Abstract
BackgroundOne in five Americans under age 18 lives in a family below the Federal poverty threshold. These more than 15 million children are at increased risk of a wide variety of adverse long-term health and developmental outcomes. The early years of life are critical to short- and long-term health and well-being. The Legacy for ChildrenTM model was developed in response to this need and marries the perspectives of epidemiology and public health to developmental psychology theory in order to better address the needs of children at environmental risk for poor developmental outcomes.Methods/designThe Legacy for ChildrenTM group-based parenting intervention model was evaluated as a pair of randomized controlled trials among low-income families in Miami and Los Angeles. The study was designed to allow for site-stratified analysis in order to evaluate each model implementation separately. Evaluation domains include comprehensive assessments of family, maternal, and child characteristics, process outcomes, and prospective programmatic cost. Data collection began prenatally or at birth and continues into school-age.DiscussionThe societal costs of poor developmental outcomes are substantial. A concerted effort from multiple sectors and disciplines, including public health, is necessary to address these societal concerns. Legacy uses a public health model to engage parents and promote overall child well-being in families in poverty through rigorous evaluation methodologies and evidence-based intervention strategies. This study collects rich and modular information on maternal and child outcomes, process, and cost that will enable a detailed understanding of how Legacy works, how it can be refined and improved, and how it can be translated and disseminated. Taken together, these results will inform public policy and help to address issues of health disparities among at-risk populations.Trial registrationNCT00164697
Highlights
One in five Americans under age 18 lives in a family below the federal poverty threshold [1]. These more than 15 million children are at increased risk for a wide variety of adverse long-term health and developmental outcomes [2,3,4,5]
Such children are at increased risk for poor developmental outcomes, including developmental delays and
A common challenge across existing early intervention outcome evaluations was related to measurement and statistical power [13,17], which pointed to the need to collect a wide variety of child outcomes on a large enough sample to allow for the comparison of intervention effects both within and across implementation sites over time
Summary
Strengths and unique contributions The societal costs of poor developmental outcomes, including the personal costs to the individual and their families, are substantial and include medical, education, child welfare, social services, juvenile crime, and productivity loss. The results of the thorough evaluation of intervention effects, process, and costs will inform public policy on early intervention, health and well-being and help to address health disparities issues in at-risk populations. There was a corresponding cost to the external validity of the results This trade-off may limit the generalizability of findings in three ways. There may be different patterns of effects within the individual intervention groups, there was a practical need to allow a certain degree of movement across intervention groups. Examples for this need include schedule conflicts, such as a return to work, as well as the need to merge groups over time due to group attrition.
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