It is an honor to participate in an issue of Pediatrics that celebrates the work of Sally Grantham-McGregor. Her collaboration with scholars at the University of the West Indies has produced a prototype low-cost, but highly effective, home-visiting program successfully replicated at scale that has been widely emulated around the world.1 Jamaica Reach Up is not only an effective tool for child development, but it also offers insight into the sources of successful child development.
Since the beginning of human civilization, we have known the importance of the early years in shaping the mind and character of a child. Religious and social movements of all kinds have long emphasized the importance of the early years in shaping adult lives. For example, Saint Ignatius of Loyola wrote,
“Give Me a Child Till He is 7 Years Old and I Will Show You the Man”
Plato’s Republic proposed that children be placed in orphanages that treated all children alike to eliminate the powerful impact of the family in producing unequal life outcomes. Although versions of such policies, including those of the kibbutzim, were later tried with disastrous consequences, Plato was correct in emphasizing the powerful role of families in shaping the lives of children.
The insight of the ancients is now widely accepted. What is remarkable is that, for many years, under the influence of “professional educators,” this insight was ignored. Emphasis moved from families to schools, possibly because families were assumed to be functioning properly. Although there is now agreement on the importance of the early years, there is much less agreement on what should be done with this knowledge. A plethora of programs devised by numerous well-meaning advocates targets the young. The range of suggested approaches to child development is now staggering.2,3
“Clearing houses” compile lists of programs that “work” without any clear guiding analytical principles in determining program effectiveness except short-term evaluations based on psychological measures. The sheer volume of choices, and the active competition among franchise-promoting advocates, is off-putting to legislators and laymen alike seeking knowledge about best practice in early child development. On top of this is the very limited body of legitimate long-run evaluations of the various offered programs. Added to this is the dogmatism in methodology, in which randomized control trials are pronounced to be a “gold standard,” despite the fact that compromises in them are legion and follow-ups from them are often very limited and sometimes misleading.4
In addition, early childhood programs are viewed by many as versions of classrooms for the young. There are long discussions about classroom “requirements.” This approach is largely center-based with family usually placed in the background. The mentality of this approach is to find the “best program” on the shelf and implement it, and not to discover the mechanisms that promote child development that can be adapted to local circumstances and individual children. Features of programs, like educational qualifications of instructors, the quality of facilities, cleanliness of environments, and center-based activity, are the preoccupation of the what works crowd. The central role of the family in child development is often neglected, as are the basic practices of parenting that successful families provide.
Amid the chaos of this literature, Jamaica Reach Up and Learn stands out as a beacon. It recognizes the central role of the family and especially the mother (or caretaker) in shaping the life of the child. It recognizes that the mother is actively engaged in the life of the child and that warm, encouraging mother–child attachment and engagement are central to fostering successful lives. It builds on the knowledge that many mothers are not aware of how best to interact with their children.5,6 Successful mother–child interactions are not created in classrooms. They cannot be routinized into a rigid curriculum. Jamaica Reach Up is a supplement to home life and not a substitute for it, and it places the family front and center in fostering child development. While there are other parenting programs, it is the most flexible and adaptable to disadvantaged environments. Many programs developed in North America, such as the Nurse Family Partnership program and Parents as Teachers, are claimed to be effective, but are much less flexible and adaptable than Reach Up, which focuses on essential elements of parenting.
Unlike many early childhood programs, the long-run beneficial impacts of Jamaica Reach Up have been documented.7,8 A 1-hour-per-week visit with parents explaining how best to scaffold children in a 1-to-1 mothering relationship unleashes the power of parenting and leads to powerful results on child development. The evidence on Jamaica Reach Up and Learn is entirely consistent with the independent research on Preparing for Life.9
Home visitors need not be highly educated or holders of credentials or degrees from education schools, although they are trained by supervisors who often are. This feature makes Jamaica Reach Up suitable for application to less-developed environments and explains its widespread appeal. Jamaica Reach Up gets down to bare bones essentials in fostering child skills and is not trapped in the rituals of “best classroom practice,” often arrived at through consensus among like-minded education school graduates and very often not based on sound evidence.
Jamaica Reach Up is not only a fundamental addition to the policy toolkit, it is also a contribution to basic science. Like Marie Curie who isolated radium from pitchblende, Sally Grantham-McGregor and her team have isolated the successful ingredient in activities that promote child development. In work in press with Jorge Luis García (2022), we complement this research by showing that, in successful, better-known North American early childhood programs, parental engagement with the child always increased, although not always by design. By demonstrating the power of maternal engagement and early stimulation, Jamaica Reach Up contributes greatly to the science of child development. It illuminates the mechanisms underlying the treatment effects of successful interventions. It demonstrates the powerful role of the mother figure and home life in creating successful lives (Heckman and Zhou, unpublished data, 2022).
Dr Heckman wrote, reviewed, and revised the manuscript; and the author approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.
The views expressed herein are those of the author alone and do not necessarily reflect the views of the National Bureau of Economic Research or the National Institutes of Health. The author declares that he has no financial or material interests in the results reported in this article.
FUNDING: Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award #R01HD103666.
CONFLICT OF INTEREST DISCLOSURES: The author has indicated he has no conflicts of interest relevant to this article to disclose.