Scaling early childhood development- what to read this month (November 2024)

Let’s kick off with a topic that concerns many of us working on scaling parenting programmes: Can home-based parenting programmes be adapted to group-based settings and remain effective at scale? This question has been explored before – but not in the context of the Care for Child Development (CCD) approach developed collaboratively by UNICEF and the World Health Organization (WHO). This home-visiting approach has been adopted in over 40 countries. Although successful, the it requires extensive and ongoing training for professionals to undertake one-on-one education. Could group-based delivery save costs and provide a scaling solution? Consistent with evidence from other programmes, a qualitative study by McHenry et al. finds that parenting programme participants in Kenya considered CCD group sessions acceptable and feasible. Not only that, but participants were less likely to report depressive symptoms and more likely to report feeling empowered. In addition, fathers were found to be more engaged than with home-visits.

Which moves us on to, how can fathers be incentivised to take a more active role in parenting programmes? Jeong et al. investigate barriers and facilitators to fathers’ engagement in the Moments that Matter parenting programme in Western Kenya (take a look at October’s What to Read this Month for evidence on the fidelity of this programme). Findings? Key facilitators include understanding programme goals, delivery agent encouragement, strategic scheduling of sessions, and peer encouragement. Recommendations include incentivisation through income-generating activities such as monetary compensation, holding separate sessions for fathers and male caregivers, and ensuring programming design includes incorporating topics that appeal to men, such as incorporating father involvement and gender equality into wider sessions on empowerment or livelihood support. Recognising that these results may be context-specific, the authors emphasise the growing consensus on the need for more global research regarding fathers’ engagement in parenting programmes.

Does integrating early childhood development (ECD) group sessions into existing health and nutrition programmes – a common approach to scaling ECD interventions – constrain caregiver time and detract from existing services? Not according to Hemlock et al. The authors assess this question in Madagascar where ECD group sessions were added to a nationwide maternal and child health and nutrition programme. Findings show that new services did not crowd out existing services. This aligns with previous work supporting the call to integrate ECD group sessions into existing health and nutrition services. The paper also discusses whether a combination of home- and group-based delivery could expand coverage to those caregivers who are most remote or time-constrained.

On mental health, Shrestha et al. take an ethnographic perspective to examine the opportunities and barriers to the sustainability of psychosocial interventions delivered by community lay counsellors. The use of lay counselling – delivered by people without a clinical degree – is gaining popularity as a way of scaling up services in settings with a shortage of mental health professionals. The study from Nepal in the aftermath of the 2015 earthquake – explicitly considering views from counsellors and beneficiaries in addition to those of programme implementers – makes clear that long-term funding alone does not ensure service quality and sustained outcomes. Major reported barriers include inadequate training, insufficient remuneration, weak referral mechanisms and stigma around mental health and the role of community counsellors. The authors call for a broader definition of programme sustainability beyond funding to prioritise workers’ rights, care quality, and the long-term wellbeing of marginalised communities.

Staying with community-based mental health services, Dutta et al. conducted a randomised controlled trial (RCT) to assess the importance of adding a perinatal mental health intervention to routine primary maternal healthcare services in Bangladesh. The package was delivered by trained community health workers who worked (among other things) on guiding the participants during the perinatal period (from conception until the baby reaches 1 year) from a negative to a positive mindset as a way of managing stress (e.g. involvement in pleasant activities, making alternative thoughts, community or social engagement, improving self-esteem and self-care). The study finds a modest but statistically significant reduction in the severity of stress throughout the perinatal period.

Next, a new paper informs the design and implementation of integrated ECD interventions for children in informal urban settlements. Angwenyi et al. study barriers to caregiving practices in the unique context of mixed populations of Kenyans and refugees in Nairobi’s informal settlements. Barriers identified include (among others) lack of economic opportunities, limited caregiver availability, insecurity and confined space, all of which limit child exposure to play. While there are commonalities between the caregiving practices of Kenyans and the refugees, the unique challenges of the latter (e.g. the hardship of assimilating to a new culture, which is accentuated by the lack of official documentation) raise the importance of ensuring this group’s needs are prioritised in any form of intervention. These structural barriers suggest the need for innovative, tailored initiatives to promote ECD in these complex settings.

How does UNICEF’s Early Childhood Development Index (ECDI2030) – the official parent report  measure used to monitor progress towards Sustainable Development Goal Target 4.2– compare to direct assessment and teacher report measures in its ability to accurately measure and monitor the proportion of children who are developmentally on track? According to a new study by Li and Rao in China, while the ECDI2030 is a practical tool for large-scale use, it is less sensitive than direct assessment and teacher report measures in reflecting children’s developmental change over time and less able to discriminate competencies across child age. The authors encourage cross-method validation of child development data within and across cultures and caution against over-reliance on a single measure to inform early child development at the population level.

Let’s bring this issue to a close with a round-up of two new literature reviews! First up, a new systematic review by Sousa et al. looks at parental resilience in the context of political violence. The review underscores how parenting efficacy and parenting practices are concurrently compromised within contexts of political violence and that many facets of parenting are intertwined with parental psychological and social wellbeing. Van der Windt et al.’s systematic review provides an overview of long-term follow-up studies of RCTs evaluating interventions to prevent pre-term births. The review concludes that only 15 of 188 RCTs followed the children to assess their long-term outcomes. Of these studies, the main domains of interest evaluated were neurodevelopmental and behavioural outcomes. It seems that long-term follow-up in studies of this nature remains a challenging task, not least in terms of data protection in tracking of participants.