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Proven Parenting Program Leverages Massive Adult Education Network (Updated January 6, 2015)

Hands to Hearts International (HHI) improves the health and development of vulnerable children by training parents/caregivers on early childhood development (ECD) and nurturing parenting skills. Caregivers are empowered with the skills to better their child’s health, brain development and early learning by engaging in ECD skill-building exercises as well as health, hygiene, and nutrition. "When applied at scale HHI is cheaper than providing only one vit. A supplement to a child." UNICEF The Project has two main goals: 1. Provide meaningful parenting education to nurture children’s development 2. Scale program through existing adult education network to serve community organizations, women’s self-help groups and community health work

Photo of Jessica Burg
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By partnering with Reach India, Hands to Hearts International will scale up a proven ECD project to equip 100,000 poor mothers, fathers and grandparents, and community health workers to offer 50,000+ children the nurturing attention, health, nutrition, and protection they need to achieve their developmental potential.

This partnership will  (a) integrate health, nutrition, hygiene and ECD curricula; and (b) train a massive network of rural trainers, in a train-the-trainers model, equipping 100,000 caregivers with life changing knowledge, skills, attitudes and behaviors to support early brain development, promote health and prevent maltreatment and abuse for 50,000+ vulnerable children 0-3 years of age.

This project is unique. It marries the proven strengths of Reach India’s massive community training platform, and HHI’s proven ECD curriculum. This fills a critical need - every parent wants to provide the very best for their baby, but no baby comes with an instruction manual.
Via HHI’s training  caregivers learn how to use their everyday interactions to nurture their children’s language, social, cognitive and physical development, and how to support their health, nutrition and early learning. It also cultivates bonding and attachment, establishing the base for all future relationships and a healthy social fabric.
HHI’s outcomes for children include earlier and improved  language, cognitive, physical and social-emotional development, as well as improved health. While outcomes for caregivers include: increased confidence, more interactions and more meaningful interactions with their child, increased bonding, more nurturing and gentle, more responsive feeding practices,  and decreased corporal punishment and domestic violence. While HHI training has reached 42,000+ caregivers, it has lacked a network to go to scale. Enter Reach India.

Reach India, an expert in experiential adult education, utilizes self-help groups, which in India represent the single largest form of microfinance in the world, encompassing nearly 100 million women. These groups also represent a powerful mother’s platform on which to extend education on ECD. The Project will leverage Reach India’s network of social entrepreneur trainers who are paid a modest fee by community organizations to train those organizations, facilitating life skills education for self-help groups of mothers and mothers-in-laws who come together to save and find solidarity and solutions to their daily problems. This fee-for-service model sustains services and supports children and mothers with a life-changing resource.

Who will benefit from this idea and where are they located?

The potential is huge! 100,000 mothers, fathers and grandparents, and community health workers would be trained in Samastipur District, Bihar, India the first two years. The estimated 50,000+ young children in their care would benefit. The multiple positive outcomes will have effects on communities for generations to come. While this project focuses in rural India to leverage Reach India’s established and far-reaching network, HHI’s model and curriculum has been successfully adapted and applied in the post-conflict zone of northern Uganda, where it was met with great enthusiasm and incredible outcomes, ie. tripling linguistic interactions from mother to infant and doubling cognitive interactions. Thus we feel confident that HHI’s educational model can be successful adapted and transferred to any low-resource setting.

How could you test this idea in a quick and low-cost way right now?

HHI’s model has been applied around India, as well as in Uganda, Namibia, and Russia. In 2010 the Asia-Pacific Regional Network for Early Childhood (ARNEC) identified HHI as a promising practice and published their research on HHI titled, “Empowering Caregivers for Holistic Child Development”. While, USAID featured HHI as a Promising Approach and a tremendous resource to serving young children and families infected or affected by HIV/AIDS, published in AIDSTAR’s “Technical Brief: Early Childhood Development for OVC – Key Considerations.”

What kind of help would you need to make your idea real?

We would love to hear feedback from the community of creating new partnerships to fully spotlight what each brings to the table.

