The impact of a Caribbean home-visiting child development program on cognitive skills
加勒比地区家访儿童发展项目对认知技能的影响

A child's experiences in the first years of life lay the basis for outcomes in adolescence and adulthood (Grantham-McGregor et al., 2007, Heckman, 2006, Shonkoff and Phillips, 2000, Young, 2002). Young children who lack adequate nutrition, early cognitive stimulation, or emotional bonding may suffer developmental delays that will be more difficult to overcome as the years progress. Especially children from disadvantaged households, such as poor or lowly educated families, run the risk of falling behind their more fortunate counterparts at a young age. This might result in an ever-widening gap between poor and non-poor children.
儿童在生命最初几年的经历为青少年期和成年期的结果奠定了基础（Grantham-McGregor et al.， 2007， Heckman， 2006， Shonkoff and Phillips， 2000， Young， 2002）。 缺乏足够营养、早期认知刺激或情感纽带的幼儿可能会遭受发育迟缓，随着时间的推移，这些迟缓将更难克服。特别是来自弱势家庭的儿童，如贫困或受教育程度低的家庭，有可能在很小的时候就落后于更幸运的同龄人。这可能会导致贫困儿童和非贫困儿童之间的差距不断扩大。

To prevent the perpetuation of this ‘intergenerational cycle of poverty’, early intervention programs have been set up all over the world to reach the most vulnerable children. However, rigorous evaluations of Early Childhood Development (ECD) programs in developing countries are limited, in particular of home-based interventions.² This paper provides an impact evaluation of a Caribbean home-visiting program aimed at disadvantaged children between birth and three years of age. The paper estimates the short-term program impact on cognitive child development one year after implementation.
为了防止这种“贫困的代际循环”持续存在，世界各地都设立了早期干预计划，以惠及最脆弱的儿童。然而，对发展中国家儿童早期发展 （ECD） 计划的严格评估是有限的，尤其是基于家庭的干预措施。² 本文对针对出生至 3 岁间弱势儿童的加勒比地区家访计划进行了影响评估。该论文估计了实施一年后短期计划对认知儿童发展的影响。

Quantitative evaluations of home-based interventions in Latin America and the Caribbean have been published for Jamaica (Powell et al., 2004, Walker et al., 2005) and Boliva (Super, Guillermo Herrera, & Mora, 1990). These studies focus specifically on undernourished children that were selected into the sample based on anthropometric indicators of stunting or general malnutrition. They find significant short-term effects of early stimulation on the overall cognitive development of children and on eye–hand coordination, but not on loco-motor development, i.e. children's increased mastery of mobility such as crawling, running, and jumping. Impact on vocabulary and speech is inconclusive. Sweet and Appelbaum (2004) conduct a meta-analysis of 60 impact studies of home-based programs in the United States. They report a significant but small average effect on cognitive development. The authors comment that the small size of the benefits may not outweigh the costs of the interventions, although impact estimates may vary across subgroups of children.
已经针对牙买加（Powell等人，2004年，Walker等人，2005年）和玻利瓦（Super，Guillermo Herrera和Mora，1990年）发布了对家庭干预的定量评估。这些研究特别关注根据发育迟缓或一般营养不良的人体测量指标被选入样本的营养不良儿童。他们发现早期刺激对儿童的整体认知发展和手眼协调有显着的短期影响，但对运动发育没有影响，即儿童对爬行、跑步和跳跃等活动能力的掌握程度提高。对词汇和语音的影响尚无定论。Sweet 和 Appelbaum （2004） 对美国 60 项家庭计划的影响研究进行了荟萃分析。他们报告了对认知发展的显著但较小的平均影响。作者评论说，尽管影响估计可能因儿童亚组而异，但益处的小规模可能不会超过干预的成本。

This study evaluates the Roving Caregivers Program (RCP), a program that is widely implemented throughout the Caribbean. To our knowledge, this is one of only two existing impact evaluations of home-based interventions in the region that target the general low-income population instead of undernourished children. Powell (2004) reports on the randomized evaluation of a similar program in Jamaica.
本研究评估了 Roving Caregivers Program （RCP），该计划在整个加勒比地区广泛实施。据我们所知，这是该地区仅有的两项现有的针对一般低收入人群而不是营养不良儿童的家庭干预措施影响评估之一。Powell （2004） 报告了牙买加类似计划的随机评估。

