Jack P. Shonkoff|Dana Charles McCoy
Raising the Bar for Evaluating Effectiveness of Early Childhood Interventions
Harvard University Press|Harvard University|Massachusetts General Hospital|Harvard University Press|Harvard University
despite growing recognition foundational importance early childhood period persistence significant socioeconomic racial ethnic disparities school readiness remains challenge1 challenge reflected decades program evaluations across multiple sectors revealing modest effect sizes limited replication promising interventions minimal evidence significant impact scale23 issue pediatrics chamberlain et al4 address important question facing pediatricians done primary care practice strengthen building blocks literacy children reached programs contributions article fall within two categories first includes findings tipsbytext tbt evaluation second arguably instructive includes questions study leaves unresolvedthe premise investigation based proposition young childrens access primary health care united states near universal thus offering opportunity engage families difficult reach services eg preschool rationale testing existing intervention easy incorporate within health care setting well founded positive overall impact tbt childrens knowledge literacy fundamentals encouragingalthough potential benefits text messaging isolated families promising important contribution article opportunity consider questions unable answer namely value statistically significant mean difference treatment control group embedded explicit theory change connects intervention measured outcome precision linkage missing implications findings either practical application investigationmore specifically theory change intervention uses text messages empower parents improve childs early literacy skills assumes messages 1 received viewed parents 2 inform motivate 3 lead engage greater interactivity language exchanges children turn improve early literacy skills lack data report program takeup parental empowerment combined null impacts parents selfreported reading literacy interactions children generates questions answers mechanisms intervention affected childrens literacy knowledgesimilarly although chamberlain et al take important step examine subgroup differences outcomes absence conceptual framework guide analyses makes interpretation challenging meaning attributed relatively larger intervention effects associated firstborn status 2parent families englishspeaking caregivers children 48 months age differences basis caregiver education without hypothesized causal mechanisms pediatricians expected modify practice response potential variation intervention effectiveness5the challenges faced chamberlain et al explaining tbt program led stronger versus weaker impacts child literacy unique indeed recent systematic review 277 highquality early childhood program evaluations spanning 5 decades found information program takeup reported fewer half studies whereas process outcomes tests moderation reported fewer 206 collectively lack consideration whether programs used intended recipients work effective led questions answers maximize impact equity early childhood interventionin summary although average effect confirmed conclusion parentdirected texting produced three months literacy gains young children without evidence takeup impact parenting behaviors parentchild interaction explanation subgroup heterogeneity makes difficult identify active ingredients turn generalize stated conclusions tbt program significant mean differences treatment control groups outcomes linked intervention clear mechanism explain changes limits understanding match services children parents benefit themthe important contribution instructive article recommendation text messaging improve early literacy context pediatric primary care rather power lies opportunity provides underscore fundamental challenge faced early childhood services broadly half century reporting average effects subgroup differences without exploring causal explanations programs target child development major limitation affecting many similar studies entire early childhood field would benefit substantially confronting important challenge impedes ability develop efficient effective interventions targeted would benefit although tbt program found lead improvement need studies designed explicitly elucidate complex mechanisms underlying reported effects early literacy achieve sustainable populationlevel impacts