Avaliação da Room to Grow para crianças (RTG)
Apoio parental abrangente na primeira infância e saúde e desenvolvimento infantil
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Descrição detalhada
O objetivo do programa inovador da RtG é ajudar os pais a aumentar a probabilidade de seus filhos entrarem na escola prontos para aprender e continuar a atingir todo o seu potencial em educação, trabalho e cidadania. A abordagem terapêutica e psicodinâmica e o relacionamento robusto de três anos com as famílias são projetados para atuar como o catalisador para mudanças sustentáveis e de longo prazo nos métodos parentais e na estabilidade do sistema familiar. Criticamente, e em contraste com outros programas destinados a melhorar a paternidade e o desenvolvimento infantil, o RtG acredita que fornecer assistência material concreta aumenta a eficácia do aconselhamento e encaminhamentos para famílias de baixa renda, reduzindo o estresse econômico e liberando recursos escassos. O programa baseia-se em décadas de pesquisa sobre a importância do apoio aos pais para famílias de baixa renda e seus filhos, a importância do apoio material concreto e da redução da pobreza para melhorar a saúde e o desenvolvimento das crianças e o reconhecimento de que os primeiros anos são um momento eficaz para fornecem suportes críticos que influenciam os resultados de longo prazo. Numerosos programas, como modelos de visitas domiciliares que fornecem apoio aos pais para novas mães de baixa renda, mostraram resultados promissores. Após décadas de pesquisa correlacional estabelecendo relações entre renda, pobreza e saúde e desenvolvimento infantil, há uma literatura emergente que fornece evidências causais convincentes de que a renda é importante para os resultados da criança. Ambas as linhas desta pesquisa se baseiam em pesquisas adicionais que sugerem claramente que a primeira infância é um período chave de vulnerabilidade, onde as intervenções podem fazer uma diferença duradoura na sorte de crianças de baixa renda e suas famílias. A pesquisa se baseará nessa literatura, testando uma intervenção que combina suporte parental e provisão significativa de suporte material - em essência, avaliando se uma abordagem combinada pode ser potencialmente mais poderosa do que a soma de suas partes.
A avaliação do RtG oferece uma oportunidade sem precedentes para testar o valor combinado da educação parental com apoios sociais e materiais. O projeto utiliza uma abordagem inovadora que combina apoio à renda, educação parental e conexão com serviços comunitários para promover a saúde e o desenvolvimento precoce de crianças pequenas. Tanto os programas parentais quanto os de apoio à renda visam promover a saúde e o desenvolvimento positivo das famílias de baixa e média renda, mas muitas vezes trabalham isoladamente, potencialmente limitando sua capacidade de reduzir as disparidades na saúde e no desenvolvimento dos pais e das crianças. O modelo inovador do RtG oferece uma oportunidade de testar o efeito combinado desses serviços e fornecer informações valiosas para profissionais e formuladores de políticas sobre os efeitos sinérgicos desses componentes do programa. A pesquisa proposta pode facilitar a mudança no campo da primeira infância, demonstrando evidências preliminares de que esse modelo inovador pode alcançar efeitos demonstráveis nos principais resultados proximais durante o primeiro ano de vida e fornecer um primeiro passo para a construção de evidências para abordagens multifacetadas para atender às necessidades necessidades das famílias de baixa renda. As descobertas deste estudo podem orientar o campo para abordagens mais integradas que combinam apoio material, conexão com recursos e assistência aos pais para causar impactos reais na saúde e no desenvolvimento de crianças pequenas. O Room to Grow e sua avaliação fornecerão contribuições claras para o desenvolvimento de uma cultura de saúde e políticas relevantes no espaço da primeira infância. Este será o primeiro RCT que oferece uma combinação de apoio parental e comunitário com fornecimento substancial e capacitador de apoio material. Muitos programas para pais fornecem alguns livros ou brinquedos apropriados para o desenvolvimento, mas é incrivelmente raro fornecer o equivalente no varejo a cerca de US$ 10.000 em apoio durante os primeiros três anos de vida. Isso estabelecerá se um modelo como o do RtG é promissor para transformar os programas de criação de filhos na primeira infância, ajudando a construir uma cultura de saúde e reduzindo as disparidades de saúde entre crianças de origens divergentes. A organização e sua liderança esperam aprender com o projeto de avaliação para entender mais sobre o que está funcionando bem e o que pode ser melhorado na entrega do programa e no currículo. A equipe da RtG criou propositalmente uma cultura que usa dados para informar a tomada de decisões e espera entender todo o escopo dos resultados do RCT. A RtG está atualmente desenvolvendo planos de expansão nos próximos cinco anos como parte de um processo formal de planejamento estratégico. A organização espera eventualmente atender o dobro ou mais o número de famílias em cada cidade onde opera, Nova York e Boston. Os resultados das avaliações internas até o momento são extremamente encorajadores. É a esperança dos pesquisadores que outras fundações e agências governamentais (ou doadores privados) fiquem entusiasmadas para aproveitar o apoio da Fundação Robert Wood Johnson e que os pesquisadores possam estender o impulso inicial gerado por este projeto ao longo do tempo.
