CASITA : Response to the problem of 'Early Childhood Development'.

Written by: Valia Ayola

Karen Ramos, head of the Community Health Program, comments that, since the beginning of the quarantine, one of the achievements of Socios En Salud (SES) was to protect the staff; in that sense they have prioritized the use of technology in all projects to continue helping the population; in addition to, making use of their creativity to reinvent themselves as a program and continue with the commitment to the welfare and development of early childhood.

In the Community Health Program are all projects related to community intervention, addressing the issues of maternal and child health, child development, chronic non-communicable diseases, anemia in children and recently breast cancer.

One of the projects of the Community Health Program is “Accompaniment in early stimulation and community-based social support to children from 6 to 24 months in Lima, Peru (CASITA)”.

CASITA is a community strategy in early childhood development that seeks to strengthen the skills of caregivers in raising their child in order to build a solid foundation that will help them reach their full potential as a responsible and productive citizen. This project is led by a Community Health Agent (CHA), who has been trained in the methodology and leads a group of caregivers (mother, father, aunts or grandparents) during 12 weekly sessions. This project started as a pilot test in 2013 with a duration of two years and received funding from Grand Challenges Canada.

Ramos, identifies four key moments in CASITA 1) screening, consists of identifying potential participants in the community through a census or sweep applied by the team and subsequently with the EEDP test (Evaluation of psychomotor development of children under 2 years of age); 2) enrollment, informed consent is provided to the caregiver to ensure their participation and complete the entire battery of questions about the caregiver and child; 3) follow-up, delivery of the 12 sessions where the adherence of the caregiver to the intervention is sought, the technical team makes constant accompaniment, monitoring visit to the groups and culminates in the final evaluation; 4) closure of all sessions, a battery of questionnaires is applied again including the EEDP, also a HOME card, where the interactions between the caregiver and the child are seen in order to have a final result.

The main components of the CASITA methodology are early stimulation activities, delivery of socioemotional support to caregivers, promotion of health and nutrition practice in the child through key and dynamic messages; and ensuring the practice of “give and take” interactions, which is transversal during the sessions.

“We consider ‘Give and Respond’ to be the heart of the CASITA intervention because it is what we promote and we are aware that scientific evidence tells us that it really generates change in the child,” indicates, Nancy Rumaldo, coordinator of the CASITA Project.

Rumaldo, mentions that culminating CASITA (pilot) several findings were identified, one of them was the community model to improve child development of children; that is, that a trained Community Health Agent (ACS) by giving continuous accompaniment could reduce the risk of delay in children. In addition, the risk of delay was identified in the urban area compared to the rural area. A third finding is related to the type of individual methodology that was delivered by an ACS to a CAREGiver at home and on the other hand there was the methodology as a whole (groups of 8 to 10 caregivers), which was the same, but in virtual format.

A second stage of the project, started in 2016 with CASITA SCALING UP, in which different health facilities were incorporated at the level of the entire district of Carabayllo, both urban and rural, continuing with the community methodology and serving 3000 children unlike the first stage, in which only 120 were served.

“This scaling up was financed by Grand Challenges Canada (50%), the other 50% was managed by Socios En Salud with public and private institutions such as KOICA, Inka Farma and an indispensable ally in the coverage, was the Municipality of Carabayllo, who through the participatory budget supported us with more spaces in the community,” he adds.

A lesson learned from CASITA, which is taken to scale, is that not only is there the primary caregiver (mom), but there is also the secondary caregiver who in many cases can be the father, aunt, grandmother, older sister, etc.

Between March and April the delivery of sessions in the community was paralyzed due to covid-19; however, there was constant communication with the caregivers and starting in May a new virtual strategy was created, where the child development interaction videos were implemented through the caregivers’ WhatsApp, which lasted 6 weeks. This strategy was delivered to caregivers who had been enrolled in CASITA before the pandemic.

“We applied some cards related to the pandemic context to know how the families were at that moment, then the team also made the calls or gave them a follow-up to be able to meet those needs, by way of socioemotional support, but individualized,”she explains.

One of the concerns that the CASITA team had, was how to perform the first phase (screening) without having to go to the community, that is where they plan and design a new virtual strategy ‘Chatbot’; which serves as instant messaging in which the caregiver answers all the questions regarding the child’s milestones, and depending on the answers a diagnosis (screening) is provided, but also gives you a link with more information on child development and socio-emotional support for the caregiver to read and internalize, in order to apply it.

“It is hoped that the CASITA BOT can help diagnose risk in child development. If this were to work we could share it with the Ministry of Health or Social Development, so that they can use it as a tool,” mentions Ramos.

This CASITA strategy is going to be complemented with the delivery of 12 sessions virtually, which corresponds to the part of early stimulation and “give and take” through 6 child development interaction videos (UNIVERSAL BABY) and 6 new early stimulation videos that are currently being developed. In addition, health messages and infographics will be implemented through flyers and micro-video messages in a single week.

We are currently working remotely and have had great willingness on the part of caregivers and community agents, to continue delivering and conducting the sessions virtually. As evidence, the caregivers send photos and/or videos of the activities they carry out with their children to continue with the evaluations by the CASITA team.

Within this new way of working, gaps have been found such as technology, since some caregivers do not have a smart phone or do not have data packages that allow them to access the applications or send the evidence; however, “they are so eager to participate and that their children develop properly, that they lend the cell phone of a relative to continue with the activities corresponding to the sessions”, quotes, Rumaldo.

Another barrier that was found corresponds to the schedule that the caregivers now have, since previously in the face-to-face sessions they had an established day and schedule, currently time plays against, because being at home, the caregivers must support in the virtual classes that their other children receive, they have more activities at home, they must support in the husband’s work, among other things, but they do not neglect the realization of the sessions because they know that it is essential for the development of their children.

For Rumaldo, one of the successes he has found in this context of covid-19, is that they have been able to carry out with the support of Socios En Salud and also with the willingness of the caregivers an intervention strategy for the attention of ‘early child development’ at home, since this population was not left aside, another success is that it has allowed for greater family participation in the implementation of this strategy.

“It is very usual for the caregiver to say ‘the session I have not seen it alone, I saw it with my husband, with my daughter’ and I think it is a moment that can be shared and involve more actors who are related to the care of the child at home,” she points out.

An important point has been the inclusion of community health agents in this topic of the virtual strategy, since they have become more familiar with the use of technology, the application of digital media and this has made them begin to empower themselves in this topic, and have greater confidence in the management of digital media.

Rumaldo, ensures that learning has not been limited, on the contrary, has given more alternatives to see if you are doing the activities at home and see that they are permeating other knowledge, also considers that more things will continue to be discovered on the road.