Increasing Reach of Preventive Programs through a Tiered Approach Tailored to Heterogeneity in Risk

• In Event: Participation in Early Childhood Parenting Programs: An Ecological Framework Perspective in the U.S. and Globally

Abstract

Background: Early preventive interventions have shown promise in reducing developmental disparities related to social determinants of health, but parents who are young or first-time parents, have low education or income, or depression are less likely to participate in such programs (Reyno & McGrath, 2006), making these risks critical barriers to population level impact (Burke et al., 2014). Smart Beginnings (SB) is a novel, tiered intervention combining primary prevention in pediatric primary care (Video Interaction Project; VIP; Mendelsohn et al., 2005) with secondary prevention in the home for families with increased psychosocial risk (Family Check-Up; FCU; Dishion & Stormshak, 2007) to promote child development in low-income families. Previous studies prior to 6 months—examining VIP alone before initiation of FCU—indicated that SB effectively reached mothers with sociodemographic risks (Miller et al., 2020).

Objective: To determine whether the integrated, tiered SB model is associated with increased program engagement in the context of varied sociodemographic risk.

Method: Participation data across two sites (Table 1) from child age 6-18 months was analyzed as part of an ongoing RCT. Primary predictors: Sociodemographic variables (maternal age, parity, public assistance receipt, education); psychosocial indicators (maternal depression, parenting self-efficacy); VIP participation birth-6 months. Primary outcomes: FCU engagement at 6 months; VIP participation from 6-18 months.

Results: In regression analyses for all SB families (n=201), first-time parents and those with lower education and parenting self-efficacy had higher VIP attendance (Table 2). Similarly, for 90 families (45%) meeting risk criteria for FCU, first-time parents and those with lower education were more likely to engage in FCU. Mediation models controlling for sociodemographic and psychosocial variables indicated significant indirect effects predicting FCU and 6-18 month VIP attendance from first-time parenthood, through effects on early VIP attendance (Fig 1a,b). A serial multiple mediation model indicated a significant total indirect effect of first-time parenthood, through early VIP attendance to FCU engagement, and finally to later VIP attendance (Fig 1c).

Conclusions: Results indicate that the SB tiered approach may mitigate important risk-related barriers to population-level reach for preventive interventions, as indicated by higher VIP attendance among families with increased risk through a pathway of ongoing increased SB participation. Findings broadly support the role of pediatric primary care as a platform to engage families in tiered interventions tailored to individual family needs.

Authors

• Caitlin Ford Canfield, NYU Grossman School of Medicine
  Presenting Author

• Elizabeth B. Miller, New York University School of Medicine
  Non-Presenting Author

• Daniel S. Shaw, University of Pittsburgh
  Non-Presenting Author

• Pamela Morris-Perez, New York University
  Non-Presenting Author

• Erin Roby, NYU Grossman School of Medicine
  Non-Presenting Author

• Alan L Mendelsohn, NYU Grossman School of Medicine
  Non-Presenting Author