ANYAS Special Issue

This paper frames the dimensions and components, fundamental to the understanding of implementation processes for nurturing care interventions; factors for improving implementation of interventions; and strategies to scale by embedding interventions in delivery systems. It discusses emerging issues in implementation research for ECD including (1) role of context in adaptation and implementation, (2) standardized reporting of implementation research, (3) importance of feasibility studies to inform scale-up and capacity building, (4) fidelity and program quality improvement, and (5) intervention integration into existing systems. 

Full Article

Authors: Pia R. Britto, Manpreet Singh, Tarun Dua, Raghbir Kaur, and Aisha K. Yousafzai

As early childhood interventions move from small- to large-scale programs, the partnerships among researchers, policymakers, communication experts, practitioners, and local communities become increasingly critical for successful implementation. The results from evaluations of programs need to guide policymakers so that they can make informed administrative and fiscal decisions. This paper makes five recommendations for researchers to consider when designing early childhood programs for scale.

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Author: Joan Lombardi

Lack of clear and strong ownership of and champions for ECD, operational and communication siloes of constituent sectors that constitute ECD, political pressures for investment in other arenas, and low international investment in ECD inhibit making a compelling and cohesive investment case for ECD. This paper explores how a global ECD network can facilitate systematic alignment and action across sectors to support country systems, strengthen political will, and increase investment to deliver results for young children’s development. The ECD Action Network is in formation and offers an opportunity for the field to share knowledge among countries and sectors, identify pathways for sectoral coordination and collaboration, and undertake advocacy to generate the scale of political and financial support necessary to ensure that every child receives the nurturing care he/she needs. 

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Author: Shekufeh Zonji

The 2018 special issue of Annals of the New York Academy of Sciences on implementation research and practice for early childhood development brings together emerging evidence on implementing effective nurturing care programs, addressing issues of quality and scale. Translating evidence to practice requires addressing the barriers perceived by policymakers, which have been highlighted in the published literature. This paper describes how UNICEF and other global partners are addressing these barriers. 

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Author: Pablo Stansbery

Meta-analyses of interventions such as parenting, stimulation and early childhood education have reported consistent medium-to-high effect sizes on early childhood development (ECD) and early learning outcomes. However, few effective interventions promoting ECD have achieved scale. In order to increase access to effective or high-quality services, greater focus on implementation research of interventions promoting ECD is necessary. This paper describes the development of ‘Reporting Guidelines for Implementation Research of Nurturing Care Interventions Designed to Promote Early Childhood Development’ following an expert consensus-building process. The goal of these guidelines is to support transparent and standard reporting of implementation evidence on nurturing care interventions designed to promote ECD. 

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Authors: Aisha K. Yousafzai, Frances E. Aboud, Milagros Nores, and Raghbir Kaur

A survey conducted by FSG in 2015 across 4407 low-income families in urban India showed that 95% of them send their children to preschools, a majority choosing affordable private preschools (APSs), as parents perceive the quality of government schools to be poor. The APS system tends toward rote approaches using inappropriate pedagogy, leading to poor learning outcomes. Affordable high-quality activity-based preschool solutions exist and could be brought to the APS to significantly improve the classroom environment and learning outcomes. This paper presents FSG’s approach to shaping demand for quality preschool services and to improving learning outcomes in urban Indian APSs through the implementation of the pilot Program to Improve Private Early Education (PIPE). 

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Author: Vikram Jain, Ahmed Irfan, and Gauri Kirtane Vanikar

Building capacity within health and education systems of low- and middle-income countries in order to deliver high-quality early childhood services requires coordinated efforts across sectors, effective governance, sufficient funding, an adequate workforce, reliable data systems, and continuous monitoring, evaluation, and improvement cycles; it also requires partnerships with the private sector, communities, and parents. In addition, building capacity requires leadership, innovation of strategies to fit into existing structures, evidence-based intervention models, and effective partnerships that help make interventions more culturally relevant, help finance them, and help create institutional long-term support and sustainability for them. This paper focuses on identifying eight critical aspects of enabling systemic support for early childhood services. 

