Pilar Fort, Whole Child International, San Salvador, El Salvador; Karen Spencer, Whole Child International, Northampton, United Kingdom; and Carolina de Guevara, Instituto Salvadoreño para el Desarrollo Integral de la Niñez y Adolescencia, San Salvador, El Salvador
Whole Child International (WCI) was running a USAID-funded project in El Salvador to build governmental capacity for quality of care and protection for vulnerable children, including educators and directors of the Instituto Salvadoreño para el Desarrollo Integral de la Niñez y Adolescencia (ISNA). When COVID-19 struck, lockdown forced in-person activities to pause. The project leaders swiftly adapted and innovated key activities, developing short-duration and high-frequency sessions, using videoconferencing, a co-creation approach, best practices, and nurturing care. Sessions were created and delivered in record time, producing positive outcomes and the prospect of using the model for the scale-up of interventions.
Whole Child International (WCI) was founded in 2004 by social entrepreneur and Ashoka fellow Karen Spencer. WCI’s mandate is to help improve quality of care in the most resource-challenged environments around the world, and to raise awareness of the importance of relationship-centered care. In 2018, USAID El Salvador signed a 5-year Cooperative Agreement with WCI entitled “Protection and Quality of Care for Salvadoran Children,” the main objective of which was to achieve “Increased capacity of the government of El Salvador to protect and care for children most at risk of being perpetrators or victims of violence.”
The Cooperative Agreement expressly mentioned that WCI would work with a main governmental partner, the Instituto Salvadoreño para el Desarrollo Integral de la Niñez y Adolescencia (Salvadoran Institute for the Holistic Development of Children and Adolescents), known as ISNA. The project was designed with children’s rights in mind (Office of the High Commissioner on Human Rights, 1990) and on the premise that infants and young children who establish strong relationships with their primary caregivers will have a better chance of becoming more resilient, acquire high levels of socio-emotional health, and “become productively engaged adults and citizens” (USAID, 2018).
During the first year of implementation, WCI staff carried out an extensive analysis of the early childhood and protection sector policies and services. They identified weaknesses and strengths within the government systems to ensure that subsequent training and technical assistance efforts would build on capacities in early childhood education and target the areas where improvements were still needed. In year two of the project, WCI began the caregiver training efforts with educators from 15 of ISNA’s “Centros de Desarrollo Integral” (Integral Development Centers), known as CDIs.
On September 2019, the government of El Salvador approached WCI to discuss the urgent need to build capacity among their direct service staff (“Educadoras”), directors, and community volunteers on best practices for provision of quality of care in the CDIs and the rural Centros de Bienestar Infantil (Early Childhood Well-Being Centers), known as CBIs. This effort is part of a nurturing care (“cuidado cariñoso, sensible y respetuoso”) approach (World Health Organization et al., 2018) led by the First Lady of El Salvador as part of the national policy of “Crecer Juntos” (Grow Together; Crecer Juntos, 2021).
WCI started these capacity-building efforts by delivering two training events, in October 2019 and February 2020. The components included:
- in-person trainings (e.g., workshops);
- preparation and hand-out of materials (e.g., hard-copy guidelines);
- use of large meeting rooms to convene groups of people, traveling from different locations nationwide;
- providing meals during 6-8-hour-long daily sessions for several days;
- typical presentations delivered with projections (instructive fashion), followed by group work/activities and reconvening;
- instruction would mostly be “one-sided”, although interactive;
- and the audience was technical and supervisory staff who, in turn, would transfer the knowledge and skills to their direct service personnel (educators). After training, WCI would mentor ISNA staff over 9 months, followed by certification.
The Impact of COVID-19
When the pandemic was declared in March 2020, the government of El Salvador dictated a lockdown of all personnel and offices. All early childhood centers closed nationwide, and after uncertainties, staff were advised to start teleworking. Likewise, the WCI office closed and technical staff went home. The two international staff (the project Chief of Party, equivalent to project director, and the Early Childhood Care and Development Advisor) left the country in the last airplane before the national airport closed.