The evaluation is set up as a longitudinal, quasi-experimental study that follows almost four hundred children in St Lucia over time from the baseline survey in 2006 to the follow-up survey in 2008. The children were aged between birth and 24 months at the start of the study. Half of them lived in communities where RCP was introduced after the baseline. The other children lived in comparable communities that did not receive the intervention.
该评估是一项纵向的准实验研究，从 2006 年的基线调查到 2008 年的后续调查，对圣卢西亚的近 400 名儿童进行了跟踪调查。研究开始时，这些孩子的年龄在出生到 24 个月之间。他们中的一半生活在基线后引入 RCP 的社区。其他儿童生活在未接受干预的类似社区。

To measure program impact, the econometric analysis uses a differences-in-differences methodology with multivariate child fixed-effect regressions. The evaluation is based on an intention-to-treat approach. It focuses on a comparison of all eligible children in the intervention communities with similar children in the non-intervention communities. The analysis is complemented with a more detailed investigation of child outcomes in relation to home-based versus center-based care.
为了衡量项目影响，计量经济学分析使用具有多变量子固定效应回归的双重差分方法。评估基于意向性治疗方法。它侧重于将干预社区中所有符合条件的儿童与非干预社区中的类似儿童进行比较。该分析还补充了对家庭护理与中心护理相关的儿童结局的更详细调查。

Child development cannot be understood in isolation from its cultural context (Shonkoff & Phillips, 2000). Therefore the next section will start with a description of early childhood experiences and parenting practices in the Caribbean. It also describes the characteristics of RCP. Section 3 discusses the research design with a focus on the comparability of the treatment and the matched control group. It discusses response rates as well as the psychological assessment tool used to measure cognitive development. The econometric strategy is explained in Section 4. Section 5 shows enrollment rates in RCP and discusses targeting effectiveness. Impact results are given in Section 6. The final section concludes.
儿童发展不能脱离其文化背景来理解（Shonkoff & Phillips， 2000）。因此，下一节将首先描述加勒比地区的幼儿经历和育儿实践。它还描述了 RCP 的特征。第 3 节讨论了研究设计，重点是治疗和匹配对照组的可比性。它讨论了反应率以及用于测量认知发展的心理评估工具。计量经济学策略在第 4 节中解释。第 5 节显示了 RCP 的注册率并讨论了定位有效性。影响结果在第 6 节中给出。最后一部分结束。

To estimate the impact of RCP on child outcomes, we use a differences-in-differences estimator. This estimator compares changes in outcomes over time in the treatment group with the changes over that same period of time in the control group. It includes child fixed-effects to eliminate any unobserved time-invariant heterogeneity between the two groups. This method yields consistent impact estimates of RCP as long as unobserved individual differences between the two groups (such as innate ability or parenting skills) did not differentially change over time independent of RCP, as long as external factors affected both groups to the same extent (such as price rises, fluctuating employment rates, hurricanes, fertility trends), and new policies and interventions aimed at young children were not systematically favoring the treatment group over the control group or vice versa. It is impossible to completely rule out the presence of unobserved time-varying differences. However, the geographical proximity of the communities, and their similarities in key community characteristics provide support for the assumption of parallel trends. The comparability of child outcomes at baseline is also reassuring, because the outcomes reflect the cumulative effect of both observed and unobserved environmental factors prior to baseline that may have been of influence on child development.
为了估计 RCP 对儿童结局的影响，我们使用了双重差异估计器。该估计器将治疗组结果随时间的变化与对照组在同一时间段内的变化进行比较。它包括子固定效应，以消除两组之间任何未观察到的时间不变异质性。只要两组之间未观察到的个体差异（例如先天能力或育儿技能）不随时间发生独立于 RCP 的差异变化，只要外部因素对两组的影响程度相同（例如价格上涨、就业率波动、飓风、生育趋势），该方法就可以产生对 RCP 的一致影响估计， 针对幼儿的新政策和干预措施没有系统地偏爱治疗组而不是对照组，反之亦然。不可能完全排除未观察到的时变差异的存在。然而，群落的地理接近性及其在关键群落特征上的相似性为平行趋势的假设提供了支持。基线时儿童结果的可比性也令人放心，因为结果反映了基线前观察到和未观察到的环境因素的累积效应，这些因素可能对儿童发育产生影响。

