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Innovative Programs Address Inequality in Young Children’s Development

Adult male and child look eye-to-eye


Parent education programs and interventions that begin shortly after the birth of a child have been shown to significantly impact parenting behaviors that support social and academic engagement for children growing up in poverty, according to a study led by pediatricians and psychologists across the country, including NYU Grossman School of Medicine, NYU Steinhardt School of Culture, Education, and Human Development, and the University of Pittsburgh.

The study, published online February 19 in the journal Pediatrics, examines the Smart Beginnings project, a first-of-its-kind comprehensive approach to the promotion of 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.

“Lack of opportunities for pretend play and children’s book reading leaves children, particularly those in poverty, less prepared for learning and less healthy, and is even linked with lower income throughout their lives,” says Alan L. Mendelsohn, MD, professor in NYU Langone’s Departments of Pediatrics and Population Health, director of research in the Division of Developmental–Behavioral Pediatrics, and one of the study’s principal investigators. “Smart Beginnings provides a practical approach for helping all children have an equal start in school and in life.”

Smart Beginnings addresses these longstanding challenges by integrating the Video Interaction Project, reaching families during routine pediatric check-ups, with a second targeted program, Family Check-Up, during at-home visits for families identified as having additional risks and challenges.

The Video Interaction Project is provided to families at the child’s well-visit early in infancy. During the session, a trained parenting coach meets with the family, provides a children’s book or toy, and records a brief video of the parent and child reading or playing. The video is watched together in real-time to support family strengths and goals. This process strengthens relationships between parents and children during this critical period for brain development in children from birth to 3 years of age.

The second targeted program, Family Check-Up, is home based and family centered for those found to have added risks and challenges. Family Check-Up helps families see their strengths and think about their challenges. The program uses clinical-level guidance tailored to the family’s needs and goals to provide additional support to families who need it.

What the Study Showed

The two-site study replicates and extends prior Video Interaction Project findings across racially and ethnically diverse families in New York City and Pittsburgh.

The results of the study showed large increases in parents engaging their children in reading, playing, and talking, measured by surveys and observing parents reading and playing with their children. Comparable impacts across the two sites supports the feasibility for parents from diverse geographic locations and racial and ethnic backgrounds to improve parent–child interactions. The study also supports bringing this model “to scale” as an inexpensive solution for reaching families in need.

“One clear advantage of providing parents with a program like the Smart Beginnings project is that it can be delivered at about one tenth of the cost of other programs with comparable impacts,” says lead author Erin Roby, PhD, developmental psychologist and research scientist at NYU Langone. “Smart Beginnings had large impacts, demonstrating that this model has the potential to address some of the most important equity issues of our time.”

Researchers conducted a randomized controlled trial at two sites: NYC Health + Hospitals/Bellevue, affiliated with NYU Langone Health, and UPMC Children’s Hospital of Pittsburgh. The study enrolled 403 pairs of mothers and children in two phases starting in the postpartum units of NYC Health + Hospitals/Bellevue from June 2015 to January 2017 and at UPMC Children’s Hospital of Pittsburgh from June 2016 to October 2017. Families were then randomly assigned to either the Smart Beginnings project or a control group, who received standard pediatric care.

The study will continue to follow families over time to determine the overall impact of the full Smart Beginnings model, including potential additive impacts of the Family Check-Up for families at elevated risk.

Growing Up in a Pandemic: How COVID-19 Is Affecting Children’s Development

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,” says Dr. 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, Dr. Mendelsohn and the team have adapted the Smart Beginnings model to be delivered fully remote to continue to provide support to families in isolation during the pandemic.

Most recently, the Video Interaction Project has expanded to Flint, Michigan, a community deeply affected by a major crisis when its drinking water was contaminated by lead. The team is prepared for a large-scale implementation of the program nationwide. “Expanding our programs will make a tremendous difference for families facing large challenges that will continue long after the pandemic ends,” says Dr. Mendelsohn.

Other principal investigators of the study were Pamela Morris, PhD, at NYU Steinhardt School of Culture, Education, and Human Development, and Daniel Shaw, PhD, Distinguished Professor of Psychology at the University of Pittsburgh.

The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.



Pamela Morris

Professor of Applied Psychology (Fall 2020 Sabbatical)