|Strengthening the Family - Implications for International Development (United Nations University - UNU, 1991, 268 pages)|
|Perspectives from international development assistance and from family programmes|
Programmes that provide services directly to children
There have been a number of reviews of the effects of early interventions on children (Simeonsson, Cooper, and Scheiner 1982; Halpern and Myers 1984; White and Casto 1985; Dunst 1986; Farran 1990; Myers 1992). Despite the considerable methodological flaws in the database, there are by now enough studies to allow us to draw conclusions for practice.
The majority of the studies reviewed focused on children at high risk for school problems, developmental delays, or problems in learning to read. The children studied also tended to be of low socioeconomic status and most were Black, though some studies included Hispanics and children in developing countries. While most studies were carried out in North America or Europe, two reviews (Halpern and Myers 1984; Myers 1992) considered the impact of programmes in developing countries.
From the data on children in developed countries, it may be concluded that when intervention services are provided directly to the child there is gain in school achievement and intelligence test performance. Intelligence test score gains are of the magnitude of up to one standard deviation (10-15 IQ points) in the short term. In developing countries (Myers and Hertenberg 1987) it may be concluded that most, if not all, early childhood intervention programmes have the effect of making children more alert, sociable, curious, and well prepared for primary school. Consistent with the findings from developed countries, children from the most deprived backgrounds (lower income, more socially distressed) tend to benefit the most from programme participation.
Data on the long-term impact of early intervention suggest that continued intervention is necessary for continued higher IQ scores but not for some improvements in school achievement. Data from the United States show that by five years of age, intervention children tend to score one-half standard deviation above control children; by the time they are seven years old and older there are no reported remaining intervention-control group differences in IQ scores, though a number of studies show decreased drop-out rates, fewer special education placements, and fewer grade retentions (Berrueta-Clement et al. 1984). Programmes in developing countries have not yet produced documentation of long-term effects beyond the third grade, but field experiences suggest that the readiness of the school to respond to more active and curious children is crucial in the process of maintaining the effects. While initial adjustment to school is better, the long-term impact seems to be overwhelmed by the limitations of the schools that the children enter.
While there are few data to suggest that preschool intervention, which is not continued into elementary school, has a long-term impact on IQ scores (Farran 1990), when the intervention is continued into the early elementary grades the effects are long lasting. Effects include intervention children both performing on grade level and graduating from high school at a higher rate than the controls (Becker and Gersten 1982; Meyer, Gersten, and Gutkin 1983; Gersten and Carnine 1984; Meyer 1984). Effective interventions tended to consist of improving the quality of the school day, for instance monitoring the teachers to make sure that classes receive academic instruction for 60 per cent of the school day (Farran 1990).
Programmes that provide services to families
Interest in family-based interventions has been spurred by the evidence that early interventions, when focused on the child alone, have a time-limited impact (Simeonsson, Cooper, and Scheiner 1982) and that a multifaceted approach appears to be more effective in both developed and developing countries (Farran 1990; Myers 1992).
Interventions focusing on providing services to children through their parents generally foster a partnership between the parent and programme on behalf of the child. In reviewing interventions nearly two decades ago, Bronfenbrenner (1979, 595) concluded that,
The involvement of the child's family as an active
participant is critical to the success of any intervention program. Without such
family involvement, any effects of intervention, at least in the cognitive
sphere, appear to erode fairly rapidly once the program ends.
One approach to parental involvement considers the parent to be the primary teacher of the child, with the intervention team showing the parent how to work with the child. Home intervention programmes typically have used this approach, in which a paraprofessional home visitor makes a home visit, showing the parent how the child's development can be furthered if the parent engages the child in specific cognitive or language-based activities. These programmes have the advantages of keeping responsibility for children centred in the family, increasing the likelihood of long-term improvements through changes in parental behaviours, and providing services to children at a relatively low cost. As Myers (1992) points out, field experience with home visiting programmes suggests that they have the greatest impact if:
1. The learning is reinforced with occasional group meetings;
2. All family members, not just mothers, are involved;
3. The home visits focus on concrete problems and activities;
4. Parents are active participants in working out the details of the activities, rather than having the home visitor use a "cookbook" approach.
Another approach to parental involvement is to educate the parent about children and their development. Such parent education programmes tend to be training programmes in which the main goals are to direct changes in parental knowledge, attitudes, and behaviours. Bailey and Simeonsson (1990) summarize the outcome of research on parent training:
1. Parents can be taught to use correct and consistent educational interventions, behaviour management techniques, or therapeutic techniques.
2. Parent training programmes often result in desired changes in child behaviour and development.
3. Effective training includes modelling, practice, and specific feed back as well as a way of monitoring parental performance.
4. Long-term maintenance of changes in parental behaviour has not been adequately documented.
Seitz and Provence (1990, 423) review caregiver-focused models of early intervention, concluding that the following outcomes "appear open to influence through caregiver-focused early intervention":
1. Raising children's development and intelligence quotients (DQs and IQs);
2. Improving children's school adjustment;
3. Increasing maternal education;
4. Increasing spacing of subsequent child-bearing;
5. Improving the quality of parent-child interaction;
6. Improving parental responsiveness to children;
7. Improving children's socialization.
The evidence on direct training interventions with families seems convincing, that parents can be taught skills, knowledge, and techniques that facilitate their children's development. This instruction also is applicable to other children in the family and seems to be related to greater feelings of parental satisfaction and control (Myers and Hertenberg 1987). We also know, however, that the more negative circumstances the family suffers, the less they are able to benefit from a highly focused intervention programme. For such families, a more comprehensive system of community support and crisis interventions also may be necessary.