Global Health eLearning Center M&E of Holistic ECD Programs

Session 1: Three Levels of Intervention - What Does This Mean for M&E?
After completing this session, the learner will be able to: Describe the purposes of M&E frameworks Define child well-being, caregiver well-being, and caregiving environment and their significance related to monitoring and evaluation of holistic ECD programs Build a logic model and results framework for ECD programs

M&E Frameworks
Clearly describing a program is an important first step in conducting M&E activities. A clearly described program is easier to monitor and evaluate and facilitates the use of M&E data to improve the program. Developing an M&E framework helps to clarify goals and objectives, and helps to identify internal program elements and external factors that may affect the success of a program in a particular context. This design process deepens the understanding of managers, implementers, and other partners in many practical ways, including serving as the foundation for selecting appropriate, useful M&E indicators. In this course, we will describe two different types of frameworks - a Results Framework and a Logic Model Framework.

Goals and Objectives of an M&E Framework

Designing program frameworks is one way to develop a clearer understanding of the goals and objectives of a project, with emphasis on short-term and long-term measurable objectives. Developing an M&E framework helps clearly define the relationships among factors key to the implementation and success of a project - factors that are both internal and external to the program. M&E frameworks: Are useful tools for understanding and analyzing a program Help in the development of sound M&E plans and implementation of M&E activities Articulate program goals and measurable objectives (short-term, intermediate, and long-term) Define relationships between program inputs, activities, outputs, outcomes, and impacts Clarify the relationship between program activities and external factors

Results Framework for the Essential Package

Results frameworks are diagrams that present program strategies for achieving specific objectives in working towards the overall goal of the program. Strategic objectives, intermediate results of the program, and explanations as to why the strategy is expected to work are included in these frameworks. Results frameworks serve as the foundation to select the specific program strategies or interventions that the ECD program will support. Each program strategy or intervention that is selected for implementation should be associated with and contribute to one, and most often, multiple intermediate results that the program targets.

Results frameworks are useful in: Building consensus around shared objectives and strategies Communicating shared objectives and strategies with partners and external stakeholders Planning a program Managing a program Communicating about a program Obtaining buy-in for a program Reporting the results of a program Source: Save the Children 2010

Constructing a Logic Model Framework

Constructing a logic model can help highlight the elements that are critical to program success and identify the points where M&E is crucial to measure and understand effectiveness of program activities. To begin constructing the logic model, you must identify: 1. Inputs (resources such as staff, money, supplies and materials) 2. Programmatic activities (refer to your results framework) 3. Outputs (direct products of the program's activities) 4. Outcomes (results of the program) At each step, ask yourself, "If we do [X], what will happen?" Once you have decided the specifics of each component (inputs, activities, outputs, outcomes), arrange them in a logical order. Then portray the steps graphically, with lines and arrows to show the relationships between and among them.
Glossary Term:

Input Activities Output Outcome

Three Levels to Monitor & Evaluate

Before developing a logic model for your ECD program, it is important to consider the three levels of interventions: 1. Child well-being 2. Caregiver well-being 3. Caregiving environment The Essential Package promotes a monitoring and evaluation (M&E) framework that covers all three of these levels. The child's development is dependent not only on physical factors, but also on the caregiver's well-being and the caregiving environment. For example, a caregiver who is depressed may not be able to provide appropriate care for the young child. A child living in an environment which is chronically stressed due to poverty or violence, or which does not include a consistent caregiver can severely impact the child's development. The three levels are interlinked and should not be viewed in isolation. Interventions targeted at these three levels are intended to lead to measurable changes in the well-being of children while also improving the environment in which children grow, learn, and develop. Indicators across all the domains give program managers an opportunity to better understand the impact their programs are having on children and their caregivers. Comprehensive assessment is crucial for determining the current status of the child, caregiver, and caregiving environment in order to identify follow-up steps and support needed in each of the focus areas. Proper assessment also plays an important role in establishing a framework for ongoing monitoring and eventual

evaluation of changes in child and caregiver status and caregiving environment.

What is Child Well-Being?

The Essential Package is concerned with child well-being across multiple domains: Physical Cognitive Language Social-emotional A child's well-being can be influenced by a number of factors including the well-being of his/her caregiver as well as the environment in which he or she lives. Program managers should assess whether children are able to reach their full developmental potential. By assessing child well-being, programs will be able to identify critical 'red flags' or warning signs of concern, which may indicate a problem in need of intervention. Red flags may include a childs lack of a consistent caregiver, lack of birth registration, failure to thrive, and general poor health.

