Reach Up Origins: Jamaica Home Visit Programme
The Reach Up Early Childhood parenting programme : origins, content and implementation
Susan P Walker, Susan M Chang, Joanne A Smith, Helen Baker-Henningham and the Reach Up Team, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica and School of Psychology, Bangor University, UK (HBH)
Nurturing care in early childhood requires responsive interactions and opportunities to learn. There are few large scale programmes in low and middle income countries that support parents’ ability to provide responsive care and activities that help children learn. The Reach Up training programme was developed to increase capacity of implementing agencies to deliver effective parenting programmes for children up to age 3 years. The programme 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.
We developed the Reach Up Early Childhood Parenting programme and accompanying training package to provide an effective, adaptable programme , feasible for low resource settings. Our aim is to facilitate building the capacity needed to implement these programmes. In this article we describe the origins and content of the programme and discuss the process of adapting and implementing the programme with lessons learned from implementation in several countries.
The Reach Up Early Childhood Parenting programme is based on the Jamaica Home Visit (JHV) intervention designed by Sally Grantham-McGregor. The JHV has substantial evidence showing benefits to children’s development and to parenting practices that promote development (Grantham-McGregor & Smith, 2016). The intervention has been successfully adapted and evaluated in Bangladesh and Colombia with benefits to children’s development (Attanasio et al., 2014; Hamadani, Huda, Khatun, & Grantham-McGregor, 2006; Nahar et al., 2012), and was adapted and implemented at a large scale by the Peruvian government through its Cuna Mas programme (Rubio-Codina, Tomé & Araujo, 2016). There is also evidence from 3 small cohorts in Jamaica that benefits continue into later childhood with one cohort providing evidence of wide ranging gains in adulthood to education, mental health and income and reductions in violent behavior (Grantham-McGregor, Powell, Walker, Chang, & Fletcher, 1994; Walker, Chang, Younger, & Grantham-McGregor, 2010; Walker, Chang, Vera-Hernandez, & Grantham-McGregor, 2011).
Core principles of the JHV/Reach Up Early Childhood Parenting programme
- Works through parents by building a positive relationship to support them in strengthening skills to promote child development.
- Aims to build mothers’ skills, self-esteem and enjoyment in helping her child play and learn.
- 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.
- Uses a structured curriculum of develpmentally appropriate activities
- Uses an interactive approach of demonstration and modelling and practice of activities to build skills.
- Emphasises praise for parent and child.
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. The visits begin with some time catching up with how the family has been and how the mother and child have progressed with the activities from the last visit. The visitor then engages the mother and child in a play session. The home visotor introduces new activities through an interactive approach: observing what the child does, demonstrating and describing the activity to mother and child, helping the child with the activity, encouraging mother and child to practise, giving positive feedback and celebrating success. The visit ends with review of activities to continue during the week and encouragement to continue the activities and to try and include them in daily routines.
The home visitors model desired actions and demonstrateactivities to encourage mothers to respond to their child’s vocalisations and actions. They demonstrate ways to talk about and show her child objects and activities in their environment, and how to introduce new activities and concepts. The visitors promote giving praise, celebrating the child’s achievements and efforts, and showing love throughout the visit.
The JHV uses a structured curriculum with activities arranged in order of difficulty; children usually move on to the next set of activities each week (Grantham-McGregor & Smith, 2016). Many activities build on earlier ones, so that if a child can already do one the visitors can introduce the next step. An activity can be also be broken down in steps if it is difficult for the child. Activities and play materials are specifically designed for the intervention, and include blocks, dolls, sets of puzzles, sorting and matching activities, and books. Toys were designed with locally available and affordable materials in mind such as cardboard and plastic bottles. Simple picture books and pictures are used to support language development activities.
Many of the activities for children under 2 years support abilities described by Uzgiris & Hunt (1978) including object permanence, causation, imitation of gestures and vocalization, and exploration of objects. For older children, activities were informed by Francis Palmer’s concept curriculum (Palmer, 1971) and were designed to facilitate teaching concepts such as size, quantity, colour, shape, position, and classification. Additional activities were included to facilitate the development of problem solving, attention and persistence, language and general knowledge.
Prior to developing the Reach Up programme , with support from Grand Challenges Canada, the JHV had been adapted and used in Bangladesh, Colombia, and Peru. There was an increasing desire internationally, to scale up programmes to reach the many families in need, however, policy makers and programme implementers needed guidance on how to deliver effective parenting programmes. We recognized 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. The goal was to increase the capacity of implementing agencies including NGOs and governments to deliver programmes that enhance nurturing care for children under 3 years.
