Early Literacy Research Library (ELRL) - Article

Tiered Universal and Targeted Early Childhood Interventions: Enhancing Attendance Across Families with Varying Needs

Canfield, C.F., et al. (2023) Tiered Universal and Targeted Early Childhood Interventions Enhancing Attendance Across Families with Varying Needs. Early Childhood Research Quarterly, 63, 362-369.,

Access: Institutional Access

Publication year


study description

Secondary Analysis of an RCT

core topic(s)

Early Literacy , Pediatric Primary Care

Population Characteristics

Poverty/Low-Income , Urban

Exposures, Outcomes, Other

Clinic-Based Programs and Interventions , Disparity/Adversity , Home Visitation , Implementation and Evaluation , Language and Literacy Development , Parent-Child Relationships/Interactions , Programs and Interventions (other) , School Readiness and Educational Outcomes , Smart Beginnings


This study examined whether a two-tiered parenting program, which provides universal primary prevention along with targeted secondary prevention only for families with increased needs, would have mutually beneficial impacts on attendance across two program components.


Smart Beginnings

outcomes evaluated

Program attendance


Mother-infant dyads were enrolled in the RCT of SB in the postpartum units of large urban hospitals in NYC between June 2015 and February 2017 (N = 200) and Pittsburgh between June 2016 and October 2017 (N = 203).


A secondary analysis of the Smart Beginnings (SB) randomized controlled trial was conducted. SB takes place from birth to age 3 and combines universal delivery of the Video Interaction Project (VIP) with targeted delivery of the Family Check-Up (FCU) for families identified as having increased risks following yearly screening. The current study analyzed whether attendance in VIP in the first six months was associated with FCU attendance for eligible families at six months, and whether FCU attendance at six and 18 months was associated with subsequent VIP attendance. Analyses included logistic and mixed-effects Poisson regression, as well as group-based trajectory analysis.

sample size

n=403 (mother-infant dyads, total); n=200 (mother-infant dyads, NYC); n=203 (mother-infant dyads, Pittsburgh)


  • Measure of VIP Attendance: number of sessions attended for three sub-periods aligned with timing of the FCU screening and delivery: 0-6m, 9-18m, 21-30m and by generating subgroups by examining trajectories of VIP attendance from 9-36m (Sessions 5 to 14) to examine patterns of attendance following the first FCU screening point using group-based trajectory analysis in Stata.
  • Measure of FCU Attendance: completion of both the Get-to-Know-You and Feedback sessions.
  • Measure of Maternal Depressive Symptoms: Edinburgh Postnatal Depression Scale (EPDS)
  • Measure of Parenting Self-Efficacy: 10-item Karitane Parenting Confidence Scale (KPCS)


VIP attendance predicted later FCU attendance (AOR = 5.43, p < .01), and FCU attendance predicted later VIP attendance (IRR = 1.35, p < .01) and a high-stable VIP attendance trajectory (AOR=14.98, p < .01).


Findings provide strong support for the ability of tiered models to engage parents, to promote effective and efficient service delivery to reduce disparities in school readiness, and their potential to overcome common barriers to attendance and scaling by addressing the heterogeneity of risk among low-income families.


Despite the strengths of this study, it is not without limitations. First, we cannot make causal inferences based on the present analyses. For example, there may be unobserved family characteristics that enable families to self-select into receiving more or fewer services. However, convergence of findings across analyses examining patterns of session attendance support the robustness of the bidirectional associations between attendance in VIP and FCU. Second, the focus on attendance alone in the SB program may limit its applicability. Program engagement is a multidimensional concept, and other aspects of engagement that are important for program impacts (Berkel et al., 2018; Sims & Crump, 2018) are not captured in the outcome variables in this study, which include only program attendance, and are limited to count and dichotomous variables. Future research should examine broader participation to determine whether predictors differ between these aspects of engagement and their interrelatedness. Third, the focus of the SB intervention and RCT on families with limited resources and primarily from racial/ethnic minority communities may limit the generalizability of these findings. However, given that families from marginalized backgrounds are often the most difficult to engage in programs (e.g., Gross et al., 2001), findings may provide important knowledge for program design and implementation. Finally, although the current study is one of the only to examine effects of attendance across components of a tiered program, the present analyses could not answer how or why attendance in VIP may impact attendance in FCU or vice versa. Further mixed methods research to provide a deeper understanding of parents’ reasons for continued engagement is needed to answer these critical questions for effective implementation of tiered parenting programs.