CASITA Intervention for Children at Risk of Delay in Carabayllo, Peru

Brigham and Women's Hospital61 enrolled

Overview

Building on an intervention for early child development from the SPARK Center in Boston, Socios En Salud (SES) pilot tested "CASITA" a community-based package to screen and treat young children (ages 1-3 years of age) diagnosed with neurodevelopment risk and delay in Carabayllo, Lima, Peru. Ministry of Health CHWs identified children with developmental delays within the clinics and community and delivered a structured early intervention that included parent coaching and social support. In order to test the hypothesis that CASITA improves early child development, caregiver, and home environment, dyads received either nutrition supplements alone, nutrition + "CASITA" early child development sessions individually, or CASITA in a group of 10 dyads.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Child Developmental Delay Child Development Community Health Workers Low Income Population

Eligibility

Sex: ALLMin age: 6 MonthsMax age: 24 MonthsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: 1. Age between 6 - 24 months of age; 2. Known primary caregiver (parent or legal guardian) living with child; 3. Living within the catchment area of the 6 Health Centers that comprise the study zone. 4. Screen positive for neurodevelopment delay ("at risk" or "delayed" in neurodevelopment based on Evaluation del Desarrollo Psicomotor (EEDP) assessment). 5. Be at risk by scoring \<45 on the Progress Out of Poverty Index. Exclusion Criteria: 1. A known medical condition that would make the child unresponsive to early intervention; 2. Family anticipates moving within the next three months.

Outcomes

Primary Outcomes

Change in risk of delay, as measured by the EASQ

The Ages and Stages Questionnaire (ASQ) is an internationally-validated instrument that can be used to assess change in developmental risk over time. Fernald et al incorporated additional observation-based assessments and the following modifications: 1) addition of child observation exercises to allow for validity check of parent responses (original ASQ questions), and 2) the incorporation of ASQ questions from the next highest age range. The Extended Ages and Stages Questionnaire (EASQ) was utilized as an assessment tool to allow us to better quantify degree of risk at baseline (based on quintiles of scores). By incorporating ASQ questions from the next two highest age ranges, scores will be continuous across the study period of three. The EASQ has been applied to children in four countries, including 2,845 children in Peru.

Time frame: baseline, 3 months

Secondary Outcomes

Change in global HOME score

The Infant Toddler Home Observation Measurement of the Environment (HOME) evaluates parenting and home influences on child development.

Time frame: baseline, 3 months

Change in HOME subscore of parent responsivity

This HOME subscore is defined in the manual as "the extent to which the parent responds to the child's behavior including reinforcement for desired behavior and communication through words and actions".

Time frame: baseline, 3 months

Change in HOME subscore of parent involvement

This HOME subscore is defined as "parental acceptance of the child's behavior that is less than optimal and examines avoidance of undue restriction and punishment".

Time frame: baseline, 3 months

CASITA Intervention for Children at Risk of Delay in Carabayllo, Peru

Overview

Conditions

Interventions

Eligibility

Outcomes

Primary Outcomes

Secondary Outcomes