The Reach Up Programme
The existing JHV training materials included the curriculum and an instruction manual that explained how to make the toys. The curriculum is designed for use by community workers with primary education and gives activities and goals for each visit. The manual was updated using simple language and pictures, with plans for each visit organized by Materials needed, Objectives of the visit, and Things to Do. To support the home visitor, the curriculum incudes brief reminders of the steps for introducing an activity and some suggested dialogue. We produced a curriculum for weekly visits, as in the original JHV, and a fortnightly curriculum (biweekly visits) which may be more feasible for use in larger scale programmes.
Reach Up Team
The Reach Up programme was developed by Sally Grantham-McGregor, Susan Chang-Lopez, Christine Powell, Susan Walker, Helen Baker-Henningham, Jena Hamadani, Marta Rubio-Codina, Joanne Smith, Amika Wright, Kristy Fernandez.
Zero to Three Journal Article: Reach Up Early Childhood Parenting programme
Attanasio, O. P., Fernandez, C., Fitzsimons, E. O., Grantham-McGregor, S. M., Meghir, C., & Rubio-Codina, M. (2014). Using the infrastructure of a conditional cash transfer programme to deliver a scalable integrated early child development programme in Colombia: cluster randomized controlled trial. BMJ, 349, g5785.
Black, M. M., Walker, S. P., Fernald, L. C. H., Andersen, C. T., DiGirolamo, A. M., Lu, C. et al. (2017). Early childhood development coming of age: science through the life course. Lancet, 389, 77-90.
Grantham-McGregor, S., Powell, C., Walker, S., Chang, S., & Fletcher, P. (1994). The long-term follow-up of severely malnourished children who participated in an intervention programme . Child Dev., 65, 428-439.
Grantham-McGregor, S. & Smith, J.A. (2016). Extending The Jamaican Early Childhood Development Intervention. Journal of Applied Research on Children: Informing Policy for Children at Risk, 7, Article 4. Grantham-McGregor, S. M., Powell, C. A., Walker, S. P., & Himes, J. H. (1991). Nutritional supplementation, psychosocial stimulation, and mental development of stunted children: the Jamaican Study. Lancet, 338, 1-5.
Hamadani, J. D., Huda, S. N., Khatun, F., & Grantham-McGregor, S. M. (2006). Psychosocial stimulation improves the development of undernourished children in rural Bangladesh. Journal of Nutrition, 136, 2645-2652.
Nahar, B., Hossain, M. I., Hamadani, J. D., Ahmed, T., Huda, S. N., Grantham-McGregor, S. M. et al. (2012). Effects of a community-based approach of food and psychosocial stimulation on growth and development of severely malnourished children in Bangladesh: a randomised trial. Eur.J Clin.Nutr., 66, 701-709.
Palmer, F. (1971). Concept Training Curriculum For Children Ages Two To Five, vol 1-V. Stony Brook: State University of New York.
Powell, C., Baker-Henningham, H., Walker, S., Gernay, J., & Grantham-McGregor, S. (2004). Feasibility of integrating early stimulation into primary care for undernourished Jamaican children: cluster randomised controlled trial. BMJ, 329, 89-91.
Rubio-Codina, M., Tomé, R., & Araujo, M.C. (2016) Los primeros años de vida de los niños peruanos: una fotografía sobre el bienestar y el desarrollo de los niños del Programa Nacional Cuna Más. Inter-American Development Bank Technical Note IDB-TN-1093.
Smith, J.A., Henningham-Baker, H., Brentani, A., Mugweni, R. & Walker, S.P. (2018). Implementation of Reach Up early childhood parenting programme . Appropriateness, Acceptability, Feasibility in Brazil and Zimbabwe. Ann. N. Y. Acad. Sci, in press.
Uzgiris, I.C. & Hunt, J.M. (1978). Assessment in Infancy: Ordinal Scales of Psychological Development. Chicago: University of Illinois Press.
Walker, S. P., Chang, S. M., Vera-Hernandez, M., & Grantham-McGregor, S. (2011). Early childhood stimulation benefits adult competence and reduces violent behavior. Pediatrics, 127, 849-857.
Walker, S. P., Chang, S. M., Younger, N., & Grantham-McGregor, S. M. (2010). The effect of psychosocial stimulation on cognition and behaviour at 6 years in a cohort of term, low-birthweight Jamaican children. Developmental Medicine and Child Neurology, 52, e148-e154.
Walker, S. P., Powell, C., Chang, S. M., Baker-Henningham, H., Grantham-McGregor, S., Vera-Hernandez, M., Lopez-Boo, F. (2015). Delivering parenting interventions through health services in the Caribbean: impact, acceptability and costs. IDB Working Paper Series. IDB-WP-642 Washington DC, Inter-American Development Bank.