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Early childhood interventions have the potential to reduce children's developmental inequities. We aimed to estimate the extent to which household income supplements for lower-income families in early childhood could close the gap in children's developmental outcomes and parental mental health. Data were drawn from a nationally representative birth cohort, the Longitudinal Study of Australian Children (N = 5107), which commenced in 2004 and conducted follow-ups every two years. Exposure was annual household income (0–1 year). Outcomes were children's developmental outcomes, specifically social-emotional, physical functioning, and learning (bottom 15% versus top 85%) at 4–5 years, and an intermediate outcome, parental mental health (poor versus good) at 2–3 years. We modelled hypothetical interventions that provided a fixed-income supplement to lower-income families with a child aged 0–1 year. Considering varying eligibility scenarios and amounts motivated by actual policies in the Australian context, we estimated the risk of poor outcomes for eligible families under no intervention and the hypothetical intervention using marginal structural models. The reduction in risk under intervention relative to no intervention was estimated. A single hypothetical supplement of AU$26,000 (equivalent to ∼USD$17,350) provided to lower-income families (below AU$56,137 (∼USD$37,915) per annum) in a child's first year of life demonstrated an absolute reduction of 2.7%, 1.9% and 2.6% in the risk of poor social-emotional, physical functioning and learning outcomes in children, respectively (equivalent to relative reductions of 12%, 10% and 11%, respectively). The absolute reduction in risk of poor mental health in eligible parents was 1.0%, equivalent to a relative reduction of 7%. Benefits were similar across other income thresholds used to assess eligibility (range, AU$73,329-$99,864). Household income supplements provided to lower-income families may benefit children's development and parental mental health. This intervention should be considered within a social-ecological approach by stacking complementary interventions to eliminate developmental inequities. • Income supplements provided to lower-income households may improve children's development. • Household income supplements may also be beneficial to parental mental health. • The absolute reduction in risk of poor outcomes ranged between 0.8% and 2.8%. • Household income supplements alone are insufficient to eliminate child inequities. • Stacking multiple complementary interventions over the life course is needed. [ABSTRACT FROM AUTHOR]

A growing body of evidence suggests that engagement with quality early childhood education and care (ECEC) programs such as preschool can enhance children’s early development. The Australian Early Development Census (AEDC) provides a unique opportunity to explore the relationship between ECEC and children’s developmental outcomes in a full population cohort of Australian school entrants. The AEDC is a teacher-rated checklist that provides data on ECEC experiences in the year before starting school, as well as five important domains of child development at school entry: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. In 2009, the AEDC was completed for 97.5% of Australian children in their first year of formal schooling ( N = 261,147; M = 5 years, 7 months of age). Logistic regression analyses revealed that attendance at preschool was associated with reduced odds (OR = 0.69, p < 0.001 to OR = 0.40, p < 0.001) of being in the vulnerable range (<10th percentile) on four of the five AEDC domains (with the exception of emotional maturity; OR = 0.89, p = 0.002), compared to other ECEC experiences, or care exclusively by parents. Subsequent analyses revealed that this effect was evident for children living in both advantaged and disadvantaged communities. Together, the results suggest that engagement with preschool programs in Australia may present a plausible, equitable, and modifiable approach to improving children's developmental outcomes. [ABSTRACT FROM AUTHOR]

• 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 opening paper presents the background to this Special Issue devoted to new international research using Early Development Instrument (EDI). The Canadian EDI and its adaptations to the Australian Early Development Census (AEDC), as well as the Chinese version used in Hong Kong, are examples of an assessment tool that brings data on child development at 4–6 years to a population level, in an accessible, feasible, and psychometrically valid manner. EDI measures are increasingly being used by governments, at all levels of jurisdiction, as a means of monitoring the status of early childhood development and then tracking progress over time. Recent innovations linking administrative datasets with EDI data have enabled research into the predictors, correlates, and sequelae of developmental status in early childhood. The eleven papers included in this Special Issue represent thoughtful, systematic, theory-based programs of research, informed by the broad scope of the EDI and supported by the availability of data for large, normative populations and especially often under-reported sub-populations of children. [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]

Psychosocial and socioeconomic adversity in early childhood (termed 'social adversity') can have lifelong detrimental effects on health and development. Physiological stress is one proposed mechanism by which social adversity 'gets under the skin'. There is substantial research interest in whether hair cortisol, a biomarker proposed to measure the cumulative physiological stress response over time, can illustrate this mechanism. As a result, a growing number of studies have tested for associations between indicators of social adversity and child hair cortisol. The aim of this paper is to conduct a comprehensive, systematic review of the evidence for associations between indicators of social adversity and hair cortisol, specifically in young children (birth to 8 years) published any time up to 31 December 2019. The literature search identified 44 published studies that met inclusion criteria. The studies examined associations between one or more indicators of social adversity and child hair cortisol across 35 independent cohorts comprising 8370 children. Indicators of adversity examined in the identified literature included socioeconomic factors (e.g. low parental education, low income and unemployment), psychosocial factors (e.g. parent stress, poor mental health and family violence), and children's direct exposure to maltreatment, abuse and stressful events. Across all indicators of adversity, a total of 142 associations with hair cortisol were examined. Evidence of associations was limited and inconsistent; 34/142 (24%) showed evidence of a positive association between adversity and higher hair cortisol, 8/142 (6%) showed a negative association, and more than two thirds (100/142, 70%) of all examined associations were null. The collective evidence appears insufficient to conclude that there is a relationship between social adversity and hair cortisol, as a measure of physiological stress response, in young children. • Systematic review of associations between social adversity and child hair cortisol. • 44 published studies comprising 8370 children met inclusion criteria. • Associations between social adversities and child hair cortisol were limited. • More than two thirds (100/142, 70%) of all examined associations were null. • Challenges and considerations for child hair cortisol research are highlighted. [ABSTRACT FROM AUTHOR]

