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Creating synergies between primary health care providers and families for optimal child development

Listening to parents voices through participatory research leads to effective communication and positive lasting change for infants/toddler

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Updates: How has your idea changed or evolved throughout the Prize? What updates have you made to this submission? (1500 characters)

We have made a few changes based on the conversations and feedback from the mentorship experience and guiding documents from OpenIdeo as well as brainstorming with our partners. Creating a proposal that is more specific, relevant to US and Bolivia, as well as feasible and hopefully sustainable over time were the overarching messages received. We started out with a very general description of the Participatory Learning and Action methodology and did not provide specific examples of research experience from which the ideas were built. Thus we added more details and pictures/videos of similar experiences. In addition, we had not identified specific ways in which the project would be implemented and sustained. Over the course of the past few weeks, we talked with different stakeholders and members of AINI and explored the option of starting out with one health center. Our concern was how to ensure that community health workers were not going to feel that additional tasks and responsibilities were going to be added to their already full plate. Bringing in psychology and pedagogical university students would enable the research to take place and families' voices heard without creating an initial resistance from health staff. In addition, university students would gain knowledge and experience of participatory methodology that they could in turn apply in their own work. Another element that we considered was how this could be applied in the United States. Having worked extensively domestically and overseas focused on early childhood development, we included examples of how this could be transcreated to a different context. For example, community mapping, a tool used in Participatory Learning and Action PLA, was conducted in an early childhood setting in Washington DC with parents to empower them to identify and advocate for needed resources for their children. The experience highlighted the importance of handing over the baton (in this case its the marker) so parents/stakeholders are in charge of what is documented and how the information is used. Too often, community needs assessment, such as in Head Start, is conducted by external entities to check off a box, and not to gather meaningful information that can be used at different levels. The Storytelling toolkit helped tremendously to clarify the message and bring the story to life! For example, originally I hadn't thought of including the story of the young couple that had role-played the birthing process in rural Bolivia. But as I spoke to my mentors and shared the concept with others, I started including the story and it helped the listener understand what was innovative and excited us about the proposal. The whole process of developing this proposal has helped all of us grow and learn from each other. It has also affirmed that we need to start by listening and building relationship before any significant change can happen. Thank you!

Name or Organization

McFarren Aviles & Associates, LLC

Geography

The work would take place in Bolivia with participatory strategies that are transcreatable in the US

What is your stage of development?

  • Advanced Innovator with 3 to 10+ years of experience in ECD

Type

  • For-profit

What is the stage of your proposal?

  • Research & Early Testing: I am exploring my idea, gathering the inspiration and information I need to test it with real users.

Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)

Primary health care providers attend to infants and toddlers on a regularly basis through well-baby check-ups and disease prevention interventions. They are strategic influencers of parents in how they raise and support the optimal growth and development of their children. Parents and families on the other hand have their own understanding and child rearing practices that affect their child's development. By listening and observing child care rearing practices and turning these into educational material, health care professionals can create meaningful, relevant messages with & for parents.

Select an Innovation Target

  • Channel: A new way to deliver existing products or services to customers or end users.

Tell us more about your innovation (1500 characters)

The research team will develop an innovative tool-kit through a participatory research process, to increase the competency and knowledge of primary health care providers. As a result, the primary health care providers will value and enhance parents' child rearing practices that support optimal growth and development of their children 0-3 years of age, living in disadvantaged communities in La Paz, Bolivia. The participatory research follows human centered design process of hearing/observing parents’ child rearing practices, using the information as the basis to develop relevant messages and deliver these to primary health care providers in order to support parents’ responsive interaction. University students who are completing their practicum in the health centers will be trained on Participatory Learning and Action - PLA. They will use the strategies to engage parents who bring their infants and toddlers for well baby checks. Primary health care providers will also build their competency and knowledge to apply the participatory research process with parents if they are interested in using these tools. In addition to gathering parents' voices, the participatory research process will facilitate networking between parents that empowers them as primary educators of their children. Social marketing communication facilitators will develop messages that are engaging and culturally relevant for low literacy groups. The PLA tools can easily be transcreated for the US context.

