Investing in Quality in Global
Early Childhood Development:
Parent-Focused, CenterBased and Systems Levels
Hirokazu Yoshikawa, Ph.D.
Harvard Graduate School of Education
August 27, 2012
South Asian Regional Conference on Early
Childhood Care and Education
New Delhi, India
Overview
• Rationale for investing in quality:
Neuroscientific, biological and evaluation
sciences
• Examples of quality investment in ECD:
1) Parent-focused programs – investing
in the relationship
2) Center-based programs – investing in
the social setting
3) Systems-level – quality in
governance and finance of ECD
systems
RATIONALE FOR INVESTING
IN ECD QUALITY
NEUROLOGICAL AND BIOLOGICAL
PERSPECTIVES
The Importance of Early Childhood
The healthy development of all young
children benefits all of society by
providing a solid foundation for
responsible citizenship, strong
communities, and a productive nation.
Core Concepts of ECD
Brains are built over time, neural circuits are
wired in a bottom-up sequence, and the
capacity for change decreases with age.
The interaction of genes and experience shapes
the architecture of the developing brain, and a
primary active agent is the “serve and return”
nature of children’s relationships with the
important adults in their lives.
The Rationale for Quality
New data from neuroscience, genetics and
biological sciences indicate that early enriched
environments can mitigate effects of
disadvantage on later cognitive outcomes,
mental health, and executive functioning.
The new science of the benefits of enriched early
environments suggests an important rationale for
investments in the quality of ECD services, with
particular attention to the most vulnerable children
and families (Britto, Yoshikawa, & Boller, 2011;
Engle et al., 2011; Kaul & Sankar, 2009).
Socioeconomic Status and Child
Development (Hackman, Farah, & Meaney, 2010,
Nature Reviews: Neuroscience; Yoshikawa, Aber, & Beardslee,
2012, American Psychologist)
Mechanisms of Long-Term Effects of Enriched
Early Environments
(Hackman, Farah, & Meaney, 2010)
• Changes in gene expression associated with
fear responses
• Changes in HPA axis functioning (more
adaptive stress responses)
• Neuronal growth factors and synaptic
density
• Increased fetal and infant growth
How Early Experiences Alter Gene
Expression and Shape Development
Neuron
Genes Carry Instructions that Tell
Our Bodies How to Work
Gene
Nucleus
DNA
Chromosome
Early Experiences Leave Lasting
Chemical “Signatures” on Genes
External
Experience
Gene
Regulatory
Proteins
Epigenetic
“Signature”
Turns Gene
On or Off
Early Enrichment Prevents
Stress-Induced Cognitive Disruption
(Cui et al., 2006, Neuroscience Letters)
90
remediation
Correct choices on
memory test
75
“normal” range
60
45
Normal
Normal +
Early
Stress
Enriched
Environment
Early Stress +
Enriched
Environment
Source: Cue et al. (2006)
Timing of Enrichment in the
Context of Severe Disadvantage
Bucharest Early Intervention Program (Nelson et al.,
2007, Science)
100
IQ/DQ
(Mean)
Tested at 3 1/2 Years Old
Tested at 4 1/2 Years Old
“normal” range
90
“normal” range
80
70
60
0-18 18-24 24-30 30+
0-18 18-24 24-30 30+
Age of placement in foster care (months)
Source: Nelson et al. (2007)
Monitoring, assessing and investing in
quality (UNESCO & UNICEF, End of Decade Review)
• Quality of ECD is not assessed solely
through child outcomes, but by assessing
effectiveness factors in:
Relationships (e.g., home visitor-parent)
Settings (e.g., parent or child groups; preschools)
Larger systems (of support and training; policy
implementation; finance and data systems)
• A new generation of research on ECD quality
improvement is emerging: Compare services
with specific investments in quality
improvement to services without (rather
than comparing ECD services to no services)
INVESTMENT IN THE
RELATIONSHIP: ECD QUALITY
IN PARENT-FOCUSED
PROGRAMS
[EFFECTIVENESS FACTOR:
RESPONSIVENESS AND SENSITIVITY]
EXAMPLES FROM BANGLADESH,
PAKISTAN AND COLOMBIA
Example from Bangladesh
• Hamadani, Huda, Kharun, & GranthamMcGregor (2006): cluster-randomized trial
of community health centers
• Nutrition supplementation only
• Nutrition supplementation + parent-child
stimulation component.
• Combination of supplementation and
stimulation: Increased children’s overall
cognitive development (Bayley MDI).
