Mary Catherine Arbour
Faculty Project: Enlace 27/02 Initiative
Faculty Project: A Good Start: A Randomized Controlled Trial of Integrated Health and Education Intervention in Chilean Preschools
Un Buen Comienzo
This program was originally designed and implemented jointly by Harvard Graduate School of Education and Fundación Educacional Oportunidad beginning in 2006, with interventions in language and literacy in preschools from low income families in Chile. The project offers the first large-scale experimental longitudinal evaluation in South America in 64 public schools to examine impacts of improving preschool education. The project assisted over 3,800 at-risk children from four to six years of age between 2008 and 2010 in 31 schools in Santiago in six vulnerable school districts, and evaluated approximately 2,300 children in health, language and socioemotional development.
The mission of UBC is to reduce levels of reading difficulty, reduce the vocabulary gap between low-income families and more advanced counterparts, increase levels of social participation and improve attendance in the classroom with preventive health measures. To best measure success, children participating in the program are evaluated before intervention begins at prekinder year and followed at the end of their prekindergarten and kindergarten year. Some schools received full professional development intervention and some receive 5 books per classroom and self-care workshops. In schools selected for full development intervention, a system has been designed to provide teachers with twelve training modules and over 32 coaching and reflection sessions, and workshops across a two year period, to improve their efficiency and confidence as a teaching professional. Either way, the success of the program depends on support from workshops and coaching preschool teachers and other professionals involved in the education of children.
Today, UBC is in seven communities in the Metropolitan area and reaches over 5,000 students per year, and in the Sixth Region, UBC works with three communities and over 1,000 students annually. In 2012, the first comprehensive outcome-based study in Latin America to measure the effects of health interventions and advanced teacher training in classroom practices praised the ever-expanding work of the UBC initiative. We are proud to support a program that has pioneered methodology that is being replicated in numerous countries and is currently the subject of more than 18 graduate school theses.
Participating Harvard Faculty: Catherine Snow, Henry Lee Shattuck Professor of Education; Hirokazu Yoshikawa, Professor, Harvard Graduate School of Education; Judith Palfrey, T. Berry Brazelton Professor of Pediatrics, Harvard Medical School, Dr. Mary Catherine Arbour, Senior Resident, Howard Hiatt Global Health Equity Residency in Internal Medicine, Brigham and Women´s Hospital, Harvard University.
Collaborating Institutions: Fundación Educacional Oportunidad, HGSE, DRCLAS, Center for the Developing Child; Harvard Medical School Hospitals,Ministries of Health and Education in Chile, Universidad Diego Portales.
Enlace 27/02 Initiative
Harvard has been involved in relief efforts in Chile since a few days following the February 27, 2010 disaster. Harvard faculty members visited displaced-persons camps to provide mental health assessments of children. Alumni rallied the Harvard Club of Chile to deliver two planeloads of medical supplies. Alumni were appointed to key positions working in reconstruction and prevention of tsunami-related damage and were some of the first on the scene. Harvard students also lent a hand in planning and reconstruction efforts through volunteer work in the earthquake zone.
