Cultural Pride Reinforcement for Early School Readiness: Pilot Randomized Controlled Trial of a Clinic-Based Intervention for Young African American Children

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PROJECT SUMMARY/ABSTRACT This career development award will establish Dr. Ashaunta Anderson, MD, MPH, MSHS, as an independent investigator with a focus on the development, implementation, and dissemination of evidence-based racial socialization interventions for young African American children, using experimental and mixed-method approaches. This K23 award will provide her with the support she needs to develop expertise in 4 areas: 1) randomized controlled trials, 2) structural equation modeling, 3) mixed methods in dissemination and implementation science, and 4) leadership and professional development. African American children disproportionately experience racism, which is associated with behavioral health problems and school failure. Behavioral health problems impede learning and are more likely to be chronic, severe, disabling, and untreated in African Americans compared to Whites. Clinic-based interventions that boost cultural pride may improve outcomes related to behavioral health in young African American children. However, little is known about cultural pride interventions in this population. It is important to understand these processes in young children because early childhood is a period during which racial bias may develop and stymie behavioral health and learning, and cultural pride may support it. This project will recruit patients from AltaMed primary care clinics affiliated with Children’s Hospital Los Angeles. AltaMed is the United States’ largest system of Federally Qualified Health Centers. The project will pilot a cultural pride intervention (Cultural Pride Reinforcement for Early School Readiness (CPR4ESR)) in young African American children using experimental and mixed methods. CPR4ESR provides culturally themed children’s books and advice at health supervision visits of children enrolled at ages 2-4 years. It is based on a well-established national program called Reach Out and Read (ROR). ROR provides children’s books and book-sharing advice at health supervision visits with reports of increased book-sharing behaviors and literacy. The specific aims of the proposed project are to: 1) assess the feasibility and acceptability of CPR4ESR implementation among parents and providers, 2) evaluate the capacity of CPR4ESR to improve cultural pride reinforcement and book-sharing behaviors in parents of young African American children, and 3) evaluate the capacity of CPR4ESR to improve behavioral health and literacy in young African American children. The interviews conducted in Aim 1 will guide refinement of the intervention tested in Aims 2 and 3. The qualitative assessment will be complemented by quantitative trial statistics (e.g., recruitment rate) that inform trial feasibility and acceptability. Finally, the mechanism by which CPR4ESR impacts the primary outcome, behavioral health, and the secondary outcome, literacy, will be evaluated by structural equation modeling. This project will inform the development and implementation of early childhood interventions that address the deleterious health-related effects of racism among African Americans.