Preventive health is a mainstay of modern pediatrics, yet preventive strategies targeting early child development and school readiness—essential to overall health outcomes—can be underutilized, particularly in children who face adversity.
New strategies developed by Alan L. Mendelsohn, MD, and Erin M. Roby, PhD, together with colleagues at NYU Langone Health and its Hassenfeld Children’s Hospital, are helping parents build skills in reading aloud and play that support early child development and school readiness, while helping physicians and researchers identify families at risk for disparities.
“Early relational health greatly impacts resilience. Our work aims to mitigate the developmental impact of poverty and racism with preventive interventions.”Alan L. Mendelsohn, MD
“We know that early relational health—how children engage with parents and other caregivers—greatly impacts resilience,” notes Dr. Mendelsohn. “Our work aims to mitigate the developmental impact of poverty, racism, and trauma by equipping parents and care providers to implement preventive interventions.”
An estimated two in five children in the United States live in low-income households, says Dr. Roby; half of these children lack the skills needed for learning when they enter school, she adds. These poverty-related achievement gaps begin in infancy, widening over time in the absence of intervention.
Cognitive stimulation and parent–child interactions—including talking, teaching, playing, and reading—are associated with a reduction in these gaps. However, measuring the frequency and quality of these interactions has been limited to resource-intensive professional assessments that often take place in the home.
Funded by seven NIH grants, the methods developed by Dr. Mendelsohn, Dr. Roby, and colleagues are designed to increase the adoption of both comprehensive developmental promotion strategies and assessment tools that can be used during pediatric well-child visits.
Capturing a Picture of Cognition in the Home
Recently, the research team evaluated and updated the StimQ, a measure of the cognitive home environment that has informed at least 93 research studies worldwide—29 at NYU Langone alone—since its creation in 1996. The tool assesses parents’ verbal responsivity, teaching, reading behaviors, and availability of home learning materials.
The revised version, StimQ2, is updated to reflect developments in both available technology and the field’s understanding of cognitive stimulation and its impact on outcomes.
The interviewer-administered questionnaire takes approximately 20 minutes to complete; it is freely available online in several languages and has been used by early childhood programs to measure the effectiveness of interventions.
“The use of this tool over the past 25 years has dramatically expedited our understanding of the value of developmental interventions while building the capacity of individual programs to measure their impact on a given child and family,” says Dr. Roby.
The Well Exam: A Ready Intervention Opportunity
To identify opportunities for intervention at the point of pediatric primary care, the research team developed the Video Interaction Project (VIP). The parent education program is designed to be delivered at the time of every pediatric well visit from birth through 5 years.
Within each session, a VIP coach leads a development-focused discussion with parents, then creates a three-minute video of the parents interacting with their children during reading or play.
The coach then watches the video with the parent, reinforcing strengths and discussing opportunities to enhance interactions that stimulate early brain development and provide children with the cognitive, language, and social–emotional capacities critical for learning.
“Our family-centered, culturally aligned approach empowers parents to build on their strengths and have agency over their children’s healthy development.”Erin M. Roby, PhD
“The elegance of this solution is in its simplicity and low cost at just $250 per child per year,” says Dr. Mendelsohn.
Studies of the impact of VIP have found that the intervention enhances parent–child relationships, improves child literacy and social–emotional development, and measurably reduces behavior problems that interfere with learning, such as hyperactivity.
Expanding Access to Strengths-Based Tools
Currently implemented across 10 locations in the New York area, the VIP program, supported by the team at NYU Grossman School of Medicine, is also available in Hudson County, New Jersey; Pittsburgh, Pennsylvania; and Flint, Michigan, where it was implemented to support families impacted by the city’s water crisis.
The team is also working on global implementation, with work underway in Brazil and plans for expansion in Singapore.
Over the next five years, the researchers aim to reach 20,000 families by expanding the VIP program to 50 sites nationally.
“The success of this intervention is its family-centered, culturally aligned approach,” says Dr. Roby. “It recognizes the enormous pressures families face—from poverty, trauma, racism, and the global pandemic—and empowers parents to see where they can build on their strengths and have agency over their children’s healthy development.”