At this point, it appeared that the only possible response was to pause or cancel our project activities due to the pandemic.
Urgent Response and Adaptation
Given the sudden turn of events, the question was “What do we do now?” WCI’s senior executives and staff had an emergency meeting with the CEO, Karen Spencer. During the meeting, after reviewing the almost inevitable consequences of delaying or stopping activities, she suggested going “online.” Karen was part of a network of social entrepreneurs and decided to reach out to that community for advice on how best to provide training and technical assistance remotely. Anand Arkalgud, of the international business firm Socion Advisers, graciously offered to share the basic framework and lessons learned from his time working with project ECHO (Extension for Community Healthcare Outcomes), and outlined how WCI could develop an alternative online strategy to achieve our objectives with a different/adaptive methodology (ECHO, 2021).
Based on the commitment to bring quality of care and best practices to early childhood and protection centers, and the acute need for support brought on by the realities of the country in lockdown with many struggling with providing care, WCI decided to continue to pursue the original goals of the project. ISNA’s Early Childhood Department executives also remained committed to looking for alternative ways to reach the educators and the families. They quoted a famous phrase by Nobel laureate educator and poet Gabriela Mistral: “The future of our children is always today. Tomorrow will be too late” (El Mostrador, 2010). WCI developed content that included the same essential components but they were adapted to the new reality of distance learning. The new online sessions would attempt to create capacity by making full use of available technology in the country.
WCI quickly realized that the methodology and contents had to change drastically and that we had to be innovative to succeed (Center on the Developing Child, 2011; WCI, 2021). On the basis of advice from Socion Advisers, the sessions were to be of short duration and high frequency, given the attention span and technological difficulties of online learning. The content would be given through 15-minute sessions, with ample time after to discuss and share, and create a “Community of Practice” (COP). During the approximately 45 minutes of COP sessions, participants would have time to discuss, reflect, expand, and reinforce the content, and even plan on how to reach families (UNESCO, 2017).
The online option was seen as feasible because of the widespread use in El Salvador of the “WhatsApp” smart phone messaging application, in particular among the urban population. However, not all government staff had or were able to use computer equipment and video teleconference software on a regular basis. In addition, there were issues of connectivity and costs.
Because of these challenges, WCI renegotiated with government officials from ISNA, offering the alternative route. Given the critical context of the pandemic and the technological limitations at ISNA, it was clear that the new online strategy would be a pilot initiative, with the hope of it becoming a model of future activities, if successful.
The New Initiative
To put in practice the new initiative, ISNA’s Early Childhood Department manager suggested the formation of a “grupo núcleo” (Core Group) to be responsible for developing activities. The group would interact openly, assertively, and equally, in true teamwork fashion to collectively produce a valued outcome. It was agreed that participants would share power, continuous feedback, and decision-making (Jean-Sigur et al., 2021; Masterson et al., 2019). Given these characteristics, the initiative was referred to, from the beginning, as a “co-creation” initiative (USAID, 2017). WCI used some of the original co-creation concept from USAID (USAID, 2021), however greatly expanding and adding concepts as the initiative evolved (see Figure 1).
Key staff from WCI and ISNA formed the Core Group. It used evidence-based practices such as coaching (“Acompañamiento”); accessing needed resources; identifying their strengths and challenges; envisioning next steps to take, and how to adapt their beliefs and knowledge to engage with families. Within the Core Group, a technical sub-group was created to start designing the sessions. The sub-group was multidisciplinary, including early childhood, maternal and child health, psychology, nutrition, and social work professionals. The sub-group became known as the “Routine Group” because it was formed to develop the first themed session.
The 15-minute sessions were developed as intense high-content with the following characteristics: little narrative; abundance of graphs and videos, frameworks (“a picture is worth a thousand words”), evidence-based case scenarios, data, voice scenarios from children, and questions to trigger self-reflection and be carried over to the COP (Balongo González, 2017). Each session had objectives and the overall purpose was always the application to families and communities.
