Parents as First Teachers Integrated Models for Promoting Early Child Education, Nutrition and Health -- Davis and McEwan

1. 20 April 2017
Tom Davis, Consultant
Elena McEwan, CRS Senior Technical Advisor Maternal and Child Health
Parents as First Teachers: Integrated
Models for promoting Early Child
Education, Nutrition and Health

2. Introduction: Parents as First Teachers
 One shot:
 By age of 5, more than 90% brain architecture is in place.
 Children who attend preschool are less likely to drop out of high school, be
placed in special education and held back a grade, and score better on
reading/math achievement tests.
 Our ally: Parents and other family caregivers are children’s “first teachers:”
 They often spend the most time with their children and can have the most
impact.
 Ex: 30 million word gap
 “Drop-off” preschools will not be scaled anytime soon.
 However, by training caregivers, we can help them to improve their
parenting skills, become more involved in their children’s schooling, and
learn to detect delays and health problems.

3. Ruler Exercise: Where do you stand?
 On a scale of 1 to 10 with 10 being Extremely
Important, how important do you think it is to
integrate early child education/ development
interventions into our traditional health and
nutrition interventions?
 On a scale of 1 to 10 with 10 being Very Skilled, how
skilled do you feel like your organization is (or you
are) in integrating ECD interventions into your
health and nutrition programs?

4. CRS THRIVE Model

5. Elena McEwan, STA MCH
Global Health Practitioners
Conference
April 20-21, 2017 -Washington DC

6. Why integrate ECD?
 First 1000 days is the most rapid
and crucial developmental
processes in cognition, language,
social-emotional development,
and physical health occur during
this period.
 Healthy food, clean water, health
care, protection, and opportunities
to learn are crucial elements for
brain development.
 Combining ECD with existing
interventions is efficient as
programs can make use of same
facilities, transportation,
community networks and
distribution systems.

7. 7

8. Thrive Adapted Care Group Model
Community
Health Worker
Community
Health Worker
Community
Health Worker
Master
Trainer
Master Trainer
trains and
supervises 2 – 4
Community
Health
Volunteers in
Care Group
approach and
integrated ECD
messages.
Community Health
Volunteers (CHV)
organize, train and
supervise 4 care
groups each.
Each Care Group is made of
up to 8-10 Care Group
Volunteers (CGV). CHVs train
the Care Group Volunteers in
integrated ECD messages.
CHVs also supervise group
sessions and home visits
conducted by the Care Group
Volunteers..
Each CGV organizes up to 8-12
neighbor mothers to share
integrated ECD messages
during monthly group
sessions. CGVs also conduct
monthly home visits to review
key messages and practice ECD
behaviors with neighbor
mothers.

9. How services are delivered
 Trained case managers and
Care Group Volunteers lead
the sessions at neighbor
mother groups
 Each session delivers 30
minutes of the mothers an
babies course and 30 minutes
of integrated ECD, IYCF,
BBwash messages
 Home visits during this time
period to support mothers
practicing behaviors, check
their mood, and provide
booster sessions
9
Developed By: Ricardo F. Muñoz, Ph.D., Huynh-Nhu Le,
Ph.D.

10. Integrated messages curriculum
 Module I: Parenting Messages During Pregnancy and
Postpartum
 E.g. Stimulation during pregnancy
 Module II: Parenting Message at 0 to 24 Months
• Parenting Message at 0 to 6 Months
 Card #1: Communication and play
 Card #2: Child nutrition: exclusive breastfeeding
 Card #3: Common breastfeeding problem
 Parenting Message at 6 to 11 Months
₋ Card #4: Communication and play
₋ Card #5: Child nutrition: feeding at 6 months
₋ Card #7: Child nutrition: feeding 7 to 8 months
₋ Card #8: Child nutrition: feeding 9 to 11 months
₋ Card #9 Feeding a child during and after illness
10

11.  Parenting Message at 12 to 24 Months
 Card #10: Communication and play
 Card #11: Child nutrition: 12 to 24 months
 MODULE III: General Parenting Messages at 0
to 24 Months
 Card #1: Child health—child welfare clinic
 Card #2: Child development chart
 Card #3: Emotional wellbeing
 Card #4: Communication and play
 Card #5: Behavior management
 Card #6: Male involvement
 Card #7: Handwashing at critical moment
 Card #8: Drinking water treatment & storage
 Card #9: Keeping Food and Food Containers Clean
 Card #10: Keeping the environment clean
11

