Primary care strategies for promoting parent-child interactions and school readiness in at-risk families: the bellevue project for early language, literacy, and education success

Objective: To determine the effects of pediatric primary care interventions on parent-child interactions in families with low socioeconomic status. Design: In this randomized controlled trial, participants were randomized to 1 of 2 interventions (Video Interaction Project [VIP] or Building Blocks [BB]) or the control group. Setting: Urban public hospital pediatric primary care clinic. Participants: Mother-newborn dyads enrolled post partum from November 1, 2005, through October 31, 2008. Interventions: In the VIP group, mothers and newborns participated in 1-on-1 sessions with a child development specialist who facilitated interactions in play and shared reading by reviewing videos made of the parent and child on primary care visit days; learning materials and parenting pamphlets were also provided. In the BB group, parenting materials, including age-specific newsletters suggesting interactive activities, learning materials, and parent-completed developmental questionnaires, were mailed to the mothers. Main Outcome Measures: Parent-child interactions were assessed at 6 months with the StimQ-Infant and a 24-hour shared reading recall diary. Results: A total of 410 families were assessed. The VIP group had a higher increased StimQ score (mean difference, 3.6 points; 95% confidence interval, 1.5 to 5.6 points; Cohen d, 0.51; 0.22 to 0.81) and more reading activities compared to the control group. The BB group also had an increased overall StimQ score compared with the control group (Cohen d, 0.31; 95% confidence interval, 0.03 to 0.60). The greatest effects for the VIP group were found for mothers with a ninth-grade or higher reading level (Cohen d, 0.68; 95% confidence interval, 0.33 to 1.03). Conclusions: The VIP and BB groups each led to increased parent-child interactions. Pediatric primary care represents a significant opportunity for enhancing developmental trajectories in at-risk children. Trial Registration: clinicaltrials.gov Identifier: NCT00212576.