4 June 2018, Singapore – The first thousand days of a child’s life are the first opportunity, and a critical period, to lay strong foundations for optimal development in children. The Temasek Foundation Cares Kids Integrated Development Service 0-3 (“Temasek Foundation Cares KIDS 0-3”) programme, was piloted in July 2014 to optimise the developmental potential of young children from vulnerable families through a multi-layered and integrated community health and social care support system. Led by KKH, in partnership with AMKFSC Community Services Ltd (AMKFSC), and funded by Temasek Foundation Cares, the programme includes home visitations and centre-based activities coordinated by a cross-sector, multi-disciplinary team. The programme has to date, supported 150 pairs of mother and child.

From July 2016, the KIDS 0-3 programme has also received funding support from the Early Childhood Development Agency under the KidSTART pilot, so that more children are able to benefit from the home visitation programme.

Early Outcomes of the Programme

Significant outcomes from the programme are summarised below, with details set out in Annex A.

• Child Health – There were significant improvements in the immunisation rate; and birth weight of the children born to mothers who were in the programme during the antenatal phase.
• Child Development – 97 per cent of children in the programme were assessed to have normal cognitive ability, which is significantly higher compared to other study findings among children from families with challenging socio-economic backgrounds.
• Child Behaviour – A smaller number of children in the programme were found to have emotional and behavioural problems compared to other studies in Singapore using the same measurement tool.
• Family Function – As families grow with the programme, parents have shown an increased ability to help their children learn, and to find the right resources when they need help.
• Parent-child Interaction/Bonding – A large number (≥ 96 per cent) of parents in the programme were able to show appropriate parent-child interaction to help their child learn and develop. This is important as appropriate parent-child interaction also correlated with better cognitive and language development in the children.

Mr Richard Magnus, Chairman, Temasek Foundation Cares, said, “Children are very precious to us. Their development and social mobility are critical. From as early as pre-school age, children from vulnerable families are at-risk of displaying developmental gaps with other children in the areas of literacy, social skills, cognitive ability and health. Inequalities result from these. We hope that all children especially those from vulnerable families are provided with equal opportunities to maximise their potential. Temasek Foundation Cares initiated this programme to build an integrated eco-system of support to nourish and optimise these children’s developmental outcomes”.

“The outcomes we have set for the programme are clearly evidence-based. We have used established assessment tools to measure the various outcomes of the KIDS 0-3 programme. This has proven to be delivering encouraging results. These results are a nod to the community capabilities that we have built to support vulnerable families and bring about better outcomes for their children,” said Adjunct Associate Professor Winnie Goh, Programme Lead, KIDS 0-3 programme and Senior Consultant, Division of Medicine, KK Women’s and Children’s Hospital.

Singapore’s First Integrated Child Health and Social Congress

To create awareness of the early formative years and the importance of cross-sector coordination of services and collaboration in the delivery of services to support children from vulnerable families, KKH and AMKFSC have organised an integrated child health and social congress from 4 to 6 June 2018 at Grand Copthorne Waterfront.

Highlights of the three-day congress include presentations by Dr Tim Moore, the first author of The First Thousand Days: An Evidence Paper, a paper which aims to provide a comprehensive summary of evidence for the significance of the first 1,000 days, and Ms Theresa Schreifels, an infant mental health specialist (please refer to Annex B for their profiles), as well as a panel discussion on mitigating the impact of adverse childhood experiences to influence positive outcomes.

Themed Building the Child beyond Neurons for a Resilient Nation, the conference will bring together, for the first time, about 200 professionals from the health, social and early childhood sectors. The congress is graced by Minister of State, Ministry of Foreign Affairs and Ministry of Social and Family Development, Mr Sam Tan.

Mr Tan said, “What children experience in the first few years are very important for their future development. While the government has done a lot for preschool education, the health and social sectors are still our important partners in nurturing and developing our children. MSF will continue to work with these sectors to ensure that our children can have a good start in life.”

“By bringing together the health, social and early childhood sectors in this congress, we hope to enhance collaborations among these sectors to provide more holistic support for young children from vulnerable families especially in the critical first 1,000 days, so that these children can have a higher chance to succeed in life and improve their social mobility,” said Dr Terence Yow, Divisional Director (Family & Community Support), AMKFSC Community Services Ltd.

Under the Child Health outcome, the birth weight of children born to mothers who joined the programme earlier during the antenatal phase was higher compared to those who joined after delivery. Also, children enrolled in the programme have an 83 per cent immunisation rate, which is 23 per cent higher than the immunisation rate of children from an earlier study commissioned by KKH on families with challenging socio-economic backgrounds in Singapore¹.

It was also established that early involvement in the programme has significant impact on the child’s Developmental outcome. Children whose mothers participated early in the programme have better language development. Among the children from the programme who were assessed, 97 per cent were found to have normal cognitive ability, and 81 per cent were found to have normal language ability.

To measure the programme’s Family Functioning outcome, a Family Outcome Survey was conducted during two different time points. When it was first conducted at the 18-month mark, the families’ awareness of community support and resources recorded a mean value of 3.92. When the survey was performed at the 32-month mark, the mean value had increased to 4.3, against a full score of 5 that denotes complete understanding. In addition, at the 18-month mark, 100 per cent of the families showed some to complete understanding of how to support their child’s growth, development and learning.

Based on the Child Behaviour Checklist (CBCL), which measures Behavioural outcome, it was found that 11.3 per cent of the children were identified to have emotional and behavioural problems. This was based on an assessment performed between 18 and 22 months among 142 children in the programme. By comparison, studies using CBCL have recorded a higher prevalence of emotional and behavioural problems of 12.5 per cent among a community sample of Singaporean children aged between six and 12 years old².

The use of the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO) has also yielded favourable results for the Parent-child Interaction and Bonding outcome. A research-based observational tool, the PICCOLO measures four domains of developmental parenting, namely, affection, responsiveness, encouragement and teaching. Among the parent-child pairs who were evaluated using PICCOLO at a 24-month mark, 98 per cent of the parents had average to above average ratings in affection (warmth, physical closeness and positive expressions towards their child). Another 96 per cent of the parents had average to above average ratings in responsiveness (responding to their child’s cues, emotions, words, interests and behaviours).

¹ Chong W H, Choo H, Goh E C L, Wee P Y Y, Goh W H S, Chay O M. Preventive Child Healthcare in Singapore: A Parents Well Being Perspective. Annals of Academy of Medicine Dec 2015;
44(12):550-553
² Woo B S C, Ng T P, Fung D S S, Chan Y H, Lee Y P, Koh J B K, Cai Y. Emotional and behavioural problems in Singaporean children based on parent, teacher and child reports. Singapore Med J 2007;
48(12):1100–1106

 

Speakers’ Profiles

Dr Tim Moore is a developmental psychologist and Senior Research Fellow at Murdoch Children’s Research Institute and the Royal Children’s Hospital Center for Community Child Health, Australia. He advocates for community programs towards prevention and early intervention for best outcomes for children and their families. He will present on “The First Thousand Days”, that highlights conception to age two as most susceptible to adverse experiences.

Ms Theresa Schreifels is an Infant Mental Health Specialist who provides training, consultation and therapy. Ms Schreifels serves as co-chair or the Minnesota Association for Children’s Mental Health-Infant and Early Childhood Division. She teaches for the Centre for Early Education and Development at the University of Minnesota, and is an Adjunct Professor at St Cloud State University. As a practitioner, Tracy provides in-home family therapy, classroom support for children identified with challenging behaviours as well as reflective consultation and therapeutic parent education groups.