CARE and DBS for developmental screening and intervention

More than 40% of children under 5-years-old in middle-low income countries are under the risk of not reaching developmental potential for causes associated with poverty and psychosocial deprivation. A way to improve the life chances and opportunities of low-income children, families, and communities might get reached with developmental screening using parents’ reports and intervention with dialogical book-sharing. 

Using a tool administrated by parents, a compilation of activities to report enhanced development (CARE®) and Dialogical book-sharing (DBS) interventions are in the line of interventions that enhance parental sensitivity and child cognitive development as well. CARE and DBS both were proved in different populations and high accuracy and improvements in developmental delay, parental sensitivity, and child cognitive development were reported (Giraldo, 2019; Murray et al., 2016).

More than 40% of children under 5-years-old in low-income countries are under the risk of not reaching developmental potential for causes associated with poverty and psychosocial deprivation (Black et al., 2016) and this percentage should be major in low- and middle-income countries (LMIC).

Colombia as an example of LMIC, report lack of access to early education, critical overcrowding, lack of access to green areas and basic sanitation services (i.e., drinkable water) in more than a third of the child population in Colombia. The age group with the highest indicator of multidimensional poverty is children aged 3 to 5 years (37%). García et al. (2013) also reveal that about 80% of children 3-5 years-old do not receive initial education or attend early childhood centers. This situation reported in Colombia increases the overall probability of children in poverty being considered at risk of not reaching developmental potential. Giraldo, Cano & Pulido-Alvarez (2017) reports that 80% of the participating children between 0 and 6-years-old in Colombia, do not reach more than 65% of the abilities and behaviors expected in relation to percentile distribution of items in a developmental screening tool.

The parent–child dyads who used CARE before, will be enrolled in childcare centres or programs located in Bogotá D.C., Cajicá, Chía in Cundinamarca, and Cali (Valle del Cauca) and Aguabonita (Caqueta) in Colombia, with children aged between 24 and 59 months old. The specific interest in this age group is related with the highest indicator of multidimensional poverty in children aged 2 to 5 years in Colombia (57%; García et al., 2013) and those who assist to Children’s Centers (CCs) and ex-combatants´families in urban and rural contexts in Colombia. 

About Dialogic Book-sharing (DBS), DBS shown to be highly effective in trails in the US and in a deprived South Africa population (Cooper et al, 2014; Vall 2015; Murray et al, 2016). The content of this intervention is described in some detail by Dowdall et al (2017). 

Now, in Colombia, more than 1300 families are participant in screening, some using CARE and 10% receiving DBS. 

We provide direct screening using a the Haizea-Llevant screening table (H-Ll) is a developmental screening tool derived from Denver Developmental Screening Test (Frankenburg, 1987; Frankenburg, van Doorninck, Liddell & Dick, 1976) and the Denver Pre-screening Developmental Questionnaire (PDQ) and compare that observation with the parents or caregivers’ report using The Compilation of Activities to Report and Enhance development – C.A.R.E. (henceforth CARE). CARE is a booklet created to obtain information of daily activities of interaction between parents or caregivers with children. Detected children at risk, received DBS. DBS is a training programme is for parents/carers to promote supportive and reciprocal book-sharing with young children, delivered by a trained facilitator. This programme has been trialed in South Africa and found to be highly effective in improving carer book-sharing skills, and to have a significant benefit on child attention, language, and pro-social behaviour (Cooper et al, 2014; Vally et al, 2015; Murray et al, 2016). The programme has been piloted in a UK Children’s Centre (Pen Green in Corby) where it was enthusiastically received by both staff and parents. The programme involves parents meeting in small groups and receiving instruction from a facilitator over six, weekly, one-hour sessions. These sessions, which are organized around a ‘book of the week’, involve a powerpoint presentation with demonstration video clips to illustrate key learning points, with skills being built up incrementally. The group session ends with each parent being given the book to take home to share with their child, with encouragement to do so if possible, on a daily basis for approximately ten minutes.

Before and after interventions, Independent assessments will be made within participants in Language, and Executive Function, Attention, Prosocial behavior, Theory of Mind and Book sharing behavior (sensitivity, elaborations and reciprocity). Technology is now restricted to basic ICTs, but we search electronic and interoperability process basic model of interoperability into an IT information-transfer context that recognize a specific definition for thecnology use (Provonost et al., 2018). Our version considers the same data exchanges’ three levels but is focused in developmental-care transformation toward parent-child interaction-driven and institutional support in Children’s Centres (CCs): facility-to-facility (macrotier), intra-facility (meso-tier), and at the point of care (micro-tier). To optimize our model, we use information from multiple sources, devices, and organizations across the development-care continuum, that must be able to flow like original proposal: at the right time, to the right party, for the right child.

CARE and DBS for children at risk are in the line of interventions that enhance parental sensitivity and child cognitive development as well. Our innovation is a partial service and process change that might be adapted in other SOLVE innovations, like Neopenda, E-Heza, 40K plus, Open Learning Exchange (OLE) and Baan Dek Foundation. All those innovations give universal and non-specific tracking or intervention in developmental skills and interactions with parents who probably need a particular and unique intervention. CARE will detect those needs; DBS might be a general intervention and all other technological solution would keep tracking and following changes in initial conditions for their participants. The interoperability process would guide our model into an IT information-transfer context that recognizes a specific definition for technology use (Provonost et al., 2018) to enhance parental and child developmental skills.

