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Study: Doctor Visits Give Opportunity for School Readiness Check-up

In the first years of a child's life, he or she has far more contact with the family pediatrician than the local school district, and a series of newly released studies suggest educational partnerships with physicians may help disadvantaged families prepare their children to start school.

In a pair of just-released studies published in the January issue of the Archives of Pediatrics and Adolescent Medicine, Dr. Alan L. Mendelsohn, a developmental-behavioral pediatrician at Bellevue Hospital Center and an associate pediatrics professor at the New York University School of Medicine, led a team of researchers studying the effectiveness of two parent-education initiatives that build upon the Reach Out and Read program, which provides books and reading guidance for parents of children ages 6 months and up.

Dr. Mendelsohn's team randomly assigned 675 pairs of mothers and their newborns to receive either general pediatric care or one of the two interventions. All three groups received books and literacy materials from the Reach Out and Read program. Both interventions teamed early childhood educators and child development experts with pediatricians to work with low-income parents during regular child check-ups from birth through age 5. "Children have to come in for immunizations and screenings ... and this provides an opportunity for working with families who may be at risk at relatively low-cost," Dr. Mendelsohn told me. "We can build on the fact that families already have to be there, and that the infrastructure is already there."

Through one of the interventions—the Building Blocks program—parents were mailed monthly developmental questionnaires as well as age-related newsletters and materials with suggested reading and play activities to encourage child development and early literacy.

In the second intervention, known as the Video Interaction Project, a child development expert met with a child's family in connection with 15 wellness visits in the first 3 years, including visits at two weeks, a month, two months and four months after birth. The expert talked with the family about the child's stage of development, provided toys or other materials, and then recorded a video of the family playing with the child for 10 to 15 minutes. After this, the expert reviewed the video with the family, pointing out strengths and weaknesses in the play and suggesting additional activities. The family was given a copy of the video to review at home.

The researchers found that at 6 months old, the infants in the video intervention had significantly higher scores than those in the control group in all four domains of the standardized StimQ infant test, which covers parent-child interaction and preliteracy activities, such as toy interaction, reading activities, and the parent's teaching and verbal responsiveness to the child. Families who participated in the Building Blocks program also had higher StimQ scores than those in the control group, but these improvements were weaker than those of families participating in the video intervention.

"I think what we're doing in health care is looking to reinforce what is happening in the early childhood education system," Dr. Mendelsohn said. "We don't have the opportunity to work directly with children that the early childhood educators do. What we do have is the opportunity to work with virtually all students ... at the earliest age possible."

Moreover, a related study showed the increase in parent-child activities coincided with less exposure to television and other media, something prior research has shown does not improve early childhood development. On average, families participating in the video intervention reported exposing their babies to about 20 fewer minutes of television per day than did families in the control group or those who received the mail-only interventions. "By increasing those wonderful things, like reading and play, we were able to reduce the television exposure," he said.

Though these studies covered only the first few months of interventions, the researchers have continued the programs at each health visit and are tracking the students through age 5 to determine whether the increased family activity will lead to children better prepared to start school.

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