Measurement of Home Environment: The Family Care Indicators Patrice Engle California Polytechnic State University Yuko Nonoyama-Tarumi UNICEF

Why Indicators for Family Care? Caregiving Practices and Resources Quality of Interactions with the Child Child Development Outcomes It is widely recognized that caregiving practices during the early years of life have a powerful influence on children’s developmental trajectories, due to (1) rapid gain in all domains, and (2) the importance of stimulation from environment—family is the immediate environment of the child and is the major source of stimulation. There are many programs or polices that are based on this theory both in the industrialized and developing countries: Increased caregiving practices and resources would lead to higher quality of interactions between the caregiver and the child, and hence, result in positive child developmental outcomes. However, in developing countries, there is dearth of data on caregiving practices and resources, because there are no standard measures. Data that exist in developing countries tend to be single country studies with small sample size. In this context, UNICEF, with its partners, took the initiative to develop family care indicators, and have included them in a cross-national household survey. This presentation will consist of three parts. Process of development of family care indicators (Yuko) Preliminary cross-national analyses (Yuko) Validation of the measures from more in-depth analyses focusing on one country (three countries?) (Pat)

Multiple Indicator Cluster Survey (MICS) Household Survey Nationally representative sample www.childinfo.org MICS 3 (2005) 56 countries Household module household characteristics, education, water and sanitation, nutrition, child labor, support HIV/AIDS orphans, etc. Women module women’s characteristics, child mortality, maternal and newborn health, marriage/union, HIV/AIDS knowledge, female genital mutilation, sexual behavior, etc. Children under five module children’s characteristics, birth registration, early learning, breast feeding, immunization, anthropometry, malaria, etc.

Development of Items Phase I: Item identification Literature review Meeting of global experts (Nov, 2002) Phase II: Item evaluation Field tests in 7 countries (Spring, 2003) Qualitative analyses: Focus groups (Content validity) Quantitative analyses: Frequency analyses (Discrimination) Phase III: Item selection Meeting of global experts (Nov, 2003)

Domains selected Caregiving Practices Caregiving resources Quality of verbal interaction Learning/stimulating activities Limit setting and discipline techniques Responsiveness and acceptance Responsive feeding Caregiving resources Caregiver stress Caregiver physical health Caregiver knowledge Alternate caregiver Father’s involvement Family cohesion Social networks Learning/stimulating materials

Family Care Items in MICS3 (Core Early Learning Module: 52 countries) Learning/stimulating activities Engage in any of the activities with the child (in the past 3 days) [multiple responses] (Asked to caretakers of children under 5 years old for each child) ( Mother Father Other No one Read books or look at picture books Tell stories Sing songs Take outside the home, compound yard or enclosure Play Spend time naming, counting and/or drawing things

Family Care Items in MICS3 (Optional Child Development Module: 33 countries) Learning/stimulating materials (Asked to caretakers of children under 5 years old once) Number of books Number of children’s books Play materials that child play with at home Household objects; Objects and materials found outside the living quarters; Homemade toys; Toys that come from a store; None Alternate caregiver (in the last week) Number of times the child was left in the care of another child (younger than 10 years old) Number of times the child was left alone

Child Discipline Items in MICS3 (Child Discipline Optional Module) Setting Limits (Methods used in the past month) (Asked to caretakers of children 2-14 years old for a randomly selected child) Non-violent Forbade something he/she liked Explained why something was wrong Gave him/her something else to do Psychological aggression Shouted, yelled at or screamed at him/her Called him/her dumb, lazy, etc Minor physical assault Shook him/her Spanked, hit or slapped him/her on the bottom with bare hand Severe physical assault Hit him/her on the body with something a belt, stick, etc Hit or slapped him/her on the face, head or ears Hit or slapped him/her on the hand, arm, or leg Beat him/her with an implement Do you believe that in order to bring up properly, you need to physically punish him/her Discipline styles (focusing on physical violence in response to bad behavior) (linked to child dev) Questions asked to the mother or caretaker of the children aged 2-14 years of age One child was randomly selected per family “All adults use certain ways to teach children the right behavior or to address a behavior problem. Have you or anyone else in your household used this method with the child in the past month.”

