Integrated Model for Promoting Parenting and Early School Readiness in Pediatrics

This study tests a comprehensive approach to the promotion of school readiness in low-income families, beginning shortly after the birth of the child, through enhancement of positive parenting practices (and when present, reduction of psychosocial stressors) within the pediatric primary care platform. The investigators do so by integrating two evidence-based interventions: 1) a universal primary prevention strategy (Video Interaction Project [VIP]); and 2) a targeted secondary/tertiary prevention strategy (Family Check-up [FCU]) for families with infants/toddlers identified as having additional risks. VIP provides parents with a developmental specialist who videotapes the parent and child and coaches the parent on effective parenting practices at each pediatric primary care visit. FCU is a home-based, family-centered intervention that utilizes an initial ecologically-focused assessment to promote motivation for parents to change child-rearing behaviors, with follow-up sessions on parenting and factors that compromise parenting quality.

Two primary care settings serving low-income communities in New York City, NY and Pittsburgh, PA will be utilized to test this integrated intervention in hospital-based clinics, providing information about translation across venues where one of the two interventions has been previously used alone.

The investigators plan to test the VIP/FCU model in a randomized trial of 400 families utilizing parent surveys, observational data on parent-child interactions, and direct assessments of children's development, at key points during intervention follow-up. Analyses will address questions of program impact for the integrated program across all families and by key subgroups.

The largest single contribution made by this study is to test whether an integrated primary and secondary/tertiary prevention strategy implemented in pediatric primary care can produce impacts on early school readiness outcomes, including social-emotional, pre-academic, and self-regulation. As such, this study has the potential to provide the scientific and practice communities with information about an innovative approach to promoting school readiness skills among low-income children.

Inclusion Criteria:

• Baby is getting pediatric care at Bellevue Hospital Center or Pittsburgh Children's Hospital
• Caregiver primary language is English or Spanish
• Family can be contacted (has a working phone)
• Family attended second (follow-up) meeting with study team between when the child was aged 10days and 6weeks old

Exclusion Criteria:

• Birth weight <2500gm
• Gestational age < 37 weeks
• Not singleton birth (twin, triplet, etc.)
• Known or suspected significant genetic abnormality
• Known neurodevelopmental/neuromuscular disorder likely to affect development, movement, e.g., seizure disorder, microcephaly (low head circumference)
• Known sensory defect
• Known significant malformation likely to affect development or likely to require significant therapy
• Meets criteria for Early Intervention at birth
• Not in level I nursery at time of enrollment
• Significant postnatal complication requiring level II or III nursery stay. Examples: sepsis, significant hypoglycemia, seizures
• Mother with known significant impairment that will be barrier to communication and participation (e.g., intellectual disability, schizophrenia)
• Baby not being discharged to mother or father
• Mother and baby will be staying in shelter
• Not planning to stay in NYC/ Pittsburgh for at least 3 years
• Has previously participated in VIP or FCU projects
• Baby experiencing significant medical issues
• Doctor has concerns about baby's hearing or vision