# Pathways to scale up integrated early childhood development programs

> **NIH NIH K99** · YALE UNIVERSITY · 2020 · $123,242

## Abstract

PROJECT SUMMARY/ABSTRACT
The impact of poverty on child development is a critical public health issue. Nearly 1 billion children live below
the poverty line worldwide. The early years of a child's life form the foundation for all later development.
Investments in Integrated Early Childhood Development (ECD) programs are critical for breaking the
intergenerational poverty cycle. Evidence is still lacking on how to implement and integrate ECD interventions
in poverty setting where many competing priorities are in place. Specifically, it is unknown which pathways
drive the implementation of ECD programs and whether integrating ECD program components into an existing
national program targeting impoverished children can improve development outcomes. Recently, Brazil rolled
out the Criança Feliz ECD program in response to the 2016 Brazilian National ECD legal framework This
program focuses primarily on fostering nurturing care parenting skills to buffer the negative effects of poverty
on children under 3 years and their families enrolled in Bolsa Família, the largest conditional cash transfer
(CCT) program in the world. The Brazilian ECD and CCT programs lack integration. Filling in this gap is vital
to improving ECD policies and initiatives embedded within existing programs targeting the most vulnerable
children. This implementation science project takes a systems approach to achieve two goals: 1) identify
pathways of implementation and bottlenecks of Criança Feliz, and 2) help optimize the impact of Bolsa
Família on ECD outcomes through the integration of Criança Feliz with the food security components of the
program. This project will use a mixed-methods approach grounded within a novel complex adaptive
framework previously used for understanding the scaling up of breastfeeding and ECD programs in diverse
countries but not in Brazil. Analyses will be based on the Program Impact Pathways process evaluation and a
program optimization computational modelling approach informed by context and program specific data.
Findings will be widely disseminated among decision makers in Brazil in conjunction with a policymaker
toolbox to empower them to continue applying the optimization methodology in the future to continue
improving ECD outcomes through Bolsa Família. Findings have great potential to be translated to other CCT
programs worldwide. This proposal fits well with the candidate's long-term research interest to become an
implementation science researcher in the field of ECD, specifically in program and policy evaluation. The
completion of this project will provide data for a subsequent R01 grant application examining the impact of the
optimized cost-effectiveness integration of food security and ECD programs to improve ECD outcomes under
real-world conditions. Through this project the candidate will receive training in implementation science
methods, health economics and ECD and will be able to transition to an independent academic position.

## Key facts

- **NIH application ID:** 9856504
- **Project number:** 5K99HD097301-02
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Gabriela Buccini
- **Activity code:** K99 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $123,242
- **Award type:** 5
- **Project period:** 2019-02-01 → 2021-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9856504

## Citation

> US National Institutes of Health, RePORTER application 9856504, Pathways to scale up integrated early childhood development programs (5K99HD097301-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9856504. Licensed CC0.

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