Early Childhood Development Services Research Articles

Digital tools to improve parenting behaviour in low-income settings: a mixed-methods feasibility study

IntroductionDigital parenting interventions could be potentially cost-effective means for providing early child development services in low-income settings. This 5-month mixed-methods pilot study evaluated the feasibility of using Afinidata, a comprehensive...

Triple Benefit: Impact of an Integrated Early Childhood Development and PMTCT Intervention on ART Outcomes Among Mothers Living with HIV and Infants in Malawi—An Endline Evaluation

We conducted a programmatic, observational cohort study with mother-infant pairs (MIPs) enrolled in prevention-of-mother-to-child-transmission (PMTCT) programs in Malawi to assess the feasibility and potential HIV-related benefits of integrating Early Childhood Development (ECD) services into PMTCT programs. Six health facilities were included in the intervention. We offered ECD counseling from the WHO/UNICEF Care for Child Development package in PMTCT waiting spaces while MIPs waited for PMTCT and broader treatment consultations. Primary outcomes were mothers’ retention in HIV care at 12 months and infant HIV testing at 6 weeks and 12 months after birth. Routine facility-level data from six comparison health facilities were collected as an adhoc standard of care comparison and used to calculate the cost of delivering the intervention. A total of 607 MIPs were enrolled in the integrated ECD-PMTCT intervention between June 2018 and December 2019. The average age of MIPs was 30 years and 7 weeks respectively. We found that 86% of mothers attended ≥ 5 of the 8 ECD sessions over the course of 12 months; 88% of intervention mothers were retained in PMTCT versus 59% of mothers in comparison health facilities, and 96% of intervention infants were tested for HIV by six weeks compared to 66% of infants in comparison health facilities. Costing data demonstrated the financial feasibility of integrating ECD and PMTCT programs in government health facilities in Malawi. Integrating ECD into PMTCT programs was feasible, acceptable, resulted in better programmatic outcomes for both mothers and infants. Further investigation is required to determine optimal delivery design for scale-up.

Pattern of Community Participation in Holistic-Integrative Early Childhood Services in Garut District

This study aims to analyze the forms and levels of community participation in holistic-integrative early childhood services at Tk Al-Mukhlis, Tarogong Kaler District, Garut Regency, West Java Province. With a quantitative approach, this research is descriptive. The data obtained on an ex post facto basis are expected to accurately describe individual characteristics, circumstances, symptoms, or certain groups or find the spread (frequency) of a symptom and other symptoms in the community in Dukuh Village, Pananjung Village, Tarogong Kaler District, Garut Regency, in particular who came from elements: the precise foundation, educators and education staff Al Mukhlis, and guardian parents, which were then determined as a sample of 89 people. The research results show that: 1) Al Mukhlis Kindergarten has organized a holistic-integrative early childhood service program systematically 2) forms of community participation provided in holistic-integrative aged childhood services at all three stages, which are very varied and experiencing changes. The most dominant form of participation given by the community is in the form of contributions of ideas or thoughts; 3) the level of community participation provided in holistic-integrative aged child services at the three stages tends to increase at each stage. The results of the analysis show that from the initial stage of activity implementation in the form of planning, which is then followed by the implementation stage, up to program evaluation, the level of participation provided by the community is slowly increasing, from the lower ladder, namely consultation at the planning stage. The author conducted a different study and had not been carried out by previous research, where the context of the research carried out was community participation in holistic-integrative early childhood development services, using different indicators from previous research, namely participation of ideas, the participation of labor, the participation of property, participation of skills, and social participation. Keywords: community participation, holistic-integrative early childhood, services. https://doi.org/10.55463/issn.1674-2974.50.3.17

Records and information management in evidence-based decision-making public schools in South Africa

