Inside The Program Bill Clinton Name-checked At The DNC

In the Democratic National Convention last week, Bill Clinton highlighted an exemplary pre-school program that Hillary Clinton helped transfer from Israel to Arkansas in the 1980s.

Clinton told the delegates, 'There are a lot of young adults in America who are enjoying better lives because they were in that program.'

In fact, there are a lot of young adults in some twenty countries who are enjoying better lives because of the program, called HIPPY. Started to help immigrant children in Israel in the 1960s, it has quietly spread to some 20 countries around the world, enrolling 60,000 children in this year alone, and become a prime example of how proven innovations can be transplanted from place to place.

A further seven countries, including Nigeria, Bermuda, Nicaragua and Kenya, got in touch after Clinton's speech to find out how to replicate it. Although it has been around for nearly 50 years and has succeeded in all kinds of different countries, there is presently no systematic means of introducing it to new places.

Dr Miriam Westheimer, who first brought the program to the US and is now its International Director, told Apolitical that transplanting it was laborious at first. 'In the early days, it seemed quite challenging actually, translating materials and training people and all of that. But I've been International Director now for about 15 years, and we're finding that we really have it down, you know. We've been doing it for so long that we know how to get people up and running pretty quickly - in about a week.'

The program was founded in Israel in 1969 to boost the educational attainment of immigrant children from Asia and North Africa. Based on the realisation that disadvantaged children were already substantially behind their peers on the first day of school, it teaches parents to prepare their three-to-five-year-olds before they begin.

The parents are given a 30-week curriculum with materials that include role-play activities and nine storybooks along with supplies like scissors and crayons. The parents are helped and trained by home visitors who are themselves parents of children in the program and are recruited from their community. They are overseen by a program co-ordinator who brings them together for fortnightly meetings to discuss problems and offer reciprocal support.

'The core concept is that we work with parents who want to help their children succeed, and that's a universal concept. It's as true in New York city as it is in Monrovia or aboriginal Australia.'

Nevertheless, the concept does have to be localised. That works by drawing the home visitors from the same community as the parents they're visiting, so as to cut out any problems of miscomprehension or cultural dissonance. Moreover, in countries like Liberia, Australia or New Zealand, the storybooks have been replaced with local narratives, re-written to fit the curriculum. Finally, countries with the resources to do it, such as Norway, Sweden and Finland, have taken the concept and written entirely new curricula and created new materials.

In order to get started rapidly in a new country, the materials will initially be re-used from somewhere else, such as in Liberia (which started with HIPPY USA's English-language texts) or Guatemala (which started with HIPPY USA Spanish). Said Dr Westheimer, 'My philosophy is that we have to take something existing, get it off the ground quickly, see how it works in that country and then find investment to work on the curriculum.'

Although HIPPY is an NGO with philanthropic support, it provides its services on behalf of numerous government agencies from the German Ministry of the Interior to the municipality of Buenos Aires. The only country where a program has had to be closed down was South Africa, where the management were pocketing the cash rather than spending it on materials.

That experience aside, the program has won support wherever it has gone. HIPPY cannot point to positive results in a successful randomised controlled trial, considered the gold standard of evidence. In the one trial which has been run, the results were inconclusive. Nevertheless there are several studies showing its efficacy in other ways and its US branch was selected as one of the first set of home-visiting programs to meet evidence standards for federal funding.

Dr Westheimer said, 'I've been working in this field a long time and I think we have enough evidence. When children go into kindergarten and we ask the teachers who don't know who's been in the program, they can pick those kids out right away.

'RCTs are very expensive and if I can find an extra couple of hundred thousand dollars, I'm not putting it into an RCT, I'm going to put it into African countries. It's taken me this long in my career to say that to a reporter, but I'll say it loud and clear.

'I don't in any way want to belittle the importance of good research, but I do think that we sometimes tilt too far to that side where we could be providing services to many many many families.'

Although the program has been running for nearly 50 years to the satisfaction of so many countries, the innovation at its heart is still not spread systematically. Schemes in new countries begin when some organisation gets in touch to register its interest. Then a tiny pilot project is set up, aiming to provide results that prompt government to scale it up.

A perfect example of that process is HIPPY Australia, which began 12 years ago with 22 families in a mixed suburb of Melbourne called Fitzroy. Dr Westheimer said, 'We struggled to raise the money to keep that program going. After a couple of years, the NGO running it said, I think we've had enough, it's just not going anywhere. Then one day the ministry came and looked and, long story short, today it's a national program running a hundred sites.'