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Early Childhood Development (ECD)

Jane Fisher

Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

Jane Fisher

Jane Fisher, BSc Hons, PhD, MAPS
Clinical and Health Psychologist
Professor of Women’s Health and Director of the Jean Hailes Research Unit in the School of Public Health and Preventive Medicine at Monash University, Melbourne, Australia
jane.fisher@monash.edu

Jane Fisher is an academic Clinical and Health Psychologist, Professor of Women’s Health and Director of the Jean Hailes Research Unit in the School of Public Health and Preventive Medicine at Monash University in Melbourne Australia. The Jean Hailes Research Unit is a formal partnership between a community-based organisation specialising in translation of knowledge, and an academic institution, with a shared emphasis on the health and wellbeing of women, their families and the health professionals who care for them.

Jane’s research focuses on investigating the social determinants, in particular gender-based risks, to women’s mental health and psychological functioning. She has a particular interest in the mental health and caregiving capabilities of women who are pregnant, have recently given birth or are caring for young children and the flow-on impacts on early childhood development. She has completed major epidemiological studies in clinical and community settings in Australia and Vietnam; intervention trials and investigations using quantitative and qualitative methods.

She heads and mentors a research group, which includes senior and early career research fellows, research assistants and high calibre postgraduate students. They are drawn from diverse disciplines including: biological sciences, education, epidemiology, gender studies, implementation science, nursing, clinical and health psychology, pharmacy, psychiatry, public health and sociology. Jane has been a technical adviser to and worked closely with colleagues in the World Health Organisation Headquarters, and SEARO and WPRO Regional Offices and UNICEF on projects related to maternal health and infant health and development.

Currently Jane has a multi-stranded research program related to the promotion of maternal health and infant health and development.  One particular focus is the cluster randomised-controlled trial of a low-cost psycho-educational intervention called What Were We Thinking. It is novel in including couples and babies and is offered in local primary care services within a month of the baby’s birth. It focuses on equipping parents with the skills to soothe and settle their infants and to establish sustainable routines of care, and also on the skills required to renegotiate roles and responsibilities in non-adversarial ways between members of the intimate partnership.

She has also developed a collaborative research program with colleagues in Viet Nam and Australia over the past fifteen years.  They are presently building evidence of the interactions among micronutrient deficiencies (iron, iodine and vitamins A and D), maternal psychological functioning and social and economic circumstances in determining early childhood development in a cohort of 1600 mothers and their children in rural Viet Nam.  They are assessing early childhood development using the Bayley Scales of Infant and Toddler Development III adapted for local use.  They have documented high prevalence of both common mental disorders and micronutrient deficiencies among women and that these contribute to delays in different developmental domains among their infants.