An example of a child’s voice scenario was to imagine him/her saying to a caregiver: “When you read to me, I learn that the lines have a form, that the drawing has colors, and I start to recognize those figures called numbers.”
When developing the sessions, we considered themes participants may already know but that could be refreshed (e.g., current practices such as routines), and also how such themes might be happening currently in the homes. During the pandemic, families became “educators” themselves so they needed to learn both new concepts on child development and ways to see their children’s actions as opportunities to learn, enjoy, develop, and grow. Content had to reflect how the environment at home (e.g., small, limited spaces; the number of adults living there) could support the children’s learning. But educators could not enter the families’ homes and speak with them in-person to transfer this knowledge.
Flexibility and Adaptability
Restrictions related to COVID-19 meant ISNA educators and directors often could not follow the typical “9 to 5” workday. They mostly worked from home (and thus had difficulty caring for their own families and finding workspace for their constant communication needs with families), and they also took turns on late nights or early mornings to work with colleagues to complete additional tasks from other programs or to physically cover shifts in residential care centers.
We started with the themes of “Relationships” and “Play” to test whether we could work well with these themes, and then developed other content. With the addition of the “Routines” theme, the full co-creation group synergy was cemented. The plan was to teach each theme to the educators, and then orient them to apply the themes in a more empathetic way with their families. Content in each theme linked to the other themes, to improve continuity and integrality. WCI chose content that related to family challenges in trying times:
- Strengthening of relationships encouraged use of “serve and return” (Center on the Developing Child, 2020) in responsive approaches (Lally & Mangione, 2006) and program planning (Wittmer & Peterson, 2017) to emphasize the importance of healthy and emotional interactions between children and adults as a key means for learning.
- Let’s play! used as an “excuse” or case-scenario to introduce to the educator the importance of pausing-reflecting and observing a child playing (in action) before judging, interrupting, or taking any action (e.g., if child is playing with a ball, not judging as “making noises”; UNICEF-LEGO Foundation, 2018); the adult should observe if and how the child is learning. The foundations of reflective practices were introduced (ZERO TO THREE, 1992, 2016).
- Practicing positive parenting focused on pairs of videos on a father reacting in two alternative ways (one positive, one not positive) after not fulfilling a promise with a child. Example: A father leaves home, promising to return on time to play with the child. The father returns late, which makes the child upset. In the first scenario, the father gets annoyed; in the second scenario, the father realizes why the child is upset and responds more positively by apologizing. Educators use tools from previous sessions to reflect on what they are watching.
- Do routines have meaning? helped educators discover that routines used at the Centers were different from the families’ understanding of routines (e.g., eating lunch or putting the child to bed were not seen as a “routine” and families believed there was “nothing to learn about [them]”). It is important to emphasize that one family, after realizing the meaning of routines, created a video in which a mother uses tooth brushing to interact positively with her daughter to introduce a routine practice, which was used for this session!
- Learning with my family created awareness that every activity or moment of interaction with the child and every conversation within the family is an opportunity for learning. Also, it is important to build attachment through a safe and healthy environment where the caregiver responds in a positive and timely manner to the child and they feel loved and accepted.
- Keeping children active during social distancing even during the extraordinary situations into which families went through daily. Educators had the opportunity to dance in the sessions, to become aware of how “liberating” freedom of movement is for children to combat stress, develop balance and coordination, and learn to calculate risks as they grow (David & Appell, 2001; WCI, 2015a, 2015b). A representative of Pickler-US facilitated this session.
- Building a participation bridge with the families used a focus on nutrition to discuss how responsive feeding is an important part well-being. This topic helped build a bridge between educators and families and between families and their children. Known as Parallel Process, it is “important to become aware of your own feelings, beliefs and values, and to seek to understand [those] of others" (Pawl & Dombro, 2001, p. 30).
