fit with children and family circumstances and with community needs. Professor Fisher’s opening remarks set the tone for this theme, underscoring the importance of listening to adults in the lives of young children and then supporting children, their communities, and their families in ways that they are asking for. “Many of us have been sitting in academia and thinking of what we think is best for them,” Dr Fisher noted. This needs to shift toward approaches that meet people where they are.
Dr Joanne Yoong, Founder and Principal Economist, Research for Impact Singapore, built on this theme in a later panel. Behavioural interventions that seek to educate parents about the value of early childhood education, for example, are only useful if people have meaningful access to nurseries and pre-schools. "There's no point in ‘nudging’ people whose backs are against the wall," she noted. At worst, Dr Yoong said, “a nudge solution is offensive" if someone cannot make different choices because of circumstance or context.
There is a need to ensure that those who actually need support are receiving it and that gaps in support are filled. For example, despite the numerous programs in Singapore to support children and families, there may still be a sense for some families that there are “many helping hands, but no hands are helping me,” according to Minister of State Sun Xueling.
Consultation and engagement with individuals are vital to ensure that solutions are contextualised in ways that will maximise impact. Dr Florence Sheen from the Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, described her team’s work to provide parents with better information through front-of-pack labelling on commercial food products, citing the “immense value of patient and public involvement and engagement” to their work.
Theme 4: Integrating evaluation activities into program implementation is key to ensure solutions are working as intended for target groups
Undertaking evaluation and gathering evidence of what is working and what may work to address social challenges was a key theme of the conference. In a keynote on Day 2, Ms Tan Li San, CEO of the National Council of Social Service (NCSS) Singapore spoke on the theme of “The Power of Research in Transforming Social Services” and described NCSS’s work to synthesise, generate, and disseminate evidence for the social sector and to support agencies to build skills to use evidence. For example, NCSS has just established an independent research ethics board in Singapore.
Evaluation need not wait until ‘the end’ to assess interventions, and studies that look to assess implementation as well as effectiveness were described by a range of panelists and presenters.
Dr Lim Hong Huay, Board Chair at CaringSG, and Dr Grace Chng, Senior Advisor at CEI Singapore, described CaringSG’s ground-up caregiver-led initiative, Project 3i, which has aims to connect, enable, and empower caregivers as well as build an inclusive community for families in Singapore. While the intervention evidence-based, Dr Lim was keen to integrate evaluation even in the pilot phase. CEI is partnering to conduct a formative evaluation to look at ‘how does it work’, ‘for whom’ and ‘what needs to be in place for it to scale’.
Formative evaluation is useful because it allows us to improve programs along the way, similar to a chef adjusting as he prepares food. Summative evaluation is akin to after the dish has been completed. By that time, it’s too late to do anything to fix it! – Dr Grace Chng
Dr Keri McCrickerd, Research Scientist at A*STAR SICS and Assistant Professor at National University of Singapore described the Appetite Toolbox Study Protocol. This is an ongoing implementation-effectiveness trial assessing a program designed to promote children’s eating awareness and regulation skills in preschool.
Jane Lewis, Managing Director at CEI, shared details about a recently completed evaluation of Our Skills, a family literacy program that aims to help parents and caregivers to support children's early reading. This pilot evaluation assessed implementation outcomes (feasibility, acceptability, and appropriateness) and evidence of promise and recommended testing hybrid or face-to-face delivery modes and a modular or shorter course, as well as reconsidering the definition of eligible families. The evaluation also advised on strategies to improve school and family take-up and leverage school engagement.
The lightning talks included several presenters from the National Institute of Education (NIE) and the National Institute of Early Childhood Development (NIEC), among others, sharing the findings of program or intervention evaluations that sparked discussion of how to use the findings in ongoing service provision. Evaluation is a critical part of assessing whether interventions are working as expected in context and securing the information needed to refine them to better meet needs and deliver greater impact.
Theme 5: Implementation science holds promise for early childhood researchers, practitioners, and policymakers to support efforts to drive evidence-driven policy and practice
People cannot benefit from what they do not receive, and the potential for implementation science in enabling research evidence to be implemented in practice in complex systems was a recurring theme at the conference.
In remarks at the opening ceremony that CEI’s CEO Dr Robyn Mildon called “refreshing”, Minister Masagos Zulkifli, Minister for Social and Family Development and Second Minister for Health emphasised the importance of drawing on good research and assessing evidence and outcomes. “Equally important to research is its implementation”, he remarked.
In a keynote, Professor Bryce McLeod, Professor and Co-Director of Clinical Training in the Department of Psychology, Virginia Commonwealth University, described the “Common Elements” approach to help span the science to practice gap. Professor McLeod spoke in practical terms about this approach, which helps us to know “what works for whom, under what settings” and adapt elements of effective practice for local context. “The further we get away from implementing programs from the populations, from the settings, from the kids, they were originally developed on, we need more potential for tailoring,” said Professor McLeod.
CEI, in collaboration with partners, is using a Common Elements Approach in a number of projects, including in the Singapore-based Enhancing & Supporting Early Development to Better Children’s Lives (EASEL) Approach. The EASEL Approach aims to better enhance early childhood educators' practices in the classrooms to promote children's social, emotional, behavioural and executive functioning outcomes. Dr Evelyn Tan, Advisor at CEI, described the work on EASEL to move from evidence to implementation, explaining how EASEL seeks to “innovate and build upon existing evidence to mobilise 'what works' to promote early child development."
In one of the conference’s closing panels, Professor Nick Sevdalis, Director, Centre for Implementation Science at King’s College London and Visiting Professor, Yong Loo Lin School of Medicine, National University of Singapore, described how implementation science seeks to drive uptake of evidence in complex systems by testing different approaches, including approaches like audit and feedback as well as coaching that are known to be strongly evidence-informed.
A panel moderated by CEI Director Dr Cheryl Seah further touched on implementation themes. In this panel, Dr Sylvia Choo, Senior Consultant (Department of Child Development), KK Women's and Children's Hospital noted that we cannot simply train practitioners but that ongoing mentoring and coaching are key. This is a finding that is well supported in the literature.
Conclusions
The inaugural CHILD Conference theme was about how knowledge and collaboration can support transformation in early childhood. There was strong convergence on the importance of early intervention to positively affect the entire life course. The conference also illustrated the degree to which senior leaders across research, policy, and practice are aligned in their understanding of the need for cross-departmental, -government, and –sector partnerships that help to drive systemic change for children and families and treat the child and family’s needs holistically. It is clear that there is a collective drive to make substantial and meaningful change for young children and families both locally and globally, and an exciting time to be working together in the field of early childhood.