Early Literacy Research Library (ELRL) - Article

Improving Parent-Child Interactions in Pediatric Health Care: A Two-Site Randomized Controlled Trial

Roby, E., Miller, E.B., Shaw, D.S., Morris, P., Gill, A., Bogen, D.L., Rosas, J., Canfield, C.F., Hails, K.A., Wippick, H., Honoroff, J., Cates, C.B., Weisleder, A., Chadwick, K.A., Raak, C.D., Mendelsohn, A.L. (2021) Improving Parent-Child Interactions in Pediatric Health Care: A Two-Site Randomized Controlled Trial. Pediatrics, 147(3), e20201799.,

Access: FREE/Open Access

Publication year


study description

Two-site randomized controlled trial.

core topic(s)

Early Relational Health , Pediatric Primary Care

Population Characteristics

Infant/Newborn , Poverty/Low-Income , Pregnancy/Postpartum

Exposures, Outcomes, Other

Clinic-Based Programs and Interventions , Disparity/Adversity , Family Check-Up , Home Visitation , Parent-Child Relationships/Interactions , Play , Programs and Interventions (other) , Smart Beginnings , Technology and Digital/Screen-Based Media , Video Interaction Project


Our objective was to assess initial SB impacts on parent-child activities and interactions at 6 months, reflecting early VIP exposure.


Smart Beginnings (SB).

outcomes evaluated

Parent-Child activities and interactions.


The postpartum units of NYC Health+Hospitals and Bellevue from June 2015 to January 2017 and UPMC Magee-Women’s Hospital adjacent to the UPMC Children’s Hospital of Pittsburgh from June 2016 to October 2017.


Smart Beginnings (SB) integrates two interventions: Video Interaction Project (VIP) (birth to 3 years), delivered universally to low-income families in pediatric primary care, and Family Check-Up (6 months to 3 years), targeted home visiting for families with additional family risks...Two-site randomized controlled trial in New York City (84% Latinx) and Pittsburgh (81% Black), with postpartum enrollment and random assignment to treatment (SB) or control. At 6 months, we assessed parent-child interactions through surveys (StimQ, Parenting Your Baby) and observation (video-recorded play, coded by using Parent-Child Interaction Rating Scales - Infant Adaptation).

sample size

n=403 (families at birth); n=362 (families at 6 months)


Measure of Cognitive Stimulation and Parent-Child Interaction: Three subscales of the StimQ2 Infant were administered:

    1. Parent Verbal Responsivity (PVR), measuring verbal interactions across 2 subdimensions (Everyday Routines, Play and Pretend).
    2. Parental Involvement in Developmental Advance (PIDA), measuring teaching activities.
    3. Reading Activities (READ), with 3 subdimensions (Quantity, Quality, Diversity of Concepts)

Measure of Parental Warmth: examined as a secondary outcome using the Supporting and Enjoying subscale of the Parenting Your Baby questionnaire.


Measure of Cognitive Stimulation and Parent-Child Interaction: Observational measures of global parent-child interaction quality were assessed by using video recording and review of 10 minutes of free play…Coding of the videos was performed by using the Parent-Child Interaction Rating Scales – Infant Adaptation (PCIRS-IA), using five domains:

    1. parental sensitivity (awareness of child’s needs, interests, and capabilities).
    2. parental intrusiveness (imposition of own agenda).
    3. parental support for cognitive development (intention to support learning).
    4. parental support for language quantity (verbal stimulation).
    5. parental support for language quality (richness of language).


A total of 403 families were enrolled at child's birth (201 treatment) with 362 (89.8%) assessed at 6 months. Treatment families had increased StimQ, including total score (Cohen's d = 0.28; P < .001) and domains reflecting reading (d = 0.23; P = .02) and teaching (d = 0.25; P = .01), and Parent-Child Interaction Rating Scales - Infant Adaptation, including a cognitive stimulation factor (d = 0.40; P < .001) and domains reflecting support for cognitive development (d = 0.36; P < .001), and language quantity (0.40; P < .001) and quality (d = 0.37; P < .001). Thus, significant effects emerged across a broad sample by using varied methodologies.


Findings replicate and extend previous VIP findings across samples and assessment methodologies. Examining subsequent assessments will determine impacts and feasibility of the full SB model, including potential additive impacts of Family Check-Up for families at elevated risk.


First, the study was not powered to show differences across the two sites and populations, resulting in exploratory subgroup analyses. Second, because race and ethnicity fully confounded site, the design did not allow consideration of either characteristic separately in interpreting findings. Third, this study took place during a period of specific stressors for immigrant and other racial and ethnic minority families, including heightened racism and discrimination.34 Experience of stress in these communities may have impacted enrollment and participation in assessments and could have implications for generalizability. Finally, in the current study, we excluded several high-risk populations including newborns qualifying for Early Interventions and preterm or low birth weight infants. Although these exclusions limit generalizability of findings to higher-risk groups, pilot adaptation of SB is currently being implemented for these populations, children in foster care, and those with prenatal opioid exposure. Future research will be necessary to examine the efficacy of SB for parenting and child outcomes in these groups.