Faculty Bibliography

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.

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).

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.

Parenting in very early childhood (0-2 years) provides important context for children's socioemotional development. The present study aims to address limitations of extant parenting literature, namely the reliance on white, middle-class samples and use of variable-centered approaches that often mask the rich heterogeneity of parenting styles. Using data from an efficacy trial of a tiered parenting program to promote school readiness, the current study examined parenting styles across three waves when children were 6, 18, and 24 months with a sample of Black/African American and Latina mothers with low incomes using person-oriented, latent class analysis. Based on multiple fit indices and interpretability, a three-class model was found to best fit the data. Two of the three parenting classes were identified for both Black/African American and Latina groups across all three ages: one was characterized by high levels of sensitivity, positive regard, and language quality/quantity (High Support and Warmth) and the other was characterized by moderate levels of these indicators (Moderate/Low, Moderate, and Moderate/High Support and Warmth). The third class varied the most between groups and over time. For Black/African American mothers, the third class was characterized most notably by the level of directiveness (ranging from High at 6 months, Moderate at 18 months, and Low at 24 months). For Latina mothers, this class was characterized by varying levels of directiveness and stimulation that were High at 6 months and Moderate at 18 and 24 months. Within most classes, mean levels of parenting behaviors varied by age. Findings emphasize the importance of considering age, culture, and time when assessing maternal parenting from infancy to toddlerhood.

Parenting in very early childhood (0-2 years) provides important context for children's socioemotional development. The present study aims to address limitations of extant parenting literature, namely the reliance on white, middle-class samples and use of variable-centered approaches that often mask the rich heterogeneity of parenting styles. Using data from an efficacy trial of a tiered parenting program to promote school readiness, the current study examined parenting styles across three waves when children were 6, 18, and 24 months with a sample of Black/African American and Latina mothers with low incomes using person-oriented, latent class analysis. Based on multiple fit indices and interpretability, a three-class model was found to best fit the data. Two of the three parenting classes were identified for both Black/African American and Latina groups across all three ages: one was characterized by high levels of sensitivity, positive regard, and language quality/quantity (High Support and Warmth) and the other was characterized by moderate levels of these indicators (Moderate/Low, Moderate, and Moderate/High Support and Warmth). The third class varied the most between groups and over time. For Black/African American mothers, the third class was characterized most notably by the level of directiveness (ranging from High at 6 months, Moderate at 18 months, and Low at 24 months). For Latina mothers, this class was characterized by varying levels of directiveness and stimulation that were High at 6 months and Moderate at 18 and 24 months. Within most classes, mean levels of parenting behaviors varied by age. Findings emphasize the importance of considering age, culture, and time when assessing maternal parenting from infancy to toddlerhood.

The goal of this study was to examine the impacts of the Smart Beginnings (SB) intervention, a tiered model that combines universal primary prevention and targeted secondary prevention, on parental negative affect during discipline and children's externalizing behavior. Analyses included 273 families who were randomly assigned to SB or control groups at birth. Parental negative affect during discipline and child externalizing behavior were assessed through parent report at age four and six, respectively. Compared to the control group, families in SB had significantly reduced parental negative affect during discipline, with indirect effects on children's externalizing behavior through impacts on parent affect during discipline, both for the full sample and specifically for families with increased risks. Findings suggest that interventions aimed at promoting positive parent-child interactions may have important impacts on parenting behaviors and may prevent the onset of child behavior problems, with important implications for the implementation of preventive interventions. This study examined the impacts of the Smart Beginnings (SB) tiered model, which combines universal primary prevention and targeted secondary prevention, on parental negative demeanor during discipline-negative parental behavioral traits that are expressed through anger, verbal aggression, or demeaning behavior-and children's externalizing behavior. Analyses included 273 families randomly assigned to SB or control groups at birth. Parental negative demeanor during discipline was assessed through parent report (Socolar Discipline Survey) at age four and child externalizing behavior (CBCL) at age six. Compared to controls, regression analyses indicated that families in SB had significantly reduced parental negative demeanor during discipline, with mediation analyses suggesting indirect effects on child externalizing through impacts on parent demeanor during discipline, moderated by family risk level. Findings indicate that interventions aimed at promoting positive parent-child interactions may impact parenting behaviors and prevent onset of child behavior problems, with important implications for implementation of preventive interventions.

The COVID-19 pandemic increased maternal depression and anxiety, imperiling both mothers' own wellbeing and that of their children. To date, however, little is known about the extent to which these increases are attributable to economic hardships commonly experienced during the pandemic: income loss, job loss, and loss of health insurance. Few studies have examined the individual impacts of these hardships, and none have lasted beyond the first year of the pandemic. This study harmonizes data from six evaluations of pediatric-based parenting programs for women with young children and low incomes across three U.S. cities (N = 1,254). Low-income mothers are of special interest because their families have been disproportionately affected by economic shocks due to COVID-19, and mothers of young children have been more distressed than other mothers by COVID-19. The studies' combined window of observation lasted from the onset of the pandemic to over three years later. Results indicate that income loss, job loss, and health insurance loss were all significantly associated with depression and anxiety. When each hardship was assessed net of the others, lost income was associated with more than a two-fold increase in the odds of anxiety, and a lost job and lost health insurance were associated with 50% and 90% greater odds of depression, respectively. Associations between hardships and maternal mental health did not diminish over time during the window of observation. These associations are likely to have been even greater in the absence of generous social policies enacted during the pandemic.

Early literacy promotion in pediatric primary care supports parents and caregivers in reading with their children from birth, offering counseling in interactive, developmentally appropriate strategies and providing developmentally and culturally appropriate and appealing children's books. This technical report reviews the evidence that reading with young children supports language, cognitive, and social-emotional development. Promoting early literacy in pediatric primary care offers a strengths-based strategy to support families in creating positive childhood experiences, which strengthen early relational health. An increasing body of evidence, reviewed in this report, shows that clinic-based literacy promotion, provided with fidelity to an evidence-based model, has benefits for children, for parents and caregivers, and for pediatric physicians and advanced care providers as well. Reading with young children supports early brain development and the neural "reading network," and improves school readiness. High-quality literacy promotion is especially essential for children who face disparities and inequities because of social factors, systemic racism, and socioeconomic risk. All families benefit from high-quality and diverse books and from developmentally appropriate guidance supporting interactions around books and stories. Thus, literacy promotion can be a universal primary prevention strategy to strengthen families and support healthy development. Partnerships at community, local, and state levels offer opportunities for integration with other programs, services, and platforms. Literacy promotion in primary care pediatric practice, recognized by the American Academy of Pediatrics as an essential component since 2014, has become increasingly common. There are successful models for public funding at federal, state, county, and municipal levels, but sustainable funding, including payment to pediatric physicians and advanced care providers, remains a need so that the benefits of pediatric early literacy promotion and the joys of books and shared reading can truly be offered on a population level.