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acceptable approach, it is proposed that the effectiveness of early intervention should also be evaluated along conceptual dimensions. Specifically, it is proposed that determination of effectiveness should be based on the expansion of assessment approaches and a distinction should be made between scientific evidence and clinical accountability. To this end, problems contributing to the difficulty of documenting effectiveness raised previously in the four explanations should be addressed.

Generalization of the current model and future proposals

From the results of the study and the discussion following it, the family intervention model appears to be a feasible, simple model which can be incorporated into the existing health care delivery system. Its efficacy is enhanced by the fact that in addition to improving well being in mothers and changing family life styles, it also brings about definite improvement in nutrition and cognitive status. The relatively better results for nutrition as compared to cognitive status might be a function of the cognitive tests used. It is proposed that more subtle and sensitive tests (such as the Griffith's and Denver's developmental scales) be used in future assessments as measures for improvement, rather than those which measure gross function.

Family intervention as a model can be extrapolated to other programmes of health care and can form an integral part of any health care delivery system. As discerned from the subjective reports of the Anganwadi workers, it does not appear to be a strain and also gives more satisfaction to the workers. As it can be incorporated into the existing tasks it is also time saving. The workers' perception that the intervention also led to better utilization of services indicates that it might also improve cost effectiveness of the ongoing programmes.

Emphasis should be laid on adequate training which would involve better methods, field training and exposure to intervention done by experts. In addition an ongoing supervision programme, which will ensure in-depth discussion of the interventions made and problems encountered will probably improve motivation in the health workers. The ICDS/Anganwadi workers seem to be the appropriate personnel in order to carry out this task as their focus is maternal and child health. Intervention programmes related to home care have shown consistent and sustained improvement if the visits are more frequent. Hence, it should be ensured that the visits are at least weekly or biweekly. Evaluations of the efficacy of intervention should be measured in tangible as well as conceptual terms. Improvement


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