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1.  Data Resource Profile: The Australian Early Development Index (AEDI) 
Every 3 years, the Australian Government conducts a developmental census across the entire population of children in their first year of full-time schooling (median age 5 years). The first developmental census was conducted in 2009, including 261 147 children, and in 2012 data were collected on 289 973 children—representing 97.5% and 96.5% of the estimated eligible population, respectively. The questionnaire is completed by teachers on the basis of at least 1 month’s knowledge of the child, including aspects of physical, social, emotional, language and cognitive development, as well as data on special needs. Teachers are also asked to include details of the child’s care arrangements and attendance in early education programmes in the years preceding school. Demographic and geographical data are recorded at the individual and area levels. Aggregate data are publicly available and microdata (including data for linkage studies) can be applied for via (
PMCID: PMC4258780  PMID: 24771275
2.  Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities 
The risk of poor maternal and perinatal outcomes in high-income countries such as Australia is greatest for those experiencing extreme social and economic disadvantage. Australian data show that women of refugee background have higher rates of stillbirth, fetal death in utero and perinatal mortality compared with Australian born women. Policy and health system responses to such inequities have been slow and poorly integrated. This protocol describes an innovative programme of quality improvement and reform in publically funded universal health services in Melbourne, Australia, that aims to address refugee maternal and child health inequalities.
A partnership of 11 organisations spanning health services, government and research is working to achieve change in the way that maternity and early childhood health services support families of refugee background. The aims of the programme are to improve access to universal health care for families of refugee background and build organisational and system capacity to address modifiable risk factors for poor maternal and child health outcomes. Quality improvement initiatives are iterative, co-designed by partners and implemented using the Plan Do Study Act framework in four maternity hospitals and two local government maternal and child health services.
Bridging the Gap is designed as a multi-phase, quasi-experimental study. Evaluation methods include use of interrupted time series design to examine health service use and maternal and child health outcomes over a 3-year period of implementation. Process measures will examine refugee families’ experiences of specific initiatives and service providers’ views and experiences of innovation and change.
It is envisaged that the Bridging the Gap program will provide essential evidence to support service and policy innovation and knowledge about what it takes to implement sustainable improvements in the way that health services support vulnerable populations, within the constraints of existing resources.
PMCID: PMC4425879  PMID: 25924721
Quality improvement; Partnerships; Universal health services; Refugee families; Time series design; Process evaluation
3.  Jurisdictional, socioeconomic and gender inequalities in child health and development: analysis of a national census of 5-year-olds in Australia 
BMJ Open  2012;2(5):e001075.
Early child development may have important consequences for inequalities in health and well-being. This paper explores population level patterns of child development across Australian jurisdictions, considering socioeconomic and demographic characteristics.
Census of child development across Australia.
Setting and participants
Teachers complete a developmental checklist, the Australian Early Development Index (AEDI), for all children in their first year of full-time schooling. Between May and July 2009, the AEDI was collected by 14 628 teachers in primary schools (government and non-government) across Australia, providing information on 261 147 children (approximately 97.5% of the estimated 5-year-old population).
Outcome measures
Level of developmental vulnerability in Australian children for five developmental domains: physical well-being, social competence, emotional maturity, language and cognitive skills and communication skills and general knowledge.
The results show demographic and socioeconomic inequalities in child development as well as within and between jurisdiction inequalities. The magnitude of the overall level of inequality in child development and the impact of covariates varies considerably both between and within jurisdiction by sex. For example, the difference in overall developmental vulnerability between the best-performing and worst-performing jurisdiction is 12.5% for males and 7.1% for females. Levels of absolute social inequality within jurisdictions range from 8.2% for females to 12.7% for males.
The different mix of universal and targeted services provided within jurisdictions from pregnancy to age 5 may contribute to inequality across the country. These results illustrate the potential utility of a developmental census to shed light on the impact of differences in universal and targeted services to support child development by school entry.