Publications 2008 -

Refereed publications

  • Tran T, Biggs BA, Tran T, Simpson J, Hanieh S, Dwyer T, FISHER J. Impact on infants’ cognitive development of antenatal exposure to iron deficiency disorder and common mental disorders. PLOS One 2013; 8(9): e74876
  • FISHER J, Hammarberg K, Wynter K, McBain J, Gibson F, Boivin J, McMahon C. Assisted conception, maternal age and breastfeeding: an Australian cohort study. Acta Paediatrica 2013; 102: 970–976
  • Wynter K, Hammarberg K, McMahon C, Gibson F, McBain J, Boivin J, FISHER J. Spontaneous conceptions within two years after having a first infant with assisted conception Australian and New Zealand Journal of Obstetrics and Gynaecology 2013; 53(3): 471-476
  • Rahman A, FISHER J, Bower P, Luchters S, Tran TD, Yasamy T, Saxena S, Waheed W. Interventions for common perinatal mental disorders in women in low- and middle-income countries: a systematic review and meta-analysis Bulletin of the World Health Organization, 2013; 91:593–601
  • Hanieh S, Tran H, Tran T, Casey G, Tran T, Simpson J, Pasricha S, Dwyer T, FISHER J, Biggs BA The effect of intermittent antenatal iron supplementation on maternal and infant outcomes in rural Vietnam: a cluster randomized trial PLOS Medicine 2013; 10(6):  e1001470.
  • Wee KY, Pier C, Milgrom J, Richardson B, FISHER J, Skouteris H Fathers’ mental health during the ante and postnatal periods: knowledge, recommendations and interventions British Journal of Midwifery 2013; 21 (5): 236 – 246.
  • Hammarberg K, Wynter K, FISHER J, McBain J, Gibson F, Boivin J, McMahon C. The experience of pregnancy: does age or mode of conception matter? Journal of Reproductive and Infant Psychology, 2013; 31(2): 109-120
  • Wilson C, Hammarberg K, Bruinsma F, Berg T, Amor D, Sanson A, FISHER JR, Halliday J, Health and development of ART conceived young adults: a study protocol for the follow-up of a cohort. Reproductive Health 2013; 10: 13
  • Kirkman M, Stern C, Neil S, Winship I, Mann GB, Shanahan K, Missen D, Shepherd H, FISHER JRW Fertility management after breast cancer diagnosis: A qualitative investigation of women’s experiences of and recommendations for professional care. Health Care for Women International, 2013; 34:1, 50-67
  • McMahon C, Boivin J, Gibson F, Hammarberg K, Wynter K, Saunders D, FISHER J Pregnancy specific anxiety, ART conception, and infant temperament at four months postpartum Human Reproduction 2013; 28 (4): 997–1005
  • Tran TD, Tran T, Fisher JRW Validation of the depression anxiety stress scales (DASS) 21 as a screening instrument for depression and anxiety in a rural community-based cohort of northern Vietnamese women BMC Psychiatry 2013, 13:24
  • FISHER JR, Tran TD, Biggs B, Dang TH, Nguyen TH, Tran T. Intimate partner violence and perinatal common mental disorders among women in rural Vietnam. International Health 2013; 5: 29 –37
  • Matthey S, FISHER JR, Rowe H. Using the Edinburgh postnatal depression scale to screen for anxiety disorders: conceptual and methodological considerations Journal of Affective Disorders, 2013 146(2) 224-230.
  • Rowe HJ, Holton S, FISHER JRW. Postpartum emotional support: a qualitative study of women’s and men’s anticipated needs and preferred sources. Australian Journal of Primary Health 2013, 19, 46–52
  • FISHER JRW, Tran TD, Tran T. Validation of the Intimate Bonds Measure for women who are pregnant or have recently given birth in Vietnam Asia Pacific Psychiatry 2012; DOI:10.1111/appy.12011
  • Newton DC, Keogh L, Temple-Smith M, Fairley CK, Chen M, Bayly C, Williams H, McNamee K, Henning D, Hsueh A, FISHER J, Hocking J Key informant perceptions of youth-focussed sexual health promotion programs in Australia Sexual Health. 2012; 10(11),
  • Tran TD, Tran T, Wynter K, FISHER J. Interactions among alcohol dependence, perinatal common mental disorders and violence in couples in rural Vietnam: a cross-sectional study using structural equation modelling. BMC Psychiatry 2012, 12:148
