Funder: NIH, NICHD

PI: Buccini

Period: 2019-2024

Abstract: Strengthening vulnerable families through an integrated nurturing care approach has become a global priority. Brazil is the largest country in South America, with over 212.6 million people, and about 55% were experiencing some level of household food insecurity in 2020. Black and brown individuals (55% of the Brazilian population) are disproportionately affected by social vulnerabilities. Understanding that these vulnerabilities affecting many families could undermine their capacity to provide nurturing care, the Brazilian government rolled out the Programa Criança Feliz (PCF). The PCF intervention aims to foster parenting skills and promote better early childhood outcomes (ECD) through two core functions: (1) home visits to foster parenting skills and provide early stimulation and (2) complementary intersectoral actions to coordinate regional programs for social assistance, healthcare, education, culture, and human and children’s rights to reduce families’ vulnerabilities. In-depth interviews in the K99 phase indicated that PCF home visits enhance ECD services in Brazil; however, complementary intersectoral actions to address families’ vulnerabilities are not fully operationalized. Thus, identifying practical ways to integrate PCF home visits with existing multisectoral nurturing care interventions is desired, and it is a way to promote the PCF’s sustainability. Household food insecurity (HFI) among families enrolled in PCF is a direct measure of social vulnerabilities that could be addressed by the complementary intersectoral actions. HFI is strongly linked with adverse ECD benefits and outcomes. Therefore, finding ways to operationalize intersectoral actions to reduce the burden of HFI on ECD can enhance PCF intervention and maximize ECD benefits at scale. PCF targets families registered in the National Database of Vulnerable populations, which includes those beneficiaries of the Programa Bolsa Família (PBF), the largest conditional cash transfer (CCT) program globally, designed to impact relevant ECD factors through health, education, and social assistance conditionalities. However, the implementation of PCF is not integrated with PBF. Combining participatory system dynamics modeling approach with cost-effectiveness optimization techniques, this implementation science project takes a systems approach to fill knowledge gaps needed for policy decisions on how best to operationalize the integration of PCF and PBF (programs targeting the same population) to promote nurturing care by reducing HFI (families’ vulnerabilities) and maximizing ECD outcomes (dynamic complementarity). The specific aims of this project are to:  

Aim 1. Conduct implementation research to identify pathways of how PCF is implemented at the municipal level assessing program (i) fidelity in relation to the national analysis (findings from K99 phase), (ii) adaptations, and (iii) critical quality control processes.

Aim 2. Develop three alternative system-level scenarios to integrate PCF and PBF conditionalities to reduce HFI to maximize ECD outcomes. 

Aim 3. Develop and test an optimization cost analysis protocol for municipalities to select the best solution for integrating PCF and PBF nurturing care conditionalities in their contexts

Team:

Muriel Gubert, PhD

Georgiana Esteves, MPH

Lidia Godoi, MsC, PhD candidate at University of Sao Paulo

Keishmer Cardoso, PhD student at UNLV

Collaborators:

Sonia Isoyama Venancio, MD, PhD, Brazilian Ministry of Health

Rafael Pérez-Escamilla, PhD, Dr. Honoris Causa, Yale School of Public Health

Krystyna Stave, PhD, Professor, University of Nevada Las Vegas

Poliana Palmeira, PhD, Federal University of Campina Grande, Department of Health, Brazil

Katherine Marcal, PhD, MSW, Assistant Professor of Social Work at Rutgers University

Mireya Vilar-Compte, PhD, Associate Professor, Montclair State University