Records are important assets in the decision-making process and promote transparency and accountability. The successful provision of educational and training services in public schools relies on reliable and authentic records. Thus, evidence-based decision-making can help address the challenges in the basic education sector in public schools. The challenges manifest as weaknesses between the different sectors and departments responsible for early childhood development services and poor quality of school education outcomes in public schools. The said challenges were identified in the National Development Plan 2030 and their resolution can contribute to the achievement of education and training goals. The main purpose of this study was to outline the role played by records and information management in supporting evidence-based decision-making in public schools in South Africa. This study adopted the qualitative research approach and used content analysis to identify challenges hindering national development plan goal achievement in the basic education sector. A content analysis of available literature consisting of policy documents, internet sources, books and journal papers was used to identify and describe the challenges and propose solutions. It is guided by the Association of Records Managers and Administrators’ Generally Accepted Record Keeping Principles as a framework. The study found that poor educational outcomes could be improved through proper records management practices enabling evidence-based decision-making to thrive. The study recommends that governmental bodies in South Africa utilise the power of records and information management to enable goal achievement, with the professional assistance rendered by the National Archives and Records Service of South Africa (NARSSA) and provincial archives.

Role of Pediatricians, Pediatric Associations, and Academic Departments in Ensuring Optimal Early Childhood Development Globally: Position Paper of the International Pediatric Association.

Early childhood (birth-8 years), particularly the first 3 years, is the most critical time in development because of the highly sensitive developing brain. Providing appropriate developmental care (i.e., nurturing care, as defined by the World Health Organization [WHO]) during early childhood is key to ensuring a child's holistic development. Pediatricians are expected to play a critical role in supporting early childhood development (ECD) through providing developmental services such as developmental monitoring, anticipatory guidance, screening, and referral to medical and/or community-based services when delay is identified. Pediatricians are also expected to serve as advocates within their clinics and communities for improved delivery of ECD services, such as advocating for increasing funding for ECD initiatives, increasing insurance coverage of ECD services, and working to increase other pediatricians' awareness of the principles of ECD and how to deliver developmental services. However, this does not always occur. Typically, pediatricians' training and practice emphasizes treating disease rather than enhancing ECD. Pediatricians are further hindered by a lack of uniformity across nations in guidelines for developmental monitoring and screening. In this article, we present the vision of the International Pediatric Association (IPA) of the roles that pediatricians, academic departments, medical training programs, and pediatric associations should fulfill to help support ECD, including raising ECD to higher levels of priority in routine pediatric care. First, we present the challenges that face these goals in supporting ECD. We then propose, with supportive literature, strategies and resources to overcome these challenges in collaboration with local and international stakeholders, including the IPA, the WHO, UNICEF, and the World Bank.

Improving Access and Quality in Early Childhood Development Programs: Experimental Evidence from the Gambia

We evaluate two experiments of early childhood development (ECD) programs in the Gambia, one increasing access to services and another improving service quality. In the first experiment, new community-based ECD centers were introduced into randomly chosen villages that had no preexisting structured ECD services. In the second experiment, a randomly assigned subset of existing ECD centers received intensive provider training. We find no evidence that either intervention improved average levels of child development. Exploratory analysis suggests that the first experiment, which increased access to community-based ECD services, led to declines in child development among children from less disadvantaged households.

Improving policy environments for infants and young children: global status of multisectoral national policies for early childhood development

ABSTRACT Multisectoral national policies for early childhood development (ECD) have been developed since 1979, yet until now the number of countries adopting them has not been systematically documented. Numerous global declarations, including Education for All and the Sustainable Development Goals (SDGs), have supported ECD policy planning. Selection and search criteria were established and applied to identify and classify multisectoral ECD policy documents. A descriptive study was conducted to assess historical trends in policy adoption, regional coverage, income levels, governance categories, and crisis countries. Policies were first developed in Colombia, and later in Namibia, South Africa, Mauritius and Maldives. By December 2019, 76 countries (39% of 197 countries worldwide) and one territory had adopted 125 multisectoral ECD policy instruments. Of them, 51% were policies; 37% strategies and/or action plans; 11% laws; and 7% regulatory documents. By 2010, 43 countries had adopted an ECD policy instrument, peaking in 2011 when 14 countries adopted policies. From 2012 to 2019, 29 countries adopted a policy. South Asia (88%), Latin America and the Caribbean (65%), and Sub-Saharan Africa (58%) lead policy development. Policies have been adopted by 53% of low-income countries and 55% of lower middle-income countries. Fewer upper middle-income countries (38%) and high-income countries (14%) have adopted an ECD policy. Previous research found that countries using participatory policy planning processes resulted in well-implemented ECD policies. The presence of a multisectoral ECD policy prepared in a participatory manner helps establish a strong enabling environment for expanding and improving ECD services. To attain SDG 4.2, additional lower- and middle-income countries, countries with emergencies, and authoritarian regimes should be prioritized for support. Finally, we recommend an indicator be established to identify the number of countries that have adopted ECD policies to help measure SDG 4.2.

