BUILDING BABY BRAINS

Children in rural India are at risk of harm to their developing nervous system caused by environmental stressors such as chronic poverty and family dysfunction. Core competencies needed for future success are developing during pregnancy and in the first 1000 days of life. Accumulated research demonstrates that the infant-parent relationship can moderate the harmful effect of environmental stress during this critical time. Supporting Child Caregivers (SCC), a U.S. based non-profit, has developed a training program aimed at strengthening infant resiliency, “Protect, Nurture, and Enjoy” (PNE) and has taught student nurses at Christian Hospital of Kasganj (CHK) yearly for 8 years. A 2017 study demonstrated the effectiveness of this health worker training in supporting mothers in their relationship with their infants. COVID-19 interrupted travel, motivating our initiative to put the training online to make it more reliable and accessible. This technological intervention could easily be scalable and available for global use.

The knowledge gap in Infant Parent Mental Health is particularly serious in low-income countries (LMIC) such as India, where infants are at greater risk of death or disability than in a high-income country (WHO, 2019).  Many studies, including the ACE study (Felitti et al, 1998), demonstrate the harmful effect of adverse childhood experiences on the physical and mental health of the individual. Stressors associated with poverty can harm the child’s nervous system during pregnancy and the first months of life, when core competencies necessary for future success are developing (HUCDC). Infant research describes the moderating effect of the infant-parent relationship on environmental stressors such as chronic poverty and family dysfunction (Beeghly et al, 2016, Liu & Tronick, 2016). The Protect Nurture Enjoy (PNE) training teaches nursing students methods for supporting maternal mental health and procedures for strengthening the mother-infant relationship, critical elements of good health care for pregnant women and young children. Socioeconomic factors causing stress are famously difficult to change, but PNE provides nurses and other health workers useful knowledge to support health and resiliency in pregnant and new mothers and their children. Filling the IPMH knowledge gap can make a difference.

Online PNE will offer IPMH training-- (1) lectures in pregnancy, the transition to parenthood, early development, and obstacles to healthy development; and (2) clinical methods in strengthening the infant-parent relationship, such as the Newborn Behavioral Observation (NBO). Recorded lectures will be supported by power point and videotape illustrations with Hindi subtitles. Stage 1 of the project involves training the trainers—staff nurses at CHK. Remote lectures for nurses will be recorded on a confidential Zoom platform and stored with instructional videos on a protected subscription-based website. Clinical demonstrations will be remote but live whenever possible. Stage 2 of the project will comprise the new trainers teaching CHK student nurses using the recorded PNE materials and supported remotely by SCC staff. Subsequent stages will include (1) training additional nursing students and community health workers in the region;  (2) disseminating online training to other local institutions collaborating with SCC in India and globally; (3) outreach to families with smartphone apps. In all 3 stages, SCC collaborating institutions will actively participate in adapting the training to their local needs, first becoming co-owners and eventually owners of their IPMH training, with continuing SCC support.

Directly, PNE training supports CHK in delivering high quality maternal and infant care to the surrounding community. Indirectly, PNE serves the local rural community residents who are the recipients of improved health care. SCC’s long relationship with CHK has facilitated SCC’s adaptation of PNE to the needs and values of the local community. This model of collaboration with local institutions will allow continuing adaptation of online PNE to local cultures, underpinning effective IPMH training for health workers in greater India and in further global sites. Providing initial training and continuing educational support without cost, the skilled volunteers at SCC offer an affordable, targeted, intervention to support the infant-parent relationship. The intervention aims to strengthen the resiliency of children born into chronic poverty and experiencing the adverse conditions documented in the ACE study. Additionally, the intervention provides needed attention to pregnant women and mothers of young children. High rate of illness, disability, and school failure of children in rural India and in other disadvantaged communities demands urgent efforts to build resiliency in young children by protecting them as much as possible from the harmful effect of environmental stressors on the developing competencies necessary for future success.

Infants die and suffer illness and disability disproportionately in India and other LMIC. A knowledge gap in IPMH presents an obstacle to good care for infants and their families by limiting targeted, skilled support to the infant-parent relationship, which is shown to potentially protect infants against the harmful effects of environmental stress. In its focus on the infant-parent relationship, “PNE” training supports simultaneously the mental health of pregnant women and mothers, and their infants’ developing nervous systems.  Online “PNE” training will close the knowledge gap and makes current scientific information and practical clinical methods accessible to health workers without cost.