PMCID: PMC3437432  PMID: 22952161
Social Epidemology; Inequality; Public Health Policy; Child Health and Development; Australia
4.  Improving outcomes of preschool language delay in the community: protocol for the Language for Learning randomised controlled trial 
BMC Pediatrics  2012;12:96.
Early language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system.
A large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or ‘usual care’ control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a ‘step up-step down’ therapeutic approach depending on the child’s language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills.
A key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework.
Trial registration
Current Controlled Trials ISRCTN03981121.
PMCID: PMC3504523  PMID: 22776103
Language development; Mass screening; Language development disorders; Early intervention; Outcome assessment; Child development; Randomized controlled trial; Population characteristics
5.  Population health and wellbeing: Identifying priority areas for Victorian children 
Population health information, collected using soundly-designed methodologies, is essential to inform policy, research, and intervention programs. This study aimed to derive policy-oriented recommendations for the content of a health and wellbeing population survey of children 0–12 years living in Victoria, Australia.
Qualitative interviews were conducted with 54 academic and policy stakeholders, selected to encompass a wide breadth of expertise in areas of public health and inter-sectoral organisations relevant to child health outcomes, including universities, government and non-government agencies across Victoria. These stakeholders were asked to provide advice on strategic priorities for child health information (data) using a structured interview technique. Their comments were summarised and the major themes were extracted. The priority areas of health and wellbeing recommended for regular collection include obesity and its determinants, pregnancy and breastfeeding, oral health, injury, social and emotional health and wellbeing, family environment, community, health service utilisation, illness, and socioeconomic position. Population policy questions for each area were identified.
In contrast to previous population survey programs nationally and internationally, this study sought to extract contemporary policy-oriented domains for inclusion in a strategic program of child health data collection, using a stakeholder consultation process to identify key domains and policy information needs. The outcomes are a rich and relevant set of recommendations which will now be taken forward into a regular statewide child health survey program.
PMCID: PMC1180818  PMID: 16029511
6.  Assessing the capacity of the health services research community in Australia and New Zealand 
In order to profile the health services research community in Australia and New Zealand and describe its capacity, a web-based survey was administered to members of the Health Services Research Association of Australia and New Zealand (HSRAANZ) and delegates of the HSRAANZ's Third Health Services Research and Policy Conference.
Responses were received from 191 individuals (68%). The responses of the 165 (86%) who conducted or managed health services research indicated that the health services research community in Australia and New Zealand is characterised by highly qualified professionals who have come to health services research via a range of academic and professional routes (including clinical backgrounds), the majority of whom are women aged between 35 and 54 who have mid- to senior- level appointments. They are primarily employed in universities and, to a lesser extent, government departments and health services. Although most are employed in full time positions, many are only able to devote part of their time to health services research, often juggling this with other professional roles. They rely heavily on external funding, as only half have core funding from their employing institution and around one third have employment contracts of one year or less. Many view issues around building the capacity of the health services research community and addressing funding deficits as crucial if health services research is to be translated into policy and practice. Despite the difficulties they face, most are positive about the support and advice available from peers in their work settings, and many are actively contributing to knowledge through academic and other written outputs.
If health services research is to achieve its potential in Australia and New Zealand, policy-makers and funders must take the concerns of the health services research community seriously, foster its development, and contribute to maximising its capacity through a sustainable approach to funding. There is a clear need for a strategic approach, where the health services research community collaborates with competitive granting bodies and government departments to define and fund a research agenda that balances priority-driven and investigator-driven research and which provides support for training and career development.
PMCID: PMC1079789  PMID: 15755322
Health services research; capacity; resources; funding; outputs; Australia; New Zealand
7.  Outcomes of population based language promotion for slow to talk toddlers at ages 2 and 3 years: Let’s Learn Language cluster randomised controlled trial 
Objective To determine the benefits of a low intensity parent-toddler language promotion programme delivered to toddlers identified as slow to talk on screening in universal services.
