Understanding parental engagement in tiered prevention in primary care: Predictors of participation in Smart Beginnings

• In Event: 1-013 - Family Engagement in Early Childhood: New Findings Across Developmental Periods, Intervention Types, and Ecological Settings

Integrative Statement

Despite well-documented impacts from parenting interventions aimed at improving child school readiness among low income families, making progress at the population level has been limited (Shonkoff, 2017); a key limitation being the engagement of families in such programs. As an example, only approximately 1/3 of Early Head Start families complete the program. Key barriers to engagement have been logistical issues (e.g., work, time, transportation) exacerbated by attitudes toward services (Spoth et al., 2007). Yet, there is limited research on which families actively take part in preventive programs and, thus, whether such programs are appropriately targeting and successfully engaging families most in need. Addressing such questions can substantially support intervention design and implementation, potentially improving child outcomes at the population level from birth.

This paper examines such questions as part of the NICHD-funded Smart Beginnings (SB) Project (MPIs Mendelsohn, Morris, and Shaw). SB is designed to address poverty-related disparities through a tiered model that integrates a universal parenting program in pediatric primary care (Video Interaction Project [VIP]; Mendelsohn et al., 2005) with a secondary/tertiary prevention in the home (Family Check-Up [FCU]; Shaw et al., 2006). SB is a birth to 3 program addressing child school readiness by targeting parent-child relational health and proximal psychosocial stressors that compromise relational health, with the goal of population-level engagement and scalability. The SB project tests the effects of the tiered model in a randomized control trial of 403 families, across two sites (New York, NY and Pittsburgh, PA), representing diversity of urban contexts (large vs middle) and sociodemographic characteristics (primarily immigrant Hispanic/Latino families in NYC and Black/African-American families at Pitt). Preliminary findings through child age 6 months demonstrate substantial promise, with positive impacts on relational health (enhanced parenting), on survey and observed measures of parenting (e.g., teaching, play, sensitivity and language use).

This paper will examine intervention engagement in the first phase of the SB study, when parents are offered VIP visits at pediatric primary care appointments. We particularly examine the sociodemographic and psychosocial predictors of engagement in this low-income sample of parents. Findings demonstrate very high levels of participation in the program. For example, of possible VIP visits through age 12 months, nearly 80% of treatment-assigned families at NYC have received 5 or more (of a possible 6) sessions and nearly as many (76%) have done so in Pittsburgh. Findings for this paper using Poisson distribution models (n = 201 in the treatment group), show that demographic, SES, and psychosocial variables are associated with program participation, but not always in the expected direction. While analyses indicate that first-time mothers have higher levels of program participation (as expected), we also find that more educated mothers and those with higher parenting self-efficacy have lower levels of participation, perhaps indicating effective program targeting. Further analyses for the conference will examine differences across sites and the association between these participation findings and improvements in parenting at 6 months. Implications for pediatric-based interventions with population-level accessibility will be discussed.

Authors

• Elizabeth B Miller, New York Univeristy
  Presenting Author

• Caitlin Canfield, NY UMC
  Non-Presenting Author

• Pamela A. Morris, New York Univeristy
  Non-Presenting Author

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

• Carolyn Brockmeyer Cates, New York University
  Non-Presenting Author

• Alan L. Mendelsohn, New York University School of Medicine
  Non-Presenting Author