Evaluating the effects of a large-scale parenting intervention in Chile: Nadie es Perfecto

• In Event: 2-154 - Cost-effective and Scalable Early Childhood Interventions in LMICs: Evidence from Chile, Kenya, India, and Madagascar.

Integrative Statement

There exists strong evidence that there are high potential returns to early childhood programs, especially when they are targeted to disadvantaged families. However, not all early childhood interventions are equally successful. The success of many early childhood interventions often relies on their ability to enhance the quality of parent and child interactions and the home environment in a sustained way. To date, there is little evidence of cost-effective interventions that are able to sustain impacts in parental behaviors and child developmental outcomes over time, and that can be implemented at scale in low- and middle-income settings. “Nadie es Perfecto” (NEP) is a program in Chile that aimed to improve the quantity and quality of parental investments in children by providing parents with the information, motivation and self-confidence to implement good parenting behaviors. NEP is delivered in local public health centers by trained health workers who organize weekly group sessions with caregivers of children of 0-5 years old, using an experiential learning model through group discussions. NEP is delivered at scale, at a low cost, and implemented using infrastructure and human resources already existing in the Chilean health system. The study objective was to measure the impacts of NEP in parental behaviors and other traits, as well as in child outcomes, almost 3 years after the end of the interventions.

We conducted a cluster-randomized control trial. The objective of the study was to test experimentally two modalities of the program against a control group. The first modality is the standard program (NEP Basico), where only parents are invited to participate in 6-8 biweekly group meetings (no children). A second more intensive modality (NEP Intensivo) was implemented only in the experimental sample and complemented the caregiver-only sessions with two additional structured sessions where children participate together with their parents, and which are focused on the importance of language and play. A total of 2916 households with 3597 children across 162 public health centers were randomly selected into the three treatment arms. We administered a baseline survey in 2011, right before parents in the treatment groups received the invitation to participate in the program. We re-surveyed the same households and children in 2014.

Three years after the end of the intervention, we find that the receptive vocabulary of children whose parents participated either versions of the program improved by 0.42 standard deviations (SD) relative to children whose parents did not participate in it. We also find that the intensive version of the program leads to sustained improvements in parental practices regarding child cognitive stimulation (0.66 SD) and reduction of harsh discipline strategies (0.33 SD) at home. The changes in parenting practices were mirrored by improvements in perceived self-efficacy (0.41 SD), perceived social support (0.37 SD) of comparable magnitude. The least intensive version of the program produced impacts on parental outcomes that are positive but smaller in magnitude. In line with international evidence, our results from the impact evaluation of NEP show larger effects for children from poor and more disadvantaged backgrounds.

Authors

• Emanuela Galasso, The World Bank Development Research Group
  Non-Presenting Author

• Italo Lopez Lopez Garcia, RAND Corporation
  Presenting Author

• Pedro Carneiro, University College of London
  Non-Presenting Author

• Miguel Cordero, University of Bristol
  Non-Presenting Author

• Paula Bedregal, Universidad Catolica de Chile
  Non-Presenting Author