Objectives The primary objective was to determine whether a behaviour change intervention delivered to hospital staff would (1) improve the proportion of Aboriginal and/or Torres Strait Islander (Aboriginal) babies being registered and (2) reduce hospital admissions and emergency presentations for babies <6 months old. The secondary objective was an observational analysis to determine factors that might influence the proportion of registered Aboriginal births in Western Australia (WA).Design Quasi-experimental design and cohort study.Setting Five tertiary birthing hospitals in WA.Participants The intervention was delivered to health service providers who were in the five tertiary birthing hospitals. Outcome data were collected on Aboriginal babies born between 1 January 2016 and 30 June 2018 who were delivered within these hospitals. Babies in the control group (n=226) were born 6 months before the intervention and intervention babies (n=232) were born 6 months following the intervention. For the secondary objective, there were 4573 babies included in the analysis.Interventions A behaviour change intervention delivered to hospital staff in five hospitals.Primary and secondary outcome measures The primary outcomes were the proportion of babies who were registered and whether a baby had been admitted to hospital or an emergency department by 3 and 6 months old. The secondary outcome was to determine factors that might influence the proportion of registered Aboriginal births in WA (cohort study).Results There was evidence of a 38% reduction in emergency presentations within 6 months for babies born to hospitals 6 months following the staff training (OR 0.62, 95% CI 0.42 to 0.91), and little evidence of improvements in birth registrations, hospital admissions within 3 or 6 months of birth or emergency department presentations within 3 months of birth. Of the 4573 babies included in the cohort study, 3769 (82.4%) babies had their births registered and 804 (17.6%) babies did not. Factors that were associated with not having a birth registered included low birth weight babies with a 34% decrease in odds of having a registered birth compared with those with a normal birth weight (adjusted OR (aOR) 0.66, 95% CI 0.51 to 0.86). Timing of first antenatal visit was associated with reduced odds of having a birth registered if this occurred in the second (aOR 0.77, 95% CI 0.64 to 0.93) or third trimester (aOR 0.59, 95% CI 0.45 to 0.77) compared with the first trimester.Conclusions Our study identifies the complexities surrounding birth registrations and improved hospital utilisation for Aboriginal babies, the importance of targeted interventions and ongoing efforts needed to address this issue comprehensively.Trial registration number ACTRN12615000976583.

BACKGROUND:Discharge against medical advice (DAMA) is a priority issue for the health system. Little is known about the factors associated with DAMA for Aboriginal and/or Torres Strait Islander (Aboriginal) children in Australia. OBJECTIVES:Investigate the associations between DAMA for hospital admissions and emergency department (ED) presentations and: (i) child, family and episode of service characteristics and (ii) 30-day readmission/ re-presentation. METHODS:We conducted a cohort study of Aboriginal children born in Western Australia (2002-2013) who had ≥1 hospital admissions (n = 16,931) or ED presentations (n = 26,546) within the first 5 years of life. The outcome of interest was hospital and ED DAMA and adjusted odds ratio were derived using multilevel mixed-effects logistic regression. RESULTS:In the Hospital Cohort, there were 43,149 hospitalisations for 16,931 children, with 684 hospitalisations (1.6%) recorded as DAMA. In the ED Cohort, there were 232,082 ED presentations in 26,546 children, with 10,918 ED presentations (4.7%) recorded as DAMA. DAMA occurring in hospitals between 2014 and 2018, the adjusted odds decreased by 75% compared to the period between 2002 and 2005. The adjusted odds of ED DAMA increased by 46% over the same period. Hospital admissions in regional and remote hospitals were almost seven times the adjusted odds of DAMA compared with hospital admissions in Perth metropolitan hospitals. The adjusted odds of ED DAMA decreased by 12% for ED presentations in regional and remote hospitals compared to those in Perth metropolitan hospitals. There was no evidence of hospital DAMA being associated with hospital readmission within 30 days and limited evidence of ED DAMA being associated with re-presenting to an ED within 30 days. CONCLUSIONS:The study identified several important determinants of DAMA, including admission status, triage status, location and calendar year. These findings could inform targeted measures to decrease DAMA, particularly in regional and remote communities.