What is Caregiver Well-Being?

Caregiver well-being refers to the state of a caregiver of a young vulnerable child in terms of his or her health and psychosocial well-being. Studies reveal that maternal depression has a significant impact on the wellbeing of the child. Self-reported stress should be taken seriously by programs as this may indicate larger problems at the household level. Similarly if the caregiver is in poor health, disabled, or elderly, s/he may need additional support in order to provide adequate care for their children.

What is Caregiving Environment?

Caregiving environment refers to the physical and social environment in which a child is raised. HIV and poverty often coincide, creating conditions that may pose serious threats to young children. The caregiving environment can often provide clues on areas for improvement and available resources (for example, other family members or neighbors) at the household level that support healthy growth and development of children. An assessment of the physical and social environment in which the child lives and an understanding of potential protection threats, as well as sources of support for child and family, is absolutely essential when developing programs for this group.

Outcome Indicators
The Essential Package monitoring and evaluation (M&E) framework provides a set of indicators used to measure the outcomes at the three levels of programming. As programs develop their M&E plans, these indicators can be integrated to assess results in each of the focus areas.

Glossary Term:

Indicator Outcome

Building a Logic Model Using the EP as an Example

Before selecting which indicators to measure, it is a crucial first step to develop a logic model of one's program. Recall the three levels of intervention and the ultimate goal or outcome of ones program. The logic model visually presents a series of if-then relationships that, if implemented as intended, lead to the desired outcomes. Click on each step below to build a logic model for a program targeting young vulnerable children and their caregivers. After clicking on steps 2 - 6, review each column, consider its specific elements and the links between elements. You can start the development of your logic model with any component. Start with what you know most about your program. Step 1: State the problem that frames a particular challenge for the population your program will serve. What is the problem to be addressed? Step 2: Consider the previous courses, especially Course 3: Improving the Lives of Young Vulnerable Children and Their Caregivers, which describes the content of the Essential Package and Visual Reference Guides. What kinds of resources (inputs) do program implementers need to address the problem? Step 3: Add planned strategies/interventions. What activities might we do to achieve these objectives? Step 4: Add outputs that are expected from the activities. How much will need to be done (outputs) to achieve our goal? Step 5: Add outcomes that are expected assuming the outputs are achieved. What is our goal? Click here for the M&E frameworks from the Essential Package, which include logic models for the child status, caregiver status, and the caregiving environment and associated indicators.

Session 2: Introduction to EP Tools for Assessment, Monitoring, & Evaluation

After completing this session, the learner will be able to: Describe the EP tools and their use for assessing, monitoring, and evaluating holistic ECD programs across the three levels of intervention

Overview of EP Tools

The EP provides a number of tools which can be used for assessment, monitoring, and evaluation of a holistic, integrated ECD program that targets the child, caregiver, and caregiving environment. These include: Situational Analysis Tool The Frameworks Comprehensive Checklist Reflection Meeting Tool Home Visit Monitoring Tool Household Care Plan Visual Reference Guides (Children and Caregiver) These tools allow for both qualitative and quantitative data to be collected in a systematic manner. Throughout the program cycle, these tools can be integrated into your existing program to track over time how your program is doing. While the EP is ultimately concerned about the well-being of the child and the caregiver, programs must monitor various elements across the program cycle. Tools are, therefore, meant to monitor the quality of the household visit and your overall program.

Utilizing the Tools along the Program Cycle to Monitor, Assess, & Evaluate
STEP 1: Perform a situational analysis to determine what services are currently available in the community and what the specific barriers are to accessing those services. The data collected will help to determine what the home visitor can link the household to once a need is identified. STEP 2: Train HBCV and other relevant community service providers on the EP and implement your home visits. STEP 3: Conduct a baseline assessment using the comprehensive checklist to measure quantitative data across the three levels of intervention (child, caregiver, and caregiving environment). This assessment will be critical to developing a household care plan, which will be used for ongoing monitoring. STEP 4: Program staff and HBCVs should visit each household to fill out a household care plan with the primary caregiver for effective case management. The household care plan will be the main tool that will support ongoing monitoring at the household level. The care plan is developed jointly with the caregiver and can change over time as the household situation changes. It should track referrals made and next steps for follow-up. STEP 5: Home visitors should begin using the household care plan and visual guides during their home visits to impart critical messages, model optimum behavior, refer to needed services, and follow-up on referrals. The care plan should be revisited after each contact with the caregiver and child to track changes. Home visitors will need support to use this tool and supervisors should support them to understand its usefulness as a job aide. STEP 6: Program staff should provide regular and consistent feedback, mentoring, and supportive supervision to the HBCVs. This can be accomplished through the program staff accompanying HBCVs on their home visits once a month and filling out the Home Visit Monitoring tool for each visit. This tool is a

