Promoting Brain Building Moments™ Within Community Traditions and Cultural Practices

Written by Amee Barlet, Save the Children Washington Deputy Director
and Rochel White, Early Steps to School Success Early Childhood Coordinator

Early Childhood Coordinator Rochel White sings a traditional Twulshootseed butterfly song during a home visit while a mother engages her child in back-and-forth interactions through drumming.

Save the Children’s Early Steps to School Success (Early Steps) program and Vroom® celebrate parents and caregivers as their child’s first and most important teachers. Vroom, an early learning initiative from the Bezos Family Foundation, empowers parents and caregivers to play a proactive role in their child’s brain development by turning everyday moments into Brain Building Moments®.  

Save the Children has integrated Vroom’s science-based tools and tips into our early learning programs to advance educational outcomes in some of America’s most isolated and low-resourced communities. By celebrating a community’s strengths, cultural traditions and values – Save the Children is able to foster community-wide commitment to early learning while bringing Vroom’s Brain Building Moments™ to cultural celebrations and traditional practices.

In Washington State, we partner with the Quinault Indian Nation to promote healthy childhood development. Rochel White has served as an Early Steps Early Childhood Coordinator since 2017 and has two decades of experience in early learning. She speaks English and Twulshootseed (the language of the Puyallup Tribe and Southern dialect of the greater Lushootseed language) and takes Quinault language classes.

Taholah, where the Quinault people have lived for time immemorial, is the main village of the Quinault Indian Nation. It is an isolated community – with one road in and out – set on the coast at the mouth of the Quinault River. Services are difficult to access, the nearest library is over an hour away, and while there is a Tribal Health Clinic on the reservation, many families must travel for at least an hour for primary care and speciality and support services. There is also a dearth of pediatricians and reproductive health practitioners in the county.

Fish runs through the Quinault River have been low lately due to climate change, hurting families that rely on them for income and subsistence. To make early learning more accessible to more families, Rochel implements Early Steps around the working hours of those involved in the hunting fishing, and shellfish industries, which follow schedules set by the tides. This has led to an increase in enrollment and engagement with the program and the visits. 

Over the past year, Rochel has hosted a series of Vroom events for families with young children throughout the community. At each event, she has shared brain development information and has used the five Brain Building Basics™ to support culturally centred parent child interactions.

At one event, Rochel hosted a button blanket activity. Button blankets are traditionally worn by northwest coastal tribes. The blankets typically feature a family crest and abalone buttons. “The buttons signify your wealth – how much you have to give away and how large your family is, as those were traditional Native American determinants of prosperity,” Rochel explained. Rochel handed out felt squares, traditional shapes and buttons. Parents were encouraged to talk about their families, count buttons in English and Quinault, make patterns and talk about shapes, textures and colors.

Rochel shared, “The buttons had Velcro on the back so families could rearrange their designs. We used felt pieces for the little ones and buttons for children ages 3-5. I showed how it was an opportunity to count with little ones and how families have always used cultural practices to teach their children. I posted the 5 Brain Building Basics and discussed with families how they were able to include these when they are counting, asking their little ones where they want to place their buttons or what crest they wanted, and talking about what button blankets are. Each family took home their button blanket and a copy of the Brain Building Basics sheet. I suggested families hang their blankets up or use them with a baby doll.”

Rochel noted, “One grandparent sat down and counted in Quinault with her grandchildren while they chose their buttons. I was so happy to hear this and told her how much brain building she is supporting by doing that with them. She remarked ‘I don’t often read to them anymore, on account of my bad eyes, but I tell them stories every day.’  We chatted about how much eye contact and facial expressions are utilized in storytelling.”

After the activity, Rochel posted information about the event on Facebook and a parent commented, “I loved the craft! I can’t wait until it’s all dry and the kids can redecorate it over and over.”

The vast majority of the 100 students at Taholah School struggle to meet grade level standards in Math and English Language Arts. The school superintendent reached out to Rochel to plan and implement early childhood activities to build family/school connections and help children feel more comfortable the day they start kindergarten.