To estimate program impact we estimate the following panel regression equation:$Y_{it}=\alpha +\beta P_i+\gamma P_i\times T_t+\delta T_t+\theta X_{it}+{\eta }_{it}$where Y_it measures child outcome Y for child i at time t (with t = 0 for the baseline in 2006 and t = 1 for the impact round in 2008). P_i is a dummy variable equal to 1 if child i lives in a community assigned to the program and 0 if the child lives in a community assigned to the control group. The coefficient β captures any baseline differences between the program and the control communities. Given the comparability of treatment and control communities, we expect this variable not to be significantly different from zero.¹¹ T_t is a dummy variable equal to 0 for the baseline survey and equal to 1 for the follow-up survey in 2008. The coefficient δ captures any time trends in child outcomes and environmental factors that are common to the treatment and the control group, e.g. general economic trends in St Lucia, the aging of the children, the changing team of child testers.
为了估计项目影响，我们估计以下面板回归方程： $Y_{it}=\alpha +\beta P_i+\gamma P_i\times T_t+\delta T_t+\theta X_{it}+{\eta }_{it}$ 其中 Y_测量儿童 i 在时间 t 的子结果 Y（2006 年的基线为 t=0,2008 年的影响轮次为 t=1）。P 是一个虚拟变量，如果孩子 i 生活在分配给该计划的社区中，则等于 1，如果孩子生活在分配给对照组的社区中，则等于 0。系数 β 捕获项目群与控制社区之间的任何基线差异。鉴于治疗群落和对照群落的可比性，我们预计该变量不会与零有显著差异。¹¹T_t 是一个虚拟变量，对于基线调查等于 0，在 2008 年的后续调查中等于 1。系数δ捕捉治疗组和对照组常见的儿童结果和环境因素的任何时间趋势，例如圣卢西亚的总体经济趋势、儿童的老龄化、儿童测试团队的变化。

The term P_i × T_t captures program introduction after the baseline survey. It is equal to 0 for all children in 2006 as well as for control children in 2008; and equal to 1 for children living in treatment communities in 2008. In other words, the coefficient γ measures the impact of RCP on children living in a community where RCP was implemented after the baseline. It compares changes in child outcomes from baseline to follow-up for children in RCP communities with the changes in outcomes for children in the control group. To analyze treatment heterogeneity, impact will not only be estimated for the full sample but also by gender and by birth cohort.
术语 P×T_t 捕捉了基线调查后的项目介绍。2006 年所有儿童和 2008 年对照儿童的 0 都等于 0;2008 年，生活在治疗社区的儿童等于 1。换句话说，系数γ衡量 RCP 对生活在基线后实施 RCP 的社区中的儿童的影响。它比较了 RCP 社区儿童从基线到随访的儿童结局变化与对照组儿童结局的变化。为了分析治疗异质性，不仅要估计整个样本的影响，还要估计性别和出生队列的影响。

The coefficient γ is an “intention-to-treat” (ITT) impact estimator. It measures the effect of being offered RCP services irrespective of whether the child actually participated in RCP or not. It represents a lower bound on the average treatment effect on the treated (ATET) on children who actually enrolled in the program. Given the voluntary nature of participation in RCP and in the absence of instrumental variables, the impact of the program on participants cannot directly be assessed. A comparison of participants in treatment communities with either the population in control communities or with non-participants in treatment communities would yield biased impact estimates since the subsamples are likely to differ systematically in unobserved characteristics that directly affect children's developmental paths over time. Unfortunately, there are no adequate instruments available to plausibly correct for selection bias.
系数 γ 是“意向治疗”（ITT） 影响估计器。它衡量的是获得 RCP 服务的效果，无论儿童是否实际参与了 RCP。它代表了实际参加该计划的儿童对接受治疗的平均治疗效果 （ATET） 的下限。鉴于参与 RCP 的自愿性质并且没有工具变量，无法直接评估该计划对参与者的影响。将治疗社区的参与者与对照社区的人群或治疗社区的非参与者进行比较将产生有偏差的影响估计，因为子样本可能在未观察到的特征上系统性地存在差异，这些特征会直接影响儿童随时间的发展路径。不幸的是，没有足够的工具来合理地纠正选择偏倚。

