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Restacking the Odds

  • Too many children are born into circumstances that do not provide them with a reasonable opportunity to make a good start in life. Inequities emerging in early childhood often continue into adulthood, contributing to unequal rates of low educational attainment, poor mental and physical health and low income and in some cases, this experience is part of a persistent cycle of intergenerational disadvantage. Inequities constitute a significant and ongoing social problem and – along with the substantial economic costs – have major implications for public policy.

    To redress inequities, research tells us that efforts should be delivered during early childhood (pregnancy to eight years of age) to deliver the greatest benefits.

    About the project

    Restacking the Odds (RSTO) aims to reduce intergenerational disadvantage by creating a set of metrics and tools that can help push a reconfiguration of the existing service system through an equity and evidence lens; driving changes that result in the best quality services reaching the most disadvantaged areas of Australia. 

    The project focuses on five key evidence-based interventions/platforms in early childhood: antenatal care; sustained nurse home visiting; early childhood education and care; parenting programs; and the early years of school. These five strategies are only a subset of the possible interventions, but we have selected them carefully. They are notably longitudinal (across early childhood), ecological (targeting child and parent), evidence-based, already available in almost all communities, and able to be targeted to benefit the ‘bottom 25 per cent’. 

    Our premise is that by ‘stacking’ these fundamental interventions (i.e. ensuring they are all applied for a given individual) there will be a cumulative effect - amplifying the impact and sustaining the benefit. The RSTO team analysed data from the Longitudinal Study of Australian Children to show that ‘stacking’ early interventions has a positive effect on child development outcomes. Access the evidence on 'stacking'.

    View more project information


    What will I learn?

    Our publications aim to help you learn about quality factors that are most impactful on children’s development, who should be participating and what quantity and what infrastructure/workforce is required to deliver these services and programs effectively.

    Quality: Are the strategies delivered effectively, relative to evidence-based performance standards? A strategy with ‘quality’ is one for which there is robust evidence showing it delivers the desired outcomes. A large number of research studies have explored aspects of this question (i.e. “what works?”). Therefore, we pay particular attention to the quality dimension in our work and analysis.

    Quantity: Are the strategies available locally in sufficient quantity for the target population? ‘Quantity’ helps us determine the quantum of effort and infrastructure needed to deliver the strategy adequately for a given population.

    Participation: Do the appropriately targeted children and families participate at the right dosage levels? ‘Participation’ shows us what portion of the relevant groups are exposed to the strategy at the level required to generate the desired benefit (e.g. attending the required number of antenatal visits during pregnancy). Participation levels can be calculated whether the strategy is universal (for everyone), or targeted (intended to benefit a certain part of the population).

    How can I use this information?

    These indicators will help identify gaps and priorities in Australian communities. We will test preliminary indicators in communities over the next three years to determine which are pragmatic to collect, resonate with communities, and provide robust measures to stimulate community and government action. 

    Communication summaries

    The communication summaries give an overview of system indicators. You can use the indicators to ‘test’ whether your organisation’s practices align with the sort of best practice likely to lead to better outcomes for children. You can also use the indicators to start developing a monitoring system for your organisation’s performance.

    Technical reports

    The technical reports supplement the communication summaries by way of providing a detailed account of the reviewed literature that informed the development of best practice indicators for antenatal care, early childhood education and care, and parenting programs. The technical reports for sustained nurse home visiting and the early years of school will be available in due course, in the meantime if you are interested please contact  Dr Carly Molloy

    Community report (example) 

    RSTO provides participating communities with a report containing a service environment summary and findings specific to their community. These are presented and distributed to the communities and relevant stakeholders. Below is an example of what a community could expect.

    Peer-reviewed articles

    Molloy, C., O'Connor, M., Guo, S., Lin, C., Harrop, C., Perini, N., & Goldfeld, S. (2019). Potential of 'stacking' early childhood interventions to reduce inequities in learning outcomes. J Epidemiol Community Health, 73(12), 1078-1086. doi:10.1136/jech-2019-212282 

      Participate in our 'solutions' project

      As part of this project, we are interested in the reasons why some children and families who could benefit from key early childhood services are not accessing them, and what can be done to increase children and families’ participation in these services.

      We are currently conducting a study investigating these barriers and facilitators of participation, focusing on two key evidence-based community health/education services: early childhood education and care (ECEC), and parenting programs.

      By hearing the perspectives of service providers as well as parents/guardians/carers, we hope to deepen understanding of the issues and identify potential solutions. This study currently involves a series of 10 minutes surveys followed by an optional interview.

      If you would like to participate, click on the survey links most relevant to you:

      Project team

      Restacking the Odds is a collaboration between three organisations, each with relevant and distinctive skills and resources:

      Murdoch Children's Research Institute (MCRI) is an independent medical research institute. MCRI’s research covers the breadth of health and medical research from basic science through to clinical sciences and population health. MCRI is committed to giving all children the opportunity to have a happy and fulfilled life.

      • Prof Sharon Goldfeld –  Director Centre for Community Child Health and Theme Director, Population Health, Royal Children’s Hospital Melbourne and Murdoch Children’s Research Institute.
      • Dr Carly Molloy – Senior Research Officer and Senior Project Manager, Murdoch Children’s Research Institute. Carly is the Project Manager for Restacking the Odds, and can be contacted at

      Bain & Company is one of the world’s leading management consulting firms. Bain works with executives and organisations to help them make better decisions, convert those decisions into actions, and deliver sustainable success.

      • Chris Harrop – Partner, and member of Bain’s worldwide Board of Directors.

      Social Ventures Australia (SVA) supports partners across sectors to increase their social impact. SVA helps business, government and philanthropists to be more effective funders and social purpose organisations to be more effective at delivering services

      • Nick Perini – Director, SVA Consulting.

      Our collective aspiration is to create a new approach to tackling intergenerational disadvantage in Australia that delivers ground-breaking results.


      Restacking the Odds is funded by the Commonwealth Department of Social Services and philanthropic grants, including the Paul Ramsay Foundation.


    Murdoch Childrens Research Institute

    The Centre for Community Child Health is a department of The Royal Children’s Hospital and a research group of Murdoch Childrens Research Institute.