Association for Public Policy Analysis & Management

A wide range of intervention programs have sought to prevent school readiness disparities by promoting positive parenting and attenuating effects of psychosocial stressors. While there is significant evidence of efficacy of programs at the individual child level, impacts at population-level have been limited. This is in part due to the fact that existing programs have not successfully leveraged platforms that easily support population-level impact (e.g., public school systems) while simultaneously addressing heterogeneity of risk among low-income families.

The NICHD-funded Smart Beginnings (SB) Project addresses this challenge through universal family engagement with primary (1°) prevention in pediatric primary care (Video Interaction Project [VIP]; Mendelsohn et al., 2005) integrated with secondary (2°) prevention in the home (Family Check-Up [FCU]); Shaw et al., 2006). SB’s tiered approach addresses parent-child relationship and proximal psychosocial stressors from birth-3 years. Importantly, SB utilizes pediatric primary care as a platform for population-level identification, engagement, and scalability.

This poster presents early impact findings on parental support of teaching and play and cognitive stimulation from the randomized trial of the SB project. 403 families were recruited at the child’s birth across sites in New York, NY and Pittsburgh, PA. Families at each site were randomized at the 2 week visit to either: 1) VIP/FCU (n=201) or 2) Control/routine care (n=202). Baseline data show that families at both sites were predominantly low-income; as intended, the racial/ethnic mix at the two sites differed with the majority of mothers in NYC of Latino origin (84%), and, in Pitt, African-American (81%). Critically, there were no statistically significant differences between SB/control groups on baseline measures (including demographic characteristics and measures of parent psychosocial stress and support), and a joint F test across characteristics was nonsignificant, F = .85, p=.66 in NYC, and F=.85, p=.64 in Pitt.

Our preliminary data shows substantial promise of the SB tiered model in pediatric care, with strong engagement in the integrated intervention and positive, statistically significant impacts on parent support of cognitive stimulation as measured by parental survey as well as observed parenting assessed via videotaped, coded interactions between parent and child at 6 months. More specifically, there are statistically significant impacts on teaching and play (ES=.25, p <.05) and the cognitive home environment (ES=.20, p <.05) as measured via parental survey (StimQ). And, impacts on observed parenting demonstrate strong, statistically significant effects on parent support for children’s cognitive development (ES=.34, p <.01), parent language quantity (ES=.38, p <.001) and parent language quality (ES=.32, p<.01). Implications for intervention programs using pediatric primary care as initial point of contact are discussed.