X_it is a vector of explanatory variables that measure individual child and household characteristics for child i at time t. It includes child age in months, employment status of the primary caregiver, and a measure of household wealth.¹² The analysis also includes categorical variables identifying the nurses who tested the children. Despite intensive training and regular consistency checks across testers, some of them gave systematically higher or lower scores than the others. Since testers were randomly assigned to children within districts, it is unlikely that these deviations were caused by real differences in child developmental status. Rather, they must have been related to tester differences, for example in the interpersonal contact with the child. Interviewer effects are common, as has been shown for other types of large-scale surveys,¹³ but they are often ignored in empirical analyses and rarely explicitly discussed. Each tester was purposively assigned to an approximately equal number of treatment and control children to avoid multicollinearity with the treatment indicator. This allows filtering out systematic level effects across testers through the inclusion of tester identifiers in the regressions, in line with e.g. Powell et al. (2004).
X_是解释变量的向量，用于测量时间 t 时儿童 i 的个体儿童和家庭特征。它包括以月为单位的儿童年龄、主要照顾者的就业状况以及衡量家庭财富的指标。¹² 该分析还包括确定对儿童进行检测的护士的分类变量。尽管对测试人员进行了密集的培训并定期进行一致性检查，但其中一些测试人员给出的分数系统性地高于或低于其他测试人员。由于测试人员被随机分配到学区内的儿童，因此这些偏差不太可能是由儿童发育状况的真正差异引起的。相反，它们必须与测试者的差异有关，例如在与孩子的人际接触方面。采访者效应很常见，正如其他类型的大规模调查所显示的那样，¹³ 但在实证分析中经常被忽视，也很少明确讨论。每个测试者被有目的地分配到大致相等数量的治疗儿童和对照儿童，以避免与治疗指标的多重共线性。这允许通过在回归中包含测试人员标识符来过滤测试人员中的系统级效应，这与 Powell et al. （2004） 一致。

Finally, ${\eta }_{it}$ is an unobserved component for child i at time t. The analysis assumes that ${\eta }_{it}={\mu }_i+{\epsilon }_{it}$, i.e. that it consists of a fixed component ${\mu }_i$ that captures child-specific effects that do not vary over time (such as innate ability, or time-invariant household characteristics and parenting abilities) and a random term ${\epsilon }_{it}$. Standard errors are clustered at the community level to account for community heterogeneity. This is equivalent to a Hierarchical Linear Model with nests at the community level to capture community random effects.
最后， ${\eta }_{it}$ 是子 i 在时间 t 的未观察到的分量。该分析假设 ${\eta }_{it}={\mu }_i+{\epsilon }_{it}$ ，即它由一个固定的成分组成，该成分 ${\mu }_i$ 捕捉不随时间变化的儿童特定影响（例如先天能力，或时间不变的家庭特征和养育能力）和一个随机项 ${\epsilon }_{it}$ 。标准误差在社区级别进行聚类，以说明社区异质性。这相当于在社区级别具有嵌套的分层线性模型，用于捕获社区随机效应。

The average age at enrollment for children in the study was 17.6 months, while the average length of enrollment at the time of follow-up was slightly more than a year (13.2 months). Children who graduated from RCP because they reached the age limit of 36 months, had been participating for 11 months on average, while children who dropped out before reaching 36 months had been enrolled for 10.5 months.
研究中儿童的平均入组年龄为 17.6 个月，而随访时的平均入组时间略多于一年 （13.2 个月）。因达到 36 个月年龄限制而从 RCP 毕业的儿童平均参加 11 个月，而在 36 个月之前辍学的儿童平均参加 10.5 个月。

Caregivers who were employed were significantly less likely to enroll their child in RCP. This is in line with the program requirement that a caregiver should be present during the Rover visit. Age, education level of the caregiver, and household wealth were not significantly correlated with RCP participation. The lack of a significant correlation with education or wealth is a reflection of program implementation. RCP selects poor communities but it does not specifically target the children most at risk within the selected communities.
有工作的看护人让他们的孩子参加 RCP 的可能性要小得多。这符合计划要求，即在 Rover 访问期间应有护理人员在场。年龄、照顾者的教育水平和家庭财富与 RCP 参与率没有显著相关性。与教育或财富缺乏显著相关性是计划实施的反映。RCP 选择贫困社区，但并没有专门针对所选社区中风险最大的儿童。