Inclusion of children living with disability in early childhood development and education: construction of a stakeholder‐informed framework

School‐level data shows that a large number of Children living with Disability (ClwD) are not accessing Early Childhood Development and Education (ECDE) services in Nepal (Department of Education, 2020). This research explores the factors affecting the inclusion of ClwD in ECDE programs aiming at informing policy, plans and strategies about existing barriers to early intervention and education services for ClwD. Through interviews, focus group discussions with key stakeholders and document reviews, the research identified the interconnection of several organisational and contextual factors created multiple barriers to successful inclusion. Organisational factors were: policy, attitudes, teacher efficacy, resources, coordination, communication processes and parental engagement. Contextual factors were: spirituality, caste, ethnicity, language, economic status, and geographic location. The very interactive nature of organisational and contextual factors resulted in the development of an inclusive education framework to inform future policies.

Priorities for access to early childhood development services for children with disabilities in South Africa

Background: South Africa has migrated the responsibility for early childhood development (ECD) centres from the Department of Social Services to the Department of Basic Education. This functional shift has ushered in consultations and discussions on how best to implement ECD, including opportunities the change may bring.Aim: By anchoring the understanding of ECD services in nurturing care, this study aimed to elucidate the provision of appropriate, inclusive services in early childhood development, including early childhood intervention, for children with disabilities in South Africa against the backdrop of the migration of services from one government ministry to another.Methods: This is an analytical article based on South African literature on ECD services, including interventions, with particular attention to children with disabilities, basing our understanding of these services in nurturing care.Results: We elucidate how the ideals of the Nurturing Care Framework can be achieved in the context of children with disabilities in South Africa using five themes: the need to localise services, developing tools and strategies for screening and early intervention, enhancing the efficacy of caregivers, supporting and training staff and collaborations.Conclusion: It is necessary to empower caregivers and professionals to address early childhood intervention and ECD needs of children with disabilities. Early childhood development centres are an important context for nurturing care, providing opportunities to promote and sustain health amongst a large number of children. Considering the function shift of ECD services in South Africa, these centres are well positioned to further nurturing care to children with disabilities through the provision of supportive environments that promote health and well-being.

Young children with disabilities, marginalised and voiceless: A case of Eswatini

Significantly, many people with disabilities are victims of classification over generalizations with the assumption that disability is equal to inability. This study focused on challenges faced by children with disabilities in accessing Early Childhood Care and Development (ECCD) services in Manzini Region of Eswatini. Anchored on the Critical Disability Theory which views disability as a cultural, historical, relative, social, and political phenomenon, the study assessed and analysed the disability issues on the accessibility to ECCD services for young children. Through interviews, data was collected from10 ECCD centres in Manzini which were purposively selected. Ten ECCD teachers, 5 principals, and 5 parents/caregivers participated in the study. The results revealed that failure by these children to access ECCD services in the community impacts negatively on their holistic development. Sadly, young children living with a disability in Eswatini face significant challenges, one of the reasons, just like most of our African countries, being that those who have some form of disability were bewitched or inflicted by some bad spirits. ECCD specialist educators highlighted the need for comprehensive training services that will help them cater to children with special needs. The study recommended for extensive awareness programmes to sensitize communities on the rights of the child, regardless of body, mental or sensory condition.