During a recent family math night, Rochel planned a shape sorting and pattern activity that incorporated formline – a feature of the indigenous art of the region. One participating family included Leo[1], who was almost 3, his parents and his older sister, a kindergartener. Both parents had consistently read to their son, but now talk to him more and make a point of keeping eye contact, as Rochel had encouraged them to do. “Leo’s mom was one of the first parents to really get involved in the Vroom activities. She consistently asks for more ideas each week and lets me know how Leo liked them, and if he needed more support,” said Rochel. “I see that dad, as well as mom, is engaged in asking questions about growth and development as well as wanting to learn more activities to help support Leo,” says Rochel.

Rochel uses the Early Steps Plan and Play curriculum, elements from the Positive Indian Parenting curriculum and her own creative ideas to enrich her home visits and parent child groups with a cultural focus. Rochel has taught parents to use heirloom cradleboards (traditional padded frames for swaddling babies) to soothe their infants. She has shown parents how drumming and singing songs can be a way to bond and develop language, math and listening skills.

“Rochel has helped us learn how to teach our children in so many ways. When we started the program my husband and I had disagreed on a lot of parenting and learning stuff, but I have become more confident teaching them now,” shared an Early Steps mom.

During the current pandemic, Rochel continues to engage and support the Taholah community in fostering healthy childhood development. Rochel integrated early learning resources and critical hygiene materials into the school’s distribution efforts. She held a book fair while families were picking up laptops for their school-age children. Families arrived at staggered times to collect their laptops and choose from a large selection of recently donated children’s books. The event reached over 50 families, and about 170 children received books. Additionally, Rochel created early learning Boredom Buster resource kits and brought them to families who were staying safe at home.

The connections that Rochel has forged are proof of the impact she has made in the community and her dedication to raising the quality of all programs serving Quinault children. She has developed strong relationships with families as well as other agencies serving them. Rochel is frequently asked to plan an activity, drum, sing or be a storyteller for events at the school and at Early Head Start and Head Start programs.

The Director of Taholah’s Head Start program asked Rochel to join their policy council, providing her with another opportunity to share her expertise on early childhood and her deep knowledge of incorporating culture into routines, curriculum and interactions. Through the Early Steps Book Bag Exchange program, community read-alouds among other endeavors, she is able to mentor other professionals and model best practice. Amee Barlet, Save the Children’s Deputy Director for Washington shares, “I am inspired by Rochel’s approach to relationships, culture and mentoring. I believe Rochel is an early childhood leader creating high quality culturally appropriate learning opportunities for children in the Taholah community. She is an advocate for all children.”


[1] Child’s name has been changed.

Monitoring and Evaluation Plan Key to Basics Uptake and Scaling

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

Written by the BASICS team

BASICS will implement a robust monitoring and evaluation, learning and data use plan designed to be institutionalized and sustained within national and local government health systems.

Data from healthcare facilities in our four demonstration countries (Bangladesh, Cambodia, Nigeria and Tanzania) will be reported to district-level governments through established quality improvement or infection prevention systems, depending on the country context. Information related to infection prevention readiness, staff and patient behavior compliance, cleanliness, supply and antibiotic burn rates and health outcomes will be reported.

The BASICS team will validate the quality of this data through our monitoring systems at representative sentinel facilities.

This data will be aggregated and analyzed to assess infection preparedness, behavior compliance and health improvements.

During the first three years of BASICS’ implementation, we will use this rigorous data to demonstrate significant cost savings, improvements to quality healthcare and improvements in health outcomes for health systems. With this data in hand, we will also advocate for national scale in our demonstration countries and globally.

We will also develop an M&E toolkit that can be leveraged to contextualize and scale-up beyond the initial four countries.

How BASICS Will Adapt to Respond to Unique Cultural Barriers

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

BASICS (Bold Action to Stop Infections in Clinical Settings) will launch in four countries where governments have shown commitment to reducing infection risk. Yet, local cultural, economic and social barriers can pose unique challenges. We have received a number of questions on how we see BASICS adapt and flex to meet unique cultural contexts.


In this video, our staff on the ground share their perspective and experience on how they worked with behavior change interventions to achieve significant promising results in their countries.

