Promoting Early School Readiness in Primary Health Care

描述(由申请人提供)：亲子互动是入学准备问题中的一个关键的和可修改的因素，这在很大程度上是由于自出生以来的社会和环境问题。需要采取低强度的预防办法，以解决大部分处于发展和社会情感问题风险中的学龄前人口。儿科初级保健为提供有效、低成本的干预措施提供了潜在的环境。 我们提出了一项随机对照试验(RCT)，其中我们比较了两种不同强度的基于初级保健的方法与对照组：1)视频互动项目(VIP)提供与发展专家的会议，该专家将父母和孩子一起玩耍的过程录制下来，与父母讨论录像带，并在每个健康儿童访问的当天提供玩具、书籍和育儿小册子；2)年龄和阶段问卷/积木(ASQ/BB)方法强度较低，每月邮寄BB育儿通讯+以发展活动为中心的玩具，外加每4个月父母完成的ASQ筛选。这两种方法都涉及亲子关系的社会/情感和认知/语言方面。纽约市两家公立医院为贫困、高危社区提供服务的675名新生儿将被纳入这项随机对照试验，并随机接受：A)良好儿童探视时的VIP干预，B)通过邮寄的ASQ/BB干预，或C)常规初级保健(对照)。将对儿童进行跟踪，直至3岁，定期评估家庭照料环境(亲子互动、发展/识字支持)和儿童发展成果(语言、认知、社会情感)。 该项目还希望获得有关孩子们的长期学业成绩信息。通过在具有不同教育、种族、种族、文化适应、压力和风险背景和条件的大样本城市家庭中比较这两种不同强度的干预措施，该研究将检查给定的干预措施是否更适合特定的亚群或风险类别的家庭。这两种干预措施都有足够的定义、低成本和实用性，有可能大规模复制。据设想，VIP和ASQ/BB办法等低成本干预措施可构成根据儿童和家庭的需要和风险水平提供一系列预防服务的总体战略的核心组成部分。

DESCRIPTION (provided by applicant): Parent-child interaction is a crucial, and modifiable factor in school readiness problems, which are due in large part to social and environmental problems operating since birth. Low intensity preventive approaches are needed to address the large segments of the preschool population at-risk for developmental and social-emotional problems. Pediatric primary care offers a potential setting for delivering effective, low cost interventions. We propose a randomized controlled trial (RCT) in which we compare two primary care-based approaches of different intensities to a control group: 1) the Video Interaction Project (VIP) provides sessions with a developmental specialist, who videotapes the parent and child playing together, discusses the videotape with the parent, and provides toys, books and parenting pamphlets on the day of each well child visit; 2) the Ages & Stages Questionnaire / Building Blocks (ASQ/BB) approach is lower intensity, and provides monthly mailed BB parenting newsletters + toys centered on a developmental activity, plus parent-completed ASQ screenings every 4 months. Both approaches address social/affective as well as cognitive/language aspects of the parent-child relationship. 675 newborns at two NYC public hospitals serving poor, high risk communities will be enrolled in this RCT and randomized to receive: A) VIP intervention at well child visits, B) ASQ/BB intervention by mail, or C) routine primary care (control). Children will be followed through age 3 years with periodic assessment of the home caregiving environment (parent-child interaction, developmental / literacy support) and of child developmental outcomes (language, cognition, social-emotional). The project hopes to also obtain long-term school outcome information on the children. By comparing these two interventions of varying intensity within a large sample of urban families with a diverse range of educational, ethnic, racial, acculturation, stress, and risk backgrounds and conditions, the study will examine whether a given intervention is more suited to specific subgroups or risk categories of families. Both interventions are sufficiently well defined, low cost and practical to have the potential for wide scale replication. It is envisioned that low cost interventions such as the VIP and ASQ/BB approaches could form core components of an overall strategy providing a continuum of preventive services depending on the children's and families' needs and level of risk.