Creating a COP
The approach in the COP was “learner-centered,” meaning it was interactive and participative. Participants were able to share knowledge, experiences, beliefs, and values, using the content from the sessions to discuss openly. They paused, observed who they were (as educators and as persons), and reflected before deciding what to do or how to act (reflective practices). They could express what they needed to learn in a constructive way without feeling judged (“safe and supportive environment”), both among the peers (“peer learning”, UNESCO, 2017) and when they were with their supervisors (Alegre, 2010; Fernández Batanero, 2013). This environment helped to continue the co-creation (see Figure 2).
The initiative included improving facilitation techniques for presenters. Prospective facilitators were evaluated on the technical platforms they already had. They became familiar with “virtual facilitation” and the additional skills needed to do it well. They were encouraged to use a holistic and comprehensive view and the nurturing care (“cuidado cariñoso, sensible y respetuoso”) approach. Directors became “educator instructors,” learning how to use reflective practices, both with their staff and also when engaging with families, to ensure open exchange of information, and building relationships. For the pilot, WCI decided to have a maximum of 15 directors/educators per facilitator, for the sessions and COP. The pilot was implemented in 15 CDIs.
As part of monitoring, evaluation, and learning, WCI carried out a limited baseline assessment to explore perceptions among families with children before the initiation of activities. A sample survey of 46% of families found they had an average of two children under 7 years old. On routines, 91% implemented some form of positive routine, 40% thought tooth-brushing and handwashing were routines, and less than 10% considered common actions like bathtime, sleeptime, drawing, or playing as being routines that they could use for learning and development (this finding was used to strengthen the concept in the development of sessions). On family engagement, the majority (~60%) were mothers, while fathers were mostly engaged during playing (22%). Assessment of qualitative perceptions revealed that it would be difficult to engage fathers in parenting and care so that special efforts would be required.
Technology and Connectivity
The decision to use online technology for the initiative led to an extensive discussion about what to use (e.g., Google Meet, Google Classroom, Webex, Zoom). In the end, WCI decided to use Zoom (which provided more access and did not collapse when used with many people) and Whatsapp (which was commonly used in El Salvador). Whatsapp groups were created for each of the session groups (15 educators plus facilitator). We also found out that not all families had connectivity or devices, which would have to be addressed. WCI had to provide airtime (“datos”) to educators for the sessions, and computers and modems to allow participants of the Core Group to follow all sessions.
Effects and Impact
The initiative led to positive effects and impacts on both program staff members and program participants.
- Methodologies were well received and adopted. The co-creation, reflective practices, and coaching methodologies created contrasts and added new knowledge and skills for the Core Group participants. They started thinking more about learner orientations, appreciated the “confidence, warmth, openness, enthusiasm, and optimism of those attending the virtual sessions,” as one facilitator trainer stated. Other facilitators highlighted: “I started to develop my capacity to communicate ideas in front of an audience through a virtual manner, with more confidence…it will be a pleasure to keep learning”; “Share experience and consolidate as a team”; and “New experiences.”
- Key project activities continued. The pilot initiative ensured that the key activities planned for the project in terms of trainings and capacity-building for the ISNA personnel took place (starting in May 2020) despite needing to switch to online delivery. Although not exactly as originally planned, the adaptive model achieved the following results:a. The Core Group was established (14 members from WCI and ISNA), learned full use of teamwork, and completed (1) facilitator training, and (2) development of the 7 ECD themes and sessions.b. Eight 15-minute sessions plus eight approximately 75-minute COPs were held for a total of 139 ISNA direct service staff (98 educators, 27 cooks, 7 maintenance, 5 cleaning, 2 secretaries) plus 15 directors of the 15 CDI centers (a total of 154 participants and 1,848 person-hours of instruction).c. All participants “graduated” and received a diploma in a special virtual ceremony (December 2020) with the presence of the executive director of ISNA, CEO and founder of WCI, the WCI project Chief of Party, and other authorities.
