Test Brazil

How ReachUp came to Test Brazil

In her efforts to identify an intervention to promote early childhood stimulation in Brazil, Professor Alexandra Brentani from the Faculty of Medicine, University of São Paulo, through her networks, learned of the work of the UWI Child Development Research Group and the Reach Up program. The intervention first began as a pilot in Brazil in the urban south west municipality of São Paolo, through funding provided by Maria Cecilia Vidigal Foundation and Grand Challenges Canada (GCC). It was tested through a randomized controlled trial, which included a total of 826 mother-child dyads.. At the time, the family health strategy (ESF) using community health agents was implemented as a primary care modality. Considering that the ESF coverage in Brazil was less than 30%, the intention was to test the relative effectiveness of implementing Reach Up as the ECD stimulation arm, through two delivery platforms – using Community Health Workers (CHWs) in areas covered by ESF and using agents from the community (CDAs) in areas not covered by ESF.

In 2016, the Federal government launched the national ECD home visit program, the Programa Criança Feliz, nested in the Ministry of Social Development and using CDAs as the workforce. The Reach Up adaptation was well received at the local level in São Paulo and was then transitioned to scale through the “Survive and Thrive Brazil: Boa Vista Early childhood program” in 39 vulnerable communities in Boa Vista, in the Amazon area in 2017. The project was funded by grand Challenges Canada, Maria Cecília Souto Vidigal Foundation and the Interamerican Development Bank. Implementation of the program was through two (2) delivery strategies, home visits delivered by the Programa Criança Feliz visitors and center-based group-meetings. This program was ongoing up to March 2020, when the COVID-19 pandemic began. However, with the lockdowns and suspension of in-person interactions, the program was transitioned to remote delivery in June 2020.

The Municipal Government of Boa Vista, in partnership with the Faculty of Medicine, University of São Paulo, (FMUSP) implemented the delivery of the content from the Reach Up Parent Manual to 4,000 families via WhatsApp (video calls and messages) once per week, two phone calls per month and weekly text messages. In 2021, the research group created a Reach-up based methodology for the Programa Criança Feliz in a project funded by the LEGO foundation and implemented it in 11 municipalities across Brazil, focusing on the improvement of the quality of the visits and the adaptation of the methodology to traditional communities and refugee settings.

Country team

Prof. Alexandra Brentani

Department of Pediatrics, Faculty of Medicine University of São Paulo

Prof. Günther Fink

Epidemiology and Household Economics, University of Basel, Household Economics and Health Systems Research Unit, Swiss Tropical and Public Health Institute

Implementation partners

Implementation of Reach Up is spear headed through faculty in the Department of Pediatrics and the Child Development Center, Faculty of Medicine, University of São Paulo, Bazil. https://www.fm.usp.br/en/departments/

Maria Cecilia Vidigal Foundation supported the pilot project in São Paulo in 2015. https://www.fmcsv.org.br/en-US/a-fundacao/

Communities we serve

Some intro

Community Name

Our Approach

Reach Up in Brazil, complements the existing government-run program, , the Criança Feliz (Happy Child) launched in 2016. We deliver the intervention through group sessions, home visits, or remote meetings. Group sessions usually accommodate 8 mother/child dyads and are held at community social assistance centers. (Photo credit: Alexandra Brentani)

Key Stats

Age Group  0 – 36 months
Frequency  1x/week
Duration  40 – 50 minutes/session
Total Period  6 – 15 months

Organisational Structure

During the impact evaluation project in São Paulo SP, we trained and empowered two groups of home visitors – CHAs who were the existing cadre of staff in the primary care FHS program and CDAs, a new cadre of staff employed specifically by the research team at the University of Sao Paulo, for the project.

During the Transition to Scale project, in Boa Vista in Roraima, the Program was implemented at the Social Assistance Sector, the Familia que Acolhe Program, using social visitors to deliver the visits and facilitate group meetings.

Cultural Adaptations

Between 2014 and 2016, the Reach Up curriculum was adapted to the Brazilian context. We translated the training manual, toy manual, supervisor manual, and train-the-trainer video voiceovers into Portuguese. The adaptation included addition of short messages to the caregivers to the language activities and the revision of visit frequency (fortnightly rather than weekly). Based on feedback from 100 participants (who were not a part of the projects), modifications were made to some of the toys and materials. Additionally, instead of 10 consecutive days, the training was modified to a series of 5-day workshops.

Transition to scale phase

In 2017, in order to align with the Programa Criança Feliz, the national ECD policy, we extended the curriculum from Pregnancy to 36 months. Reach up was used as the PCF methodology in the municipality of Boa Vista, Roraima, in the north region of Brazil. Besides de home visits, we delivered the Program in small group meetings at the social service units. The extended version of the curriculum was also adapted to group meetings, with the reduction of activities per meeting (1 or 2 instead of 3 to 4). The toy kit was also reduced for the delivery at scale. During the curriculum adaptation, all toy activities that were used only once in the curriculum were substituted by other activities with toys used more frequently.

We used 6 figures to talk about and 1 scene to talk about, 8 books, 13 puzzles, 12 sorting and matching cards, 18 plastic toys, and fewer pretend toys (tea set, doll house, truck and 2 roads, shop, butterfly lace board, village and cardboard farm were not included in the curriculum).

In 2021, to be able to serve the large migrant and refugee population from the refugee shelters in Boa Vista, we tested the feasibility and acceptability of Reach Up in small groups. Since the length of stay in the shelters is relatively short (3 months in average), the Parent Manual was used so that the parents could continue practicing the activities with the children after leaving the shelter and because the activities require less toys, and many of them can be made by the caregiver or facilitator.

We also tested to different delivery strategies: using a previously trained employee from the shelter to facilitate the meetings and using one person from the refugee community, who received the Reach Up training before facilitating the meetings. This option was tested to avoid the cultural and language barriers since most of the refuges come from Venezuela and speak Spanish instead of Portuguese.

Outcomes

Research & Publications

  • Smith, JA. Chang, SM, Brentani, A, Fink G, Lopez-Boo F, Torino BM, Rubio Codina, M. Walker, SP (2023); A Remote Parenting Program and Parent and Staff Perspectives: A Randomized Trial. Pediatrics May 2023; 151 (Supplement 2): e2023060221F. 10.1542/peds.2023-060221F
  • Rubio-Codina, Marta and Lopez Boo, Florencia (2022) What Have We Learned from the Hybrid Delivery of ECD Services During the Pandemic? IDB Publication. http://dx.doi.org/10.18235/0004411
  • Brentani A, Walker S, Chang-Lopez S, Grisi S, Powell C and Finket G (2021). A home-visit based early childhood stimulation programme in Brazil – a randomized controlled trial. Health Policy and Planning, 1-10.
  • Brentani A, Scolezze Ferrer A, Bessa L, Chang SM, Walker SP, Powell CA, Hamadani J, Ferraz SJ, Grisi E, Fink G (2020). Survive and Thrive in Brazil: The Boa Vista Early Childhood Program: study protocol of a stepped-wedge, randomized controlled trial. Trials, Published on 07 May 2020
  • Smith JA, Baker-Henningham H, Brentani A, Mugweni R, Walker SP (2018). Implementation of Reach Up early childhood parenting program: acceptability, appropriateness, and feasibility in Brazil and Zimbabwe. Ann N Y Acad Sci 2018;1419:120-40.