Nurturing Parents and Children: an early stimulation and father's engagement intervention in Indonesia

Our project adapts and tests Reach Up and Learn (RL), a proven early childhood development intervention, for children aged 0 to 3 at risk of developmental delays due to poverty and malnutrition. Additionally, we develop a complementary co-parenting component to engage fathers in early childhood care and stimulation.
Our first innovation is to adapt and further test group-based Reach up and Learn (RL) to target 0 to 3-year-olds from poor families in Indonesia. RL is a proven ECD program that was first implemented in the 1980s in Jamaica using a structured early stimulation curriculum delivered through weekly home visits by community health workers (CHWs) for 2 years. Since the original individual approach can be challenging to scale-up, RL has been adapted to a group setting where it is delivered in small groups led by trained facilitators. Each group has 8 to 12 children and caregivers, and they usually meet for 18 months. The sessions teach mothers how to promote child development using low-cost and recycled materials.
Our second innovation is the adaptation of a complementary intervention that targets fathers’ engagement in early stimulation. While ECD interventions often focus on mothers, family decision-making and caregiving are shaped by both parents (Attanasio, et. al., 2022). We are developing a RL module for fathers by adapting activities from available curricula to actively involve fathers in co-parenting. Nurturing the family as a whole will promote positive socio-cultural norms and behaviors around co-parenting, addressing topics like attachment, positive discipline, and gender norms.
Our third innovation is to use existing infrastructure and personnel in the community as the delivery mechanism for cost-effectiveness, scalability, and grassroots support. We aim to pilot the use of local facilitators—i.e. BKB cadres—who are already engaged in parenting support activities at the community level. These facilitators are familiar with local families and have experience conducting sessions through programs like BKB and Posyandu. By building on existing workforce, we can reduce implementation costs and increase the feasibility of integrating the program into local systems.
Our project aims to test the feasibility and implementation logistics of the adapted RL curriculum and the new fathers’ component and to test first-order impacts on parenting outcomes. The pilot uses a small-scale RCT in Bojonegoro district (East-Java). Our target population is low-income households with children aged 6 to 36 months, identified through their current participation in government welfare programs, including conditional cash transfers, public health insurance, and food social assistance programs. We target low SES families, as their young children are at risk of not attaining their full developmental potential due to poverty and malnutrition.

Our treatment is RL for both mothers and fathers delivered in a group-based setting, with 8 families per group. Mothers are invited to participate in bi-weekly meetings for 6 months (excluding the Ramadan period), while fathers are invited to participate in monthly meetings. In addition, families receive reminders before each session and recap messages in between sessions to reinforce key learnings. To incentivize participation and address nutrition, both mothers and fathers receive a small nutrition supplementation package at each session. Moreover, since conducting sessions during the Ramadan period is not feasible, we will send reminder texts to both mothers and fathers.

RL sessions facilitators: We prioritize Bina Keluarga Balita (BKB) cadres to deliver the intervention as their roles and responsibilities in the villages align well with the objective of the RL program. BKB (Young Family Development) cadres are local facilitators from the National Population and Family Planning Board/Badan Kependudukan dan Keluarga Berencana Nasional (BKKBN), our champion ministry. However, to ensure scalability, we have developed a menu of facilitators that can be adapted in the larger scale-up using other cadres in the communities. For the pilot RCT, facilitators are recruited and trained by the local research team using the RL combined curriculum. The local research team also acts as supervisors and provides ongoing coaching to ensure the quality delivery of the sessions.

The results of this feasibility and pilot study will inform the design of a large-scale RCT to evaluate the full intervention and further test the complementarities of parental inputs on child development.

Note: This trial was initially registered before funding was secured. As funding took time to obtain, the study’s design and objectives evolved from the original version.

2024-11-01

2025-08-15

Improved family inputs and home environment should support child development, and they are key first-order outcomes of our proposed intervention.
Our first-order outcomes of interest include mothers' and fathers’ parenting knowledge, attitudes, and practices, which are expected to respond after 6-months and which have been proven as mechanisms of child development. The following are our main outcomes domains and instruments:
1. Parenting knowledge: Child rearing Knowledge instrument developed by Reach-Up team.
2. Beliefs /attitudes: Parental Cognitions and Conduct Toward the Infant Scale (PACOTIS)
3. Parental self-efficacy: Parenting sense of competence scale.
4. Practices and behaviors: UNICEF Family Care Indicators (FCI)

Please see the previous item.

