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Potential of ‘stacking’ early childhood interventions to reduce inequities in learning outcomes
  1. Carly Molloy1,
  2. Meredith O'Connor1,2,3,
  3. Shuaijun Guo1,
  4. Colleen Lin4,
  5. Christopher Harrop5,
  6. Nicholas Perini6,
  7. Sharon Goldfeld1,2
  1. 1 Policy and Equity, Centre for Community Child Health, Murdoch Children’s Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
  2. 2 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
  3. 3 ANU College of Arts & Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
  4. 4 Bain & Company, San Francisco, California, USA
  5. 5 Bain & Company, Melbourne, Victoria, Australia
  6. 6 Social Ventures Australia, Sydney, New South Wales, Australia
  1. Correspondence to Dr Sharon Goldfeld, Murdoch Childrens Research Institute, The University of Melbourne, Parkville, VIC 3052, Australia; sharon.goldfeld{at}


Background Early childhood interventions are critical for reducing child health and development inequities. While most research focuses on the efficacy of single interventions, combining multiple evidence-based strategies over the early years of a child’s life may yield greater impact. This study examined the association between exposure to a combination of five evidence-based services from 0 to 5 years on children’s reading at 8–9 years.

Methods Data from the nationally representative birth cohort (n=5107) of the Longitudinal Study of Australian Children were utilised. Risk and exposure measures across five services from 0 to 5 years were assessed: antenatal care, nurse home-visiting, early childhood education and care, parenting programme and the early years of school. Children’s reading at 8–9 years was measured using a standardised direct assessment. Linear regression analyses examined the cumulative effect of five services on reading. Interaction terms were examined to determine if the relationship differed as a function of level of disadvantage.

Results A cumulative benefit effect of participation in more services and a cumulative risk effect when exposed to more risks was found. Each additional service that the child attended was associated with an increase in reading scores (b=9.16, 95% CI=5.58 to 12.75). Conversely, each additional risk that the child was exposed to was associated with a decrease in reading skills (b=−14.03, 95% CI=−16.61 to −11.44). Effects were similar for disadvantaged and non-disadvantaged children.

Conclusion This study supports the potential value of ‘stacking’ early interventions across the early years of a child’s life to maximise impacts on child outcomes.

  • child development
  • cumulative risk
  • socioeconomic disadvantage
  • early childhood interventions
  • child inequities
  • cumulative benefit

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  • Contributors SG contributed to and oversaw the planning and reporting of the work described in this article. CM, MO and SG wrote the first draft of the manuscript. CL and SG conducted the data analysis. SG, CM, MO, CL, CH and NP contributed to the planning of the work described in this article.

  • Funding The authors thank the Australian Government Department of Social Services for funding this analysis of the LSAC data. The research is also supported by the Victorian Government’s Operational Infrastructure Support Program. SG is supported by Australian National Health and Medical Research Council (NHMRC) Practitioner Fellowship (APP1155290).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The LSAC methodology was approved by the Australian Institute of Family Studies Human Research Ethics Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.