Early Literacy Research Library (ELRL) - Article

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

Mendelsohn, A.L., Huberman, H.S., Berkule, S.B., Brockmeyer, C.A., Morrow, L.M., Dreyer, B.P. (2011) 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. Archives of Pediatrics & Adolescent Medicine, 165(1), 33-41. ,

Access: FREE/Open Access

Publication year


study description

Randomized controlled trial.

core topic(s)

Early Literacy , Pediatric Primary Care

Population Characteristics

Infant/Newborn , Poverty/Low-Income , Urban

Exposures, Outcomes, Other

Building Blocks , Child Development (general) , Clinic-Based Programs and Interventions , Language and Literacy Development , Parent-Child Relationships/Interactions , Play , Programs and Interventions (other) , School Readiness and Educational Outcomes , Video Interaction Project


To determine the effects of pediatric primary care interventions on parent-child interactions in families with low socioeconomic status.


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

outcomes evaluated

Parent-Child interactions.


Mother-newborn dyads enrolled post partum from November 1, 2005, through October 31, 2008 from urban public hospital pediatric primary care clinic.


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...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.

sample size

n=410 (families)


Measure of Parent-Child Interactions: StimQ-Infant (StimQ-I) including the following 4 subscales:

    1. Availability of Learning Materials: learning materials, such as toys, provided by the caregiver in the home.
    2. Reading Activities: number and diversity of books read to the child, frequency of reading activities, and associated interactions.
    3. Parental Involvement in Developmental Advancement: caregiver teaching and play activities, such as naming objects, teaching the child to play with toys, and playing make-believe games with the child.
    4. Parental Verbal Responsivity: caregiver-child verbal interactions, such as talking while feeding and making sounds together.

Measure of Shared Reading Behaviors: 24-hour shared reading recall diary asking the mother to provide information about any reading or storytelling involving the infant that had taken place during the last typical day, including the material used (eg, book or magazine) and time spent for each reading activity that had taken place. We calculated total daily duration by adding each exposure during the 24-hour period.


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).O20.


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.


First, there was larger-than-expected loss to follow-up at 6 months because of limitations in resources, which led us to prioritize later assessment points. The threat to validity resulting from loss to follow-up may have been limited because assessed participants were equivalent across groups for all measures. Second, results at 6 months were based on parent report, which can be subject to biases. However, StimQ has been shown to be reliable and valid, and convergent results regarding shared reading were found using 2 different types of interviews (a structured interview [StimQ] and an open-ended reading diary). Later assessments will also include observational measures based on videos made of parents and children. Third, participating mothers were primarily first-generation Hispanic/Latino immigrants. Results may not be generalizable to families with other sociodemographic characteristics.