Reducing Poverty-Related Disparities in Child Development and School Readiness: The Smart Beginnings Tiered Prevention Strategy that Combines Pediatric Primary Care with Home Visiting

Abstract

This paper describes the Smart Beginnings Integrated Model, an innovative, tiered approach for addressing school readiness disparities in low-income children from birth to age 3 in the United States through universal engagement of low-income families and primary prevention in pediatric primary care integrated with secondary/tertiary prevention in the home. We build on both public health considerations, in which engagement, cost and scalability are paramount, and a developmental psychopathology framework (Cicchetti & Toth, Journal of Child Psychology and Psychiatry, and Allied Disciplines 50:16-25, 2009), in which the child is considered within the context of the proximal caregiving environment. Whereas existing early preventive models have shown promise in promoting children's school readiness, the Smart Beginnings model addresses three important barriers that have limited impacts at the individual and/or population level: (1) identification and engagement of vulnerable families; (2) the challenges of scalability at low cost within existing service systems; and (3) tailoring interventions to address the heterogeneity of risk among low-income families. Smart Beginnings takes advantage of the existing platform of pediatric primary care to provide a universal primary prevention strategy for all families (Video Interaction Project) and a targeted secondary/tertiary prevention strategy (Family Check-Up) for families with additional contextual factors. We describe the theory underlying the Smart Beginnings model, some initial findings from its recent application in two cities, and implications for changing social policy to promote school readiness beginning during very early childhood.

Pre-pandemic support for shared reading buffers adverse parenting impacts: an RCT in Brazil

“…Second, findings extend prior work showing the effects of UBB on cognitive stimulation 38 and demonstrate that these early impacts also mediate effects of UBB on parenting and parent-child reading, with effects sustained 6 months into the pandemic. These findings align with existing conceptual models, 32 , 34 and suggest that promotion of parent-child reading and provision of books beginning in pregnancy and early infancy supports early relational health and childhood development.…”

“…These findings are consistent with conceptual models and pre-pandemic evidence suggesting that both exposure to stressors and limited resources are major contributors to disparities in child development. 32 – 34 Specifically, this literature indicates that environmental stressors, similar to those related to the COVID-19 pandemic, 9 , 15 , 20 , 35 are associated with psychosocial vulnerabilities and relational health (i.e., parent-child relationship quality and parenting practices) and that resource deprivation may limit provision of cognitively stimulating materials and experiences in the home. 32 – 34 …”

“… 32 – 34 Specifically, this literature indicates that environmental stressors, similar to those related to the COVID-19 pandemic, 9 , 15 , 20 , 35 are associated with psychosocial vulnerabilities and relational health (i.e., parent-child relationship quality and parenting practices) and that resource deprivation may limit provision of cognitively stimulating materials and experiences in the home. 32 – 34 …”

“…Prior to the COVID-19 pandemic, many preventive early childhood development (ECD) programs focused on promotion of parenting and cognitive stimulation as a key strategy to prevent effects of stressors on relational health and child development. 34 , 36 For example, a reading aloud program called Universidade do Bebê (UBB), the focus of the current analysis, has undergone two studies in Brazil prior to the pandemic showing impacts on parenting (cognitive stimulation and quantity and quality of reading interactions) and child cognitive-linguistic and socioemotional outcomes in families with low income. 37 , 38 Emerging studies have suggested that these strategies may also mitigate early learning losses resulting from the COVID-19 pandemic.…”

The potential of COPCA's coaching for families with infants with special needs in low- and middle-income countries

“…Most early intervention programs in LMICs focus on families in challenging social conditions, for instance families dealing with poverty ( 44 ). Early intervention in these situations is most effective when it consists of parenting interventions, i.e., of intervention that aim to improve caregivers' knowledge, attitudes, practices, and skills, including responsive caregiving.…”