Current IPMH interventions include parent education, home visiting, dyadic and family therapy, and video-feedback.  These interventions have the limitations of moderate effect sizes, high expense, being time-consuming, and being performed only in high-income countries, (Mikton & Butchart, 2009, Compendium of Parenting Interventions, 2015, McLuckie et al, 2019). Protecting children in the most vulnerable populations requires creative, culturally sensitive, cost-effective solutions. Two critical factors suggest that training caregivers of infants and their parents in methods of strengthening the parent-infant relationship may be the most cost-effective path to resiliency for infants in disadvantaged populations: (1) the psychological and biological sensitivity of both parents and infants to positive care in pregnancy and the newborn period, and (2) the potential for health workers to provide this protective attention during their usual maternity and pediatric care. PNE has several unique features: (1) It is adapted to cultural needs and values through the collaboration of SCC and local institutions, who will eventually “own” the training; (2) The online training will be provided free of charge; (3) SCC teacher/clinicians are embedded in academic communities involved in current developmental knowledge and research, allowing for continual updating of course content.  Putting PNE online with the potential for scaling it for use in training community health workers and nursing students in a wider field fills a critical knowledge gap and makes this IPMH training reliable and accessible for global use.

Stage 1 of Building Baby Brains (BBB) project will consist of putting PNE online for teaching at CHK. Staff nurses and student nurses will be given access to an online teleconferencing platform for live interactions, where lectures, power point slides, clinical videos, and demonstrations will be shared. Content will be made available on-demand through a secured, HIPPAA compliant interface on the SCC website. We will curate course content with updates involving PNE live course schedules, podcasts, blog postings, and informational YouTube videos through an interactive app, and create Hindi subtitles for the lectures and videotapes. We also plan a survey to evaluate the efficacy of the training. Stage 2 of BBB, will leverage YouTube, Zoom, and other technology to bring PNE training to greater India, and then into the global reach of health workers worldwide. This expansion will involve collaborations with local institutions, such as SCC’s existing collaborations in other areas of India, Pakistan, El Salvador, Peru, and Grenada. In Stage 3 of BBB, we will design a smartphone app to deliver reminders to parents in local villages about good infant care practices. The technology of stage 3 will include the behavioral science of “nudges”. Just as in the case of the PNE training, the app will provide a basic framework but be modifiable to accommodate the particular needs, values, and beliefs of the local community.

(1) The first stage of the Building Baby Brains (BBB) utilizes the widely used and accepted technology—Zoom and YouTube. In order to protect the privacy of demonstration videos, the Zoom platform will be HIPAA-compliant and include a protected, subscription-only section of the website. The technology will include the creation of Hindi subtitles. The YouTube channel will also be private. (2) The second stage of BBB will utilize the same technology and include subtitles of languages spoken in the additional local communities. (3) The third stage of BBB will involve a technique for changing individual behavior without coercion or economic incentives. Behavioral economist Sunstein refers to this tool as “nudges”. This technique is described as an approach designed to act as reminders or suggestions to influence behavior in the direction of the individual’s interest (Benartzi et al, 2017). A good example of a “nudge” is the highly successful campaign against littering,“Don’t Mess with Texas”.  Nudges to promote positive parenting practices will be delivered to parents of newborns and young children through messages on smartphones. Although in many cases Western beliefs and values are strongly reflected in parent guidance interventions, SCC’s foundational principle of local collaboration will serve to protect the cultural values and agendas of local communities in the creation of "nudges" about good parenting practices.

BBB first proposes to change nursing practice at CHK by putting online an IPMH training, PNE, designed to fill a critical knowledge gap in health care—current knowledge of early development and practical methods for strengthening the infant-parent relationship (Tomlinson et al, 2014). Filling this knowledge gap is critical to protect infants growing up in rural India and other LMIC, who suffer disproportionately from illness and disability due to adverse childhood experiences (ACE’s) such as chronic poverty and family dysfunction (Felitti et al, 1998). Accumulating evidence suggests that supporting the infant-parent relationship can moderate the harmful effects of environmental stress (Sroufe et al, 2010; HUCDC, Beeghly et al, 2016). PNE provides nurses who care for pregnant mothers and their infants with practical tools to support the infant-parent relationship. In 2017 SCC did an RCT to evaluate the effect of PNE training on the care given new mothers during their maternity hospitalization at CHK (paper in process). The results demonstrated that mothers treated by PNE-trained nurses felt better able to read their babies’ behavioral cues than the mothers treated by non-PNE trained nurses. These results and results in similar studies suggest that PNE provides a basis for responsive caregiving (McManus & Nugent, 2012). The pandemic motivated us to put PNE online to increase its reliability and accessibility. Benefits of online training include scalability for use with additional groups of health workers and for global use. While maintaining its basic framework, PNE is individualized to meet local cultural values and needs in a process of collaboration between SCC and the local institution that will eventually “own” its PNE. In the future, we plan to expand PNE to include refresher courses and direct outreach to parents of infants with “nudges” to their smartphones to influence positive parenting practices. We expect this cost-effective training to increase the quality of health care to pregnant mothers and their infants by supporting mothers’ capacity to provide responsive caregiving and healthy attachment to their infants, in that way strengthening the infants’ resiliency to ACE’s.    

