208768 Un Buen Comienzo: Cluster Randomized Controlled Trial of Early Education and Health Intervention in Preschools in Santiago, Chile

Wednesday, November 11, 2009

MaryCatherine Arbour Arbour, MD , Division of Global Health and Social Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA
Hirokazu Yoshikawa, PhD , Harvard Graduate School of Education, Cambridge, MA
Andrea Rolla, PhD , Graduate School of Education, Harvard University, Cambridge, MA
Alice Lorch , Harvard Medical School, Boston, MA
Maria Jose Ramirez, PhD , Facultad de Educacion, Universidad Diego Portales, Santiago, Chile
Ernesto Trevino, PhD , Facultad de Educacion, Universidad Diego Portales, Santiago, Chile
Lorenzo Moreno, PhD , Mathematica Policy Inc, Princeton, NJ
M. Clara Barata, MEd , Graduate School of Education, Harvard University, Cambridge, MA
Catherine Snow, PhD , Graduate School of Education, Harvard University, Cambridge, MA
Judith S. Palfrey, MD , Division of General Pediatrics, Children's Hospital Boston, Boston, MA
Chile has second highest rate of economic inequality in Latin America. Integrated preschool programs that include education and health have been shown to reduce economic inequality, but rarely measure health outcomes. Un Buen Comienzo (UBC) is two-year, cluster randomized controlled trial of intensive professional development for preschool teachers to improve literacy and health among low-income Chilean children. UBC coordinates efforts between public clinics and municipal preschools with four goals: improve language and literacy practices; improve respiratory health, well child visit attendance and nutrition; improve socio-emotional development; foster family engagement in children's learning. UBC consists of monthly modules of workshops, in-classroom coaching, and feedback. Pilot occurred in 2007. Randomization and implementation for first cohort of 6 preschools with 800 children occurred in 2008. By 2010, 54 schools, 240 teachers/aides and 8800 children will enroll. Health component contents were determined with local stakeholders and pilot data: 18% of preschoolers had respiratory problems causing high rates of absenteeism, 58% were up-to-date on well-child visits, 21% were overweight, 19% were obese. We will present health component goals, methods and preliminary outcomes. Respiratory intervention introduces alcohol-based hand gel to reduce respiratory infections among all children and written asthma action plans to improve symptom control among asthmatics. Outcome measures include absenteeism, clinic visits, emergency room visits, and hospitalizations for respiratory symptoms. Well-child visit intervention uses teacher-initiated reminders and parent-child activities to increase children up-to-date on well-child screening. Nutrition component includes anthropometrics on all children to document nutritional status of this population.

Learning Objectives:
1. Describe methods of creating an interdisciplinary, community-based preschool health and education intervention and randomized controlled trial in Chile 2. Discuss the process used to determine which health priorities to include in the intervention (respiratory health, well-child visits, nutrition) 3. Analyze the impact of training preschool teachers and teacher aides to implement specific health interventions in school on child and family outcomes.

Keywords: School-Based Programs, Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have presented at international conferences since 1995. I am a current member of Un Buen Comienzo collaborative research team and direct the health intervention.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.