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Author: Milagros Nores and Camila Fernandez

This paper analyzes the need for consistent and accurate cost data on early childhood development (ECD) interventions as a basis for increasing and improving the effectiveness of current spending on ECD. It establishes the key components necessary in a costing model and presents a new standardized costing tool intended for use across a broad range of stakeholders and contexts. Learning from piloting the tool in Bangladesh, Malawi, Mali, Mexico, and Mozambique are shared. Providing a standardized methodology for costing ECD is an important contribution to the field and has the potential to improve both the volume and effectiveness of ECD financing. 

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Authors: Emily Gustafsson-Wright and Izzy Boggild-Jones

Young children living in conditions of war, disaster, and displacement are at high risk for developmental difficulties that can follow them throughout their lives. While there is robust evidence supporting the need for early childhood development (ECD) in humanitarian settings, implementation of ECD programming remains sparse, largely due to the lack of evidence of how and why these programs can improve outcomes in humanitarian settings. This paper reviews the current state of implementation research for ECD programming (targeting children 0–8) in humanitarian settings, through a literature review and a series of key informant interviews. Drawing from existing frameworks of implementation research and the findings from our analysis, this paper presents a framework for ECD implementation research in humanitarian settings and propose an agenda for future research. 

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Authors: Katie Maeve Murphy, Hirokazu Yoshikawa, and Alice J. Wuermli

Evidence demonstrates that encouraging stimulation, early communication, and nutrition improves child development. Detailed feasibility studies in real-world situations in Africa are limited. We piloted Care for Child Development through six health surveillance assistants (HSAs) in group and individual sessions with 60 caregivers and children <2 years and assessed recruitment, frequency, timings, and quality of intervention. We collected baseline/endline anthropometric, child development (MDAT), maternal stress (SRQ), and family care indicators (FCIs) data and determined acceptability through 20 interviews with caregivers and HSAs. HSAs could only provide coverage on 14.2% of eligible children in their areas; 86% of group sessions and a mean of 3.6/12 individual sessions offered to mothers were completed. Pre- and post-assessment of children demonstrated significant changes in MDAT language and social Z-scores and FCIs. Caregivers perceived sessions as beneficial and HSAs good leaders but that they could be provided through other mechanisms. Integrated Care for Child Development programs for 0–2 years old are readily accepted in Malawi, but they are not feasible to conduct universally through HSAs due to limited coverage; other models need to be considered. 

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Authors: Melissa Gladstone, John Phuka, Richard Thindwa, Fatima Chitimbe, Kate Chidzalo, Jaya Chnndna, Selena Gleadow Ware, and Kenneth Maleta

An early childhood parenting training package, called Reach Up, with the aim of providing an evidence-based, adaptable program that is feasible for low-resource settings was evaluated in Brazil and Zimbabwe to inform modifications needed and identify challenges that implementers and delivery agents encountered. The program was well accepted by mothers and visitors, who perceived benefits for the children; training was viewed as appropriate, and visitors felt well-prepared to conduct visits. A need for expansion of supervisor training was identified and the program was feasible to implement, although challenges were identified, including staff turnover; implementation was less feasible for staff with other work commitments (in Brazil). However, most aspects of visit quality were high and the Reach Up program can expand capacity for parenting programs in low- and middle-income countries. 

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Authors: Joanne A. Smith, Helen Baker-Henningham, Alexandra Bretani, Rose Mugweni, and Susan P. Walker

Literature would suggest that efforts to both report and improve program implementation are vital for nurse home visiting (NHV) to have population impact and policy sustainability. This paper is a case study of the design, testing, and implementation of the right@home program, an Australian NHV program and randomized controlled trial. The study addresses existing gaps related to implementation of NHV programs by describing the processes used to develop the program to be trialed, summarizing its effectiveness, and detailing the quality processes and implementation evaluation. The weight of the evidence suggests that NHV can be a powerful and sustainable platform for addressing inequitable outcomes, particularly when the program focuses on parent engagement and partnership, delivers evidence-based strategies shown to improve outcomes, includes fidelity monitoring, and is adapted to, and embedded within, existing service delivery systems. 