Example from Pakistan
• LHW community health worker program –
proven positive impacts on infant mortality
(Bhutta et al., 2011)
• Pehla Qadam (Aisha Yousafzai):
• Support for lady health workers implementing
preventive and promotive nutrition and health
education and links to primary care (incl. Care
for Development module)
• Mentorship, coaching, community sensitization
• Sensitivity and responsiveness in the facilitator
– LHW relationship parallels target of sensitivity
and responsiveness in the LHW – parent
relationship
• Randomized evaluation
Example from Colombia (Bernal, 2010)
• Hogares Comunitarios: Challenges of
community-based child care quality given
education level of the community caregivers
• Development of intensive certification / training
in ECD for caregivers (ICBC, Inst Colomb de
Bienestar Fam and SENA) – classes, group and
individual work (3 semesters, classes 3 nights a
week)
• Controlled comparison of caregivers with and
without this training:
• Positive impacts on quality as measured by
FDCRS; reductions in diarrhea and incidence of
flu / colds; increases in communication; motor
development, and socio-emotional development
(ASQ reported by parents)
Didactic course only effective when accompanied by
on-site coaching for center- and home-based child
care providers (Neuman & Cunningham, 2009)
115
Early
Childhood
Language
Teaching
Strategies
(ELLCO)
110
105
100
95
PD only-C
90
PD +Coaching-C
Control-C
85
Pre
Post
Neuman & Cunningham, 2009; similar findings: Landry, Crawford, Gunnewink,
& Swank, 2001
Emerging Principles from Quality Improvement
of Home- and Community-Based Programs
• Psychosocial and cognitive stimulation
added as component to nutritional programs
improves impacts on children’s cognitive
development (Engle et al., 2011)
• Effectiveness factors / active ingredients –
emphasis on sensitivity, responsiveness and
language interaction
• In professional development for visitors /
community mothers / health promoters –
incorporate same sensitivity and
responsiveness in trainer relationship with
visitors / mothers / promoters
INVESTMENT IN THE SOCIAL
SETTING: ECD QUALITY IN
CENTER-BASED PROGRAMS
[EFFECTIVENESS FACTOR:
EDUCATIONAL PROCESS QUALITY]
EXAMPLES FROM CAMBODIA, CHILE,
BANGLADESH, USA
Cambodia: Level of Investment in preschool
education matters
• Rao et al., 2007, 2011 Child Development:
• Comparison of children in 3 programs of
preschool education with different levels of
quality investment, intensity:
• State preschool (highest training, funding)
• Community preschool and Home-based
program (lower training, funding)
• Children in all 3 programs – better cognitive
and motor development than those in none
• Children in State preschool better outcome
than Community or Home-based
Chile: Un Buen Comienzo
• Un Buen Comienzo
• Teacher professional development through
coaching to improve children’s language and
respiratory health outcomes
• Based on model proven in Costa Rica (Rolla,
2011)
Cycle of coaching each month
12 cycles in 2
years of program
ACOMPAÑAMIENTO
PRE
ACOMPAÑAMIENTO
POST
Group
Reflection
Mtg (Every 2
Didactic
Workshop
Acompañamie
nto 2:
Acompañamie
nto 1:
Implementing
Modeling
months)
Design of UBC impact evaluation
• Low-income municipalities of Santiago, Chile
• 1868 4-year-olds in 64 schools; 91 classrooms; 119
teachers in total sample
• Cluster-randomized trial with 64 preschools (Moreno &
Lugo-Gil, 2008) randomly assigned to:
• Condition 1) Full UBC condition
• Condition 2) Comparison condition (minimal program:
stress reduction class; books provided to classrooms)
• Principal mediator: CLASS assessment of educational
process quality
Focus on educational process quality as
effectiveness factor, in addition to structural
• CLASS Subscales of process quality:
• Emotional support:
• Shared activities, positive emotion and expectations, warm,
respectful interactions
• Productive time use:
• Learning activities with few disruptions, clear instructions, brief
transitions, lesson and material preparation
• Instructional support:
• Open-ended questions and prompts, responsiveness, problem
solving,, elaboration, cplanning, back-and-forth exchanges
27
Figure 1. Effect sizes for impacts on classroom quality: CLASS dimensions and number
of books.
1.00
0.80
0.77***
0.61~
0.60
0.51**
0.41~
0.40
0.28
0.20
0.00
Emotional
support
Apoyo
emocional
-0.20
Instructional
support
Behavior
Apoyo instruccional
Manejo management
de la conducta
Productive
time use
Uso
productivo
del
tiempo
Number
booksen sala
Total
de of
libros
-0.40
-0.60
-0.80
-1.00
Statistical significance levels are indicated as ~ = .10, * = 0.05, ** = 0.01, *** = 0.001
Bangladesh: Quality improvement for
language and math skills
• Opel, Ameer, & Aboud, 2009, International
Journal of Educational Research:
• Dialogic Reading training for preschool
teachers.
