Web-based early stimulation program and technical support

Innovation Summary

0461_centrelogo Inadequate home stimulation is one of the key problems preventing children in middle and low income countries from reaching their full developmental potential. [1-3] Recent evidence points to the importance of the home environment and appropriate interactions with the parent or primary caregiver during early childhood as critical mediators to the achievement of optimal child development.[4] Few evaluated programs exist and there is a lack of adequate guidance and expertise for agencies who would like to address these issues.

The goal of this innovation is to use an evidence-based child development intervention program to develop a sustainable, low-cost, web-based package designed to be delivered by community women. The intervention is targeted towards disadvantaged mothers and their children, and is implementable at scale.

The web-based package is comprised of a child development curriculum, training manuals for supervisors and home visitors, training workshop videos, an adaptation guide, and evaluation tools to track the maintenance and fidelity of the intervention.

Impact

During the initial phase, conducted in four early-user countries:

260 children are expected to benefit.
320 parents will receive the intervention to increase their knowledge and practice of responsive parenting in the home.
40 community workers will be trained to conduct the intervention program.
8 supervisors will be trained to conduct the training workshops.
1000 stakeholders and users will be reached through regional meetings and listserv.

Three areas are critical foundations for healthy child development: stable, responsive, and nurturing care-giving with opportunities to learn; safe and supportive physical environments; and appropriate nutrition.
-- Margaret Chan, May 2013

Innovation

The innovation is comprised of a child development curriculum that was developed in Jamaica through a home visiting stimulation program. This curriculum includes components of responsive parenting through interaction with the child at the appropriate developmental level. The curriculum combines the use of inexpensive learning materials – homemade toys and age appropriate activities – which are demonstrated to mother and child by a home visitor.

The relationship of the home visitor with mother and child is important for the success of the intervention; therefore, the innovation includes the development of training manuals for supervisors and home visitors.

These manuals will contain step-by-step instructions on how to utilize the materials when interacting with mother and child, and how to establish respectful relationships with them.

Training videos will be developed to illustrate the activities as well as demonstrate how to conduct the visit, and how to encourage the mother to actively participate in the process. These videos, which will be filmed in Jamaica, Peru and Bangladesh, will be utilized during the home-visitor training workshops that will be conducted by supervisors in each user country. An adaptation guide will be developed to assist countries in adapting the intervention materials for their culture in a way that will ensure the fidelity of the intervention.

Collaboration

Funders

Grand Challenges Canada

Key Partners

Film Production:

Early users:

University of Sao Paulo (Brazil)
China Development Research Foundation (China)
Open Society Foundation (Zimbabwe)
World Bank

Implementation:

Key Drivers

1. Experienced Team

Experienced program team including key consultants and collaborators identified to ensure production of high quality training package

2. Development of Training Workshops and Manuals

Training workshops and manuals will be developed to ensure that the supervisors can effectively demonstrate how to conduct the intervention when it is being implemented in user countries

3. Effective Communication Strategy

An effective communication strategy including web-based communications and development of the advocacy materials will be important to drive sustainability

Challenges

1. Inadequate Uptake of Program

The major potential challenge may be a lack of sufficient early users to obtain evaluation results to inform broader implementation. To counter this, the capabilities of the user countries will be reviewed to ensure that the necessary structures are in place to support the intervention. Technical support will also be provided as needed.

Continuation

During the implementation of the communication strategy, other governments and non-governmental agencies will be made aware of the available web-based intervention programme and may therefore utilize the materials to develop programmes in these additional settings. The versatility of the adaptation guide, development of culturally appropriate materials/toys and the translation of the training videos in other languages would be important for the use of the innovation in other settings.

Evaluation Methods

Systems and process evaluations will be conducted in user countries to ensure fidelity of innovation delivery. These will be accomplished through 1) in-depth interviews to identify challenges, and 2) questionnaires to monitor the quality of training and of the home visits. Impact evaluations will also be conducted with the parents through questionnaires which will measure knowledge and changes in the home environment. Early users will be assisted with their evaluation design and implementation.

Given the nature of the project, success will be measured by the production, availability and accessibility of materials, and how relevant organizations access and use them.

Impact of Innovation

The original home-visit intervention has been extensively evaluated through 10 trials in three countries (Jamaica, Bangladesh, and Colombia). All trials have shown the intervention has substantial benefits to child development.

In Jamaica, studies were conducted with children who were severely malnourished[5,6], disadvantaged [7], stunted [8,9] and/or low birth weight children [10,11]. In one case, the intervention was integrated into government health services [12]. In Bangladesh, four trials were conducted. [13-15] A large trial in Colombia showed improvement to the children’s cognitive and language development and home stimulation (personal communication, Attanasio).

In all studies mothers had increased knowledge of child development and/or provided increased quality of home stimulation. In one study, mothers’ depressive symptoms were reduced [15]. In three follow-up studies the children had sustained cognitive benefits [5, 16-19]. In the longest follow-up, 22-year old participants who had the intervention as children showed benefits in IQ, educational attainment, mental health, social skills and general knowledge, reduced violent behaviour and higher wages. [16]