From Uganda to Lebanon: Experiences with Integrating Early Childhood Development, Health and...

©2012 International Medical Corps

Experiences With Integrating Early Childhood Development, Health

And Nutrition ProgramsPresenters:

Dr. Inka Weissbecker, PhD, MPHGlobal Mental Health and Psychosocial Advisor, IMC

& Jennifer Burns, MSPH

Senior Development Nutritionist, IMC

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Agenda

• IMC’s approach to ECD programming– ECD components– Guidelines & adaptation of material– Measuring outcomes

• How has integration been achieved? – Three country examples: Sierra Leone, Uganda,

and Lebanon.

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Key Messages1. Varying approaches for integrating ECD, nutrition and health

programming

2. Integration is feasible within emergency, transitional and development contexts

3. The hands-on learning approach in group sessions and home visits is key in producing positive outcomes

4. Investing in a training of trainers approach in the community is essential for sustained ECD programming

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IMC’S APPROACH TO ECD PROGRAMMING

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IMC ECD Programs

• Jordan, Syria, Lebanon, Gaza• Uganda, Ethiopia, Sierra Leone• Haiti

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ECD Components

• Settings• Staffing• Trainees• Training• Approaches

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Guidelines, Resources & IMC Contribution

• UNICEF Guidance Note

• IASC MHPSS Guidelines in Emergency Settings

• Hincks Del-Crest (HDC), Learning Through Play (LTP)

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Adaptation of training materials: Ethnographic Background

• Local developmental milestones• Child rearing practices

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IMC ECD Materials Adapted to Local Context

9

Haiti

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Ethiopia

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Sierra Leone

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Lebanon

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Monitoring and Evaluation

① Caregiver Knowledge, Attitudes and Practices

② Mother-child Interaction

③ Mental Health & Psychosocial Wellbeing of Caregivers, including Maternal Mood

④ Health, Nutrition and Feeding practices

⑤ Behavior Change (Parenting)

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UGANDAEMERGENCY/RELIEF CONTEXT

Case Studies

A Controlled Evaluation From Northern Uganda

“Does Combining Infant Stimulation With Emergency Nutrition Improve Psychosocial

Outcomes for Displaced Mothers and Babies? “

Reference: (Jones 2012. American Journal of Orthopsychiatry 2012, Vol. 82, No. 3, 349–357)

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Context

• Community-based management of acute malnutrition (CMAM) program for severe and moderately malnourished children.

• Integrated with health and nutrition education (e.g. IYCF, HIV, family planning, WASH, and child health).

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Objective

• Assessing the impact of combining a group-based psychosocial intervention with an existing emergency nutrition program for internally displaced mothers in Northern Uganda.

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Program Design: The Psychosocial Intervention

Two components:

• Six weekly mother and baby group sessions: knowledge, discussion and practice (ECD education, play, toy making, challenges)

• Follow-up home visits by psychosocial facilitator and nutrition counselor

*Training materials were adapted from the Learning through Play program.

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Study Design and Selection of Participants

• Five centers in the Kitgum district:

– Attending mothers received nutritional support plus the psychosocial intervention

– Control group received the therapeutic and supplementary feeding support alone.*

* These mothers were wait-listed for the psychosocial intervention, which they received after the research was complete.

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Outcomes Investigated

(a) The Acholi Home Observation for Measurement of the Environment (HOME) was used to assess the impact of the intervention on mother’s ability to stimulate her child

(b) The Kitgum maternal mood scale to assess changes in maternal mood, and (c) KAP test to assess changes in maternal knowledge of ECD.

