Promoting Early School Readiness in Primary Health Care

This project will measure the degree to which parenting programs based in pediatric primary
care can be effective in promoting language development and school readiness in at-risk young
children. The study will represent a collaboration between the Department of Pediatrics at
New York University School of Medicine - Bellevue Hospital Center, the Medical and Health
Research Association of New York City, Inc., and the Center for Research on Culture,
Development and Education at New York University Steinhardt School of Education. Initial
funding was provided by NICHD for 4 years. NICHD provided 5 additional years of competing
renewal funding beginning in July, 2010.

The study is a randomized controlled trial in which two different primary care-based
parenting programs will be compared to a control group in a population that is at risk on the
basis of poverty. The two programs represent varying levels of low intensity, but each has
the same goals: enhancing parent-child interaction in order to improve language, cognitive
and social-emotional development and ultimately promote school readiness and school
performance.

One program is called the "Video Interaction Project". While waiting to see the primary care
provider for well child care, the family meets with a child development specialist, who
videotapes the parent and infant interacting together. The videotape is then rewound and
watched together by the parent and child development specialist. This leads to a discussion
about child development, infant cues and parenting, with the child development specialist
building on observed strengths in the interaction. In addition, families are provided with
parenting pamphlets developed for the project, and with inexpensive developmentally
stimulating toys.

The other program is called the "ASQ-Building Blocks Project". This project employs a public
health approach to facilitate parental engagement in child development. Families are sent
monthly newsletters that focus on child development, infant cues and parenting; included with
each newsletter is an inexpensive, developmentally stimulating toy. In addition, families
periodically receive Ages and Stages Questionnaires, which they complete and mail back to the
program. Based on the questionnaires, the program determines whether the infant has screened
positive for possible developmental delay and provides this information to both the family
and the primary care provider.

The study will take place at Bellevue Hospital Center, a public hospital serving low
socioeconomic status families from throughout New York City. Infant-mother dyads will be
enrolled during the postpartum period and followed through age 2 years. Periodic assessments
will be performed of parent-child interaction and child developmental outcome.

At age 3 years, VIP and control families were re-randomized to receive either additional VIP
from age 3 to 5 years or to control during that period. This factorial design will allow for
assessment of dose and timing in relation to outcomes.

We further plan to follow children into school, so that we can assess long-term educational
outcomes including standardized test scores. Should long-term funding be obtained, we will
follow children through high school to assess intervention impacts on graduation rates.

Inclusion Criteria:

- Intention to receive primary care in the well-child clinic (FCC or newborn clinic) at
Bellevue Hospital Center.

- Intention to remain in the New York City area for at least 3 years.

- Primary caregiver's language is English or Spanish.

- Birthweight 2000gm or higher

- Gestational age 35 weeks or higher

Exclusion Criteria:

- Significant newborn medical complication

- Significant congenital anomaly or syndrome