|
Field
Trial Status
|
Before
in_development
|
After
on_going
|
|
Field
Abstract
|
Before
The first years of life are characterized by a high degree of brain plasticity and form a critical period for skill development. Unfortunately, in developing countries, poverty and other risk factors undermine children’s full developmental potential due to the lack of stimulating, nurturing and responsive caregiving. Moreover, fathers are generally not actively engaged in co-parenting. Our goal is to implement a scalable group-based early childhood development (ECD) intervention and explore its complementarities with an additional father’s involvement component. This proposal seeks to conduct a feasibility and pilot study to adapt a proven ECD intervention (Reach-up and learn, RL) to the Indonesian context and design a complementary father’s co-parenting component by: i) identifying a scalable delivery mechanism; ii) adapting the RL curriculum to ensure cultural acceptability; iii) examining and adapting activities from proven father’s engagement programs; and iv) testing the interventions using a randomized control trial. This study will be conducted in 4 stages using focus-group discussions, in-depth interviews, and survey data collection. The results from this pilot will inform the design of a large-scale RCT, which will allow us to rigorously test the proposed interventions at a larger scale, paying special attention to feasibility, cost-effectiveness and sustainability of impacts.
|
After
The first years of life are characterized by a high degree of brain plasticity and form a critical period for skill development. Unfortunately, in developing countries, poverty and other risk factors undermine children’s full developmental potential due to the lack of stimulating, nurturing and responsive caregiving. Moreover, fathers are generally not actively engaged in co-parenting. Our goal is to implement a scalable group-based early childhood development (ECD) intervention and explore its complementarities with an additional father’s involvement component. This proposal seeks to conduct a feasibility and pilot study to adapt a proven ECD intervention (Reach-up and learn, RL) to the Indonesian context and design a complementary father’s co-parenting component by: i) identifying a scalable delivery mechanism; ii) adapting the RL curriculum to ensure cultural acceptability; iii) developing a paternal engagement curriculum; and iv) testing the interventions using a small-scale (pilot) randomized control trial. This study will be conducted in 4 stages: 1) Feasibility (Desk review, stakeholder engagement, and identification of the delivery mechanism); 2) Initial development of the RL package, including the paternal engagement component (in 4 villages); 3) Refinement of the RL package, including the paternal engagement component (pre-tested in 4 villages); 4) Small-scale pilot RCT in 30 villages. The results from this pilot will inform the design of a large-scale RCT, which will allow us to rigorously test the proposed interventions at a larger scale, paying special attention to feasibility, cost-effectiveness, and sustainability of impacts.
|
|
Field
Trial Start Date
|
Before
January 04, 2021
|
After
August 12, 2024
|
|
Field
Trial End Date
|
Before
December 31, 2022
|
After
February 01, 2026
|
|
Field
Last Published
|
Before
August 27, 2020 10:44 AM
|
After
July 18, 2025 11:30 AM
|
|
Field
Intervention (Public)
|
Before
Our first intervention will adapt and further test group-based Reach up and Learn (RL) to target 0 to 3 year olds from poor families in Indonesia. Poor families are identified as those eligible for the Indonesian CCT program.
Our second intervention corresponds to the adaptation of a complementary intervention that targets fathers' engagement in co-parenting. We will adapt activities from existing evidence-based programs. We will test if an intervention that targets mothers and fathers can produce complementarities to enhance child development.
|
After
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.
|
|
Field
Intervention Start Date
|
Before
December 01, 2021
|
After
November 01, 2024
|
|
Field
Intervention End Date
|
Before
June 30, 2022
|
After
August 15, 2025
|
|
Field
Primary Outcomes (End Points)
|
Before
Improved family inputs and home environment should support child development, and they are key first-order outcomes of our proposed intervention. To capture family inputs, enumerators will record parenting attitudes and items from UNICEF’s Family Care Indicators (Kariger et al., 2012) to capture the quality of the home environment. To measure parental knowledge (mothers and fathers) about child development, we will select items from the Knowledge of Infant Development Inventory (KIDI) (MacPhee, 1981). We will also assess parental self-efficacy using the Self-efficacy in the Caregiver Role Test– Modified (Pedersen et al., 1989; Porter and Hsu, 2003), which evaluates parental feelings while taking care of their children.
