Promoting Cognitive Stimulation in Parents Across Infancy and Toddlerhood: A Randomized Clinical Trial

Abstract

Objective: To test the impact of the fully integrated Smart Beginnings model on parental support of cognitive stimulation from 6 to 24 months across infancy and toddlerhood.

Study design: This was a single-blind, 2-site randomized clinical trial of the Smart Beginnings intervention. Enrollment took place at birth in postpartum units of hospitals in New York City and Pittsburgh, Pennsylvania, with a consecutive sample of 403 mother-infant dyads. Smart Beginnings combines a Video Interaction Project-14-session universal primary prevention program delivered in the pediatric clinic at the time of well-child visits birth-36 months-with potential for Family Check-Up-3-4 sessions targeted secondary prevention home-visiting program. The principal outcome was parental support of cognitive stimulation assessed via parent survey and video-recorded observations of parent-child interactions. Ordinary least squares and mixed effects regressions were conducted.

Results: Families were mostly Black/African-American (50%) or Latinx (42%); all were Medicaid eligible (100%). Smart Beginnings significantly promoted cognitive stimulation during infancy and toddlerhood for most survey outcomes across time, including StimQ common total (effect size [ES] = 0.25, P = .01) and READ Quantity (ES = .19, P = .04) and Quality (ES = .30, P = .001). For the observations, the impact of Smart Beginnings varied by time, with significant impacts at 6 (ES = 0.37-.40, P < .001) and 24 (ES = 0.27-.30, P < .001) months, but not 18 months.

Conclusions: Smart Beginnings positively promotes cognitive stimulation from infancy through toddlerhood using the integrated model. This study adds to the body of research showing preventive interventions in pediatric primary care and home visiting can support early relational health including parental support of cognitive stimulation.

Trial registration: NCT02459327.

Figure 1. Population-Level Conceptual Model: SB Tiered Intervention, Mechanisms of Action

Figure 2.. Participant Enrollment and Assessment in SB

Note: participants who were not eligible for the study may have met more than one exclusion criteria and therefore the individual criteria numbers do not sum to the total number not eligible

Figure 3a. Treatment Impact on StimQ Common Total 6-24 Months

Note. * indicates significant mean differences (* p < 0.05). Curve interpolated from 3 times points at 6, 18, and 24 months. Effect sizes (ES) were calculated by dividing the estimated difference between the SB intervention and control groups by the square root of the sum of the Level-1 error variance of the control group and the variance of the random intercept. Since time was coded as 0, 2, and 3, the Level-1 error variance of the control group and the variance of the random intercept conesponded to 6 months.

Figure 3b. Treatment Impact on Observed Cognitive Stimulation Factor, 6-24 Months

Note. * indicates significant mean differences (* p < 0.05). Curve interpolated from 3 times points at 6, 18, and 24 months. Effect sizes (ES) were calculated using the standard deviation of the control group at each corresponding wave.