Currently, we train 140 student nurses at CHK per year and 6 staff nurses, per year. These nurses treat 500 infants and their families per year. Within the next 5 years, we plan to train 1600 student nurses and 30 staff nurses at CHK and at other regional nursing schools and 2,000  community health workers. We estimate that these nurses and community health workers will treat 5,000 infants and their families. Online PNE training in other sites where SCC has collaborations will directly reach many other health workers and indirectly many other infants and families, but these plans have not yet been consolidated.

Within the next year SCC will (1) accomplish the first stage of the Building Baby Brains (BBB) of putting PNE online for teaching nursing students at CHK. This will involve creating Hindi subtitles for the PNE lectures and videos, and putting PNE on Zoom and YouTube, using a HIPAA-compliant Zoom platform and a protected, subscription-only YouTube channel on our SCC website.  Within five years we will achieve the second and third stages of BBB. (2) In stage 2, we will extend the network of PNE to train community health workers and nurses in other hospitals in Uttar Pradesh; expand further by collaborating with local institutions in other parts of India; and finally expand to other countries, beginning with existing SCC collaborations. We will utilize the same technology and include subtitles of languages spoken in the additional local communities. (3) The third stage of BBB will involve reaching out directly to parents of newborns through apps to their mobile phones with reminders—“nudges”—about positive parenting practices. The nudges will be individualized to fit local culture through collaboration with local institutions. Each stage of the BBB project will include an evaluative component that will involve surveys to health workers and parents and will also include the establishment of infrastructure for a long-term follow-up study.   

Within the next year, we will encounter barriers of (1) limited technological experience at CHK - Students and tutors hesitant to transition to e-learning due to less tech experience. Teaching an online course is a new platform for the tutors and student nurses, which will require additional training and practice. (2) Internet and power backups – Kasganj is a rural district; sometimes internet and power/electricity is erratic, potentially causing disruption in the delivery of live lectures and recorded content. (3) Translation and editing of IPMH videos – Video subtitles must be translated and edited precisely with captions in appropriate places. This will require translation by a technical/medical translator and editing by a professional editor.

In the next five years as BBB expands, we anticipate barriers in introducing online training in new sites—from the point of view of technology and culture. As we move into different language speaking areas, we will also need to create subtitles for the educational material in local languages We  anticipate encountering barriers in forming alliances with local institutions—hospitals, schools, and government administrations. We also anticipate challenges partnering with professional groups and associations of community health workers, who have previous alliances and have been accustomed to practicing without IPMH training. Further expansion involves outreach into villages with apps that communicate “nudges” will present another level of creative and technological barriers.

Within the next year, (1) The IT department of CHK has agreed to provide training to the staff and student nurses in the use of the online platform. They will also set up the hardware and be available for trouble-shooting. (2) A provision of $500 has been included in the budget for a power backup that will provide uninterrupted power to the equipment. (3) The video editor will work closely with SCC/CHK medical experts to ensure that the subtitles are accurately edited.

In the next five years, SCC will work with the local institutions, beginning with CHK in India, to introduce the training to community health workers. SCC will also work to expand and establish existing collaborations in Pakistan, El Salvador, Peru, and Grenada. The online PNE will require adaptation to individual sites, including the creation of subtitles for the educational material. This will require translation by local partners and technological support to create the subtitles. SCC will first train the trainers, as in CHK, and will then support the trainers in their teaching the online training. The next step will be nudges. Successful nudges require an intimate knowledge of local culture and will be generated in partnership with local colleagues. The apps to communicate the nudges to families in villages will be done with technological consultation either in the US or in the local site.

