Child:

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Case Report
care, health and development
doi:10.1111/cch.12544

Care for Child Development: an intervention in

support of responsive caregiving and early child
development
J. E. Lucas,* L. M. Richter† and B. Daelmans‡
*Independent Consultant
†DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa, and
‡Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
Accepted for publication 13 November 2017

Keywords
Care for Child
Development, early child
development,
intervention, nurturing
care, parenting support,
responsive caregiving
Correspondence: Dr Jane
E. Lucas, Social Psycholo-
gist, Consultant in Inter-
national Health and Child
Development, 115 Fourth
Avenue, New York, NY
10003, USA
E-mail:
janeelucas@gmail.com
Abstract
Background An estimated 43% of children younger than 5 years of age are at elevated risk of
failing to achieve their human potential. In response, the World Health Organization and UNICEF
developed Care for Child Development (CCD), based on the science of child development, to
improve sensitive and responsive caregiving and promote the psychosocial development of young
children.
Methods In 2015, the World Health Organization and UNICEF identified sites where CCD has been
implemented and sustained. The sites were surveyed, and responses were followed up by phone
interviews. Project reports provided information on additional sites, and a review of published
studies was undertaken to document the effectiveness of CCD for improving child and family
outcomes, as well as its feasibility for implementation in resource-constrained communities.
Results The inventory found that CCD had been integrated into existing services in diverse sectors
in 19 countries and 23 sites, including child survival, health, nutrition, infant day care, early
education, family and child protection and services for children with disabilities. Published and
unpublished evaluations have found that CCD interventions can improve child development,
growth and health, as well as responsive caregiving. It has also been reported to reduce maternal
depression, a known risk factor for poor pregnancy outcomes and poor child health, growth and
development. Although CCD has expanded beyond initial implementation sites, only three countries
reported having national policy support for integrating CCD into health or other services.
Conclusions Strong interest exists in many countries to move beyond child survival to protect and
support optimal child development. The United Nations Sustainable Development Goals depend on
children realizing their potential to build healthy and emotionally, cognitively and socially
competent future generations. More studies are needed to guide the integration of the CCD
approach under different conditions. Nevertheless, the time is right to provide for the scale-up of
CCD as part of services for families and children.

children younger than 5 years of age are at elevated risk of not

Introduction
realizing their human potential because they are undernour-
Since 1990, child mortality has declined by almost 53% (WHO ished or live in extreme poverty (Black et al. 2017; Daelmans
2015). Among the survivors, however, an estimated 43% of et al. 2015).