What problem are you aiming to solve? (3 sentences)

1. Primary health care providers have standard messages that may not be aligned with traditional child rearing practices. 2. Parents child rearing practices are passed down from generation to generation, some of which foster learning, while others inhibit optimal growth and development. 3. Important messages to and from health practitioners and families are not heard because a trusting relationship between health care providers and parents has not been established.

Explain your idea (5000 characters)

Through the partnership with organizations that are part of a 20-year-old multi-sectoral network called AINI (Association Integral para la Niñez) researchers will develop a participatory research protocol that gathers information about child rearing practices of families living in disadvantage and vulnerable communities. The sectors represented by the AINI members include health, education, communication, and international NGOs. The current proposal builds upon a similar participatory research project conducted through one of its members to gather information on gender specific child rearing practices in the rural village of Bolivia. The importance of listening and understanding child rearing practices was a valuable lesson learned through that research. For example, in one community, a young couple role played the birthing process in their village. They showed how herbal insense is used to calm the mother, how the father participates in cutting the umbilical cords and how boys and girls are treated differently from birth. In this case they said it was a boy and he would not be breastfed for 24 hours so that he could get accustomed to being hungry and provide for his family. The results from listening to the key stakeholders led the local health center to talk about how breastfeeding actually helped to prepare their son to provide for his family by protecting him and supporting his immune system. By building a trusting relationship and listening respectfully to the parents stories, healthy care providers acknowledge parents' motivation of preparing their children for the future before new information was provided.The attached pictures were taken during the "birthing process" For the current proposal, university students doing their practicum for psychology and pedagogical classess will be trained on Participatory Learning and Action-PLA techniques and will work with health staff to align the information gathered to the common health messages given to families and information available on brain development, importance of serve and return interactions. They will then present the information back to the families to ascertain that the message had been received. The results of the engagement will lead to the creation of toolkit for use by primary health care providers working in community health clinics. The toolkit will include ways to integrate their messaging of health/nutrition with learning, and build on child rearing practices identified through the participatory research process. As a new cohort of university students complete their practicum in the health center they will continuously support updating and expanding the toolkit to meet the holistic growing needs of children 0-3. A research protocol will be created to describe how the tools can be used and transcreated for different context, such as the United States. The protocol will included a variety of tools that faciliate understanding families perspectives, the layout of the community in terms of resources that families use to support their children, as well as child rearing practices that have been passed down from generation to generation.

Who benefits? (1500 characters)

Four interrelated stakeholders will benefit from this innovation and synergies will be created amongst and within each group. The first are the children 0-3 years of age. Their overall health and development will increase. This in turn have a synergetic effect on their families as they see the positive changes in their children. The second are the parents, who will feel valued, connected to others, and empowered to contribute to a toolkit that will be used by primary health care providers. This in turn will increase trusting relationship with health practioners and increased frequency of well-baby checkups. The third will be the primary health care providers who will reach a wider audience and engage key stakeholders to develop messages that are relevant and responsive to the population. And, lastly, are the university students who will gain skills and knowledge that mirrors the responsive approach they will need to be successful in their careers.

What kind of impact will your idea have? (1500 characters)

The impact of this innovation will be both short and long-term. Short term impact includes establishing partnerships between parents and primary health care providers to develop a toolkit that is meaningful, relevant and is aligned with positive child rearing practices. Parents will understands how their role and responsive parenting, including serve and return strategies, will affect their child's brain development. Long term impact will be seen when children have the skills, competency and executive function skills needed to enter and finish school and are positive contributors to society. The PLA methodology could be used to identify and respond to other challenges, such as environment or economic development, both of which are also important contributors to a child's optimal development.