O projeto é projetado para investigar os resultados proximais. A longo prazo, a equipe de pesquisa espera desenvolver esses resultados proximais e, eventualmente, acompanhar as crianças até a idade escolar, bem como expandir bastante o número de crianças incluídas no projeto RCT.
Tipo de estudo
Inscrição (Real)
Estágio
- Não aplicável
Contactos e Locais
Locais de estudo
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New York
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New York, New York, Estados Unidos, 10032
- Columbia University - Columbia Population Research Center (CPRC)
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Descrição
Critério de inclusão:
- Fêmea
- Deve ter pelo menos 16 anos
- No terceiro trimestre (semanas 28-34) de gravidez
- Atender aos critérios do programa Room to Grow
- Baixa renda
- Precisando de serviços
Critério de exclusão:
- Não sabe ler/escrever inglês e/ou espanhol
- Macho
- Último terceiro trimestre
- Já deu à luz
- Renda média a alta
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Outro
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
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Experimental: Intervention Group
The treatment group will consist of mothers who were randomly selected to receive Room to Grow services, which include three years of social and practical support for the mother and baby through a combination of one-on-one sessions with an expert clinical social worker in-person every three months and provision of essential baby items and equipment.
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O grupo de tratamento consistirá de mães que foram selecionadas aleatoriamente para receber os serviços Room to Grow, que incluem três anos de apoio social e prático para a mãe e o bebê.
O modelo de programa baseado em pesquisa combina sessões individuais personalizadas com um assistente social clínico especialista pessoalmente a cada três meses, fornecimento de itens essenciais para bebês, incluindo livros, brinquedos, roupas e equipamentos (valor de varejo de itens em espécie mais de três anos custa em média US$ 10.000) e conexões com recursos comunitários vitais (por exemplo, moradia, direitos, assistência infantil, serviços sociais).
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Sem intervenção: Control Group
The control group will consist of mothers who will not receive Room to Grow services.
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
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Mean Score of Depressive Symptoms Using the CES-D Scale
Prazo: At Baseline (weeks 28-34 of pregnancy); 10.5 months after birth of child; 25 months after birth of child
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The Center for Epidemiological Studies-Depression (CES-D), is a 20-item measure that asks caregivers to rate how often over the past week they experienced symptoms associated with depression, such as restless sleep, poor appetite, and feeling lonely. Response options range from 0 to 3 for each item (0 = Rarely or None of the Time, 1 = Some or Little of the Time, 2 = Moderately or Much of the time, 3 = Most or Almost All the Time). Scores range from 0 to 60, with high scores indicating greater depressive symptoms. The Baseline and 25-month surveys included 12 items from the scale, and the 10.5-month survey included 7 items. The subscale scores range from 0 - 21 and 0 - 36, respectively. Higher scores indicate greater depressive symptoms. |
At Baseline (weeks 28-34 of pregnancy); 10.5 months after birth of child; 25 months after birth of child
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Mean Score of Perceived Stress Scale (PSS)
Prazo: At Baseline (weeks 28-34 of pregnancy); 10.5 months after birth of child; 25 months after birth of child
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The Perceived Stress Scale (PSS) is a widely used instrument for measuring the perception of general stress. This 14-item scale measures how stressful or uncontrollable participants find their lives. Respondents rate the frequency of their feelings and thoughts related to events and situations that occurred in the last month. Individual scores on the PSS can range from 0-40 with higher scores indicating higher perceived stress. Scores ranging from 0-13 would be considered low stress. Scores ranging from 14-26 would be considered moderate stress. Scores ranging from 27-40 would be considered high perceived stress. The Baseline and 10.5-month surveys included 4 items from the scale. The 25-month survey included 6 items. Scores ranged from 0 - 16 and 0 - 24, respectively. Higher scores indicate higher perceived stress levels. |
At Baseline (weeks 28-34 of pregnancy); 10.5 months after birth of child; 25 months after birth of child
