Integrated model for promoting parenting and early school readiness in pediatrics: Follow-up and getting ready for scale

摘要 尽管有充分的证据表明，旨在改善儿童学校教育的父母干预措施对家庭产生了影响， 在为低收入家庭做好准备方面，在人口一级取得的进展有限。主要障碍 包括家庭确定和参与、低成本的可扩展性和可持续性的挑战 现有的服务系统，以及即使在高风险人群中风险的异质性。亲子脆弱性 关系健康与儿童入学准备的提高有关;然而，这种脆弱性尚未得到解决。 这些措施被系统地纳入人口一级的战略，限制了人口一级的进展。 Smart Beginnings（SB）模型（R 01 HD 076390 -05）是一个从出生到3年的计划，解决了以下每个问题 这些障碍通过：1）利用儿科初级保健作为一个通用平台，以促进人口- 参与程度和可扩展性; 2）通过普及初级教育提供分层预防干预措施 预防（视频互动项目[VIP]，通过卫生保健提供）与有选择的，有针对性的 二次干预（家庭检查[FCU]，通过战略性家访提供）。显著 SB方法的创新之处在于它使用了早期亲子关系健康的周期性、系统性筛查 通过解决生态和近端压力因素，为有针对性地提供育儿支助提供信息。 战略支助处纳入的两项干预措施（脆弱生命和金融稳定股）都为以下方面带来了持续影响的既定记录： 低收入家庭我们目前的研究（包括2岁以下儿童的计划交付和评估） 在一项随机对照试验（RCT）中，对400个家庭的综合模型的影响进行了研究。 可扩展平台：儿科初级保健。2岁之前的初步结果表明， 实质性的承诺，对关系健康产生积极影响（加强对婴儿/幼儿的养育）， 儿童发展（减少幼儿问题行为），为提高以后的入学准备铺平道路。 目前的建议旨在通过完成3岁儿童的SB模式的交付， 并对RCT中4岁和6岁的儿童进行评估，以确定早期影响 关于关系健康和儿童早期发展的SB分层干预转化为以后的好处， 学校准备。此外，该提案还将解决改进所需的重要差距， 实施SB等分层预防模型，包括：1）了解行动机制（即， 调解）SB在所有家庭和干预提供，和2）适度的治疗反应的基础上 财务/人力资本和心理社会风险的基线差异。申请结果将 提供一个长期的测试计划的有效性与信息，以支持下一阶段的缩放。完成 研究目标将直接支持NICHD的优先事项，寻求在经济上优化入学准备技能， 这可能会导致政策和做法的变革。

ABSTRACT Despite well-documented effects on families from parenting interventions aimed at improving child school readiness for low-income families, making progress at the population level has been limited. Key barriers include identification and engagement of families, challenges of scalability and sustainability at low cost within existing service systems, and heterogeneity of risk even in high-risk populations. Vulnerability in parent-child relational health is linked to detriments in child school readiness; however, such vulnerabilities have yet to be systematically integrated into population-level strategies, contributing to limitations in population-level progress. The Smart Beginnings (SB) model (R01HD076390-05) is a birth to 3 year program that addresses each of these barriers through: 1) utilization of pediatric primary care as a universal platform to facilitate population- level engagement and scalability; 2) provision of a tiered preventive intervention through universal primary prevention (Video Interaction Project [VIP], delivered through health care) integrated with a selective, targeted secondary intervention (Family Check Up [FCU], delivered through strategic home visiting). A significant innovation of the SB approach is its use of periodic, systematic screening for early parent-child relational health risks to inform targeted delivery of support for parenting by addressing ecological and proximal stressors. Both of the interventions integrated in SB (VIP and FCU) bring an established record of sustained impact for low-income families. Our current study (including program delivery and assessment through child age 2 years) examines the impact of the integrated model in a randomized controlled trial (RCT) of 400 families in a scalable platform: pediatric primary care. Preliminary findings with initial outcomes through age 2 demonstrate substantial promise, with positive impacts on relational health (enhanced parenting of infants/toddlers) and child development (reduced toddler problem behaviors), paving the way for enhanced later school readiness. The current proposal seeks to build on this work, by completing delivery of the SB model through child age 3 and performing assessments of children in the RCT at ages 4 and 6 years to determine whether early impacts of the SB tiered intervention on relational health and early child development translate to later benefits for school readiness. In addition, the proposal will address important gaps necessary for refinement and implementation of tiered prevention models like SB including: 1) understanding mechanisms of action (i.e., mediation) of SB across all families and by intervention offer, and 2) moderation of treatment response based on baseline differences in financial/human capital and psychosocial risk. Findings from the application will provide a long-term test of program efficacy with information to support next-stage scaling. Completion of study aims will directly support NICHD priorities seeking to optimize school readiness skills in economically and socially disadvantaged children and could result in transformative changes in policy and practice.