Assessing the Impacts of Pediatric Primary Care Parenting Interventions on EI Referrals Through Linkage With a Public Health Database

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Publication year

2019

study description

Single-blind, three-way RCT, with two intervention groups compared with a control group.

core topic(s)

Early Relational Health

Population Characteristics

Poverty/Low-Income , Urban

Exposures, Outcomes, Other

Building Blocks , Clinic-Based Programs and Interventions , Libraries and Public Resources , Parent Behaviors and Skills , Parent Knowledge, Attitudes, and Beliefs , Positive Parenting , Programs and Interventions (other) , Video Interaction Project

metric(s)

Woodcock Johnson Tests (WJ)
Preschool Language Scale (PLS)
Baley Scales of Infant and Toddler Development (BSID)
Clinical Evaluation of Language Fundamentals (CELF)

objectives

We sought to determine whether pediatric primary care interventions targeting positive parenting among low socioeconomic status mothers resulted in reduced referrals to the New York City Early Intervention Program (NYC-EIP).

exposure

Interventions: Video Interaction Project (VIP) and Building Blocks (BB).

outcomes evaluated

Eligibility and referral to EI.

setting

Enrollment in the BELLE Project was performed in the postpartum ward of an inner-city public hospital serving low income, primarily immigrant families from November 2005 through October 2008.

methods

Participants in Building Blocks (BB) and the Video Interaction Project (VIP) were linked with the NYC-EIP administrative dataset to determine referrals.

sample size

n=422 (total participants); n=139 (referred participants)

measures

Measures of Sociodemographic and Characteristics: parental interview at enrollment assessed mother’s age, country of origin, education, primary language, marital status, family Hollingshead Socioeconomic Status, infant gender and birth order.

 

Measure of Word Reading as an Indicator of Maternal Literacy: the Woodcock–Johnson III/Bateria III Letter-Word Identification Test.

 

Measure of EI referral and EI eligibility: matching mother and child data collected as part of the BELLE Project to corresponding data obtained for children referred to NYC-EIP and maintained in the KIDS database… Outcomes were measured using the Bayley Scales of Infant and Toddler Development (Bayley, 1993) for cognitive development, the Preschool Language Scale (Zimmerman, Steiner, & Pond, 1992) for language development at 14 and 24 months, and the Clinical Evaluation of Language Fundamentals (Semel, Wiig, & Secord, 2003) for language development at 36 months. Overall

results

In all, 139 of 422 study participants (31.4%) meeting inclusion criteria were referred to the NYC-EIP. Although referrals did not differ overall by group (VIP 29.8%; BB 33.8%; control 35.3%), differences were found for mothers with education/literacy of seventh grade or higher (interaction p = .02). In that subgroup, VIP was associated with reduced referrals by age 3 years (22.4%; adjusted odds ratio 0.53; 95% confidence interval [0.29, 0.97]), compared with BB (35.0%) and controls (34.3%), with survival analysis showing reduced cumulative risk (p = .04).

conclusions

We conclude that VIP resulted in reduced referrals for early intervention evaluation among children of mothers with seventh-grade education or higher.

limitations

"A potential limitation of the linkage process is the possibility of under-identification of referred families. Because the linkage was performed only for the NYC-EIP KIDS database, referrals to EI programs among families that moved away from New York City may have been missed. Other potential limitations in the matching process include the possibility of duplicate names or inaccurate records, leading to an over- or underestimation of referrals... It is also possible that those families who refused to participate in the study may limit overall generalizability of study findings...It is also important to note that although referrals to EI represent a marker for potential developmental delay, they do not precisely correspond to need for or eligibility for delivery of services (K. M. Clements et al., 2006). Although our study considered a reduction in EI referrals as a proxy measure for a reduction in the need for EI services, this is only one possible interpretation of our results...Despite robust group differences, it should be reiterated that these estimated measures of eligibility do not necessarily equate to eligibility as determined by existing EI standards, as the BELLE Project criteria did not assess comprehensively all aspects of development relevant to EI (e.g., physical development). One potential issue is that generalizability of study results may be limited as the current study is not representative of the entire population of EI children, particularly those with recognized genetic or congenital issues at birth who require EI services, as these individuals were excluded from the present study."