supervisor job aide which can support the supervisor to better track the home visitor ability to transmit the correct messages based on the assessment done at the household level and help course correct. STEP 7: Program staff should hold monthly refection meetings with home visitors in which they record the findings in the Reflection Meeting Tool. Moreover, to reinforce key messages from the Visual Guides and to bring the most marginalized households out of isolation, parenting meetings should occur once a month. This can be done with different types of caregivers or smaller meetings which target the specific type of caregiver as these meetings not only impart key messages but also provide a support group for the caregivers themselves.

The Comprehensive Checklist

The Comprehensive Checklist for the Essential Package is the measurement tool used to collect information on the three levels of intervention (i.e., child wellbeing, caregiver well-being, and caregiving environment) at critical points during program implementation. The Comprehensive Checklist identifies barriers, opportunities, and assets that are available in a household and captures data on socioeconomic status, caregiving status, child status, and the caregiving environment. The Checklist should be used for baseline and endline data collection in order to track changes over time. Baseline data collection is usually conducted before the start of the program to assess childrens well-being before the intervention. This information can be used: to inform program managers and staff about the key needs and positive practices occurring in the community in preparation for the implementation phase and in program evaluation Endline data collection is usually conducted at the end of the program/intervention to assess changes in childrens well-being over time.

The Comprehensive Checklist: What Information Is Collected?

The Comprehensive Checklist consists of the following seven sections: 1. Introduction and Informed Consent: This section collects background information about the household, details about the interview as well as informed consent statement. 2. Household Register: This section collects socio-economic and demographic information about a particular household. Information collected is related to: household composition (adults and children); changes in household composition; age categories of children living in the household; identification of primary and other caregivers; level of education of the primary caregiver; and household source of income. 3. Caregiver Status and Support: This section collects information about caregivers of young vulnerable children, specifically related to their health, psychosocial well-being, and access to support systems and viable livelihood. This section consists of questions 10-21 in the comprehensive checklist. 4. Child Status (Health, Nutrition, and Protection): This section collects information about the ability for children to reach their full developmental potentials related to health, nutrition, and protection needs. This section consists of questions 22-43 in the comprehensive checklist. 5. Caregiving Environment: This section collects information about the environment in which children are raised in terms of whether children live a safe, stable and consistent caregiving environment. This section

consists of questions 44-51 in the comprehensive checklist. 6. Child Status (Development and Behavior): This section collects information about the ability for children to reach their full developmental potentials related to development and behavior. This section consists of questions 52-62 in the comprehensive checklist. 7. Observations: This section concludes the interview. It is meant to document key observations about the interview process and other information about the household, caregivers, and children.

The Household Care Plan

The Household Care Plan is a critical tool for assessment and ongoing monitoring at the individual household level. It is a job aide for the home visitor and program manager to ensure that actions taken in support of the household correspond to the assessed needs. What information is collected? Information on the household situation including number of children, identification of primary caregiver, and others who may provide care to the child Caregiver status (health, well-being, age and ability to engage in income generating activity, access to external support) Child status (health, well-being, age and ability, ability to interact with other peers, whether the child lives in a protective environment) Caregiving environment (safety of the environment, presence of hazards or other concerns which may be detrimental to the proper growth and development of the child) How to use the Care Plan: The information collected during the course of the home visit through the care plan is meant to trigger a response by either the caregiver, home visitor, or program manager. The care plan should be regularly updated as the household situation changes. It being one of the job aides for the home visitor, program managers/supervisors can use this to assess what is happening at the household level and with the home visitor to determine appropriate courses of action. These can then be discussed during regularly scheduled reflection meetings using the reflection meeting tool and tracked.