  • Holton S, Kirkman M, Rowe H, FISHER J, The childbearing concerns and related information needs and preferences of women of reproductive age with a chronic, non-communicable health condition: a systematic review. Women Health Issues. 2012; 22(6) e541–e552.
  • FISHER J, Tran T, Tran TD, Dwyer T, Nguyen T, Casey GJ, Simpson JA, Hanieh S, Biggs B-A, Prevalence and risk factors for symptoms of common mental disorders in early and late pregnancy in Vietnamese women: A prospective population-based study Journal of Affective Disorders 2013, 146(2): 213-219.
  • Xu Y, Herrman H, Tsutsumi A, FISHER J. Psychological and social consequences of losing a child in a natural or human-made disaster: a literature review of the evidence. Asia Pacific Psychiatry, 2012 DOI:10.1111/appy.12013
  • FISHER J, Chatham E, Haseler S, McGaw B, Thompson J. Uneven implementation of the National Perinatal Depression Initiative: findings from a survey of Australian women’s hospitals. Australian and New Zealand Journal of Obstetrics and Gynaecology 2012; 52 (6), 559-564
  • Le M, Tran T, Huong NT, FISHER J. Experience of low mood and suicidal behaviours among adolescents in Viet Nam: findings from two national population-based surveys. Journal of Adolescent Health 2012; 51(4): 339-48.
  • FISHER J, Tran TD, Nguyen TT, Tran T. Common perinatal mental disorders and alcohol dependence in men in northern Viet Nam. Journal of Affective Disorders 2012; 140: 97–101
  • FISHER J, Rowe H, Hammarberg K. Admissions for early parenting difficulties among women with infants conceived by assisted reproductive technologies: a prospective cohort study. Fertility and Sterility 2012; 97 (6): 1410 – 1416
  • Bolch CE, Davis PG, Umstad MP, FISHER JRW. Multiple birth families with children with special needs: A qualitative investigation of mothers’ experiences. Twin Research and Human Genetics. 2012;15 (4):1-13.
  • Cooklin A, Rowe H, FISHER J. Paid parental leave supports breastfeeding and mother-infant relationship: a prospective investigation of maternal postpartum employment. Australian and New Zealand Journal of Public Health 2012; 36:3 (249-256)  
  • FISHER J. Gender-based violence, perinatal mental health in women and child development. Evidence-Based Medicine 2012. doi:10.1136/ebmed-2011-100412
  • Holton S, FISHER J, Rowe H. To have or not to have? Australian women’s childbearing desires, expectations and outcomes. Journal of Population Research 2012; 28(4): 353 – 379
  • Tran T, Tuan T, FISHER J. Validation of three psychometric instruments for screening for perinatal common mental disorders in men in the north of Vietnam Journal of Affective Disorders 2012 136(1-2): 104–109.
  • FISHER J, Cabral de Mello M, Patel V, Rahman A, Tran T, Holton S, Holmes W. Prevalence and determinants of common perinatal mental disorders in women in low and lower middle income countries: a systematic review of the evidence. Bulletin of the World Health Organization 2012; 90:139–149
  • FISHER JRW, Hammarberg K. Psychological and social aspects of infertility in men: an overview of the evidence and implications for psychologically-informed clinical care and future research Asian Journal of Andrology 2012; 14: 121–129
  • Newton DC, Bayly C, Fairley CK, Chen M, Williams H, Keogh L, Temple-Smith M, McNamee K, FISHER J, Henning D, Hsueh A, Hocking J Pelvic inflammatory disease and its adverse impact on relationships and sexual intimacy. Journal of Sexual Medicine (in press 27.09.2011)
  • FISHER J, Tran T, Biggs B, Tuan T, Dwyer T, Casey G, Tho D, Hetzel B. Iodine status in late pregnancy and psychosocial determinants of iodized salt use in rural northern Viet Nam. Bulletin of the World Health Organization 2011; 89: 813 – 820
  • FISHER J, Rowe H. Soothing the unsettled baby. Medical Observer, 2011; October: 35
  • FISHER J, Cabral de Mello M. Using the World Health Organization's 4S-Framework to strengthen national strategies, policies and services to address mental health problems in adolescents in resource-constrained settings. International Journal of Mental Health Systems; 2011; 5: 23
