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• One in four children delay school entry in New South Wales, Australia. • Boys, younger children, and advantaged children are more likely to delay. • The tendency to start school when first eligible clusters in disadvantaged urban areas. • Older starters are more likely to be ready for the first year of school. In Australia's most populous state, New South Wales (NSW), children born between January and July have the choice to start school in the year they turn five, or delay entry until the year they turn six. We used linked administrative data for children who started school in NSW in 2009 or 2012 (N = 162,878) to identify child, family and area characteristics associated with delayed entry, and to explore the relationship between school starting age and five domains of child development, measured using the Australian Early Development Census (AEDC) in the first year of school. Among both the 2009 and 2012 cohorts, 26% of children delayed starting school until the year they turned six. Area-level rates of delay ranged from 8% to 54% across 198 areas in NSW, with lower levels in disadvantaged urban areas. Factors associated with delayed entry included male sex, a birth date close to the enrolment cut-off date, socioeconomic advantage, and having a mother born in Australia. There was a strong, significant relationship between school starting age and early childhood development: each month of maturity corresponded to an increase of approximately 3% in the probability of scoring above the 25th percentile in all five AEDC domains. Independent of school starting age, children who were older in relation to their classroom peers had better development outcomes. The potential for initial age-related differences to impact later school outcomes warrants further longitudinal research. [ABSTRACT FROM AUTHOR]

• This is the first Australian health service utilisation data for children in out-of-home care (OOHC). • Very few children attended all recommended services for routine and timely health assessment. • Most children entering OOHC saw a General Practitioner within one year of entering care. • One in three children saw a GP within the recommended one month of entering OOHC. • This study provides benchmarking data for monitoring of future system improvements and research. Children in out-of-home care (OOHC) have high rates of health needs; consequently, many countries (including Australia) have policies and/or statutory requirements for health assessment upon OOHC entry. However, Australia has no data on health service utilisation or timeliness. We aimed to describe timing and extent of health service utilisation by children in the state of Victoria upon entry to OOHC, exploring demographic and specific service exposure variations. Population-based retrospective cohort study. Data from Victoria's Child Protection dataset (2010–2015) were linked to federal (Medicare Billing Schedule (MBS)) and state (Community Health, Mental Health, Community Dental and outpatient clinic) health datasets. Victorian first-time entrants to OOHC (April 2010 – December 2015): 6,201 0 – 12 year old children. Proportion visiting health services within 12 months of entering care; proportion visiting within recommended timeframes. Descriptive statistics, multivariable logistic regression, and Kaplan-Meier survival curves. Pre-post health service use following the limited introduction of health assessment clinics was compared with trends elsewhere in Victoria. 5,676 (92%) children were successfully linked to the MBS dataset. 41 children (<1%) had attended all recommended health services within 12 months of OOHC entry. While most (90%) within the linked cohort visited a General Practitioner, only 37% attended within the recommended 30 days. Around a third visited a paediatrician; fewer than 20% visited a community dentist, optometrist, or audiologist. Children in foster care had higher odds of attending services than those in kinship care. The pre-post trends in health service use in areas where a dedicated assessment clinic commenced were more positive than for areas without the clinic. A minority of Victorian children in OOHC accessed health services according to national or state (Victorian) standards, very few in a timely manner. Children in kinship care were less likely to meet guidelines. [ABSTRACT FROM AUTHOR]

Limited evidence suggests that positive experiences in childhood may promote cardiovascular health, providing additional opportunities for prevention and early intervention. This study aimed to examine the effects of adverse and positive experiences on cardiovascular health in late childhood. Data sources: Longitudinal Study of Australian Children (N = 1874). Exposures: Adverse and positive experiences assessed repeatedly (age 0–11 years). Outcomes: Cardiovascular health (high versus low or moderate) quantified by four health behaviors (diet, physical activity, cigarette smoking, and sleep) and four health factors (body mass index, non-high-density lipoprotein, blood pressure, and blood glucose) (age 11–12 years) as per the American Heart Association's Life's Essential 8 metrics. Analyses: Separate generalized linear models with log-Poisson links were used to estimate the effects of adverse and positive experiences on cardiovascular health, adjusting for confounders. Children exposed to multiple adverse experiences (≥ 2) were less likely to have high cardiovascular health (RR = 0.82, 95% CI = 0.67 to 1.02) than those not exposed. Children exposed to multiple positive experiences (≥ 2) were more likely to have high cardiovascular health (RR = 1.14, 95% CI = 0.94 to 1.38) than those not exposed. Stratified analyses suggested that exposure to multiple positive experiences might buffer the detrimental effects of multiple adverse experiences on cardiovascular health. Both adverse and positive experiences were found to be modestly associated with cardiovascular health in Australian children. Future research and practice should not only consider addressing childhood adversity but also use a strengths-based approach to promoting positive experiences to improve cardiovascular health. • Adverse experiences have detrimental effects on cardiovascular health in children. • Children exposed to positive experiences have better cardiovascular health. • Positive experiences may buffer the detrimental effect of adverse experiences. • Promoting positive experiences is needed to improve cardiovascular health. [ABSTRACT FROM AUTHOR]

• Foster and kinship carers play a key role facilitating healthcare for children in out-of-home care. • A lack of services contributes to long wait-times and out-of-pocket costs. • Consent processes are a significant barrier to healthcare. • Caseworker support is an important enabler of healthcare. • Flexible healthcare delivery is highly valued by foster and kinship carers. Children living in out-of-home care are known to have more health needs than same-aged peers. Routine health assessment with subsequent management of need is recommended by health experts. In Victoria, Australia, the out-of-home care system relies upon home-based care through kinship (with family) and foster carer placements, placing some of the healthcare access and utilisation burden upon foster and kinship carers. This paper explores the experiences of Victorian foster and kinship carers accessing timely health assessment and ongoing healthcare for a child placed in their care; identifying barriers and enablers. Through interviews with 19 carers, we found that while carers play a significant role in facilitating healthcare, it is often difficult to navigate a complex health system especially while concurrently navigating the child protection system. Although some carers had faced few challenges, barriers were frequently reported at every step in accessing healthcare: receiving necessary paperwork (including child Medicare numbers); obtaining past medical history including immunisations; knowing what appointments were required; gaining appropriate authorisation for healthcare; identifying appropriate healthcare services; accessing timely appointments; attending appointments and paying for services. Carers had often been strong advocates for children in their care and had found support from case managers or carer support workers to be instrumental in enabling healthcare. Carers identified potential solutions to help children in their care receive timely healthcare. [ABSTRACT FROM AUTHOR]