© 2017 The Authors. Child: Care, Health and Development Published by John Wiley & Sons Ltd 41
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any
medium, provided the original work is properly cited and is not used for commercial purposes.
42 J.E. Lucas et al.
From birth, an infant learns through contingent, enjoyable
interactions with adults (Goldstein 1994). Inadequate nutri-
tion and frequent illness contribute to stunted growth, and
growing up in an unstable environment further limits
cognitive and social potential. The seminal work of
Grantham-McGregor et al. (1991) in Jamaica encouraged play
and other learning activities for growth-stunted children, age
9–24 months. These children had poorer cognitive and
performance skills compared with non-stunted children of
the same age. Weekly sessions for 2 years, conducted by
trained home visitors, improved their psychosocial develop-
ment. Children at age 24 months who had received both
stimulation and nutrition supplementation very closely
approximated the developmental capacities of non-stunted
children (Grantham-McGregor et al. 1991). Follow-up studies
showed that, at age 22 years, children who received
stimulation alone or with nutrition supplementation, com-
pared with controls, had higher IQ scores (Wechsler Adult
Intelligence Scale), attained higher grades and had better
general knowledge, fewer symptoms of depression and less
involvement in violent behaviour (Walker et al. 2011). They
were more likely to have jobs and had 25% higher earnings
than controls, and they had caught up to the earnings of their
non-stunted peers (Gertler et al. 2014).
For many children, opportunities for learning at home are
limited (UNICEF 2012), and many schools in resource-poor
areas do little to compensate for inadequate early stimulation.
Many already vulnerable young children are profoundly
affected also by the poor mental and physical well-being of
their parents and other caregivers, who may have difficulty
responding to a young child’s needs in sensitive and responsive
ways. For example, depressed mothers are less able to provide
responsive parenting, and some of their children exhibit
delayed development early in infancy, posing a risk for poor
neurological development (Holt & Mikati 2011), poor infant
growth, common childhood illness (Cozolino 2006; Rahman
et al. 2004; Surkan et al. 2011) and delayed language
development (Baydar et al. 2014). A child’s condition may
also contribute to ineffective caregiver responsiveness
(Sameroff & Fiese 2000); for example, a very low birthweight
child may be too weak to project clear signs of hunger.
Children with disabilities may also present confusing cues
about their physical needs, affection and learning. Conse-
quently, parents may need assistance to recognize and interpret
the behaviour of children with special needs for attention and
care.
Building on the child survival agenda, the World Health
Organization (WHO) and UNICEF developed Care for Child
© 2017 The Authors. Child: Care, Health and Development Published by John Wiley & Sons Ltd, Child: care, health and development, 44, 1, 41--49
Development (CCD) to promote the psychosocial develop-
ment of young children (WHO & UNICEF 2012). Evidence of
the importance of integrating nutrition and stimulation, as well
as how children learn through play and communication with a
caring, responsive adult, contributed to its design (Pelto et al.
1999; Richter 2004). This paper describes CCD and its history,
its theoretical and empirical background, examples of its
application, evidence of its effectiveness and its potential for
future expansion.
The intervention
Care for Child Development provides guidance to help
caregivers build stronger relationships with young children
and solve challenges in providing nurturing care. CCD
encourages responsive caregiving in building relationships
between caregivers and children (Ainsworth et al. 1974). This
includes sensitivity to children’s movements, sounds and
gestures and interpreting and responding appropriately to
them. Responsive caregiving is the basis for protecting children
against injury, recognizing and responding to illness, enriching
learning and building trust and social relationships. The
concept has been applied also to ‘responsive feeding’ (Black &
Aboud 2011), especially important for effective feeding of low
weight or ill infants.
In applying CCD, counsellors ask caregivers how they play
and communicate with their children, how they get their
children to smile and how they think their children are
learning. The counselling aims to increase the time parents
spend with their children and improve the quality of
interactions that affect learning and health. The counsellor
observes how the caregiver responds, comforts, shows love and
guides the child’s exploration. The counsellor uses the
information to praise the caregiver, build the caregiver’s
confidence, increase child-directed language and identify
enjoyable activities that the caregiver and child can do together
at home. Central to the intervention is a set of age-appropriate
and developmentally appropriate recommendations on play
and communication that guide counsellors in helping
caregivers interact with their children. The activities promote
strong emotional bonds between caregivers and children,
enabling families to stimulate motor, cognitive, social and
emotional learning of children (Fig. 1). Playing with common
household items (e.g. tin cups, empty containers and cooking
pots) can help a child learn, and even a busy caregiver can be
given the motivation and confidence to talk with a child during
feeding, bathing and other routine household tasks.

Based on methods for behaviour change (Aboud &Akhter
2011), caregivers practice these activities with their children
during the counselling session to gain confidence and
encourage changes in their parenting behaviours. Caregivers
may receive counselling individually during home visits or
clinic consultations, or during parent, nutrition education or
other group sessions. Sensitive and responsive caregiver
capacities are encouraged and reinforced, and they are linked
to recognizing signs of hunger and being alert to indications of
a child being sick, in discomfort or in danger. In this way, these
basic interactional skills contribute to the healthy growth and
survival of young children, as well as to their physical,
intellectual, language and emotional development. Supporting
the implementation of the CCD intervention are a counselling
card, training manual and videos, facilitator guides for
classroom activities and hands-on practice, presentations on
its technical background and tools for monitoring and
evaluation.
Providers in a range of sectors – health, education, nutrition,
child care, emergencies, child and social protection and other
family services – can learn the CCD counselling approach
through an interactive course. Training includes hands-on
Figure 1. Care for Child Development: recommendations for play and communication activities. [Colour figure can be viewed at wileyonlinelibrary.com]
© 2017 The Authors. Child: Care, Health and Development Published by John Wiley & Sons Ltd, Child: care, health and development, 44, 1, 41--49
Care for Child Development 43
practice in coaching caregivers interacting with their children.
The duration of training and follow-up supervision depends
on the prior training of providers, the delivery settings and the
capacity of the system. For example, most pre-service
education of professionals and community workers allows
extended training and close supervision during practical
sessions. These supports are more limited during in-service
and on-the-job training. The delivery settings also determine
the number and duration of counselling sessions. During sick
child clinic visits, the health worker might counsel the
caregiver and child for only 5–10 min of the consultation
once or, with follow-up, twice. Integrating CCD into home
visits, parent groups, child care centres and nutrition
rehabilitation programmes can sustain longer and more
frequent contacts.
History
The roots of CCD are in the WHO and UNICEF strategy
Integrated Management of Childhood Illness (IMCI), a
syndromic approach designed to address the common causes
44 J.E. Lucas et al.

