Reach Up JAMAICA

A Low-Cost Home-Visiting Model

The ReachUp Jamaica project is an early childhood intervention that aims to improve children’s welfare over a comprehensive set of outcomes, spanning cognitive skills, socioemotional learning, and health. The project’s relatively inexpensive design, inherent simplicity, and track-record of success have generated numerous replications of the original program across the globe. Acclaimed for rigorous research, the Center for the Economics of Human Development (CEHD) is leading thriving international partnerships that aim implement, measure, and analyze the results of the ReachUp model in China, Brazil, and Chicago to produce policy-relevant work. This research has potential to inform legislators and practitioners on a global scale on the merits of nutrition, social stimulation, parenting, and home-visiting programs delivered at a low cost.

Motivation

Socioeconomic inequality and poverty around the world are perpetuated through disparities in skills and abilities due to a dearth of investment in human capital. At the Center for the Economics of Human Development (CEHD), we study the role of skill formation at different stages of the life cycle in remediating inequality and alleviating poverty. We examine when in the life cycle interventions to promote skills are effective and what form they should take. Early childhood intervention is o en e effective in terms of impact and cost. CEHD’s research has shown that the formation of early life cognitive and socio-emotional skills plays a large part in determining later-life outcomes in dimensions such as earned income, crime, and health, leading to an estimated annual rate of return of anywhere between 7-14%. There are currently many competing early intervention models, from center-based childcare to home-visiting interventions. The Reach Up Jamaica model is a low-cost home-visiting program that provides nutrition and social stimulation to children as well as parental support to families. The program has a track record of long- term success and is currently being replicated in a host of international contexts. CEHD seeks to study these various implementations to be er understand how these interventions work and in what contexts they can have the most impact.

Reach Up Jamaica: The Original Model

Pioneered by Sally Grantham-McGregor, the Jamaica Intervention, named for its successful implementation in that country, is a home-visiting intervention targeted towards stunted and disadvantaged children between 9 and 24 months of age. These children were recruited from neighborhoods of Kingston and received nutritional supplementation, social stimulation, or a combination of the two in a randomized control trial conducted in the late 1980s. Nutritional supplementation was proposed to compensate for the nutritional deficiencies that may have caused stunting. Children received fortified formula that satisfied nutritional requirements for calories, protein, and micronutrients. Social stimulation involved trained home visitors playing with children, guided by a curriculum designed to develop cognitive, language, and psychosocial skills. Home visits were minimal, with only 2 one-hour visits per month, however the program effects were substantial. Short-term follow up studies showed that social stimulation was crucial in improving school-aged outcomes of the treated children. A longer-term analysis when participants were 24 years of age showed that the intervention increased the labor market earnings of the treated children by 25% (Gertler et al., 2014).

Comparing Across Contexts

This low-cost, high-impact Reach Up intervention has proven highly adaptable across a host of cultural contexts. Working with collaborators who are replicating the Jamaica program, we hope to study the variable impacts of the program across socioeconomic and cultural groups. Additionally, as we guide future implementations, we hope to collect additional data to better understand the mechanisms through which the Jamaica model effects long-lasting change.

China

In 2015, China Development Research Foundation (CDRF) launched the Rural Education and Child Health (ChinaREACH) project in response to a call for evidence-based pilot-to-policy applications made in China’s State Council, and new focus on reducing poverty and promoting social mobility. The project, the first independent impact evaluation of a national program in rural China, implemented nutrition and parenting treatments for at-risk families in rural Gansu Province using the Jamaica model. CDRF’s Lu Mai oversaw the ChinaREACH treatment implementation within the field and CEHD’s Professor James Heckman directed the design of ChinaREACH drawing on his extensive experience designing intervention strategies to foster human skills and capacities to remediate disadvantage. Rural China serves as an ideal location for testing early childhood development treatments with 680 nationally designated “high poverty counties” and 20.3% stunting rate, the CEHD-CDRF ChinaREACH project will soon extend to additional provinces and stand as a flagship for global poverty efforts. As the first rounds of data collection wrap up, we have the opportunity to analyze and compare program impacts.

Brazil

In partnership with Alexandra Brentani at the University of São Paulo, CEHD is providing advice and guidance on the implementation of the Jamaica model in two communities in Brazil—São Paulo and Boa Vista. Dr. Brentani’s team has already implemented a version of the Jamaica model in São Paulo and is currently conducting follow-ups of the original cohort. Meanwhile, the team is preparing for another implementation in Boa Vista. CEHD, in partnership with Dr. Jack Gilbert at the University of Chicago, hopes to study not only cognitive and socio-emotional data, but also data on the microbiome. The microbiome has recently been shown to form a “gut-brain” axis, mediating interactions between nutrition, environmental influences, human growth, and brain development in early childhood. By collecting panel data on microbiome measures among the Boa Vista cohort, we can connect insights about the Jamaica model with a possible mechanism of action through the microbiome.

Chicago

As we begin to amass evidence on the effectiveness of early childhood interventions, we have also turned our focus towards implementing these programs closer to home. Despite the effectiveness of the Reach Up intervention in Jamaica, it has not yet been implemented in the U.S. It appears to be a low-cost competitor for many high-cost programs. CEHD hopes to champion such an effort, bringing the Jamaica model to disadvantaged populations in Chicago. The program promises a low-cost effective intervention that will likely survive budgetary scrutiny while gathering the essential ingredients of building successful lives. Instead of operating expensive childcare centers, our proposed solution is to promote community-adopted, culturally-sensitive home-visiting programs. We will adapt and implement versions of home-visiting programs that can (i) provide children with social stimulation in the form of toys and games administered by trained professionals, and (ii) teach guardians effective parenting strategies that can improve the home environments of children. We also plan to enrich the diets of children and caregivers using recent evidence on the microbiome (gut bacteria).

Project Team

 

Tanya Rajan

The University of Chicago


Jin Zhou

The University of Chicago


 

Project Partners


The Center for the Economics of Human Development (CEHD)’s mission is to advance knowledge that fosters human flourishing by identifying sources of disadvantage and promoting equality of opportunity. The Center produces empirical and theoretical research that integrates ideas and methods across the social and natural sciences to create rigorous evidence for public policy.

The Microbiome Center brings together an unprecedented group of researchers and scientists who are leading diverse fields of study. By galvanizing this expertise, the Microbiome Center will tackle complex questions, help scientists quickly translate their findings to private and clinical sectors, and train the next generation of microbiome scientists. Project ECHO, led by Dr. Erika Claud and Dr. Jack Gilbert, aims to investigate the effect of the microbiome and environmental influences on neurodevelopment in infancy.


The Rural Education and Child Health project (ChinaREACH), a collaboration between The Center for the Economics of Human Development, the China Development Research Foundation, and the Insitute of New Economic Thinking, is a groundbreaking early childhood randomized control trial designed to evaluate the joint impact of China’s Children Nutrition Improvement Project in Poverty-stricken Areas (CNNIP) and the Jamaica Parenting and Psychosocial Stimulation Curriculum. Improved developmental outcomes for rural children anticipated by ChinaREACH—including health, cognitive and social-emotional skills—will serve to inform China’s national and provincial government and encourage a new National Health and Parenting policy.

The Universidade de São Paulo Medical School is recognized for its pioneering and excellence in teaching and research. It was founded in 1912 and established in 1913. In 1934, it became part of the Universidade de São Paulo. Dr. Alexandra Brentani leads the team implementing versions of ReachUp in São Paulo and Boa Vista. Her research team is investigating the continued high rates of neonatal mortality, and the large disparities in early childhood development in regions of Brazil.