This study investigated patterns of universal health and education service use from birth through Kindergarten (age 4 years) and estimated associations between cumulative risk and service use patterns, and between service use patterns and children's developmental vulnerability in the Preparatory Year (age 5 years). The study used population-wide linkage of health and education administrative data records for 5168 children who had a 2018 AEDC instrument collected in Tasmania and were born in Tasmania (2011–2013). Latent class analysis (LCA) identified three service use patterns: Regular (72.2 per cent of children; reference group), Low (15.6 per cent of children) and High service use (12.2 per cent of children). The patterns of Regular, Low and High service use were consistent across health and education services used at different ages and stages of child development. Membership of the Low and High service use groups was associated with higher cumulative risk and increased odds of developmental vulnerability, relative to the Regular service use group. This population-wide view of universal service use can be used by the health and education sectors to explore ways in which their specialist expertise, resources and referral processes can be further integrated within and across services to meet the developmental needs of children and families.

In this paper, we aim to contribute to the understanding of the multidimensional nature of school readiness. In a sample of over 4,000 Australian children in their first year of school, we used latent class analysis to examine patterns of school readiness based on child, family, school and community characteristics, and examine the relationship between these patterns of school readiness and subsequent outcomes (reading comprehension, school absence and emotional and behavioural difficulties). We identified four distinct groups: a Developmentally Enabled group (70 per cent of children), a Parenting Risk group (16 per cent of children), an Emotionally Immature Risk group (7 per cent of children) and a Language and Developmental Risks group (7 per cent of children). The four profiles showed differential patterns of association with low reading comprehension and emotional and behavioural difficulties at age 8, but no association with school absence. The study highlights the importance of family, school and community factors when considering school readiness.

Background In Australia, the health and education sectors provide universal early childhood services for the same population of children. Therefore, there is a strong imperative to view service use and outcomes through a cross-sectoral lens to better understand and address the service needs of young children and their families. Objectives To investigate patterns of health and education service use from birth through Kindergarten (age four years), the associations with cumulative risks, and developmental vulnerability in the first year of full-time school (age five years). Methods A retrospective cohort study that used population-wide linkage of health and education administrative data records for 5,440 children with a Tasmanian 2015 Australian Early Development Census (AEDC) record who were born in Tasmania (2008-2010). Results Four service use patterns were identified: Regular (46% of children), Declining (24%); Low (18%); and Selective service use (12%). Regular service use (aOR 0.8, 95% CI 0.7 to 0.9), adjusted for cumulative risks, was associated with decreased odds of developmental vulnerability, compared to the other service use groups. Low (OR 6.1, 95% CI 4.5 to 8.2) and Declining service use (OR 2.5 95% CI 1.9 to 3.4) were more likely for children with the highest levels of cumulative risks. Low and Declining service use, adjusted for cumulative risks were associated with increased odds of developmental vulnerability, compared to the Regular service use group. Conclusion This study provides a whole population view of the differential use of universal services and the complex risk circumstances that influence service use. The association between patterns of multiple risk and service use points to barriers to service use, and the varying level of developmental vulnerability within each service use group draws attention to children who may benefit from higher sustained participation in core health and education services across the whole of early childhood.

AbstractIn this chapter we use rich longitudinal data to examine the typical growth of vocabulary in children as they age from 4 years onwards. Vocabulary is a robust indicator of language development and of early cognitive growth. The data demonstrate the surprising variability among children of similar ages in their early cognitive growth. This variability leads to difficulties in predicting early vulnerability and in subsequently selecting children for targeted interventions. By examining the developmental circumstances that accelerate or retard changes in the growth of this aspect of language development we assess the implications of the findings for the subsequent population reach and actual participation of children in programs designed to reach those who are variously vulnerable.

There is a large volume of research on the persistence of advantage and disadvantage across generations. Intergenerational studies typically address family resources as independent factors, which ignores how risks cluster together and accumulate over time. Using data from the Longitudinal Study of Australian Children, we conducted two latent class analyses to separately identify latent classes based on grandparent and parent characteristics for study children. We then examined the association between our identified latent classes and grandchild educational outcomes in Years 3 to 9. Five distinct latent classes of grandparent characteristics and four latent classes of parent characteristics were identified. There was association between parent and grandparent latent classes indicating intergenerational multiple disadvantage. Grandchildren in at-risk parent latent classes tended to have significantly lower literacy and numeracy scores from Years 3 to 9. The effects of grandparent latent classes were inconsistent. The developmental circumstances of children can be defined using the characteristics of both parents and grandparents, and the role of grandparents on children's development extends beyond the influence they have on parent outcomes. This study highlights that addressing intergenerational transfers of disadvantage requires multiple, integrated and coordinated policy approaches that go beyond individual indicators of disadvantage.