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Mean Score of Parental Sense of Competence Using PSOC Scale
Prazo: At Baseline (weeks 28-34 of pregnancy); 10.5 months after birth of child; 25 months after birth of child
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The Parenting Sense of Competence Scale (PSOC). The PSOC measures parental competence on two dimensions: Satisfaction and Efficacy. It is a 17-item Likert-scale questionnaire (on a 6-point scale ranging from strongly agree [1] to strongly disagree [6]), with nine questions under Satisfaction and eight under Efficacy. Satisfaction section examines the parents' anxiety, motivation and frustration, while the Efficacy section looks at the parents' competence, capability levels, and problem-solving abilities in their parental role. Scores range from 17-102. A higher score indicates a higher parenting sense of competency. The Baseline and the 10.5-month surveys included 5 items from the scale with a modified 4-point scale ranging from strongly agree [1] to strongly disagree [4]. The 25-month survey included 8 items with the modified 4-point scale. Scores ranged from 4 - 20 and 4 - 32, respectively, with higher scores indicating a higher parenting sense of competency. |
At Baseline (weeks 28-34 of pregnancy); 10.5 months after birth of child; 25 months after birth of child
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Mean Score of the Confusion, Hubbub, and Order Scale (CHAOS)
Prazo: At Baseline (weeks 28-34 of pregnancy); 10.5 months after birth of child; 25 months after birth of child
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The Confusion, Hubbub, and Order Scale (CHAOS) is a questionnaire filled out by parents that is designed to assess the level of confusion and disorganization in the child's home environment. The statements are scored using a 4-point scoring system. The questionnaire consists of 15 statements, to each of which a parent or caregiver responds (1) True, or (0) False (scoring was adjusted for items that required reverse coding). Scores ranged from 0-15. The Baseline and the 10.5-month surveys included 2 items from the scale with a modified 4-point scale ranging from 0 - 3: 0 = Not at all like your own home; 1 = A little bit like your own home; 2 = Somewhat like your own home; 3 = Very much like your own home. The 25-month survey included 5 items from the scale. Item scores were averaged and ranged from 0 - 3. A higher score represents characteristics of a more chaotic, disorganized, and hurried home. |
At Baseline (weeks 28-34 of pregnancy); 10.5 months after birth of child; 25 months after birth of child
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Mean Score of Cognitive Stimulation in the Home (STIMQ)
Prazo: 10.5 months after birth of child; 25 months after birth of child
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STIMQ is a measure of cognitive stimulation in the home consisting of 4 subscales: Availability of Learning Materials (ALM), Reading, Parental Involvement in Developmental Advance (PIDA), and Parental Verbal Responsivity (PVR). The 10-month & 25-month surveys contained 4 of the 7 items in the PVR scale to measure cognitive stimulation. Respondents reported on the frequency of verbal responsiveness during everyday routines with their child. The full PVR scale uses an 8-point response scale ranging from 0 (never) - 7 (every day) and total scores range from 0 - 49 for preschool-age children. A modified 4-point response scale ranging from 1 (not at all) - 4 (every day). The average score of the four items was used and total scores ranged from 1-4. A higher score represents more responsivity and reflects greater stimulation in the home (a more favorable outcome). |
10.5 months after birth of child; 25 months after birth of child
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Mean Score of Aggravation in Parenting Scale
Prazo: 10.5 months after birth of child; 25 months after birth of child
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A measurement of stress experienced by parents associated with caring for children.
It measures the amount of parenting stress brought on by changes in employment, income or other factors in the parent's life.
Research has shown that high levels of aggravation in parenting are related to mothers' employment status and to child behavior problems.
High stress and aggravation in parents are associated with poor cognitive and socioemotional development of young children.
6 of the 9 items in the scale were included in the surveys.
Response categories being (0) Strongly agree, (1) Somewhat agree, (2) Somewhat disagree, (3) Strongly disagree.
This 0-3 score is reverse coded, and items are averaged to create an overall score with higher scores indicating more stress.
Total scores ranged from 0-3.