How does or how could your idea impact low-income children? (1500 characters)

Families who live in disadvantaged and vulnerable communities face multiple challenges, including limited or zero access to economic or human resources needed for reach their full potential. Low levels of literacy and educational achievement, coupled with other toxic stress related factors such as violence, alcoholism, and drug addiction negatively impact children's development, especially for children under three years of age. Access to and use of health care services is affected by the quality and responsiveness of the health care staff. Providing a cohort model that brings families and primary health care providers together will increase the quality of services, resources and strategies to establish and increase ongoing trusting relationship with families, which will lead to increase use and impact of holistic primary health care. Although, Bolivia and the United States context is very different, infants and toddlers and their families face similar challenges. There are many child rearing practices that are passed down from one generation to another that can have a positive or negative affect. Environmental factors, such as violence and alcoholism, that contribute to toxic stress are found in many vulnerable communities across the globe. Participatory strategies can contribute to a better understanding of the context and come up with locally driven solutions that are sustainable.

Innovation: What makes your concept innovative? (5000 characters)

The participatory research process that captures and uses the story of the end user of the community health centers is what is unique about this proposal. Parents of children have a great deal of knowledge and experience that they bring to the table. Likewise, building trusting relationship with is a great motivator of change. Health and child development messages are constantly created based on scientific evidence. However, the voices of the end user are often not heard, or the message is interpreted differently based on their understanding. In my experience working in Bolivia, an in many other parts of the world, health centers tend to be a place where children and families are moved through quickly so medical staff can get to the next patient. Health centers are also a place that has direct contact with the mother and child during well baby-checkups on a regular basis. Engaging a participatory process in a setting that has access to children in their most vulnerable years will lead to a new way of increasing the knowledge and competencies of families and health practitioners leading to optimal growth and development of children.

Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)

Members of AINI have extensive coverage within the country and work closely with the health centers run by the Bolivian government. They sit on various private/public task forces that influence health sector policies, including fostering an integrated approach to address holistic needs of children within their 1000 day critical learning and growth period.

Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)

Members of AINI include organizations that work with government run community health centers, are social communicators, and have trusting relationships with low income families. Although, they are part of the network, for the most part their work has focused on providing direct services based on their area of expertise. Designing and implementing a participatory process linked to health centers will increase their knowledge on participatory methodology aimed at increasing the quality and scope of the health centers. Coverage of well-baby check-ups and immunization varies from community to community. The hypothesis is that the participatory process will increase participation of families since they will be contributor to the messaging included in the toolkit. Members of AINI have had experience with including health and development messages in the health centers, but have not had the support with participatory methodology. As members of public/private tasks force they are in a unique position to influence policy at a local, regional, and national level.

Business Viability: How viable is your business model? (5000 characters)

Creating synergies between primary health care providers and families for optimal child development will be piloted in a community health center for the first time. We will be testing to see how viable it will be for health practitioners to invest time in getting to know the families with infants and toddlers. The organization that supports the community health center, Sociedad San Jose, has worked in the community for more than xxx of years. Increasing the workload of health practitioners is the main concern. Psychology students of a nearby university who have a semester of practicum will be used to support the collection of data using PLA techniques. This will have a double benefit of reducing burden on the health practitioners and also increasing the competencies of psychology students around human centered design. In addition, another small research project with a community health center supported by Save the Children in Oruro, showed that when play and other non-medical activities were incorporated into the well-baby clinic, participation and repeat in service was observed, and led to increased satisfaction of the community health center staff.

HCD: How have you used human centered design to build or refine your concept? (5000 characters)

The sweet spot where Desirable, Feasible, and Viable aspects of a project come together is the essence of our proposal. Each element is also seen from different perspectives. We are looking at what families’ desire for the present and future for their children. What is their story? What is their knowledge, experience, and beliefs that contribute and affect their child's wellbeing? Similarly, what are the desires of health practitioners as they treat thousands of families and young children. And lastly, what does scientific evidence tell us about what contributes to optimal growth and development. By starting out with a participatory research process using PLA techniques, we can try to find where these align and start communication from there. In terms of feasibility, we looked at the workload of health practitioners in a community health center. They tend to be have low wages, long hours, and are constantly having to respond to competing demands. By engaging university students, who would receive training, a certificate, and increased knowledge/competence, we aim to reduce the burden on the health practitioner, while still providing the necessary information to support their practice. Working with organizations that are part of the AINI network, we are optimizing the experience and respect that they have with the community. It is through their relationship and outreach to the community that this project will become viable.

