Care for Child Development: an intervention in support of responsive caregiving and early child development.

BACKGROUND: An estimated 43% of children younger than 5 years of age are at elevated risk of failing to achieve their human potential. In response, the World Health Organization and UNICEF developed Care for Child Development (CCD), based on the science of child development, to improve sensitive and responsive caregiving and promote the psychosocial development of young children. METHODS: In 2015, the World Health Organization and UNICEF identified sites where CCD has been implemented and sustained. The sites were surveyed, and responses were followed up by phone interviews. Project reports provided information on additional sites, and a review of published studies was undertaken to document the effectiveness of CCD for improving child and family outcomes, as well as its feasibility for implementation in resource-constrained communities. RESULTS: The inventory found that CCD had been integrated into existing services in diverse sectors in 19 countries and 23 sites, including child survival, health, nutrition, infant day care, early education, family and child protection and services for children with disabilities. Published and unpublished evaluations have found that CCD interventions can improve child development, growth and health, as well as responsive caregiving. It has also been reported to reduce maternal depression, a known risk factor for poor pregnancy outcomes and poor child health, growth and development. Although CCD has expanded beyond initial implementation sites, only three countries reported having national policy support for integrating CCD into health or other services. CONCLUSIONS: Strong interest exists in many countries to move beyond child survival to protect and support optimal child development. The United Nations Sustainable Development Goals depend on children realizing their potential to build healthy and emotionally, cognitively and socially competent future generations. More studies are needed to guide the integration of the CCD approach under different conditions. Nevertheless, the time is right to provide for the scale-up of CCD as part of services for families and children.

Investing in the foundation of sustainable development: pathways to scale up for early childhood development.

Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals.

A job analysis of community health workers in the context of integrated nutrition and early child development.

Stunting and poor child development are major public health concerns in Malawi. Integrated nutrition and early child development (ECD) interventions have shown potential to reduce stunting, but it is not known how these integrated approaches can be implemented in Malawi. In this paper, we aimed to evaluate the current jobs status of community health workers and their potential to implement integrated approaches. This was accomplished by a desk review of nutrition and ECD policy documents, as well as interviews with key informants, community health workers, and community members. We found that Malawi has comprehensive policies and well-outlined coordination structures for nutrition and ECD that advocate for integrated approaches. Strong multidisciplinary interaction exists at central levels but not at the community level. Integration of community health workers from different sectors is limited by workload, logistics, and a lack of synchronized work schedules. Favorable, sound policies and well-outlined coordination structures alone are not enough for the establishment of integrated nutrition and ECD activities. Balanced bureaucratic structures, improved task allocation, and synchronization of work schedules across all relevant sectors are needed for integrated intervention in Malawi.

Strengthening systems for integrated early childhood development services: a cross-national analysis of governance.

While there has been substantial growth in early childhood development (ECD) services in low- and middle-income countries (LMICs), there is considerable inequity in their distribution and quality. Evidence-based governance strategies are necessary, but currently they are insufficient for widespread, quality implementation. In particular, there is a limited understanding of the use of systems approaches for the analysis of ECD services as they go to scale. The aim of this paper is to present findings from four countries, using a cross-national case study approach to explore governance mechanisms required to strengthen national systems of ECD services. While different sets of governance strategies and challenges were identified in each country, overarching themes also emerged with implications for systems strengthening. Study results focus on local, mid-level and central governance, with recommendations for effective coordination and the integration of ECD services in LMICs.

Primary care strategies for promoting parent-child interactions and school readiness in at-risk families: the Bellevue Project for Early Language, Literacy, and Education Success.