Background: Maternal mental health is critically important given its impacts on both women's and children's outcomes. Hair cortisol concentrations (HCC) may provide insight into physiological processes underpinning mental health. This study investigated associations between mothers' self-reported mental health symptoms and their HCC at 1, 2 and 3 years postpartum.Methods: Longitudinal study of Australian mothers recruited for their experience of adversity in pregnancy ('right@home' trial, N=722). Mental health symptoms were self-reported using the Depression, Anxiety and Stress Scales (DASS). Associations between DASS total and subscale scores and HCC were estimated using linear regression and generalized estimating equation (GEE) models, examining associations: at each age; across all ages (multivariate GEE); and with persistence of high symptom severity. Missing data were addressed using multiple imputation.Results: 546/722 (76%) women provided at least one hair sample (71% at 1, 61% at 2, 49% at 3 years). Associations between DASS total or subscale scores and HCC were not evident across time points. Only dichotomized high depression symptom severity was associated with higher HCC in the GEE models (β=0.12, p=0.04). There was no evidence of associations between persistence of high DASS symptom severity and HCC at 3 years.Limitations: The DASS measured self-reported symptoms for the preceding week whereas HCC captured average cortisol over three months. Associations amongst mothers experiencing adversity may not represent patterns in the general population.Conclusions: Considered in context with existing literature, these findings suggest that HCC provides limited insight into the mental health of mothers experiencing adversity across the early postpartum years. [ABSTRACT FROM AUTHOR]

Major policy reforms were instigated in 2008 in Australia to ensure that all children have access to a preschool program in the year before starting school. The Australian Early Development Census (AEDC) provides a means of monitoring the impact of these reforms at the population level, as teachers of all children in their first year of school retrospectively report on children's preschool experiences every three years. Early indications from AEDC data spanning the preschool years of 2008–2011 indicated that the proportion of children attending preschool remained relatively stable over this period. In this short communication, we update this with analysis of preschool trends from 2008 to 2014. We find evidence of increasing preschool attendance over this longer time frame (80.43% in 2008, compared to 91.30% in 2014; OR 2.53, 99% CI 2.44–2.62). Consistent with earlier data, children from disadvantaged communities had higher odds of non-attendance, compared to those living in the most advantaged communities (OR 2.94, 99% CI 2.74–3.15). In 2014, children who did not attend preschool were also disproportionately Indigenous and from non-English speaking backgrounds. Findings suggest that participation in preschool appears to have increased, concurrent to government efforts to promote participation through universal access. Engaging the most vulnerable families in preschool programs remains a major challenge that requires continued policy focus. [ABSTRACT FROM AUTHOR]

Participation in a preschool program in the year before starting school can promote children’s healthy development, and has the potential to reduce inequities in developmental outcomes for at-risk subpopulations. In Australia, boosting preschool attendance has emerged as a national policy priority. In this paper, we draw on data from the Australian Early Development Census (AEDC) to describe preschool attendance in two sequential population cohorts, with preschool experiences in 2008 and 2011 reported retrospectively by teachers of children in their first year of school. Overall, findings show that the proportion of children attending preschool remained relatively stable between the two AEDC cohorts (in 2008, preschool attendance ranged from 57.0% to 85.8% across the states and territories, while in 2011, attendance ranged from 49.2% to 93.7%). At a subpopulation level, children from non-English speaking and Indigenous backgrounds and children living in disadvantaged communities all had substantially higher odds of not attending preschool in both 2008 and 2011. These findings highlight the need to maintain policy attention on efforts to further reduce barriers to preschool access for at-risk subpopulations, and the value of monitoring population trends in preschool attendance to better inform policy and service provision. [ABSTRACT FROM AUTHOR]

There is growing interest from policy-makers, practitioners, and academics alike in creating indicators of the built environment to measure progress towards achieving a wide range of policy outcomes, including enhanced health and wellbeing. Public open space (POS) is a built environment feature that is important for health and wellbeing across the life course, and contributes to the liveability of a region. To optimise health and community wellbeing outcomes, there is a need to test different policy standards and metrics to understand which measures are impactful. Identifying the best POS indicators would be useful tools to measure and monitor progress towards achieving a range of policy and health and wellbeing outcomes. Thus, we propose a method to develop POS indicators from a health and wellbeing lens through: 1) developing a framework conceptualising the pathways in which POS influences health and wellbeing outcomes; and 2) using this conceptual framework as a guide to identify upstream policy-relevant indicators of POS that are evidence-based, specific, quantifiable, and measurable across regions. We also highlight methodological issues and challenges in developing these indicators. In doing so, we have identified eleven potential POS spatial measures to test with population health and wellbeing datasets in Australia. However, these methods may be relevant and applicable to other developed countries, and could be modified for use in developing countries. Together, spatial indicators are analytic tools in the policy environment to benchmark and measure neighbourhoods in terms of POS provision, thereby helping to improve neighbourhood liveability and wellbeing, and people's 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]