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Authors: Sharon Goldfeld, Anna Price, and Lynn Kemp

Policy and program implementers require evidence on whether integrated psychosocial stimulation and nutrition interventions can be effectively delivered at-scale, how, and at what cost. To address some of these issues, a comprehensive evaluation of implementation was designed for a trial in Pakistan that integrated psychosocial stimulation and nutrition interventions in a community health service. The first objective was to describe, analyze, and assess the quality and accuracy of the implementation of the interventions. The second objective was to identify barriers and facilitators for uptake of interventions. A mixed-methods evaluation of implementation processes was conducted. Interventions were accepted by the community and health providers and there was evidence for behavior change uptake of the care for early childhood care recommendations. The new interventions did not dilute delivery of routine services. However, fidelity and quality required supportive supervision and active use of monitoring data, which would require attention in scale-up. 

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Authors: Aisha K. Yousafzai, Muneera A. Rasheed, and Saima Siyal

This paper describes the development of the Irie Classroom Toolbox, a school-based violence prevention, teacher training program for use with children aged 3–6 years. In-depth interviews were conducted with Jamaican preschool teachers, who had participated in a trial of a classroom behavior management program, at posttest (n = 35) and 5 years later (n=20). An on-going process evaluation was also conducted. Teachers’ preferred behavior management strategies and training methods were documented, and enablers and barriers to implementation were identified. Teachers were most likely to adopt strategies that they liked, found easy to use, and were effective. These included paying attention to positive behavior and explicitly teaching children the expected behavior. Teachers preferred active, hands-on training strategies based on social-cognitive theories. Enablers to intervention implementation included positive teacher–facilitator relationships, choice, collaborative problem solving, teachers recognizing benefits of the intervention, group support, and provision of materials. Barriers to intervention implementation were also identified. These data were integrated with behavior change theory (i.e., the behavior change wheel and theoretical domains framework) to develop an intervention grounded in common core elements of evidence-based programs while also utilizing teachers’ perspectives. The resulting program is a low-cost, adaptable intervention that should be suitable for training preschool teachers in other low-resource settings. 

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Author: Helen Baker-Henningham

This paper summarizes findings on program quality and teacher practices and perceptions for the aeioTU program, a center-based Reggio-inspired program in Colombia, now serving more than 13,000 children. The research found engaged, committed staff who valued the emergent approach and understood the children as requiring opportunities to express themselves, being the source for the curriculum, and having relationships with the materials around them. Although the average classroom quality was low in 2011, it increased significantly by 2014, particularly in the language and reasoning and interactions items. Indicator-level analyses showed that higher-order interactions and language processes were observed in a large proportion of classrooms by 2014. Teachers’ self-reports on the environment and their teaching and learning showed high levels of quality by 2013. These findings illustrate the significance of process data for program improvement, especially when a program is young. Program quality can be raised after teachers improve their skills, have experience enacting a curriculum, and after training has been strengthened in response to information, while simultaneously scaling up the program. 

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Authors: Milagros Nores, Alexandra Figueras-Daniel, Maria Adelaida Lopez, and Raquel Bernal

This paper draws on a case study of Philani+ (a maternal and child health intervention implemented in South Africa) to distill eight features of health programming that aid intervention effectiveness. It argues that implementation science should turn its attention to the human resource “process” features of interventions. It also describes the importance of staff selection (rigorous selection and hiring procedures); training (developing a set of common core pragmatic problem-solving skills); monitoring (feedback about quality); community and institutional support (rapport with intervention communities); the importance of stable leadership (consistent leadership focusing on how to optimize the potential of staff); the importance of implementing with sustainable, long-term change in mind; and, finally, it describes how cultivating consistency within an organization requires disciplined action and disciplined focus on the organization’s vision. 