12. Communication & play with an infant
(0-6 months) messages
 Keep your baby warm with direct skin-to-skin contact
immediately after birth
 Talk and sing to your child often; while changing his/her
clothes, bathing, during breastfeeding, to soothe them to
sleep.
 Slowly move a rattle around and watch while baby follows
where the sound is coming from and tries to grab it
 Softly grab child legs and make movements arms and legs in
round circles
 Allow your infant space to stretch their limbs by not covering
them tightly all the time
 Ensure what your child puts in the mouth is clean and safe to
put in the mouth12

13. 13
Examples of integrated messages
1. At 6 months of pregnancy your child can hear your voice; Talk to
unborn baby softly, sing, or tell stories, while gently massaging
your bell
2. Wash your hands with clean water and soap before breastfeeding
your baby
3. Talk and sing to your child while breastfeeding, to soothe
him/her to sleep
4. Look for cues the child is hungry before starts to cry (e.g. puts
fingers in the mouth, spits, looks what others are eating)
5. Feed your child slowly and patiently, make eye contact,
encourage and motivate the child to eat.
6. Softly grab child’s legs and make movements arms and legs in
round circles when changing his/her clothes, and after bathing
7. Encourage the child to smile, show child hands, fingers, toes
8. Give your child clean, safe household things to handle

14. Mood
Thoughts Activities
MY PERSONAL REALITY
Internal Reality
(in your mind)
Alone
External Reality
(In the world)
With Others
TheMothersand Babies Course
Developed By: Ricardo F. Muñoz, Ph.D., Huynh-Nhu Le, Ph.D.

15. Quasi-Experimental Design
Intervention
Area
Comparison
Area
Mothers and Babies Course
integrated into Neighbor Mother
Groups and Home Visits
X
Monthly Care Group &
Neighbor Mother Groups X X
Monthly Neighbor Mother Home
Visits X X
Facility-delivered ECD messages
X X
15

16. Data Collection Methods
 Structured questionnaire applied at baseline
 Pregnant women enrolled at baseline will also
be interviewed at 6-8 weeks after the birth of
child
 Structured questionnaire applied after 6
months (upon completion of Mothers and
Babies Course)
 Structured questionnaire applied after 12
months
16

17. Research Questions
 To what extent does the integration of the mothers and babies
course into a community-based child development intervention
affect:
 Attainment of age-appropriate developmental milestones among
children 0-23 months?
 Maternal mental well-being and maternal self-efficacy of
mothers of children 0-23 months?
 Uptake of key infant and young child feeding (IYCF) and
WASH behaviors of mothers of children 0-23 months?
 Uptake of early stimulation and positive parenting behaviors
of mothers of children 0-23 months?
 Uptake of health seeking of mothers of children 0-23 months?
17

18. 18

19. PCI’s Education Cascade Group Approach
PARTNERS IN DEVELOPMENT
F O U N D A T I O N

20. Education Cascade Group (ECG) Approach
 Part of PCI/Tanzania’s USDA-funded Food for Education III Project
(2016-2021)
 Early concept (Davis) as part of Food for the Hungry’s Child-
focused Community Transformation [CFCT] Model (2012)
 Later modified, integrating the Care Group approach with Partner
in Development Foundation (PIDF)’s Tūtū and Me Traveling
Preschool model.
 PCI pilot of the approach in 2017, scaling-up to 5,376 HHS (10%) in
2018, then to 27K and 54K HHs by 2020. Longitudinal study
starting in 2018.
 Testing mostly ECD-focused lesson plans in 2017/2018 and then will
integrate all health, nutrition and ECD lessons into one curricula.
 PCI’s main partners are PIDF, Hesperian Health Guides (46
lesson plans and imagery), School-to-School (PDI and impact
study), USDA, and the Tanzanian MOE and MOH.

21. Antecedents of the Approach
ECG Approach =
Care Groups +
Tūtū and Me Preschool Model
Tūtū and Me created because:
 More and more grandparents
take care of their
grandchildren in many parts
of the world:
 High cost of child care
 Cultural reasons

22. Basic Premise of Tūtū and Me
In order to improve
child outcomes, we
must increase adult
capabilities.
We want caregivers to be
their child’s first and
most influential teacher!

