by Florencia Lopez Boo and Jane Leer(*)

home visit

Photo by MIDIS

My 3-year old son is starting pre-kinder and it is now a requirement of the public school system in Washington, DC (DCPS) to do home visits to all prospective students. That is how I had my first home visit ever, woo-hoo!  The two teachers came along, asked a few questions but, mostly, they established a great connection with my little one and somehow they all ended up dancing in my living room. The objective of the DCPS home visits is to “allow for teachers and parents to come together to form trusting relationships so they can better support the child.” This visit made me connect with some of the parenting programs we have been supporting through our work at IDB in our region. It is not a coincidence that  Nicholas Kristof  wrote a  article in the New York Times about the “power of parenting programs to beat poverty”.

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Parenting programs with trained home visitors demonstrate ways to encourage child development to parents and have the potential to significantly reduce inequalities in cognitive and social child development across socioeconomic groups.  Most of the evidence on impacts from home visits comes from small-scale programs, like the one from Jamaica. In order to scale-up existing programs and develop new ones, we need to know how to maintain the quality—in particular—how to maintain the quality of interactions between home visitors and families.

This summer, one of us, Jane , visited five parenting programs in the region to gather data on what happens during home visits carried out by existing programs, in order to contribute to an understanding of what is important when analyzing their quality.   Here are a few of her observations about the programs visited:

–          Child Development Group at the University of West Indies, Jamaica: The Jamaican visitors consistently emphasized language development throughout the visit, discussing with the caregiver the importance of talking to children, even (or especially) during day-to-day activities like bathing, cooking, and cleaning.

–          Programa de Primeira Infancia Melhor (PIM), Brazil: It was impressive to see the flexibility and responsiveness of the PIM visitors. They were able to identify and respond to the needs of each family, often adapting visit activities according to children’s interests and/or caregivers’ requests.  

–          Cuna Más, Peru: Cuna Más is one of the few parenting programs that works with several different indigenous communities. Another innovative aspect of the program is the Espacios de Juego (“Play Spaces”). With the help of the visitor, families create a safe play area for children in the home. The Espacios de Juego encourage fathers to get involved in their child’s development, as fathers take pride in constructing toys for their children.

–          Amor para los más chiquitos (APLMC), Nicaragua: APLMC’s strength lies in the use of available resources (toys and games made from objects found in the household or in nature). In one visit I observed, for example, a visitor showed the mother how to use an empty water bottle and corn kernels to help the child practice fine motor skills (putting the corn kernels into the small opening of the bottle). Demonstrating the use of these resources is important, as it shows parents that fancy toys are not necessary to promote early learning.

–          Creciendo con Nuestros Hijos (CNH), Ecuador: CNH visitors stand out for their ability to actively engage caregivers. During the visit, visitors pause to ask the caregiver to review and evaluate the visits’ activities, (“Did Maria easily solve this puzzle? How can we make it easier? How can we challenge her?”). CNH visitors clearly explain each activity’s objective and ensure that the caregiver understands why each activity has been selected.

In each program, I was blown away by the dedication and expertise of the visitors I observed. Beyond the physical demands of the job (walking miles from house to house), visitors must earn families’ trust and effectively communicate new concepts that at times contradict societal norms and attitudes about child development. In each program it was clear that families and communities really value the visitors’ work. Grandparents, mothers, fathers, and teachers spoke to me of the positive improvements they have seen in their children or students since the program’s start.

We are still learning how best to provide the job stability, recognition, training and ongoing support that visitors need to excel. Simultaneously, programs have to operate efficiently, maintaining operational costs low in order to reach as many children as possible.

As Jane mentions, the region has still a lot to learn in terms of improving home visits. Preliminary results from these visits show that the quality items most difficult to reach are exactly those that potentially most influence child development (the bad news) but that can still be influenced by training (the good news!)

Some examples of such items are whether the visitor asks the caregiver to demonstrate activities practiced, to explain activities for the caregiver, to demonstrate activities for the child, to seek their opinion, to positively reinforce caregiver, to use the program manual appropriately, to actively promote language development through the visit, etc.

Have you had a home visit? How was your experience? Share this article for more people to know about these initiatives.

(*) We wish to extend our utmost gratitude,  to the families who welcomed Jane into their homes, the visitors who allowed her to observe them in their work, and the program coordinators and directors who organized the visits and shared with her their valuable insights and observations.  

Florencia Lopez Boo is a senior social protection economist with the Social Protection and Health Division (@BIDSPH) at the IDB. Her work focuses on early childhood development and evaluation of the impact of social protection programs.

Jane Leer worked as a consultant for the IDB, supporting several early childhood development programs in the region, and is now pursuing a Masters in International Education Policy at Stanford University.

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