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Authors: Mark Tomlinson, Xanthe Hunt, and Mary Jane Rotheram-Borus

To elucidate concrete lessons learned and suggestions on accelerating the transition to impact at scale, this paper reviewed the Saving Brains portfolio to better understand three points: (1) the extent to which useful signals of impact could be extracted from data at the seed phase, (2) the ways in which innovators (project leaders) were approaching human resource challenges critical for scaling, and (3) the multi-sector diversity of the portfolio and the way innovators entered partnerships. The findings suggest key considerations for transitioning early childhood development interventions to scale and sustainability: strong entrepreneurial leadership, rigorous measurement and active use of data in support of adaptive learning, and champions acting at subnational levels. Together, these can enable flexible, iterative learning that can make the scaling process an opportunity to increase the level of benefit each child receives from an intervention. 

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Authors: James M. Radner, Marvin J.S. Ferrer, Dominique McMahon, Anuraj H. Shankar, and Karlee L. Silver

This paper describes ways to measure variables of interest when evaluating the implementation of a program to improve early childhood development (ECD). The variables apply to programs delivered to parents in group sessions and home or clinic visits, as well as in early group care for children. Measurements for four categories of variables are included: training and assessment of delivery agents and supervisors; program features such as quality of delivery, reach, and dosage; recipients’ acceptance and enactment; and stakeholders’ engagement. Quantitative and qualitative methods are described, along with when measures might be taken throughout the processes of planning, preparing, and implementing. A few standard measures are available, along with others that researchers can select and modify according to their goals. Descriptions of measures include who might collect the information, from whom, and when, along with how information might be analyzed and findings used. By converging on a set of common methods to measure implementation variables, investigators can work toward improving programs, identifying gaps that impede the scalability and sustainability of programs, and, over time, ascertain program features that lead to successful outcomes. 

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Authors: Frances E. Aboud and Elizabeth L. Prado

This paper summarizes the state of the field of implementation research and practice for early child development and proposes recommendations. First, conclusions are drawn regarding what is generally known about the implementation of early childhood development programs, based on papers and discussions leading to a published series on the topic. Second, recommendations for short-term activities emphasize the use of newly published guidelines for reporting data collection methods and results for implementation processes; knowledge of the guidelines and a menu of measures allows for planning ahead. Additional recommendations include careful documentation of early-stage implementation, such as adapting a program to a different context and assessing feasibility, as well as the process of sustaining and scaling up a program. Using existing implementation information by building on and improving past programs and translating them into policy are recommended. Longer term goals are to identify implementation characteristics of effective programs and determinants of these characteristics. 

Full Article

Authors: Frances E. Aboud, Aisha K. Yousafzai, and Milagros Nores

The Early Childhood Development Action Network and NIEER announce a webinar series  exploring implementation research and practice for early childhood development, based on the recent Annals of The New York Academy of Sciences Special Issue Implementation Research and Practice for Early Childhood Development.

PREVIOUS

“Costing ECD Programs”
The fourth webinar in our series exploring implementation research and practice for early childhood development will focus on generating consistent and accurate cost data on early childhood development interventions, identifying key components necessary in a costing model and sharing learning from Bangladesh, Malawi, Mali, Mexico, and Mozambique. Watch the webinar here. For the audio version, listen here 

“Programmes in Conflict Settings”
This webinar, featuring Katie Maeve Murphy, Hirokazu Yoshikawa and Alice J. Wuermli, co-authors of the article recently published in the ANYAS Special Issue, focused on the challenges, opportunities and realities of providing early learning opportunities for young children living in conditions of war, disaster, and displacement. Research finds these children are at high risk for developmental difficulties that can follow them throughout their lives; yet implementation of ECD programming in humanitarian settings remains sparse. Watch the webinar here. Listen here for the audio version only.

