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Initial Impacts of the Smart Beginnings Project Linking Pediatric Primary Care and Home Visiting

Fri, March 22, 1:00 to 2:30pm, Hilton Baltimore, Floor: Level 2, Key 10

Integrative Statement

A wide range of intervention programs have sought to prevent school readiness disparities by promoting relational health, potentiating parenting assets, 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 at al., 2005) integrated with secondary/tertiary (2°/3°) prevention in the home (Family Check-Up [FCU]); Shaw et al., 2006). SB’s tiered approach addresses parent-child relational health and proximal psychosocial stressors from birth-3 years and builds on a developmental psychopathology framework (Cicchetti & Toth, 2009) in which the child is considered within the context of caregiving (“relational health”), proximal family assets/stressors, and the broader ecology. Most importantly, SB utilizes pediatric primary care as a platform for population-level identification, engagement, and scalability. See Figure 1.

This paper presents early impact findings on proximal psychosocial stressors and relational health from the randomized trial of the SB project. To date, the project has recruited 403 families 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 (88%), and, in Pitt, African-American (80%). 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 parenting/relational health at 6 months. Intervention effects include enhancements in the parent-child relationship and parent-child interactions (see Table 1). More specifically, there are statistically significant impacts on teaching and play (ES=.26) as measured via parental survey (StimQ). And, impacts on observed parenting as assessed through videotaped, coded interactions between parent and child, demonstrate trend-level improvements in parenting sensitivity (ES=.20, p<.10) and strong, statistically significant effects on parent support for children’s cognitive development (ES=.40, p<.001), parent language quantity (ES=.40, p<.001) and parent language quality (ES=.35, p<.01). Furthermore, while overall effects are not found for reductions in psychosocial stressors at 6 months, depression scores were reduced for families not meeting FCU criteria (r=-.17, p=.01), consistent with need for additional services for families with relational health risks. Implications for prevention programs will be discussed.

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