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Bridging the Gap: Helping Parents and Kids in Poverty

A person making a heart with their hands around a baby's feet
Education programs and interventions that begin shortly after birth have shown to significantly improve parenting of children growing up in poverty, according to a national study led by the University of Pittsburgh and New York University.

The study, from Pitt’s Department of Psychology and UPMC Children’s Hospital of Pittsburgh along with NYU’s School of Medicine and Steinhardt School of Culture, Education and Human Development was published Feb. 19 in the journal Pediatrics. It examines the Smart Beginnings Project, a first-of-its-kind comprehensive approach promoting school readiness in low-income families. This model addresses one of the most important causes of inequity—that many children from low-income families start school behind and may never catch up.

“These findings are significant because they signal that a universal program, the Video Interaction Project, previously only tested in pediatric primary care with primarily immigrant Latino families in New York City, also supports parent skills for promoting cognitive and language development for ethnically diverse, low-income parents living in Pittsburgh,” said principal investigator Daniel Shaw, distinguished professor of psychology at Pitt's Kenneth P. Dietrich School of Arts and Sciences and director of its Center for Parents and Children.

Check-ups and home visits

Smart Beginnings addresses these longstanding challenges by integrating a universal program offered to all families as well as a selective program offered to only those with additional family risk factors:

  1. Video Interaction Project (VIP—universal program): Delivered during pediatric well-child visits up to 3 years of age by a trained parenting coach who meets with the family, this project provides a children's book or toy and records a brief video of the parent and child reading or playing. They then watch the video together, which strengthens relationships between parents and children during this critical period for brain development from birth to 3 years of age.
  2. Family Check-up (selective program) delivered by a masters-degree level family coach at the home of families identified as having additional family challenges such as parent well-being or low social support. The program embeds motivational interviewing and evidence-based family management approaches that are tailored to the individual family's needs and goals to promote parent-child relationship quality and prosocial child development.

“In future publications, we hope to demonstrate the additional impact of the full Smart Beginnings model, which also incorporates the more selective Family Check-up intervention,” Shaw said. “Theoretically, adding Family Check-up to the Video Interaction Project for low-income families with additional family stressors holds the promise of finding comparable and sustained effects on parenting and children’s developing cognitive and social development for higher-risk, low-income families in both New York City and Pittsburgh.”

Besides Shaw, the other principal investigators were Alan Mendelsohn, professor in the departments of pediatrics and population health and the Division of Developmental-Behavioral Pediatrics at NYU Grossman School of Medicine, and Pamela Morris, interim dean of NYU’s Steinhardt School of Culture, Education, and Human Development. The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health.

"Lack of opportunities for pretend play and children's book reading leaves children, particularly those in poverty, less prepared for learning, less healthy, and is even linked with lower income throughout their lives," Mendelsohn said. "Smart Beginnings provides a practical approach for helping all children have an equal start in school and in life."

Findings: More time together

The two-site study replicates and extends prior VIP findings across racially and ethnically diverse families in New York City and Pittsburgh. The results showed large increases in parents' engaging their children in reading, playing and talking. Comparable impacts across the two sites supports the feasibility for parents from diverse geographic locations and racial/ethnic backgrounds to improve parent-child interactions.

Researchers conducted a randomized controlled trial for more than a year, starting in the postpartum units at both NYC Health + Hospitals/Bellevue, affiliated with NYU Langone Health, and UPMC Children's Hospital of Pittsburgh. Families were then randomly assigned to either the Smart Beginnings project or a control group, which received standard pediatric care. The study will continue to follow families over time.

Other co-authors from Pitt include Anne Gill, co-director of the Center for Parents and Children; Debra Bogen, director of the Allegheny Health Department and professor of pediatrics, psychiatry, and clinical and translational science; Johana Rosas, project coordinator, Smart Beginnings Study; Katherine Hails, graduate student, Department of Psychology; and Kelly Chadwick, research assistant, Parents and Children Laboratory.

Adapting to a pandemic

With childcare programs closed and social distancing measures in place, many children are missing out on opportunities for development. Pediatricians have noted delays in speech and language as well as trouble sharing and being in groups.

"Children are not getting the cognitive and social experiences that they would normally get outside their home," said Mendelsohn. "Numerous studies suggest that COVID-19 is causing challenges and stressors for families that will affect children throughout their lives, yet there has been little attention to the effects of the pandemic on families with very young children."

Over the last year, the Smart Beginnings model has been adapted to be used online to support families in isolation during the pandemic. Most recently, VIP has expanded to Flint, Michigan, a community deeply affected by a major crisis when its drinking water was contaminated by lead. In Pittsburgh, VIP and Family Check-up are two of the evidence-based interventions being offered as part of the Early Childhood Community Collaborative of The Pittsburgh Study, a population-level initiative to make preventive interventions accessible to support early child thriving in the local community.