Faculty Bibliography

We combined data from five cohorts of mothers of young children across three cities to understand how COVID-19 affected parenting among predominantly Black and Latine families with low incomes. We examined whether mothers reported that their parenting got worse, got better, or stayed the same; drew on a qualitative substudy to identify themes describing parenting experiences; and used quantitative data to identify psychosocial characteristics associated with changes in parenting. Forty-four percent of mothers reported their parenting stayed the same after COVID-19 onset, 32% reported improvements, and 24% reported their parenting got worse. Qualitative data illustrated that mothers whose parenting got better spent more and higher-quality time with children, whereas mothers whose parenting got worse did not maintain family routines, had financial worries, and exhibited harsh responses to child problem behaviors. Quantitative data showed that depression, social support, COVID-19-related distress, and parenting self-agency were all associated with reported changes in parenting.

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.

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.

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.