Promoting Early School Readiness in Primary Healthcare

描述（由申请人提供）：贫困与幼儿发展，入学准备和教育成就的差异密切相关。差距的早期出现和长期存在突出表明，必须在入学前采取有效的干预措施。响应父母是一个有希望的干预目标，以减少这些差距。虽然家访方案有可能影响父母的养育，但接触人口和费用是实施的障碍。儿科初级保健是一个创新机会，可以促进养育子女，有可能普及到学龄前（0-5岁）人口，并通过建立现有基础设施降低成本。视频互动项目（VIP）的目的是利用儿科初级卫生保健提供的机会，以减少成就差距低SES儿童通过促进响应父母。VIP的核心战略包括一名儿童发展专家，他利用提供的玩具和书籍在录像互动期间指导父母;审查录像带是为了促进和加强互动。通过向父母提供磁带以及学习材料和载有父母意见和计划的育儿小册子，促进在家中使用VIP战略。在NIH资助的第一个周期中，我们进行了一项随机对照试验，发现VIP 0-3（最初的0至3年计划）与响应式育儿和儿童早期发展有关的主要益处;许多效应量在0.3至0.6的范围内，对于育儿干预来说是显着的。这些结果表明，VIP是一个非常有前途的，以证据为基础的干预措施，以解决儿童的贫困相关的发展和教育的差距。纵向和干预研究表明，在学前3-5年期间，进一步加强响应式育儿有可能对入学准备产生额外的影响，特别是对于低社会经济地位的家庭，他们的孩子面临最大的风险，但他们很少有机会获得高质量的学前教育计划。因此，我们为3-5岁的儿童开发了一个新的VIP学前教育部分（VIP 3-5）。VIP 3-5有一个扩大的重点，以帮助家长参与他们的孩子在越来越丰富的假装游戏和早期识字活动的水平，增加了新的元素，改编自循证学前教育计划，为家长使用假装游戏和共享阅读。这一延续将在现有队列的基础上，评估从出生到5岁的VIP影响。最初接受VIP 0-3或0-3岁对照组的家庭将在3岁时重新随机分配至VIP 3-5或3-5岁对照组。这项研究设计将允许测试VIP的影响（0-3，3-5和组合），并确定这种已经试验过的干预措施是否会显著改善儿童的长期学业和社会情感健康。它还将允许在入学前几年测试与父母干预的最佳时机和剂量有关的关键问题。调查结果将有广泛的公共卫生的影响，儿科初级卫生保健的作用，在促进儿童早期发展和入学准备的风险，由于贫困的儿童。 公共卫生相关性：在儿童早期发展、入学准备和教育成就方面，与贫穷有关的差距很早就出现，而且长期存在，这突出表明有必要在入学前采取有效的干预措施。我们开发了视频互动项目（VIP），以利用儿科初级卫生保健提供的机会（普及学龄前人口的潜力，通过建立现有基础设施降低成本），通过促进响应式育儿来减少与贫困相关的差距。调查结果将有广泛的公共卫生的影响，儿科初级卫生保健的作用，在促进儿童早期发展和入学准备的风险，由于贫困的儿童。

DESCRIPTION (provided by applicant): Poverty is strongly related to disparities in early child development, school readiness and educational achievement. The early emergence and long-term persistence of disparities underscore the need for effective interventions prior to school entry. Responsive parenting is a promising target for interventions to reduce these disparities. While home visitation programs have potential to influence parenting, access to populations and costs are barriers to implementation. Pediatric primary health care is an innovative opportunity to promote parenting with potential for universal access to the preschool (0-5 year) population and low cost by building on existing infrastructure. The Video Interaction Project (VIP) is designed to leverage the opportunity presented by pediatric primary health care in order to reduce achievement gaps in low SES children through promotion of responsive parenting. VIP's core strategy involves a child development specialist who coaches the parent during videotaped interactions utilizing provided toys and books; review of tapes is used to facilitate and reinforce interactions. Use of VIP strategies at home is facilitated by providing the parent with the tape as well as learning materials and parenting pamphlets incorporating parents' observations and plans. In the first cycle of NIH funding, we performed an RCT that found major benefits resulting from VIP 0-3 (the original 0 to 3 year program) related to responsive parenting and early child development; many effect sizes were in the .3 to .6 range, remarkable for a parenting intervention. These results suggest that VIP is a highly-promising, evidence- based intervention for addressing children's poverty-related developmental and educational disparities. Longitudinal and intervention studies suggest that further enhancement of responsive parenting during the preschool 3-5 year period has potential for additional impact on school readiness, particularly for low SES families whose children are at greatest risk but who have less access to high quality preschool programs. We therefore developed a new preschool component of VIP for 3-5 year old children (VIP 3-5). VIP 3-5 has an expanded focus to help parents engage their children in increasingly rich levels of pretend play and early literacy activities, adding new elements adapted from evidence-based preschool programs for parents to use pretend play and shared reading. This continuation will assess the impact of VIP from birth to 5 years, building on the existing cohort. Families originally receiving VIP 0-3 or in the 0-3 year Control group will be re- randomized at age 3 years to either VIP 3-5 or to a 3-5 year control group. This study design will allow testing of the impact of VIP (0-3, 3-5, and combined) and determination of whether this already-trialed intervention leads to significant improvements in children's long term academic and social-emotional wellbeing. It will also allow testing of critical questions related to optimal timing and dose of parenting intervention during the years prior to school entry. Findings will have broad public health implications related to the role of pediatric primary health care in the promotion of early child development and school readiness in children at risk due to poverty. PUBLIC HEALTH RELEVANCE: The early emergence and long-term persistence of poverty-related disparities in early child development, school readiness and educational achievement underscore the need for effective interventions prior to school entry. We developed the Video Interaction Project (VIP) to leverage the opportunity presented by pediatric primary health care (potential for universal access to the preschool population, low cost by building on existing infrastructure) in order to reduce poverty-related disparities through promotion of responsive parenting. Findings will have broad public health implications related to the role of pediatric primary health care in the promotion of early child development and school readiness in children at risk due to poverty.