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The Early Child Development Working Group Newsletter The Global Health Delivery Partnership Summer 2014 Volume 1
Our Story Child health is a major priority on the global health agenda. Over 200 million children under five years of age in developing countries have delays in cognitive, social and emotional development. Among the leading causes are: malnutrition, illness, exposure to harmful environments and inadequate stimulation during the first five years of life. Effective and low-cost interventions to prevent developmental delay from each of these causes are known. However, strategies are needed to broadly implement these interventions in resource-poor settings. The Early Child Development Working Group is an initiative of the Global Health Delivery Partnership (GHDP), housed within the Department of Global Health and Social Medicine at Harvard Medical School (HMS). The group aims to spearhead collaboration at Harvard and among field sites to incorporate child development assessment, intervention and research into existing child health programs. The ECD Working Group brings together clinicians, researchers, educators, and public health professionals to bring maximum impact to child development research, policy and programming. The ECD Working Group is led by Ann Miller, an epidemiologist at HMS, and Sara Stulac, a pediatrician at Brigham & Women’s Hospital and Partners In Health (PIH). Currently, the ECD Working Group consists of members from Partners In Health, the Department of Global Health and Social Medicine at HMS, the Division of Global Health Equity at Brigham & Women’s Hospital, Harvard
University’s Center on the Developing Child, Boston Children’s Hospital, Brazelton Touchpoints Center, Ummeed Child Development Center, Boston University School of Medicine, the SPARK Center at Boston Medical Center and PIH sister sites in Peru, Mexico, Rwanda, Malawi and Haiti. Members include: Abwenzi Pa Za Umoyo - Malawi o Blessings Banda Compañeros En Salud - Mexico o Mercedes Aguerrebere o Luis Castillo Socios En Salud - Peru o Leonid Lecca o Maribal Munoz o Arturo Tapia Inshuti Mu Buzima (IMB) - Rwanda o Hema Magge o Felix Rwabukwisi Cyamatare Zanmi Lasante (ZL) - Haiti o Rupinder Legha Brigham and Women’s Hospital o Mary Catherine Arbour – BWH & Center on the Developing Child o Katrina Nelson – BWH & PIH Peru o Peter Rohloff – BWH & Mayan Health Alliance in Guatemala o Sonya Shin – BWH & COPE, PIH New Mexico o Sara Stulac - BWH & PIH Harvard Medical School o Noel Kalanga o Ann Miller
o Megan Murray o Sadath Sayeed Harvard School of Public Health o Theresa Betancourt – HSPH & Center on the Developing Child o David Grelotti – HSPH and ZL Boston Children’s Hospital o Betsy Kammerer o Judith Palfrey o Giuseppe Raviola – BCH, HMS & PIH o Joshua Sparrow - BCH & Brazelton Touchpoints Center o Kim Wilson – BCH & IMB SPARK Center o Lili Peacock – BMC & BCH o Martha Vibbert – SPARK, BCH & BUSPH Ummeed Child Development Center o Vibha Krishnamurthy Partners In Health o Caroline McCallum o Harriet Napier If you’re interested in learning more about the Working Group, please contact Caroline McCallum cmccallum@pih.org or Harriet Napier at hnapier@pih.org
Summer 2014
Working Group Update --The members of the ECD Working Group began efforts with a brief needs assessment survey of its international partners, all of whom at present are PIH sister sites. The objectives of the survey were as follows: o
To determine what field site directors and their staff believe are the most pressing child development problems at their sites
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To determine what (if any) data are currently being collected to assess these development concerns
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To determine what programs or resources exist at the sites to address these concerns
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To determine what resources are still needed to address the concerns.
Results were returned from sites in Mexico, Rwanda, Malawi, and two sites in Peru—Caraballyo and Pisco/Chincha (PC). Malnutrition and maternal depression were mentioned as major and pressing developmental problems by sites. Based on the results, collaborative projects should be feasible and all sites have expressed interest. While there are challenges, if funding becomes available, there do not seem to be any insurmountable hurdles to collaboration. The ECD Working group is also exploring potential grant funding opportunities for pilot and collaborative research projects and is continually brainstorming potential avenues for the integration of early child development components into existing programs and in new projects.