Current evidence about the prevalence of interparental conflict (IPC) during early parenthood is primarily based on mothers’ reports. Drawing upon Australian longitudinal data from 4136 fathers, the aims of the study were to: (a) report on the extent to which fathers report IPC across six biennial time intervals when their children were aged 6–12 months to 10–11 years, (b) identify trajectories of IPC over time and (c) identify postnatal factors (at the initial time point) associated with high risk trajectories of IPC. One in 10 fathers reported high IPC at each time interval. A high and increasing pattern of IPC was observed for 6% of fathers. Factors associated with this trajectory were fathers being from a non-English speaking background and high postnatal psychological distress reported by mothers and fathers. These findings underscore the importance of early intervention for some families experiencing IPC in the early years of their children’s lives.

There is a large volume of research on the persistence of advantage and disadvantage across generations. Intergenerational studies typically address family resources as independent factors, which ignores how risks cluster together and accumulate over time. Using data from the Longitudinal Study of Australian Children and latent class methods, we used grandparent and parent characteristics to identify risk circumstances of grandchildren and then examined the association between risk circumstances and grandchild educational outcomes. Five qualitatively and quantitatively distinct latent classes of grandparent characteristics and four latent classes of parent characteristics were identified. Of these, Low Grandparent Education Capital, Parent Financial Hardship, and Multiple Parent Risks latent classes were associated with lower grandchild literacy and numeracy scores in Year 3. Disadvantages were concentrated within three-generation family units; grandparent latent classes were associated with parent latent classes, and grandparent and parent latent classes were associated with the grandchild’s educational achievement.

Interparental conflict (IPC) has the potential to adversely affect children's social, emotional, and behavioural functioning. The overall objective of this study was to investigate the relationship between both the severity and chronicity of IPC across early and middle childhood and children's emotional-behavioural functioning at 10-11 years. Specifically, we aimed to: (1) identify distinct trajectories of IPC spanning 10-11 years since birth of the study child as reported by mothers, and (2) examine the emotional-behavioural functioning of children exposed to the identified IPC trajectories. Drawing from a nationally representative longitudinal study of Australian families (N = 4875), four distinct trajectories of IPC were identified: (1) consistently low exposure to IPC over time, (2) persistently elevated exposure to IPC, (3) increasing IPC exposure over time, and (4) decreasing IPC exposure over time. Children exposed to trajectories with high IPC at any point during the study period were reported by their mothers to be experiencing more emotional-behavioural difficulties than children exposed to low IPC over time. Based on teacher report, there were no differences in emotional-behavioural functioning of children exposed to the different patterns of IPC. Our findings reinforce that high parental conflict at any point in a child's life is a form of adversity that can have adverse consequences for their mental health, and that early interventions for parents and caregivers experiencing high IPC are critical.

This study assessed if the association between mental disorders and higher student absences varies across different profiles of risk factors, and estimated the proportion of student absences associated with mental disorders. Data included responses from a nationally representative Australian survey of child and adolescent mental health (Young Minds Matter, N = 5,081). A latent class analysis identified four classes of multiple risk exposure for students and their families, including On Track (55%), Low Resources (22%), Child Concerns (15%), and Overwhelmed (7%). Negative binomial regression models with adjustment for misclassification probabilities showed that absence rate ratios were higher among students classified as Low Resources (1.8 times), Child Concerns (1.7 times), or Overwhelmed (3.0 times) than On Track students. Overall, students with an anxiety or depressive disorder had 1.2 times as many absences as students without a disorder, after adjusting for latent class membership. There was no support for the hypothesis that the association between anxiety/depressive disorder and absences would be greater for students experiencing multiple risk exposures. Behavioral disorders were not associated with higher absences. Mental disorders accounted for approximately 8.6% of absences among secondary students (Years 7–12) and 2.4% of absences among primary students (Years 1–6). The estimated contribution of mental disorders to school absences is not trivial; however, the contribution is about half that estimated by previous research. The educational impacts of mental disorders must be considered in conjunction with the broader social contexts related to both mental disorders and student absences.