Last-mile delivery of early childhood development services: The role of community health workers in dadra nagar-haveli district

Last-mile delivery of early childhood development services: The role of community health workers in dadra nagar-haveli district

Establishing outcome measures in practice: Developing a model for services working therapeutically with children and families

Abstract Providers of therapeutic services to children and families have, in recent times, been subject to pressure to supplement traditional service output measures with evidence-based measures, which capture outcomes for service users. In this article, we report on the near decade long establishment of a range of standardised measures within an Irish non-governmental agency providing therapeutic help to children and families across two settings, family centres and early childhood development services. We describe the organisational conditions necessary for the introduction of standardised outcome measures and provide an illustrative overview of participant characteristics and some examples of key findings across both services as they relate to the important outcome domains of child and parent functioning. We further propose a model for the introduction and sustainability of outcome measures as a necessary and enduring feature of therapeutically orientated organisations providing services to children and families. Lastly, we identify organisational commitment to the development of outcome data, plans to ensure sustainable arrangements for ongoing data analysis, and conceptual linkage between evidence informed practice and the values of an organisation as key considerations.

What is my child telling me? Reducing stress, increasing competence and improving psychological well-being in parents of children with a developmental disability

High levels of stress in parents of children with a developmental disability have been extensively documented. These heightened stress levels seem independent of diagnosis and are better explained by the level of challenging behavior of the children. Furthermore, the relationship between stress level and difficult behavior appears reciprocal. The negative impact of stress on parents’ skill development, response to difficult behavior, sense of competence, well-being and the child’s developmental outcomes have also been thoroughly detailed. The Parent Child Relationally Informed - Early Intervention (PCRI-EI) aims to expand the response repertoires of parents to help address the challenges of parenting a child with a developmental disability, including through reducing parental stress. The current study presents a quasi-experimental assessment of the efficacy of PCRI-EI in reducing stress levels and increasing sense of competency and psychological well-being in a sample of 22 parents of children with a variety of disabilities presenting to a community early childhood development service. Statistically and clinically significant changes in overall stress levels (Parenting Stress Index), psychological well-being (K6) and sense of competence (PSOC) were observed across time.

Integrated early childhood development services improve mothers\u2019 experiences with prevention of mother to child transmission (PMTCT) programs in Malawi: a qualitative study

BackgroundHIV-positive mothers who face the dual burden of HIV-positive status and motherhood, may benefit from holistic services that include early childhood development (ECD). We evaluated the acceptability and impact of integrated ECD-PMTCT interventions for mothers and their children.MethodsWe implemented an integrated ECD-PMTCT intervention in 4 health facilities in Malawi for HIV-positive mothers and their infants. WHO/UNICEF Care for Child Development (CCD) education and counseling sessions were offered during routine PMTCT visits between infant age 1.5–24 months. From June–July 2019, we conducted in-depth interviews with 29 mothers enrolled in the intervention for ≥6 months across 4 health facilities. The interview guide focused on perceived impact of the intervention on mothers’ ECD and PMTCT practices, including barriers and facilitators, and unmet needs related to the program. Data were coded and analyzed using constant comparison methods in Atlas ti.8.ResultsThe vast majority of mothers believed the ECD-PMTCT intervention improved their overall experience with the PMTCT services, strengthened their relationship with providers, and excited and motivated them to attend PMTCT services during the postpartum period. Unlike prior experience, mothers felt more welcome at the health facility, and looked forward to the next visit in order to interact with other mothers and learn new ECD skills. Mothers formed new social support networks with other mothers engaged in ECD sessions, and they provided emotional and financial support to one another, including encouragement regarding ART adherence. Mothers believed their infants reached developmental milestones faster compared to non-intervention children they observed at the same age, and they experienced improved engagement in caregiving activities among male caregivers. Nearly half of women requested additional support with depression or anxiety, coping mechanisms to deal with the stresses of life, or support in building positive dynamics with their male partner.ConclusionThe integrated ECD-PMTCT intervention improved mother’s experiences with PMTCT programs and health care providers, increased ECD practices such as responsive and stimulating parenting, and created social support networks for women with other PMTCT clients.