Supporting Child Caregivers (SCC) is a non-profit organization based in the United States dedicated to providing support to child caregivers-- parents and others-- in various settings around the world. SCC is a registered charity under 501.....

CHK is a registered non-profit organization working in the rural district of Uttar Pradesh, India since 1925. The hospital is a general hospital with maternity and pediatric departments, dental, emergency and eye departments. More than 300 nursing and paramedical students are enrolled in the hospital training center at a given time.

India Team: H Lyall, Administrator CHK; N Lyall, Obstetrician CHK.

SCC (U.S.) Team: A Harrison, Child Psychiatrist, President, SCC; G Gregory, IPMH specialist; A Bala, Child Psychiatrist, MPH; R Singh, Biomedical Scientist. All SCC team members are volunteers.

CHK in India is SCC’s primary and most well established site. BBB's CHK team includes H Lyall, CHK administrator, and N Lyall, obstetrician—and four members of the U.S. based India team—G Gregory, IPMH specialist, A Harrison, Child Psychiatrist and IPMH specialist, Abishek Bala, MPH and Child Psychiatrist, and Rashmi Singh, Biomedical Scientist. This team comprises the combination of medical, educational, administrative, and cultural knowledge necessary to create PNE online training and to manage continuing updates. H Lyall and N Lyall have worked at CHK for 40 years and know the patient population and culture. In addition, since CHK provides low fee and pro-bono care to the community, CHK has generated trust and good will in the local community. H and N Lyall have been supportive and active participants of BBB from the beginning.  G Gregory and A Harrison bring decades of clinical and teaching experience to BBB. A Harrison developed the original PNE and teaches IPMH in several academic institutions. In addition, the SCC advisory board includes eminent infant researchers. A Bala and R Singh bring both clinical knowledge and the scientific skills to design evaluations of PNE effectiveness. H Lyall, N Lyall, and R Singh are bilingual in English and Hindi. SCC has spent years developing collaborative relationships with local institutions in other international sites, and their teams are similarly well-positioned to deliver the solution in South India, Pakistan, El Salvador, and Peru.

Currently, SCC partners with CHK, as described above.

SCC is partnered with Deenabandhu Trust, Chanamaranagar, Karnataka, providing consultation to school and ashram, and is exploring IPMH training in local hospital.

SCC is providing training to 2 projects through Harvard TH Chan School of Public Health-- IPMH training to home visitors in research project in Lima, Peru, and trauma training to ashram caregivers of children rescued from child labor in New Delhi.

SCC has trained 30 medical professionals in Newborn Behavioral Observation method in San Salvador and maintains partnership with this group. SCC also trained 20 nurses, social workers, and psychologists in NBO at Maternidad Hospital in Lima, Peru.

BBB provides cost-effective IPMH training (PNE) to health workers to fill their knowledge gap in IPMH and improve their practice, with the longer-term goal of improving health care for pregnant mothers and their infants. We assume, based on recent infant research, that strengthening the infant-parent relationship will improve the resiliency of infants born into chronic poverty and support their healthy growth (Shonkoff et al, 2009, Beeghly et al, 2016, Liu & Tronick, 2012). We also assume, based on our study of 2017, that our PNE training is successful in supporting the infant-parent relationship (paper in process). Putting PNE online will make the training sustainable at CHK and will make it scalable to train other nurses and community health workers in India and other LMIC, beginning with established SCC collaborative relationships in Pakistan, El Salvador, and Peru. Putting PNE online will require: (1) organizing the material and bringing the content up to date—done by the volunteer team; and (2) putting the PNE online—which requires funding to support the technology in the CHK classroom, the Zoom platform, a power back-up, and the creation of Hindi subtitles. Once PNE is online, we expect it to become a valuable asset to health worker trainings worldwide, available to be integrated into the training programs of existing non-profits and other educational and government institutions.  The expansion of PNE information directly to parents in villages through app nudges is an extension of the SCC mission of supporting child caregivers and is included in our long-term planning.

SCC is a volunteer organization. We are looking for startup funds to convert a successful in-person training to an online course which can taught by CHK nursing staff, supported by SCC IPMH specialists. The continuing costs such as maintaining the internet platform, updating the course content, and expanding to other institutions will be covered by SCC volunteers and current and future collaborating institutions.  SCC expenses such as travel, after COVID, and administrative expenses will be covered by donations in the U.S. Future outcome studies to evaluate the online PNE in various sites will be funded by individual grants.