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10.5 months after birth of child; 25 months after birth of child
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Number of Toys and Goods in the Home
Prazo: 10.5 months after birth of child; 25 months after birth of child
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Subjects are asked if they have certain types of developmentally appropriate toys and games in the categories of symbolic play (doll, toy pots, small car), art (crayons, Play-Doh, paint), adaptive/fine motor toys (puzzle, shape sorter, pop-up toy), language (toy letters or numbers, toys that make animal sounds) and life-size toys (toy car or animal for child to ride).
Respondents can answer yes/no for each (1=yes, 0=no).
Subjects were asked about 13 items in the 10-month survey and 16 items in the 25-month survey.
Items were replaced or supplemented for age-appropriateness at each wave.
Item responses were tallied resulting in scores ranging from 0-13 and 0-16, respectively.
A higher score or number of developmentally appropriate toys and goods in the home reflects a more favorable outcome for the child.
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10.5 months after birth of child; 25 months after birth of child
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Worry Enough Money for Baby Scale Score
Prazo: At Baseline (weeks 28-34 of pregnancy); 10.5 months after birth of child; 25 months after birth of child
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Subjects are asked to rate (on a scale of 1-10) how worried they are about having enough money to cover their baby's expenses with 1 being "Not at all worried" and 10 being "Very worried".
A lower score indicates less concern and is therefore favorable.
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At Baseline (weeks 28-34 of pregnancy); 10.5 months after birth of child; 25 months after birth of child
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Mean Score of Parent Supportiveness Using the 3-bag Task
Prazo: At follow-up in-person meeting (42-72 months after birth of child)
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The 3-bag task utilizes a semi-structured play protocol in which the parent-child dyad is instructed to play with the toys in each of three bags in a predetermined sequence.
The semi-structured play interactions are videotaped and the parent-child behaviors scored in accordance with the 3-bag task coding scales used in the National Institute of Child Health and Human Development Study of Early Child Care.
Parent supportiveness is the average of three measures: maternal sensitivity, positive affect, and the extent to which the parent provides cognitive stimulation while interacting with their child.
Scoring for all three considers both the quantity and quality or intensity of behavioral indicators observed for each; a score of 1 represents virtually no evidence of the particular behavior and a score of 7 indicates very high levels of the behavior.
As an average of the three, parent supportiveness follows the same scoring scheme and higher scores represent a more favorable outcome.
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At follow-up in-person meeting (42-72 months after birth of child)
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Mean Score of Parent Detachment Using 3 Bag-task
Prazo: At follow-up in-person meeting (42-72 months after birth of child)
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The 3-bag task utilizes a semi-structured play protocol in which the parent-child dyad is instructed to play with the toys in each of three bags in a predetermined sequence.
The semi-structured play interactions are videotaped and the parent-child behaviors scored in accordance with the 3-bag task coding scales used in the NICHD Study of Early Child Care.
The parent detachment scale is based on observations of the parent's awareness of, attention to, and engagement with the child.
Behavioral indicators of detachment include being consistently inattentive, being inconsistently attentive, and/or interacting with the child in a perfunctory or indifferent manner.
Scoring considers both the quantity of behavioral indicators observed and the quality or intensity of the behaviors.
A score of 1 represents very low detachment and score of 7 indicates very high detachment.
A lower score represents a more favorable outcome.
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At follow-up in-person meeting (42-72 months after birth of child)
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Mean Proportion Correct Score on Working Memory Span Performance
Prazo: At follow-up in-person meeting (42- 72 months after birth of child)
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This task measures working memory.
Working memory involves holding information in short-term storage and attending to one item (i.e., a house) while overcoming interference from the other (i.e., an animal or color).
The task requires children to perform the operation of naming and holding in mind two pieces of information simultaneously and to activate one while overcoming interference occurring from the other.
The task becomes more difficult as the number of houses increases.
In the pretest phase, it is established that children can name both the colors and the animals in the task.
Children then receive three 1-house trials, three 2-house trials, and three 3-house trials.
There are 18 items.
Individually, incorrect items receive a score of 0 and correct items receive a score of 1. Item scores are averaged and the total score on this activity is a proportion correct score of all items which ranges from 0 to 1.
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At follow-up in-person meeting (42- 72 months after birth of child)
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Mean Proportion Correct Score on Inhibitory Motor Control Performance
Prazo: At follow-up in-person meeting (42-72 months after birth of child)
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This task measures inhibitory motor control and is a standard go no-go task.
Children are presented with a large green button on the screen that makes a "popping" sound when it is touched.
