The Smart Beginnings Study tests a comprehensive approach to the promotion of school readiness in low income families, beginning shortly after the birth of the child, through enhancement of positive parenting practices (and when present, reduction of psychosocial stressors) within the pediatric primary care platform. We do so by integrating two evidence-based interventions: a universal primary prevention strategy (Video Interaction Project [VIP]) and a targeted secondary/tertiary prevention strategy (Family Check-up [FCU]) for families with infants/toddlers identified as having additional risks.
VIP provides parents with a developmental specialist who videotapes the parent and child and coaches the parent on effective parenting practices at each pediatric primary care visit. FCU is a home-based, family centered intervention that utilizes an initial ecologically focused assessment to promote motivation for parents to change child-rearing behaviors, with follow-up sessions on parenting and factors that compromise parenting quality.
Two primary care settings serving low-income communities in New York City, NY (Bellevue Hospital) and Pittsburgh, PA (Magee Women’s Hospital and Children’s Hospital) will be utilized to test our integrated intervention in hospital-based clinics, providing information about translation across venues where one of the two interventions has been previously used alone. We are currently testing the VIP/FCU model in a randomized trial of 400 families (200 to VIP/FCU, 200 to routine care) utilizing parent surveys, observational data on parent-child interactions, and direct assessments of children’s development, at key points during intervention follow-up.
Analyses will address questions of program impact for the integrated program across all families and by key subgroups, and the added value of FCU to VIP. At a broader level, we will test whether an integrated primary and secondary/tertiary prevention strategy implemented in pediatric primary care can produce impacts on early school readiness outcomes, including social-emotional, pre-academic, and self-regulation. As such, this study has the potential to provide the scientific and practice communities with information about an innovative approach to promoting school readiness skills among low-income children.
EARLY STEPS MULTISITE STUDY
The Early Steps Project is an ongoing, longitudinal study of 731 ethnically-diverse families from urban (Pittsburgh, PA), suburban (Eugene, OR), and rural (Charlottesville, VA) sites. Families were recruited when children were 2 years old, and at recruitment, all families displayed sociodemographic, family, and child risk factors, suggesting that this cohort of children are at high risk for displaying trajectories of conduct problems (CP) and later drug use.
The Early Steps Multisite study builds on the Pitt Early Steps Pilot Study to examine the efficacy of the Family Check-Up (FCU) intervention in this sample from ages 2 to 16, with intervention ending when children were age 10.5. The study consists of regular home assessments and treatment sessions with families who were randomly assigned to the intervention group. The families were previously assessed annually when children were ages 2 to 5 years old and 7.5 to 10.5 years old Ongoing follow-ups are taking place when youth are ages 15 and 16 years old, involving home assessments of youth functioning, the quality of the family environment, and collection of saliva samples from youth from which to obtain genetic data.
In the current study, impressive intervention effects of the FCU have been found through the school-age period on such child outcomes as child conduct and emotional problems, inhibitory control, language development and academic achievement, as well as maternal depression and social support. Youth outcomes have been reported by parents and teachers at home and school, respectively.
In the current follow-up, we seek to understand whether these intervention effects will continue to be found for child problem behavior, including substance use and high-risk sexual behavior, as well as facets of the home environment (e.g., parental monitoring and well-being). In addition, we will be examining whether intervention effects will be moderated by neighborhood deprivation (i.e., weakened effects in higher-risk neighborhoods) and genetic risk.
LINK TO CHILD AND FAMILY CENTER: http://cfc.uoregon.edu
SAFEKEEPING YOUTH (SKY) STUDY
This project is testing the effectiveness of integrating and adapting two procedures for use in primary care pediatric clinics serving low-income youth: the Urgency Indicator (UI) - a screening tool for high risk of substance use (SU) prior to high school; and the Family Check-Up (FCU) - a brief, family-based program to prevent SU. The project has three aims: 1) to replicate the effectiveness of the UI screening tool in terms of concurrent and predictive validity and the engagement rate in the FCU; 2) to identify and address challenges in implementing and integrating the UI/FCU prevention strategy within a primary care clinic serving urban, low-income youth; and 3) to test the effectiveness of the UI/FCU on emerging SU, sexual activity, and conduct problems, as well as the putative mediators of outcomes including parenting and parental well-being.
500 dyads of parents and their 10- to 13-year-old children from low-income, ethnically diverse families are being recruited from primary care clinics serving low-income families in the Pittsburgh metropolitan area. This sample affords statistical power for effectiveness testing even in subgroups (e.g., age, gender, race). The FCU will be delivered for one or two years to test impact of dosage. Participants will be followed-up one year after completing FCU to evaluate longitudinal outcomes of the integrated UI/FCU. In addition to traditional effectiveness estimates, analyses will test for mediators and moderators of UI/FCU outcomes. This approach represents a critical step toward a transformational advance in SU/SUD prevention by delivering intervention in a setting that offers fiscal self-sustainability, infrastructure for dissemination, and a venue for individualized intervention.
EARLY GROWTH AND DEVELOPMENT STUDIES I AND II
The premise of the Early Growth and Development Study (EGADS) is based on increasing evidence that genetic and social influences are intricately intertwined in early development. EGADS is an adoption study in which the child is genetically unrelated to the adopting parents. This research design allows one to disentangle the distinct influences of genetic and social factors and to delineate the mechanisms by which these two sets of influences may combine. The sample includes 561 "yoked family" adoptive units each consisting of the birth parents, an infant adopted at birth, and the non-related adoptive parents followed from the child’s birth until age 2. Birth parents were assessed for their psychopathology, their competencies and for intrauterine risk shortly after the child's birth and when the children are 18 months. In addition, data are available about prenatal risk, including drug exposure, and genetic data on participating children.
Adopted children have been assessed for behavioral, cognitive, and social characteristics from infancy through age 9, with ongoing assessments for the first of the two cohorts (361 and 200 in size, respectively) at age 10. To date, the study has provided a plethora of findings demonstrating the importance of environmental factors and gene x environment interactions on children’s early development. This study is the first of its kind to examine such issues and general adoption issues such as openness.
LINK TO EGADS WEBSITE: http://www.gwumc.edu/cfr/earlydevelopment/