Initial results from an innovative parenting program in Jamaica showed that it benefited children’s cognitive development and parents’ attitudes about caring for children. However, evaluations in subsequent years found that these effects had disappeared. In this post, we present an early childhood program that is incorporated into the country’s health system, as well as the program’s short- and medium-term results, the lessons it taught us, and the lingering questions it raised.
The faces of Abisai and Jameca shine with excitement. Three months ago, they became the parents of Jena, a gleeful Jamaican baby. Waiting for a doctor’s appointment, the brand-new parents think through questions and concerns to share with the nurse or pediatrician. Like all parents, they both want the best for their little girl.
This appointment is different because in the waiting room Abisai and Jameca met Victoria, a community health worker from the Jamaican health system. While waiting for Jena’s routine checkup, Victoria showed them a video of parents doing activities with their kids that stimulate their development. Then they talked about what they saw in the video. By the time Jena is 18 months old, they will have a total of five sessions of this kind.
Abisai and Jameca were part of an innovative program in the Caribbean that aimed to benefit children and parents by taking advantage of the time they spend at health centers waiting for appointments. In this project, community health workers teach them good parenting practices, like talking with their children, using bath time as a learning opportunity, or reading a book. The interactions included playing short videos and demonstrating the activities there at the medical centers. Families were also given materials to take home (cards with simple messages and pictures to reinforce the topics covered, a picture book, and puzzles).
When this type of program is integrated into a health system, it can be easier to scale up than other types of parenting programs, like those based on home visits or carried out in community centers.
What were the results?
The short-term evaluation (when the children were 18 months old) found positive effects on children’s cognitive development and parents’ knowledge and attitudes about caring for and raising children. However, it revealed no effects related to the quality of the home environment. In the medium-term evaluation, when the children were six years old, the positive effects that were found had disappeared.
As far as we know, this is the first medium-term evaluation of an early childhood development program in low- or middle-income countries that is integrated into the health system and delivered during visits to medical centers.
A possible explanation for this result that all parents present in the waiting room participated in the sessions (regardless of whether they were part of the program). This led to large groups of 37 people on average, which could have negatively affected individual participation. Another variable we considered was the age at which the program ended: the last contact was when children were 18 months old, whereas other similar programs end when children turn 24 months old.
Lessons from the program
The results from the Jamaican program suggest that it is crucial for this type of action to impact the home environment if its effects are to continue once contact with families has ended. Our results, together with those of similar initiatives in the United States, seem to indicate the importance of staying in contact with parents beyond 18 months, and even until the child is 4 1/2 to 5 1/2 years old.
This poses additional challenges, especially for scaling up this type of program, given the low number of contacts at health centers after a child is 12 months old, since immunization and checkup schedules for healthy children are more spread out once they turn two years old.
We know the human brain develops more during the first five years than at any other time in life. The study helps us find new pathways for early childhood development actions in order to enhance all abilities of small children. To read the study (in English) and learn more about this program and discussion, click here.
Do you know about results from other programs of this kind? Do you have an example of how this type of program has been effectively scaled up within health systems? Leave us a comment below.