Reflection Meeting Tool

The Household Care Plan and staff reflections are shared at a monthly meeting and provide rich information about how the home visitors are able to use the tools; how the caregivers are applying the messages to their practices; and how the program team is providing mentoring and coaching to the home visitors to improve their interactions with caregivers. The program manager should use this information to analyze positive changes and existing challenges for caregivers to meet their needs and the needs of their children as well as staff and home visitors capacity to helping the caregiver meet these needs. After the program manager evaluates these successes and challenges, he/she should develop strategies to address these challenges that can be discussed during the monthly planning meetings with staff to guide their work with home visitors at the reflection meetings and during monitoring visits. The program manager should look for opportunities to share successes as well as this positive feedback will motivate staff and home visitors to continue their effective work. What does the Reflection Meeting Tool collect?

The tool collects information that will support home visitors to troubleshoot situations they encounter at the household level with their peers and their supervisors. It collects information about what the home visitors learned new during the month, what positive changes they are seeing at the household level and what challenges they have encountered. How the Reflection Tool is used? Each home visitor takes a few minutes to share what they are proud of this month in their own practice, or what they have observed at the household level and the challenges they are facing with regards to using the tools. Staff member discusses with the home visitors the challenges they are facing and brainstorms with the group on effective strategies that can be tested over the next month. This time also allows for home visitors to receive additional training as well depending on the topic and length of the meeting.

Home Visit Monitoring Tool

The tool should be used by program staff to evaluate and effectively mentor the home visitors in a systematic way. Each month a staff member should accompany each home visitor to at least one household. This tool will allow the staff to understand whether the home visitor is using the tools correctly as well as providing the correct messages based on need. The tool should not be filled out at the time of the visit but rather shortly thereafter. After the home visit, the staff member and home visitor should sit down one on one and discuss the home visit. Program managers should observe the work of their staff during home monitoring visits and reflection meetings to evaluate how they are able to mentor the home visitors. These monitoring visits should be intensive at the beginning of the program to ensure that the staff has the skills to guide the home visitors work. After the visit or meeting, the program manager should hold a feedback session with the staff member. The staff member should first receive guidance on what she/he is doing well and together, they should develop clear strategies to improve the staff members practice. If the team has the time, they can also work in pairs to mentor each other during field activities.

Session 3: Linking the Three Levels of Intervention to the EP Building Blocks

After completing this session, the learner will be able to: Recall the EP Building Blocks Explain how the EP M&E framework relates to the Building Blocks Identify specific indicators as they relate to the EP Building Blocks

Linkages with the Essential Package Building Blocks

The EP provides a framework for action to support those at the point of service delivery. By addressing the needs of children according to their age and stage of development, the EP empowers families to provide the necessary support to their children in a way that enables them to reach their full developmental potential. The three levels of intervention were identified to provide those at the point of service delivery the tools necessary to address four key underlying building blocks deemed necessary for successful programming for young vulnerable children. The EP framework and the supporting tools all work together to enhance the following four important building blocks:

1. Foster positive caregiver-child interaction and support 2. Employ developmentally appropriate approach to enhancing childrens health & development 3. Support linkages to broader systems of integrated care 4. Eliminate barriers to care and support

Building Block 1: Foster Positive Caregiver-Child Interaction and Support

Childrens future well-being depends as much on having a supportive caregiver and a stimulating environment as it does on receiving food, health care, and shelter. When a child and caregiver have a strong and supportive relationship, the child is more likely to be healthy, physically and emotionally, and more resilient. The EP building block of fostering positive caregiver-child interaction and support provides age-appropriate recommended actions on how caregivers can/should interact positively with their children to provide needed care and stimulation for physical, cognitive, language, and social-emotional development, and for addressing their health, nutrition, and protection needs. This building block is linked to the caregiver status and caregiving environment levels of intervention. Indicators related to fostering positive caregiver-child interaction include those that measure both the ability of a child to reach his/her full developmental and the level of safety, stability, and consistency of the caregiving environment. The box below provides examples of indicators and the questions from the Comprehensive Checklist linked to fostering positive caregiver-child interaction and support.

