By Susan Walker
Integrating early childhood development programs with health services can be an important way of reaching larger numbers of the millions of children and families in need. Understanding how to make this work so that programs are effective and feasible is essential, yet there is little information to guide the process of integration so that it can be achieved at a large scale.
Routine Health Checks and Child Development
Designing a program that can be easily integrated with health services can be tricky, especially in light of competing demands on time and resources for both mothers and health staff.
A couple of years ago, a joint team from the University of the West Indies (UWI) and the Inter-American Development Bank designed a parenting program to be integrated into routine well child visits in some Caribbean health centers, where parents bring their children aged from 3 to 18 months for health checks and immunizations. The program was conducted in the clinic waiting area and involved videos, group discussions and interactive practice sessions for parents led by community health workers. Message cards displaying loving caregiving practices and a few toys were given out by nurses when the health checks were completed.
Did it Work?
Almost all of the participating mothers (83%) attended all 5 routine health visits throughout the duration of the program.
An impact evaluation showed that the program made a difference on child cognitive development and on parents’ awareness and attitudes about helping their children learn. It also suggested that the training and ongoing guidance given to the health staff by our team were valued and the quality of most aspects of the program was adequate to good. It seemed like this approach was a good way to reach parents and that the community health workers could deliver the program well.
Although both the mothers and the health staff reported perceiving benefits for themselves and the children, we wanted to know more about what they thought of the program and how well it had been implemented. To gather this information, we watched sessions in the clinics and interviewed some of the mothers and staff.
What Did They Think About the Program?
Mothers who participated said the program had helped their children’s development and shared ways in which their own behavior had changed towards better and healthier parent-child interactions.
For example, one mother said about her baby, “If she’s crying, I don’t feel that I’m spoiling her, I just take her up and hush her and love her”. Another said, “I didn’t use to play with her before… Since I participated in the program I’ll sit with her, sing with her and play with her”.
Mothers also affirmed they talked and interacted more with their children as a result, for example when taking them out on walks and pointing out different things that were encountered on the way.
Health staff also saw the change in parent behavior. As one community health worker said, “Sometimes you will sit and watch them and see how they love up the baby, kiss them, play with them”.
A nurse commented, “I would notice that the mothers kept talking to their babies and they wanted the nurse to know that baby knows this, and baby knows that, so they would tell their babies ‘show nurse your nose’ or ‘show nurse your eyes’. It’s really good to see them doing that.”
The program also increased the satisfaction health staff felt in their work, as well as their motivation and sense of contributing to better child development, which is important to ensure continuity and sustainability in the program. A community health worker expressed, “When they come back you can see the babies enjoying what they are doing. And so it makes me feel like I’ve been doing something.”
There were some challenges. The program was done in the waiting areas, where groups were often large and sometimes noisy and this was difficult for some of the community health workers to manage. Furthermore, both community health workers and nurses agreed that the main challenge is juggling enough time for the program as well as their regular work.
This project showed that early childhood development programs can be successfully linked to health services. The lesson is that to integrate and expand such programs will require sustainable investment to strengthen health clinics and incorporate additional staff, where needed.
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Susan Walker is the Director of the Caribbean Institute for Health Research and leads the Child Development Research Group within the Epidemiology Research Unit.