Is this an idea that you or your organization would like to take forward?

  • Yes. I am ready and interested in testing this idea and making it real in my community.
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Attachments (4)

Final- User Experience Map.pdf

User Experience Map- PDF

Focus Group Questions 1.5.2015.pdf

DRAFT- we are currently finalizing the questions for the focus groups that will be held the week of January 11. This is a current draft of questions that we will continue to refine

28 comments

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Photo of Natalie Lake
Team

Hi Jessica and Team,

It sounds like you guys have a great approach and a great handle on your monitoring/evaluation. I think that training the trainers, is essential to any sustainable community education project. I also like that your model requires a small economic contribution. I think that this ensures a higher attendance (will you be sharing your outputs by the way?) because people will have literally invested in the workshop and only those truly interested would do so.

I'm very curious about your project! Is your team predominantly foreign workers or does it include local nurses and healthcare workers? Do you face many cultural misunderstandings? Because child rearing can sometimes be a touchy subject, does your team ever face misgivings from the audience about any of your techniques? I cannot wait to see how your project progresses. Happy New Year!

Photo of Jessica Burg
Team

Hi Natalie,

Thank you for your comments!

Our trainers are all local facilitators, familiar with the local culture and context that women are parenting in. All our materials are based on basic human development (when babies hit milestones, etc) and then adapted to the appropriate local context with songs, stories, habits, etc.

We are very sensitive to the local conditions are take all precautions to avoid cultural misunderstandings in our work, because you are absolutely correct, child rearing can be a very touchy subject!

Thanks again and Happy New Year!!

Jessica

Photo of Theodora Papatheodorou
Team

Hi Jessica. This is a great idea and I like us to collaborate as we propose something similar to develop in the Democratic Republic of Congo. Capacity building of ECCD caregivers and parent/primary caregivers is at the heart of our idea. We developed a training programme and a system of ECCD services, so that ECCD caregivers train as they work. With your agreement, I would like to include you in our team. I look forward to hearing from you.

Photo of Jessica Burg
Team

Hi Theodora,

Thank you for your comment. I was just looking at your program yesterday and was thinking the exact thing. We would love the opportunity to collaborate with you. Please add me and Laura Peterson, the executive director of Hands to Hearts, Int. to your team.

Thanks!

Photo of Chioma Ume
Team

Hello Jessica! We've been having early childhood experts take a look at the ideas in Refinement and want to share some of their feedback with you: Very well done. Your proposal is also sophisticated in understanding principles of change; using trainers, role modeling and social networks to bring impact. Very good. What are some tangible next steps to take this forward, for example who would you need to speak to, what materials would need to be prepared, what would the timeframes look like? It would be great to have more information on the ECD model and approach that you are using so far and how you are planning to test through this idea? How you are going to equip individuals with a completely new skill, a bit away from what they are used to? Learning new skills takes time. How feasible is this? Can you think of other people that can be the TOTs? How is what you are proposing unique?

Photo of Jessica Burg
Team

Thank you for these questions, Chioma. We'll take a look and post the answers soon!

Photo of Chioma Ume
Team

Thanks Jessica and Happy New Year!

Photo of Jessica Burg
Team

Happy New Year!!
These questions are great! They really got us thinking. I wanted to check to see if there is any kind of word limit. Our team had quite a bit to say when answering these questions!
Thanks!

Photo of Chioma Ume
Team

Hi Jessica! Glad to hear! While there is no word limit, we'd love if you could aim to keep your answers concise so that we have an easier time reading and processing the information. Feel free to use point form if you like. Looking forward to reading your answers!

