Smart Beginnings

About the program

Smart Beginnings integrates two interventions:

1. A universal prevention program, the Video Interaction Project (VIP), is delivered in paediatric primary health care to maximise identification, engagement, and retention while minimising costs. VIP’s core component is video recording of the parent and child interacting using a provided toy or book, with real-time review to identify and reinforce strengths in the interaction. 
2. A targeted prevention program, Family Check-Up, is provided in the home for families meeting risk criteria, based on screening beginning at 6 months. Clinical-level support is tailored to family heterogeneity.

Who does it work for?

This program is designed for low-income families with toddlers at risk for conduct problems.

An RCT conducted in the USA had a total final sample of 403 families (Roby et al. 2021) randomly assigned into the intervention and control conditions; 200 families were in NYC and 203 in Pittsburgh. Participants were children and their parents, across a broad range of locations, race and ethnic background (primarily low-income Latinx and Black/African American). There were many between-site differences, with NYC primarily Latinx and Pittsburgh primarily Black/African American participants. Mothers in NYC had higher rates of marriage and cohabitation and were less likely to be high school graduates. No significant differences emerged between the treatment and control groups across baseline variable data.

The review did not identify any evidence that the program has been evaluated in Australia or with First Nations communities.

What outcomes does it contribute to?

Positive outcomes:

Caregiver cognitive stimulation, Parent-child interaction: The program positively impacted multiple domains of parent-reported cognitive stimulation, including reading, verbal responsivity, and teaching behaviours; and significantly improved parent-child interaction, including parental support for cognitive development, language quantity, and language quality.

These findings replicate previous research on the effect of VIP on cognitive stimulation and parent-child interactions, and widen the generalisability of findings due to the comprehensive set of survey and observational measures and a more demographically diverse sample.

The impacts are notable given substantial research demonstrating that the above caregiver behaviours mediate the relationship between poverty and school readiness. This has implications for long-term educational trajectories. The results are especially significant given that replication of findings in the behavioural sciences is often challenging.

No effect:

None

Negative outcomes:

None

Is the program effective?

Overall, the program had a positive effect on client outcomes.

How strong is the evidence?

Promising research evidence:

• At least one high-quality RCT/QED study reports statistically significant positive effects for at least one outcome, AND
• Fewer RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects

How is it implemented?

Smart Beginnings includes the Video Interaction Project (VIP) as a universal primary prevention strategy. In the study, the program wasprovided to all families with children randomly assigned to the treatment group at birth, and Family Check-Up was provided to treatment families with identified psychosocial risks beginning at 6 months.

In the VIP program, Bachelor’s level educated coaches hired for this project delivered fourteen 25-30 minute sessions in paediatric primary care to families with children from birth to 3 years. Coaches received a 3-day training course and ongoing supervision.

Every VIP session follows the same format. The coach provides a developmentally appropriate learning material (book, toy) to the parent to engage them in interaction with their child. The coach records a short video of the parent and child interacting with the book or toy, and immediately reviews the video with the parent, identifying and reinforcing strengths in the interaction and encouraging self-reflection. The coach also provides the parent with a copy of the video; a personalised pamphlet with information about age-specific developmental milestones (e.g., making sounds at 6 months); age-specific suggestions for engaging with their child (e.g., imitating infant sounds at 6 months); a developmentally appropriate toy (e.g., hand puppets), and the parent’s goals for interacting with their child at home.

Family Check-Up is an evidence-based home visiting model that seeks to reduce the development of early disruptive behaviour and motivate parents to engage in services that improve parenting practices. Whereas VIP begins at birth in the Smart Beginnings model, families do not begin receiving Family Check-Up until the infant is 6 months.

How much does it cost?

Information not provided

What else should I consider?

This study had many strengths, including a multimethod assessment across a geographically, racially and ethnically diverse sample. It had the following limitations:

• The study did not have sufficient statistical power to show differences across the two sites and populations, resulting in exploratory subgroup analyses
• Due to specific race and ethnicity profiles at the different sites, these presented as confounding variables in the study design. Future studies need to isolate the role of each characteristic in analysis of intervention effects.
• The study took place during a period of specific stressors for immigrant and other racial and ethnic minority families, including heightened racism and discrimination. Experience of stress in these communities might have impacted enrolment and participation in assessments and could have implications for generalisability
• Future studies need to assess whether the observed patterns of change persist longitudinally.

Where does the evidence come from?

One RCT conducted in the USA with a sample of 403 families (Roby et al. 2021).

Further resources

• https://steinhardt.nyu.edu/ihdsc/projects/smart
• Roby, E., Miller, E.B., Shaw, D.S., Morris, P., Gill, A., Bogen, D.L., Rosas, J., Canfield, C.F., Hails, K.A., Wippick, H., Honoroff, J., Cates, C.B., Weisleder, A., Chadwick, K.A., Raak, C.D., and Mendelsohn, A.L. 2021. Improving Parent-Child Interactions in Pediatric Health Care: A Two-Site Randomized Controlled Trial. Pediatrics, 147(3), 1-12.