Sociodemographic and Psychosocial Predictors of VIP Attendance in Smart Beginnings Through 6 Months: Effectively Targeting At-Risk Mothers in Early Visits

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Publication year

2019

study description

Randomized controlled trial.

core topic(s)

Early Relational Health , Pediatric Primary Care

Exposures, Outcomes, Other

Child Development (general) , Clinic-Based Programs and Interventions , Disparity/Adversity , Family Check-Up , Implementation and Evaluation , Parent-Child Relationships/Interactions , School Readiness and Educational Outcomes , Video Interaction Project

metric(s)

Edinburgh Postnatal Depression Scale (EPDS)

objectives

Using data from a randomized control trial (RCT) of Smart Beginnings, we explore predictors of attendance in the intervention.

exposure

Smart Beginnings tired intervention, including Video Interaction Project (VIP) and Family Check-Up (FCU).

outcomes evaluated

Intervention attendance.

setting

Mothers and infants were enrolled in the Smart Beginnings RCT in the postpartum units of Bellevue Hospital in NYC between June 2015 and February 2017 (N = 200, treatment arm, n = 101) and Magee Women’s Hospital adjacent to the Children’s Hospital of Pittsburgh (N = 203, treatment arm, n = 100) between June 2016 and October 2017.

methods

Data from a randomized control trial (RCT) of Smart Beginnings, an integrated, tiered model for school readiness, were used to explore predictors of attendance in Video Interaction Project (VIP) through 6 months. VIP is a primary preventive intervention delivered in tandem with pediatric well-child visits, aimed at reducing income-based disparities in early child development through promotion of responsive parent-child interactions.

sample size

n=403 (total); n=201 (treatment); n=202 (control)

measures

Measure of VIP Attendance: site interventionists recorded if the family completed, partially completed, or missed the following four VIP sessions: 1 month, 2 months, three months, and 4 months.

 

Measure of Primary Predictors: survey including questions about predictors known to correlate with enrollment, attendance, and participation in parenting programs, including:

• • Sociodemographic Characteristics: maternal age, primiparous birth, Temporary Assistance for Needy Families (TANF) and Supplemental Security Income (SSI), and maternal education.
  • Psychosocial Characteristics: maternal depression and parenting self efficacy, measured using the Edinburgh Postnatal Depression Scale (EPDS).

results

Using Poisson distribution models (N = 403; treatment arm, n = 201), we find that demographic, socioeconomic status (SES), and psychosocial variables are associated with program attendance but not always in the expected direction. While analyses show that first-time mothers have higher levels of program attendance as expected, we find that less-educated mothers and those with lower parenting self-efficacy have higher levels of attendance as well. The latter findings may imply that the VIP intervention is, by some indicators, effectively targeting families who are more challenging to engage and retain. Implications for pediatric-based interventions with population-level accessibility are discussed.

conclusions

In sum, the results lend support for the ability of pediatric primary care to facilitate high attendance, and potentially broader participation rates, a critical component of widespread implementation of preventive parenting programs. There is evidence that such dissemination may improve children’s and families’ future economic outcomes by addressing the immediate impacts of poverty for both parents and children (Van Ryzin et al. 2018). By understanding which families actively take part in VIP, we can improve intervention design and implementation to have the most effective practice, with the eventual goal of improving parenting practices and children’s school readiness at the population level beginning at birth.

limitations

First, despite our confidence in the findings, the results reported here are not based on causal inference. Nonetheless, because findings replicated across multiple model specifications, including across racial and ethnic groups that have previously had lower engagement (O’Brien et al. 2012), we believe them to be the best estimate of predictors of parent attendance in VIP through the first 6 months in the current effort. Further, this study examined only attendance, which while important (Reyno and McGrath 2006), is one of several dimensions of participation in interventions (Sims and Crump 2018). Future studies should include additional aspects of participation like parent feedback and interventionist perceptions to create a fuller picture of engagement, as these are likely important predictors of participation (Ingoldsby 2010). Future studies will also more explicitly assess how program attendance affects parent and child outcomes and can include higher-income families who may also benefit from parenting interventions.