Photo of Bettina Fliegel
Team

Great idea! I like that it leverages a network that includes mothers and other/older women. There are many concepts that are geared for mothers alone but as we know, and have revisited continually, mothers live within an ecosystem and this varies within cultures and communities. Including other women organically in this parenting program can open many doors for mothers. Mothers may be enabled and encouraged to apply the learnings and skills that they received via HHI as other women in their lives have also been educated with them side by side. (as per your User Experience Map where a new mom attends with her mother-in-law as they both participate regularly in the same Self Help Group.) In the same vein, are you considering this training for fathers? Are there SHGs for men in India?
Excited to watch this project develop!_

Photo of Laura Peterson
Team

Hello Bettina,

Thanks for the encouragement and the question! I'm Laura, with Hands to Hearts International (HHI). I fully agree in (a) mother who are supported in HHI's groups apply their new learnings in more ways than we ever could imagine. I just reposted on FB about one story from the field that was this exact issue, you can read about that here - http://handstohearts.org/learn-more/blog/2006/12/unpredictable-miracles/

And, (b), yes we would love to have men participate! In a project we were involved in, in the post conflict zone of N. Uganda, we had both female and male HHI trainers, and they delivered HHI's training on early childhood/parenting, together in their villages. The participants were 37% male and this led to some huge changes in how wives/husbands parented and interacted not only with their baby, but with each other. The project trained 14,366 moms/dads and health workers, and the outcomes that USAID reported in the final report were not only impressive, but found to be sustained 18 months after HHI's training. The results included:

Cognitive stimulation from parent to child increased from 30% – 76%
Showing affection during feeding (responsive feeding is important to preventing malnutrition) increased from 54% – 91%
Mothers talking or singing to their child while feeding increased from 23% – 64%

Qualitative findings on this project were equally impressive, findings included:

– Parents reported that they felt their relationships with their children improved and the child-caregiver bond was stronger.

– Stopping domestic violence. Improved relationships between spouses. Helping parents better understand and interact with their children seems to help them also interact with each other more easily and without violence.

– Fathers increased their role in caregiving; reported less alcoholism.

One father’s story, which was representative of numerous fathers interviewed at both mid-term and final evaluation, indicated that the HHI trainings showed him that he had value as a caregiver, something he had not seen before. This realization led him to come home at nights and not stay out drinking. At home he enjoyed the affection his child had for him.

Sorry, I may be giving you far more information than you wanted, but I can get carried away in my excitement! The answer to your question is that yes, we are seeking to reach the fathers and grandpas via Farmer's Groups, that are prevalent in the areas we will be working and Reach India has collaborated with them in the past.

Thanks again and happy new year to you!
Laura

Photo of Bettina Fliegel
Team

Hi Laura. I am happy to learn more about your work! (I am a pediatrician working in low income communities in NYC. I understand your excitement about a great resource!) Thanks for sharing stories, outcomes, impact! I checked your website to find out more about the curriculum and course structure/presentation. Can you link it to the post above?

One thing that I have been thinking while reading many IDEAS in this challenge is that while many include parent education the focus as presented is primarily on physical growth, physical health, disease prevention and treatment and factors and systems that effect these. This education is vitally important as based on evidence. The expanded scope of your project provides other information and experiences for parents also very important to the overall health and development of children and their families, one key component being on the emotional health and development of young children, and the relationship between parent and child as a key influencer in this area. The other modules focusing on distinct aspects of early childhood development are also key each building on the other. Promoting language requires talking to your baby, which requires a bond between baby and parent etc. etc. and communicating between baby and parent strengthens the bond. Great stuff Laura!

Do you know if any of the parent classes continued on as informal parenting groups - forums for parents to support each other and perhaps share best practices, knowledge of resources - local and perhaps others - web based, mobile phone programs, professional resources - as parents learned of them?

Good luck bringing these two initiatives together to create impact!
Would love to see your HHI program roll out in resource poor communities in the US as well. Any plans for that?