Tell us more about you (3000 characters)

I have over 36 years of experience providing bilingual customized training, technical assistance and coaching to early care and education staff, parents, and government and non-governmental organizations working with excluded and vulnerable children. Having worked extensively in the United States, Latin America, Asia, and the Middle East, I specialize in the design, piloting, and evaluation of infant/toddler programs, curriculum development, and participatory research, particularly for the Latino community. I have worked and partnered with diverse national and international organizations in the District of Columbia, including Mary’s Center, Office of the State Superintendent of Education (OSSE); University of the District of Columbia Community College; in Virginia, Fairfax County Office for Children, Campagna Center, and internationally with Association for Childhood Education International (ACEI) Plan International; Save the Children; International Step by Step Association - ISSA, and UNICEF. During my 10 years working in Bolivia, I partnered with Plan International and UNICEF to design and conduct a participatory research project to identify gender-based child rearing practices in rural communities with low-literacy levels. In 2013 I launched a Women-Owned Small Business (WOSB) designed to foster leaders in early childhood programs, especially those working with children under three years of age and across the life cycle. In my work I observed that pre and in-service workshops were not effective strategies on their \achieve sustainable positive change, I developed and implemented a strength-based coaching framework to support ongoing, effective professional development for a diverse infant toddler workforce. Through-out my career I have prioritized setting up networks and partnering with organizations, including establishing the first interagency network in Bolivia and supporting other regional and global interagency networks aimed at increasing access, quality, and funding of equitable early childhood programs.

Do you have the people and partners you need to do what you’ve described? (600 characters)

Yes, the project will be implemented in partnership with AINI members who represent different sectors, including communication, health, education, universities, as well as international and local organizations. An AINI member, Sociedad Catolica San Jose, will be the location of the pilot program. The San José Catholic Society (SCSJ) is a non-profit private Civil Association, founded on August 4, 1878, with 140 years dedicated to the care of children, adolescents, families and communities in a situation of vulnerability.

As you consider your next steps, what kinds of help could you use? Is there a type of expertise that would be most helpful? (1800 characters)

It will help to have the support of communicators with expertise in developing Information, Education, and Communication (IEC) material linked to holistic child development. Currently, IEC is primary focused on health messages. Messages are needed that are engaging, culturally relevant and show the synergetic effect of breastfeeding and engaging in conversation on brain development.

Would you like mentoring support?

  • Yes

If so, what type of mentoring support do you think you need? (1200 characters)

It would be helpful to have the support from others on how to link participatory research with social marketing strategies.

Are you willing to share your email contact information submitted on OpenIDEO with Gary Community Investments?

  • Yes, share my contact information

[Optional] Biography: Upload your biography. Please include links to relevant information (portfolio, LinkedIn profile, organization website, etc).

I am the Founder/Director, of McFarren Aviles & Associates, LLC that fosters leaders in early childhood development. I hold a Master’s degree in Curriculum Development from Teacher’s College, Columbia University and extensive experience working in United States, Latin America, Asia, and the Middle East. I am passionate about working with infant/toddler early childhood professionals, the Latino community, and creating synergies amongst key stakeholders. @leadersforecd www.mcfarrenaviles.com

Mentorship: How was your idea supported? (5000 characters)

The opportunity to share my idea with a mentor helped to confirm that I was on the right track and provided specific feedback as to how I could improve my concept. Through this exchange it became clear that I had not given enough background of where the idea came from and the specific impact it could have on infants/toddlers overall well being. Although, I had indicated that I was using a human centered design, there were not enough details as to how it would take place. Since then, I've engaged the AINI partners more closely and we continue to exchange ideas as to the feasibility and operation. For example, the organization that would take the lead in Bolivia has psychology students that could support the participatory process at the health center. These students would in turn gain the skills and knowledge of participatory methodology and continue using it in their practices.

