Faculty Bibliography

This study examined longitudinal associations between maternal mindful parenting and child social-emotional, behavioral, and language development. Maternal mindful parenting at 18 months was tested for associations with concurrent observed maternal responsivity and lack of punishment toward the child and as a predictor of child internalizing symptoms, externalizing symptoms, social competence and productive language 6 months later, independent of maternal depressive symptoms (a known predictor of both parenting and child outcomes). We also tested whether child negative emotionality (NE) moderated associations between mindful parenting and child outcomes. Participants (N = 316 mothers) were low-income (mean annual income = $19,024), racially and ethnically diverse mothers (48.4% Black; 43.0% Latinx) recruited from Pittsburgh, PA and New York City, NY. Higher mindful parenting was concurrently associated with higher observed maternal responsiveness toward the child and longitudinally associated with all four child outcomes in expected directions; maternal depression was a significant predictor of child internalizing and externalizing symptoms. Contrary to hypotheses, at moderately high levels of child NE, the positive effects of mindful parenting on child outcomes were attenuated. Results provide preliminary evidence that mindful parenting is meaningfully associated with parenting behaviors and early childhood developmental outcomes above and beyond symptoms of maternal depression.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Despite longstanding efforts to design, implement, and study parenting interventions early in life to address disparities in school readiness, gaps remain related to understanding their long-term effects and pathways of influence on child development. Here we describe sustained impacts at child age 6 of the innovative, tiered birth to age 3 Smart Beginnings (SB) model. METHODS:We performed a single-blind, 2-site randomized clinical trial of the SB model. SB integrates PlayReadVIP, a universal, pediatric primary care-based program, and Family Check-Up, a targeted secondary home-based parenting intervention. Mother-infant dyads (N = 403) were randomized at birth to standard pediatric care or the SB model. In line with SB's theory of change that supporting parents will promote their children's development, single and serial mediation pathways evaluated intervention effects of SB on age 6 child academic skills through parental cognitive stimulation at age 2 and child academic functioning at age 4. RESULTS:We found significant single and serially mediated indirect effects of SB on academic outcomes through parental cognitive stimulation in toddlerhood and preacademic skills in preschool. The total indirect pathways were positive and statistically significant for all academic outcomes at age 6, including receptive vocabulary (effect size [ES] = 0.04, P = .04), oral comprehension (ES = 0.05, P = .04), letter-word recognition (ES = 0.04, P = .04), phonemic decoding (ES = 0.04, P = .04), and applied problems (ES = 0.05, P = .04). CONCLUSIONS:Findings build on the demonstrated scalability of the SB model, support the cumulative process of academic functioning in childhood, and offer a promising model to address disparities early in life.

According to the family stress model (FSM), economic stressors undermine optimal child development through negative impacts on parent psychological well-being and family relationships, which in turn disrupt positive parenting. However, few studies have examined the role of interparental conflict among these pathways and the resilience factors that buffer the FSM processes. Understanding risk and resilience is especially relevant for families in Flint, MI, for whom poverty resulting from structural racism and chronic disinvestment has coincided with public health crises. Using 199 families from low socioeconomic backgrounds in an ongoing parenting intervention in Flint, this study examined whether parent psychological distress and interparental conflict mediated the association between economic pressure at baseline (around birth) and cognitive stimulation at 9 months, and whether parenting self-efficacy and social support moderated the sequential mediation. Data were collected through parent interviews at both time points. We found that the negative association between economic pressure at baseline and cognitive stimulation at 9 months was sequentially mediated by parent psychological distress and interparental conflict. Furthermore, this negative sequential mediation was reduced and became nonsignificant when parents reported higher levels of parenting self-efficacy and social support. These findings suggest that improving interparental relationships in addition to parent mental health may promote positive parenting in at-risk two-parent families and that strength-based interventions are needed to reinforce parenting self-efficacy and facilitate parents' social networks and connections with the community to foster positive parenting. Programs should address these issues during infancy to build a strong foundation for long-term healthy development. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Children living in the rural US are more likely to live below the poverty line than their urban counterparts, and rural poverty is associated with greater disparities than urban poverty for many indicators of health, behavior, and school readiness. However, rural communities have often been overlooked in research focused on prevention of disparities in child development. Early Relational Health (ERH), which includes positive parenting practices and parent-child relationship quality, can support family resilience and buffer the consequences of racism, poverty, and related stressors on child development in families across geographical regions. In this narrative review, we describe the unique contextual factors within rural communities that facilitate and impose barriers to ERH and demonstrate the need for implementation and study of interventions that can support ERH in rural families. We describe platforms that have previously been used to deliver interventions in rural settings and recognize pediatric primary care as an underutilized context for supporting ERH and reducing disparities in child development in rural populations. Finally, we provide examples of key strategies that can reduce barriers to population-level delivery of interventions to rural families including improving access and providing culturally appropriate programming. Additional research is needed to address core gaps in the knowledge base related to prevention of inequities in rural populations through supporting ERH.