Barriers to accomplishing the first stage of BBB  focus on the technology involved in putting PNE training online. In particular, these challenges will include (1) translation of the course content into Hindi and creating Hindi subtitles for the recorded lectures and videos; (2) training the staff and students at CHK--who are not technologically sophisticated--in the use of the technology; (3) establishing a confidential zoom platform; and (4) and--because there are significant problems with the local internet and electricity supply-- securing the internet and protecting the electricity supply by procuring a power back-up. All these steps will require start-up funding.  Moreover, given SCC's long experience working in U.P., we anticipate additional complications. Barriers to the second stage include forming alliances with government administrators of the community health workers and with the health workers themselves. These workers have established alliances, priorities, and methods of working that do not include IPMH. Barriers to the third stage, which will include outreach to families in rural villages through "nudge" messages to their smartphones, will involve expertise in behavioral economics and app technology new to SCC.

SCC will need help creating a viable business model to support us in moving to the second stage of the development of our BBB solution—expanding online PNE to government health workers in the surrounding region, other areas of India where SCC has collaborators, and globally.  We would also benefit from technological consultation in this second stage, in which we plan to add content adapted to new cultures and languages. Technological support will be especially needed in the third stage, when we plan to add the new technology of “nudges” sent to village families’ smartphones. We would like to build monitoring tools into BBB from the beginning, so that we can continually assess our output and evaluative tools so that we can gather data about our outcome. Talent recruitment, especially in social media—advertising (“marketing”) the BBB project to international non-profits and educational institutions would be very helpful.   

(1) A business plan for future stages of our BBB solution could come from SOLVE members. This could help us prepare to scale up our project from stage 1 in the hospital of U.P. to other areas of India and globally.

(2) Technological support, especially in the development of "nudges" and designing an app to deliver the nudges could use the support of MIT faculty or students. The creation of "nudges" requires a combination of deep cultural knowledge and behavioral economics sophistication. SCC has the cultural knowledge but not the behavioral economics sophistication.

(3) Monitoring and evaluative tools to track our output and to gather data about outcome would also require the experience and knowledge of measures that we could put in place to gather this data. This knowledge is most likely available in the MIT faculty or students.

(4) Talent recruitment--particularly in the area of social media--in MIT students or SOLVE members.

(5) Marketing--in terms of advertising the BBB project to local hospitals, government programs, and educational institutions globally--could involve either MIT students or SOLVE members.

Building Baby Brains is an online training designed to improve the health and wellbeing of infants in LMIC and their families. Children in rural India are at risk of harm to their developing nervous system caused by environmental stressors such as chronic poverty and family dysfunction. Competencies needed for future success are developing during pregnancy and in the first 1000 days of life. Accumulating research suggests that the infant-parent relationship may moderate the harmful effect of environmental stress during this critical time. Eliminating socioeconomic stressors is not a viable option at present. However, strengthening the resiliency of infants by training health workers in early development and in methods for supporting the infant-parent relationship during their usual practice, is a practical and cost-effective alternative. Supporting Child Caregivers (SCC), a U.S. based non-profit, developed a training program, “Protect, Nurture, and Enjoy” (PNE) and taught student nurses at Christian Hospital of Kasganj (CHK) yearly for 8 years. A 2017 study demonstrated the effectiveness of this teaching in supporting mothers in their relationship with their infants.  Innovative features of PNE include: (1) the timing of the intervention during a transformational period for infant and mother when they are most “open” to positive caregiving; (2) collaboration of SCC and local institutions for essential cultural input and with the goal of that institution’s future “ownership” of “their” PNE; (3) SCC’s connections to academic developmental research to provide for continually updating information.  Putting PNE online (BBB) will make it easily scalable and available for global use.

Building Baby Brains (BBB) is a project designed to improve the health and wellbeing of infants and their families in LMIC by putting infant-parent mental health (IPMH) training online to make it reliable and accessible.

Children in disadvantaged communities are at risk of harm to their developing nervous system caused by environmental stressors such as chronic poverty and family dysfunction. Core competencies needed for future success are developing during pregnancy and in the first 1000 days of life ((HUCDC). Accumulating research demonstrates that the infant-parent relationship can at least in part moderate the harmful effect of environmental stress during this critical time (Sroufe et al, 2010;HUCDC; Beeghly et al, 2016; Liu & Tronick, 2012). More broadly speaking, individuals exposed to adverse childhood events (ACE's) are at risk of poor health outcomes in later life, including lower life expectancy (Felitti, 1998). Eliminating  socioeconomic stressors is not a viable option at present. However, strengthening the resiliency of infants against this stress with IPMH interventions is a reasonable choice.

