Building the capacity for early childhood parenting programmes

Comprehensive Training

Nurturing care in early childhood requires responsive interactions and opportunities to learn. There are few large scale programs in low and middle income countries that support parents' ability to provide responsive care and activities that help children learn. The Reach Up training program was developed to increase capacity of implementing agencies to deliver effective parenting programs for children up to age 3 years.

The program provides a comprehensive training package for trainers, supervisors, and home visitors. Based on the Jamaica Home Visit intervention which has substantial impact evidence, Reach Up has been used in several countries where it has provided evidence of its feasibility and lessons that can guide future implementation.

History

We developed the Reach Up Early Childhood Parenting Program and accompanying training package to provide an effective, adaptable program, feasible for low resource settings. Our aim is to facilitate building the capacity needed to implement these programs.

The Reach Up Early Childhood Parenting Program is based on the Jamaica Home Visit (JHV) intervention designed by Sally Grantham-McGregor. The intervention has been successfully adapted and evaluated in Bangladesh and Colombia with benefits to childrenís development, and was adapted and implemented at a large scale by the Peruvian government.

Milestones

1975

Jamaica

Participants: Children living in suburban communities of Kingston

Intervention: 1 hour play sessions at home for 8 months

Results: Significant Benefits to DQ**

1980

Jamaica

Participants: Severely malnourished children

Intervention: 1 hour daily play session in hospital. Home visits 1 hour per week for 2 years then 1 hour biweekly for 1 year

Results: Significant Benefits to DQ

1989

Jamaica

Participants: Children from the inner city

Intervention: Home visits 1 hour per month for 2 years or 1 hour biweekly for two years

Results: Biweekly group had benefits to DQ. Monthly group had no significant benefits.

2003

Jamaica

Participants: Low birth weight children

Intervention: Home visits 1 hour per week for 8 weeks after birth

Results: Intervened group had better problem solving scores at 7 months

2004

Jamaica

Participants: Low birth weight children

Intervention: Home visits 30 minutes per week for 17 months

Results: At 24 months intervened children had higher scores in Performance and Hand and Eye Sub-Scales.

2004

Jamaica

Participants: Undernourished children

Intervention: Home visits for 30 minutes per week for 12 months.

Results: The intervened children had higher DQs.

2006

Bangladesh

Participants: Undernourished children

Intervention: Group meetings for 1 hour per week for 10 months and 1 hour every 2 weeks for 2 months and home visits weekly for 12 months.

Results: There was a benefit to children’s Bayley Scales Mental Development Index (MDI)

2009

Bangladesh

Participants: Severely malnourished children

Intervention: Group meetings for 30 mins and individual session for 2 weeks in hospital. Home visits or clinic visits for 6 months

Results: Children in the intervened group had significant benefits on mental score and motor score.

2012

Bangladesh

Participants: Severely malnourished children, randomized to 4 groups (stimulation only, supplementation only, stimulation and supplementation and control).

Intervention: Play sessions for 1 hour in clinic biweekly for 6 months

Results: Stimulation alone or with supplementation improved Bayley Scales MDI.

2013

Bangladesh

strong>Participants: Children with iron-deficiency anaemia

Intervention: Weekly home visits for 9 months

Results: Non-anemic intervened group improved more than the non-anemic controls in MDI. The IDA intervened children did not improve significantly.

2014

Colombia

Participants: Children from low socio-economic environments, randomized to 4 groups (stimulation only, supplementation only, stimulation and supplementation and control).

Intervention: Home visits 1 hour per week for 18 months

Results: Intervened children’s cognition and language showed improvements

**Developmental Quotient. For further details on the intervention studies see paper by Smith et al. 2016.

There was an increasing desire internationally, to scale up programs to reach the many families in need.

We recognised the need for a more comprehensive training package that would make it easier to train trainers, and for these trainers to be able to train home visitors.

Core Principles

The intervention is guided by core principles and was developed so that it could be delivered by para-professionals with a minimum of completed primary education. These principles include:

1

Works through parents by building a positive relationship to support them in strengthening skills to promote child development.

2

Uses a structured curriculum of develpmentally appropriate activities.

3

Aims to build mothers' skills, self-esteem and enjoyment in helping her child play and learn.

4

Uses an interactive approach of demonstration and modelling and practice of activities to build skills.

5

Home visitor is trained to listen to the mother, seek her opinions and ask about things she already does with her child and to acknowledge these and give encouragement and praise.

6

Emphasises praise for parent and child.