The regression also includes cognitive development status at baseline in 2006. This allows examining whether RCP attracted especially those children who started off with relatively high or instead low scores. As the results show, Visual Reception was positively correlated with subsequent enrollment in RCP, suggesting that participants may have been slightly better off than non-participants. None of the other baseline cognitive skills were statistically significant, either individually or jointly.
回归还包括 2006 年基线时的认知发展状态。这允许检查 RCP 是否特别吸引了那些一开始得分相对较高或相对较低的孩子。结果显示，视觉接收与随后的 RCP 注册呈正相关，表明参与者可能比非参与者略好。其他基线认知技能均不具有统计学意义，无论是单独还是联合。

This evaluation of the Roving Caregivers Program in St Lucia is one of the few existing impact evaluations of home-based interventions in the Caribbean. One year after implementation, we do not find a program impact on the average child in treatment communities. However, the estimates for the full sample mask pronounced treatment heterogeneity by age. The findings show significant positive program effects for the younger birth cohort, which was on average twelve months old at program introduction, on the two Mullen Scales of Early Learning that are related to eye–hand coordination and early reading readiness. The impact estimates indicate that the outcome changes since baseline are more than a third of a standard deviation larger in the treatment group than changes over that same period of time in the control group.
对圣卢西亚巡回护理人员计划的评估是加勒比地区为数不多的现有家庭干预影响评估之一。实施一年后，我们没有发现该计划对治疗社区的普通儿童产生影响。然而，对完整样本掩模的估计值在年龄上显示出明显的治疗异质性。研究结果显示，在与眼手协调和早期阅读准备相关的两个 Mullen 早期学习量表上，年轻出生队列（在计划引入时平均 12 个月大）具有显着的积极计划影响。影响估计表明，治疗组自基线以来的结果变化比对照组同期的变化大三分之一以上。

The effects on the older birth cohort, which was on average twenty-four months of age when the program started, are not significant. The lack of impact does not seem attributable to a ceiling effect. Except for Gross Motor Skills, at most 3.6% of the scores of the older cohort were at the maximum on any scale of the assessment tool, and 94.1–99.0% of the cohort scored below +2 standard deviations from the mean on any scale. Nor does it seem related to vanishing gains over time for the oldest birth cohort since the average length of enrollment as well as the time elapsed since drop-out for those who left the program, were relatively comparable among the two cohorts. A core feature of the program relates to the involvement of parents in the Rover interactions with children, enabling them to adopt these practices on a daily basis. Opportunities for caregiver practice with their children with feedback have been identified as a key success factor for home-based programs (Engle et al., 2011). However, especially in the early stages of RCP implementation, caregivers were not always fully involved during Rover visits. This may provide a partial explanation of the low impact, although it is not clear why this would undermine impact for the older but not the younger cohort. Unfortunately, data limitations prevent us from analyzing this in more detail.
对年龄较大的出生队列（该计划开始时平均年龄为 24 个月）的影响并不显着。缺乏影响似乎不是由于天花板效应造成的。除粗大运动技能外，年龄较大的队列中最多 3.6% 的分数在任何量表上都是最高分，94.1-99.0% 的队列得分低于任何量表的平均值 +2 个标准差。这似乎也与最年长的出生队列随着时间的推移而消失的收益无关，因为两个队列的平均入学时间以及退出该计划的人从辍学后经过的时间相对可比。该计划的一个核心特点是让父母参与 Rover 与儿童的互动，使他们能够每天采用这些做法。照顾者与孩子一起练习的机会和反馈已被确定为家庭计划的关键成功因素（Engle 等人，2011 年）。然而，尤其是在 RCP 实施的早期阶段，护理人员并不总是完全参与 Rover 访问。这可能提供了低影响的部分解释，尽管尚不清楚为什么这会削弱对老年人群的影响，而不是对年轻群体的影响。遗憾的是，数据限制使我们无法对此进行更详细的分析。

