Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

This afternoon is a good opportunity to consider the area of early childhood and vulnerability—the almost somewhat mystical zero-to-five space that state and territory governments are grappling with. Increasingly the federal government, too, is realising that there is an important role in collaborating. There can be no greater priority than giving every child a start in life. That opportunity is at the heart of everything we do in this building: giving every individual, every soul, a chance at the great wealth, benefits and opportunities that this beautiful country can provide. There is no better quote than that of Shonkoff and Phillips in their 2000 work looking at childhood vulnerability, when they said:

What they are saying is that there is an almost dose-like effect of early intervention from family that is essential for a child to arrive at school and be able to function, cope and benefit. Where that is not the case—where family circumstances, for whatever reason, do not offer that—then we have significant social challenges for our families.

Of course, if we reinvented the whole school system, we would probably start children a little younger than the age of six. We are increasingly realising that the decisions we make for children in the first five years of their lives have a huge impact on how expensive it is to educate children over that age. But, alas, we cannot rethink our school system and current budgets are difficult to move, so instead there has been a shift in focus towards the early years because we know that the outcomes from those investments are far richer and offer far more potential. The long-term Abecedarian work, led in part by Joe Sparling from the University of North Carolina at Chapel Hill in the United States, in multiple scenarios worldwide, regardless of culture, has shown that regular, purposeful, bilateral stimulation of young children where they are not getting it at home really can change trajectories and, in some cases, move these highest risk kids to performing even better than those who have no intervention at all.

As many will tell you, we start in life with various levels of opportunity, high and low. Some children with high levels of opportunity go on a falling trajectory, usually owing to poor parenting. There is no guarantee that starting off well will mean that you get through school and into life successfully. By the same token, we see children coming from very poor circumstances and some of them—paradoxically, strangely—simply rise up to perform to the mean or even surpass it because of the quality and intensity of their parenting.

No state can step in and start telling every parent how to parent, but a state is responsible for ensuring that, if there are decent services and opportunities provided, well-meaning parents accepting parenting payments from the state will demonstrate some reciprocity by accessing those services and giving their kids a start. There is no doubt that, if you speak to some of these truly high-need parents, all of them, bar the most incapacitated, will say, 'I want to do whatever is right for my child.' I just appreciate that, in highly complex and dysfunctional lives, sometimes that does not really translate to reality. To assist, we do need to have a specific focus on kids where the parenting is not quite as good as it could be—and there is no need to start judging. No. There is just an essential element here of public reporting where families are struggling. It should not just be left to the doctor. It should not just be left to the child protection worker. We are not talking about physical or sexual abuse; we are simply talking about a deficiency in parenting leading to a child basically not being able to cope at school.

As Shonkoff has shown in his early work and as the work of many great academics around the world has shown, the actions in those first five years really determine whether a child can emotionally self regulate and sit in a classroom without beating up the kid next to them or throwing furniture through a window. You can imagine what impact a large class having one, two or three children who are suffering in such a way has on a teacher. What is quite alarming is that work out of Canada, particularly by Paul Kershaw, showed that even in the most wealthy developed economies like Canada, over 25 per cent of children were vulnerable and potentially at risk.

These numbers will have an extraordinary impact on our future economic planning because, as Kershaw pointed out, a failure to invest at that age means the very same kids who struggle through school, who tear down the others in the class and who drain the resources of teachers and principals will end up as teen pregnancy cases at the hospital or will end up with a curriculum vitae of crime greater than capacity and, ultimately, will never get into college or further education. They themselves are then denied a fulfilling family life when their children have exactly the same experience.

We make very general and superficial observations about intergenerational welfare. But, at the heart of it, instead of just hating people who do not have a job, why not go back to the root cause? We have to be looking at the epigenetic impact of young children coming from extremely disadvantaged circumstances where even in the antenatal period young mums are simply unable to give the care to those children that you and I and everybody else here probably takes for granted.

When the ABS does vulnerability studies, where it looks for levels of economic poverty, and we look at the AEDI carried out by prep teaches all around the country to identify within classes the proportion of children that are vulnerable and then lastly we look at the LSAC, the longitudinal study of children, what we are learning increasingly is that targeted interventions are highly effective. Today, in the time that I have, I want to sketch out what this service would look like because right now state governments ask: is it all to fall upon our shoulders? The federal government, paradoxically, is investing huge amounts of health resources through Medicare but most of it does not actually reach these children who are in greatest need.

In general principles, what I propose today is that doctors around the country together with the college of general practice and AMA need to have a renewed focus on childhood vulnerability when assessing children who come in for immunisation. If you are going to see every child in the country at 18 months of age, why not take the time to do a small parent survey, a red flag test for child development. Potentially, where there is any risk at all a PEDS test could be carried out by one of the doctors, one of the staff members or a health clinic staff member at a public health service. They would simply be identifying vulnerability for which Medicare has generous payments—team based care, chronic disease management, and access to allied health services. It is just a matter of unlocking Medicare resources for children instead of that very so short-sighted view that these chronic disease care plans only apply to adults. That is not the case.

Any condition in any Australian citizen likely to last more than six months is eligible for a chronic disease plan. Children should not be denied those services. There is $138 for the care plan, $220 for team based arrangements and five visits to allied health services. That would surely be enough to pull those vulnerable children into a system of wraparound care. The elements of that care really should be that they are ensuring some form of single accountability somewhere. I hope the new primary health care networks will be fulfilling that role so that if there is a care plan developed by GP for a child at risk, it makes its way to a central area that ensures that child care, and that educational services are in some way coordinated.

We need to ensure that services start right from birth if not beforehand. If health workers see in our antenatal clinics mums at risk, please identify them and the siblings of the expected child to ensure that that they are offered the services they need. I am not talking about lazy parents; I am talking about parents who live in extremely complex situations—usually a caregiver with a mental illness or a partner who is in and out of jail or closely spaced kids in the context of poverty. These children just do not get the stimulation they need from their caregivers. In those cases we need a more flexible response. We have seen in the Challis model and through Minderoo Foundation in Western Australia an ability to pull in the services as they are designed to be by Professor Fiona Stanley. What we have seen is that the most at-risk children can end up with an educational performance that surpasses the mean of non-at-risk kids.

Of course, there needs to be an element of risk management which stratifies these children and ensures that, if there is any element of physical or sexual abuse, that is catered for under state legislation and immediately trumps the work in vulnerability, because there is no excuse for not treating physical or sexual abuse of a child as the absolutely pre-eminent issue, as I know state entities endeavour to do at the moment. What we also need is a tailored dosing. We do not need simply to say five visits to an allied health provider for every child. We need to have that central care navigator ensuring that these children get the support they need from zero to five, after which we can rely on the education system.

We have got to build the confidence in child care. Childcare workers can play a role. It should not be simply thrown onto the medical or the health system, because appropriately trained early educators can deliver many of these internationally proven services.

Lastly, within the system we need goals. We need fidelity of this system to ensure we do not miss kids. You cannot rely on finding cases, as we have looked at in the childcare centre. We cannot rely purely on GPs. But, together with a coordinated scheme, we can ensure that no Australian child is left behind.