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Results and Discussion

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Way Forward

• Mothers established new mother-to-mother groups

• Integration of ECD psychosocial interventions via group and home visits as part of nutrition programs

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SIERRA LEONEDEVELOPMENT CONTEXT

Case Studies

A Comprehensive And Integrated Approach To Reducing Food Insecurity And Chronic

Malnutrition In Sierra Leone

A USAID Food for Peace Multi-Year Assistance Program

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Context

• Sierra Leone: 11-year civil war, highest child morality rate, 180 out of 187 on the HDI, 36% stunted, 21% underweight, 10% wasted

• IMC, in partnership with ACDI/VOCA and OIC, implements the health, nutrition and SBCC activities of a USAID MYAP

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Program Design

Using the Care Group model, project staff, health promoters, and peer educators (LM) trained on WASH, IYCF and family planning

1O LMs150

PLWS

1 HP

43 HPs

1 LM

50 LMs

15 PLWs

2200

750 PLWs

43671 PLWs

220

5 CGs

1 CG

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Pilot Study: Structure & Approach

1. Community mapping/ethnographic background study2. Development of culturally appropriate ECD curriculum

and study tools3. Cascade training for District Supervisors, Health

Promoters, Care Group Volunteers on ECD modules 4. 10-week group educational sessions or home visits

integrated into existing MCGs• Positive caregiver-child interaction• Safe play • Supporting child development- relationships,

communication, understanding, physical, and sense of self

.

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Pilot Study: Structure & Approach

• Research: – impact [maternal knowledge of early child development, quality of

mother and child interaction, and maternal mood]– Approach [group sessions, HH visits]

• Research limitations [staff turnover, lack of technical support on-the-ground]

• Ethnographic research on child-rearing practices, SBC materials, study tools

.

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LEBANONWORKING IN TRANSITIONAL CONTEXTS

Case Studies

“A Comprehensive Approach to integrating Nutrition & Health within ECD Psychosocial

Programming”

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Context

• IMC providing sessions in Early Childhood Development to refugee and vulnerable host populations since 2009.

• Community Based ECD Psychosocial Program established within PHC clinics and community centers.

• Emergency and Post Emergency Settings:– New Refugees (Syrian Refugees)– Refugees who have been in Lebanon for over 1 year (Iraqis)– Vulnerable host population

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Objectives

The objectives of the education program are:

(a)Improve knowledge in ECD, health and nutrition.

(b) Teach parents play activities that enhance child development; and

(c) Promote active parental involvement in their child’s development.

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Program Design• Caregivers with children from 0-3years and 3-6years.

• IMC psychologists and social workers as ECD facilitators.

• ECD facilitators paired with ECD educators from the refugee/host community.

• Sessions are delivered in the presence of and active engagement of caregivers with their children.

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ECD TopicsThe ECD program is based on 10 learning sessions.• Session 1. Early Years and the Brain• Session 2. Attachment• Session 3. Child Growth and Development• Session 4. Sense of Self and Relationships• Session 5. Understanding and

Communication• Session 6. The Importance of Play• Session 7. Toys and Toy Making• Session 8. Guiding Behaviors• Session 9. Child Nutrition and Health• Session 10. Child Safety

Each session discusses hygiene, nutrition, health,

and the developmental milestones associated with the specific age

group.

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ECD Materials

• Adapted from Hincks Del Crest , Learning Through Play Material

– LTP material included a chapter on Nutrition.

• Formative research showed a need among caregivers for nutrition and health support.

• Revised Material now includes more focused and age specific nutrition and health messages and activities within ECD curriculum.

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Monitoring & Evaluation Tools

Pre/Post KAP Test that includes questions in line with previously described topics including Child Growth and Development, Understanding and communication, Mother/father role, etc.

Pre/Post Psychosocial Wellbeing Measure with the following domains:- Daily functioning- Family dynamics- Social connectedness

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Outcomes

A Sample of 36 parents/caregivers with children from 0-3 years. Caregivers from the Iraqi and Syrian Refugee populations residing in Lebanon.

Knowledge increased by 21.9%.

Caregivers’ wellbeing improved by 16.5%  

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Other Reported Outcomes①Caregivers reported a significant change in their behaviors with their

children

②Caregivers reported following health, nutrition and safety messages

③Mothers reported making friends as part of the ECD sessions and continue to meet regularly.

④ECD educators from the refugee community now run their own ECD groups within their community.

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Take Away Messages• Varying approaches to integrating ECD, nutrition and health

Programming

• Integration is feasible within emergency, transitional and development contexts.

• The hands-on learning approach in group sessions and home visits is key in producing positive outcomes.

• Investing in a training of trainers approach in the community is essential for sustained ECD programming.

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Thank you!