Assessing Health Equity in Partnership with Children's Mental Health Organizations: Considerations Before the Implementation of Parenting Programs.

Objectives: Understanding and addressing how an individual's social, political, economic, and cultural context affects their ability to achieve optimal health is essential to designing and implementing interventions. Before evaluating two parenting programs, in partnership with four children's mental health organizations, we used the Health Equity Impact Assessment tool (HEIA) to identify groups that may experience unintended health impacts, as well as generated mitigation strategies to address these impacts. Methods: HEIA activities included a review of the published literature, a review of organizational documents, key informant interviews with staff (n = 12) and other related community service providers (n = 7), and a geographic information systems analysis. All sources of evidence were considered and analyzed using reflective thematic analysis. Summary reports were shared with all partners. Results: A range of groups were identified as at risk of experiencing unintended health impacts, including caregivers who are racialized, immigrants, Indigenous, living with mental health issues or addictions, dealing with intellectual challenges and/or low literacy levels, survivors of childhood trauma, single parent families, or families experiencing financial difficulties. Unintended health impacts were sorted into 6 main themes which fell under the overarching themes of accessibility of the programs and cultural appropriateness. Mitigation strategies as well as innovative strategies already being applied by participating organizations are discussed. Conclusion: Although this HEIA focused on parenting programs, the findings address equity issues applicable to the provision of a wide spectrum of children's mental health services.

A Pan-Canadian Data Resource for Monitoring Child Developmental Health: The Canadian Neighbourhoods and Early Child Development (CanNECD) Database.

The Canadian Neighbourhoods and Early Child Development (CanNECD) database is a unique resource for research on child developmental health and well-being within the socioeconomic and cultural context of Canadian neighbourhoods. This paper describes the CanNECD database and highlights its potential for advancing research at the intersection of child development, social determinants of health, and neighbourhood effects. The CanNECD database contains cross-sectional population-level child developmental health data from all across Canada collected through regional implementation of the Early Development Instrument (EDI), geo-coded information on residential neighbourhoods covering all of Canada, and socioeconomic and demographic variables from the Canada Census and Income Taxfiler database. Individuals are not identified in the database, as no identifying information, such as names and addresses, is attached to the EDI record. At data collection, each individual child is given a unique number which is a combination of site, school, and position on a class list. Each neighbourhood receives a unique identifier which then is linkable across datasets. The nearly 800,000 EDI records spanning 2003-2014 and representing all Canadian provinces and territories (with the exception of Nunavut) are compiled in a secure electronic collection system at the Offord Centre for Child Studies, McMaster University in Hamilton, Canada. Early studies using the EDI demonstrated its utility as a tool for assessing child developmental health at a population level, and its potential for both community-level and large-scale monitoring of child populations. Research using the CanNECD database is now examining to what extent social determinants and the steepness of the social gradients of developmental health differ between geographical jurisdictions and between different sub-populations. We are also working to identify outlier neighbourhoods in which EDI scores are substantially higher or lower than predicted by a neighbourhood's demographic and socioeconomic characteristics, and exploring other potentially important determinants of children's developmental health. Finally, we are examining the extent to which change-over-time in aggregate EDI scores varies geographically, and how well it coincides with changes in socioeconomic factors. Thus, the CanNECD database offers the opportunity for research that will inform national policies and strategies on child developmental health.

Neighbourhood socioeconomic status indices and early childhood development.

The developmental health of young children is highly influenced by the socioeconomic conditions in which they are raised. How to accurately measure these conditions is a point of debate in the current literature on child development, health, and social determinants. We have evaluated four existing indices of socioeconomic status (SES) to determine the most relevant for the analysis of early childhood development (ECD) in Canada. Following a literature review of published SES indices which used 2006 Canadian Census data, four indices were chosen based on their relevance to ECD and the number of citations in subsequent articles. These were: the Canadian Deprivation Index, the Socioeconomic Factor Index, the Canadian Marginalization Index and an index created by the Early Childhood Mapping Project in Alberta, Canada. The indices were replicated using SES data for 2038 customized geographic neighbourhoods encompassing 99.9% of the Canadian population, and the relationship of the indices to ECD was investigated by linking to aggregated data from the Early Development Instrument (EDI), a teacher-completed questionnaire used to assess kindergarten children's physical, social, emotional, and cognitive development, and communication skills. The derived SES indices were compared based on four criteria: the input variables used, the index structure, the interpretability of the index and the variance they explained (R2) in the different EDI outcome measures. In terms of variance explained, material components of the SES indices (e.g., income, education) consistently showed the strongest association with children's language and cognitive development. The patterns of association for the non-material SES components and the other developmental domains of the EDI were more complex. We discuss the findings in regard to current developments in the field, and the need for refining empirical and theoretical approaches to examine associations between different facets of SES contextual factors and different aspects of ECD outcomes.

Examining the social determinants of children's developmental health: protocol for building a pan-Canadian population-based monitoring system for early childhood development.

INTRODUCTION: Early childhood is a key period to establish policies and practices that optimise children's health and development, but Canada lacks nationally representative data on social indicators of children's well-being. To address this gap, the Early Development Instrument (EDI), a teacher-administered questionnaire completed for kindergarten-age children, has been implemented across most Canadian provinces over the past 10 years. The purpose of this protocol is to describe the Canadian Neighbourhoods and Early Child Development (CanNECD) Study, the aims of which are to create a pan-Canadian EDI database to monitor trends over time in children's developmental health and to advance research examining the social determinants of health. METHODS AND ANALYSIS: Canada-wide EDI records from 2004 to 2014 (representing over 700,000 children) will be linked to Canada Census and Income Taxfiler data. Variables of socioeconomic status derived from these databases will be used to predict neighbourhood-level EDI vulnerability rates by conducting a series of regression analyses and latent variable models at provincial/territorial and national levels. Where data are available, we will measure the neighbourhood-level change in developmental vulnerability rates over time and model the socioeconomic factors associated with those trends. ETHICS AND DISSEMINATION: Ethics approval for this study was granted by the Behavioural Research Ethics Board at the University of British Columbia. Study findings will be disseminated to key partners, including provincial and federal ministries, schools and school districts, collaborative community groups and the early childhood development research community. The database created as part of this longitudinal population-level monitoring system will allow researchers to associate practices, programmes and policies at school and community levels with trends in developmental health outcomes. The CanNECD Study will guide future early childhood development action and policies, using the database as a tool for formative programme and policy evaluation.