Part of the iLab Primeira Infância [1]/ FOI Latin American Innovation Cluster
[2]Supportive, responsive relationships with adults are integral to a child’s early development. A supportive caregiver can nurture a child, help her explore her environment, and encourage her learning. Science tells us that just one responsive caregiver can make a critical difference in helping a child develop resilience [3] in the face of adversity. But when caregivers themselves experience ongoing, extreme stress, their capacity for responsiveness can be undermined, and the critical dynamic with the children in their care can be weakened. Formação de Vínculo na Adversidade (“Forming Bonds in Adversity”), a completed project of the Brazilian Innovation Cluster [4], seeks to address this challenge in Fortaleza, a city in northeastern Brazil with particularly high rates of violence.
Fast-Cycle Iteration is a process for quickly incorporating what a program team learns back into the design of that program, in order to refine what is and isn’t working and move toward higher levels of evidence at a faster pace.
Forming Bonds is a coaching program for young parents (ages 18-25) with young children (newborn to 3 years old). It aims to strengthen the quality of caregiver-child interactions, build resilience among vulnerable children, and improve a variety of developmental outcomes through a combination of home visits, based on International Child Development Program [5] and More Intelligent Sensitive Child (MISC) principles, video coaching, and individualized text messaging. The intervention is delivered by psychologists and psychology students affiliated with the city’s Instituto Primeira Infância (IPREDE).
Applying the IDEAS Framework [6]: Fast-Cycle Iteration
To understand the program’s potential for impact, the Forming Bonds project team engaged in three rounds of fast-cycle iteration [7] during the first 18 months. Between these rounds of implementation, the project team refined the program based on data, observations, and participant feedback. This case study focuses on the transition between the first feasibility test and the pilot study.
“As a researcher, I was not used to engaging in fast-cycle iteration. … Being able to apply the IDEAS Impact Framework, look at each individual part of a program, see what is and is not successful, and make adjustments, gave me and my team confidence in the direction of our research design, and the applicability of the Framework beyond this one project.”
The feasibility test explored the project team’s ability to effectively engage with the community in Fortaleza. Throughout the design and implementation process, the team consulted extensively with community leaders to gain a more nuanced understanding of pervasive challenges. These conversations informed the program’s fundamental design as well as the team’s approach to engaging mothers from the community, many of whom live in adverse conditions. Input and feedback from community members not only strengthened the intervention overall, but also helped home visitors gain participants’ trust and operate safely in neighborhoods with high levels of violence. To address the community’s suspicion of outsiders, for example, community leaders recommended that the IPREDE logo be prominently added to the home visitors’ vehicles and clothing so they could be identified quickly as part of a known and trusted organization. Home visitors also gave participants the option to involve their partners in the sessions if they wanted.
[8]The Forming Bonds team also evaluated program materials and the intervention format during this round of fast-cycle iteration. The eight-week program consisted of weekly one-hour home visits, video coaching, and personalized text messages. At the end of the feasibility test, the project team asked mothers for feedback on the program’s brochures and other materials. Many of the mothers felt that the brochures were written at too high a literacy level and contained too much text overall. They also did not connect with the stock photos used in the brochures and recommended incorporating images of people and places that were more representative of their community. After strategic revisions, the program’s materials minimized the amount of text and featured photographs of participating families engaging in responsive, serve-and-return [9] interactions.
The feasibility test also helped the project team identify key revisions to the program’s theory of change [10] (TOC). The team’s initial TOC focused on four moderators, or factors they believed could affect which participants benefit more and less from the program. These moderators were maternal education, maternal mental health, maternal adverse childhood experiences [11] (ACEs), and family dysfunction. Based on what they observed during the feasibility test, the team revised their TOC to focus on just two moderators that seemed to have the greatest potential to influence outcomes—maternal education and maternal ACEs.
Lessons Learned
[12]In using the IDEAS Impact Framework [6]TM and engaging in fast-cycle iteration, the Forming Bonds team was able to continue to develop their program strategies, improve their materials, and refine their TOC, laying a solid foundation for their next cycle of implementation and learning. This approach not only impacted the Forming Bonds program, it also impacted Márcia Machado, Universida de Federal do Ceará professor, and her work as a researcher and project lead. “As a researcher, I was not used to engaging in fast-cycle iteration. Research happens at a different pace. Being able to apply the IDEAS Impact Framework, look at each individual part of a program, see what is and is not successful, and make adjustments, gave me and my team confidence in the direction of our research design, and the applicability of the Framework beyond this one project.”
What’s Next?
The Forming Bonds project team views the program’s implementation as an ongoing, co-creative process that can always be improved. After several fast-cycle iterations, the team is now embarking on the following next steps:
- exploring partnerships with the public sector to reach other neighborhoods in Fortaleza,
- improving their facilitator and implementation guides, and
- leveraging local public health professionals to help engage community members.