of childhood mortality in low-income and middle-income
countries (Bryce et al. 2004). There was concern that focusing
only on survival would fail to meet the needs of the majority of
children who survived but who had limited opportunities to
develop their capacities. To address this, WHO commissioned
a review of effective nutrition and early childhood develop-
ment interventions (Pelto et al. 1999). It concluded that the
most effective and sustainable child development interventions
a) occurred early in the child’s life, b) involved parents, c)
focused on children with the greatest need, and d) were
delivered through muliple channels and combined with other
services.
Based on the review, the first version of CCD was
implemented in 2002 through an adaptation of the IMCI
module for counselling caregivers on child nutrition. The
second version, launched in 2012, separated the intervention
from its dependence on the IMCI sick child visit. This opened
options for delivery though other family services and allowed
for an increased frequency of contacts through well-baby
clinics, home visits, parent groups and other settings. In 2014,
WHO and UNICEF produced a module specifically for
community health workers who provide integrated nutrition,
health and preventive services for young children (WHO &
UNICEF 2014). Care for the Child’s Healthy Growth and
Development integrates CCD into scheduled home visits to
engage parents in talking and playing with their young
children, as well as meeting their children’s basic health needs
(Table 1).
Methods
An inventory was compiled to ascertain where and how CCD is
being implemented and to identify modes of delivery. Requests
to locate possible implementation sites were sent to WHO and
UNICEF staff and training consultants. Online searches for
‘Care for Child Development’ using Google, Google Scholar and
MedlinePlus found no additional sites. Questionnaires designed
to populate the inventory were sent to the 30 identified sites.

Table 1. Three versions of Care for Child Development

Caring for the Child’s Healthy

Care for Development Care for Child Development Growth and Development
Description (version 1) (version 2) (version 3)

Year launched 2002 2012 2014

Content Counselling the caregiver on play and Counselling the caregiver on play and
communication activities to promote communication for children up to
child development for children up to 5 years old to
5 years of age ● promote child development
● strengthen caregiver sensitivity and
responsiveness in interactions with
the child
Delivery system Health and nutrition clinic service Multiple entry points, including
health, education, nutrition, day care,
child protection, emergency and cash
transfer systems
Providers Health workers (doctors and nurses) Health workers (doctors and nurses),
pre-school and day care workers,
social workers
Integration with Newborn care, sick child consultations Maternity services, sick child and well-
other services in clinics baby clinics, family services for
children with disabilities, mother–
child groups, nutrition rehabilitation
clinics, home visits for families at risk
Intensity (contacts One consultation plus follow-up, 5– Determined by delivery system
with family 10 min of a sick child consultation
by design)
Integrated counselling on play and
communication with counselling to
improve child health, growth and
development, with an emphasis on
children up to 3 years old, including
● breastfeeding and complementary
feeding
● recognition of signs of illness
● response to illness
● prevention of illness and injury
Home health visits
Community health workers
Home visiting for newborn and young
child health care
● Three visits (child age up to
2 months, age 3 to 4 months and age
4 months)
● Up to an additional four contacts,
based on other prevention or
treatment contacts

© 2017 The Authors. Child: Care, Health and Development Published by John Wiley & Sons Ltd, Child: care, health and development, 44, 1, 41--49