• Post-test positive impact on vocabulary
• Opel, Khanom, Zanam, & Aboud, 2010:
• Interactive math activity training for
preschool teachers and children:
• Positive Impacts on math skills
Boston: Quality Improvement in Lang+Math at
Scale with Impacts on Lang, Math, Exec Function
• Weiland & Yoshikawa, 2012
• Combined language (OWL) and math curricula
(Building Blocks) + coaching at scale across 76
public preschools serving largely low-income
families
• Evaluation at scale using regressiondiscontinuity design based on birthday cutoff
• Moderate to large, positive impacts on
vocabulary, letter-word identification, all
dimensions of math skills
• Small, positive effects on 3 dimensions of
executive function: inhibitory control, working
memory, cognitive flexibility
Principles of Quality Improvement in Centers
/ Preschools
• Curricula matter – those with
developmental relevance, implemented
with activities that children and teachers
enjoy (structure + play), aligned with ECD
learning standards
• Process quality in ECE can be increased
through in-service training provided onsite in classrooms
• Combination of developmentally focused
curricula and coaching can be
implemented at scale
INVESTMENT IN SYSTEMS:
QUALITY IN THE
GOVERNANCE AND FINANCE
OF ECD
EXAMPLES FROM PERU, INDIA AND
BANGLADESH
Quality Governance and Finance:
Systems-Level Effectiveness Factors
• Political will and collaborative policy process
(national action planning in ECD)
• A causal theory for strategic investment and
intervention
• Child budgeting (Kaul & Sankar, 2010;
Purkayastha, 2010) + Performance-based
budgeting (Carlin & Guthrie, 2001,
International Public Mgmt Reform)
• Strategic differential investments to address
state, local, population disparities
• Building local and subnational data systems
• Front-line provider and community
involvement in quality improvement
The fight against chronic child
maltnutrition in Peru (Luna; Garatea; Abogattás)
• Leadership across government and civil
society (e.g., Mesa de Concertación de la
Lucha Contra la Pobreza)
• Legislation with approved budget and
increased investments to achieve specific
ECD goals (in context of rapidly expanding
economy)
• Commitment of ministries of finance +
sectoral ministries
• Ministry of finance particularly powerful –
institutional integration into this ministry of
ECD priority was key
Logic Model for Strategic Support to Reduce Chronic Malnutrition
Key INTERVENTIONS
Productos [Servicios]
RESULTADOS
CAUSAL MECHANISMS AND RESULTS
inmediatos
intermedios
finales
↑ Vacuna
1
Anti Rotavirus
Anti Neumococo
Three Key Practices
↑ CRED
[control de crecimiento y desarrollo]
Counseling
Educational Sessions
2
Demonstration
Sessions
↑ Hand Washing
Higiene
Madres de niños
menores de 24 meses
↑ up to 6 mos:
Breastfeeding
Madres de niños
menores de 6 meses
↓ Diarrea
↓
Infecciones
Respiratorias Agudas
Niños menores
de 24 meses
↓
Chronic
Malnutrition
Niños menores de
60 meses
↑ Calidad de la
la dieta
Niños de
6 a 24 meses
↑ Nutritional
Suppl 6-24mos
Niños de
de 6 a 24 meses
… si alcanzamos coberturas mayores al 80% en las dos
intervenciones claves podríamos reducir la desnutrición crónica
de 49% a 35% puntos al 2016
Click aquí
para regresar
2007-2008: No Alignment between Need and Spending at Regional Level re: Child Malnutrition
Monto asignado en Enero 2008
por los gobiernos regionales para
Reducir la desnutrición crónica
(expresado en soles por niño menor de 5 años)
Valor de la Prevalencia de
Desnutrición Crónica al 2007
2010: Alignment between Regional Need and Spending
Prevalencia
Desnutrición
Crónica (%)
PIA 2009: 1,052 M
PIA 2010: 1,535 M
Incremento 50%
Hay un Incremento
Focalizado del
presupuesto
Presupuesto por niño menor de 36 meses
+ Increases in funding for component products /
services, 2009-2010
…. para las intervenciones que rigurosamente han sido probadas que son eficaces ….
