Caregiver Interventions for Developmental Delays in Young Kenyan Children
Condition: Child Development; Parenting; Cognitive Developmental Delay
Study type: Interventional

Summary: 
      In this study, the investigators will only administer the intervention to children known to
      have neurodevelopmental delays. By focusing on adapting the intervention to be only a
      clinic-based treatment, a small number of community members could be trained to administer
      the program and increase the potential for sustainability. If the clinic-based group sessions
      prove to be effective for young children with neurodevelopmental delays, this would help
      inform the key areas of fidelity needed to maintain effectiveness of the intervention. This
      study is a critical first step to evaluating the Care for Child Development Intervention
      (CCDI) program's potential as a cross-cultural intervention that is sustainable and effective
      for the children at highest risk for neurodevelopmental delay. These results will have
      significant impacts in improving early childhood neurodevelopment both in Kenya and
      worldwide.
    

Detailed description: 
      Objectives:

      The broad objective of this proposal is to pilot the CCDI program as an intervention to treat
      neurodevelopmental delays among 56 young children in Kenya

      Specific Aims:

      Aim 1: Determine the feasibility of a randomized controlled trial protocol to examine the
      effectiveness of the CCDI Program for Kenyan children with neurodevelopmental delays aged
      18-24 months within a public Maternal-Child Health (MCH) clinic setting.

      Hypothesis: The CCDI Program will be feasible, as measured by ≥90% of participants being
      willing to be randomized to either the intervention or the control group; ≥ 80% attending all
      10 biweekly caregiver meetings; ≥80% of children returning for their 6 month follow-up; and
      ≥80% returning for 12 month follow-up.

      Aim 2: Determine the acceptability, facilitators, and barriers of the CCDI Program for use in
      eligible children.

      Hypothesis: The CCDI Program will be acceptable, as determined by an analysis of prospective,
      concurrent, and retrospective acceptability, and specific facilitators and barriers to the
      program will be identified. Using focus group discussions and semi-structured interviews with
      caregivers, clinical providers, and community leaders, the investigators will determine
      aspects of the program are acceptable, facilitators, and barriers to improved
      neurodevelopmental care and allow the CCDI program to function optimally in this setting.

      Aim 3: Estimate the effect size of the CCDI Program to reduce neurodevelopmental delays in
      young Kenyan children.

      Hypothesis: The investigators will demonstrate a 40% decrease in the number of children with
      neurodevelopmental delays, as determined by a culturally adapted Bayley Scales of Infant and
      Toddler Development, 3rd edition (BSID-III) standardized score with implementation of the
      CCDI Program. This data will inform sample size justification for a future intervention
      study.
    

Intervention name(s): Mother groups using principles of UNICEF/World Health Organization's Care for Child Development
Intervention type(s): Behavioral
Intervention description(s): The intervention is expected to occur every two weeks for a total of ten sessions. On the study day, the child- caregiver dyads randomised to intervention group will be shown to the study room. Each intervention session will be estimated to last 90 minutes allocated as follows: 6
Introduction (10 minutes)
Lesson on *Early Childhood Development* topic (20 minutes)
Discussions on strengthens in caregiving around this topic and areas for improvement (30 minutes)
Observe caretakers one-on-one in play role with the child (25 minutes)
Wrap up/Re-cap (5 minutes) Early Childhood development topics that will be covered include per session are: i) Importance of early childhood development ii) Showing love and building trust iii) Awareness of child's well-being iv) Consistency and daily routines v) Discipline and correction vi) consistency and daily routines vii) Nutrition and cleanliness Viii) Importance of play iX) Dealing with life stresses X) Planning for the future
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research