Promoting Early School Readiness in Primary Health Care

亲子互动是入学准备问题的一个关键和可改变的因素， 很大程度上是由于自出生以来就存在的社会和环境问题。低强度预防方法 需要解决大部分学龄前人口面临发展和社会风险的问题， 情绪问题儿科初级保健提供了一个潜在的环境，提供有效的，低成本的 干预措施。我们提出了一项随机对照试验（RCT），在该试验中，我们比较了两种基于初级保健的 不同强度的方法：1）视频交互项目（VIP）提供会话 与一位发展专家，谁录像的父母和孩子一起玩，讨论 与家长一起录像，并在每个孩子出生当天提供玩具，书籍和育儿手册 访问（费用240美元/儿童/年）; 2）年龄和阶段问卷/积木（ASQ/BB）方法较低 强度，并提供每月邮寄的BB育儿通讯+玩具集中在一个发展活动， 加上父母每4个月完成一次ASQ筛查（费用为100美元/儿童/年）。这两种方法都涉及 社会/情感以及认知/语言方面的亲子关系。675个新生儿在两岁时出生 为贫困、高风险社区服务的纽约市公立医院将入组本RCT，并随机分配至 接受：A）健康儿童访视时的VIP干预，B）邮寄ASQ/BB干预，或C）常规初级保健 （对照）。儿童将被随访至3岁，并定期评估家庭状况。 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）。该项目还希望获得长期的学校成果 关于孩子们的信息。通过在大样本中比较这两种不同强度的干预措施， 城市家庭的教育，民族，种族，文化适应，压力和风险的多样性 背景和条件，研究将检查是否一个给定的干预更适合于特定的 家庭的亚组或风险类别。这两种干预措施都有充分明确的定义，成本低， 具有大规模复制的潜力。据设想，低成本的干预措施，如 重要人物和ASQ/BB方法可以构成整体战略的核心组成部分，提供一个连续的 根据儿童和家庭的需要和风险程度提供预防服务。

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 (cost $240/child/yr); 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 (cost $100/child/yr). 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.