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

促进儿科育儿和早期入学准备的综合模型：后续行动和为规模化做好准备

• 批准号: 10237365
• 负责人: ALAN L. MENDELSOHN
• 金额: $ 108.74万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10237365
• 关键词: 2 year old; 3 year old; Address; Age; Birth; Child; Child Development; Child Rearing; Childhood; Cost Analysis; Data; Databases; Economically Deprived Population; Family; Funding; Health; Healthcare; Heterogeneity; Home visitation; Infant; Intervention; Link; Mediation; Mediator of activation protein; Modeling; National Institute of Child Health and Human Development; New York; Nursery Schools; Outcome; Outcome Assessment; Parents; Pediatrics; Periodicity; Policies; Population; Poverty; Prevention; Primary Health Care; Primary Prevention; Problem behavior; Randomized Controlled Trials; Readiness; Resources; Risk; Schools; Services; Site; Social Work; Subgroup; System; Testing; Time; Toddler; Translating; Translations; Work; base; checkup examination; cost; early childhood; early screening; efficacy evaluation; follow-up; high risk population; human capital; improved; innovation; intervention refinement; literacy; lower income families; maternal depression; prevent; preventive intervention; programs; psychosocial; scale up; skills; social disadvantage; stressor; targeted delivery; treatment response

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.

抽象的 尽管旨在改善儿童学校状况的育儿干预措施对家庭产生了有据可查的影响 低收入家庭的准备工作在人口层面取得的进展有限。主要障碍 包括家庭的识别和参与、可扩展性和低成本可持续性的挑战 现有的服务系统，以及即使在高风险人群中风险的异质性。亲子关系中的脆弱性 关系健康与儿童入学准备程度的损害有关；然而，此类漏洞尚未得到解决 系统地纳入人口层面的战略，从而限制了人口层面的进步。 Smart Beginnings (SB) 模型 (R01HD076390-05) 是一个从出生到 3 年的计划，解决了以下每个问题： 这些障碍是通过以下方式消除的：1）利用儿科初级保健作为一个通用平台，以促进人口 参与度和可扩展性； 2) 通过全民初级教育提供分级预防干预措施 预防（视频互动项目[VIP]，通过医疗保健提供）与选择性的、有针对性的预防措施相结合 二次干预（家庭检查 [FCU]，通过战略性家访进行）。一个重要的 SB方法的创新在于定期、系统地筛查早期亲子关系健康 通过解决生态和近端压力源，为有针对性地提供养育支持提供信息的风险。 SB 中集成的两种干预措施（VIP 和 FCU）都为以下方面带来了持续影响的既定记录： 低收入家庭。我们当前的研究（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) 中检验了综合模型的影响，该试验涉及 400 个家庭 可扩展的平台：儿科初级保健。初步调查结果显示，2 岁时的初步结果表明 实质性承诺，对关系健康产生积极影响（加强对婴儿/幼儿的养育）和 儿童发展（减少幼儿问题行为），为以后的入学准备铺平道路。 当前的提案旨在以这项工作为基础，完成 SB 模型到 3 岁儿童的交付 在随机对照试验中对 4 岁和 6 岁的儿童进行评估，以确定早期影响是否 SB 对关系健康和儿童早期发展的分层干预转化为后来的益处 上学准备。此外，该提案将解决改进和改进所必需的重要差距。 实施像 SB 这样的分层预防模型，包括：1）了解行动机制（即 SB 在所有家庭中通过干预提供进行调解），以及 2）基于治疗反应的调节 财务/人力资本和心理社会风险的基线差异。申请结果将 提供项目功效的长期测试，并提供支持下一阶段扩展的信息。完成 研究目标将直接支持 NICHD 的优先事项，寻求优化经济方面的入学准备技能 和社会弱势儿童，可能会导致政策和实践发生变革。