Integrated model for promoting parenting and early school readiness in pediatrics

描述（由申请人提供）：我们提出的研究测试了一种全面的方法来促进低收入家庭的入学准备，在孩子出生后不久开始，通过加强积极的育儿实践（以及当存在时，减少心理社会压力）在儿科初级保健平台。我们通过整合两种循证干预措施来实现这一目标：1）普遍的一级预防策略（视频互动项目[VIP]）; 1、2和2）针对有婴儿/幼儿的家庭的有针对性的二级/三级预防策略（家庭检查[FCU]）。VIP为父母提供一位发展专家，他会为父母和孩子录像，并在每次儿科初级保健访问时指导父母有效的育儿实践。FCU是一个以家庭为基础，以家庭为中心的干预措施，利用最初的生态评估，以促进父母改变育儿行为的动机，并就育儿和影响育儿质量的因素进行后续会议。两个服务于纽约州纽约市和宾夕法尼亚州匹兹堡市低收入社区的初级保健机构将被用来测试我们在医院诊所的综合干预措施，提供关于在两种干预措施之一以前单独使用的场所之间的转换的信息。此外，我们还将利用由一项名为“伸出手来阅读”（ROR）的倡议开发的实践网络，为以后的传播提供基础设施。我们计划在500个家庭的随机试验中测试VIP/FCU模型（200个VIP/FCU，200个常规护理，100个单独VIP），利用父母调查，亲子互动的观察数据，以及在干预随访期间的关键点对儿童发育的直接评估。分析将解决方案对所有家庭和关键亚组的综合方案的影响问题，以及FCU对VIP的附加值。这项研究的最大贡献是测试在儿科初级保健中实施的综合一级和二级/三级预防策略是否会对早期入学准备结果产生影响，包括社会情感，学前教育和自我调节。因此，这项研究有可能为科学界和实践界提供有关创新方法的信息，以促进低收入儿童的入学准备技能。

DESCRIPTION (provided by applicant): Our proposed study tests a comprehensive approach to the promotion of school readiness in low-income families, beginning shortly after the birth of the child, through enhancement of positive parenting practices (and when present, reduction of psychosocial stressors) within the pediatric primary care platform. We do so by integrating two evidence-based interventions: 1) a universal primary prevention strategy (Video Interaction Project [VIP]); 1, 2 and 2) a targeted secondary/tertiary prevention strategy (Family Check-up [FCU]) 3 for families with infants/toddlers identified as having additional risks. VIP provides parents with a developmental specialist who videotapes the parent and child and coaches the parent on effective parenting practices at each pediatric primary care visit. FCU is a home-based, family-centered intervention that utilizes an initial ecologically- focused assessment to promote motivation for parents to change child-rearing behaviors, with follow-up sessions on parenting and factors that compromise parenting quality. Two primary care settings serving low-income communities in New York City, NY and Pittsburgh, PA will be utilized to test our integrated intervention in hospital-based clinics, providing information about translation across venues where one of the two interventions has been previously used alone. Also, we will leverage the practice network developed by an initiative known as Reach Out and Read (ROR), 4 providing an infrastructure for later dissemination. We plan to test the VIP/FCU model in a randomized trial of 500 families (200 to VIP/FCU, 200 to routine care, 100 to VIP alone) utilizing parent surveys, observational data on parent-child interactions, and direct assessments of children's development, at key points during intervention follow-up. Analyses will address questions of program impact for the integrated program across all families and by key subgroups, and the added value of FCU to VIP. The largest single contribution made by this study is to test whether an integrated primary and secondary/tertiary prevention strategy implemented in pediatric primary care can produce impacts on early school readiness outcomes, including social-emotional, pre-academic, and self-regulation. As such, this study has the potential to provide the scientific and practice communities with information about an innovative approach to promoting school readiness skills among low-income children.