Florencia Lopez-Boo

Integrating a Parenting Intervention With Routine Primary Health Care: A Cluster Randomized Trial.

OBJECTIVE: More than 200 million children globally do not attain their developmental potential. We hypothesized that a parent training program could be integrated into primary health center visits and benefit child development. METHODS: We conducted a cluster randomized trial in the Caribbean (Jamaica, Antigua, and St Lucia). Fifteen centers were randomly assigned to the control (n = 250 mother-child pairs) and 14 to the intervention (n = 251 mother-child pairs) groups. Participants were recruited at the 6- to 8-week child health visit. The intervention used group delivery at 5 routine visits from age 3 to 18 months and comprised short films of child development messages, which were shown in the waiting area; discussion and demonstration led by community health workers; and mothers’ practice of activities. Nurses distributed message cards and a few play materials. Primary outcomes were child cognition, language, and hand-eye coordination and secondary outcomes were caregiver knowledge, practices, maternal depression, and child growth, measured after the 18-month visit. RESULTS: Eight-five percent of enrolled children were tested (control = 210, intervention = 216). Loss did not differ by group. Multilevel analyses showed significant benefits for cognitive development (3.09 points; 95% confidence interval: 1.31 to 4.87 points; effect size: 0.3 SDs). There were no other child benefits. There was a significant benefit to parenting knowledge (treatment effect: 1.59; 95% confidence interval: 1.01 to 2.17; effect size: 0.4). CONCLUSIONS: An innovative parenting intervention, requiring no additional clinic staff or mothers’ time, was integrated into health services, with benefits to child cognitive development and parent knowledge. This is a promising strategy that merits further evaluation at scale.

Economic perspectives on integrating early child stimulation with nutritional interventions.

There is a strongly held view that a narrow window exists for effective nutritional interventions and a widely known stylized depiction of age‐dependent economic rates of returns to investments in cognitive and socioemotional development. Both indicate critical periods in early life. Moreover, the fact that both the physical and cognitive development of a child in these early years are highly dependent on childcare practices and on the characteristics of the caregivers motivates an interest in finding effective means to enhance stimulation in the context of nutritional programs, or vice versa. Nevertheless, there is relatively little evidence to date on how to align integrated interventions to these age‐specific patterns and how to undertake benefit–cost analyses for integrated interventions. Thus, many core questions need further consideration in order to design integrated nutritional and stimulation programs. This paper looks at some of these questions and provides some guidelines as to how the economic returns from joint nutrition and stimulation programs might be estimated.

Early Child Development and Nutrition: A Review of the Benefits and Challenges of Implementing Integrated Interventions

Poor nutrition (substandard diet quantity and/or quality resulting in under- or overnutrition) and the lack of early learning opportunities contribute to the loss of developmental potential and life-long health and economic disparities among millions of children aged <5 y. Single-sector interventions representing either early child development (ECD) or nutrition have been linked to positive child development and/or nutritional status, and recommendations currently advocate for the development and testing of integrated interventions. We reviewed the theoretical and practical benefits and challenges of implementing integrated nutrition and ECD interventions along with the evidence for best practice and benefit-cost and concluded that the strong theoretical rationale for integration is more nuanced than the questions that the published empirical evidence have addressed. For example, further research is needed to 1) answer questions related to how integrated messaging influences caregiver characteristics such as well-being, knowledge, and behavior and how these influence early child nutrition and development outcomes; 2) understand population and nutritional contexts in which integrated interventions are beneficial; and 3) explore how varying implementation processes influence the efficacy, uptake, and cost-benefit of integrated nutrition and ECD interventions.

Implementation of parenting interventions through health services in Jamaica

ABSTRACT Integration of parenting programmes that promote early child development with health services has been recommended as one strategy to reduce the large numbers of children not achieving their potential in low and middle-income countries. There is limited information on implementation to guide integration for delivery at scale. We conducted a cluster randomized trial of (1) a home visit and (2) a health centre-based intervention, in primary health services in Kingston, Jamaica, delivered separately or combined. The two approaches to delivery had similar effects on child cognition (home visit 0.34 SD; health centre 0.38). In this report, we describe the inputs required such as intervention content, staff training and supervision and resources. Intervention delivery was assessed through contacts achieved and quality documented. Views of health staff (n = 29) and mothers (n = 25) were obtained through qualitative interviews and analysed using thematic content analysis. The interventions provided modelling of behaviours and activities, and interactive practice but varied in how this was conducted. Supervision was provided by the research team. Community health workers (CHWs) conducted 75% of planned home visits and 83% of mothers attended all 5 health centre sessions. CHWs were able to implement the interventions with adequate to good quality. Mothers and health staff perceived benefits for mothers’ parenting practices and child development. Health staff also felt they personally benefited. Mothers who received both interventions preferred the home visit intervention and thought their child benefitted more. The main implementation challenges perceived by CHWs were engaging parents who were less interested and conducting the intervention in addition to their existing workload. Staff workload was the main challenge reported by nurses. Sustainable implementation at scale would require investment in additional staff, particularly for programme management and supervision.

Assessing the quality of home visit parenting programs in Latin America and the Caribbean

ABSTRACT Home-visit parenting programmes have been linked to positive developmental outcomes among participating children, yet few studies have explored the mechanisms behind this impact. We observe 40 home visits across seven countries in Latin America and the Caribbean, using an observational tool to assess visit content, coaching strategy, and the quality of the relationship between the home visitor (HV) and families. Across nearly all visits observed, we find strong rapport between visitors and families, and active participation in play-based learning activities introduced by the HV. Other aspects of home visit design are weakly implemented, namely the revision of topics from previous sessions, demonstration of activities, and dialogue between caregiver and HV. The visits observed provide an opportunity for caregivers to practice early stimulation activities, but it is unclear whether this strategy contributes to strengthening caregivers’ knowledge of child development.

La calidad de los Centros Infantiles del Buen Vivir en Ecuador

This study analyzes data collected in 2012 from a sample of public child care centers in Ecuador. It aims to characterize different quality aspects of the services provided by these centers to children under 3 years of age. The main finding is that the child care services studied have a considerable margin for improvement in terms of structural and process aspects. The quality challenges faced by these centers are consistent with those of similar services in different countries throughout the region, such as Peru, Colombia, and Brazil. The study also finds that while efforts undertaken in recent years in Ecuador to improve service quality are aimed in the right direction, continuous, long-term interventions will be required in order to make significant improvements in the quality indicators studied. The most complex changes?but also the most necessary?are related to aspects of process quality, particularly those connected to the training of child care staff and the skill-building necessary to offer experiences that maximize well-being and promote learning in all areas of child development.