CenteringParenting Clinical Intervention on Kindergarten Readiness in Early Childhood

Children raised in environments with limited stimulation and lack of exposure to positive
interactions are likely to have developmental delays in expressive and receptive language,
vocabulary, social skills, behavior—all factors critical for school readiness. Children who
enter kindergarten underprepared are more likely to struggle academically and experience
lower school achievement, and ultimately impaired opportunities for economic and social
mobility as adults.

The CenteringParenting intervention is designed to reduce negative health and developmental
outcomes within a model of group routine child health care. This bundled intervention
supports healthy parent-child interactions and early learning through education and
experiential learning within a group well-child visit model. The intervention reduces social
isolation and creates a community of support for caregivers, as well as utilizes a positive
parenting approach to empowering parents with knowledge and skills to support optimal child
development. The CenteringParenting intervention includes written materials provided at an
annual clinical visit, as well as specific training for the facilitators/providers. To date,
there is no research evidence of the benefits of the CenteringParenting intervention on
school readiness, or improvements in parental behaviors that support optimal developmental
milestones and achievement.

Study Design: A multi-site, cluster randomized controlled trial evaluating the impact of the
CenteringParenting clinical intervention on kindergarten readiness, as measured by expressive
and receptive language and vocabulary at 24 months of age.

Objective Hypothesis: Compared to those receiving standard routine health care, the
CenteringParenting intervention will result in improved language development at age 2 years
and increased parental behaviors to encourage reading, talking and playing.

Specific Aim 1: In a cluster randomized controlled trial, assess the effectiveness and
implementation of the CenteringParenting intervention. Specific Aim 2: Evaluate the fidelity
of the implementation of the CenteringParenting intervention. Specific Aim 3: Evaluate
caregivers' experience and engagement with the CenteringParenting intervention model and
explore the relation between degree of engagement and development stimulating behaviors.

Primary outcomes are: expressive and receptive language and vocabulary based on the
MacArthur-Bates Communicative Development Inventory (CDI) and Preschool Language Scale-5
(PLS-5) 5th Edition Parent Questionnaire. The secondary outcome is: parental behavior based
on the Stim-Q (a reliable and valid measure of cognitive stimulation provided in the home).

Inclusion Criteria:

For participating practice sites

- Practice provides care to patients who are covered by public insurance and/or
uninsured (no minimum threshold: all insurance types eligible)

- Practices have at least 3,000 primary care visits per year

For parent-child dyad

- Index child age must be 0-3 months

- Parent must be female

- Parent must be 18 years of age and older

- Parent and child must attend one of the 10 study clinical sites

- Parental consent

- Parent must be fluent in English or Spanish

Exclusion Criteria:

For participating practice sites

- Does not accept public insurance

For parent-child dyad

- Child born prior to 34 weeks gestation

- Child with chronic conditions known to affect neurodevelopment

- Child with a positive screen on the Children with Special Healthcare Needs screener