UNLABELLED:Social-emotional competence is critical to children's social and school success, prompting interest in understanding factors that promote these skills prior to elementary-school. Cognitive stimulation (e.g., reading, playing) is related to preschool children's social outcomes; However, few studies have examined these associations earlier, or determined whether interventions that encourage cognitive stimulation may enhance children's early social-emotional competencies either directly, or through impact on these behaviors. The present study examined whether cognitive stimulation in infancy predicted social competence in toddlerhood and the impact of a positive parenting intervention on these child outcomes. Mother-infant dyads in the Smart Beginnings (SB) RCT (primarily Hispanic/Latino or Black and from low-income backgrounds) were randomly assigned to treatment or control. SB integrates universal primary prevention in pediatric primary care (PlayReadVIP); and targeted/secondary prevention through home visiting (Family Check-Up). Mothers' cognitive stimulation at 6 months significantly predicted children's social-emotional competence at 24 months. Although there was no direct effect of SB on children's social-emotional competence, there was an indirect effect on children's social competence through maternal cognitive stimulation. Findings suggest that associations between cognitive stimulation and children's social-emotional competence emerge earlier than previously shown, and that positive parenting interventions can support early social-emotional competence through impact on cognitive stimulation. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov identifier: NCT02459327.

The COVID-19 pandemic has significantly impacted families with young children (age 0-5). Using a subset of data from the randomized clinical trial of an integrated, preventive parenting model, Smart Beginnings (SB), this study examined associations between COVID-19-related school disruptions in early childhood education (ECE) and children's early elementary school outcomes. A secondary, exploratory aim sought to determine whether SB attenuated these relations. Path analyses demonstrated that school disruptions in ECE were associated with lower literacy skills at age 6 in letter-word identification (β=-.32, p<.01) and phonemic decoding (β=-.26, p<.05), but not for math or oral language skills. School disruptions in ECE were also related to increased internalizing behavior in children (β=.34, p<.01), with a trend for increased externalizing behavior (β=.22, p<.10). There was no significant moderation by SB intervention group. Implications for future school disruptions and acute stressors more broadly, as well as the role of preventive interventions, are discussed.

OBJECTIVE:Primary care-based literacy promotion enhances caregiver-child shared reading and child language outcomes, yet variation in implementation may dilute its impact. This study examines expert perspectives on intended outcomes of literacy promotion, as well as its core components, those necessary to achieve intended outcomes, and components that are recommended but adaptable to context. METHODS:We purposively sampled healthcare and policy experts in primary care-based literacy promotion from the U.S. and Canada for online, in-depth interviews. Interviews were recorded, transcribed verbatim, and analyzed iteratively engaging emergent and a priori codes based on the COmponents and Rationales for Effectiveness Fidelity Method and the team's prior work to identify themes. RESULTS:We achieved saturation after 22 interviews with 24 participants (16 U.S. participants, 8 Canadian). We identified four themes: 1) Traditionally, literacy promotion focused on enhancing preliteracy skills and school readiness. Over time, this outcome has evolved to include fostering early relational health as a foundational goal; 2) Core components include a trusted clinician delivering a strength-based, family-centered message, while modeling developmentally-informed shared reading; 3) Components that are adaptable to setting and context include literacy-rich clinical environments and community resource referrals; 4) Experts diverged on whether providing a children's book during literacy promotion is essential, but there was congruence that book provision alone is insufficient. CONCLUSION/CONCLUSIONS:Experts identified strength-based, family-centered guidance from a trusted clinician with developmentally-focused modeling as core to support intended outcomes of early relational health and school readiness. This understanding can inform training and healthcare improvement activities aimed at optimizing primary care-based literacy promotion.

