Australian Governments are increasingly understanding the impacts of early adversity, evidenced by ongoing policy and investment in two of the most widely implemented early interventions: nurse home visiting (NHV) and early childhood education and care (ECEC). Neither intervention fully redresses the developmental inequities engendered by early adversity, yet their synergistic impacts (“dynamic complementarity”) are unknown. In this research, we aimed to (1) inform evaluation of policy implementation by (2) experimentally testing the dynamic complementarity of NHV and ECEC. We capitalised on an opportunity afforded by the Australian “right@home” randomised trial, which involved 722 pregnant women experiencing adversity, randomised to receive NHV or usual care to child age 2 years. Detailed data describing family‐accessed ECEC were collected from parents at 3–4 years, and “quality ECEC” was categorised according to meeting quality recommendations defined by Australian policy and provision. Children's developmental outcomes (language, executive functioning, behaviour and well‐being) were parent‐reported or assessed directly at 4 years. At 4 years, 33 per cent of families had received neither intervention; 40 per cent NHV only; 14 per cent quality ECEC only; and 13 per cent had received both. We used linear regression to estimate differences in mean outcomes between exposure groups, including interaction between NHV and ECEC. Unadjusted analyses indicated modest effects of the combination of NHV and ECEC, which attenuated after adjustment for socioeconomic confounders. We present the design and preliminary findings as an approach that could be used to evaluate equitable implementation at scale and enable policymakers to determine the most effective evidence‐based policy.

中文翻译：

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护士家访和优质托儿服务对经历逆境的儿童的互补影响

澳大利亚政府越来越了解早期逆境的影响，对两种最广泛实施的早期干预措施的持续政策和投资就证明了这一点：护士家访（NHV）和幼儿教育和护理（ECEC）。这两种干预措施都不能完全纠正早期逆境造成的发展不平等，但它们的协同影响（“动态互补性”）尚不清楚。在本研究中，我们的目的是 (1) 通过 (2) 实验测试 NHV 和 ECEC 的动态互补性来评估政策实施。我们利用澳大利亚“right@home”随机试验提供的机会，该试验涉及 722 名经历逆境的孕妇，随机接受 NHV 或常规护理至 2 岁儿童。描述家庭获得的 ECEC 的详细数据是在 3-4 岁时从父母那里收集的，并且根据澳大利亚政策和规定所定义的质量建议对“优质 ECEC”进行了分类。儿童的发展结果（语言、执行功能、行为和幸福感）由家长在 4 岁时直接报告或评估。 4 年时，33% 的家庭没有接受过这两种干预措施；仅 40% NHV；仅 14% 优质 ECEC； 13% 的人两者都收到了。我们使用线性回归来估计暴露组之间平均结果的差异，包括 NHV 和 ECEC 之间的相互作用。未经调整的分析表明 NHV 和 ECEC 组合的影响不大，在对社会经济混杂因素进行调整后减弱。我们将设计和初步结果作为一种方法提出，可用于评估大规模的公平实施，并使政策制定者能够确定最有效的基于证据的政策。