There was no response to four requests. All completed forms
were followed by a phone interview. Three sites had not yet
implemented CCD. Published literature and project reports
were reviewed for six sites where key implementers were no
longer available. Data from 23 sites in 19 countries were
included in the database. For each site, the questionnaire
identified when and how CCD was introduced, the sectors
involved, the service providers and their training, the setting and
the type of expansion after initial implementation.
Results
Implementation
Care for Child Development has been integrated within a range
of existing government and non-governmental services, and 20
of the 23 implementation sites are sustained to the present time.
These services include child survival and health (Botswana,
India, Kazakhstan, Kenya, Kyrgyzstan, Mozambique, Pakistan
and Tajikistan); nutrition rehabilitation (Mali and India); infant
care and early education (Kenya and Brazil); services to families
with developmentally disabled children (India and Turkey); and
a conditional cash transfer programme (Brazil). In no place was
a new category of worker created specifically to deliver CCD.
Instead, providers working with families were trained in CCD to
promote the child’s development and build caregiving skills
through the services they already deliver. Examples include
community health workers (Botswana, India and Pakistan),
social workers and day care workers (Brazil) and paediatricians
and others working with children with developmental disabil-
ities (India and Turkey). Thus, where implemented, the CCD
approach has been fully integrated into existing services as a way
to strengthen the skills of persons who work with families with
young children.
In the Haryana and Maharashtra states in India, for
example, the child development component of the services of
Anganwadi workers has been strengthened, with structured
activities on play and communication introduced during
mothers’ group meetings and home visits (J. Lucas, 2014,
unpublished). Paediatricians apply the CCD counselling tools
in 11 referral centres across Turkey for families with children
with developmental disabilities (Ertem et al. 2006; I. Ertem,
2015, pers. comm.). They engage families in more positive
interactions with their children and helping children learn. In
Australia, CCD was introduced through child protection
services in remote Aboriginal communities to help address
the consequences of broken intergenerational families and
prevent violence and child abuse (M. Looney, 2015, pers.
© 2017 The Authors. Child: Care, Health and Development Published by John Wiley & Sons Ltd, Child: care, health and development, 44, 1, 41--49
Care for Child Development 45
comm.). An effort to apply CCD in Uganda, begun in 2015, is
bringing together health, early childhood education and family
protection services by training professional and community
workers across ministries to add greater support for child
development (J. Nsungwa-Sabiiti, 2015, pers. comm.).
In 2005, doctors, nurses and feldshers (medical officers)
were trained in CCD in Kazakhstan, Kyrgyzstan and Tajikistan
to strengthen services for newborns and young children. Clinic
nurses conduct weekly home visits during the child’s first
month or two after birth and monthly up to age 2 years, to
monitor the infant’s health and advise families on child
nutrition and preventive care. Six years after the introduction
of CCD in these countries, Engle (2011) observed and
interviewed health providers and found that CCD was well-
integrated, although under different names, in the training of
visiting nurses and clinic doctors. In Kazakhstan, for example,
almost all health workers interviewed reported that they had
received training to counsel parents on play and communica-
tion activities. Engle found that children had improved levels
of development, particularly in language, gross motor and
social development skills.
The questionnaires revealed that core training materials
(counselling cards, participant manual, and facilitator notes)
have been translated from English to 17 languages or dialects:
Armenian, Mandarin Chinese, Chichewa (Malawi), Farsi (Iran),
French (West Africa), Hindi (India), Kinyarwanda (Rwanda),
Kiswahili (Zanzibar), Lugandan (Uganda), Mahrati (India),
Portuguese (Brazil and Mozambique dialects), Russian, Sindh
(Pakistan), Spanish, Tajiki (Tajikistan) and Turkish. These
translations, with the adaptation to fit different cultures and
delivery systems, support the continuing application of the CCD
approach to new countries and language groups.
WHO and UNICEF, the agencies that developed CCD, have
been able to provide only limited financial support for
implementation, and neither has been able to maintain a
central reporting system. For this reason, the 2015 inventory
may have missed additional countries in which CCD was being
implemented. Other complexities in developing a complete
picture are that different forms of implementation arise from
the three CCD versions and subsequent adaptations, CCD is
integrated within a variety of services and its ownership lies in
different organizations.
Evaluation
Early field tests focused on the process of delivering the
intervention and its feasibility. In 1999, a trial in Brazil found
that health workers could use the counselling tools, adding an
46 J.E. Lucas et al.

