Supporting parent engagement in a school readiness program: Experimental evidence applying insights from behavioral economics

Evaluation of Virtual Enhanced Child Adult Relationship Enhancement in Primary Care Intervention

OBJECTIVE

Because of COVID-19 pandemic social distancing requirements, the in-person Child Adult Relationship Enhancement in Primary Care (PriCARE) positive parenting intervention was adapted for virtual delivery. Objective was to evaluate the efficacy of the virtual PriCARE program to improve parenting capacity, decrease child behavioral problems, and decrease child maltreatment risk.

METHODS

Caregivers of children 2 to 6 years old recruited from pediatric primary care were randomized to PriCARE (n = 92) or waitlist control (n = 90). Dysfunctional parenting, positive parenting skills, child behaviors, and child maltreatment risk were measured at baseline and 2 to 3 months after intervention using the Parenting Scale (PS), Dyadic Parent-Child Interaction Coding System (DPICS), Eyberg Child Behavior Inventory (ECBI), and Child Abuse Potential Inventory (CAPI). Kruskal-Wallis test compared median change scores from baseline to follow-up by treatment arm.

RESULTS

Of 182 enrolled caregivers, 92% (168) were mothers and 67% (122) completed study measures at baseline and follow-up. The median decrease (improvement) in total PS score was greater in the PriCARE group compared with the control group (-0.3 [IQR 0.69] vs -0.1 [IQR 0.56], p = 0.028) as was the median decrease (improvement) in ECBI problem score (-3 [IQR 9] vs -1 [IQR 7], p = 0.045) and ECBI intensity score (-9 [IQR 21] vs 0 [IQR 25], p = 0.006). Improvements in 4 positive parenting skills measured by DPICS were greater in the PriCARE group compared with the control group (all p< 0.003). Median decrease in CAPI abuse score did not differ significantly by study arm (p = 0.055).

CONCLUSION

The PriCARE virtual adaptation demonstrated promise in promoting positive parenting and decreasing child behavior problems.

Preschool Programs that Help Families Promote Child Social-Emotional School Readiness: Promising New Strategies

Parents play a central role in supporting the early learning that positions young children for success when they enter formal schooling. For this reason, efforts to engage families in meaningful collaboration is a long-standing goal of high-quality early childhood education (ECE). Family-school engagement can take multiple forms; in this review, we focus on universal preschool-based outreach strategies that help parents support growth in child social-emotional and self-regulation competencies and prepare them for the transition into formal schooling. Recent research has expanded understanding of the neurodevelopmental processes that underlie child school readiness, and the impact of parenting (and the social ecology affecting parenting) on those processes. These new insights have fueled innovation in preschool-based efforts to partner with and support parents, expanding and shifting the focus of that programming. In addition, new approaches to intervention design and delivery are emerging to address the pervasive challenges of reaching and engaging families, especially those representing diverse racial, ethnic, cultural, and socioeconomic backgrounds. This paper reviews developmental research that underscores the importance of prioritizing child social-emotional learning (with attention to self-regulation and approaches to learning) in universal preschool-based parenting programs targeting young children. We highlight the intervention strategies used in programs with strong evidence of impact on child readiness and school adjustment based on randomized controlled trials (RCTs). New directions in intervention design and delivery strategies are highlighted, with the hope of extending intervention reach and improving family engagement and benefit.

Dietary habits and physical activity patterns in relation to nutritional status among school-aged children in Pakistan: A cross-sectional study

Background

Childhood malnutrition remains a significant public health problem impacting the physical and mental growth if school aged children, particularly in limited-resource countries.

Objective

The study objective was to assess levels of physical activity, patterns of screen time (S.T.), the relationship between physical activity and screen time patterns, and how these factors affect growth status (adjusting for socioeconomic status).

Methodology

A cross-sectional study included 3,834 children between 6-14 years attending pre-selected schools. Teachers, students, and parents were invited to fill out a standardized questionnaire, and Body Mass Index (BMI) was calculated using Center for disease control (CDC) centile charts. A Chi-square was performed to see the possible association between any height and weight abnormalities and all possible risk factors. Multivariate logistic regression was applied to see the effect of variables significantly associated with univariate analysis.

Results

Approximately 2,447 (63.8%) children were between 11-14 years old and 1,387 (36.2%) were between 4-10 years old. The mean height was 143.71 ± 16.51 centimetres, the mean weight was 36.5 ± 12.9 kilogram, and the mean BMI was 17.16 ± 3.52. Multivariate logistic regression status and junk food combined affected stunting socioeconomic status was significantly associated with being underweight p = 0.001.

Conclusion

Childhood obesity and stunting remain significant problems in Pakistani school-going children. These are significantly associated with poverty, a lack of physical activity opportunities, and available food quality.

A behavioral economics analysis of the participation in early childhood development social programs promoted by civil societies in Mexico

Based on a behavioral economics (BE) approach, we analyzed the decision to participate in an early childhood development (ECD) program implemented in Mexico by a non-governmental organization. We conducted a literature review and a qualitative study of four localities participating in the ECD program. Situated in the state of Oaxaca, these communities are characterized by high and very high levels of social marginalization. From May 20 to 30, 2019, we collected primary data through semi-structured interviews (n = 30) and focus groups (n = 7) with a total of 61 informants (51 women and 10 men). We then performed an inductive systematic analysis of the data to identify documented cognitive bias associated with the decisions of individuals to participate and remain in or abandon social programs. The interviewees were living in conditions of poverty, facing difficulties in meeting even their most basic needs including food. Program participants attached far greater weight to incentives such as the basic food basket than to the other benefits offered by the program. The four localities visited maintained traditional views of domestic roles and practices, particularly regarding child-rearing, where women were in charge of childcare, home care and food preparation. Problems linked to child malnutrition were a decisive factor in the decision of residents to participate and remain in the program. Testimonials gathered during the study demonstrated that the longer the mothers remained in the program, the more they understood and adopted the concepts promoted by the interventions. In contexts marked by economic vulnerability, it is essential that ECD programs create the necessary conditions for maximizing the benefits they offer. Our analysis suggests that cognitive load and present bias were the biases that most severely affected the decision-making capacity of beneficiaries. Therefore, considering loss aversion and improving the management of incentives can help policymakers design actions that "nudge" people into making the kinds of decisions that contribute to their well-being.

Behavioral Economics and Parent Participation in an Evidence-Based Parenting Program at Scale

Evidence-based and culturally relevant parenting programs strengthen adults' capacity to support children's health and development. Optimizing parent participation in programs implemented at scale is a prevailing challenge. Our collaborative team of program developers, implementers, and researchers applied insights from the field of behavioral economics (BE) to support parent participation in ParentCorps-a family-centered program delivered as an enhancement to pre-kindergarten-as it scaled in a large urban school district. We designed a bundle of BE-infused parent outreach materials and successfully showed their feasibility in site-level randomized pilot implementation. The site-level study did not show a statistically significant impact on family attendance. A sub-study with a family-level randomization design showed that varying the delivery time of BE-infused digital outreach significantly increased the likelihood of families attending the parenting program. Lessons on the potential value of a BE-infused approach to support outreach and engagement in parenting programs are discussed in the context of scaling up efforts.