Improving parenting skills in Chile: the
evaluation of Nadie es Perfecto
Emanuela Galasso
Development Research Group
The World Bank
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 age
 Parenting 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 1980s
 Targets families with children 0-5
 Universal to all families accessing public health
 Preferential to household with vulnerabilities
 Group based parent education sessions (6-8)
 Structured sessions led by a trained facilitators
 Adult 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 phase
 Can be a key tool to assess the relative effectiveness
of alternative service delivery mechanisms
 Allow 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:
Half invited to participate this year to NeP
2. Half invited to participate one year from now
(access to unstructured parenting sessions)
1.


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 design
Eligible list (by facilitator)
invited to participate to NeP
In the first year
(‘treatment’ group)
Guaranteed to be invited to participate
to NeP after 12 months
(‘control’ group)
protocols and informed consent to be cleared by the
national Comité de Etica
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 groups


NEP basic
2. NEP plus (intensive)
3. Control group (access to non structured education
sessions)
1.


(1) vs (3) and (2) vs (3) allow to quantify returns
(1) vs (2) allows to relative effectiveness
The evaluation timeline
2010
+6m +12m
baseline
follow-up
survey
survey
intermediate
START PROGRAM ACTIVITIES
+3yrs
( 2nd follow-up
survey)
Questions addressed by the evaluation
 Does 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 benefits
 Awareness 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-being
 Perceived social support
 Child 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 development
 Executive function (attention, working memory,
inhibition)
Evaluation team
 Secretaria 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)