What is your stage of development?

  • Advanced Innovator with 3 to 10+ years of experience in ECD

Type

  • Team

What is the stage of your proposal?

  • Research & Early Testing: I am exploring my idea, gathering the inspiration and information I need to test it with real users.

Are you willing to share your email contact information submitted on OpenIDEO with Gary Community Investments?

  • Yes, share my contact information

2 comments

Join the conversation:

Comment
Spam
Photo of Iliriana Kacaniku
Team

Hey Jill,
Welcome to the Early Childhood Innovation Prize. We're thrilled to host your idea and help it grow through our human-centered design approach and toolkits. I found your idea very interesting and would like to learn more about your vision to implement it in the United Stats. "This Prize is focused on solutions that can be implemented in the United States. If you are an innovator from another part of the world, we welcome your participation though ask that you address how your solution fits into the early childhood context in the United States." For innovators like yourself, we have developed the Localization toolkit (see the link: https://d3gxp3iknbs7bs.cloudfront.net/attachments/cf799b7d-a091-4fa8-bb9e-d7eeaf2c9efb.pdf)
to help you translate your idea into the local context of the target geography/market.

Take a look and let us know what you think.

Best regards,
Iliriana

Spam
Photo of JIll
Team

Dear Iliriana,

Thanks for your message and link to the Localization toolkit. They were both music to my ears! I have worked in the United States and abroad for the past 36 years and believe that early childhood strategies are universal if they are transcreated (not translated). Every culture and setting is different, and unless we take the time to listen to the key stakeholders, in this case families of infants and toddlers and health care practitioners, we can not achieve sustainable change. The participatory tools are ones that I have used in Bolivia, and in the States to a lesser degree. Using Participatory Learning and Action - PLA techniques opens up the dialogue between stakeholders. It creates an empowering framework for the parent to be heard and acknowledged for the knowledge they bring to the table. It's precisely what the Localization toolkit seems to emphasize as well- getting to know the end users in terms of what are they thinking, how do they support infant and toddler development? Even within the United States there is a wide range of perspectives. Infants and toddlers come from multicultural-lingual families and live in urban and rural settings. The PLA tools are aimed at understanding their perspective, engage in a feedback loop to share the results of the research, and together develop plan of action. For example, in a program I worked in the District of Columbia, we used the PLA tool of community mapping to understand what resources were identified by parents that could support them with the development of their child. They each took turns "taking control of the baton (marker)" and drawing the resource they used or new of. It was interesting that this activity was completed right after another organization had given them a lecture on all of the resources available. The parents however didn't list those resources on their map. They listed many others that hadn't even been discussed during the lecture presentation.

Although, the PLA technique is not widely used in the United States, from my experience working in urban early childhood settings in New Jersey, DC, Virginia and West Virginia, and developing infant/toddler curriculum and training programs, I am convinced that if used more widely, parents and caregivers' voices would be heard more effectively. Programs for infants and toddlers in the United States vary widely in the quality of the programs, including the effectiveness of family engagement. Likewise, research has shown that toxic stress negatively affects neuron connections in young children and has lasting impact on the health of adults. Severe Neglect in Family settings, is a phenomenon that is wide spread in the United States that is found in families who are themselves under a great deal of stress or haven't had positive roles model. Hearing their voices and understanding and valuing their own experiences can be a powerful tool that builds trusting relationships needed to make positive change.

Here is a link to the participatory research I conducted in Bolivia and proposed for the current project http://www.ecdgroup.com/download/ca120ctl.pdf I would love to engage with you and others on how to transcreate the tools to fit into the Colorado context.