Photo of Bettina Fliegel
Team

Laura,
I see you linked a video on Baby Massage to the post to GHEI below. Are you aware of any evidence based studies on baby massage as a supportive measure for moms with Post Partum Depression? Muideen has a project in this shortlist - a proposal for a screening program for PPD in moms and growth delay in infants in Nigeria. I commented that infant massage might be something to introduce to facilitate bonding between mom and baby.
https://openideo.com/challenge/zero-to-five/refinement/incorporating-depression-and-developmental-screenings-into-the-national-program-on-immunization-npi-in-nigeria
I will share your video link with him.
Bettina

Photo of Laura Peterson
Team

Hello Bettina,

Thanks for learning more about our work. I worked for 10 years in children's mental health and from that founded HHI on the premise of building the bond between baby-parent, and thus preventing Attachment Disorder. So, our entire program is steeped in the simple, yet critical idea of "love the baby" and it is woven into every lesson, domain of development and aspect that HHI shares. While knowing about all of the domains of development, and what happens when, and how to promote it, I remain committed to the belief that the quality of the relationship (baby-caregiver) is the most important thing we can build/support and that ripples into everything else, like you mention how they talk to the baby, feed them, respond when they are sick, help them learn to roll over and then walk - on and on!

From the feedback we have from the field, an estimate is that at least 70% of our trainees share the training with others, and those who lead Mothers' Groups as a part of their work (India's day care workers, Anganwadi workers) use it in their groups. However, to date, we haven't been able to formally measure or track this.

I know there is strong evidence for the power of massage, particularly for baby massage, and the positive effects it has on both baby and mother. I haven't delved into this research in quite some time, so please feel free to share anything you come across. It all goes back to how to build/support the early bonding, and loving, gentle touch is such an easy and effective way to accomplish so much for the relationship and for a host of other benefits. Please do feel free to share our massage video far and wide, it is subtitled in 24 languages exactly for that reason!

I'd love to see HHI be available here in the US, I think it could be a complementary (lower level, yet far less expensive and thus widely available) partner to programs like Nurse Family Partnership. If you see some ways we could collaborate and support your work in NYC - please let me know.

Warmest wishes, happy new year and thanks for your active participation in all of this!
Laura

Photo of Ghana Health and Education Initiative
Team

Thanks for this great idea! I would love to learn more about your curriculum and potentially adapt it for our mother mentor program in rural Ghana. What are your thoughts on how this could be adapted for one on one interactions?

Would you be willing to share your curriculum?

Thanks so much!

Photo of Laura Peterson
Team

Hi GHEI,
Thanks for your comment and inquiry. I'm Laura, with Hands to Hearts International. I've read about your project and would be very interested in speaking with you to learn more and brainstorm ways in which we might be able to collaborate. I especially like that your Mother Mentors are of the local communities and serving the local communities, that is a key component of success, trust and ensuring relevance.

What curriculum do you have/use now for teaching about ECD? HHI's curriculum has been adapted to different areas, and for different uses. We are currently adapting it to fit for a massive expansion via women's Self Help Groups in rural India. In the past though, our program has been adapted and used by our partners in N Uganda, for both group trainings, and for individual home visits. You can read about that project, and others we have worked on, here http://handstohearts.org/about-us/hhi-resume/.

I am partial to having HHI's trainings conducted in groups, as that helps moms, dads, grandparents, and other caregivers all recognize that they are in it together, and that if they want to make changes, they are not alone. However, given your Mother Mentors, their long-term relationship and support would offer significant trust and safety.

One piece of our training that I can offer you immediately is this instructional video on Baby Massage, subtitled in 24 languages - http://www.healthphone.org/hhi/

Let's find a time to talk/skype and learn more about each other's work.
Happy new year!
Laura

Photo of OpenIDEO
Team

Congratulations on making the Zero to Five Challenge Refinement list, Jessica! We are excited about the potential of leveraging existing networks and bringing together two independently successful programs. We are interested in learning more about the roles that each of the organizations will play in your idea – for example, will Thrive be implementing the idea? How will HHI be involved? What was the rationale for choosing Samastipur District in Bihar? Completing a User Experience Map will help our community understand how a mother might hear about and participate in the program that you are proposing: http://ideo.pn/0to5-map. You might also consider gauging interest in this idea by seeking feedback about this idea from parents in Samastipur who are members of the saving groups you hope to involve. We would love to see you prototype an aspect of this idea to help you shape it more fully and iterate on your initial idea. Check out tips for Refinement http://ideo.pn/0to5-tips-refine for some tools to help you get started.