Building Block 2: Employ Developmentally Appropriate Approach

The EP framework provides guidance on addressing age specific needs in areas critical for the optimal health and development of the child including health, nutrition, stimulation, and rights and protection . The EP also works with caregivers to identify the positive caregiving practices they are already employing in their household, providing positive reinforcement for these behaviors, and helping caregivers to understand why paying attention to childrens developmental stages and domains is important. Therefore, it is important to employ a developmentally appropriate approach to enhancing childrens health and development. This building block is specifically linked to interventions aimed at improving child status and the caregiving environment. The box below provides an illustrative list of indicators and questions from the Comprehensive Checklist related to the building block of employing developmentally appropriate approach to enhancing childrens health and development.

Building Block 3: Support Linkages to Broader Systems of Integrated Care

The Essential Package provides an entry into the households which may be socially isolated by allowing for regular and consistent interaction between a caregiver and broader systems on integrated care usually through home visitors. These home visitors serve as intermediaries between the caregiver and the services they may need. Such support are enhanced and consolidated with integrated multi-sectoral support across the physical and social aspects for child and family.

A rich and stimulating environment, with safe, stable, and nurturing relationships in childhood contributes to improved developmental outcomes, increasing the likelihood of an individual breaking the cycle of poverty. It is, therefore, important to support caregivers to establish and sustain linkages to broader systems of integrated care. This building block is linked to the caregiver status level of intervention with the outcome that caregivers are healthy and able to respond effectively to their childrens needs. Indicators and questions from the Comprehensive Checklist related to Building Bock 3 are shown in the box below.

Building Block 4: Eliminate Barriers to Care and Support

Families and communities often face significant hurdles to accessing support. These hurdles are not only related to potential stigma and discrimination but can include issues of distance to services, lack of sustainable livelihoods, and other policy-related matters. For elderly caregivers and child-headed households, appropriate responses are needed and must involve a countrys social welfare systems. A safe, stable, and consistent caregiving environment will ensure that children can continue to participate in educational activities without being pulled out of school to work and can ensure that elderly grandparents are not pulled into activities which may weaken their ability to love and care for children. The EP recognizes the critical importance of economic strengthening and protection as foundational elements of support to families. It highlights the role that social welfare plays in meeting the needs of vulnerable children and families and suggests appropriate linkages for families to meet their needs and attain their rights. It is, therefore, important to eliminate barriers to caregivers accessing care and support. This building block is also linked to the caregiver status level of intervention with the outcome that caregivers are healthy and able to respond effectively to their childrens needs. Indicators and questions from the Comprehensive Checklist related to Building Bock 4 are shown in the box below. For more information on the specific actions recommended for each of the EP Building Blocks, see Course 3: Improving the Lives of Young Vulnerable Children and Their Caregivers.

Session 4: Using M&E Data for Decision Making, Planning, and Learning
After completing this session, the learner will be able to: Identify sources of monitoring data in the Essential Package (EP) framework Understand the process of monitoring, evaluation, and learning as it relates to the EP Describe the role of evaluation data in influencing decision making on program, national, and global levels

Using the Available Data

Once the results framework is in place and the logic model has been developed, it is important to focus on the use of the available data for programmatic review, adjustment, learning and decision making. In order to be able to use M&E data, it is important to identify the data sources.

Practical exercise:
Fill in the table with data sources that you might look at for monitoring data at each of the three levels of intervention. Include tools which your organization already uses.

The Cycle of M&E Activities

For each of the households participating in the program, there is a cycle from identification to graduation. As discussed in Session 1 of this course, the process of assessment takes place using the Comprehensive Checklist. The Checklist collects information that can be used to inform program managers and staff about the key needs and positive practices occurring in the community in preparation for the implementation phase and in evaluation. The Comprehensive Checklist is administered by trained enumerators. Following the assessment, individual data is entered into the project database and is aggregated for baseline measures, which can later be accessed to determine whether or not children and households received services and support that met their priority needs. Once the household is enrolled in the program, a Household Care Plan is designed which results in a plan of action based on the priority needs of this household.

Household Care Plan

The EP's Household Care Plan is a case management tool used to document child status, caregiver status, and the caregiving environment while identifying and outlining the needed actions. As a case management tool, the Household Care Plan is the central instrument used for monitoring interventions and services offered. This tool can help the home visitors to follow-up on the concerns that were discussed in a previous visit, referrals that were made, and indicate any major emergency needs at the time of the visit. In order to support the quality of program delivery and strengthen the process of reflection and learning, an Implementation Guide was designed for program managers.