- A new technology was learned and utilized. ISNA and WCI staff learned to use video teleconferencing at the same time they were engaging participants in a lively discussion (which can be challenging). They also appreciated the enhancements of communication (e.g., having live interaction despite not meeting in person; Soriano & Vigo, 2008). Some participants had never used such platforms. For example, an elderly nun member of the Core Group did not have email and had never used videoconferencing before the project. She not only learned to use all applications but ended up being one of the most animated facilitators of the group. Given the mixture of personnel of different ages and the interface that has occurred with the initiative, this use of technology has effectively been considered as provoking “intergenerational growth.”
- Core Group as leaders. Not only did the members of the Core Group become the facilitators of sessions and COPs (providing some coaching to individual persons) to all subsequent groups, but in effect they are seen as the leaders of the co-creation initiative.
- Reflective method seems to work with session participants. Session participants have picked up the communication methodology in a positive and proactive way. Doing so seems to have created an early impact, not only among government personnel, but also filtering into the beneficiary families. An anecdote illustrates this assertion: One of the few male educators shared some hesitancy about calling on families because of a cultural barrier in communication (where males should not call female caretakers). We worked on his communication style, in feeling confident of his role, suggesting that the family would likely appreciate his commitment. The educator called and established a first contact. Two weeks later, he called again, somewhat afraid that the family may not answer or remember him; however, to his surprise, the mother not only responded to the call but knew immediately who he was, his name, and telephone number! He conveyed to the team that he felt accepted and comfortable to carry on his job. He believed they had started creating a trusting relationship!
- Families are getting the message. Before the training sessions, interactions were more “assisting” or prescriptive, rather than observing, reflecting, and supporting (Raikes & Edwards, 2009). Families started learning the value of routines at home; one actually made a video themselves (being patient with child, observing). Families accepted the educators (including a male educator). One mother said, “I never realized that when I fed, bathed [child]…that was important to [him/her]…we played without realizing it…but now I know!”
- Satisfaction with the initiative. After the first graduation of participants from CDIs took place, and they started using the newly acquired competencies with positive results, the Core Group started receiving constructive feedback, acknowledging the learnings and their improved performance. Institutionally, USAID has also expressed satisfaction with the project progress, noting that—understandably—several other projects had delays or had to be paused or cancelled because of the pandemic. At ISNA, while reporting on this initiative in multisector meetings, they have started to call it the “co-creation model,” to be used in future undertakings (see the next section).
Conclusion and Next Steps
The lockdown imposed by the COVID-19 pandemic shuttered planned in-person trainings and capacity-building efforts for local directors, educators, and volunteers working with families and young children. It threatened the closure of a donor-funded project. With clear government commitment and support, WCI moved to swiftly collaborate, learn, and adapt together by adopting innovating technology and best practices. There was plenty of risk-taking and uncertainty, counteracted by building trust in a positive environment, exerting behavior change and quick decision-making, and assuming responsibility for self-learning as adults. As a participant coined it, the video-conferences “became our virtual campus!” The preliminary results presented in this article confirm that the innovation was successful and is poised to become a new model for ISNA.
The next steps are to scale up the initiative in 2021 to provide capacity-building activities to 607 community volunteer “educators” from rural area centers (CBIs) in 111 municipalities covering the entire country. We will use and adapt co-creation, reflective practices and supervision, as well as coaching, to achieve the intended objectives. The Core Group will train 37 “promoters” (ISNA technical staff where the CBIs are located), who will become the facilitators for the next phase. By using the model presented in this article, carefully adapted, WCI hopes to obtain successful results “for a safer, more prosperous and self-reliant El Salvador” (USAID, 2021).
