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Enhancing early language and literacy skills for racial/ethnic minority children with low incomes through a randomized clinical trial: The mediating role of cognitively stimulating parent-child interactions

Miller, Elizabeth B; Canfield, Caitlin F; Roby, Erin; Wippick, Helena; Shaw, Daniel S; Mendelsohn, Alan L; Morris-Perez, Pamela A
Parenting is a critical mediator of children's school readiness. In line with this theory of change, data from the randomized clinical trial of Smart Beginnings (tiered Video Interaction Project and Family Check-Up; N = 403, treatment arm n = 201) were used to examine treatment impacts on early language and literacy skills at child age 4 years (nLatinx  = 168, nBlack  = 198, nMale  = 203), as well as indirect impacts through parental support of cognitive stimulation at child age 2 years. Although results did not reveal direct effects on children's early skills, there were significant indirect effects for early literacy (β = .03, p = .05) and early language (β = .04, p = .04) via improvements in parental cognitive stimulation. Implications for interventions targeting parenting to improve children's school readiness beginning at birth are discussed.
PMID: 38153204
ISSN: 1467-8624
CID: 5623282

Promoting Cognitive Stimulation in Parents across Infancy and Toddlerhood: A Randomized Clinical Trial

Miller, Elizabeth B; Roby, Erin; Zhang, Yudong; Coskun, Lerzan; Rosas, Johana M; Scott, Marc A; Gutierrez, Juliana; Shaw, Daniel S; Mendelsohn, Alan L; Morris-Perez, Pamela A
OBJECTIVE:To test the impact of the fully integrated Smart Beginnings model on parental support of cognitive stimulation from 6-24 months across infancy and toddlerhood. STUDY DESIGN/METHODS:Single-blind, two-site randomized clinical trial of the SB intervention. Enrollment took place at birth in postpartum units of hospitals in New York City and Pittsburgh, PA with a consecutive sample of 403 mother-infant dyads. SB combines Video Interaction Project (VIP) - 14-session universal primary prevention program delivered in the pediatric clinic at the time of well-child visits birth-36 months - with potential for Family Check-Up (FCU) - 3-4-session targeted secondary prevention home-visiting program. The principal outcome was parental support of cognitive stimulation assessed via parent survey and video-recorded observations of parent-child interactions. Ordinary least squares and mixed effects regressions were conducted. RESULTS:Families were mostly Black/African-American (50%) or Latinx (42%); all were Medicaid eligible (100%). SB significantly promoted cognitive stimulation during infancy and toddlerhood for most survey outcomes across time, including StimQ common total (Effect Size [ES]=.25, p=.01) and READ Quantity (ES=.19, p=.04) and Quality (ES=.30, p=.001). For the observations, the impact of SB varied by time, with significant impacts at 6 (ES=.37-.40, p<.001) and 24 (ES=.27-.30, p<.001) months, but not 18 months. CONCLUSIONS:SB positively promotes cognitive stimulation from infancy through toddlerhood using the integrated model. This study adds to the body of research showing preventive interventions in pediatric primary care and home visiting can support early relational health including parental support of cognitive stimulation.
PMID: 36481243
ISSN: 1097-6833
CID: 5383142

Spanish Instruction in Head Start and Dual Language Learners' Academic Achievement

Miller, Elizabeth B
Data from the Head Start Impact Study (N = 1,141) and the Head Start Family and Child Experiences Survey, 2009 Cohort (N = 825) were used to investigate whether Spanish instruction in Head Start differentially increased Spanish-speaking Dual Language Learners' (DLLs) academic achievement. Although hypothesized that Spanish instruction would be beneficial for DLLs' early literacy and math skills, results from residualized growth models showed there were no such positive associations. Somewhat surprisingly, DLL children instructed in Spanish had higher English receptive vocabulary skills at the end of the Head Start year than those not instructed, with children randomly assigned to Head Start and instructed in Spanish having the highest scores. Policy implications for Head Start-eligible Spanish-speaking DLLs are discussed.
PMCID:5722255
PMID: 29230077
ISSN: 0193-3973
CID: 4529382

Do the effects of head start vary by parental preacademic stimulation?