There is no evidence of a positive impact of RCP on language development of either birth cohort, despite this being an explicit aim of the program. A non-published randomized controlled evaluation of RCP in Jamaica finds similar positive effects on eye–hand coordination and no effect on hearing and speech (Powell, 2004). Personal communications suggest that the lack of impact in this respect may be due to relatively little focus of the Rovers on language stimulation.¹⁷ Intensified Rover training in the language domain seems warranted. This recommendation is supported by a recent review that suggests home-based programs are most effective when based on a structured, evidence-based curriculum coupled with systematic training methods for the home visitors (Engle et al., 2011). Noteworthy is that a meta-analysis of 60 home-visiting interventions in the United States finds no differences in performance of paraprofessionals such as the Rovers compared to professional home visitors (Sweet & Appelbaum, 2004).¹⁸
没有证据表明 RCP 对任何出生队列的语言发展有积极影响，尽管这是该计划的明确目标。牙买加一项未发表的 RCP 随机对照评估发现，对手眼协调有类似的积极影响，而对听力和言语没有影响（Powell，2004 年）。个人通信表明，这方面没有影响可能是由于 Rovers 对语言刺激的关注相对较少。¹⁷ 加强语言领域的 Rover 训练似乎是有道理的。最近的一项评论支持了这一建议，该评论表明，当基于结构化、循证的课程与针对家庭访客的系统培训方法相结合时，以家庭为基础的计划最有效（Engle 等人，2011 年）。值得注意的是，一项针对美国60次家访干预的元分析发现，与专业的家庭访客相比，像流浪者这样的辅助专业人员的表现没有差异（Sweet & Appelbaum，2004）。¹⁸

This evaluation measures only the impact on cognitive development in the short run. There may be beneficial effects of RCP on other child outcomes such as non-cognitive development or on parent outcomes such as maternal stress and knowledge, which are not captured in the evaluation (Cunha and Heckman, 2008, Engle et al., 2011, Sweet and Appelbaum, 2004). Moreover, benefits may not materialize until a later age (Heckman & Kautz, 2013).
该评估仅衡量短期内对认知发展的影响。RCP 可能对其他儿童结果（例如非认知发展）或父母结果（例如母亲的压力和知识）产生有益影响，这些影响未包含在评估中（Cunha 和 Heckman，2008 年，Engle 等人，2011 年，Sweet 和 Appelbaum，2004 年）。此外，好处可能要到晚些时候才会显现出来（Heckman & Kautz， 2013）。

Medium- and long-term evaluations of the program are also necessary to shed light on the sustainability of the gains among the youngest cohort. Findings from other studies are promising in this respect (e.g. Claessens et al., 2009, Deming, 2009, Gertler et al., 2013, Hazarika and Viren, 2013, Walker et al., 2005). They find that the impact of early learning interventions on school performance and adult labor productivity can be substantial, with improvements in indicators of up to 40%.
对该计划的中期和长期评估也是必要的，以阐明最年轻群体中收益的可持续性。在这方面，其他研究的结果很有希望（例如 Claessens 等人，2009 年，Deming，2009 年，Gertler 等人，2013 年，Hazarika 和 Viren，2013 年，Walker 等人，2005 年）。他们发现，早期学习干预对学校表现和成人劳动生产率的影响可能很大，指标提高了 40%。

Overall, the findings suggest that there are windows of opportunity for improving cognitive child development through home-based interventions. Programs may therefore opt to enroll families as soon as possible after birth of the child. From a programmatic point of view, cooperation with maternal and child health centers seems a promising way forward as it allows reaching caregivers at an early, even pre-natal, stage. Research points out to a number of health and nutrition concerns in St Lucia, especially for children living in the poorest and least educated households (Groot Bruinderink & Janssens, 2010). Being a program that works with parents and specifically targets young vulnerable children, RCP seems particularly well suited to address health problems and malnutrition in this population. This would directly benefit the healthy development of the most disadvantaged children, and may indirectly translate into better cognitive outcomes, although evidence in this respect is mixed (Alderman et al., 2001, Maluccio et al., 2009, Walker et al., 2005).
总体而言，研究结果表明，存在通过家庭干预改善儿童认知发展的机会之窗。因此，计划可以选择在孩子出生后尽快招募家庭。从规划的角度来看，与妇幼保健中心的合作似乎是一个很有前途的前进方向，因为它允许在早期甚至产前阶段接触到护理人员。研究指出，圣卢西亚存在许多健康和营养问题，特别是对于生活在最贫困和受教育程度最低的家庭中的儿童（Groot Bruinderink & Janssens，2010年）。作为一个与父母合作并专门针对弱势儿童的计划，RCP 似乎特别适合解决这一人群的健康问题和营养不良。这将直接有利于最弱势儿童的健康发展，并可能间接转化为更好的认知结果，尽管这方面的证据喜忧参半（Alderman et al.， 2001， Maluccio et al.， 2009， Walker et al.， 2005）。