The importance of the parent-child relationship during early childhood (i.e., 0-5 years) on children's socioemotional functioning has been extensively documented in the literature. However, limited work has examined the degree to which dyadic features of the parent-child relationship changes over the course of early childhood and whether growth in these features relate to children's functioning. The present study aimed to address this limitation by examining change trajectories of dyadic affective mutuality and mutual enjoyment during the first 2 years of life and whether these trajectories were associated with child problem behavior at age four. The sample was comprised of 374 low-income, infant-mother dyads recruited for an efficacy trial of a tiered parenting program designed to promote school readiness. Affective mutuality and mutual enjoyment were assessed via coded interaction tasks between mothers and their infants at 6, 18, and 24 months. Mothers reported on children's internalizing and externalizing problem behavior at 48 months. Results from latent growth curve analysis revealed dyads' affective mutuality significantly increased, and mutual enjoyment significantly decreased, from 6 to 24 months. Initial levels and positive change in affective mutuality from 6 to 24 months were both negatively associated with child internalizing problems, but not externalizing problems, at 48 months. These findings emphasize the importance of conducting work that conceptualizes the dyad as the unit of study and explores how changes in the parent-child relationship may themselves be important indicators for children's future functioning.

BACKGROUND:Eleven years have passed since the 2014 Flint water crisis (FWC), yet many voices still go unheard. There is limited evidence of the impact of the FWC on maternal health. This paper used a cross-sectional study design to survey 152 women enrolled in the Supporting Parents and Raising Resilient Kids (SPARRK) study in Flint, Michigan to examine racial differences in women's perceptions of their overall health pre- and post-FWC, perceived maternal health services, and explore the interaction of race and living in Flint on maternal morbidity. METHODS:Perceived maternal health was defined using the Centers for Disease Control and Prevention's 21 Severe Maternal Morbidity (SMM) diagnosis codes. SMM were obtained via questionnaire. Logistic regression analyses were performed to identify factors associated with SMM within two domains: (1) overall health pre- and post-FWC and (2) perceived maternal health care received during birth. RESULTS:There were 17 cases of SMM in which Black women accounted for 62.5% of these cases. Perceived quality of care was overall positive; yet, perceived overall health decreased post-FWC for all women. The odds of SMM were 6 times higher for those who had a college degree or higher. CONCLUSION/CONCLUSIONS:In the predominately Black city of Flint, race was not a significant factor in the perception of health and quality of care. Surprisingly, educational attainment was significantly associated with a 6-time increase in odds of experiencing an SMM. More research is needed to examine the association of patient-provider perception of quality care and education on maternal health outcomes.

OBJECTIVE:Little is known about how parenting interventions might influence families' access to related healthcare services during early childhood. This study describes the effects of a parenting intervention, Smart Beginnings (SB), on referrals to early intervention (EI) or early childhood special education (ECSE) after evaluation within a predominantly Black/Latine sample with low incomes. SB is a tiered intervention integrating a universal parenting program delivered in primary care clinics (PlayReadVIP) with a targeted home visiting program (Family Check-Up). METHODS:Data were drawn from a randomized controlled trial of SB, with sites in NYC and Pittsburgh, PA. The 280 families (132 treatment; 148 control) were 43% Black, 47% Latine, 37% Spanish-speaking, and 100% Medicaid-eligible. Hierarchical logistic regressions examined associations between expressive vocabulary and problem behaviors (internalizing and externalizing symptoms) at 2 years, and the impact of the SB intervention on the likelihood of EI/ECSE evaluation and service referrals based on evaluation results by 4 years. RESULTS:Across sites, children's lower expressive vocabulary and higher problem behaviors at 2 years predicted receiving EI/ECSE evaluation and service referrals by age 4. Assignment to the SB intervention reduced the likelihood of evaluations leading to referrals for EI/ECSE service. CONCLUSIONS:Results from this RCT showed that children with early behavior and language challenges were more likely to receive EI/ECSE evaluation and services by preschool-age. Children assigned to SB were less likely to be referred for services. Studying factors that predict EI/ECSE involvement for children from historically marginalized populations can help promote equity in early care systems.