Miller, Elizabeth B; Farkas, George; Vandell, Deborah Lowe; Duncan, Greg J
Data from the Head Start Impact Study (N = 3,185, age = 3-4 years) were used to determine whether 1 year of Head Start differentially benefited children from homes with high, middle, and low levels of parental preacademic stimulation on three academic outcome domains-early math, early literacy, and receptive vocabulary. Results from residualized growth models showed positive impacts of random assignment to Head Start on all three outcomes, and positive associations between parental preacademic stimulation and academic performance. Two moderated effects were also found. Head start boosted early math skills the most for children receiving low parental preacademic stimulation. Effects of Head Start on early literacy skills were largest for children receiving moderate levels of parental preacademic stimulation. Implications for Head Start are discussed.
PMCID:4107068
PMID: 24597729
ISSN: 1467-8624
CID: 4529332

Predictors of television at bedtime and associations with toddler sleep and behavior in a medicaid-eligible, racial/ethnic minority sample

Miller, Elizabeth B; Canfield, Caitlin F; Wippick, Helena; Shaw, Daniel S; Morris, Pamela A; Mendelsohn, Alan L
This study examined predictors of TV use at bedtime and associations with toddlers' sleep and behavior using data from the Smart Beginnings study with 403 Medicaid-eligible, racial/ethnic minority participants from two cities in the United States. We first estimated predictors of TV use at bedtime at 18 months. We then examined whether TV at bedtime was associated with concurrent parent-report of nighttime sleep duration and quality, and later problem behavior at 24 months. Results showed that around half of the sample reported using TV at bedtime with their toddlers, and particularly first-time mothers and those receiving public assistance. We also found that use of TV at bedtime was related to concurrent sleep issues and increases in later problem behavior. Mediational path analyses revealed that TV at bedtime affected behavior via sleep quality. Despite the heterogeneity within this Medicaid-eligible sample, the results underscore the universally harmful effects of TV use at bedtime and lend support for structuring nighttime routines for toddlers to promote better sleep and behavioral outcomes.
PMID: 35272177
ISSN: 1934-8800
CID: 5190442

Improving Parent-Child Interactions in Pediatric Health Care: A Two-Site Randomized Controlled Trial

Roby, Erin; Miller, Elizabeth B; Shaw, Daniel S; Morris, Pamela; Gill, Anne; Bogen, Debra L; Rosas, Johana; Canfield, Caitlin F; Hails, Katherine A; Wippick, Helena; Honoroff, Julia; Cates, Carolyn B; Weisleder, Adriana; Chadwick, Kelly A; Raak, Caroline D; Mendelsohn, Alan L
BACKGROUND AND OBJECTIVES/OBJECTIVE:Heterogeneity in risk among low-income families suggests the need for tiered interventions to prevent disparities in school readiness. Smart Beginnings (SB) integrates two interventions: Video Interaction Project (VIP) (birth to 3 years), delivered universally to low-income families in pediatric primary care, and Family Check-Up (6 months to 3 years), targeted home visiting for families with additional family risks. Our objective was to assess initial SB impacts on parent-child activities and interactions at 6 months, reflecting early VIP exposure. METHODS:Two-site randomized controlled trial in New York City (84% Latinx) and Pittsburgh (81% Black), with postpartum enrollment and random assignment to treatment (SB) or control. At 6 months, we assessed parent-child interactions through surveys (StimQ, Parenting Your Baby) and observation (video-recorded play, coded by using Parent-Child Interaction Rating Scales - Infant Adaptation). RESULTS:< .001). Thus, significant effects emerged across a broad sample by using varied methodologies. CONCLUSIONS:Findings replicate and extend previous VIP findings across samples and assessment methodologies. Examining subsequent assessments will determine impacts and feasibility of the full SB model, including potential additive impacts of Family Check-Up for families at elevated risk.
PMID: 33608413
ISSN: 1098-4275
CID: 4793982

Impacts of a tiered intervention on child internalizing and externalizing behavior in the context of maternal depression