The authors thank Wendy McFarren, Chief of Party of the WCI project, for adding a few inputs on the project’s context, original purposes, and accommodations as activities unfolded in a changing environment. Similarly, they would like to acknowledge the leadership of Manuel Sánchez Estrada, executive director of ISNA, who kept the commitment and pushed forward to help surmount several obstacles alluded to in the article, and Ernesto Machado, chief of Early Childhood Department of ISNA, the true “engine” of the Core Group. To all the participants of Core Group, who gave their very best amid trying circumstances, to ensure the successes reported. To WCI staff, who actively contributed the needed operations during project implementation. To Julie Grier-Villatte, Gracia López, and USAID El Salvador, for their funding and continuous support throughout the project cycle, especially during the pandemic crisis. To Alfredo Fort, who gladly offered sound advice on several aspects and thoroughly reviewed and edited the article. Finally, we dedicate this paper to the educators, volunteer promoters, families, and children of El Salvador, because they are the ultimate reason and motivation for our efforts.
Pilar Fort, MA, early childhood care and development technical advisor for the USAID project in El Salvador at Whole Child International (WCI), is an early childhood professional with more than 30 years’ experience in program design and implementation, coaching and mentoring stakeholders and professionals in the area of early childhood and family engagement. She licensed in Peru in early childhood education and proceeded to obtain a diploma on adolescent health from Cayetano Heredia University (Peru), a master of arts from Duke University (North Carolina, USA), and certificates as an infant and young children specialist from Erikson Institute (Chicago, USA) and on Head Start management from the University of California-Los Angeles (California, USA), among others. She has worked in several programs and institutions such as QualityStarNY of City University New York, The Campagna Center, ZERO TO THREE, Head Start/Early Head Start, and CARE International, among others. Pilar has also been adjunct faculty to the University of Cincinnati (Ohio, USA), teaching infant and child development, and been consultant to the World Health Organization, Fundación Integra (Santiago, Chile), Chile Crece Contigo/Government of Chile (Santiago, Chile), Cuna Más national program (Lima, Peru), ChildFund International (Luanda, Angola), USAID, US Department of State (Guatemala and Chile), among others. She is member of Childhood Education International (CEI), where she was president of the board from 2017-2019. She has published several articles, available upon request.
Karen Spencer, Countess Spencer, is a social entrepreneur, who champions ideas to transform the world through systems-level change. She founded Whole Child International in 2004 to address the socio-emotional well-being of children living in residential care in many countries around the world, and is currently its CEO. She has led an international team to improve systems of care, advocate and influence policy, and conduct related research. She has provided the vision and strategic direction for the organization’s growth, with a passion for systems change, sustainability, scalability, research, and third-party evaluation. She is co-author of articles published in the peer-reviewed Infant Mental Health Journal and Perspectives in Infant Mental Health, contributing important insights and realistic solutions to the public debate. In 2010, His Holiness the 14th Dalai Lama came to Los Angeles, especially to lend his personal support to Whole Child. Karen’s work in the area awarded her the Ashoka Fellow in 2015. In 2016, she was made a fellow at the University of Northampton in the United Kingdom. In 2017, she received the Pikler/Lóczy USA Founders Award, and People magazine named her one of “25 Women Changing the World.” She is also current board member of the Center for Global Development. Karen founded in 2020 Catalyst 2030, a movement of social entrepreneurs collaborating to accelerate progress toward the Sustainable Development Goals.
Carolina de Guevara, early childhood manager of ISNA, is a licensed psychologist from the Universidad Centroamericana José Simeón Cañas (UCA) of El Salvador, Central America. She is a renowned expert in early childhood development and rights, and adolescents, including through interinstitutional management and external cooperation programs. Since early in her career, she worked as an educator for early childhood. She was part of a small group that created the Centros de Bienestar Infantil (Early Childhood Well-being Centers) in El Salvador, which operate primarily in rural and disadvantaged areas. She has visited and/or learned of early childhood programs implemented in many countries such as in the US (Texas, Omaha, New Jersey, Washington), Israel, Chile, and Colombia. Carolina was a member of the government team that implemented the program of Early Childhood Education through the Family (EDIFAM) in El Salvador.
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