We are looking forward to how previous innovations like Neopenda, E-Heza, 40K plus, Open Learning Exchange (OLE) and Baan Dek Foundation might include Developmental Screening (DS) and Dialogical book-sharing (DBS) interventions. Those interventions are used by parents, caregivers or professionals to identify and detect risk indicators of delay in typical development. When delay or any risk indicator is founded, this will be changed using early interventions in childhood and before six years of age. Technology will be used in searching, tracking and include participants who potentially will receive DS and DBS when are detected and identified in other innovations interested in families and children development at risk.

A short-scaled interoperability model using CARE and DBS was designed and probed in an LMIC, Colombia. Our model for interoperability considers three levels of data exchange: facility-to-facility (macrotier), intra-facility (meso-tier), and at the point of care (micro-tier). Focused on developmental-care, we include parent-child interaction-driven and institutional support in Children’s Centres (CCs). The first components of this model include a baseline with the previous measurement of developmental outcomes in children of two major geopolitical regions in a middle-low income country (n=1177) and the use of a tool administrated by parents to report different items related to sociocognitive milestones. The first analysis within a regression model founded 14 variables significantly associated with a socio-cognitive development index. The second component is related to results obtained in a specific CC, where developmental screening indicates the effect of intra-facility activities as a positive factor that avoids the loss of development potential that can be expected in uncontrolled environments or institutions, such as those in the first sample (t(207)=-2.026, p=0.044). Finally, at the point of care, the use of a tool administrated by parents, a compilation of activities to report enhanced development (CARE®), denotes optimal psychometric properties (Sensitivity = .95, Specificity = .85, LR + = 6.2, LR- = .06) and significant changes in the risk indexes for a control group of children (Delayed items: Avr.= 4.5 , SD = 3.8) compared with those who used the booklet with their parents or caregivers (Avr.= 1.2, SD = 1.1); t(17) = - 2.82,p= 0.012).

Currently: 150

One year: 450

Five years: 2500 (more using SOLVE previous innovations)

One year: better psychometric properties in tools and instruments and more CC's participants.

Five years: Incorpore CARE and DBS in electronic apps or solutions for health and well-being to children at risk.

Financial and technological support will be specifically used for improvement and expand to other LMIC and communities at risk.

Financial in different research grants (local and external to high education institutions) and technological support with alliances with other research and disciplines (e.g., IT Departments). 

Department of Psychology at Universidad de la Sabana (Chía, Colombia).

1 full-time staff (PI), 1 part-time (postgraduate student) staff and 5 by-hours staff (pre-graduate students).

Our team is continually improving and contacting tools and participants (CC, families, and individuals) with assessments and interventions to prove the impact of our services and process. We have academic and technical support by two Ph.D. professors from the University of Reading (UK).

Financial and technical support: Department of Psychology, Universidad de la Sabana (Colombia).

Technical support: Mikhulu Trust and School of Psychology and Clinical Language Sciences, University of Reading (UK).

CC for participants: Amiguitos Royal - Bogotá, Fundación Dignificar - Cali (Colombia).

Our key beneficiaries currently are parent-child dyads who used CARE and DBS before, enrolled in childcare centers or programs located in Bogotá D.C., Cajicá, Chía in Cundinamarca, and Cali (Valle del Cauca) and Aguabonita (Caqueta) in Colombia, with children aged between 24 and 59 months old. The specific interest in this age group is related with the highest indicator of multidimensional poverty in children aged 2 to 5 years in Colombia (57%; García et al., 2013) and those who assist to Children’s Centers (CCs) and ex-combatants families in urban and rural contexts in Colombia.

All-around the world the potential beneficiaries should be more than 40% of children under 5-years-old in low-income countries are under the risk of not reaching developmental potential for causes associated with poverty and psychosocial deprivation (Black et al., 2016). For previous innovations in health or children`s well-being (e.g., Neopenda, E-Heza, 40K plus, Open Learning Exchange (OLE) and Baan Dek Foundation), we could integrate our services and process with data exchanges’ technologies.
Government and private institutions might use all CARE and DBS information to improve and applied with high accuracy their programs for parents, caregivers, and children.

We are close to Service Subsidization Model. CARE and DBS interventions are close to government and CC`s in providing social programs and may enhance their missions when recognized a gap in the education market for pertinent detection of children at risk and effective interventions for parents, caregivers and communities. In response to this need, CARE and DBS developed training and materials (e.g., appropriate sharing-books) to improve the life chances and opportunities of low-income children, families, and communities, reached with developmental screening using parents’ reports and intervention with dialogical book-sharing to enhance parental sensitivity and child cognitive development as well.

SOLVE will provide us technological partners and connect us to other innovations interested in improving the life chances and opportunities of low-income children, families, and communities. We need the kind of opportunities that Neopenda, E-Heza, 40K plus, Open Learning Exchange (OLE) and Baan Dek Foundation, found in how to integrate services and process with data exchanges’ technologies for expanding the reach and improvement that help CARE and DBS to scale into other countries and communities as well.

SOLVE innovations: Neopenda, E-Heza, 40K plus, Open Learning Exchange (OLE) and Baan Dek Foundation.

Other organizations: local and regional, government or private, interested in improving the life chances and opportunities of low-income children, families, and communities.