Engaging parents in early childhood intervention: relationship as a platform for functional gains

ABSTRACT Interventions to develop functional capacity for children with developmental difficulties have tended to be therapist driven. Such approaches can present difficulties for parents who describe increased stress and feelings of incompetence in a paradigm that can feel imposed. Recent findings have questioned the efficacy of the approach, given a deeper understanding of the impact of social and relational influences on child development. This questioning has prompted the development of programmes where the parent–child relationship is considered a fundamental component of early childhood intervention. The Parent–Child Relationally Informed Early Intervention (PCRI-EI) is such a programme. The current study presents a quasi-experimental assessment of the efficacy of PCRI-EI in achieving functional gains in a sample of 56 children with differing diagnoses presenting to a community early childhood development service. Significant and marked (i.e. large effect size) increases in functional capacity were observed across time. The gains did not differ by diagnosis and parental feedback indicated the improvements were generalised across social, community and educational settings.

The Challenges Experienced by Practitioners from Under-Resourced Early Childhood Development Centres in South Africa: A Single Site Study

ABSTRACT BACKGROUND: The occupation of education prepares children for adulthood. Each child has the right to education, which has the power to end intergenerational cycles of poverty and inequality. However, poor access to and quality of education at early childhood development (ECD) centres continue to prevail in marginalised communities in South Africa AIM: This study aimed to identify the challenges experienced by ECD practitioners and coordinators regarding the quality of their ECD programme METHODS: A qualitative, descriptive enquiry was conducted with six purposively sampled participants from an ECD organisation in South Africa. Semi-structured interviews were conducted with practitioners from under-resourced ECD centres from Bloemfontein, rural towns, and the organisation's ECD coordinator. Audio recordings of the interviews were transcribed verbatim. Deductive content analysis was used to analyse the data RESULTS: Four themes were identified from interview data: (i) teaching and learning; (ii) management and leadership; (iii) ECD environment; and (iv) ECD legislation and policies. Practitioners indicated that they wanted to improve their qualifications and have access to a contextually relevant programme with appropriate resources CONCLUSION: If the expressed challenges were addressed on an inter-professional collaborative platform, the quality of this ECD service could be improved Keywords: Teaching and learning; early childhood development; ECD policy and legislation; ECD practitioners; ECD programme; occupational therapy; South Africa.

