Emanuela GalassoDevelopment Research Group

The World Bank

Improving parenting skills in Chile: the evaluation of Nadie es Perfecto

Why parenting skills? Believed to have a key role in fostering the development of

children

Parents might not have the information or psychosocial wellbeing to support them in adopting healthy and positive parenting practices

Socio-economic gradients in ECD outcomes emerge early and increase with ageParenting account for a significant fraction of the socio-economic gradients

in early childhood outcomes

Socio-economic gradients in ECD: opportunities are determined early

Nadie es Perfecto (NeP)Component of Chile Crece Contigo aiming at

improving parenting skills NeP adapted from a large scale program in Canada

offered since the 1980sTargets families with children 0-5

Universal to all families accessing public healthPreferential to household with vulnerabilities

Group based parent education sessions (6-8)Structured sessions led by a trained facilitatorsAdult education strategies to enhance participation

Program perspective: Why evaluate?Key learning tool: use the evaluation to feed back into

the design of the program during its scaling up phaseCan be a key tool to assess the relative effectiveness

of alternative service delivery mechanismsAllow to rigourously quantify (short term and

projected long term) benefits, to be combined to cost data to measure cost-effectiveness

General perspective: why evaluate NeP?Knowledge gap on the effectiveness of ECD

interventions:early childhood developments interventions that involve

home visits combined with intensive opportunities for skill building have been shown to have high returns -often associated with high costs.

Very little rigourous evidence on parenting interventions. Relatively lower costs Improved parenting practices. Do they improve child outcomes?

Use evaluations to improve our understanding of key determinants of parental behavior and investment in children

Engle et al (2007), LANCET series on early childhood development highlights parenting interventions as one of the key research gaps

The evaluation design As the program is able to cover at the beginning only

a small fraction of the target population, build in the evaluation on the current methodology of enrolling families:

Control de salud sano as the key contact point with the families

For each facilitator: identify a list of “potential” participants among the target population jointly with the health team (applied using the inclusion-exclusion criteria)

Use this list as the sampling frame for the evaluation (lista de espera)

The evaluation design From this list, invite the families to participate to the

program:1. Half invited to participate this year to NeP2. Half invited to participate one year from now

(access to unstructured parenting sessions) Given the large list of potentially eligible participants

into the program, not able to cover all at the same time, assign eligibles participants to the the two groups randomly

Power calculations (250 facilitators, 6 children each group, effect size 0.25 SD for participants)

The evaluation designEligible list (by facilitator)

protocols and informed consent to be cleared by the national Comité de Etica

invited to participate to NePIn the first year(‘treatment’ group)

Guaranteed to be invited to participate to NeP after 12 months(‘control’ group)

The evaluation design Can reproduce the same protocol to assign an

‘intensive’ version of NeP (ex. group parenting + extra session(s) with children)

Would allow us to have three groups1. NEP basic2. NEP plus (intensive)3. Control group (access to non structured education

sessions)

(1) vs (3) and (2) vs (3) allow to quantify returns (1) vs (2) allows to relative effectiveness

The evaluation timeline 2010 +6m +12m

+3yrs

baseline follow-up ( 2nd follow-up

survey surveysurvey)

intermediateSTART PROGRAM ACTIVITIES

Questions addressed by the evaluationDoes the parenting program improve knowledge and

behavior in parenting practices? Does the program improve the mental well being of

mothers, parental psychosocial distress, perceived social support?

Do the improved practices translate in improved child health and safety?

Do the improved practices and mental health translate into proved child development outcomes?

What is the value-added of increased intensity on the same outcomes?

Who is going to take-up the program? Take-up of unstructured parent education session is

about 50%Parents self-select based on the expected gains and

the knowledge/awareness of the benefitsAwareness of the importance of parenting expected

to be higher in families with older children (3-5)Aim at reaching the younger cohorts (0-2)

Discussing an enhanced contact protocol to increase participation the younger subgroup

Outcome indicators (tbd)Parenting: knowledge, attitudes and practices (HOME)

and Parent-Child interaction (observed play)Parental mental health and psychosocial well-beingPerceived social supportChild development outcomes:

Self report (Ages and Stages questionnaire) all ages Direct tests younger children 0-2S (Bayley’s)Direct tests 3-5 on specific sub-domains: Receptive language (TVIP)Socio-emotional developmentExecutive function (attention, working memory,

inhibition)

Evaluation teamSecretaria Ejecutiva Nadie es Perfecto MINSAL

(Miguel Cordero, Cecilia Moraga, Felipe Arriet)Evaluation unit, Division Social MIDEPLAN (Rodrigo

Herrera, Paula Castro)Universidad Catolica de Chile, Departamento de Salud

Publica (Paula Bedregal)Pedro Carneiro (Department of Economics University

College London), Emanuela Galasso (Research Department, The World Bank)