OBJECTIVE: To determine the effects of pediatric primary care interventions on parent-child interactions in families with low socioeconomic status. DESIGN: In this randomized controlled trial, participants were randomized to 1 of 2 interventions (Video Interaction Project [VIP] or Building Blocks [BB]) or the control group. SETTING: Urban public hospital pediatric primary care clinic. PARTICIPANTS: Mother-newborn dyads enrolled post partum from November 1, 2005, through October 31, 2008. INTERVENTIONS: In the VIP group, mothers and newborns participated in 1-on-1 sessions with a child development specialist who facilitated interactions in play and shared reading by reviewing videos made of the parent and child on primary care visit days; learning materials and parenting pamphlets were also provided. In the BB group, parenting materials, including age-specific newsletters suggesting interactive activities, learning materials, and parent-completed developmental questionnaires, were mailed to the mothers. MAIN OUTCOME MEASURES: Parent-child interactions were assessed at 6 months with the StimQ-Infant and a 24-hour shared reading recall diary. RESULTS: A total of 410 families were assessed. The VIP group had a higher increased StimQ score (mean difference, 3.6 points; 95% confidence interval, 1.5 to 5.6 points; Cohen d, 0.51; 0.22 to 0.81) and more reading activities compared to the control group. The BB group also had an increased overall StimQ score compared with the control group (Cohen d, 0.31; 95% confidence interval, 0.03 to 0.60). The greatest effects for the VIP group were found for mothers with a ninth-grade or higher reading level (Cohen d, 0.68; 95% confidence interval, 0.33 to 1.03). CONCLUSIONS: The VIP and BB groups each led to increased parent-child interactions. Pediatric primary care represents a significant opportunity for enhancing developmental trajectories in at-risk children. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00212576.

Empowering Head Start to improve access to good oral health for children from low income families.

Surveys over 20 years have documented worsening in the dental health of preschoolers. Healthy People 2010 Midcourse Review reports the country moving away from oral health goals for young children; the slip is 57%. Exacerbating this is the inability of Medicaid to provide for those in need. Most children receive examinations only: few receive comprehensive care. We urge Head Start grantees to adopt a new approach to oral health goals and in this paper offer: (1) a review of the problem and premises preventing a solution; (2) a proposal that Head Start adopt a public health perspective; and (3) specific roles staff and dental personnel can take to mount aggressive strategies to arrest tooth decay at the grantee site.

Effects of a school-based, early childhood intervention on adult health and well-being: a 19-year follow-up of low-income families.

OBJECTIVE: To determine the effects of an established preventive intervention on the health and well-being of an urban cohort in young adulthood. DESIGN: Follow-up of a nonrandomized alternative-intervention matched-group cohort at age 24 years. SETTING: Chicago, Illinois. PARTICIPANTS: A total of 1539 low-income participants who enrolled in the Child-Parent Center program in 20 sites or in an alternative kindergarten intervention. INTERVENTIONS: The Child-Parent Center program provides school-based educational enrichment and comprehensive family services from preschool to third grade. MAIN OUTCOME MEASURES: Educational attainment, adult arrest and incarceration, health status and behavior, and economic well-being. RESULTS: Relative to the comparison group and adjusted for many covariates, Child-Parent Center preschool participants had higher rates of school completion (63.7% vs 71.4%, respectively; P = .01) and attendance in 4-year colleges as well as more years of education. They were more likely to have health insurance coverage (61.5% vs 70.2%, respectively; P = .005). Preschool graduates relative to the comparison group also had lower rates of felony arrests (16.5% vs 21.1%, respectively; P = .02), convictions, incarceration (20.6% vs 25.6%, respectively; P = .03), depressive symptoms (12.8% vs 17.4%, respectively; P=.06), and out-of-home placement. Participation in both preschool and school-age intervention relative to the comparison group was associated with higher rates of full-time employment (42.7% vs 36.4%, respectively; P = .04), higher levels of educational attainment, lower rates of arrests for violent offenses, and lower rates of disability. CONCLUSIONS: Participation in a school-based intervention beginning in preschool was associated with a wide range of positive outcomes. Findings provide evidence that established early education programs can have enduring effects on general well-being into adulthood.