By: Scott Orsey
Big news hit the scientific community in February. One hundred years after Albert Einstein first predicted their existence in his groundbreaking theory of general relativity, scientists detected gravitational waves for the first time. The implications for this discovery are huge. In addition to validating the theory, scientists now have a new tool – a gravitational telescope – that they can use to map and explore the universe in a revolutionary way.
The thought that a discovery can be made a century before the invention of technology sufficient to measure its effect can be both humbling and reassuring to those of us seeking evidence-based solutions to modern challenges. It is humbling to think that the success of our work may only be observable decades after it is put into service, perhaps long after we leave this earth. And yet it is also reassuring to reflect that as time passes, our work will someday be substantiated and validated through yet-to-be discovered measurement techniques.
In the study of childhood development, the 1990’s established solid evidence that experiences early in life produce long-term implications to health, well-being and economic success. We now know that both nature and nurture play significant roles in a person’s life-course and health outcomes. These are fundamental principles, like Einstein’s equations, that build the foundation of our work. They also implicate that both positive and negative experiences influence children’s health, their social and emotional growth, their educational success, their economic opportunities, and other areas.
Yet the influence that any single experience has on a child is so minute that we are unable to measure its incremental affect. Like the infinitesimal phenomenon of gravitational waves in Einstein’s day, other factors can drown or mitigate the impact. There is no method for us to say definitively that a specific experience is responsible for a specific result in a specific child because all experiences are interrelated and all children are unique in both their genetic make-up and their life experiences. We use words like “complexity” and “multi-modal” to explain our failure to isolate these impacts.
This dual reality of knowing that there is influence yet not being able to sufficiently measure it has the potential to leave us paralyzed in inaction.
So, what do we do? One approach is to build ever more refined measurement tools to isolate these many influencers. Researchers and practitioners have had great success in enhancing our techniques. Whole bodies of study have been lifted and borrowed from fields ranging from “Complexity Theory” in mathematics (e.g. to measure the effect of social interactions in a self-organizing, complex system like a city neighborhood) to “Big Data” in data analytics (e.g. examining various effects of genetics or behaviors on individuals). These along with many other efforts promise to relentlessly advance our ability to tease out ever more subtle impacts of our interventions.
While we have only scratched the surface of the power garnered from these new tools and even if we realize their full potential, we may still be left short of seeing the long-term impact of a specific experience on an individual. We may need yet more creativity and measurement prowess. The gravitational wave announcement gives us hope that that day will eventually come.
What does a practitioner do in the meantime? We can hardly sit around for a century waiting for the measurement to catch up to the theory. Instead, like Einstein and countless other great thinkers and scientists, we must push the theory forward. We must build upon the foundation. We must ask, “If the theory is true, what are the implications?”
This is where proxy measures can have great effect. If we know that A causes B and we believe that B causes C, then shouldn’t we believe that A causes C? If this transitive argument is reasonable, then perhaps we should seek out the intermediate points that hold the most promise. For those proxies to be useful to us they should meet just three criteria: 1) they must be causal to the long term outcome we desire, 2) they must themselves be measureable with the toolkit, timeframe and other constraints that exist for us today, and 3) they must be amenable to our interventions.
For the broad goal of promoting children’s optimal healthy development, there are a number of proxy measures that meet these criteria. At Connecticut Children’s, we are so impressed by the protective factors framework developed by the Center for the Study of Social Policy (CSSP) in their Strengthening Families Approach that we are adopting their five proxies within our work.
These protective factors, including providing families with concrete support in times of need and boosting parental resilience in managing stress, scientifically correlate with the desirable outcomes of healthy development that we desire. For example, there is evidence that another protective factor, a parent’s knowledge of parenting and child development, promotes healthy developmental outcomes in his or her children. The protective factors are also readily measureable in the near-term. We can take a measurement today and compare it to a measurement in the future and discern if change has occurred.
Finally, and perhaps most useful to an innovator with designs on improving developmental outcomes, we can conceive interventions that can “move the needle” on their results. These evidence-informed protective factors serve as great examples of how to fulfill the proxy measurement need.
While we are a long way from observing the incremental impact of each experience on the healthy development of a child, we can hold out hope that one day, like with Einstein’s great revelation about gravity, we will find a way to measure it. In the meantime, we have a promising strategy through proxy measures that will develop ever more effective interventions to promote children’s optimal healthy development.
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Categories: Promoting Health