CASITA: a controlled pilot study of community-based family coaching to stimulate early child development in Lima, Peru

OBJECTIVE: To determine whether the 3-month, community-based early stimulation coaching and social support intervention ‘CASITA’, delivered by community health workers, could improve early child development and caregiver-child interaction in a resource-limited district in Lima, Peru. DESIGN: A controlled two-arm proof-of-concept study. SETTING: Six neighbourhood health posts in Carabayllo, a mixed rural/urban district in Lima. Sessions were held in homes and community centres. PARTICIPANTS: Children aged 6–24 months who screened positive for risk of neurodevelopmental delay (using validated developmental delay tool) and poverty (using progress out of poverty tool) were enrolled with their caregivers. Dyads with children born >21 days early were excluded. INTERVENTION: 12-week parenting/support intervention plus nutritional support (n=41) or nutrition alone (n=19). OUTCOME MEASURES: Development and home environment differences and mean changes from baseline to 3 months postintervention were evaluated using age-adjusted z-scores on the Extended Ages and Stages Questionnaire (EASQ) and the Home Observation Measurement of the Environment (HOME) scores, respectively. RESULTS: Development in CASITA improved significantly in all EASQ domains, whereas the control group’s z-scores did not improve significantly in any domain. The mean adjusted difference (MAD) in change in EASQ age-adjusted z-scores between the two study arms was 1.39 (95% CI 0.55 to 2.22); Cohen’s d effect size of 0.87 (95% CI 0.23 to 1.50). Likewise, intervention significantly improved global HOME scores versus control group (MAD change of 6.33 (95% CI 2.12 to 10.55); Cohen’s d of 0.85 (95% CI 0.28 to 1.41)). CONCLUSIONS: An evidence-based early intervention delivered weekly during 3 months by a community health worker significantly improved children’s communication, motor and personal/social development in this proof-of-concept study.