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 Restacking the Odds
Restacking the Odds (RSTO) aims to transform the capacity of service providers and communities to collect and use data on service availability, quality and participation. Restacking the Odds 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 strategies (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'.
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Restacking 1.0
Today, too many early childhood services are delivered with low fidelity and variable quality, and too many children and families miss out – often because decisions on service design, delivery and improvement are based on a limited understanding of what works to improve children’s health and developmental outcomes.
To address this, the project’s first phase completed research to develop and apply evidence-based lead indicators for the effective delivery of the five fundamental strategies. These indicators define how the strategies should be delivered across three dimensions: quality, quantity and participation.
Five fundamental strategies
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Restacking 2.0
Phase two of RSTO is a prototyping phase that builds on the progress and lessons from the first phase. It aims to embed the use of the Restacking lead indicators at the scale needed to accelerate system level change and make a real difference to children experiencing disadvantage across Australia. The work will expand into new communities across Australia and include a rigorous evaluation process. This work is supported by a major, multi-year philanthropic grant.
Restacking 2.0 will:
- establish a national group of service providers and communities who routinely collect and act on Restacking indicators
- design and implement a technological solution to support regular data collection and reporting by service providers and communities
- collaborate with end users to co-design practical ways for them to collect and act on the Restacking indicators
- focus on translation and advocacy to help build broad-based interest in the framework and its adoption.
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Theory of Change
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Investigating participation barriers, facilitators, and solutions
Engaging families, and maintaining engagement, are key challenges experienced by early years service providers. A range of barriers may explain these challenges. Restacking undertook a complementary study and investigated the barriers and facilitators to participating in community interventions. This study used a mixed methods research design with information collected via online surveys and interviews.
Aim
The study aimed to help communities and policy makers better understand why families, particularly disadvantaged families with the greatest potential to benefit from participation, are disengaged with certain services.
Findings
The study’s findings are presented in the following two papers:
Publications
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 communicat
ion 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
- Beatson, R., Molloy, C., Perini, N., Harrop, C., & Goldfeld, S. (2021). Systematic review:
An exploration of core componentry characterizing effective sustained nurse home visiting programs. Journal of advanced nursing, 77(6), 2581–2594. https://doi.org/10.1111/jan.14755
- Molloy, C., Beatson, R., Harrop, C., Perini, N., & Goldfeld, S. (2021). Systematic review:
Effects of sustained nurse home visiting programs for disadvantaged mothers and children. Journal of advanced nursing, 77(1), 147–161. https://doi.org/10.1111/jan.14576
- Molloy, C., Moore, T., O'Connor, M., Villanueva, K., West, S., & Goldfeld, S. (2021).
A Novel 3-Part Approach to Tackle the Problem of Health Inequities in Early Childhood. Academic pediatrics, 21(2), 236–243. https://doi.org/10.1016/j.acap.2020.12.005
- 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
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.
- Olivia Hilton - General Manager, Murdoch Children's Research Institute. Olivia will start in the role in February 2022.
- Dr Carly Molloy – Research and Data Lead, Murdoch Children’s Research Institute.
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.
Project team
Get in touch for more information:
restackingtheodds@mcri.edu.au