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Promoting Early School Readiness in Primary Health Care

Abstract

Child health care may represent the sole universal platform for preventive interventions to address poverty-related disparities in development and early school readiness prior to age 3 years. Responsive parenting represents a promising target for child health care interventions, as it is strongly linked to poverty-related disparities and can be enhanced through targeted strategies. Health care based interventions to enhance responsive parenting have the potential to be implemented population-wide at low cost, by building on existing health care visits and infrastructure.

Beginning in 1998, our interdisciplinary team of investigators in pediatrics, developmental psychology and education developed and studied a child health care intervention for parents and their 0 to 3 year old children called the Video Interaction Project (VIP 0-3). VIP 0-3 targets responsive parenting, with emphasis on strategies supported by both experimental and longitudinal work. The core component is videotaping of mother and child, with subsequent review and self-reflection facilitated by a child development specialist in order to identify and reinforce observed interactional strengths. Additional components are written pamphlets with suggestions for play and shared reading, and developmentally appropriate toys and books. Results from both our pilot study and our current RCT (NICHD 5R01HD047740-05) suggest that VIP 0-3 results in enhancement of responsive parenting and of cognitive, language and social-emotional development during the first 3 years, with potential for savings in Early Intervention (EI) costs; preliminary follow-up pilot data suggest improved IQ, word reading and behavior in first grade.

This is a proposal to determine whether continuation of VIP during the preschool period from ages 3 to 5 years (VIP 3-5) would result in additional impacts on responsive parenting and school readiness, through study within the existing NICHD-funded cohort. Although there has been no prior study of VIP during the preschool period, studies of home- and school-based programs suggest that enhancement of responsive parenting during the preschool period has additive effects beyond that of either parenting programs during the infant/toddler period or preschool attendance. Enhancement of responsive parenting during the preschool period is likely to be especially important for low SES families such as those participating in VIP 0-3, who have children at greatest risk of disparities but less access to high quality preschool programs. Continuity of activities related to play and shared reading as well as relationships built with VIP 0-3 and health care staff increase the likelihood of both adherence and efficacy.

We designed VIP 3-5 to promote responsive parenting around play and shared reading in order to impact academic-cognitive skills and social-emotional behaviors related to subsequent school achievement, in part through targeting self-regulation characteristics (executive functions and emotional regulation) that underlie these skills and behaviors. Building on existing VIP 0-3 curricular elements related to responsive parenting, VIP 3-5 has an expanded focus designed to help parents engage their children in increasingly rich levels of pretend play and early literacy activities, and integrate pre-academic activities in these contexts. In order to achieve this goal, VIP 3-5 adds specific new elements adapted from evidence-based preschool and home visitation parenting programs for parents to utilize within pretend play and shared reading.

To the extent that VIP (both 0-3 and 3-5) shows large impacts on responsive parenting and school readiness, the opportunity afforded by integration into child health care at relatively low expense has the potential to lead to widespread dissemination and implementation. Findings from this study will inform subsequent proposals for 1) assessment of effectiveness as VIP is disseminated and 2) determination of whether enhancement of parenting through VIP has additive effects for children attending preschool. Grant ID: 200