Canfield, Caitlin Ford; Miller, Elizabeth B; Taraban, Lindsay; Aviles, Ashleigh I; Rosas, Johana; Mendelsohn, Alan L; Morris, Pamela; Shaw, Daniel
Greater maternal depressive symptoms are consistently associated with higher levels of behavioral difficulties in children, emerging in early childhood and with long-lasting consequences for children's development. Interventions promoting early relational health have been shown to have benefits for children's behavior; however, these impacts are not always realized in the context of maternal depression. This study examined whether tiered programs could address this limitation by focusing on both parenting, through universal primary prevention, and psychosocial stressors and parent mental health, through tailored secondary prevention. Analysis of a randomized controlled trial (RCT) of the Smart Beginnings (SB) intervention was conducted to determine whether SB attenuated the association between maternal depression and early childhood internalizing and externalizing behaviors. Maternal depression significantly predicted both internalizing and externalizing behaviors in linear regression models. Further, there was a significant interaction between maternal depression and treatment group, such that among mothers with higher depressive symptoms, the SB treatment attenuated the magnitude of the association between depression and child behavior. Findings suggest that while parenting support is important for all families, it may be particularly critical for those with higher levels of depression and underscores the need to consider multidimensional family processes in both research and clinical practice.
PMID: 38093598
ISSN: 1469-2198
CID: 5589322

Pediatric primary care and partnerships across sectors to promote early child development

Roby, Erin; Shaw, Daniel S; Morris, Pamela; Canfield, Caitlin F; Miller, Elizabeth B; Dreyer, Benard; Klass, Perri; Ettinger, Anna; Miller, Elizabeth; Mendelsohn, Alan L
Poverty remains a critical predictor of children's school readiness, health and longer term outcomes. Early relational health (ERH) (i.e., parenting practices and relationship quality) mediates the impact of poverty on child development, and thus has been the focus of many parenting interventions. Despite the documented efficacy of parenting interventions at reducing poverty-related disparities in child health and development, several key barriers prevent achieving population-level reach to families with young children. In the current paper we highlight several of these barriers including gaining population-level access to young children and families, reaching families only through single points of access, addressing the significant heterogeneity of risk that exists among families living in poverty, as well as addressing each of these barriers in combination. We suggest that understanding and confronting these barriers will allow family-centered interventions to more effectively address issues related to ERH at a population level, which in turn will reduce poverty-related disparities in child development.
PMID: 33352322
ISSN: 1876-2867
CID: 4726522

Collateral benefits from a school-readiness intervention on breastfeeding: A cross-domain impact evaluation

Miller, Elizabeth B; Whipps, Mackenzie D M; Bogen, Debra L; Morris, Pamela A; Mendelsohn, Alan L; Shaw, Daniel S; Gross, Rachel S
This study evaluated the collateral, or unanticipated, impacts of Smart Beginnings (SB), a two-site, tiered intervention designed to promote responsive parenting and school readiness, on breastfeeding intensity in a low-income sample. Impact analyses for the SB intervention were conducted using an intent-to-treat design leveraging a two-arm random assignment structure. Mothers assigned to the SB intervention group were more than three times more likely to give breastmilk as the only milk source at infant age 6 months than mothers assigned to the control group at one site, an effect not evident at the other study site. As development and growth are the two most salient domains of child health, understanding how interventions impact subsequent parenting practices across both domains is critical to address long-term economic and racial/ethnic disparities. Implications of the findings are discussed for improving the efficacy of interventions based on paediatric primary care.
PMID: 36218286
ISSN: 1740-8709
CID: 5348182

Does Head Start differentially benefit children with risks targeted by the program's service model?

Miller, Elizabeth B; Farkas, George; Duncan, Greg J
Data from the Head Start Impact Study (N = 3540) were used to test for differential benefits of Head Start after one program year and after kindergarten on pre-academic and behavior outcomes for children at risk in the domains targeted by the program's comprehensive services. Although random assignment to Head Start produced positive treatment main effects on children's pre-academic skills and behavior problems, residualized growth models showed that random assignment to Head Start did not differentially benefit the pre-academic skills of children with risk factors targeted by the Head Start service model. The models showed detrimental impacts of Head Start for maternal-reported behavior problems of high-risk children, but slightly more positive impacts for teacher-reported behavior. Policy implications for Head Start are discussed.
PMCID:4563874
PMID: 26379369
ISSN: 0885-2006
CID: 4529352