Intervention [Product/ Service]
2009
33254 Children with Complete Vaccinations For Age
Introducción de nuevas vacunas para prevenir las infecciones respiratorias
agudas y las diarreas en menores de 24 meses
33255 Children with CRED (complete growth and
development monitoring charts) completo según edad
2010
Increase
165 M
420 M
+254%
20 M
86 M
+432%
Incrementar sustancialmente la cobertura del control del crecimiento y
desarrollo de los niños para promover en el hogar las tres prácticas claves
de cuidado y alimentación del menor de 36 meses: lavado de manos,
lactancia materna exclusiva y la adecuado alimentación del menor .
…. Conditioned on:
• Programming and budgeting on the part of health centers
• Standardized “recipe” for services with room for local adaptation
INSUMO
Investment in Human Resources to Support Products/Services
(Growth in Hiring of Nurses for Local Health Centers)
En el 2010
crece rápidamente
En el 2008 no
se observa
cambios
En el 2009
se observa
cambios lentos
… el indicador de ejecución presupuestal vinculado con el PRODUCTO y con su
insumo crítico, se mide desde el inicio del año, mes por mes..
The Role of Data in Governance and Finance
of Peru’s Child Malnutrition Policies
• Dissemination of new data platform for
reporting numbers of children in need of
preventive measures re: malnutrition – at
the local level (each health center)
• Transparency of data allocation and
expenditures by budget line (Transparencia
Económica website updated daily; % of the
year’s allocation spent to date visible to
public)
• Data available for each budget line for
nation and for each region
Results: Reductions in Rates of
Chronic Malnutrition in Peru’s Children, 20072010
25%
PpR
20%
16%
15%
10%
7%
5%
0%
2007-1 2007-2 2007-3 2007-4 2008-1 2008-2 2008-3 2008-4 2009-1 2009-2 2009-3 2009-4 2010-1 2010-2
Lim. Superior
Lim. Inferior
Prob. desnutrición (y=1)
Cohorte de nacimiento
La probabilidad de un niño promedio de sufrir de desnutrición crónica disminuye
significativamente para los niños que nacieron a partir del 2008, controlando por otras
características del niño, del hogar, de la comunidad y de intervenciones como juntos y
SIS. La reducción en la probabilidad de sufrir de desnutrición de los niños que nacieron
en 2010-2 respecto a los que nacieron en 2007-4 es del 60%
Community and provider involvement in quality
improvement (Kaul & Sankar, 2009; UNICEF &
UNESCO, End of Decade Review, 2012)
• 1) Community involvement in service
provision and improvement: Local Resource
Groups in UNICEF’s Dular project, building
on ICDS (Dubowitz et al., 2007, Food and
Nutrition Bulletin); Mother-tongue
instruction in Bangladesh (Vijayakumar et
al., 2010)
• 2) Continuous Quality Improvement
approaches (Institute for Healthcare
Improvement; Berwick, 2003 JAMA):
Involvement of providers, local stakeholders in rapid
PDSA (Plan-Do-Study-Act) cycles utilized in Un
Buen Comienzo expansion, Region VI of Chile)
Next directions in the quality imperative in
ECD
* Parent human capital development + ECD
services
• Bhutan – UNICEF-supported non-formal
education (NFE) + ECD program
• Tulsa, Oklahoma – CareerAdvance program
– parent sector-specific workforce
development + Head Start ECE (King,
Glover, Chase-Lansdale, Yoshikawa)
* Integration of social protection / income
support and CCT with ECD
* Integration of intensive attention to children
with disabilities
Conclusions
• From increasing access to improving quality: The
next challenge in global ECD.
• Rationale for improving quality – from
neuroscience, biological and evaluation sciences
• At the level of parent or center-based programs:
Focus on responsiveness of interactions between
trainer and community mother; community
mother and parent as well as didactic content;
educational process quality in centers as well as
developmentally focused curricula.
• At the level of ECD governance and finance:
Strategic investments in capacity building at state
and local levels; results-based budgeting; data
system development; community involvement
Thanks
• Core Funder of UBC: Fundación Educacional
Oportunidad (seed funding: World Bank; UNICEF Chile
office; Harvard Center on the Developing Child and
HGSE); thanks to collaborators at Universidad Diego
Portales and Mathematica Policy Research
• Funders of Governance and Finance in Early Childhood
Development project: UNICEF Innocenti Research
Centre; Bernard Van Leer Foundation; and thanks to
collaborators Pia Britto and Jan Van Ravens
• Students / advisees: Soojin Oh, Ana Maria Nieto, Diana
Leyva, Mary Catherine Arbour, M. Clara Barata,
Christina Weiland, Celia Gomez, Nikhit D’Sa, Constanza
Gonzalez Parrao