IPMH interventions in the current literature include parent education, home visiting, dyadic and family therapy, and video-feedback.  These interventions have the limitations of moderate effect sizes, high expense, being time-consuming, and being performed only in high-income countries, (Mikton & Butchart, 2009, Compendium of Parenting Interventions, 2015, McLuckie et al, 2019).  There is an urgent need for cost-effective, culturally sensitive interventions to protect infants in LMIC.

Supporting Child Caregivers (SCC), a U.S. based non-profit with decades of experience consulting to childcare institutions and government programs in LMIC, has developed an  Infant Parent Mental Health training program, “Protect, Nurture, and Enjoy” for the three tasks of the infant caregiver (PNE). PNE offers (1) lectures in pregnancy, the transition to parenthood, early development, and obstacles to healthy development; (2) clinical methods in strengthening the infant-parent relationships such as the Newborn Behavioral Observation (NBO); and (3) refresher courses for participants.

SCC has taught student nurses at Christian Hospital of Kasganj (CHK), Kasganj, Uttar Pradesh, India, yearly for 8 years. For the past 3 years, we have taught 100 student nurses per year. In 2017 SCC did a RCT to evaluate the effect of PNE training on the care given new mothers during their maternity hospitalization at CHK (paper in process). The results demonstrated that mothers treated by PNE-trained nurses felt better able to read their babies’ behavioral cues, and more self-confident, than the mothers treated by non-PNE trained nurses. These results and results in similar studies suggest that PNE provides the basis for responsive caregiving and secure attachment (McManus & Nugent, 2012).

In comparison with other IPMH interventions, PNE is cost-effective in that it is taught by volunteer clinician-educators and focuses on training professional and paraprofessional caregivers to deliver maximal attention to supporting the infant-parent relationships during a time of life when the infant and mother (and even the father) are undergoing powerful biological and psychological transformations that make them particularly open to being influenced by positive caregiving. 

There are some excellent perinatal training manuals for health workers already in existence in LMIC. What additional advantage does PNE offer? PNE has several unique features: (1) It is adapted to community and cultural needs and values through the collaboration of SCC with local institutions, who will eventually “own” the training and can be integrated into existing trainings; (2) The online training will be provided free of charge; (3) SCC teacher/clinicians are embedded in academic communities involved in current developmental knowledge and research, allowing for frequent updating of course content.

(1) The first stage of the BBB project involves putting PNE online for use at CHK in training the trainers (young staff nurses), who will then train the student nurses, with SCC support. This will require start-up funds to provide the technological support needed at CHK and to create Hindi subtitles for the recorded lectures and illustrative videos.

(2) The second stage of BBB will utilize the same technology. The nurses and student nurses at CHK, which has an ongoing relationship with government health workers, will train 2,000 community health workers in a "mini-PNE". Training community health workers will require more funds to support their transportation and meals during the training. This stage will also involve training nursing students in other regional hospitals and additional community health workers and will gradually expand to other areas of India in which SCC has collaborative relationships, with the primary goal of training front-line workers--the government health workers, ashas and anganwadis. This expansion will require the creation of subtitles in multiple languages spoken in the additional local communities.

(3) The third stage of BBB will require additional funding to scale the PNE for use in other countries where SCC has collaborations--currently, Pakistan, El Salvador, Peru, and Grenada. For example, SCC is presently consolidating relationships with Lady Health Worker programs in Pakistan. Stage 3 will also introduce a technique for changing individual behavior without coercion or economic incentives. Behavioral economist Sunstein refer to this tool as “nudges”. This technique is designed to act as reminders or suggestions to influence behavior in the direction of the individual’s interest (Benartzi et al, 2017). A good example of a “nudge” is the highly successful campaign against littering,“Don’t Mess with Texas”.  Nudges to promote positive parenting practices will be delivered to parents of newborns and young children through messages on smartphones. Although in many cases Western beliefs and values are strongly reflected in parent guidance, SCC’s foundational principle of local collaboration will serve to protect the cultural values and agendas of local communities in terms of "nudges" about good parenting practices. When the technology for nudges is organized, it can be scaled for global use through collaboration with local institutions that will create nudges that "speak" to their communities.