Objective To investigate the prevalence of, and associations between, prenatal and perinatal risk factors and developmental vulnerability in twins at age 5.Design Retrospective cohort study using bivariate and multivariable logistic regression.Setting Western Australia (WA), 2002–2015.Participants 828 twin pairs born in WA with an Australian Early Development Census (AEDC) record from 2009, 2012 or 2015.Main outcome measures The AEDC is a national measure of child development across five domains. Children with scores <10th percentile were classified as developmentally vulnerable on, one or more domains (DV1), or two or more domains (DV2).Results In this population, 26.0% twins were classified as DV1 and 13.5% as DV2. In the multivariable model, risk factors for DV1 were maternal age <25 years (adjusted OR (aOR): 7.06, 95% CI: 2.29 to 21.76), child speaking a language other than English at home (aOR: 6.45, 95% CI: 2.17 to 19.17), male child (aOR: 5.08, 95% CI: 2.89 to 8.92), age younger than the reference category for the study sample (≥5 years 1 month to <5 years 10 months) at time of AEDC completion (aOR: 3.34, 95% CI: 1.55 to 7.22) and having a proportion of optimal birth weight (POBW) <15th percentile of the study sample (aOR: 2.06, 95% CI 1.07 to 3.98). Risk factors for DV2 were male child (aOR: 7.87, 95% CI: 3.45 to 17.97), maternal age <25 (aOR: 5.60, 95% CI: 1.30 to 24.10), age younger than the reference category (aOR: 5.36, 95% CI: 1.94 to 14.82), child speaking a language other than English at home (aOR: 4.65, 95% CI: 1.14 to 19.03), mother’s marital status as not married at the time of twins’ birth (aOR: 4.59, 95% CI: 1.13 to 18.55), maternal occupation status in the lowest quintile (aOR: 3.30, 95% CI: 1.11 to 9.81) and a POBW <15th percentile (aOR: 3.11, 95% CI: 1.26 to 7.64).Conclusion Both biological and sociodemographic risk factors are associated with developmental vulnerability in twins at 5 years of age.

ObjectiveEarly childhood is a critical time to address risk factors associated with developmental vulnerability. This study investigated the associations between clusters of early life risk factors and developmental vulnerability in children’s first year of full-time school at age 5.DesignA retrospective cohort study.SettingPopulation-wide linkage of administrative data records for children born in Tasmania, Australia in 2008–2010.ParticipantsThe cohort comprised 5440 children born in Tasmania in 2008–2010, with a Tasmanian 2015 Australian Early Development Census (AEDC) record and a Tasmanian Perinatal Collection record.Outcome measureThe AEDC is a national measure of child development across five domains: physical health and well-being, social competence, emotional maturity, language and cognitive skills (school-based), and communication skills and general knowledge. Children who scored below the 10th percentile on one or more AEDC domains were classified as developmentally vulnerable. Children with special needs are not included in the AEDC results.ResultsLatent class analysis identified five clusters of risk factors: low risks (65% of children), sociodemographic and health behaviour risks (24%), teenage mother and sociodemographic risks (6%), birth risks (3%), and birth, sociodemographic and health behaviour risks (2%). In this sample population, 20% of children were classified as developmentally vulnerable, but the proportion varied substantially by latent class. Logistic regression showed increased odds of developmental vulnerability associated with sociodemographic and health behaviour risks (OR 2.26, 95% CI 1.91 to 2.68, p<0.001), teenage mother and sociodemographic risks (OR 2.01, 95% CI 1.50 to 2.69, p<0.001), and birth, sociodemographic and health behaviour risks (OR 3.29, 95% CI 2.10 to 5.16. p<0.001), but not birth risks (OR 1.34, 95% CI 0.88 to 2.03, p=0.1649), relative to the reference group.ConclusionsThe patterning of risks across the five groups invites consideration of multisectoral policies and services to address complex clusters of risk factors associated with developmental vulnerability.

Tasmania?s Child and Family Centres (Centres) provide a single entry point to early childhood services (ECS) and aim to improve the health and well-being, education and care of Tasmania?s children through supporting families and carers. This mixed methods study investigated the impact of Centres on parents? confidence and competence. Centre users reported a slightly lower overall sense of parenting competence than non-users. There was no difference between Centre users and non-users in how they felt overall as a parent. Compared to non-Centre users, Centre users were more likely to report that ECS helped them develop new parenting skills. Centres supported parenting practices through a range of formal (i.e. parenting courses) and informal (i.e. role modelling) strategies. Centre users indicated that the combination of formal and informal parenting supports worked together to assist them build new parenting skills. The Centre model and partnership approach facilitates the development of positive parenting practices.

Background Literacy is championed as a pathway out of poverty, yet it is vulnerable to the risk circumstances it seeks to mitigate. This study explored the developmental circumstances that gave rise to stark inequalities in reading achievement in Australian children across 6 years of school. Methods We used data from Growing up in Australia : the Longitudinal Study of Australian Children linked to Australia’s National Assessment Program-Literacy and Numeracy across school years 3, 5, 7 and 9. Latent class analysis and growth curve modelling (n=4983) were used to identify risk profiles for reading achievement for children (ages 8.2–15.2). Results Four distinct profiles were identified: developmentally enabled profile (62% of children); sociodemographic risk profile (25% of children); child development risk profile (11% of children); and sociodemographic and child development (double disadvantage) risk profile (2% of children). Children with a developmentally enabled profile achieved the expected rate of growth of 1.0 year per year of school across years 3, 5, 7 and 9. By comparison, children with sociodemographic and/or child development risk profiles started behind their developmentally enabled peers, and lost ground over time. Discussion Across 6 years of school, multiple risk-exposed children lagged behind low risk-exposed children in the order of years of lost gains in reading achievement. The results point to the complex contexts of educational disadvantage and the need for cross-cutting social, health and education policies and coordinated multiagency intervention efforts to break the cycle of educational disadvantage.

