Calling all parents: Boosting early childhood outcomes in Uruguay

Early childhood is a critical period for cognitive and socio-emotional development. Children in low-income settings are more vulnerable during this stage due to limited parental resources, environmental stressors, and gaps in family investments (Adhvaryu et al. 2018, Heckman and Mosso 2014). These disparities can lead to long-term consequences, including lower educational attainment, reduced earnings, and poorer health outcomes in adulthood. While interventions aimed at improving parenting skills have proven effective (Gertler et al. 2014, Attanasio et al. 2022), they often require intensive, in-person engagement, making them difficult to scale. This raises a crucial policy question: can a cost-effective, phone-based intervention improve parenting behaviours and child development outcomes at scale?

Designing a scalable, cost-effective early childhood development intervention

We evaluated a remote, multi-component intervention designed to improve parenting practices in Uruguay (Bloomfield et al. 2025). The programme combined: (i) live calls from teleoperators, (ii) an AI-driven chatbot that provided information on local resources and allowed parents to receive biweekly feedback on their language interactions with their children, and (iii) behavioural nudges via WhatsApp messages.

Implemented over eight months, it targeted 1,360 highly vulnerable families with children aged zero to three, eligible for government support through Uruguay Crece Contigo (UCC), an agency under the Ministry of Development. Our intervention had the following objectives:

• Increase parental engagement in early stimulation activities.
• Foster child language development.
• Reduce parental stress.
• Improve access to government benefits and services.

By leveraging behavioural economics, our intervention addressed key psychological barriers that often hinder parental investment in child development, such as present bias (the tendency of individuals to prioritise immediate rewards over future benefits), cognitive fatigue (the decline in decision-making quality under stress or resource constraints), and negative identity (when individuals view themselves as incapable or unworthy of success) (Aizer 2003, Bhargava and Manoli 2015).

Present bias leads parents to prioritise immediate concerns over long-term investments in their children's development, while cognitive fatigue makes it difficult to maintain consistent engagement in stimulating activities. Our intervention sought to counteract these challenges by providing timely reminders, motivational messages, and actionable guidance in an easily accessible format.

The programme was divided into two thematic modules, with each lasting four months. The first module covered general positive parenting guidelines, including child-caregiver attachment, health, nutrition, protection, stimulation, and caregiver’s self-care. Table 1 shows an example of a message sent during the first module.

Table 1: Example of a message sent during module 1

This first module also placed a strong emphasis on providing families with access to government benefits and services.

The second module covered language stimulation. These calls and messages encouraged parents to pay attention to their child’s non-verbal cues, describe their surroundings, and initiate conversations. Parents were also guided to wait for their child’s response, engage in two-way conversations, tell them stories, and sing and read to them. Table 2 shows an example of a message sent during the second module.

Table 2: Example of a message sent during module 2

The early childhood development intervention had positive effects on parenting and well-being

We evaluated the programme using a randomised controlled trial. A total of 1,360 families were assigned to either a treatment or a control group. The treatment group received calls and text and audio messages for eight months, and had free access to the chatbot and AI feedback tool. The control group did not receive any teleassistance or messaging, but had access to a restricted version of the chatbot containing information on local resources. 

At the end of the intervention, we compared the results from the treatment group with those of the control group. Our findings were large and significant:

• Increased parental engagement: Families in the treatment group increased their weekly participation in stimulating activities.
• Enhanced knowledge of language development: The intervention significantly increased parents’ knowledge of language stimulation.
• Improved parents’ language interactions with their children: AI-driven analysis of WhatsApp audio recordings showed that the intervention enriched language interactions. Treated caregivers used more words per minute and exhibited a wider vocal pitch range (greater variation in tone), both of which are key to capturing a child’s attention and fostering emotional bonding.
• Reduced parental stress: Treated families reported lower stress levels.
• Higher access to government benefits: Programme participants were more likely to access social transfers and labour market support programmes.

Moreover, the programme was well-received by treated families: 90% of families reported that the chatbot was useful in providing information on parenting practices and language stimulation. 75% of families reported that the chatbot helped them access information on local resources. Teleoperators also valued the tool, reporting that the messages allowed them to ‘break the ice’ when calling families, as well as anchor the calls around topics families had already familiarised themselves with during the week.

Implications for early childhood development policy in developing countries

The programme features promising elements for designing cost-effective parenting interventions.

Combining scalable outreach methods: By combining calls by a teleoperator, messages, and an AI-driven chatbot, the design ensures that if one outreach method is less effective for a particular family, others may resonate better. The programme emphasises synergy among its components, which work together to amplify their combined impact, rather than focusing on the effectiveness of individual elements.

Addressing behavioural biases: Our findings indicate that families with more behavioural barriers at baseline experienced larger improvements in the frequency of parental stimulation. Since the intervention was designed to target these barriers, our results suggest it successfully engaged the right channels. In this sense, incorporating strategies to mitigate present bias, inattention, and the misinformation or stigma associated with social assistance uptake enhances programme effectiveness.

Coping with stressing environments: Most participating families faced challenges related to overcrowded living conditions, a recent death of a family member, significant debts, or legal issues (Balsa et al. 2024). Our results show that teleoperators increased access to social protection programmes (monetary transfers and labour programmes), which helped alleviate stress from economic hardship. In particular, we find that families that experienced an economic shock at baseline were more likely to improve their parental involvement and wellbeing after the intervention.

E-messaging potential: E-messages are an important component of this intervention, as families that received and read more messages were more likely to engage in developmentally stimulating activities with children.

Our findings align with the evidence supporting effective interventions that enhance parental engagement and parent-child language interactions (Bloomfield et al. 2023, Balsa et al. 2023). Beyond these impacts, we also show that incorporating one-on-one telephone assistance improves parental well-being, mostly by facilitating access to cash transfers and social benefits that families were already entitled to receive, but also by providing emotional support. A back-of-the-envelope estimate suggests that the programme's implementation cost per family is significantly lower than that of traditional home-visiting programmes. The success of this intervention highlights its potential as a scalable, cost-effective alternative for supporting vulnerable families.

References

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Bloomfield, J, A I Balsa, A Cid, and P Oreopoulos (2025), “Calling all parents: Leveraging behavioral insights to boost early childhood outcomes in the developing world,” Unpublished manuscript.

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