ECD Indicators in MICS3 Indicator Definition Support for learning % of children aged 0-59 months living in households in which an adult has engaged in four or more activities to promote learning and school readiness in the past 3 day Father’s support for learning % of children aged 0-59 months whose father has engaged in one or more activities to promote learning and school readiness in the past 3 days Support for learning: non-children’s books % of households with three or more non-children’s books Support for learning: children’s books % of households with three or more children’s books Support for learning: materials for play % of households with three or more materials intended for play Non-adult care % of children aged 0-59 months left alone or in the care of another child younger than 10 years of age in the past week Pre-school attendance % of children aged 36-59 months that attend some form of early childhood education programme School readiness %of children in first grade that attended some form of pre-school the previous year

Preliminary cross-national analyses To what extent do countries differ in their level of family care? To what extent is positive family care equally distributed within the country?

Learning/stimulating activities (four or more) by wealth

Non-children's books (three or more) by wealth

Children's books (three or more) by wealth

Inadequate care (left in the care of another child or left alone) by wealth

How well do these scales work? Item comparison across countries Validation on the HOME and Bayley Scales Validation within country data Recommendations for next steps

Descriptive data on activities by country Selected three countries with publicly available data from different parts of the world Kyrgyzstan (n=2987) Bangladesh (n=34710) and Sierra Leone (n=5904) Examined activities separately to see which have reasonable variability and if they vary as expected

Activities anyone did: Percent of households

Sources of toys: percent of households

Conclusions based on descriptive data Differences by country are reasonable All families do something Some questions have little variability (e.g., taking child outside, play with child).

Validity study: Bangladesh 800 children at 18 months HOME Bayley MDI and PDI Language Comprehension and Expression 129 of them also measured at 12 months on same measures 40 given 7-14 week test-retest on Activities and Toys Grantham-McGregor, Hamadani, and Engle, 2008

Measures 6 activity items Sources of toys Variety of toys Books Play – “play with toys” rather than “play” Sources of toys Variety of toys Books Childcare situation

Reliability Measure 1 week (18 months) 12 to 18 months Family Activity Score .64** .57** Number of sources of toys .91** .09 N 40 129

Associations of Activity Index with Outcome Measures (n=798) FCI FCI regr+ Source of toys Source regr HOME .72** ** .39** ns MDI .29** * PDI .19** .09* Language .44** .23** +Controlling for maternal education, wealth, family size, birthweight, gestational age, paternal education, income, age, gender, other family care measures

Means of MDI by Number of Family Activities controlling for age (N=800; 18 months) ANOVA significant at p<.001

Conclusion Family Activity Index appears to be reliable and valid Increases with MDI in a linear fashion – no clear cut-off Sources of toys is not so strong Variety of toys much stronger (not reported here)

Validity assessment with MICS data: Bangladesh (N=34,710) Internal consistency Association of items with age Associations with maternal education, household wealth, gender Associations with two parent report measures: Do you do anything to prepare your child for school (3 and 4 only); and do you do things to develop your child’s intelligence Value of individual activity questions

Which items are related to age? Bangladesh, N= about 34,000 Total activities .34** Read books .47** Tell stories .24** Sing Songs .01 Take outside .08* Play .02 Naming, counting, drawing .40** Do something to develop intelligence .17** Prepare for school .15**

Internal consistency of Index: Alpha = .734 Measure Item-total correlation Read books .54 Tell stories .60 Sing Songs .48 Take Outside .29 Play .38 Names, counts, draw .52

Correlations of items with SES measures controlling for age M Ed Wealth Develop IQ Prepare school Total .34 .25 .31 .29 Read Books .35 .23 .24 Tell stories .19 .16 Sing songs .21 .17 .12 Outside .07 .05 .06 Play .15 .13 .09 Name, count. .02

Conclusions Family Activities Scale works quite well Sources of toys functions less well Need more work to define a cut-off point – four or more activities may not be the best

Recommendations Analyze role of fathers separately Make a separate code for some activities such as “read books” May revise wording on some questions Could replace “take outside” Might use “play with toys” rather than “play” Complete analyses with the rest of the countries Apply and use for Advocacy