Implementation Guide for Program Managers

The Implementation Guide for Program Managers provides an overview of how program staff will mentor the home visitors and document the successes and challenges at the caregiver and home visitor levels as well as how the program managers will analyze the information collected from the field and mentor their staff to effectively build the home visitors capacity. Specifically, it provides guidance and tools for supervisors and managers to review and assure quality of work of the home visitors as well as guide the reflection process and promote learning. The Implementation Guide includes tools for home visitors: Household Care Plan

Visual Reference Guide (for Children and Caregivers) As well as for program staff: Home Visit Monitoring Tool Reflection Meeting Reporting Tool Notes for Reflection Meeting Facilitator Sample Reflection Meeting Guide

Reflection
Every month, the home visitors from each community gather to reflect on their practice and experiences with the caregivers during home visits. A program staff member facilitates the session. This presents an opportunity to document successes and lessons learned while encouraging information sharing and peer-to-peer learning. Wider project reflection meetings can also involve wider range of stakeholders, including service providers, local government and authorities as well as community representatives and can discuss potentials for improvement in project implementation as well as serves the purpose of documenting and sharing lessons and good practices. Full cycle of the monitoring process enables the project team to follow the household from assessment through the cycle of referral, service delivery and by observing changes in the three levels, make a suggestion for decision of graduating household out of the program.

Evaluation Results and Use of Evaluation Data

Evaluation of the Essential Package outcomes is based on the indicators identified in the previous session and is usually carried out by an external party. Baseline and endline results based on the Comprehensive Checklist play a critical role during evaluation of outcomes. Quality of the assessment process plays an important role from the beginning of the project, throughout implementation (as the Household Care Plan is based on the assessment), as well as at the last stage during evaluation of outcomes. Documented change in child status, caregiver status, and caregiving environment creates evidence for identifying impact on the communities targeted by the project. Results from the evaluation can be used for: Scale-up of successful practices Replication of successful approaches Improving processes for future implementation of the intervention Increased engagement of state and non-state actors in supporting action which would increase impact on well being of children and households in the community Advocating for legislative or policy change (See Course 5: Creating an Enabling Environment for Young Children and their Caregivers for more information on policy considerations)

Session 5: Additional Tools for Measuring the Three Levels of Intervention

After completing this session, the learner will be able to: Explain the role that developmental milestones play in monitoring childs status

List and describe at least three other developmental assessments used to monitor child status

Other Developmental Assessments Used to Monitor Child Well-Being

Developmental milestones play an important role in monitoring childs well-being as they represent a cornerstone of measurement for progress in outcome towards improved child health and development. Formal assessment using the Centers for Disease Control and Prevention's developmental milestone chart is useful to determining whether a child is on track or whether intervention may be needed. In addition, a number of different organizations, agencies, and academic institutions have developed tools and resources to help in the assessment, monitoring, and evaluation processes. Many of the leading tools are represented below for reference. It is important to note that most of these tools focus on various aspects of ECD with all contributing to child well-being. In addition to the Comprehensive Checklist, some of these assessments include: PEPFAR OVC Program Evaluation Tool Kit Child Status Index (CSI) Examining Early Child Development in Low-Income Countries: A Toolkit for the assessment of children in the first five years of life The Parenting Map Early Childhood Program Evaluations: A Decision-Makers Guide Ages and Stages Questionnaire, Third Edition (ASQ-3) Malawi Development Assessment Tool (MDAT)

PEPFAR OVC Program Evaluation Tool Kit

Developed by MEASURE Evaluation, supported by PEPFAR, the OVC Program Evaluation Tool Kit is a quantitative child outcomes and caregiver/household outcomes measurement tools that can be used for global application. It consists of three questionnaires: Caregiver Questionnaire Child Questionnaire Ages 0-9 years old Child Questionnaire Ages 10-17 years old The purpose of the tools is to: Enable and standardize the production of population-level child and caregiver well-being data beyond what is available from routine surveys; Produce actionable data to inform programs and enable mid-course corrections; and Enable comparative assessments of child and caregiver well-being and household economic status across a diverse set of interventions and geographical regions.

