BRIEF

Does a Home Visiting Program in Early Childhood Have Sustained Effects on Development Two Years After It Ends? Evidence from Colombia

October 3, 2016



In Colombia, researchers evaluated the medium-term effects of a home-based early childhood development intervention. The program sought to improve nutrition and development in the first two years of life through home visits to encourage children’s psycho-social development and use of micronutrient supplements. The findings are useful to help policymakers and others understand the extent to which nutrition and parental involvement at an early age can carry lasting effects into the medium term and issues around scaling up  such programs effectively for long-term impact.

 

Research area: Early Childhood Nutrition, Development, and Health
Country: Colombia
Evaluation Sample: 1,429 children 
Timeline: 2012 - 2015 (Completed)
Intervention: Psychosocial stimulation, home visits, micronutrient supplementation
Researchers: Orazio Attanasio, University College London and Institute for Fiscal Studies; Emla Fitzsimons, Institute for Fiscal Studies and Institute for Education; Emanuela Galasso, World Bank; Sally Grantham-McGregor, UCL Institute of Child Health; original researcher in the Jamaica study; Costas Meghir, Yale University and Institute for Fiscal Studies; Marta Rubio-Codina, Institute for Fiscal Studies, London; 

 

Development experts and educators know that stimulation programs for very young children are important to development and school readiness. Verbal interaction boosts vocabulary and mental development; playtime builds important physical and mental skills; and praise from a parent creates confidence and security.  As shown by the long-term study of children in Jamaica whose mothers received weekly home visits by trained health workers who showed them how to play and talk to their toddlers (read the Evidence to Policy note on the evaluation), gains go beyond better grades. Nearly 20 years later, the children -- now young adults -- were earning as much as their non-disadvantaged peers. What’s not known is how to structure these programs so that they are cost-effective and still deliver the right impact, and whether linking programs with nutritional supplements or nutritional education is important. 

This project, a follow-up evaluation of a pilot intervention that delivered psychosocial stimulation and micronutrient supplements at scale in Colombia, will help policymakers and development experts around the world improve the design of cost-effective and scalable strategies for successful early childhood development programs.

Context

Researchers piloted an 18-month early childhood intervention for poor children in 96 semi-urban municipalities in Colombia in 2010-2011. Mothers of young children received weekly home visits in which they were taught how to play and talk to their children. Some also received nutritional supplements for their children, while one group received nutritional supplements alone. The intervention used the infrastructure of the country’s existing conditional cash transfer program for the country’s poorest, Familias en Acción, to target families and deliver the services.

The first follow-up survey in 2011 showed that the stimulation led to gains in children’s cognitive development and in receptive language skills (which refers to the ability to understand and process one hears or reads). The micronutrient supplements had no significant effect, neither alone nor when paired with the stimulation.

This second follow-up survey measured whether the gains were maintained two years after the program ended. The results showed that gains faded out.  It is possible that the initial effects on child development were too small to be sustained, or that the lack of continued home stimulation support contributed to fade out. While a number of pilots have shown a continued impact of home stimulation programs --- and this intervention was based on a model implemented in Jamaica  – implementation issues at scale are very different from small pilots. Understanding the differences and how to strengthen at scale will be key for turning early childhood development interventions into effective tools for policymakers.


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Photo: World Bank

Evaluation

This follow-up evaluation sought to identify the medium-term impact on children two years after families stopped receiving the visits by measuring the children’s development skills. At the time of the second follow up (September-December 2013) the children were between four and a half and five and a half years old, and about to enter primary school. Tests focused on cognitive, language, and socio-emotional development. Researchers also surveyed mothers on their knowledge of appropriate child stimulation and measured any positive spillover effects on younger siblings.