BackgroundOne in five Americans under age 18 lives in a family below the Federal poverty threshold. These more than 15 million children are at increased risk of a wide variety of adverse long-term health and developmental outcomes. The early years of life are critical to short- and long-term health and well-being. The Legacy for ChildrenTM model was developed in response to this need and marries the perspectives of epidemiology and public health to developmental psychology theory in order to better address the needs of children at environmental risk for poor developmental outcomes.Methods/designThe Legacy for ChildrenTM group-based parenting intervention model was evaluated as a pair of randomized controlled trials among low-income families in Miami and Los Angeles. The study was designed to allow for site-stratified analysis in order to evaluate each model implementation separately. Evaluation domains include comprehensive assessments of family, maternal, and child characteristics, process outcomes, and prospective programmatic cost. Data collection began prenatally or at birth and continues into school-age.DiscussionThe societal costs of poor developmental outcomes are substantial. A concerted effort from multiple sectors and disciplines, including public health, is necessary to address these societal concerns. Legacy uses a public health model to engage parents and promote overall child well-being in families in poverty through rigorous evaluation methodologies and evidence-based intervention strategies. This study collects rich and modular information on maternal and child outcomes, process, and cost that will enable a detailed understanding of how Legacy works, how it can be refined and improved, and how it can be translated and disseminated. Taken together, these results will inform public policy and help to address issues of health disparities among at-risk populations.Trial registrationNCT00164697

The focus of this paper is on the development and evaluation of an intervention model for Florida's Infant and Young Child Mental Health Pilot Program, designed to identify families with children at risk for abuse and neglect, and to provide clinical evaluation and treatment services. The evaluation model, intervention strategies, and results presented in this paper are all part of the Florida pilot project developed as a response to the recommendations of the state's Strategic Plan for Infant Mental Health. Funded by the Florida legislature, the 3-year, multisite pilot was designed to provide earlier identification, better evaluation, and more effective treatment services for high-risk children under the age of three. The target population was children either at risk for out-of-home placement due to abuse and neglect, or those already in the child welfare system or adjudicated dependent by the state. The goals of the pilot project were: 1͒ to reduce the occurrence and re-occurrence of abuse and neglect; 2͒ to enhance the child's developmental functioning; 3͒ to improve the parent-child relationship; 4͒ to increase expeditious permanency placements; 5͒ to develop a model for intervention and treatment that could potentially be replicated in different sites; and 6͒ to document the components of a quality infant mental health intervention model and evaluate its effectiveness.RESUMEN: Este estudio se enfoca en el desarrollo y evaluación de un modelo de intervención para el Programa Piloto de La Florida para la Salud Mental de Infantes y Niños Pequeños, el cual está diseñado para identificar a niños bajo riesgo de abuso y falta de atención, así como a sus familias, y proveerles evaluación clínica y servicios de tratamiento. El modelo de evaluación, las estrategias de intervención y 259los resultados presentados en este estudio son parte del projecto piloto de La Florida, establecido como respuesta a las recomendaciones del Plan Estratégico del Estado para la Salud Mental Infantil. Financiado por la Asamblea Legislativa de La Florida, el programa piloto de tres años que se lleva a cabo en varios lugares fue diseñado para proveer una pronta identificación, una mejor evaluación, así como servicios de tratamiento más efectivos para niños de alto riesgo menores de tres años. La población a la cual se dirige este programa es la de niños que están ya bajo riesgo, o ya colocados en casas que no son sus propios hogares debido al abuso y la falta de atención, o que ya están bajo el sistema de beneficencia social o como dependiente adjudicado por el Estado. Las metas del programa piloto son: 1͒ reducir la posibilidad de que ocurra o vuelva a ocurrir el abuso o la falta de atención; 2͒ expandir el funcionamiento del desarrollo del niño; 3͒ mejorar la relación entre el niño y su͑s͒ progenitor͑es͒; 4͒ aumentar las colocaciones de permanencia expeditas; 5͒ desarrollar un modelo para la intervención y el tratamiento que pueda replicarse potencialmente en diferentes lugares; y 6͒ documentar los componentes de un modelo de...

Cocaine use during pregnancy is a high-risk indicator for adverse developmental outcomes. Three levels of intervention (center, home, and primary care) were compared in a full service, birth to age 3, early intervention program serving children exposed to cocaine prenatally. Data were collected on 130 children from urban, predominantly poor, primarily minority families. At 36 months, statistically significant, moderate to large intervention effects were found for cognition, receptive and expressive language, and gross motor development. Small effects were observed for behavior problems, and no statistically significant effects were found for fine motor or prosocial skills. Center-based care was most effective for improving language. These findings provide support that the center-and home-based early intervention programs examined in this study had positive effects on children at risk due to prenatal cocaine exposure.

Children from low SES backgrounds hear, on average, fewer words at home than those from high SES backgrounds. This word gap is associated with widening achievement differences in children’s language abilities and school readiness. However relatively little is known about adult and child speech in childcare settings, in which approximately 30% of American children are enrolled. We examined the influence of teacher and peer language input on children’s in-class language use and language development in an intervention classroom for low-SES, high-risk 2- to 3-year-olds. Over the course of a year, day-long recordings of the classroom were collected weekly with LENA recorders. Using LENA software algorithms, we found that language input from peers was positively related to children’s in-class language use, both in-the-moment and over the course of each day, as were the number of conversational turns in which children and teachers engaged Both peer input and conversational turns with teachers were also positively related to children’s language development rates, as indexed by increases in vocabulary size. Together these results indicate the importance of child-specific rates of classroom language input in the language development of high-risk, preschoolers.

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