  • Amir LH, Cullinane M, Garland SM, Tabrizi SN, Donath SM, Bennett CM, Cooklin AR, FISHER JRW, Payne MS.  The role of micro-organisms (Staphylococcus aureus and Candida albicans) in the pathogenesis of breast pain and infection in lactating women: study protocol. BMC Pregnancy and Childbirth 2011; 11: 54
  • Tran T, Tran T, La B, Lee D, Rosenthal D, FISHER J. Screening for common perinatal mental disorders in women in the North of Vietnam: A comparison of three psychometric instruments. Journal of Affective Disorders 2011; 133:  281–293
  • Holton S, Rowe HJ FISHER JRW. Women's health and their childbearing expectations and outcomes: a population-based survey from Victoria, Australia. Women’s Health Issues 2011: 21 (5): 366 – 373
  • McCallum SM, Rowe HJ, Gurrin L, Quinlivan J, Rosenthal D, FISHER JRW.  Unsettled infant behaviour and health service use: a cross-sectional community survey in Melbourne, Australia. Journal of Paediatrics and Child Health 2011; 47: 818–823
  • FISHER J, Cabral de Mello M, Izutsu T, Vijayakumar L, Belfer M, Omigbodun O. Adolescent mental health in resource-constrained settings: a review of the evidence about the nature, prevalence and determinants of common mental health problems and their management in primary health care. International Journal of Social Psychiatry Special Issue 2011: 57 (S1): 1 – 162
  • McMahon C, Boivin J, Gibson F, Hammarberg K, Wynter K, Saunders D, FISHER J. Age at first birth, mode of conception and psychological wellbeing in pregnancy: Findings from the Parental Age and Transition to Parenthood Australia (PATPA) Study. Human Reproduction 2011: 26 (6): 1389 – 1398
  • Quinlivan JA, FISHER JR, Lam LT. A randomized trial of a 4-step multidisciplinary intervention for the management of obesity in pregnancy. Australian and New Zealand Journal of Obstetrics and Gynaecology 2011; 51: 141 – 146
  • Wilson C, FISHER JR, Hammarberg K, Amor D, Halliday J. Looking down stream: A review of the literature on physical and psychosocial health outcomes in adolescents and young adults who were conceived from IVF, Human Reproduction, 2011: 26 (5): 1209 -1219
  • FISHER J, Rowe H and Hammarberg K. Admission of women for psychological or psychiatric causes with their infants in Victoria, Australia. Australian and New Zealand Journal of Public Health 2011; 35 (2): 146 – 150
  • Hammarberg K, FISHER J, Wynter K, Rowe HJ. Breastfeeding after assisted conception: A prospective cohort study Acta Paediatrica 2011; 100: 529 – 533
  • FISHER J, Cabral de Mello M, Izutsu T, Tran T. The Ha Noi Expert Statement: recognition of maternal mental health in resource-constrained settings is essential for achieving the Millennium Development Goals. International Journal of Mental Health Systems 2011; 5(1); 2
  • Wynter K, Rowe H, FISHER J, Lee M, Quinlivan J. Are adolescents' decisions about prenatal screening for Down Syndrome Informed? A controlled, prospective study. Journal of Pediatric and Adolescent Gynecology 2011; 24 (1): 29-34
  • McMahon CA, Boivin J, Gibson F, FISHER JRW, Hammarberg K, Wynter K, Saunders DM. Older first-time mothers and early postpartum depression: a prospective cohort study of women conceiving spontaneously or with assisted reproductive technologies. Fertility and Sterility 2011; 96(5):1218-1224
  • Hammarberg K, FISHER J, Baker G. Men’s experiences of infertility and infertility treatment five years after diagnosis of male factor infertility: a retrospective cohort study Human Reproduction 2010; .25(11):  2815–2820
  • FISHER J. Small survey finds that new mothers use self-care approaches to manage fatigue more often than other strategies such as seeking help from others. Invited Commentary BMJ Evidence Based Nursing Practice 2010;13 (4):116-117