To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings), visit savethechildren.org.

How Behavior Change Interventions Can Be a Key to Improving Hygiene in Healthcare

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

Written by the BASICS Team

 The 100&Change competition has challenged us to think critically and creatively about developing a solution that tackles one of the world’s most forgotten problems: healthcare-acquired infections (HAIs). BASICS was designed to catalyze and support transformative changes in how healthcare staff practice good hygiene in order to reach dramatic reductions in HAIs across national heath systems, saving lives, reducing antibiotic use and freeing up much-needed resources.

There are many reasons why following effective hygiene protocols can be difficult for healthcare staff in low-resource settings, such as lack of sanitation infrastructure and clean water and broken supply chains that fail to deliver needed materials. These physical barriers present one set of challenges – changing health workers’ longstanding habits and practices are another.  Overcoming these challenges requires work at all levels, from influencing very personal behaviors to national health policies.

How do we realize such a bold ambition – reducing HAIs by half in four demonstration countries to start, and then scaling to other high-burden countries – when our solution relies on individual and group behavior change in a diversity of settings?

One of our key strategies is to ensure that healthcare staff feel truly invested in the BASICS approach, and are actively engaged in a process that works for their social, cultural and socio-economic reality, and other important factors related to behavioral change.

The BASICS’ framework is grounded in the proven Behavior Centered Design approach. Developed and refined over a decade by scientists at the London School of Hygiene and Tropical Medicine, it combines evolutionary and environmental psychology with the best marketing practices to create imaginative and provocative behavior change interventions.

Once BASICS launches, we will begin with in-depth formative research, which consists of participatory methods inspired by anthropology, psychology and other behavioral and social sciences. This will help us understand the individual, social, and cultural drivers of the infection prevention control behaviors that BASICS is designed to change.

These insights will then be used to tailor BASICS to the local context. This will maximize both individual and institutional acceptability and adoption of changes.

BASICS partners Save the Children, London School and WaterAid have already used the approach in one of BASICS’ four demonstration countries –Cambodia. This experience will help to give BASICS a firm fooothold there, and inform work in the three other demonstration countries of  Bangladesh, Nigeria and Tanzania.

In Cambodia, we found that many people believe that if their hands don’t look soiled, that means they’re clean. Open defecation is also socially accepted, especially when there’s abundant open space.

Save the Children has, over the past six years, run the NOURISH program, which targeted behaviors in health, water, sanitation and hygiene and agriculture. The impact of the changed behaviors is very significant, including a 75 percent drop in open defecation in the program areas.

WaterAid and the London School, in partnership with the National Institutes of Public Health and 17 Triggers, recently used Behavior-Centered Design to develop a novel intervention to improve hand hygiene compliance among Cambodian midwives.

They identified the personal, institutional and cultural drivers of hygiene practices and are now testing a model that combines traditional infection prevention control training, emotional messaging that reinforces midwives’ desire to provide quality care to mothers and newborns and environmental cues to trigger hand hygiene at key moments.

Midwives’ compliance with good hand hygiene practices during childbirth will be measured later this year. These learnings will be very useful once we implement BASICS in the country.

In Bangladesh, we’re very excited about the impact of our programs addressing HAIs. When we started, there were quality standards for infection prevention in place, but they were simply not complied with. Staff were not adequately trained, supplies were limited at best, and there were no systems in place to ensure that healthcare facilities practiced effective hygiene.

We had to also address the widespread use of traditional, but harmful, practices like applying cow dung or corrosive mustard oil to a newborn’s umbilical cord. We were successful in helping staff to transition to the use of chlorhexidine through guidelines, training and the development of effective supply chains.

It was a long process, but it worked. Some 85,000 healthcare staff in 64 districts were trained. Independent monitors found that 86 percent of healthcare staff were proficient in the use of chlorhexidine. They also found great improvements in the sanitizing of medical equipment such as bag masks and suction devices.

As we’ve seen in Cambodia, Bangladesh and in many other countries, sustainable behavior change is possible at both the individual and institutional levels. BASICS will draw upon hard evidence and our collective eperiences to advance this bold solution in health facilities and across national health systems.