Enhancing And Supporting Early Development to Better Children's Lives (EASEL) Trial
Condition: Child Development
Study type: Interventional

Summary: 
      In The Lancet's series on advancing early childhood development, provision of high-quality
      early childhood care and education was listed as one of the main factors that can maximize
      children's potential to succeed in later life, particularly children from vulnerable or
      disadvantaged backgrounds. High-quality early childhood care and education is widely
      understood to be important for equipping children with essential skills and competencies
      across academic and non-academic areas, which in turn increases school readiness and has
      long-reaching impacts on outcomes later in life. Despite the government's efforts to support
      the early childhood sector, educators in Singapore continue to report difficulties in
      implementing practices in classrooms that promote children's social, emotional and cognitive
      development. To enhance educators' skills in these domains, we developed the Enhancing and
      Supporting Early development to better children's Lives (EASEL) Approach, a set of universal
      educator-led practices for use with 3-6-year-old children to improve social, emotional,
      behavioral and executive functioning (SEB+EF) outcomes. This study will evaluate the
      implementation and effectiveness of the EASEL Approach on improving early childhood
      educators' teaching practices and in turn, children's SEB+EF outcomes. We will conduct a type
      2 hybrid implementation-effectiveness design in a cluster randomized controlled trial in
      10-12 childcare centers. We will use the EPIS (Explore, Prepare, Implement, Sustain)
      Framework to support the implementation of the EASEL Approach. Implementation strategies
      include training, educator self-assessments, practice-based coaching, and data monitoring.
      Primary outcomes include educator's teaching practices and their adoption of the EASEL
      Approach in everyday practice. Secondary outcomes include the acceptability and feasibility
      of the EASEL Approach and children's SEB+EF outcomes. Quantitative and qualitative data will
      be collected at baseline, three months and six months.
    

Detailed description: 
      The specific aims of the EASEL trial are two-fold:

        1. The first aim is to test the effectiveness of the EASEL Approach, a universal
           classroom-based approach (evidence-based classroom practices identified using a common
           elements approach) on enhancing educators' classroom practices to improve SEB+EF
           outcomes in preschool children. We hypothesize that the EASEL Approach will improve
           educators' teaching practices related to promoting preschool children's SEB+EF outcomes.
           In turn, improvements in children's outcomes in these domains in the longer term (e.g.,
           six months) will also be observed.

        2. The second aim of the trial is to understand how educators implement the EASEL Approach
           within their classroom and the factors that affect the implementation. We hypothesize
           that with the use of the implementation strategies proposed for the trial (educator
           training, educator self-assessment of intention to use and self-efficacy, practice-based
           coaching, and data monitoring), the EASEL Approach will be well adopted by educators,
           implemented sustainably and achieve its desired effects.

      The EASEL trial is based on three key studies.

        -  The Growing Up in Singapore Towards healthy Outcomes (GUSTO) Study: A longitudinal birth
           cohort study of maternal and child health indicating significant relationships between
           conditions during pregnancy and early childhood on later outcomes of physical, mental
           and social well-being.

        -  McLeod et al. (2017): This trial builds on the systematic review to identify common
           elements considered for inclusion as part of the EASEL Approach.

        -  Work conducted by Assistant Professor Evelyn Law and colleagues at NUS Yong Loo Lin
           School of Medicine: The Whole Child Panel (WCP) 2.1 will be used in the EASEL trial as a
           screening measure of children's executive functioning and the Executive Function
           Playbook will be included as one of the EASEL practices.

      The EASEL trial will employ a Type 2 hybrid implementation-effectiveness design using a
      cluster randomized controlled trial. A hybrid design approach involves the simultaneous
      evaluation of both a programme's outcomes as well as the effectiveness of the implementation
      of the programme. A Type 2 hybrid design also enables the assessment of the feasibility of
      the programme.

      As part of the trial, 12 childcare centres will be randomized to receive training in the
      EASEL Approach (six sites, referred to as the intervention sites) or continue with
      business-as-usual (BAU) (six sites). Educators in the BAU group will be provided the option
      to be trained in the EASEL Approach following completion of the study.

      The EASEL trial will be guided by the EPIS (Explore, Prepare, Implement, Sustain) Framework,
      an evidence-informed framework frequently used in programme implementation and evaluation.
      The EPIS Framework considers the multilevel nature of service systems (e.g., the early
      childhood sector in Singapore), the organizations within systems (e.g., individual preschool
      operators in Singapore), and the 'client' needs (e.g., the needs of children and early
      childhood educators) when implementing a new programme. It highlights four key phases that
      guide and describe the implementation process: Exploration, Preparation, Implementation,
      Sustainment. The Exploration phase involves identifying the problem, developing appropriate
      and evidence-based solutions, and considering factors that might impact implementation. In
      this context, the problem is the gap in educators' skills to enhance children's SEB+EF
      development, and the solution is the EASEL Approach. The Preparation phase consists of a
      planning process with key stakeholders (e.g., relevant government agencies, preschool
      operators, individual childcare centers) for the implementation of the new programme. When
      sufficient preparation has occurred, the Implementation phase commences (implementation of
      the EASEL Approach by educators in their classrooms). Factors affecting implementation
      include outer and inner contextual issues (e.g., resource availability, fit with educators'
      current practices, organizational culture, and attitudes) and consumer concerns (e.g., the
      applicability of practices for educators' and children's needs). When the new practices have
      been routinely used, the Sustainment phase can begin. This involves the sustainment of the
      new programme in the current setting and may also include scaling-up to other settings and
      systems.
    

Intervention name(s): The EASEL (Enhancing And Supporting Early Development to Better Children's Lives) Approach
Intervention type(s): Behavioral
Intervention description(s): The EASEL Approach consists of a set of educator-led practices that can be incorporated into the daily classroom environment for children three to six years of age. The overall purpose of this approach is to enhance early childhood educators' teaching practices that would promote children's SEB+EF development.
Nine EASEL practices were selected for inclusion in the EASEL Approach. These are a) core fundamental practices that are evidence-based, b) practices that expert stakeholders identified as ones for which local early childhood educators may need additional training, c) practices that are not already covered in pre-service training to avoid replication for educators, d) a combination of practices that educators may already be implementing and can enhance, and new practices, and e) a balance of antecedent and consequential practices (i.e., practices that can be implemented before and after a target behavior).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The EASEL trial will employ a Type 2 hybrid implementation-effectiveness design using a cluster randomized controlled trial. A hybrid design approach involves the simultaneous evaluation of both a programme's outcomes as well as the effectiveness of the implementation of the programme. A Type 2 hybrid design also enables the assessment of the feasibility of the programme. As part of the trial, 12 childcare centres will be randomized to receive training in the EASEL Approach (six sites, referred to as the intervention sites) or continue with business-as-usual (BAU) (six sites). Educators in the BAU group will be provided the option to be trained in the EASEL Approach following completion of the study.
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: educator; teacher; preschool; child; classroom