  • FISHER JRW, Tran T, La B, Kriitmaa K, Rosenthal D, Tran T. Common perinatal mental disorders in women in northern Viet Nam: Community prevalence and health care use.  Bulletin of the World Health Organization 2010; 88: 737 – 745 
  • FISHER JRW, Wynter K, Rowe HJ. Innovative psycho-educational program to prevent common postpartum mental disorders in primiparous women: a before and after controlled study. BMC Public Health 2010, 10: 432
  • Rowe HJ, FISHER JRW. Development of a universal psycho-educational intervention to prevent common postpartum mental disorders in primiparous mothers: a multiple method approach. BMC Public Health 2010, 10: 499
  • Rowe HJ, FISHER J. The contribution of Australian residential early parenting centers to comprehensive mental health care for mothers of infants: evidence from a prospective study. International Journal of Mental Health Systems 2010, 4:6
  • Holton S, FISHER JRW, Rowe HJ Motherhood: is it good for women's mental health. Journal of Reproductive and Infant Psychology 2010; 28 (3): 223 - 239
  • FISHER JRW, Hammarberg K, Baker HWG. Long term health, wellbeing, life satisfaction and attitudes to parenthood in men diagnosed as infertile: challenges to gender stereotypes and implications for practice. Fertility and Sterility 2010; 94 (2): 574 - 580
  • Hammarberg K, FISHER J, Rowe HJ. Early postpartum adjustment and admission to parenting services in Victoria, Australia after assisted conception. Human Reproduction 2009; 24 (11):  2801–2809
  • FISHER JRW. Brief behavioural intervention for infant sleep problems reduces depression in mothers Invited Commentary for Evidence Based Mental Health 2009; 12 (2): 46
  • Holton S, FISHER JRW, Rowe HJ. Attitudes toward women and motherhood: their role in Australian women’s childbearing behaviour. Sex Roles and Society 2009; 61 (9-10): 677–687
  • Oddy B, Rowe H, FISHER J. Consumers’ views on the use of diagnostic labels to describe psychological distress in the postpartum: implications for health care. Australian Journal of Primary Health 2009; 15: 9-16.
  • Moodie M, FISHER JRW. Are youth mentoring programs good value-for-money? An evaluation of the Big Brothers Big Sisters Melbourne Program. BMC Public Health. 2009; 9:41doi:10.1186/1471-2458-9-41
  • Wong J, FISHER J. The role of traditional confinement practices in determining postpartum depression in women in Chinese cultures: A systematic review of the English language evidence. Journal of Affective Disorders. 2009; 116(3):161-9
  • Rowe HJ, FISHER JRW, Quinlivan JA. Women who are well informed about prenatal genetic screening delay emotional attachment to their fetus. Journal of Psychosomatic Obstetrics & Gynaecology 2009; 30 (1): 34-41.
  • FISHER J, Hammarberg K, Baker G, McBain J. Assessing the health and development of ART-conceived young adults: A study of feasibility, parent recall, and acceptability Reproductive Health 2008; 5:7 doi:10.1186/1742-4755-5-7
  • Hammarberg K, FISHER J, Wynter K. Psychological and social aspects of pregnancy, childbirth and the first postpartum year after assisted conception: a systematic review. Human Reproduction Update 2008; 14(5):395-414
  • FISHER JRW, Hammarberg K, Baker G. Antenatal mood and foetal attachment after assisted conception. Fertility and Sterility 2008; 89(5): 1103 – 1112
  • Rowe H, Loh WM FISHER J. The Edinburgh Postnatal Depression Scale detects but does not distinguish anxiety disorders from depression in mothers of infants. Archives of Women’s Mental Health. 2008; 11(2): 103 - 108.
  • Hammarberg K, FISHER J, Rowe H. Women’s experiences of childbirth and postnatal health care after assisted conception. Human Reproduction 2008: 23(7); 1567 – 1573
  • Kirkman M, FISHER J. Editor’s introduction to Women and Technologies of Reproduction. Special Issue of Women’s Studies International Forum. 2008; 31(4): 233 – 234
  • Cherniak D, FISHER JRW. Explaining obstetric interventionism: Technical skills, common conceptualisations or collective counter-transference? Women’s Studies International Forum; 2008; 31(4): 270 - 278 