The favorable economic climate after baseline allowed an unexpectedly high proportion of children to enroll in daycare or preschool. Whereas daycare attendance among the younger birth cohort appears unrelated with child outcomes, preschool attendance among the older birth cohort is strongly correlated with higher cognitive scores, regardless of children's prior enrollment in RCP. These results cannot be interpreted in a causal sense because of selectivity. But they are in line with ample evidence documenting the potential benefits of center-based ECD programs. Longitudinal studies find that the impact of center-based interventions can be long-lasting and reach far into the future (Currie, 2001, Engle et al., 2011, Garces et al., 2002, Schweinhart et al., 2005), although the effects of early childhood education are sometimes found to be detrimental, especially with respect to behavioral skills (e.g. DeCicca and Smith, 2013, Loen et al., 2007). Studies that evaluate center-based interventions in Latin-America and the Caribbean have found beneficial cognitive effects in for example Argentina (Berlinksi, Galiani, & Gertler, 2009) and Bolivia (Behrman, Cheng, & Todd, 2004). After the follow-up survey in 2008 however, the world financial crisis hit St Lucia particularly hard due to its economic dependence on tourism. If caregivers of young children lost their employment again, this may have fueled the need for alternative and low cost ECD services such as the home-based RCP.
基线后有利的经济环境使儿童进入日托或学前班的比例出乎意料地高。虽然较年轻出生队列的日托出勤率似乎与儿童结局无关，但无论儿童之前是否参加 RCP，年龄较大的出生队列的学龄前出勤率与较高的认知分数密切相关。由于选择性，这些结果不能从因果意义上解释。但它们与证明以中心为基础的 ECD 计划潜在好处的大量证据一致。纵向研究发现，基于中心的干预的影响可能是持久的，并且会持续到很远的未来（Currie，2001 年，Engle 等人，2011 年，Garces 等人，2002 年，Schweinhart 等人，2005 年），尽管有时发现幼儿教育的影响是有害的，尤其是在行为技能方面（例如 DeCicca 和 Smith，2013 年，Loen 等人，2007 年）。评估拉丁美洲和加勒比地区基于中心的干预的研究发现，例如阿根廷（柏林克西，加利亚尼和格特勒，2009）和玻利维亚，贝尔曼，程，和托德，2004年，产生了有益的认知效果。然而，在 2008 年的后续调查之后，由于经济依赖旅游业，世界金融危机对圣卢西亚的打击尤其严重。 如果幼儿的看护人再次失业，这可能会助长对替代和低成本 ECD 服务的需求，例如以家庭为基础的 RCP。

A key requirement for enrollment in RCP is that both the child and the child's caregiver must be present during the Rover visits. As a result, most mothers who participate in RCP are unemployed. This may introduce a bias against the working poor. The program addresses this as much as possible by allowing other persons who take care of the child during the day to participate in the program instead. Nevertheless, a significant negative correlation exists between enrollment and caregiver employment. Further efforts could be made to accommodate working caregivers’ schedules. Although conducting the visits in the evening is impractical for young families as well as the Rovers, alternative options can be thought of, such as offering services in the weekends. Concerns have also been raised that the program, if highly valued, may create unintended side-effects by providing incentives to remain unemployed. Given the poverty levels in RCP communities, it seems however unlikely that parents would forego employment in order to remain eligible for the program.
注册 RCP 的一个关键要求是，在 Rover 访问期间，儿童和儿童的看护人都必须在场。因此，大多数参加 RCP 的母亲都失业了。这可能会对在职穷人产生偏见。该计划通过允许白天照顾孩子的其他人参与该计划来尽可能地解决这个问题。然而，入学率和护理人员就业之间存在显着的负相关。可以进一步努力适应在职护理人员的日程安排。虽然在晚上进行探访对年轻家庭和流浪者来说都是不切实际的，但可以考虑其他选择，例如在周末提供服务。还有人担心，如果该计划受到高度重视，可能会通过提供保持失业的激励措施来产生意想不到的副作用。然而，考虑到 RCP 社区的贫困水平，父母似乎不太可能放弃工作以保持该计划的资格。