Parent-child interaction is a crucial, and modifiable factor in school readiness problems, which are due in large part to social and environmental problems operating since birth. Low intensity preventive approaches are needed to address the large segments of the preschool population at-risk for developmental and social-emotional problems. Pediatric primary care offers a potential setting for delivering effective, low cost interventions. We propose a randomized controlled trial (RCT) in which we compare two primary care-based approaches of different intensities to a control group: 1) the Video Interaction Project (VIP) provides sessions with a developmental specialist, who videotapes the parent and child playing together, discusses the videotape with the parent, and provides toys, books and parenting pamphlets on the day of each well child visit; 2) the Ages & Stages Questionnaire / Building Blocks (ASQ/BB) approach is lower intensity, and provides monthly mailed BB parenting newsletters + toys centered on a developmental activity, plus parent-completed ASQ screenings every 4 months. Both approaches address social/affective as well as cognitive/language aspects of the parent-child relationship. 675 newborns at two NYC public hospitals serving poor, high risk communities will be enrolled in this RCT and randomized to receive: A) VIP intervention at well child visits, B) ASQ/BB intervention by mail, or C) routine primary care (control). Children will be followed through age 3 years with periodic assessment of the home caregiving environment (parent-child interaction, developmental / literacy support) and of child developmental outcomes (language, cognition, social-emotional). The project hopes to also obtain long-term school outcome information on the children. By comparing these two interventions of varying intensity within a large sample of urban families with a diverse range of educational, ethnic, racial, acculturation, stress, and risk backgrounds and conditions, the study will examine whether a given intervention is more suited to specific subgroups or risk categories of families. Both interventions are sufficiently well defined, low cost and practical to have the potential for wide scale replication. It is envisioned that low cost interventions such as the VIP and ASQ/BB approaches could form core components of an overall strategy providing a continuum of preventive services depending on the children's and families' needs and level of risk.
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