Design Cluster randomised trial nested in a population based survey.
Setting Three local government areas in Melbourne, Australia.
Participants Parents attending 12 month well child checks over a six month period completed a baseline questionnaire. At 18 months, children at or below the 20th centile on an expressive vocabulary checklist entered the trial.
Intervention Maternal and child health centres (clusters) were randomly allocated to intervention (modified “You Make the Difference” programme over six weekly sessions) or control (“usual care”) arms.
Main outcome measures The primary outcome was expressive language (Preschool Language Scale-4) at 2 and 3 years; secondary outcomes were receptive language at 2 and 3 years, vocabulary checklist raw score at 2 and 3 years, Expressive Vocabulary Test at 3 years, and Child Behavior Checklist/1.5-5 raw score at 2 and 3 years.
Results 1217 parents completed the baseline survey; 1138 (93.5%) completed the 18 month checklist, when 301 (26.4%) children had vocabulary scores at or below the 20th centile and were randomised (158 intervention, 143 control). 115 (73%) intervention parents attended at least one session (mean 4.5 sessions), and most reported high satisfaction with the programme. Interim outcomes at age 2 years were similar in the two groups. Similarly, at age 3 years, adjusted mean differences (intervention−control) were −2.4 (95% confidence interval −6.2 to 1.4; P=0.21) for expressive language; −0.3 (−4.2 to 3.7; P=0.90) for receptive language; 4.1 (−2.3 to 10.6; P=0.21) for vocabulary checklist; −0.5 (−4.4 to 3.4; P=0.80) for Expressive Vocabulary Test; −0.1 (−1.6 to 1.4; P=0.86) for externalising behaviour problems; and −0.1 (−1.3 to 1.2; P=0. 92) for internalising behaviour problems.
Conclusion This community based programme targeting slow to talk toddlers was feasible and acceptable, but little evidence was found that it improved language or behaviour either immediately or at age 3 years.
Trial registration Current Controlled Trials ISRCTN20953675.
PMCID: PMC3191855  PMID: 21852344
8.  Specific language impairment: a convenient label for whom? 
The term ‘specific language impairment’ (SLI), in use since the 1980s, describes children with language impairment whose cognitive skills are within normal limits where there is no identifiable reason for the language impairment. SLI is determined by applying exclusionary criteria, so that it is defined by what it is not rather than by what it is. The recent decision to not include SLI in DSM-5 provoked much debate and concern from researchers and clinicians.
To explore how the term ‘specific language impairment’ emerged, to consider how disorders, including SLI, are generally defined and to explore how societal changes might impact on use the term.
Methods & Procedures
We reviewed the literature to explore the origins of the term ‘specific language impairment’ and present published evidence, as well as new analyses of population data, to explore the validity of continuing to use the term.
Outcomes & Results and Conclusions & Implications
We support the decision to exclude the term ‘specific language impairment’ from DSM-5 and conclude that the term has been a convenient label for researchers, but that the current classification is unacceptably arbitrary. Furthermore, we argue there is no empirical evidence to support the continued use of the term SLI and limited evidence that it has provided any real benefits for children and their families. In fact, the term may be disadvantageous to some due to the use of exclusionary criteria to determine eligibility for and access to speech pathology services. We propose the following recommendations. First, that the word ‘specific’ be removed and the label ‘language impairment’ be used. Second, that the exclusionary criteria be relaxed and in their place inclusionary criteria be adopted that take into account the fluid nature of language development particularly in the preschool period. Building on the goodwill and collaborations between the clinical and research communities we propose the establishment of an international consensus panel to develop an agreed definition and set of criteria for language impairment. Given the rich data now available in population studies it is possible to test the validity of these definitions and criteria. Consultation with service users and policy-makers should be incorporated into the decision-making process.
PMCID: PMC4303922  PMID: 25142091
specific language impairment; language impairment; child language

Results 1-8 (8)