Recent Writings of Note --A Focus on Child Development by Drs. Karlee Silver and Peter Singer at Grand Challenges Canada
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The editorial piece argues for reframing the UN’s Open Working Group on Sustainable Development Goals for child development. Newborn Behavior, Parent–Infant Interaction, and Developmental Change Processes: Research Roots of Developmental, Relational, and Systems-Theory-Based Practice by Dr. Joshua Sparrow at the Brazelton Touchpoints Center The article gives a brief history of the research on newborn development and parent-infant interactions, and the emergence of the concept of a ‘touchpoint.’ “Within human systems, children and parents’ development is also propelled by mutual adaptation occurring through the microprocesses of early interactions and through normative periods of disorganization and reorganization (touchpoints).” This model of development as a series of temporary regressions followed by developmental advances has since been confirmed by studies carried out internationally and cross-culturally. These “touchpoints” can be considered as potential opportunities for professionals to “touch” into the family system to protect against developmental derailment by helping the family to reorganize around the child’s new needs and emerging new capacities. Childhood growth, schooling, and cognitive development: further evidence from the Young Lives study by Drs. Günther Fink and Peter C Rockers at Harvard’s Center on the Developing Child
investigated catch-up growth in children 8-15 years and the effects of growth during this period on schooling and developmental outcomes. The study yielded 2 main results: o
catch-up growth was achieved by one-third of children, and those that caught up had smaller deficits in cognitive scores than did children who remained stunted.
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physical growth faltering was not restricted to early childhood but rather affected a substantial share of children in the 8–15y age range, with large negative consequences for cognition and schooling outcomes.
These results emphasize that child development is a dynamic process that offers opportunities for children to catch up or to fall behind in their developmental trajectories. The Annals of New York Academy of Science (Vol. 1308) partnered with the Global Child Development Group to publish an issue in January 2014 dedicated to research exploring the critical question of how to optimize and fully integrate two highly complementary fields: nutrition and child development. Many articles are relevant to the ECD Working Group’s activities varying from integrated child development/nutrition interventions and their advantages/challenges to research methods for designing culturally appropriate, integrated interventions and a job analysis of community health workers in the context of integrated nutrition and early child development.
Using longitudinal data recently collected from 4 developing countries as part of the Young Lives study, they
If you’re interested in learning more about the Working Group, please contact Caroline McCallum cmccallum@pih.org or Harriet Napier at hnapier@pih.org
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Summer 2014
ISSUE NO. 1
Field Feature - CASITA
Upcoming Grant Deadlines GRAND CHALLENGES CANADA: Saving Brains: September 8, 2014 Description: In this call for proposals, innovative approaches and sound evaluation are expected to test how the intervention should be delivered to reach the highest number of children, how the intervention should be optimized to have the most impact on each child reached, and how to financially sustain this impact at scale. http://www.grandchallenges.ca/savingbrains/ NIH NIMH: June 17, 2014, October 17, 2014 and February 17, 2015 Description: The National Institutes of Health’s NIMH has issued a series of related Requests for Proposals on topics with some relevance to Early Child Development. RFPs for R01, R33 and R34 grants have been issued on the topics of pilot testing novel interventions or effectiveness research on interventions to improve children’s mental health and modify risk factors. Letters of Intent would be due 30 days prior to the application deadline. Links: http://grants.nih.gov/grants/guide/rfafiles/RFA-MH-15-310.html http://grants.nih.gov/grants/guide/rfafiles/RFA-MH-15-330.html
Upcoming Conferences: Society for Research in Child Development - Topical Meeting in Developmental Methodology: September 11 - 13, 2014 in San Diego, CA. Call for Submissions has closed, but registration is still open. 2015 Society for Research in Child Development - Biennial Meeting: March 19 – 21, 2015 Philadelphia, PA. Please see Call for Submission here, which will be open until August, 20, 2014. 2015 Young Child Expo & Conference: April 22-24, 2015 NYC, NY. Call for Submissions is not yet released.
CASITA is a pilot program in Lima, Peru that focuses on screening and treatment neurodevelopmental delays using CHWs and home-based interventions. Data from clinics in Carabayllo, Lima suggest that about 70% of children under 2 are at risk of developmental delay based on "healthy child" check-ups. Due to high cost of care, most children living in poverty receive no stimulation until school-age, which may be too late to develop the crucial skills to navigate out of poverty. Starting in April 2014, Socios En Salud (SES) will pilot a community-based "package" to screen and treat children 1-3 diagnosed with neurodevelopmental delays. Ministry of Health Community Health Workers (CHWs) will identify children with delay and deliver a structured early intervention in home and group settings. Pre- and post- development data will explore the impact of the intervention. Environmental, caregiver, and nutritional data will describe factors associated with delay. Additional analyses will look at clinic versus community strategies for the identification of delayed children and the correlates between local and international Early Childhood Development instruments. Working with the public sector, SES hopes to scale-up an effective intervention by November 2015.
The Early Child Development Working Group Mission Statement: Our Mission: To promote healthy child development in the world’s least-resourced settings. Our Objectives: •
To increase awareness of and advocacy for the needs and opportunities in global child development.
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To develop research and interventions to understand and address risks and protective factors in global child development.
Our Approach: We work in partnership, by learning from local parents, caregivers, and communities, and by leveraging the resources of a multidisciplinary group within and beyond the Harvard community.
If you’re interested in learning more about the Working Group, please contact Caroline McCallum cmccallum@pih.org or Harriet Napier at hnapier@pih.org
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