National ECD Community of Practice 23 October 2018 E arly C hildhood D evelopment PARENTING PROGRAMME Dr Marc Aguirre
Parenting can be understood as interactions, behaviours, emotions, Parenting knowledge, beliefs, attitudes and practices associated with the provision of nurturing care
The term ‘parenting’ or ‘parent’ is not Parenting limited to biological parents, but extends to any guardian or caregiver providing consistent care to the child.
Brain A child’s socio-emotional, Development cognitive and language development is most effectively nurtured through loving and stimulating relationships with their parents and family.
In South Africa… There are approximately 70,000 teachers in ECD centres across the country. There are more than five million primary caregivers of children up to the age of four
CHALLENGES 2.4 million children in South Africa are orphans , many due to HIV HIGH RATES 64% of the of under-five mortality , country’s children live in poverty malnutrition and stunting
CHALLENGES Half of SA’s children do not have access to formal early learning opportunities Caregivers face enormous stress that impacts their parenting
Cycle of Poverty Intergenerational transmission of poverty Preschool Child Low IQ, behaviour problems Poor Stimulation School Nutrition and Health Poor school achievement Behaviour problems National Adult Low Education Economy Low skilled/no work high fertility Depressed/stressed
Affordable, high-quality, community based ECD programmes & services that target caregivers are critical for children’s: Physical Cognitive emotional development development development 9
2016 Lancet Early Childhood Development Series Advancing Early Childhood Development: from Science to Scale 4.2 By 2030, ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education www.thelancet.com/series/ECD2016
www.nurturing-care.org
VISION A South Africa where every young, vulnerable child gets the best possible start in life MISSION Transforming the lives of young children, their households and communities through: Compassion Collaboration Capacity
THEORY OF CHANGE Improve Build Child Caregiver Outcomes Capacity 14 14
NURTURING CARE FRAMEWORK • • Health education Preschool and • Child Development Household Feeding • • Screenings Nutrition Education • Referrals Parent Support Groups • Self-Esteem • Play Every Day building • • Toy & Book Libraries Positive • Playgroups Parenting Home Visits • Child Protection • Gender-Based Violence (GBV) • Referrals
Limpopo Gauteng Polokwane Johannesburg Mankweng, Nobody, Diepsloot, Zandspruit, Moletjie, Seshego, Daveyton, Ivory Park Mmotong Olivenhoutbosch, Watville, Cosmo Mpumalanga Free State Tswane • Mamelodi Mbombela Bloemfontein Kanyamazana Mangaung KwaZulu-Natal Durban Cato Manor Cato Ridge Western Cape Eastern Cape Cape Town Port Elizabeth Guguletho New Brighton 7 Provinces Nyanga Motherwell Elsies Rivers Kwazakhele
IMPLEMENTATION SITES >30% 94% unemployment, of houses are nearly informal dwellings 40% part-time employment 65% Estimated of households are receiving social 25-30% grants HIV ANC prevalence
ECD PARENTING APPROACH START-UP IMPLEMENTATION RESULTS Selection, training and Structured home Increased support of community visits: services, knowledge, referrals, and Workers skills, support assessments and services Improved Selection & Structured caregiver outcomes assessment support group/ for children of eligible play groups beneficiaries Forums 18
Caregiver Knowledge & Skills Development Process Identification of Vulnerable Household Screening & Needs Households with young OVC Assessment Workshop and establishment of a Parenting Support Group (PSG) PSG Leader PSG Leader Development Development Structured Parenting Support Group Meetings, Referrals and Visits Monthly Progress Assessments
PSG member Profile Female Female Average age 33 years (Median 30 Average age 33 years (Median 30 (15-75 years) (15-75 years) Average of 1.6 children Average of 1.6 children Unemployed, on grants Unemployed, on grants
Parent Support Groups (PSG) 12-15 members per Group 3 hour sessions twice a month – curriculum-based At a local community centres (halls, ECD centres, libraries, homes) Facilitated by HOPEww Community Worker with support from PSG Leader PSG Leaders are trained in the PSG curriculum ‘Loyalty Card’ Approach. Graduation Certificate and Gift if attend the 10 core sessions. (attrition issues)