average of only 7 min to the sick child consultation (I. dos
Santos et al., 1999, unpublished). After one session, caregivers
could recall and implement the recommendations at home. In
2001, a second evaluation in 14 community health centres in
South Africa, where IMCI was being introduced, confirmed
that trained nurses could learn the counselling tasks, and
counselling on CCD did not detract from caring for the sick
child. Instead, communication skills were enhanced for key
IMCI tasks, such as interviewing the caregiver on signs of child
illness and providing instructions on giving medicine (M.
Chopra, 2001, unpublished).
Three published studies have examined the effectiveness and
cost of CCD (Table 2). An efficacy study in China looked at
children in families who had received two counselling sessions
within 6 months from their health providers (Jin et al. 2007).
These children had higher development quotient scores,
compared with children in the control group. More responsive
and consistent caregiving, identified through self-reports on
questionnaires, was related to better child development
outcomes. Furthermore, the intervention was found to be
understandable and acceptable to families.
A case-controlled efficacy study in Turkey examined the
influence on family practices of counselling during a sick child
visit by paediatricians before and after they had received
training on CCD (Ertem et al., 2006). The communication
skills of paediatricians in assessing and treating sick children
were improved. Home visits 1 month later found improved
family practices, including increased time spent reading to
children and more toys and other learning opportunities in the
home. The study concluded that, even in a short time during a
sick child visit, a physician could influence home practices that
support a young child’s development.

Table 2. Effectiveness and cost of CCD

CCD in a sick child visit CCD in the clinic PEDS

Study characteristics (Ertem et al., 2006) (Jin et al. 2007). (Yousafzai et al. 2014 and 2015)

Country Turkey China Pakistan

Year launched 2004 2006 2009
Design description Sequentially conducted control trial Prospective follow-up study with a Cluster-randomized factorial
comparison group effectiveness trial
Integration with other Health Health Community health and nutrition
services
Providers Paediatricians Health workers Lady Health Workers (community
workers)
Provider education Advanced professional medical Medical training Up to secondary school
training
Setting Acute care clinic Clinic and home visit Mothers’ group meetings and home
visits
Participants receiving 120 children age 2 years or younger, 50 children and their mothers 757 children age 2 months,
CCD intervention and their caregivers continuing to 24 months and their
mothers
Intensity (contacts with One consultation visit, with a follow- One consultation with a follow-up One mothers’ group meeting plus one
family by design) up visit 1 week later visit within 6 months home visit per month for 2 years
Main results with Improved stimulation provided to ● Higher measures of child ● Higher measures of child
CCD (compared with child in the home (at 1 month after development on cognitive, social and development on cognitive, language
control group) first visit): linguistic scales. and motor scales at age 12 and
● Caregiver tried new play activity ● Children of more responsive 24 months.
with child. mothers (self-reported) had highest ● Higher measures of socio-emotional
● Others tried new activity with child. developmental scores. scale at age 12 months.
● Homes had more toys available and ● Counselling card is feasible and ● Other results include improved
homemade toys. acceptable for use by mothers. parent responsiveness and reduced
● Caregiver read to child. symptoms of maternal depression.
Potential for scale-up CCD was integrated in the services of Courses in CCD are now conducted in Discussions continue. Potential is high
the Child Development Centre of the national training centre. as the study was implemented within
Ankara University Medical School and the existing local Lady Health Worker
now is in 11 referral centres located service and could be a model for
throughout Turkey, serving almost other localities in Pakistan.
14 000 children with disabilities and
their families each year.

CCD, Care for Child Development; PEDS, Pakistan Early Child Development Scale-Up.

© 2017 The Authors. Child: Care, Health and Development Published by John Wiley & Sons Ltd, Child: care, health and development, 44, 1, 41--49

