MaryCatherine Arbour

Experimental Impacts of a Preschool Intervention in Chile on Children's Language Outcomes: Moderation by Student Absenteeism

ABSTRACT Despite consensus that school absenteeism has negative consequences for childrens life outcomes, until recently, little was known about the prevalence of absenteeism or its potential to moderate the impacts of school-based interventions. This study provides evidence from a randomized experiment of a preschool intervention involving 1,876 children in 64 schools in Chile that chronic absenteeism develops in preschool and is predicted by multiple risk factors for poor academic achievement. We find moreover that individual childrens likelihood of absenteeism moderated the interventions impact on childrens language and literacy outcomes such that there were positive impacts of the intervention only for children with the lowest likelihood of absenteeism. Experimental evaluations of school-based interventions that do not take absenteeism into account may thus mask heterogeneous effects. In the context of policy pushes to expand early education and preschool access in the United States and globally, these moderation analyses may prove essential for appropriately interpreting the results of experimental studies of school-based interventions.

Aftershocks of Chile’s Earthquake for an Ongoing, Large-Scale Experimental Evaluation

Evaluation designs for social programs are developed assuming minimal or no disruption from external shocks, such as natural disasters. This is because extremely rare shocks may not make it worthwhile to account for them in the design. Among extreme shocks is the 2010 Chile earthquake. Un Buen Comienzo (UBC), an ongoing early childhood program in Chile, was directly affected by the earthquake. This article discusses (a) the factors the UBC team considered for deciding whether to put on hold or continue implementation and data collection for this experimental study; and (b) how the team reached consensus on those decisions. A lesson learned is that the use of an experimental design for UBC insured that the evaluation’s internal validity was not compromised by the earthquake’s consequences, although cohort comparisons were compromised. Other lessons can be transferred to other contexts where external shocks affect an ongoing experimental or quasi-experimental impact evaluation.

Emotional, physical, and social needs among 0-5-year-old children displaced by the 2010 Chilean earthquake: associated characteristics and exposures

An 8.8-magnitude earthquake occurred off the coast of Chile on 27 February 2010, displacing nearly 2,000 children aged less than five years to emergency housing camps. Nine months later, this study assessed the needs of 140 displaced 0-5-year-old children in six domains: caregiver stability and protection; health; housing; nutrition; psychosocial situation; and stimulation. Multivariate regression was applied to examine the degree to which emotional, physical, and social needs were associated with baseline characteristics and exposure to the earthquake, to stressful events, and to ongoing risks in the proximal post-earthquake context. In each domain, 20 per cent or fewer children had unmet needs. Of all children in the sample, 20 per cent had unmet needs in multiple domains. Childrens emotional, physical, and social needs were associated with ongoing exposures amenable to intervention, more than with baseline characteristics or epicentre proximity. Relief efforts should address multiple interrelated domains of child well-being and ongoing risks in post-disaster settings.

Lo que nos enseña el 27F en Chile sobre el impacto de un desastre natural en la salud infantil

Lessons learned from the 27F on the impact of a natural disaster on child health There is a large scientific literature about disasters’ effects on adult population; however, comparatively few studies explore the effects of natural disasters on children, especially during early childhood and school years. Three years after the Chilean earthquake of 27 February 2010, we review the national and international literature on natural disasters and their effects on children. We highlight advances and identify knowledge gaps, in particular contributions and limitations of national research about the impacts of the 2010 Chilean earthquake in child health. In the three years since the Chilean earthquake, post-disaster child health research has made important advances toward better understanding of the impact of disasters on children’s mental health and overall well-being. The articles included in this edition of the Revista Chilena de Pediatria represent an important contribution to a nascent literature. (Key words: Natural disaster, earthquake, 27F, mental health). Rev Chil Pediatr 2013; 84 (1): 10-19

A quality improvement project using statistical process control methods for type 2 diabetes control in a resource-limited setting.

Quality issue Quality improvement (QI) is a key strategy for improving diabetes care in low- and middle-income countries (LMICs). This study reports on a diabetes QI project in rural Guatemala whose primary aim was to improve glycemic control of a panel of adult diabetes patients. Initial assessment Formative research suggested multiple areas for programmatic improvement in ambulatory diabetes care. Choice of solution This project utilized the Model for Improvement and Agile Global Health, our organizations complementary healthcare implementation framework. Implementation A bundle of improvement activities were implemented at the home, clinic and institutional level. Evaluation Control charts of mean hemoglobin A1C (HbA1C) and proportion of patients meeting target HbA1C showed improvement as special cause variation was identified 3 months after the intervention began. Control charts for secondary process measures offered insights into the value of different components of the intervention. Intensity of home-based diabetes education emerged as an important driver of panel glycemic control. Lessons learned Diabetes QI work is feasible in resource-limited settings in LMICs and can improve glycemic control. Statistical process control charts are a promising methodology for use with panels or registries of diabetes patients.