Prevention of disparities in child psychosocial development in underserved rural families through promotion of early relational health in pediatric health care

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PROJECT SUMMARY/ABSTRACT While there have been significant efforts seeking primary prevention of poverty-related disparities in child psychosocial development, most research has focused on urban areas, with limited study in rural settings. Such research is critical given that: 1) a higher proportion of children in the rural US live below the poverty line; 2) rural poverty is associated with greater disparities than urban poverty across short- and long-term indicators of psychosocial development; and 3) rural disparities are increased for people of color. Theoretical frameworks and empirical evidence suggest that Early Relational Health (ERH; parenting practices/relationship quality) is a source of resilience that can buffer families’ adverse experiences due to poverty and racism and therefore represents a target for interventions. Preventive interventions such as home visiting, improve ERH and child outcomes in rural low-income families; however cost and other barriers (capacity, distance) have resulted in limited reach. Pediatric primary health care (check-ups) can address these barriers by building on routine family contact from birth to 3, provider relationships, and low cost. While access is a challenge for some rural families, health care utilization in this population is nonetheless high. However, health-care based primary prevention of psychosocial disparities in rural children has not been studied. Video Interaction Project (VIP) is an exemplar program that has been used in urban settings to support ERH in health care. It has potential for effectiveness in rural settings due to 1) incorporation of strengths-based strategies aligned with cultural frameworks that address family vulnerabilities that are exacerbated by rural poverty and 2) high feasibility and impact in diverse populations. VIP (in-person or telehealth models) has not been studied in rural settings. The primary objective of this application is to support Dr. Roby’s goal of becoming an independent investigator with the aim of improving 1) parent-child ERH and 2) child psychosocial development. This will be achieved through training from an expert multidisciplinary mentorship team and formal coursework. She will gain advanced skills in 1) rural contextual factors that impact ERH 2) telehealth methods 3) qualitative research 4) Implementation Science, and 5) leadership of clinical trials. There are 3 research aims: In Aim 1, Dr. Roby will use qualitative methods to identify facilitators/barriers to engagement in a pediatric primary care parenting intervention for rural families, both broadly and specific to racial/ethnic minority groups. In Aim 2, Dr. Roby will use Aim 1 findings to adapt VIP for rural families, and to test acceptability, feasibility, and adoption/engagement in the adapted VIP models across race/ethnicity. In Aim 3, Dr. Roby will utilize a randomized controlled trial to examine the efficacy of VIP in improving ERH and short term parent (mental health) and child (psychosocial) outcomes. Successful completion of this project will lead to an R01 application to test the efficacy of the intervention in the rural context on a larger scale.