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Mitigating adverse social determinants of health in the vulnerable population: Insights from a home visitation

Kevin Wei Hao Liang^1,2,3, Keith Wei Han Liang^1,3, Qing Rong Chan²

¹Department of Paediatrics, KK Women's and Children's Hospital, Singapore.

Annals of the Academy of Medicine, Singapore

|June 26, 2024

Insights

Psychosocial risks negatively impact child development in low-income families. Early, integrated home visitation programs like KIDS0-3 are crucial for optimizing outcomes for vulnerable children.

Area of Science:

Child Development
Public Health
Social Work

Background:

Low-income families face significant psychosocial risks and adverse childhood experiences impacting child development.
The Kids Integrated Development Service (KIDS0-3) program at KK Women's and Children's Hospital offers home visitation to support these families.

Purpose of the Study:

To evaluate the impact of psychosocial risks on child development outcomes.
To assess the effectiveness of the KIDS0-3 home visitation program.

Main Methods:

Chart review of 469 mother-child dyads from June 2014 to October 2022.
Utilized the Family and Adult Support Tool to identify risk levels.
Analyzed Bayley Scales of Infant and Toddler Development cognitive, language, and motor scores.

Main Results:

67% of families were identified as moderate or high-risk.
Children in moderate/high-risk families showed poorer cognitive and language scores at 24 months.
Teenage mothers and mothers with a history of sexual abuse had children with lower cognitive and language scores.
Antenatal enrollment correlated with better language and motor outcomes compared to postnatal enrollment.

Conclusions:

Psychosocial risks significantly affect child development in low-income Singaporean families.
Early, integrated interventions are vital for supporting vulnerable families and improving child development.
Home visitation programs demonstrate potential in mitigating negative impacts.

Read full analysis

Abstract

Introduction:

Low-income families are exposed to adverse childhood experiences and psychosocial risks that impact child development. At the KK Women's and Children's Hospital in Singapore, Kids Integrated Development Service (KIDS0-3) is a home visitation programme that aims to optimise the development of children from low-income families.

Method:

Data comprising family demographics, maternal psychosocial risks and outcomes of child development were collated through a chart review of 469 mother-child dyads enrolled from June 2014 to October 2022.

Results:

Based on the Family and Adult Support Tool, 312 families (67%) were identified as moderate or high-risk. Children from moderate and high-risk families had poorer Bayley cognitive (mean 95.88 [SD 8.25] versus [vs] 98.44 [SD 8.72], P=0.014) and language scores (mean 87.38 [SD 10.35] vs 90.43 [SD 9.61], P=0.016] at 24 months of age, compared to the low-risk group. Children of teenage mothers had lower Bayley cognitive scores (mean 95.16 [SD 8.42] vs 97.76 [SD 8.55], P=0.037), and children of mothers who experienced sexual abuse had lower Bayley cognitive scores (mean 93.1 [SD 5.68] vs 99.7 [SD 8.17], P=0.013) and language scores (mean 82.3 [SD 12.87] vs 91.3 [SD 10.86], P=0.021]. Antenatal enrolment yielded better child language (mean 90.1 [SD 9.37] vs 87.13 [SD 10.79], P=0.04) and motor outcomes (mean 99.62 [SD 9.45] vs 94.72 [SD 9.51], P=0 .001) than postnatal enrolment.

Conclusion:

Psychosocial risks impact the development of children from low-income families in Singapore. Findings underscore the importance of early, integrated intervention for vulnerable families.

Keywords:

adverse childhood experiences child development outcomes low-income families maternal psychosocial risks toxic stress

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