Refereed book chapters

  • FISHER JRW, Cabral de Mello M. Mental health consequences of violence against women. In Lindert J, Levav I, Weisskopf M (editors) Violence and Mental  Health (in press 7.09.2012)
  • FISHER JRW, Holton S, Rowe H. Non-professional resources for pregnant and postpartum women. In Stuart S and Wenzel A. Oxford Handbook of Perinatal Psychology (in press 15.08.2012)
  • FISHER JRW, Herrman H, Cabral de Mello M, Chandra P. Mental health of women in Patel V, Prince M, Cohen A, Minas H. (editors) Global Mental Health: Principles and Practice (in press 30.07.2012)
  • Muzik M, Hamilton S, Rochat TJ, FISHER JR, Barnett B, Chandra P, Henshaw C, Pirec V.  Perintatl mental health in primary care: an overview of current models across the globe. In Ivbijaro G (ed) Companion to Primary Care Mental Health. World Organisation of Family Doctors Publications 2012; 365 – 384
  • FISHER J, Feekery C, Rowe HJ. Psycho-educational early parenting interventions to promote infant mental health. In: Fitzgerald H, Puura K, Tomlinson M, Paul (editors). International Perspectives on Child Psychology and Mental Health. Santa Barbara: ABC-CLIO Inc; 2011: 205 - 236
  • FISHER JRW, Rahman A, Cabral de Mello M, Chandra P, Herrman H. Mental health of parents and infant health and development in resource-constrained settings: evidence gaps and implications for facilitating ‘good-enough parenting’ in the twenty-first-century world. In Tyano S, Keren M, Herrman H, Cox J (Editors) Parenthood and Mental Health: A Bridge between Infant and Adult Psychiatry  London, John Wiley & Sons, Ltd, 2010: 461 - 474
  • FISHER JRW. The Unpaid Workload: Gender Discrimination in Conceptualization and Its Impact on Maternal Wellbeing. In Section V: Gender, Social Policy and Implications for Promoting Women’s Mental Health in Chandra P, Herrman H, Fisher J, Kastrup M, Niaz U, Rondon M,  Okasha A, (Editors) Contemporary Topics in Women’s Mental Health Oxford: Wiley Blackwell, 2009: 525 - 537
  • FISHER JRW, Herrman H. Editor’s Introductory Commentary to Section V: Gender, Social Policy and Implications for Promoting Women’s Mental Health, in Chandra P, Herrman H, Fisher J, Kastrup M, Niaz U, Rondon M,  Okasha A, (Editors) Contemporary Topics in Women’s Mental Health Oxford: Wiley Blackwell, 2009: 499 – 506
  • FISHER JRW, Cabral de Mello M, Izutsu T. Mental Health Aspects of Pregnancy, Childbirth and the Postpartum Period. In Section II: The Interface Between Reproductive Health and Psychiatry in Chandra P, Herrman H, Fisher J, Kastrup M, Niaz U, Rondon M, Okasha A, (Editors) Contemporary Topics in Women’s Mental Health Oxford: Wiley Blackwell, 2009: 197 - 226
  • FISHER JRW. Cabral de Mello M, Isutzu T. Pregnancy, childbirth and the postpartum year. In Mental Health Aspects of Women’s Reproductive Health. A Global Review of the Literature. Geneva, World Health Organization and United Nations Population Fund 2009; 8 – 43
  • FISHER JRW. Infertility and Assisted Reproducton. In Fisher JRW, Astbury JA, Cabral de Mello M, Saxena S, (editors). Mental Health Aspects of Women’s Reproductive Health. A Global Review of the Literature. Geneva, World Health Organization and United Nations Population Fund 2009; 128- 146
  • FISHER JRW. Female Genital Mutilation . In Fisher JRW, Astbury JA, Cabral de Mello M, Saxena S, (editors).  Mental Health Aspects of Women’s Reproductive Health. A Global Review of the Literature. Geneva, World Health Organization and United Nations Population Fund 2009; 147-157

Commissioned research and technical reports

  • Victorian Assisted Reproductive Treatment Authority and Monash University. Consultation with donors who donated gametes in Victoria, Australia before 1998: Access by donor-conceived people to information about donors. Victorian Government Department of Health, May 2013
  • Wynter K, Rowe H, Burns J, FISHER J. Implementation of What Were We Thinking in Victorian Maternal and Child Health services: a mixed methods investigation of acceptability, feasibility and resource implications report. Victorian Government Department of Education and Early Childhood Development, Melbourne, April 2013
  • FISHER J, Rowe H, Hiscock H, Jordan B, Bayer J, Colahan A, Amery V. Understanding and responding to unsettled infant paper. A discussion paper for the Australian Research Alliance for Children and Youth, Melbourne, August 2010
  • Rahman A, FISHER JRW, Waheed W. Maternal mental health interventions in low and middle income countries: a systematic review of the evidence. Department of Mental Health and Substance Dependence World Health Organization, Geneva February 2009
  • FISHER JRW, Cabral de Mello M, Tran T, Izutsu T. Maternal mental health and child survival, health and development in resource-constrained settings: essential for Achieving the Millennium Development Goals. Statement from the UNFPA – WHO International Expert Meeting: The interface between reproductive health and mental health. Maternal mental health and child health and development in resource constrained settings. Hanoi, June, 25th – 27th 2007; Geneva, World Health Organization, 2009
  • Shelley J, Graham M, Bayly C, FISHER J, Rowe H, Jordan L, Hardiman, A. The provision of pregnancy advisory services in Victoria. Final Report; Victorian Department of Human Services. June 2008
  • FISHER JRW, Sandahl H, Rosenthal D. The nature, recognition, management and prevention of common mental health problems in adolescents living in low income countries: A review and discussion paper. Department of Child and Adolescent Health, World Health Organization, Geneva 2008
  • FISHER JRW, Rowe H. Report of the Koori Maternity Services Data Exploration Project. Statewide Outcomes for Children Branch of the Victorian Government Office for Children, October 2008

Non-refereed publications

Links

 

Early Childhood Development (ECD)