C A R I B B E A N E A R LY C H I L D H O O D G O O D P R A C T I C E G U I D E
continuing until they were three years of age. An evaluation in 1986 5 of the benefits of the stimulation for the development of stunted children demonstrated outcomes that exceeded the benefits of nutrition supplementation. Follow-up evaluations over 20 years showed sustained and very significant benefits extending into adult life: Children were happier and did better in school, and as adults they “had better mental health, demonstrated less violent behaviour and earned more money than similar children who did not receive the programme” 6. The explanation for the success experienced incrementally by the children is that the early learning from the stimulation worked as an investment in their development, by yielding increasing gains as the children were better able to make use of later learning in school and in life. Benefits have become more wide-ranging over time. Even more encouragingly, the children who are now adults and parents themselves are providing stimulating environments for their own children. ESSENTIAL ELEMENTS IDENTIFIED FOR QUALITY IN EARLY STIMULATION INTERVENTIONS FOR CHILDREN FROM BIRTH TO THREE
1
An organisational base for the home-visiting programme: In the Jamaican study, the base was a health clinic and the home-visitors were trained community health aides. The programme can be “bolted on” to other pre-existing services such as early childhood education services, cash transfer programmes, or services provided by faith-based or community organisations.
2
Good supervision of the trained home visitors: Supervision from the base is essential for training of the home-visitors, supporting them in their visits, deploying the visits, targeting resources where needed and administration.
3
Approach of the home-visitor to supporting parent-child interaction: The approach of the home-visitor to the parent is critical for building skills and confidence. The home-visitor works with and through the mother to enhance mother-child interactions and to support the self-esteem of both mother and child. Over time, the home-visitor helps parents to engage confidently with their children and to establish a connection between their own behaviour and that of their child.
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4
A semi-structured cognitive curriculum: The Jamaica study produced a curriculum with guidance on how to use the approaches and concepts in supporting parents of children six to forty two months and produced a toy manual to guide the making of toys from recyclable materials. The curriculum and manual are available online and can be adapted to reflect local context and customs.
5
Frequency (weekly) and intensity (one hour) of the visits.
6
Duration of exposure to the home-visiting programme: Visits were made to each parent of a child who was six months old at the start of the programme until the child was three years of age.
7
Homemade toys left in the home by the home visitor: This was important for encouraging the parent to continue the programme on the days on which there was no visit, and to encourage the making of other stimulating toys.
Grantham-McGregor SM, Powell CA, Walker SP, Himes JH. Nutritional Supplementation, Psychosocial Stimulation, and Mental Development of Stunted Children: The Jamaican Study. Lancet 338, 1–5, 1991 Gertler P, Heckman J, Pinto R, Zanolini A, Vermeerch C, Walker S, Chang S, Grantham-McGregor, S. Labor Market Returns to an Early Childhood Stimulation Intervention in Jamaica. Science 344, 998–1001, 2014