Child Status Index (CSI)

Developed by MEASURE Evaluation and Duke University with PEPFAR and USAID support, the Child Status Index (CSI) is based on six domains with 12 measurable goals related to the six core services that, taken together, approximate a standard for overall child health and well-being. The CSI enables community care workers to gather information in the following areas: Food and nutrition Shelter and care Protection Health Psychosocial Education The index includes a four-point scale for each goal so that the childs well-being can be assessed as good, fair, bad, or very bad. The CSI is a tool that can be helpful in assessing and tracking priority services a vulnerable child needs. The tool could be used for initial assessment and follow-up monitoring of child well-being. It focuses on essential actions and is flexible enough that users can adapt criteria to the local context. For example, data from the CSI and community mapping of services can be used together to inform coordination of care. A pictorial version of the index facilitates use with illiterate care providers.

World Bank Toolkit for Assessment of Children in First Five Years of Live
Developed by the World Bank, the Examining Early Child Development in Low-Income Countries: A Toolkit for the assessment of children in the first five years of life is a resource for researchers from various disciplines interested in planning and evaluating programs or interventions aimed at improving the health and development of infants and young children. The toolkit aims to: Provide an overview of issues affecting early development and its measurement; Discuss the types of tests typically used with children under five years; Provide guidelines for selecting and adapting tests for use in developing countries; and Make recommendations for planning successful assessment strategies. The toolkit focuses on children who have not yet entered school, and are thus under six years old. Skills assessed through this tool are: Cognitive skills Executive function Language Skills Social/emotional

The Parenting Map

The Parenting Map, developed by Project HOPE, is a low-literacy data collection tool intended to provide caregivers with a quick but comprehensive snapshot of each childs well-being in the household.

Because of the tool's user friendliness, acceptability, and ability to function at multiple levels, the Parenting Map is easily used after a project ends: Caregivers learn how to assess their child's well-being and have markers by which to gauge progress. Community volunteers and home visitors can continue to use the supplemental tools of the Parenting Map as a focal point to provide education, make referrals, and guide their advice to families. A database of child data can be aggregated at any level to leverage additional resources. Results can be tabulated by hand at the community level (computers not mandatory).

Early Childhood Program Evaluations: A Decision-Makers Guide

The Early Childhood Program Evaluations: A Decision-Makers Guide was developed to help prepare decisionmakers to be better consumers of evaluation information since the interpretation of program evaluation research is so often highly politicized. This guide is organized around five key questions that address both the substance and the practical utility of rigorous evaluation research. 1. Is the evaluation design strong enough to produce trustworthy evidence? 2. What program services were actually received by participating children and families and the comparison groups? 3. How much impact did the program have? 4. Do the program's benefits exceed its costs? 5. How similar are the programs, children, and families in the study to those in your constituency or community? The principles discussed in the guide are relevant and applicable to the evaluation of programs for individuals of any age, but the examples provided specifically focus on early childhood.

Ages and Stages Questionnaire, Third Edition (ASQ-3)

The Ages and Stages Questionnaire, Third Edition (ASQ-3) is an assessment tool that helps parents provide information about the developmental status of their child young child across five developmental areas: Communication Gross motor Fine motor Problem solving Personal-social The tool can be administered electronically or through paper and pencil. It is written at a 4th-6th grade reading level, and has pictures to make it easier for parents to understand . Completing the questionnaire takes about 10-15 minutes, and involves parents observing the behavior of their children. Scoring takes about 23 minutes and can be conducted by professionals, paraprofessionals, or program staff. ASQ-3, which includes 21 questionnaires, covers 1 month through 5 1/2 years of age.

Malawi Development Assessment Tool (MDAT)

The Malawi Development Assessment Tool (MDAT) is one of few validated tools used in an African context and currently being used in the World Banks randomized control trial in Malawi. The assessment is divided into a series of questions on the following domains: Gross motor Fine motor Language/hearing Social For more on the evaluation of this tool, see Gladstone et al. 2010.

Conclusion
Upon completion of this course, you should now have an understanding of the Essential Package's M&E framework and an overview of how to monitor the three levels of intervention . As you construct results frameworks and logic models for your own programs, focus on incorporating relevant indicators to capture activities associated with the EP Building Blocks and the three levels of intervention. After you start implementation of your program, make sure to institutionalize the ongoing capturing of monitoring data and producing evidence of achieved results through evaluation . Through reflection and learning, you can make critical program improvements and share your M&E data and findings with other stakeholders as part of larger advocacy and policy change efforts.