ABSTRACT Background: This study investigated the characteristics of subjective memory complaints (SMCs) and their association with current and future cognitive functions. Methods: A cohort of 209 community-dwelling individuals without dementia aged 47–90 years old was recruited for this 3-year study. Participants underwent neuropsychological and clinical assessments annually. Participants were divided into SMCs and non-memory complainers (NMCs) using a single question at baseline and a memory complaints questionnaire following baseline, to evaluate differential patterns of complaints. In addition, comprehensive assessment of memory complaints was undertaken to evaluate whether severity and consistency of complaints differentially predicted cognitive function. Results: SMC and NMC individuals were significantly different on various features of SMCs. Greater overall severity (but not consistency) of complaints was significantly associated with current and future cognitive functioning. Conclusions: SMC individuals present distinctive features of memory complaints as compared to NMCs. Further, the severity of complaints was a significant predictor of future cognition. However, SMC did not significantly predict change over time in this sample. These findings warrant further research into the specific features of SMCs that may portend subsequent neuropathological and cognitive changes when screening individuals at increased future risk of dementia.

This paper analyzes the effects of "shocks" to community-level unemployment expectations, induced by the onset of the Great Recession, on children's mental well-being. The Australian experience of the Great Recession represents a unique case study as despite little change in actual unemployment rates, levels of economic uncertainty grew. This affords us the ability to examine the effects of shocks to economic expectations independent of any actual changes to economic conditions. We draw on and link data from multiple sources, including several waves of the Longitudinal Study of Australian Children (2004⁻2010), a consumer sentiment survey, and data on local economic conditions. Using our purpose-built data set, we estimate difference-in-differences models to identify plausibly causal effects. We find, for boys, there is no detectable effect of community-level unemployment expectations shocks on mental health. For girls, however, there are modest increases in mental health problems and externalizing behaviors, as measured by the Strengths and Difficulties Questionnaire (SDQ). We additionally find no discernible change in mother's psychological distress as a result of expectations shocks. These results are stable after controlling for actual labor market conditions.

Background: Late Language Emergence (LLE) in the first two years of life is one of the most common parental concerns about child development and reasons for seeking advice from health professionals. LLE is much more prevalent in twins (38%) than singletons (20%). In studies of language development in twins without overt disability, adverse prenatal and perinatal environments have been reported to play a lesser role in the etiology of LLE than adverse postnatal environments. However, there is a lack of population-level evidence about prenatal and perinatal risk factors for LLE in twins. This study investigated the extent to which prenatal and perinatal risk factors were associated with LLE in a population-level sample of twins at age 2 without overt disability. Methods: The sample comprised 473 twin pairs drawn from a population sample frame comprising statutory notifications of all births in Western Australia (WA), 2000-2003. Twin pairs in which either twin had a known developmental disorder or exposure to language(s) other than English were excluded. Of the 946 twins, 47.9% were male. There were 313 dizygotic and 160 monozygotic twin pairs. LLE was defined as a score at or below the gender-specific 10th percentile on the MacArthur Communicative Development Inventories: Words and Sentences (CDI-WS) (Words Produced). Bivariate and multivariable logistic regression was used to investigate risk factors associated with LLE. Results: In the multivariable model, risk factors for LLE in order of decreasing magnitude were: Gestational diabetes had an adjusted odds ratio (aOR) of 19.5 (95% confidence interval (CI) 1.2, 313.1); prolonged TSR (aOR: 13.6 [2.0, 91.1]); multiparity (aOR: 7.6 [1.6, 37.5]), monozygosity (aOR: 6.9 [1.7, 27.9]) and fetal growth restriction (aOR: 4.6 [1.7, 12.7]). Sociodemographic risk factors (e.g., low maternal education, socioeconomic area disadvantage) were not associated with increased odds of LLE. Conclusions: The results suggest that adverse prenatal and perinatal environments are important in the etiology of LLE in twins at age 2. It is important that health professionals discuss twin pregnancy and birth risks for delayed speech and language milestones with parents and provide ongoing developmental monitoring for all twins, not just twins with overt disability.