Jump Start+:COVID Support to improve resiliency and mitigate risks in childcare centers serving children from low-income ethnic minority backgrounds.

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Background. This is a Type 1 hybrid effectiveness-implementation trial studying the role of a community- based, childcare center-support system in improving resilience and mitigating the long-term impacts of the pandemic on child development. Public health disasters have disproportionate and long-term impacts on poor, disenfranchised communities. Miami-Dade County has one of the US's highest rates of chronic poverty, is minority majority, and has been an epicenter of the pandemic. COVID-19 is having psychosocial impacts on children that is producing anxiety, irritability, anger, and depression. Teachers in childcare centers continue to be overwhelmed by changing guidelines and how to address the downstream psychological effects children are experiencing. While numerous resources exist that can help childcare centers with disaster recovery, the information can be overwhelming and difficult to navigate, and research is yet to show the actual benefits of the resources. Approach. We will leverage our existing community-based intervention, Jump Start, with its extensive reach in Miami-Dade County, to childcare centers participating in the County’s Quality Improvement System. This system prioritizes children living in poverty who are at highest risk for problems. This study will be modeled on a successful Early Childhood Mental Health Consultation (ECMHC) intervention which utilizes mental health consultants to deliver a Jump Start+: COVID Support virtual toolkit to childcare centers via a Kubi robot. The toolkit is comprised of four strength-based strategies likely to be effective in improving resiliency following disasters: Safety Planning, Effective Communication, Adult Self-Care, and Trauma-Informed Behavior Support. We will use Reach, Effectiveness-Adoption, Implementation, Maintenance (RE-AIM) framework to guide the evaluation of our Type 1 hybrid design. Our first aim will utilize a cluster randomized trial to examine the effectiveness of Jump Start+: COVID Support on improving the psychosocial functioning of young children, as compared to an obesity-prevention intervention control group. Child development is the primary outcome, with children followed at 6, 12,18, and 24 months. The second aim will examine the mechanisms that contribute to effective teachers’ uptake of Jump Start+: COVID Support strategies on child outcomes. The third aim will explore implementation barriers/facilitators as well as potential societal contextual factors (e.g., vaccine uptake) to help centers serving disproportionately affected minority communities recover from and prepare for future crises. Impact. These aims meet a high-priority research area for NICHD because they address the social and environmental factors that can enhance children’s resilience. Employing a Type 1 hybrid design will inform the refinement and scaling of Jump Start+: COVID Support and generalize impacts to other childcare center interventions in the context of disasters. We have the potential to influence long-term trajectories of childcare center practices and child development which, in turn, can chart a course for future child health and well-being in the face of crises.