We also expect that our proposed interventions will improve children's human capital outcomes. For children’s physical health outcomes, we will measure height and weight. To capture children’s development, we will use the Ages and Stages Questionnaire.
We will also measure parents’ well-being using the Center for Epidemiologic Studies Depression Scale (CES-D) scale, bargaining power, knowledge on child development and maltreatment, and social networks. To measure women’s empowerment, we will rely on the existing body of validated instruments and behavioral games developed and tested by researchers in economics and psychology. We will review and adapt the questions compiled by Glennester, Walsh, and Diaz-Martin (2017). Overall, we will pilot and assess the reliability of the instruments, taking into account the Indonesian context. The survey instruments will also include demographic characteristics following the Indonesian Family Life Survey (Strauss et al, 2016).
|
After
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)
|
|
Field
Primary Outcomes (Explanation)
|
Before
Please see the previous item.
|
After
Please see the previous item.
|
|
Field
Experimental Design (Public)
|
Before
Our project will conduct both a small scale pilot RCT (to pre-test the interventions) and a large-scale RCT.
Prior to the pilot, we will perform a feasibility study using a mixed-methods approach to examine potential facilitators to deliver our proposed interventions taking into account how we can utilize existing infrastructure and personnel for cost-effectiveness and scalability.
In the small scale pilot, villages will be randomly assigned to either the control group or the following treatment arms. One treatment arm will be the adapted RL curriculum delivered in a group-based setting, with 8-12 families per group through weekly meetings ofr 6 months and one home visit per month. The other treatment arm will be the adapted RL complemented with the father co-parenting component, which will be delivered through weekend sessions for 3 months. Then villages in each treatment arm will be randomized to receive the intervention by two of the most promising facilitators, who will be identified from the mixed-methods analyses.
Based on the findings from the pilot study, we will identify the most promising facilitator and test our proposed interventions at a larger-scale. In the large-scale RCT, villages will also be randomized in to the three groups described above, however, the interventions will be delivered for 18 months.
|
After
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.
|
|
Field
Randomization Method
|
Before
For the pilot RCT, we will determine a list of eligible villages in two provinces and randomly select 24 villages. Then each of the 24 villages with be assigned to each of the three groups using randomization done in office by a computer.
For the large scale RCT, we will use triplet matching to randomly allocate villages to each of the intervention arms.
|
After
Randomization of villages to treatment arms will be done by research staff remotely using computer software.
|
|
Field
Randomization Unit
|
Before
The unit of randomization is the village
|
After
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.
|
|
Field
Planned Number of Clusters
|
Before
For the small pilot RCT, we will have 24 villages.
For the large-scale RCT, the treatment will be clustered, with 100 villages in each arm.
|
After
30 villages (clusters), 15 in control and 15 in treatment arms
|
|
Field
Planned Number of Observations
|
Before
For the smal pilot RCT, the sample size is 720 poor households with children ages 0-3 in 24 villages (according to administrative data, potential villages have an average of 30 CCT eligible families with children ages 0-3).
For the large-scale RCT, the sample size is: 9,000 poor families in 300 villages.
|
After
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.
|
|
Field
Sample size (or number of clusters) by treatment arms
|
Before
For the small pilot RCT: 8 villages in the control group. 8 villages in T1: RL only (4 villages delivered by Facilitator 1 and 4 villages delivered by Facilitator 2). 8 villages in T2: RL plus father's involvement (4 villages delivered by Facilitator 1 and 4 villages delivered by Facilitator 2).
For the large scale RCT: 100 villages in the control, 100 in T1 and 100 villages in T2
|
After
15 in control and 15 in treatment arms
|
|
Field
Power calculation: Minimum Detectable Effect Size for Main Outcomes
|
Before
The main goal of the pilot RCT is to generate proof-of-concept evidence to design the large-scale RCT.
For the large-scale RCT, assuming an intra-cluster correlation of 0.1-0.2 (based on data from other developing countries for similar outcomes), 80% power, 5% type I error and 10% attrition rate per cluster, the minimum detectable effect size is 0.15-0.2 SDs for parenting and children outcomes.
|
After
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.
|
|
Field
Keyword(s)
|
Before
Education, Health
|
After
Education, Health
|
|
Field
Intervention (Hidden)
|
Before
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 about 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. Most group adaptations include monthly home-visits to ensure parents’ engagement with the curriculum at home. An evaluation of a group-based RL shows better home stimulation and cognitive and socioemotional development (Attanasio et al., 2018). Also, the group-based approach will allow us to explore social capital and network as parents’ coping strategy (peer support) in ECD, which has not been studied.
