Promoting Early School Readiness in Primary Healthcare

描述（由申请人提供）：贫困与儿童早期发展、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，需要在入学前进行有效干预。响应式养育是减少这些差异的干预措施的一个有希望的目标。虽然家访计划有可能影响育儿，但接触人口和费用是实施的障碍。儿科初级卫生保健是一个促进养育子女的创新机会，有可能普遍向学龄前（0-5岁）人口提供服务，并在现有基础设施的基础上降低成本。视频互动项目旨在利用儿科初级保健提供的机会，通过促进响应式养育，缩小低经济社会地位儿童的成就差距。VIP的核心策略包括一名儿童发展专家，他利用提供的玩具和书籍在视频互动中指导家长；回顾磁带是用来促进和加强互动。通过向家长提供录像带、学习材料和包含家长观察和计划的育儿小册子，可以促进在家中使用VIP策略。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0-3年计划）带来的主要好处与响应式养育和儿童早期发展有关；许多效应值都在。3 . to…6个范围，对于父母干预来说是很了不起的。这些结果表明，VIP是一个非常有前途的、基于证据的干预措施，用于解决儿童与贫困相关的发展和教育差异。纵向和干预研究表明，在学前3-5年期间，进一步加强响应式养育对入学准备有潜在的额外影响，特别是对于那些孩子风险最大但较少获得高质量学前教育项目的低社会经济地位家庭。因此，我们为3-5岁的儿童开发了一个新的VIP学前组件（VIP 3-5）。VIP 3-5扩展了重点，帮助父母让孩子参与到越来越丰富的假装游戏和早期识字活动中，增加了基于证据的学前教育项目的新元素，供父母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VIP从出生到5岁的影响。最初接受VIP 0-3或0-3年对照组的家庭将在3岁时重新随机分配到VIP 3-5或3-5年对照组。这项研究设计将允许测试VIP（0- 3,3 -5和组合）的影响，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。它还将允许测试与入学前几年父母干预的最佳时机和剂量有关的关键问题。研究结果将对儿童初级保健在促进因贫困而面临风险的儿童早期发育和入学准备方面的作用产生广泛的公共卫生影响。

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.