Data for action on early childhood development

Early childhood development (ECD) in the first few years of life lays the foundation for a lifetime's mental and physical health, education, labour market productivity, and wellbeing.1Shonkoff JP Richter L van der Gaag J Bhutta ZA An integrated scientific framework for child survival and early childhood development.Pediatrics. 2012; 129: e460-e472Crossref PubMed Scopus (168) Google Scholar ECD is receiving increasing attention and is included in the Sustainable Development Goals (SDGs). Expanded 2020 ECD Countdown to 2030 country profiles2Countdown to 2030Early Childhood Development Profiles.https://www.countdown2030.org/early-childhood-development-profilesDate: 2020Date accessed: November 17, 2020Google Scholar will be launched by UNICEF and Countdown to 2030 on Nov 23, 2020, shortly after Universal Children's Day on Nov 20, 2020. The updated profiles cover 42 ECD indicators and 197 countries, including 60 high-income countries (HICs), that encompass 99·8% of the world's children younger than 5 years (figure). The profiles reveal substantial threats to ECD across the world: fewer than half of infants younger than 6 months are exclusively breastfed in most countries with data; at least 25% of children younger than 5 years are stunted in about a third of the countries; fewer than half of young children in a third of the countries receive the benefits of early stimulation and responsive care by adults in their home; and more than three-quarters of children aged 1–4 years experience violent discipline by their caregivers in almost half of the countries.2Countdown to 2030Early Childhood Development Profiles.https://www.countdown2030.org/early-childhood-development-profilesDate: 2020Date accessed: November 17, 2020Google Scholar Urgent action and investment in ECD by governments and national and international organisations are needed. Although the country profiles are progress towards establishing a global monitoring and accountability framework for ECD,3Richter L Black M Britto P et al.Early childhood development: an imperative for action and measurement at scale.BMJ Global Health. 2019; 4e001302Crossref PubMed Google Scholar daunting challenges remain. Among countries with available data on ECD indicators—mostly derived from UNICEF-supported Multiple Indicator Cluster Surveys (MICS), USAID-supported Demographic and Health Surveys (DHS), and other nationally representative household surveys—fewer than half have data on crucial indicators such as child poverty, or whether young children receive a minimally acceptable diet or attend early education. Rights-based advocacy has helped to raise the availability of data on duration of paid maternity leave4World Policy Analysis CenterParental Leave Database.https://www.worldpolicycenter.org/Date: 2020Date accessed: November 17, 2020Google Scholar and birth registration5UNICEFState of the world's children. UN Children's Fund, New York2019Google Scholar to above 90% in countries included in the country profiles. By 2018, only 40 countries had trend data on important ECD indicators: 17 on early education, 14 on home stimulation, and 13 on the ECD Index.6Lu C Cuartas J Fink G et al.Inequalities in early childhood care and development in low/middle-income countries: 2010–2018.BMJ Global Health. 2020; 5e002314Crossref PubMed Scopus (40) Google Scholar Variations in definitions, indicators, and questionnaires used to collect data occur between international survey programmes such as MICS and DHS, which are mostly done in low-income and middle-income countries (LMICs), and administrative and survey data collected in HICs. These variations compromise international comparability of data that is crucial to global monitoring. An important part of ECD is responsive caregiving for which operational definitions are urgently needed. While all human beings are dependent on love to survive and thrive, it is difficult to define and measure responsive caregiving across cultures and contexts in a standardised and comparable way. Similarly, comparable data on policy facilitators, such as government spending on ECD and family support for ECD, require a common understanding of what constitutes essential ECD services and how to quantify them. Despite these challenges, encouraging initiatives are underway. Coordinated by WHO, UNICEF, and the World Bank, multidisciplinary experts are moving forward with measures of responsive caregiving.7WHOUNICEFWorld BankNurturing Care Framework Implementation Working GroupNurturing care for early childhood development.https://nurturing-care.org/Date: 2020Date accessed: November 17, 2020Google Scholar Another example is the launch of the revised ECD Index 2030, along with the ECD country profiles, and its recognition as a tool for generating comparable data on children's developmental outcomes for global monitoring of SDG 4.2.1. Improvements in the availability of data on ECD indicators have been driven by the inclusion of questions on children's health, learning, nutrition, and family environment in standardised household survey programmes. Since their inception in 1984 and 1995, DHS and MICS have collected data in more than 120 LMICs. Since 2005, questions on quality of care at home, parenting practices, access to early childhood care and education, and developmental status of children are part of MICS standard questionnaires, making MICS the largest source of internationally comparable data on young children. ECD data collected before the start of the COVID-19 pandemic will provide countries with useful baselines to assess the potential effects of health and societal disruptions on young children and their families. Under lockdowns and other preventive measures, many families have become the sole providers of the nurturing care required for young children's development—good health, adequate nutrition, safety and security, learning opportunities, and responsive and supportive interactions with adults. The abilities of families to sustain nurturing care under economic and other stresses are being stretched. The likely worsening impact of continued income cuts and parental mental distress on the healthy developmental trajectory of many children will only reliably be estimated with available data on ECD. Within just a decade, ECD measurement and monitoring have started to be mainstreamed. However, to achieve a universal picture of how young children are faring, as well as progress and setbacks to improve their lives and their futures, we need more countries, including HICs, to adopt and prioritise the measurement of internationally comparable ECD indicators. Much more work is needed to advance ECD, never more so than now, when young children in all countries face threats to their survival, health, and development resulting from or exacerbated by the COVID-19 pandemic.8Yoshikawa H Wuermli AJ Britto PR et al.Effects of the global coronavirus disease-2019 pandemic on early childhood development: short- and long-term risks and mitigating program and policy actions.J Pediatr. 2020; 223: 188-193Summary Full Text Full Text PDF PubMed Scopus (88) Google Scholar LMR, SNN, CC, and NP contributed to the development, design, and production of the ECD country profiles discussed in this Comment and supporting material. CC and NP led the development and testing of the revised ECD Index 2030 discussed in this Comment and the preparation of supporting material. We declare no other competing interests. The preparation of the country profiles was led by UNICEF and was made possible through core funding to the organisation. Other funders include the Conrad N Hilton Foundation and the Bill & Melinda Gates Foundation. Work on this Comment was supported by the UK Research and Innovation (UKRI) Collective Fund Award (grant ref: ES/T003936/1) UKRI GCRF Harnessing the power of global data to support young children's learning and development: analyses, dissemination, and implementation.