23. Why the Tūtū and Me model?
By the end of the 2014-2015 school year:
 97% of Tutu and Me children entering
school demonstrated school readiness by
scoring at the highest level for the Hawaii
State Student Readiness Assessment in
language and literacy.
 Caregivers showed significant gains in
affection, responsiveness, encouragement
and teaching of their preschool children.
 Piloting Tūtū: Kenya, Philippines,
Indonesia, Peru, & 85 YMCA programs in
23 US states.
Homeless camp in Hawaii

24. Tūtū and Me Model vs. ECGs
(Differences)
PIDF Tutu and Me PCI ECGs
Caregiver contact
frequency
Two-hour group meeting
twice a week
Two-hour biweekly group
meeting + one-hour biweekly
home visit
Teaching team
3 teaching staff members
working with about 20-30
children
One ECG Volunteer working
with 8 households with
preschool children (8-12
caregivers)
Location of Learning
Station Materials
Materials brought in by truck
to each session location,
unpacked and repacked.
Each ECGV will receive one
set of LSMs that they keep for
use at sessions.

25. Manager

26. First Teachers Group Session Outline
Step # Step name Time Allocated
1 Attendance, troubleshooting and Vital
Events
10 minutes
2 First Circle (Singing National, Welcome and
Commitment Songs; Caregiver Talk/Story;
Explaining the skills and milestones covered in the
lesson; Introducing new Learning Station
Materials)
(~20-30 mins)
3 Learning Station Time (children use stations) 30-60 mins
4 Clean up time 3 mins
5 Second Circle (Tanzanian Kiswahili Word;
Focused Letter; Song based on Theme; Storybook
Time; Caregiver Homework (instructions, barriers,
solutions, commitments)
(~20-30 minutes)
6 ECG Only: ECGVs practice the lesson in pairs ~15 minutes

27. ECG Lesson Plans
 35 primarily ECD-focused and 11 primarily
health / nutrition-focused lesson plans used in
First Teachers Group (FTG) sessions
(meetings)
 Lessons describe what to do during First Circle
and Second Circle, including regular caregiver
talks/stories, how to use the Learning Station
Materials (LSMs), and how caregivers should
replicate learning activities in the home.
Lessons will be open-source.
 Skills are taught including oral language, print
awareness, alphabet knowledge, phonological
awareness, and numeracy
 We are identifying cultural values and
community traditions that are then woven into
the lessons and the approach.

28. Most Learning Station Materials (kit) Numerical Rods and Simple Slate with Chalk

29. Sensory & Dramatic Play Materials Letter & Number Cards Rhythm and Physical Play Mats.
Letter & Picture Kiswahili Flashcards Stacking, Nesting, and Measuring Cans

30. ECG Activities
 Paid PCI Promoter meets with the ECG
Volunteers every 2 weeks for training on:
 how to promote pro-education
behaviors and attitudes and essential
health, nutrition and WASH behaviors
and
 how to teach caregivers activities used
to improve the school readiness of their
preschool children.
 Then ECGVs meet with caregivers of U5
children every week – half of contacts in
group (FTG) sessions, half through
home visits.
 Learning Station Materials may be
circulated to each HH over the course of
a year.

31. ECG Activities (cont.)
School-based preschool teachers and
Volunteer Student Aids (VSAs) will
also be taught to use the learning
station materials with children in
gov’t preschools.
The ECGVs, school-based preschool
teachers, and VSAs will be taught to
use simple checklists to monitor
children’s progressive attainment of
different child milestones.

32. Stay tuned…
 PCI will keep practitioners informed (through CORE)
about the progress of this project, and availability of
the Education Cascade Group Training Manual,
curricula, checklists and other tools.

33. Activity #1: Developing Draft Design Specifications for
Integration of ECD with Health/Nutrition
Take 15 mins to brainstorm on newsprint in your small
group draft design specifications for programs that
integrate ECD with health and nutrition.
Examples (only): “The best integrated
ECD/Health/Nutrition programs will…
 work with caregivers in groups no larger than 12;
 work most with those caregivers who spend the most time
with the child, even if they are not the parents;
 focus more on health/nutrition topics in the first two years
and more on ECD in years 3-5, but promote all topics in all
years;
 include observation of the child with recommendations
provided to the caregivers on which skills/milestones the
caregivers should focus on next;
 Include extensive use of learning toys and materials ….

34.  Take 10 minutes to brainstorm on newsprint both…
(1) the resources, resource people, and relationships
that your organization has and that you know of for
developing good ECD/Health/Nutrition integrated
programs; and
(2) current barriers to moving forward with more
integrated ECD/health/nutrition activities in our field
programs (especially in terms of “adding in” ECD)
Activity #2: (1) Resources and Resource People and (2)
Barriers to moving forward with Integrated models

35. Reporting out on Activities 1 & 2

36. Wrap-up
What are your top take-aways from this
session?
What are you suggestions for key next
steps/recommendations regarding the
development of integrated ECD/ Health/Nutrition
approaches?

37. Thanks!