Children are instructed to touch the button every time that they see an animal (the 'go' response) except when that animal is a pig (the 'no-go' response).
No-go responses vary in difficulty depending on how many go responses preceded them.
In the pretest phase, children are asked to identify all of the animals.
During administration items, the task is presented in varying numbers of go trials prior to each no-go trial, including, in standard order, 1-go, 3-go, 3-go, 5-go, 1-go, 5-go, 7-go and 7-go.
There are 40 items.
Individually, incorrect items receive a score of 0 and correct items receive a score of 1. Item scores are averaged and the total score on this activity is a proportion correct score of all items ranging from 0 to 1.
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At follow-up in-person meeting (42-72 months after birth of child)
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Mean Proportion Correct Score on Attention Shifting Performance
Prazo: At follow-up in-person meeting (42-72 months after birth of child)
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This task measures attention shifting and requires children to use flexible thinking.
For the initial trials in the task, children are presented with two pictures (animals, flowers, etc.) that are similar along a single dimension of color, shape, or size.
Initially, the child is explicitly told how two of the pictures are the same in some way.
Then, the child is presented with a third picture alongside the original two and asked to state how the new picture is similar to one of the original pictures.
This task requires the child to shift his/her attention from the initial dimension of similarity to a new dimension of similarity.
In the most difficult, items all of the pictures are presented at once and children are prompted to identify both dimensions of similarity.
There are 30 items.
Incorrect items receive a score of 0 and correct items receive a score of 1. Item scores are averaged and the total score on this activity is a proportion correct score of all items ranging from 0 to 1.
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At follow-up in-person meeting (42-72 months after birth of child)
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Mean Language Total Standard Score
Prazo: At follow-up in-person meeting (42-72 months after birth of child)
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The Receptive One-Word Picture Vocabulary Test, Fourth Edition (ROWPVT-4) is a norm-referenced assessment that tests an individual's ability to match a spoken word with an image of an object, action, or concept.
The test targets the ability to understand the meaning of words spoken and name what is depicted on a test plate without context.
Scores range from 55 - 145.
This is a standardized language assessment based on a mean of 100 and a standard deviation of 15.
Scores of 85-115 are considered to be within the average range of functioning.
Scores above 115 are considered above average and scores below 85 are considered below average.
Scores from this measure indicate that a child's receptive vocabulary is above average, below average, or equivalent to their peers of the same age.
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At follow-up in-person meeting (42-72 months after birth of child)
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Colaboradores e Investigadores
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Christopher Wimer, PhD, Senior Research Scientist at CPRC, School of Social Work
Publicações e links úteis
Publicações Gerais
- Peacock S, Konrad S, Watson E, Nickel D, Muhajarine N. Effectiveness of home visiting programs on child outcomes: a systematic review. BMC Public Health. 2013 Jan 9;13:17. doi: 10.1186/1471-2458-13-17.
- Duncan GJ, Morris PA, Rodrigues C. Does money really matter? Estimating impacts of family income on young children's achievement with data from random-assignment experiments. Dev Psychol. 2011 Sep;47(5):1263-79. doi: 10.1037/a0023875.
- Chaudry A, Wimer C. Poverty is Not Just an Indicator: The Relationship Between Income, Poverty, and Child Well-Being. Acad Pediatr. 2016 Apr;16(3 Suppl):S23-9. doi: 10.1016/j.acap.2015.12.010.
- Duncan, G.J., Magnuson, K., Kalil, A. et al. Soc Indic Res (2012) 108: 87. https://doi.org/10.1007/s11205-011-9867-9
- Cates CB, Weisleder A, Mendelsohn AL. Mitigating the Effects of Family Poverty on Early Child Development through Parenting Interventions in Primary Care. Acad Pediatr. 2016 Apr;16(3 Suppl):S112-20. doi: 10.1016/j.acap.2015.12.015.
- Wimer C, Marti M, Brooks-Gunn J, Waldfogel J. Early Impacts of Room to Grow: A Multifaceted Intervention Supporting Parents and Children Age Zero to Three. Child Youth Serv Rev. 2021 Jul;126:106041. doi: 10.1016/j.childyouth.2021.106041. Epub 2021 Apr 30.
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Conclusão Primária (Real)
Conclusão do estudo (Real)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- AAAR1340
- P2CHD058486 (Concessão/Contrato do NIH dos EUA)
Plano para dados de participantes individuais (IPD)
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