Pathways to scale up integrated early childhood development programs

项目摘要/摘要 贫困对儿童发展的影响是一个严重的公共卫生问题。近10亿儿童生活在 世界范围内的贫困线。儿童生命的早期阶段是以后一切发展的基础。 对儿童早期综合发展(ECD)项目的投资对于打破 代际贫困循环。关于如何实施和整合幼儿发展干预措施，证据仍然缺乏。 在贫困环境中，有许多相互竞争的优先事项。具体地说，目前还不清楚哪些路径 推动ECD计划的实施，以及是否将ECD计划组件整合到现有的 针对贫困儿童的国家计划可以改善发展成果。最近，巴西推出了 今年推出Criança Feliz ECD方案，以响应2016年巴西国家ECD法律框架 该方案主要侧重于培养养育子女的技能，以缓解贫困的负面影响 针对在Bolsa Família注册的3岁以下儿童及其家人，这是最大的有条件现金转移 (CCT)计划。巴西的幼儿发展计划和有条件现金援助计划缺乏一体化。填补这一空白至关重要 改进针对最弱势群体的现有方案中嵌入的幼儿发展政策和倡议 孩子们。该实施科学项目采用系统方法来实现两个目标：1)确定 Criança Feliz的实施途径和瓶颈；2)有助于优化Bolsa的影响 Família关于通过将Criança Feliz与联合国粮食计划署的粮食安全部分整合而取得的幼儿发展成果 程序。这个项目将使用一种混合方法的方法，立足于一种新的复杂的自适应 以前用于了解母乳喂养和幼儿发展计划在不同领域扩大规模的框架 但不是在巴西。分析将基于计划影响途径流程评估和 由上下文和程序特定数据提供信息的程序优化计算建模方法。 调查结果将与一名政策制定者一起在巴西的决策者中广泛传播 工具箱，使他们能够在未来继续应用优化方法 通过Bolsa Família改善幼儿发展成果。这些发现有很大的潜力被转化为其他CCT 世界各地的节目。这项提议非常符合候选人成为一名 教育和发展领域的执行科学研究人员，特别是方案和政策评估方面的研究人员。这个 该项目的完成将为随后的R01赠款申请提供数据，以审查 粮食安全和幼儿发展方案的成本效益优化整合，以改善幼儿发展成果 真实世界的条件。通过这个项目，候选人将接受实施科学方面的培训 方法、卫生经济学和ECD，并将能够过渡到一个独立的学术地位。

PROJECT SUMMARY/ABSTRACT The impact of poverty on child development is a critical public health issue. Nearly 1 billion children live below the poverty line worldwide. The early years of a child's life form the foundation for all later development. Investments in Integrated Early Childhood Development (ECD) programs are critical for breaking the intergenerational poverty cycle. Evidence is still lacking on how to implement and integrate ECD interventions in poverty setting where many competing priorities are in place. Specifically, it is unknown which pathways drive the implementation of ECD programs and whether integrating ECD program components into an existing national program targeting impoverished children can improve development outcomes. Recently, Brazil rolled out the Criança Feliz ECD program in response to the 2016 Brazilian National ECD legal framework This program focuses primarily on fostering nurturing care parenting skills to buffer the negative effects of poverty on children under 3 years and their families enrolled in Bolsa Família, the largest conditional cash transfer (CCT) program in the world. The Brazilian ECD and CCT programs lack integration. Filling in this gap is vital to improving ECD policies and initiatives embedded within existing programs targeting the most vulnerable children. This implementation science project takes a systems approach to achieve two goals: 1) identify pathways of implementation and bottlenecks of Criança Feliz, and 2) help optimize the impact of Bolsa Família on ECD outcomes through the integration of Criança Feliz with the food security components of the program. This project will use a mixed-methods approach grounded within a novel complex adaptive framework previously used for understanding the scaling up of breastfeeding and ECD programs in diverse countries but not in Brazil. Analyses will be based on the Program Impact Pathways process evaluation and a program optimization computational modelling approach informed by context and program specific data. Findings will be widely disseminated among decision makers in Brazil in conjunction with a policymaker toolbox to empower them to continue applying the optimization methodology in the future to continue improving ECD outcomes through Bolsa Família. Findings have great potential to be translated to other CCT programs worldwide. This proposal fits well with the candidate's long-term research interest to become an implementation science researcher in the field of ECD, specifically in program and policy evaluation. The completion of this project will provide data for a subsequent R01 grant application examining the impact of the optimized cost-effectiveness integration of food security and ECD programs to improve ECD outcomes under real-world conditions. Through this project the candidate will receive training in implementation science methods, health economics and ECD and will be able to transition to an independent academic position.