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Overview

The SMART Beginnings project 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: 1) a universal primary prevention strategy (Video Interaction Project [VIP]); and 2) a targeted secondary/tertiary prevention strategy (Family Check-up [FCU]) for families 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 individualized follow-up sessions on parenting and factors that compromise parenting quality.

Two pediatric primary care settings serving low-income communities in New York City, NY and Pittsburgh, PA are utilized to test the integrated intervention in hospital-based clinics, providing information about translation across venues where one of the two interventions has been previously used alone.

The VIP/FCU model is tested in a randomized control trial, 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.

The largest single contribution made by this study is to 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 and strategic approach to promoting school readiness skills among low-income children.

Drs. Pamela Morris (NYU), Alan Mendelsohn (NYU School of Medicine), and Daniel Shaw (University of Pittsburgh) have received support and funding for this project from the National Institutes of Health.