RL has been adapted and implemented in other countries including Bangladesh, India, Colombia and Peru. The curriculum adaptation incorporated local games and songs and changed pictures in the books to reflect children’s environment (Grantham McGregor and Smith, 2016). The Reach Up toolkit includes a weekly curriculum; training manual with demonstration videos that were filmed in Jamaica, Peru, and Bangladesh; and a planning manual that helps countries tailor the program to their specific needs. We will further adapt and tailor RL to reflect children’s environment in Indonesia. We will address the cultural appropriateness of the intervention and foster current parenting practices that are culturally appropriate with the input of two local ECD developmental psychologists (Smith et al., 2018; Tomlinson and Andina, 2015; Kline, 2015; Callaghan et al, 2011; Rogoff et al, 2007).
Our second innovation is the adaptation of a complementary intervention. RL mainly focuses on children's cognitive stimulation, but its impacts may be larger if complemented with components that empower the family holistically to improve the child’s home environment. RL targets children’s primary caregiver, usually mothers, to increase inputs for child development, but family interactions and resource allocation depend on both parents. So, we will adapt activities from evidence-based programs like Father Support Programme, Parents with Respectability and Program P that promote positive socio-cultural norms and behaviors around co-parenting, addressing topics like bonding/attachment, positive discipline, and gender norms and socialization (Barker et. al., 2009; Baykal et. al., 2019; Siu et. al., 2017).
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 will assess potential delivery of our proposed interventions by family wellbeing development (PKK) cadres, young family development (BKB) cadres, mothers’ class facilitators, and ECD teachers. These facilitators already operate in the community and their support will be key to ensuring community buy-in and grassroots support for the intervention. Additionally, our partnership with the government is ideal to ensure policy goal alignment and identify the initiative that the intervention can piggy-back. In assessing the delivery method, we will consider the potential crowd-out of their current activities.
Conceptual framework
Our theory of change combines theoretical frameworks in developmental psychology and economics. From developmental psychology, the family system theory emphasizes how parenting and child development involve multidirectional relations and interactions between mothers, fathers and children, which are dependent on one another (Minuchin, 1985; J. Jeong et al., 2019). Another key framework is the social learning theory (Bandura, 1977), which theorized that parents and children learn through observation and practice. The ecological systems theory (Bronfenbrenner, 1986; Bronfenbrenner and Morris, 2007) postulates that the entire ecological system in a child’s and his/her environment influences his/her growth and development. This theory motivates the design of our proposed intervention by enhancing the mesosystem and exosystem: empowering the family and using community resources, through trained facilitators and group-based sessions, to impact child learning. Thus, we expect that our proposed intervention will improve family interactions and environment to boost child development.
From economics, our study is based on the human capital production theory and the importance of early investments (Cunha and Heckman, 2007; Becker 1993; Becker 2009). Child development requires inputs from mothers, fathers, and the child’s environment, including parental knowledge and time, material resources, and other community infrastructure. Human capital formation is dynamic across the life cycle, thus early life experiences have long-term consequences in later outcomes. Resource allocation for children also involves intrahousehold bargaining theory (Browning and Chiappori, 1998). Research shows that fathers have more decision-making power than mothers, but mothers have higher preferences on child wellbeing (Lundberg, Pollak, and Wales 1997). This tradeoff is more pronounced in LMICs where resources are limited and bargaining power is more imbalanced (Jayachandran, 2015; Bjorkman and Jayachandran, 2017). Thus, an intervention that targets mothers and fathers can produce complementarities to enhance child development.
Our pilot study will use a mixed-methods approach to assess the potential impacts of multifaceted interventions with these arms: C: Control, T1: RL, T2: RL+father's involvement. To address nutrition and incentivize participation, T1-T2 will include nutrition supplementation. Our pilot will provide foundational evidence for a large-scale study that will further rigorously test multiple impacts and propose a path to scale with government partnerships.
|
After
|
|
Field
Secondary Outcomes (End Points)
|
Before
|
After
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)
|
|
Field
Building on Existing Work
|
Before
|
After
No
|