WASHINGTON – Poverty-related disparities in school readiness are a "major public health crisis," in the opinion of Dr. Alan L. Mendelsohn and his colleagues at Bellevue Hospital Center in New York, and they have long been thinking about how to best take advantage of pediatric well-child care visits to promote parent-child interactions that can reduce these disparities.
One of the parenting interventions they are studying – a program called the Video Interaction Project (VIP) – already has been shown to enhance parent-child interactions at the 6-month mark.
Now, it seems that the parenting program can have a long-term impact as well – and that continuing the interventions into the 3- to 5-year age group can have further, independent effects on parent-child interactions.
"Our new findings provide support for interventions based in pediatric primary care to enhance parenting in both the infant and toddler years and the preschool periods," Dr. Mendelsohn, a pediatric developmental behavioral health specialist, reported at the annual meeting of the Pediatric Academic Societies.
Enhancing parent-child interactions, he believes, should improve language and cognitive social-emotional development and ultimately promote school readiness and school performance. Poor children are exposed to 75% fewer words, he noted.
In the VIP program, a child development specialist videotapes the parent and child interacting together with a book or a toy either before or after routine primary care visits. The parent and specialist then watch the video together, with the specialist reinforcing positive interactions, offering suggestions for further interaction, and promoting parent self-reflection. VIP families also receive parenting pamphlets and learning materials at each visit.
The project has been developed in two phases, with VIP 0-3 covering children from birth through 3 years of age, and VIP 3-5 covering the preschool years and entailing increasingly rich play and literacy activities. All told, from birth through 5 years, about 15 VIP sessions take place for each participating family.
The research is part of the Bellevue Project for Early Language, Literacy, and Educational Success (BELLE Project). New mothers were enrolled during the postpartum period at Bellevue Hospital Center and randomized to VIP 0-3 or control; then at age 3 years, the VIP and control families were re-randomized to receive either additional VIP during ages 3-5 years or to control during that period. At 54 months, investigators performed single-blind assessments of parenting and child development.
Bellevue Hospital Center is a public hospital serving families of low socioeconomic status throughout New York City. The 450 mothers enrolled in BELLE are primarily first-generation Hispanic/Latino immigrants. All had singleton, full-term uncomplicated births and spoke English or Spanish as their primary language.
A prior published analysis of the cohort showed enhanced infant-parent interactions as reflected by significantly higher StimQ scores in the VIP 0-3 group at 6 months of age (Arch. Pediatr. Adolesc. Med. 2011;165:33-41). Another analysis at 33 months showed lower levels of parenting stress and a greater likelihood of normal cognitive development in VIP children (J. Dev. Behav. Pediatr. 2007;28:206-12).
The StimQ is an office-based survey developed by Dr. Mendelsohn and others at New York University (NYU) for measuring cognitive stimulation in the homes of young children. It is validated for use in low-socioeconomic populations whose primary language is English or Spanish.
The new 54-month analysis used adaptations of three StimQ-Preschool subscales: Parent Verbal Responsivity, Reading Activities, and Parent Involvement in Developmental Advance, the last of which measures the number of different interactional activities occurring between the caregiver and child that promote cognitive development.
At 54 months, VIP 0-3 was associated with significant increases in scores for parent verbal responsivity (8.98 vs. 7.95) and reading (24.91 vs. 23.75), but only a minimal increase in the score for teaching activities. VIP 3-5 was independently associated with significant increases in verbal responsivity (9.14 vs. 7.99) and teaching (13.18 vs. 12.04), with a trend toward enhancements in reading, Dr. Mendelsohn reported.
"Importantly, the effects were independent, suggesting additive impacts for those receiving interventions during both periods," he said.
Among the next steps in their research are comprehensive assessments in the first grade.
"We also need to work on replication and on understanding whether this is equally effective in other low-income groups," Dr. Mendelsohn said. "We need to build on this burgeoning science ... but we don’t want to just dilute and spread."
Dr. Alan L. Mendelsohn reported no disclosures. VIP has been funded by the National Institute of Child Health and Human Development, the Marks Family Foundation, the Tiger Foundation, Children of Bellevue, and KiDS of NYU.