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      Effects of a scalable home‐visiting intervention on child development in slums of urban India: evidence from a randomised controlled trial

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          Abstract

          Background

          An estimated 63.4 million Indian children under 5 years are at risk of poor development. Home visits that use a structured curriculum to help caregivers enhance the quality of the home stimulation environment improve developmental outcomes. However, achieving effectiveness in poor urban contexts through scalable models remains challenging.

          Methods

          Using a cluster randomised controlled trial, we evaluated a psychosocial stimulation intervention, comprising weekly home visits for 18 months, in urban slums of Cuttack, Odisha, India. The intervention is complementary to existing early childhood services in India and was run and managed through a local branch of a national NGO. The study ran from August 2013 to July 2015. We enrolled 421 children aged 10–20 months from 54 slums. Slums were randomised to intervention or control. Primary outcomes were children's cognitive, receptive language, expressive language and fine motor development assessed using the Bayley‐III. Prespecified intent‐to‐treat analysis investigated impacts and heterogeneity by gender. Trial registrations: ISRCTN89476603, AEARCTR‐0000169.

          Results

          Endline data for 378 (89.8%) children were analysed. Attrition was balanced between groups. We found improvements of 0.349 of a standard deviation ( SD; p = .005, stepdown p = .017) to cognition while impacts on receptive language, expressive language and fine motor development were, respectively, 0.224 SD ( p = .099, stepdown p = .184), 0.192 SD ( p = .085, stepdown p = .184) and 0.111 ( p = .385, stepdown p = .385). A child development factor improved by 0.301 SD ( p = .032). Benefits were larger for boys. The quality of the home stimulation environment also improved.

          Conclusions

          This study shows that a potentially scalable home‐visiting intervention is effective in poor urban areas.

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          Most cited references27

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          Early childhood development coming of age: science through the life course

          Early childhood development programmes vary in coordination and quality, with inadequate and inequitable access, especially for children younger than 3 years. New estimates, based on proxy measures of stunting and poverty, indicate that 250 million children (43%) younger than 5 years in low-income and middle-income countries are at risk of not reaching their developmental potential. There is therefore an urgent need to increase multisectoral coverage of quality programming that incorporates health, nutrition, security and safety, responsive caregiving, and early learning. Equitable early childhood policies and programmes are crucial for meeting Sustainable Development Goals, and for children to develop the intellectual skills, creativity, and wellbeing required to become healthy and productive adults. In this paper, the first in a three part Series on early childhood development, we examine recent scientific progress and global commitments to early childhood development. Research, programmes, and policies have advanced substantially since 2000, with new neuroscientific evidence linking early adversity and nurturing care with brain development and function throughout the life course.
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            Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale).

            We derived and tested a short form of the Center for Epidemiologic Studies Depression Scale (CES-D) for reliability and validity among a sample of well older adults in a large Health Maintenance Organization. The 10-item screening questionnaire, the CESD-10, showed good predictive accuracy when compared to the full-length 20-item version of the CES-D (kappa = .97, P or = 16 for the full-length questionnaire and > or = 10 for the 10-item version. We discuss other potential cutoff values. The CESD-10 showed an expected positive correlation with poorer health status scores (r = .37) and a strong negative correlation with positive affect (r = -.63). Retest correlations for the CESD-10 were comparable to those in other studies (r = .71). We administered the CESD-10 again after 12 months, and scores were stable with strong correlation of r = .59.
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              Multiple Inference and Gender Differences in the Effects of Early Intervention: A Reevaluation of the Abecedarian, Perry Preschool, and Early Training Projects

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                Author and article information

                Contributors
                alison_a@ifs.org.uk
                Journal
                J Child Psychol Psychiatry
                J Child Psychol Psychiatry
                10.1111/(ISSN)1469-7610
                JCPP
                Journal of Child Psychology and Psychiatry, and Allied Disciplines
                John Wiley and Sons Inc. (Hoboken )
                0021-9630
                1469-7610
                03 December 2019
                June 2020
                : 61
                : 6 ( doiID: 10.1111/jcpp.v61.6 )
                : 644-652
                Affiliations
                [ 1 ] Institute for Fiscal Studies London UK
                [ 2 ] Department of Economics University College London London UK
                [ 3 ] Center for Early Childhood Education and Development Ambedkar University Delhi India
                [ 4 ] UCL Great Ormond Street Institute of Child Health London UK
                [ 5 ] Department of Economics Yale University New Haven CT USA
                [ 6 ] International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
                [ 7 ] Pratham Delhi India
                [ 8 ] Inter‐American Development Bank Washington DC USA
                Author notes
                [*] [* ] Correspondence

                Alison Andrew, Institute for Fiscal Studies, 7 Ridgmount Street, London WC1E 7AE, UK; Email: alison_a@ 123456ifs.org.uk

                Author information
                https://orcid.org/0000-0002-8908-9683
                Article
                JCPP13171
                10.1111/jcpp.13171
                7242140
                31797385
                0005bdd4-e02e-4cbe-a5dc-39b9d763ace0
                © 2019 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 January 2019
                : 21 October 2019
                : 04 November 2019
                Page count
                Figures: 1, Tables: 4, Pages: 9, Words: 7183
                Funding
                Funded by: Rushton‐Turner Fund
                Funded by: NIH Clinical Center , open-funder-registry 10.13039/100000098;
                Award ID: HD072120
                Funded by: Waterloo Foundation , open-funder-registry 10.13039/100012107;
                Award ID: 969‐1310
                Funded by: H2020 European Research Council , open-funder-registry 10.13039/100010663;
                Award ID: 695300‐HKADeC‐ERC‐2015‐AdG
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                June 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.4 mode:remove_FC converted:26.06.2020

                Clinical Psychology & Psychiatry
                child development,parent–child interaction,home visiting

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