Promoting Early School Readiness in Primary Health Care

在学校准备问题中，亲子互动是一个关键的和可修改的因素，这些问题应该在 很大程度上是由于社会和环境问题，从出生起就开始运作。低强度预防方法 需要解决大部分学龄前人口在发展和社会方面面临风险的问题 情绪问题。儿科初级保健为提供有效、低成本的服务提供了潜在的环境 干预措施。我们提出了一项随机对照试验(RCT)，在该试验中，我们比较了两个基于初级保健的 针对控制组的不同强度的方法：1)视频交互项目(VIP)提供会话 与一位发展专家一起拍摄父母和孩子一起玩耍的视频，讨论了 与父母一起录制录像带，并在每个健康儿童的当天提供玩具、书籍和育儿手册 参观(费用240美元/孩子/年)；2)年龄和阶段问卷/积木(ASQ/BB)方法较低 强度，并提供每月邮寄的BB育儿通讯+以发展活动为中心的玩具， 外加每4个月由家长完成的ASQ筛查(费用为100美元/孩子/年)。这两种方法都解决了 亲子关系的社会/情感以及认知/语言方面。675个两岁大的新生儿 为贫困、高危社区提供服务的纽约市公立医院将被纳入这项随机对照试验，并随机分配到 接受：A)VIP儿童探视干预，B)ASQ/BB邮寄干预，或C)常规初级保健 (控制)。儿童将被跟踪到3岁，并定期评估家庭照顾情况 环境(亲子互动、发展/扫盲支持)和儿童发展成果 (语言、认知、社会-情感)。该项目还希望获得长期的学校成果。 关于孩子们的信息。通过在大样本中比较这两种不同强度的干预 具有不同教育、种族、种族、文化适应、压力和风险的城市家庭 背景和条件，这项研究将检查给定的干预措施是否更适合于特定的 族的子组或风险类别。这两种干预措施都定义充分、成本低、 实用，具有大规模复制的潜力。据设想，低成本干预措施，如 VIP和ASQ/BB方法可以构成提供连续体的总体战略的核心组成部分 根据儿童和家庭的需要和风险水平，提供预防性服务。

Parent-child interaction is a crucial, and modifiable factor in school readiness problems, which are due in large part to social and environmental problems operating since birth. Low intensity preventive approaches are needed to address the large segments of the preschool population at-risk for developmental and social- emotional problems. Pediatric primary care offers a potential setting for delivering effective, low cost interventions. We propose a randomized controlled trial (RCT) in which we compare two primary care-based approaches of different intensities to a control group: 1) the Video Interaction Project (VIP) provides sessions with a developmental specialist, who videotapes the parent and child playing together, discusses the videotape with the parent, and provides toys, books and parenting pamphlets on the day of each well child visit (cost $240/child/yr); 2) the Ages & Stages Questionnaire / Building Blocks (ASQ/BB) approach is lower intensity, and provides monthly mailed BB parenting newsletters + toys centered on a developmental activity, plus parent-completed ASQ screenings every 4 months (cost $100/child/yr). Both approaches address social/affective as well as cognitive/language aspects of the parent-child relationship. 675 newborns at two NYC public hospitals serving poor, high risk communities will be enrolled in this RCT and randomized to receive: A) VIP intervention at well child visits, B) ASQ/BB intervention by mail, or C) routine primary care (control). Children will be followed through age 3 years with periodic assessment of the home caregiving environment (parent-child interaction, developmental / literacy support) and of child developmental outcomes (language, cognition, social-emotional). The project hopes to also obtain long-term school outcome information on the children. By comparing these two interventions of varying intensity within a large sample of urban families with a diverse range of educational, ethnic, racial, acculturation, stress, and risk backgrounds and conditions, the study will examine whether a given intervention is more suited to specific subgroups or risk categories of families. Both interventions are sufficiently well defined, low cost and practical to have the potential for wide scale replication. It is envisioned that low cost interventions such as the VIP and ASQ/BB approaches could form core components of an overall strategy providing a continuum of preventive services depending on the children's and families' needs and level of risk.