In Pakistan, a cluster-randomized study on the effectiveness
and cost of delivering CCD counselling was conducted by
following 1411 mother–child dyads over 3 years (Yousafzai
et al. 2014; Yousafzai et al. 2015). The intervention, delivered
during monthly home visits and in mother groups by Lady
Health Workers, improved parenting practices, including
family time with children in learning and language use,
positive caregiver–child interactions, greater availability of
learning materials in the home and reduced harsh punishment.
The incidence of childhood illness (diarrhoea, acute respiratory
illness and fever) was lower. Children in the CCD group had
higher cognitive, language and motor scores at 24 months.
Furthermore, depression was reduced among participating
mothers. The Pakistan study demonstrated that the CCD
intervention could be implemented on a large scale by existing
community health providers and at relatively low cost
compared with other interventions (Gowani et al. 2014).
However, the study also found that higher quality training and
more regular (at least monthly) supervision were needed to
strengthen the existing system.
Discussion
Interest in finding a way to strengthen support for child
development has led to the implementation of CCD in at least
23 sites. This analysis shows that there is not only a clear need,
there is also strong interest in expanding the public health
agenda for children, moving beyond survival to protect and
support optimal development. The opportunity and imperative
have been well recognized in the Global Strategy for Women’s,
Children’s and Adolescents’ Health, launched by United
Nations Secretary General Ban Ki-moon in 2015 in support
of the Sustainable Development Goals (United Nations, EWEC
2015). The Global Strategy is built around three objectives:
survive, thrive and transform. It provides a roadmap for
achieving ambitious targets towards a convergence for health
and development within a generation (Jamison et al. 2013).
The three published evaluations conducted in different
delivery systems and geographical regions, although limited,
are confirmed by the experiences reported in the inventory.
Using CCD, providers across health, nutrition, education, early
child development and child and social protection can provide
greater support for child development within their services.
Because the earliest years in a child’s life are the most
formative, however, integrating CCD into health services that
span from conception through pregnancy, childbirth and early
childhood is an opportunity that should not be missed (Lake &
Chen 2015). For example, the Pakistan study demonstrated
© 2017 The Authors. Child: Care, Health and Development Published by John Wiley & Sons Ltd, Child: care, health and development, 44, 1, 41--49
Care for Child Development 47
that CCD could be implemented within a publicly funded,
cost-effective community health programme. National, or even
regional, scale-up, however, will require changes in govern-
ment policies, including in pre-service training. In Kazakhstan,
for example, national policies brought CCD into the Better
Parenting programme of the Ministry of Health. It became
sustainable because it was institutionalized as part of the
required package of health services for mothers and children
and in the pre-service training of providers. Going to scale,
therefore, requires government support of existing services,
ready to be engaged in a greater role in early child development
and responsive parenting.
Policymakers are recognizing the accumulating evidence for
expanding the survival agenda to include greater support for
child development. Even with political will to adopt the
intervention, however, the challenges for CCD are those
encountered in other attempts to scale-up programmes.
Introducing the intervention imposes burdens on existing
systems where resources are already stretched for training,
supervision and the provision of direct services. Expansion
beyond research and demonstration sites requires support for
monitoring and maintaining quality, which is seldom adequate
once initial support is withdrawn. The generic CCD interven-
tion must be adapted to fit the delivery system and its
providers, as well as to be culturally sensitive for the families it
serves. Finally, although the costs have been demonstrated to
be lower than for other family services, implementing an
intensive, effective intervention requires a commitment
sufficient to see the desired return on the investment of
human and financial resources.
Conclusions
The Sustainable Development Goals demand that children
should be helped to realize their developmental potential,
because achieving multiple goals is contingent upon building a
healthy and emotionally, cognitive and socially competent next
generation. CCD supports caregivers in responding to this call,
and it was recognized as cost-effective and feasible in the 2017
Lancet series, Advancing Early Child Development: From Science
to Scale. Now is the time for national policymakers and the
global community to act and enable the scale-up of CCD as
part of integrated services for families and children.
Funding
This study was supported by the Conrad N. Hilton Foundation
through the US Fund for UNICEF.
48 J.E. Lucas et al.
Key messages
• Strong interest exists in many countries and in the global
community to move beyond child survival to protect and
support optimal child development, especially urgent for
43% of children less than 5 years old at risk of failing to
achieve their potential.
• The evidence-based intervention Care for Child
Development (CCD) is effective in improving
responsive caregiving practices and child health and
development outcomes, as well as being feasible to
implement at relatively low cost.
• Community-based workers and professionals in 19
countries – across health, nutrition, education, early
child development and child and social protection sectors
– have been able to use the CCD counselling approach to
provide support for child development.
• The political commitment to the Sustainable
Development Goals and the Global Strategy for
Women’s, Children’s and Adolescents’ Health has
created a facilitating environment for the scale-up of
CCD as part of services for families and children.
Acknowledgement
Gratitude goes to Sarah E. Borden, MPH, for creating the
database for the inventory on Care for Child Development.
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