1. Child discipline (child discipline module in the MICS )
2. Coparenting: Coparenting Relationship Scale (CRS)
3. Father and mother well-being: Depression (Center for Epidemiologic Studies Depression Scale ); Anxiety (GADS7)

Our small-scale pilot RCT takes place in Bojonegoro district (East Java province). Villages were screened for eligibility based on the following criteria: (1) at least 1 ECD center; (2) at least 1 Posyandu (health post); and (3) at least 20 welfare-recipient households with children under 6-30 months (2021 DTKS social welfare data). The last criterion allows us to form 2 groups of 8 families each, with at least 4 families as replacements (in case of no consent or current ineligibility). We identified 138 eligible villages, which were stratified by: (1) below and above the median number of HHs in welfare with children 0-3, and (2) below and above the median number of Posyandus. The last variable captures village socio-economic size (availability of services). We ensured that the selected villages are located beyond 1.5 kilometers of each other to minimize contamination. We sampled 15 quadruplets (total of 60 villages) and randomly assigned 2 villages (pairs) to the main/replacement samples (30 villages in each treatment-control group).
We conducted a household listing in the 30 villages to verify the current number of welfare-recipient families with young children in our target age group, as well as the availability of BKB cadres to facilitate the sessions (and the presence of other cadres in case BKB facilitators cannot be used). In each village, using the household listing, we stratified eligible families by hamlet (neighborhood) and randomly chose 16 eligible families to form two groups of 8 families to receive the intervention. In cases where villages have more than 20 families, we prioritized hamlets that are nearby to facilitate intervention implementation. After collecting consent and a small baseline survey, villages were randomly assigned to two groups:
-Control: 15 villages continue with existing government programming (light-touch parenting support).
-Treatment: 15 villages receive the adapted RL parenting program for both mothers and fathers.

Our target sample corresponds to 16 families per village for a total of 480 families (240 treatment, 240 control). An intent-to-treat (ITT) analysis will be conducted.

Randomization of villages to treatment arms will be done by research staff remotely using computer software.

Randomization was carried out at the village level. Treatment is clustered at the village level, hand in hand with the choice of unit of randomization.

Yes

30 villages (clusters), 15 in control and 15 in treatment arms

Our total target sample corresponds to 16 families per village for a total of 480 families (240 treatment, 240 control) with children aged 6-28 months at the start of the intervention. Families are identified through their current participation in government welfare programs, including conditional cash transfers, public health insurance, and food social assistance programs. At the end of the pilot intervention, we will survey 16 families per village, totaling 480 families (240 treatment, 240 control). We will survey both the mother (or primary female caregiver) and the father (or primary male caregiver), resulting in 960 respondents. We will also conduct in-depth interviews and focus groups with facilitators and a sample of parents to gather feedback on the implementation of the RL curriculum and the father component.

15 in control and 15 in treatment arms

With 15 villages per arm and a cluster size of 16 households (significance level: 5%, power: 80%): -Assuming an intra-cluster correlation (ICC) of 0.05, the minimum detectable effect size (MDES) is 0.34 standard deviations (SDs). -Assuming an ICC of 0.10, the MDES is 0.42 SDs. -The assumed ICCs are based on RL studies in Bangladesh and Colombia, respectively. For reference, a recent meta-analysis of 17 RL trials reports an average effect size on parenting and home stimulation—our first-order outcomes of interest—of 0.37 SDs [95% CI: 0.21, 0.54]. Our pilot RCT tests the adaptation of RL in the Indonesian context and the newly developed father engagement component. In addition to examining first-order impacts on parenting and home stimulation, another important component of this pilot is a process evaluation, which assesses the implementation processes and intervention delivery using existing government infrastructure for 6 months. Our pilot RCT aims to serve as proof-of-concept for a larger-scale, full impact evaluation that will last 18 months. Given the pilot nature of the study, one goal is to refine intervention delivery and study protocols for a subsequent, fully powered, large-scale impact evaluation that will assess impacts on family inputs, family well-being, and children's skill development.