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News | 24th June 2026
A recent Thrive in Conversation webinar focused on Reach Up, a highly influential programme that strengthens parents’ skills and enjoyment in helping their children learn through play and responsive interactions. The webinar featured a presentation and discussion of a more scalable, blended Reach Up delivery model using the government’s primary healthcare system. The team from the Caribbean Institute for Health Research (CAIHR) at the University of the West Indies in Jamaica presented findings from the randomised clinical trial that tested this delivery model.
The audience had many questions. Here, Dr Susan Chang-Lopez and Dr Joanne Smith-Burke from CAIHR answer some of them.
Q: Why was the Ministry of Health and Wellness preferred to lead delivery of this parenting programme? Were any other ministries involved?
A: The Reach Up programme targets parents and their children aged 0-4 years. The Ministry of Health and Wellness provides health services for this age group, e.g. vaccines and routine health checks. It is therefore a good platform to reach the population our parenting programme is targeting. Formally speaking, the early childhood sector in Jamaica is coordinated by the Early Childhood Commission, which is an agency of the Ministry of Education.
Q: What did formal collaboration with the Ministry of Health and Wellness entail?
A: Formal collaboration with the Ministry of Health and Wellness entails their endorsement of the programme. As a research team we provide scientific evidence and our results are disseminated either through reports or meetings with them.
Q: Were community health workers incentivised in any way to implement the programme?
A: The community health workers are not given any additional incentives. Carrying out ‘home visits’ is part of their job. The intervention is now part of Ministry of Health and Wellness services and is delivered to disadvantaged families with young children during some of these home visits. That said, some of our international partners think incentives should be provided.
Q: Who delivered the training to the community health workers?
A: Training is delivered by Ministry of Health and Wellness trainers. These trainers are trained by the research team.
Q: What was the role of the nurse/midwife, and how were they motivated to implement the programme?
A: The nurses routinely supervise community health workers. However, due to their workload, supervision of the early childhood development programme is inconsistent.
Q: Can you suggest any workarounds/solutions for staff turnover?
A: Staff turnover is a real challenge. Our solution is to train nurses/midwives who can deliver the training whenever needed. We encourage intermittent refresher training on selected activities and full training of the programme every few years. The programme has not been implemented long enough to know if this has worked.
Q: What could be changed in the model to strengthen impact?
A: The model tested in this study had three components: 1) manual, 2) messages, 3) home visit/phone calls. The impact we found was small. The Ministry of Health and Wellness plans to continue with home visits only. To improve impact, a sustainable approach to supervision is needed. This will likely require additional staff to assist the nurses.
Q: Is there a minimum effective dosage?
A: We would recommend home visits once every one or two weeks. Visits should be 45-60 minutes long, and the intervention period should be at least one year.
Q: What indicators is the government using for reporting?
A: The Ministry of Health and Wellness uses a monitoring tool that records the number of families receiving the programme and the number of supervised visits. The intention is for supervisors to observe visits using a checklist, which would also help the supervisor provide feedback. However, the challenges with supervision would need to be resolved.
Q: Have you found any resistance from families to the ‘at home’ visits?
A: Most of the time the families do welcome us into their homes. There may be the odd time where we have found resistance, but this is usually resolved by the community health worker and supervisor.
Q: How do you envision the next five years in terms of scaling up? And longer term?
A: The Ministry of Health and Wellness’ five-year plan for early childhood development includes phased expansion of the intervention to 78% of health districts. It also includes expansion of the companion health centre intervention.
After that, the programme would ideally be implemented in all clinics islandwide. This will require sufficient staff to manage and supervise the programme across the regions in the country and coordination by the Ministry of Health and Wellness.
Q: Are there any learnings from upper middle-income countries where caregivers’ education is higher and settings are quite different than in other countries where Reach Up has been implemented?
A: In our meta-analysis across eight countries, there was no difference in impact by mothers’ education. However, this topic needs more research.
Q: Reach Up has a long history: what would you identify as the main scaling challenge? Has it been resolved now?
A: When we started to build the evidence base for the intervention in the 1990s there was much less global attention to early childhood development. There has been substantial change, due in part to the evidence we provided. However, while early childhood development is accepted as being important it still requires more resources to be devoted to it.
Q: How were the toys made, and what materials were provided?
A: All the toys can be home made. There is a toy manual with details on making the toys. The community health workers made most of the toys. Some materials like books and pictures are printed, and wooden blocks are manufactured. Community health workers took the toys/materials needed for the activities to homes.
Q: Beyond primary caregivers (such as mothers), who else can play a role in supporting a child’s development in the community?
A: The programme emphasises strengthening relationships between the community health worker and the mother, the community health worker and the child, and the mother and child. Consistent and loving caregiver relationships with the child is important for the child’s socio-emotional development. So, working with parent and child is important. Where parents alone may not have enough time, other family members can be included. Visits may have to be done when the parent is not working e.g. evening or weekends.
Q: Is it important to continue following children’s development beyond the first 1,000 days – say until they are 6-7 years old?
A: In Jamaica, almost all children attend preschool from age three. However, the programme curriculum continues up to age four. So in other countries where fewer children have access to preschool, the programme could continue past the first 1,000 days.
Q: Is any adaptation needed specifically for teen parents?
A: Not adaptations but maybe adding childcare activities e.g. bathing baby and how to comfort baby.
Q: Does the WhatsApp adaptation of Reach Up in Brazil and Guatemala include provision of materials? Is there information available about how the content was adapted for WhatsApp?
A: The WhatsApp adaptations were done during COVID-19 and used activities in the Reach Up Parent Manual developed at that time. The manual showed how to substitute things in the home for the toys and how to make the toys. A paper from the Brazilian team is coming out shortly. For more information on Reach Up, please visit reachupandlearn.com
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