With the advocacy of Professor Daniel Hojman, a more comprehensive effort was formulated throughout 2010. Following a number of planning meetings begun in June 2010, a major symposium, funded through a grant from the Provost, took place on March 22nd, 2011 to determine areas in which Harvard could provide added value to the current efforts undertaken in Chile. The meeting was opened by President Drew Faust who emphasized the role Harvard plays in response, relief, and recovery efforts around the world. Drawing on the HKS “Acting in Time” initiative in disaster areas such as New Orleans, the Gulf of Mexico, and in earthquake zones such as San Francisco, Haiti and Indonesia, keynote speaker, HKS Dean David Ellwood, emphasized the need for addressing the effects of disasters before they happen. Three main areas are taking into consideration for potential Harvard roles: 1) Long-term planning in disaster preparedness, prevention, and recovery in cases of large scale emergencies in participatory democracies; 2) Impact of disasters on public health, especially integrated community health; 3) Coordinated reconstruction in communities incorporating local authorities and leaders to cooperate in urban design, heritage preservation, and safe construction. The next steps will include developing a concrete proposal and seek additional funding for a coordinated effort. Strategic conclusions have been developed during the work year which are current for the work that Harvard aims to do in the affected area: 1) To address the mental health recovery of communities, public health interventions are still timely even after a year since the disaster. 2) Regional and national businesses are effective partners with government in reconstruction recovery and should be partners in Harvard’s plan. 3) Government’s crucial leadership role can be fortified with effective municipal training efforts. 4) Harvard’s multidisciplinary team may be best partnered with one town and possibly one or two Universities to develop a place-based collaborative effort duplicating the model of Broadmoor in New Orleans following the Katrina disaster.
An evaluation model will need to be designed to contribute to longer-term research impact in the area of disasters worldwide.
Participating Harvard Faculty:
Daniel Hojman, Professor of Public Policy, Harvard Kennedy School, University of Chile, founder of the ENLACE initiative; Douglas Ahlers, Professor of Public Policy, Director, Ash Center for Governance Democracy and Innovation Harvard University; MaryCatherine Arbour, Resident Doctor, Howard Hiatt Global Health Equity, Brigham and Women’s Hospital, Researcher, Center on the Developing Child, Harvard University; Miho Mazereeuw, Professor of Architecture, Harvard School of Design and Judith Palfrey, T. Berry Brazelton Professor, Harvard Medical School
Collaborators: Luís Valenzuela, Architect, Consultant on risk assessment in the sixth and seventh Regions; Pablo Allard, Member of the Reconstruction Commission, Ministry of Housing and Development; Macarena Carroza Solar, Director, CREA Restorations
A Good Start: A Randomized Controlled Trial of Integrated Health and Education Intervention in Chilean Preschools
Un Buen Comienzo, a multidisciplinary, multi-faculty collaborative effort between Harvard University, the Ministries of Health and Education in Chile, Chilean Fundación Educacion Oportunidad and Universidad Diego Portales, has a an important health component, which seeks to evaluate whether preschool teachers can integrate health interventions into their curricular offerings and document improvements in children’s access to care, respiratory health and school attendance, and changes in health-promoting behaviors. The specific aims are to: determine the extent to which preschool teachers in Chile can deliver health interventions pertaining to respiratory health, well-child visits and nutrition as part of an integrated professional development program to improve cognitive, socio-emotional and health outcomes; among the entire sample of children from low-income families, to determine whether the intervention results in improved access to pediatric care, improved respiratory health, decreased absenteeism, and changes in teachers’ nutritional knowledge and children's behaviors; among a subset of these children with obstructive respiratory disease (asthma or bronchitis), to determine the extent to which the intervention results in better respiratory function; decreased clinic visits, emergency room visits and hospitalizations; and decreased absenteeism. The health subcomponent of UBC provides a one-of-a-kind opportunity for faculty and students from across Harvard University to collaborate with Chilean colleagues on an interdisciplinary approach to early childhood development in a Latin American context. It brings together faculty from Harvard Graduate School of Education, Harvard Medical School and Harvard School of Public Health, students from Harvard College and Harvard Medical School, faculty and staff from Universidad Diego Portales and Fundación Oportunidad. The initial DRCLAS funding was essential to the successful consolidation of the health intervention and operations development of the health evaluation. In 2009, DRCLAS support of the health component will be critical for its expansion, analysis and dissemination.
Participating Harvard Faculty: Judith Palfrey, T. Berry Brazelton Professor of Pediatrics, Harvard Medical School, Mary Catherine Arbour, Instructor in Medicine, Harvard Medical School
Collaborating Institutions: Ministries of Health and Education in Chile, Chilean Fundación Educacion Oportunidad, Universidad Diego Portales