Effects of a scalable home‐visiting intervention on child development in slums of urban India: evidence from a randomised controlled trial

Abstract

Background: An estimated 63.4 million Indian children under 5 years are at risk of poor development. Home visits that use a structured curriculum to help caregivers enhance the quality of the home stimulation environment improve developmental outcomes. However, achieving effectiveness in poor urban contexts through scalable models remains challenging. Methods: Using a cluster randomised controlled trial, we evaluated a psychosocial stimulation intervention, comprising weekly home visits for 18 months, in urban slums of Cuttack, Odisha, India. The intervention is complementary to existing early childhood services in India and was run and managed through a local branch of a national NGO. The study ran from August 2013 to July 2015. We enrolled 421 children aged 10-20 months from 54 slums. Slums were randomised to intervention or control. Primary outcomes were children's cognitive, receptive language, expressive language and fine motor development assessed using the Bayley-III. Prespecified intent-to-treat analysis investigated impacts and heterogeneity by gender. Trial registrations: ISRCTN89476603, AEARCTR-0000169. Results: Endline data for 378 (89.8%) children were analysed. Attrition was balanced between groups. We found improvements of 0.349 of a standard deviation (SD; p = .005, stepdown p = .017) to cognition while impacts on receptive language, expressive language and fine motor development were, respectively, 0.224 SD (p = .099, stepdown p = .184), 0.192 SD (p = .085, stepdown p = .184) and 0.111 (p = .385, stepdown p = .385). A child development factor improved by 0.301 SD (p = .032). Benefits were larger for boys. The quality of the home stimulation environment also improved. Conclusions: This study shows that a potentially scalable home-visiting intervention is effective in poor urban areas.

Group Sessions or Home Visits for Early Childhood Development in India: A Cluster RCT

“…Stimulation was based on the Reach-Up and Learn home visiting program, 13 which has a structured home visiting curriculum, previously adapted to the local context. 19 Facilitators showed mothers how to play and interact with and respond to their children in ways likely to promote development. They demonstrated play activities and encouraged mothers to participate by using toys made from locally available materials and purpose-designed books.…”

“…Previously, 19 we adapted the Reach-Up and Learn 13 home visiting intervention to the Odisha, India context. This had moderate impacts on children's development but was labor-intensive and costly.…”

Editorial: Some roads less travelled—different routes to understanding the causes of child psychopathology

“…It is therefore a pleasure to see three articles in the current issue that use this approach. Andrew et al (2020) show how social workers’ home visits in urban slums in India can enhance the quality of the home environment and improve children’s outcomes. Dong et al (2020) show that a Transdiagnostic Sleep and Circadian Intervention can improve some measures of sleep and circadian functioning in adolescents compared with an active control condition involving education about sleep and health.…”

Virtual Kindergarten Readiness Programming for Preschool-Aged Children: Feasibility, Social Validity, and Preliminary Impacts

“…Though a greater emphasis on using digital technology to support children in the home has arisen during a global pandemic, strategies to provide support to parents and young children in their home environment are not new. Following the assumption that parents and caregivers are children's first and most influential teachers (e.g., Landry, 2020;Zigler et al, 2008), a wide range of programs have been developed to influence child outcomes by helping parents and caregivers in a variety of ways, including providing education on child development and supportive interactions, yielding positive results overall (e.g., Andrew et al, 2020;Baker et al, 1999;Lahti et al, 2019;Landry et al, 2012;Leung et al, 2020;Wagner et al, 2002; see Sweet & Appelbaum, 2004 for a metaanalysis). For example, the Play and Learning Strategies (PALS) program relies on a trained coach to facilitate weekly sessions with parents of children aged birth to 5 years geared toward developing a supportive and responsive relationship between parents and children (Landry, 2020).…”