“Implementation Issues and Continuous Improvement within Preschool Settings”
This webinar, moderated by Aisha Yousafzai, featured NIEER Co-Director for Research Milagros Nores, Ph.D., an editor for the ANYAS Special Issue, and Nirmala Rao, Ph.D.,  a University of Hong Kong professor of early childhood development and education. Watch the webinar here. Listen here. 

“Why does implementation evidence matter for ECD?”
The opening webinar in a year-long series features Special Issue editors Aisha Yousafzai Harvard University; Frances E. Aboud of McGill University; and Pia R. Britto of UNICEF, exploring the central role implementation research plays in understanding context, assessing performance, improving quality, facilitating systems’ strengthening, and informing large-scale use and sustainability of early learning interventions. Elizabeth Lule of the Early Childhood Development Action Network (ECDAN) will introduce and moderate this conversation. Watch the webinar here. Listen here.

Former President Michelle Bachelet of Chile, Ministers of Health, and other global leaders recently launched “Nurturing Care for Early Child Development: A Framework for Helping Children SURVIVE and THRIVE to TRANSFORM health and human potential.” For more information

Over the past year, 1,000+ partners from 100+ countries have developed this milestone framework for young children built on state-of-the-art evidence about how early childhood development unfolds and how it can be improved by policies and interventions. Download

The ANYAS Special Issue Implementation Research and Practice for Early Childhood Development was disseminated at the event.

ANYAS Special Issue editor Aisha Yousafzai, an Associate Professor at Harvard University, explores the important role implementation research plays in early childhood education policy.

“A question commonly asked by policy makers about programs that promote early child development (ECD) is what program elements, policies, and/or family and community circumstances contribute to positive results and under what conditions? (Lombardi et al., ANYAS, 2018)

In order to answer this question, it is not enough to only collect data on the impact of interventions on intended outcomes (e.g., ECD), it is also important to collect data on the implementation context, inputs and processes that contribute to the outcomes we expect to achieve for young children, their caregivers and their community. 

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Family involvement programs can look great on paper and yet fail miserably. Programs can have defined goals, a well-defined time frame and program structure, research-based curricula, proven results for a specific target population, and still fail to produce the positive outcomes we expect.

Why do some well-designed intervention programs fail? One common reason is implementation. 

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In India, there is a high demand for affordable private preschools (APSs). Unfortunately, despite the motivations of parents and their investments, students’ learning outcomes remain poor. How can you design both an overall program and market‐based education solutions in order to achieve impact at scale? 

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Most of us want to tell the world about the success of our early childhood program. We especially want to tell others how we built it into a good program, the difficulties we overcame, and the lessons learned. We hope our experience will help others avoid problems if they are forewarned and have some solutions at hand. But it’s more than just that.

Reporting how you implemented your program adds to the body of evidence on what has been tried around the world and provides a menu of sorts from which others can choose and learn. 

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As more and more early childhood development programmes are launched globally, we want to be sure they are integrated as well as possible into the very different cultural and contextual settings which exist globally. Many ECD programmes have been created first in WEIRD (Western Educated Industrialised Rich and Democratic) countries. Many of these programmes now have excellent evidence as to their effectiveness in low- and middle-income settings, such as Pakistan and Bangladesh.

But does what works in Pakistan work well in Malawi? And how can we know before we start funding wide-scale programmes in such African settings? Detailed and considered feasibility and pilot studies are one way of understanding how implementation of ECD interventions can be conducted in the best way prior to scaling up. 

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Imagine you are in charge of developing or implementing a large scale early childhood program to reach a significant number of young children and families across a specific geographic area. Perhaps the plan is to reach several hundred children in a rural neighborhood or thousands of children in a few city blocks, or millions across a state, province or country.  Whatever the extent or reach, moving to scale a program or set of services takes ongoing research, a different set of supports and new partnerships to assure some level of quality and effectiveness as the program grows.

Public officials and other implementers need ongoing data about how key program elements are working, what are the effects of such policies on various populations and which infrastructure supports can lead to better results for children and families. (See “What policymakers need from implementation evaluations of early childhood development programs”). 

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