Empowering Home Visitors in Early Intervention: Impact Evaluation of Teacher Training and Use of Technology on Childhood Development - Evidence from t

众所周知，生命的最初几年是终身发展的基础。然而，发展中国家的许多儿童面临贫困、营养不良、疾病和缺乏刺激的家庭环境。这些因素可能对儿童的认知、运动、身体和社会情感发展产生不利影响，从而阻碍他们充分发挥发展潜力。作为成年人，他们更有可能为子女提供较少的适当刺激和资源，从而助长贫穷和不平等的代际传递。一系列综合研究提供的证据表明，在生命早期采取干预措施，可以通过促进幼儿发展，改善整个生命过程中的福祉。最有效的干预措施是为儿童及其家庭提供直接的学习经验。在过去几十年中，家访方案在拉丁美洲和加勒比及其他地方越来越受欢迎。虽然小规模试验显示出持续的长期结果，但重要的问题仍然是这种结果是否可以大规模实现。对监测的重视至关重要，因为这些方案的影响可能会因国家内部和国家之间各种环境、人力资源、制度和地理配置的执行挑战而减弱，因此，一个重要的研究和政策议程是监测、报告和维持家访者的业绩，特别是在大规模实施方案的情况下。在这项研究中，我们建议共同设计，建立和使用一个可持续的监测系统，为厄瓜多尔的弱势儿童进行大规模的家访计划：Creciendo con Nuestros Hijos（CNH）。这是一个家访方案，对象是孕妇和0至36个月的儿童，每周进行一次家访。家访员为照顾者提供有关儿童发展、健康行为和适当营养的咨询;并提高对其他社会方案的认识。CNH已经实施了20多年，目前覆盖了近20万名儿童;然而，用于监测和报告关键绩效指标的中央系统从未到位。在这个项目中，我们建议由伦敦大学学院的早期干预和家访专家组成的跨学科学术团队与厄瓜多尔经济和社会包容部（MIES）和J-PAL拉丁美洲（JPAL-LAC）合作，以实现这一重要目标。在项目的第一部分，我们将为CNH建立一个信息和报告系统（IRS）。首先，我们将与方案工作人员和主要利益攸关方共同制定一个绩效指标和系统成果框架，确定将收集的相关数据。这将包括关于方案执行情况的数据，如访问的频率、持续时间和内容（目前没有记录），以及关于儿童成长和认知发展的数据（目前以书面形式收集）。我们将为平板电脑开发相应的软件应用程序，并对家访人员进行使用培训。在项目的第二部分，我们将使用CNH-IRS来提高家访计划的质量。首先，我们将共同设计一个标准化的报告卡模板，并检查有多少变化，在节目质量;是否某些可观察到的特征的家访者与更好的性能;以及是否更好的性能指标与更好的孩子的结果。第二，我们将共同设计一种低成本的通过短信进行的激励干预，并通过随机对照试验评估其对儿童表现和结果的影响。我们的项目有可能为厄瓜多尔儿童的发展带来重大利益。

It is well established that the first years of life lay the basis for lifelong development. However, many children in developing countries are exposed to poverty, malnutrition, illnesses, and un-stimulating home environments. These factors are likely to have a detrimental effect on children's cognitive, motor, physical, and socio-emotional development, thus hindering them from reaching their full developmental potential. As adults, they are more likely to provide fewer adequate stimulation and resources for their children, thus contributing to the intergenerational transmission of poverty and inequality. A consolidated body of research has provided evidence that interventions in the early years of life can improve well-being across the life course by promoting early childhood development. The most effective interventions provide direct learning experiences to children and their families. In the last few decades, home-visiting programmes have grown in popularity in Latin America and the Caribbean (LAC) and elsewhere. While small-scale trials have shown sustained long-term results, however the important question remains as to whether such results can be achieved at scale. The focus on monitoring is critical, since the impact of these programs might be weakened by implementation challenges across a diversity of settings, human resources, systems, and geographical configurations, both within and across countries.An important research and policy agenda is therefore to monitor, report and sustain the performance of the home visitors, especially when the programmes are run at scale. In this research, we propose to co-design, set up and use a sustainable monitoring system for a large-scale home visiting programme for disadvantaged children in Ecuador: Creciendo con Nuestros Hijos (CNH). This is a home visiting program which targets pregnant women and children of ages 0 to 36 months with weekly visits. The home visitors provide counselling for caregivers regarding child development, healthy behaviours, and proper nutrition; and promote awareness of other social programs. CNH has been in place for more than twenty years, and is currently reaching almost 200,000 children; however, a centralised system for monitoring and reporting key performance indicators has never been put in place. In this project, we propose a partnership between an interdisciplinary academic team of experts in early interventions and home visiting from University College London, together with the Ministry of Economic and Social Inclusion (MIES) of Ecuador and J-PAL Latin America (JPAL-LAC), to pursue this important goal.In the first part of the project, we will set up an Information and Reporting System (IRS) for CNH. First, we will co-develop with the programme staff and key stakeholders a performance indicators and systems outcomes framework, which identifies the relevant data to be collected. This will include both data on the program implementation, such as frequency, duration and content of the visits (currently not recorded), and data on children's growth and cognitive development (now collected in paper format). The appropriate software app will be developed for the tablets and the home visitors will be trained in their use.In the second part of the project, we will use the CNH-IRS to improve the quality of the home visiting program. First, we will co-design the template for a standardised reporting card and examine how much variation there is in programme quality; whether certain observable characteristics of the home visitors are associated with better performance; and whether better performance indicators are associated with better children's outcomes. Second, we will co-design a low-cost motivational intervention via SMS messages, and evaluate with a randomized controlled trial its impact on performance and children's outcomes.Our project has the potential to yield significant benefits for the development of children in Ecuador.