Raising a new generation in a postcolonial era through decolonised early childhood development and care services

This article draws on the literature in development economics, psychology and sociology to explicate how decolonised early childhood education and care services can reverse the metacolonial cognition lingering in the postcolonial era. In particular, the author shows that colonial institutions persist even after formal colonisation has ended through the application of de facto power. Self-knowledge developed during early childhood impacts adult socio-economic life outcomes. Thus, decolonising early childhood development and care by ensuring positive representations of self will improve self-perceptions and self-awareness. The implications for practice and policy are discussed within the context of deploying decolonised early childhood development and care services to raise a new generation of confident Africans to accelerate the development of the continent and regions with similar histories of colonisation.

“The Green Sea Yard of Varna” – the innovative project in the focus of early child development

Abstract We present an innovative approach to early child development (ECD), designated as a priority for all societies. Traditional ECD services of the Bulgarian health system are predominantly medical or pedagogical provided by GPs and nurseries. This leaves space for interdisciplinary services based on the ideas of Françoise Dolto focused on child-parent relationships. The Green Sea Yard of Varna, Bulgaria, aims at providing accessible space for early socialization of children and preventive psychosocial services by experts in ECD. The process oriented work combines: psychosocial accompaniment, social group & community work, psychoanalytic consultation with medical expertise. Specialists use direct observation, interviews, analysis of available information, hypothesis development. Questions to be answered: is there a recognized need for a space enhancing and stimulating the interaction between the three main subject in ECD child-parents-specialists; is there a need for a transitional space between the home and kindergarten enabling early child socialization; which are the most prevalent mental and behavioral problems and their earliest symptoms. For 104 working days (December 2018-February 2020), 2 000 visits of 257 children have been performed, including 400 individual consultations of 51 children at risk. Smooth adaptation to nursery was experienced by 15,5% of children. The most prevalent problems are: insufficient to lacking parent-child verbal communication; delayed speech development; aggressive behavior towards peers. The main lessons are: (1) There is a recognized by specialists, families and the community need for transitional spaces enabling children to experience first social encounters and concepts of social rules and norms; (2) the space stimulates both formal and informal quality communication between specialist and parents and mutual informal support between parents; (3) leading to a new view for the child as an autonomous person. Key messages The Green Sea Yard of Varna is the first innovative space for interdisciplinary approach to ECD, early socialization, care & prevention in our community fully applicable to other places and cultures. The project is in line with SDGs, contemporary scientific visions for the first 1000 days of a child's life and the WHO strategy for the prevention of child’s health in the family and in society.

Interrelationships of Parenting Information, Family Care, and Child Development: A Cross-sectional Study in Rural China.

This paper studied the interrelationships between parenting information, family care, and early childhood development (ECD) outcomes. A total of 1787 sample households in rural China were enrolled in a cross-sectional study. A demographic questionnaire, a parenting information questionnaire, the Family Care Indicators (FCIs), and the Bayley Scales of Infant Development version III (BSID-III) were used to measure demographic characteristics, parenting information that the caregiver received, family care, and early development outcomes of the child, respectively. Structural equation modeling (SEM) was then used to estimate the interrelationships. The results showed that family care significantly mediated between parenting information and ECD outcomes. Through family care, one standard deviation (SD) increase in the parenting information was associated with the increase in the child’s four development outcomes (cognition, language, motor, and social–emotion) by 3%, 4%, 4%, and 5% of one SD, respectively. Different measurements of parenting information and different components of family care played different roles in the interrelationships. The key findings of this study are informative for providing early child development services in rural China.