Group Sessions Key Skills Development Areas: Self-Confidence/esteem Positive Parenting Key ECD-associated topics
Parent Support Group Curriculum SESSION 1: CHILD HEALTH AND WHAT TO DO WHEN A CHILD IS SICK SESSION 2: GOOD NUTRITION FOR CHILDREN SESSION 3: SOCIAL AND EMOTIONAL DEVELOPMENT SESSION 4: EMOTIONAL CONNECTION /BONDING SESSION 5: HIV PREVENTION and PMTCT SESSION 6: A CHILD’S GROWING BODY SESSION 7: PLAY AND DEVELOPMENT SESSION 8: A CHILD’S HEALTHY MIND DEVELOPMENT SESSION 9: BUILDING THE CONFIDENCE OF A CHILD SESSION 10: CHILD SAFETY AND PROTECTION
MEASURING IMPACT Parent/Caregiver Parental stress Assessment Parent-Child Bond Child Development 24
IMPLEMENTATION APPROACHES HOUSEHOLD SUPPORT
IMPLEMENTATION APPROACHES SUPPORT GROUPS: WOMEN’S GROUP
IMPLEMENTATION APPROACHES PLAY GROUPS
IMPLEMENTATION APPROACHES SUPPORT GROUPS: MEN’S FORUM
MEASURING IMPACT: PROVEN TOOLS Parental Stress Assessment CAREGIVER CAREGIVER- WELLBEING CHILD BOND CHILD DEVELOPMENT
• Used to accurately identify children who may be at risk for developmental delays (0-5 years) • Designed to encourage parent involvement and education • Low-cost, reliable and rigorously tested • Key domains: communication, gross motor, fine motor, problem solving, personal/social skills • Identify a child’s strengths as well as any areas where they may need support
Ages & Stages Questionnaire (ASQ3) Child developmental areas that the ASQ will evaluate are :
RESULTS: IMPACT ON CAREGIVERS 45 42% 36% 40 35 42 30 36 25 20 Baseline Follow-up Baseline Follow-up Linear (PSA Score) p<0.001 PSA Score Lower levels of caregiver stress related to: • Higher levels of caregiver sensitivity to the child • Higher quality of caregiver-child relationship • Improved child behaviour
Parental Depression Pilot (173 caregivers) EPDS Validated Scoring (General Population): Females Range Interpretation Tally Percentage 0 - 8 Normal 28 17% 9 -10 Slightly increased risk 15 9% 11 - 14 Increased risk 57 35% ≥ 15 Likely depression 62 38%
RESULTS: CAREGIVER-CHILD RELATIONSHIPS 8 6 4 2 0 Affection Responsiveness Teaching Encouragement Affection Responsiveness Teaching Encouragement Baseline Follow-up Overall: p<0.001 • Improved emotional connection • Reduced maltreatment
RESULTS: CHILD DEVELOPMENT 30 25 20 15 10 5 0 3 of 5 areas: DD baseline DD follow up p<0.001 • Improved developmental scores • Increased referrals
The ‘Caregiver Access & Practice’ Checklist Tool Tracks the following Indicators: Health Attendance Health RTHB: Awareness, Health Checks Nurturing & and Vaccinations Nutrition Stimulation Nutrition Breast Feeding & Balanced Meals Social Protection IDs, Birth Certificates & Grants Child Social Protection Protection Child Protection Child Proofing, Supervision, Maltreatment Nurturing & Stimulation Spending time Playing & Reading, and Hugs and saying ‘I love you’
TRANSFERING CAPACITY
Scale up and sustainability • Affordable, does not require a high level of expertise • Can be operated effectively in a range of community settings • Can be integrated into other clinical, social and community-based care programmes • PSG members from the community can be effective facilitators • Builds bottom up leadership among those who are often excluded from participation • Has spill over benefits to the communities
LESSONS LEARNED FOR SCALING UP Relationships are Key at all levels Engage other service providers to deliver a full package of care. This requires staff with ‘connector’ skills. Very mobile populations require innovative retention strategies Home visitors require support from professional staff to ensure proper case management and to address more complex situations, e.g. GBV, CP, etc. 39
LESSONS LEARNED FOR SCALING UP Work Loads need to be managed. Increased work loads and scope reduce HV morale and effectiveness and program quality. Data quality verification can be time consuming and can divert resources from other core project functions. Need for data verifiers on site. Staff motivation is vital to ensure program integrity, data quality and sustainability 40
Thank You www.facebook.com/HOPEworldwidesa.org www.hopeworldwidesa.org
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