Photo of Jessica Burg
Team

Thanks for your comments and questions! We are excited about moving forward with this project! We'll post more soon.

Photo of Meena Kadri
Team

Great to see you've uploaded your responses here. We also look forward to your User Experience Map when you are ready. And of course, in OpenIDEO-style, we hope you'll join in to look over other shortlisted ideas and provide feedback and suggestions with the wealth of knowledge from Thrive's pursuits.

Photo of Jessica Burg
Team

Hi Meena,

We're finalizing our User Experience Map and plan to upload later today or first thing tomorrow. That was a super useful exercise!

Photo of Chioma Ume
Team

Hi Jessica! So glad that you are working on the user experience map and that it was useful to your team! Over the next few weeks, we'd love to see you share your idea to some members of the self help groups you plan to involve. It seems that the HHI curriculum has been used with success – we're also interested to better understand how you plan to blend the two concepts – and your end users will definitely give you some insights about this!

Photo of Jessica Burg
Team

Hi Chioma,

Thank you for your comment. We're actually designing a focus group survey right now. We are planning to reach out to 3-5 of the Self Help Groups in Bihar to both gauge their interest in this curriculum, specifically in the context of their SHG, and to gather their input on specific topics within this particular subject. Once we have finalized our questions, I will upload the survey.

We're working on the logistics of these focus groups. We were hoping to conduct these in early January, but it is looking more like it will happen towards the end of January.

The SHGs often have education series at their weekly meeting. Reach India has trained facilitators that have provided a wide variety of life-skills trainings. HHI curriculum is designed to be delivered in an eight week series of half-hour to one hour lessons. These trainings have been delivered in communities through other means, never the SHGs, but we think that would be a natural community of women that could be very interested in our topic. We anticipate that the focus groups will support that.

Thanks again!

Photo of Chioma Ume
Team

Great to hear, Jessica. We look forward to seeing the questions that you plan to ask. Interesting that the SHG's already have an educational component to their sessions – do you know whether they have a role in deciding what training that they receive? Assuming you move forward with this project, what will happen to the SHGs after the 8 week HHI training finishes?

Photo of Meena Kadri
Team

Sounds like a really awesome approach, Jessica! For our Zero to Five Challenge, it would be helpful to isolate a specific, new initiative if you're interested in potential funding from the Amplify program as what you have outlined above is currently too broad for consideration. Perhaps, for example, you might focus on training Reach India's social entrepreneurs in a specific location – and describe in detail how you would approach this uniquely and how you might test some assumptions behind your proposed approach. In terms of testing, we're keen to know what lightweight experiments you might run before starting a pilot. You might like to check out our tips on prototyping for more direction: http://bit.ly/pr0totype

We're also curious – do you work for Reach India or Hands to Heart? Here's a friendly tip: update your OpenIDEO profile so folks can appreciate your skills, experience, passions & more. Looking forward to seeing more of you across conversations on this challenge...

Photo of Jessica Burg
Team

Hi Meena,

Thanks for your feedback! We are really excited about taking a proven concept and curriculum and pairing it with an effective distribution network. This pilot partnership will initially be tested in Samastipur District, Bihar, India, but we think we can grow this program to even greater populations.

Photo of Elizabeth Kukka
Team

Jessica, your project is inspiring! and an approach that I would like to integrate across sector here in San Francisco. I'm starting a little late on this process but would like to stick with it, or at least follow what others are putting together

https://novoed.com/hcd-acumen/users/Elizabeth_Kukka

Photo of Jessica Burg
Team

Hi Elizabeth, thank you for your kind words! We're based just across the bay in Oakland, so if you would like to discuss the work we do and how it might be used or adapted in a domestic context, we'd be happy to get coffee some time!

Photo of Meena Kadri
Team

Do let us know what comes of this! We love hearing stories of our OpenIDEO community connecting and enhancing the pursuit of social good.