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. 2020 Nov 30:8:567907.
doi: 10.3389/fpubh.2020.567907. eCollection 2020.

Rapid-Cycle Evaluation in an Early Intervention Program for Children With Developmental Disabilities in South India: Optimizing Service Providers' Quality of Work-Life, Family Program Engagement, and School Enrollment

Dinesh Krishna  1   2   3 , Sankar Sahayraj Muthukaruppan  1 , Aravind Bharathwaj  1 , Ramasubramanian Ponnusamy  1 , Bala Murugan Poomariappan  1 , Sathiya Mariappan  1 , Ayesha Beevi  1 , Janna MacLachlan  2   3 , Zoé Campbell  3 , Chamila Anthonypillai  3 , Marie Brien  1   3 , Cathy Cameron  2 , Marina Flatman  3 , Lesley Perlman  3 , Stephanie Seilman  2   3 , Abhinayaa Jeyapragash  2   3 , Lotte van der Haar  4 , Joachim Krapels  5 , Sankara Raman Srinivasan  1
Affiliations

Rapid-Cycle Evaluation in an Early Intervention Program for Children With Developmental Disabilities in South India: Optimizing Service Providers' Quality of Work-Life, Family Program Engagement, and School Enrollment

Dinesh Krishna et al. Front Public Health. .

Abstract

Background: This paper explores how implementation and refinement of an early intervention (EI) program for children with delayed development was informed by an iterative, intentional and structured process of measurement. Providing access to early intervention therapy for children in rural areas of India is challenging due to a lack of rehabilitation therapists and programs. Following a biopsychosocial framework and principles of community-based rehabilitation, a non-governmental organization, Amar Seva Sangam (ASSA), overcame those barriers by designing a digital technology supported EI program in rural Tamil Nadu, India. Program objectives included providing service access; supporting program engagement, child development and school enrollment; and positioning the intervention for scale-up. This paper contributes to a growing body of literature on how program design and implementation can be informed through a cyclical process of data collection, analysis, reflection, and adaptation. Methods: Through several strands of data collection, the design and implementation of the EI program was adapted and improved. This included qualitative data from focus groups and interviews with caregivers and service providers, and a mobile application that collected and monitored longitudinal quantitative data, including program engagement rates, developmental progression, caregiver outcomes, and school enrollment status. Results: Measurements throughout the program informed decision-making by identifying facilitators and barriers to service providers' quality of work-life, family program engagement, and school enrollment. Consultation with key stakeholders, including caregivers and service providers, and data driven decision making led to continual program changes that improved service provider quality of work-life, program engagement and school enrollment. These changes included addressing gender-related work challenges for service providers; forming caregiver support networks; introducing psychological counseling for caregivers; providing medical consultations and assistive devices; creating community awareness programs; improving access to therapy services; focusing on caregiver education, motivation and support; and advocacy for accessibility in schools. Conclusion: The process of using evidence-informed and stakeholder driven adaptations to the early intervention program, led to improved service provider quality of work-life, greater program engagement, improved school enrollment and positioned the intervention for scale-up, providing lessons that may be beneficial in other contexts.

Keywords: India; community based rehabilitation (CBR); disability; early childhood development (ECD); early intervention (EI); program engagement; rapid cycle evaluation; school enrollment.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Summary of study methods and data sources.
Figure 2
Figure 2
Summarized findings from Case 1, including the issues identified, rapid cycle evaluation actions taken and indications of effectiveness.
Figure 3
Figure 3
Impact of rapid cycle action addressing service provider challenges-questionnaire results.
Figure 4
Figure 4
Summary of program changes implemented in Case 2 that addressed aspects impacting program engagement and school enrollment.
Figure 5
Figure 5
Average program engagement rates for center-based and home-based programs during each time interval.
Figure 6
Figure 6
Cumulative program engagement over the duration of the program segregated by low (/= 81%) rates of engagement for center-based and home-based programs.
Figure 7
Figure 7
Cumulative program engagement over the duration of the program segregated by low (/= 81%) rates of engagement for various family income levels.
Figure 8
Figure 8
Distribution of children not enrolled in school by reason for non-enrollment at T5.
Figure 9
Figure 9
Percentage of children with various diagnoses enrolled in school at T5.
Figure 10
Figure 10
Percentage of children with cerebral palsy with various levels of severity as defined by GMFCS levels enrolled in school at T5.
See this image and copyright information in PMC

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