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

1. Improving parenting skills in Chile: the evaluation of Nadie es Perfecto Emanuela Galasso Development Research Group The World Bank

2. 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

3. Socio-economic gradients in ECD: opportunities are determined early

4. 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

5. 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

6. 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

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

8. 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)

9. The evaluation design • From this list, invite the families to participate to the program: • Half invited to participate this year to NeP • 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)

10. The evaluation design Eligible list (by facilitator) protocols and informed consent to be cleared by the national Comité de Etica invited to participate to NeP In the first year (‘treatment’ group) Guaranteed to be invited to participate to NeP after 12 months (‘control’ group)

11. 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 • NEP plus (intensive) • 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

12. The evaluation timeline 2010 +6m +12m +3yrs baseline follow-up ( 2nd follow-up survey survey survey) intermediate START PROGRAM ACTIVITIES

13. 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?

14. 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

15. 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)

16. 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)