TMW-Home Visiting: Early Signs of Impact

This past June saw the completion of the intervention phase of our longitudinal study, generously funded by PNC Grow Up Great. As we continue with booster sessions and data collection through 2020, we’re gaining encouraging insights into the impact of the TMW-Home Visiting curriculum.

“With the use of observation and transcription, we’re able to analyze the parents’ talk during play and book-sharing times with their children,” says Director of TMW Research Christy Leung. Initial analysis shows that, following the 12-module intervention, participants’ knowledge of early childhood cognitive and language development increased significantly. Parent participants subsequently provided richer home language environments for their toddlers, showing an average increase of 72% in the complexity and diversity of language they used with their children (such as use of plurals, verbs, etc.), compared with a 24% increase among parents in the control group.

According to Leung, “The ability to foster more complex and diverse talk among low-SES parents is an important first step to addressing the early language disparities, as well as to supporting low-SES young children’s development of language and communication skills.”

We look forward to sharing more exciting results as they become available.

A Prescription for Talk and Interaction

At the TMW Center, we believe that parents are the primary drivers of their children’s foundational brain development. The American Academy of Pediatrics (AAP) also acknowledges the impact of parent talk and interaction on children’s developing brains, as evidenced by their Agenda for Children, a statement that encourages pediatricians to support parents so that they may provide a “rich and responsive language environment” for their children.

Our recently published op-ed in the journal Pediatrics, however, asserts that pediatricians do not always engage parents in conversations regarding language and brain development. Talk, Read, Sing: Early Language Exposure as an Overlooked Social Determinant of Health, written by Pritzker Medical School students Danielle LoRe and Peter Ladner, along with Dana Suskind, MD, makes the case that pediatricians can and should buck this trend and, in doing so, help prevent disparities in brain development and school readiness.

The piece was inspired by LoRe’s experience on her pediatric rotation. She observed how her Resident thoroughly covered the first nine items on the postpartum discharge list with parents – but noticeably skipped the last point, “Talk, read, and sing to your baby.” “I wondered if her omission came with an implicit prioritization,” LoRe writes. “Not talking, reading, or singing to a newborn is, admittedly, less life-threatening than most recommendations on the newborn discharge list.” LoRe, however, soon learned just how vital these activities are to the healthy development of very young children.

Fast-forward several months to Suskind’s office where LoRe is now in the middle of a research year at TMW. She recounts this story during a meeting to discuss plans for a new Continuing Medical Education (CME) program for pediatricians and a lightbulb goes off in Suskind’s head.

“As pediatricians, we all know the critical importance of this issue, but the demands of each pediatric visit are such that it often gets overlooked,” says Suskind. “Danielle’s powerful story was a reminder of the need to catalyze the next generation of medical students and pediatric residents.”

To that end, the op-ed advances two key ideas: 1) rich early language environments are a critical and malleable social determinant of health and 2) pediatricians and the healthcare sector play a pivotal role in helping families understand the science and strategies that foster foundational brain development.

According to the authors, “By elevating the importance of foundational brain development as a public health issue that impacts all children, pediatric trainees can help shape parent investment.”

Click here to read the full feature.

The Healthcare Sector’s Role in Priming Parents

On November 30th, thought-leaders from across the country will join us in Saieh Hall for the Rohit and Harvanit Kumar Conference on the Economics of Early Childhood, Leveraging the Healthcare System to Impact Educational Disparities.  The focus of this convening, the TMW Center’s first, is to elevate the role of the healthcare sector, highlight its current approaches, and harness its capacity to impact a child’s future health and well-being.

Our decision to focus on the healthcare sector was driven by our belief that it is both uniquely positioned to disseminate evidenced-based strategies directly to parents, and vastly underutilized in its practice of doing so.

A dynamic roster of speakers from multiple disciplines will discuss ways the healthcare sector can foster parental knowledge of foundational brain development, look at current programs having impact, and examine the role of the science of scaling to replicate and scale evidence-based programs.

All are welcome to attend. Space is limited. Register here.

Community-Wide Roll Out: New Partnership Announced

After a thoughtful and productive RFP process, the TMW Center is pleased to announce the selection of Palm Beach County, Florida as our partner site for our first community-wide roll out. Over the course of the next 12 months, we’ll work closely with Children’s Services Council of Palm Beach County (The Council), to strategize how to embed TMW’s integrated suite of evidence-based interventions within already existing health, education and social service systems. Program implementation, starting in birthing hospitals, followed by pediatric clinics, and community-based organizations, is slated to begin fall 2019. Our five-year goal is to reach at least 60 percent of children birth to age three and their families living in the community.

We received a number of impressive proposals from diverse communities across the nation all doing amazing work. To guide the selection process, TMW Center leadership used clearly defined criteria, including a capacity to work across existing systems, a commitment to long-term progress, clear community stakeholder engagement, and sustainable funding streams. A history of impact and an expressed desire to partner were also essential.

Palm Beach County beautifully fit all of these criteria. In addition to the size and make-up of its population, Children’s Services Council stood out for its longstanding commitment to partnering with families, agencies, and tax payers to provide and support high-quality services and vital infrastructure for its youngest children. We were compelled by its historical and sustained commitment to providing data, staffing, and training infrastructure to its community partners.  Finally, the Council’s data-driven approach, specifically its efforts to support, evaluate, and innovate service delivery is a model for the field, and is well-aligned with TMW Center’s feedback-driven innovation cycle.

“We couldn’t have asked for a better partner than Palm Beach County and the Council,” says TMW Center Co-director Dana Suskind, MD.  “We share a belief in the important role parents play in their children’s foundational brain development.  That belief – and a commitment to partnering with others and using science to learn what works and what doesn’t – will guide our joint efforts in the coming years.”

As passionate scientists, we are committed to using science and data to guide us in this process.  We understand the importance of scaling interventions that are both feasible in the real world and reflective of the needs and desires of the community.

“Our community-wide demonstration project is an interesting mix of use and learn,” says John List, TMW Center Co-director.  “On the one hand, we will use frontier science to provide programs at scale in Palm Beach County.  On the other hand, we will learn from the project by gaining greater insights into the threats of scalability through our community wide roll out. A true win-win for the science of using science.”

At the end of five years, we expect to have developed a community model that demonstrates that it is possible to achieve population-level change in parent and caregiver behavior to optimize children’s early brain development, and what it takes to accomplish this. This project will be a foundation for learning that will inform future partnerships as we continue to expand the reach of our programs.

Exciting Updates from the TMW Center – Newsletter Issue 02

Dear Friends,

It was a busy summer at the TMW Center for Early Learning + Public Health. While others may have slowed down for vacations and the like, we were ramping up efforts, and are eager to share some exciting news.

Most notably, we’re beginning to work with our newly selected community partner to lay the foundation for our community-wide roll out. Taking our efforts to scale means there is a lot to do and much to learn in the coming months.  With the North Star of optimizing foundational brain development using science that combines theory and data, this partnership will both inform and be informed by our work around the science of scaling.  We’re thrilled to reveal the chosen community in this newsletter and look forward to sharing our progress in the coming months.

We’re also planning our first convening: Leveraging the Healthcare System to Impact Educational Disparities, the inaugural Rohit and Harvanit Kumar Conference on the Economics of Early Childhood Education. By gathering thought-leaders from across disciplines, our aim is to elevate the role of the healthcare sector in intervening early and having a lasting impact on a child’s future health and well-being. For more details and to register, please click here.  We hope to see you all at the University of Chicago for this event.

These accomplishments, along with many other ongoing projects at the TMW Center, would not have been possible without our amazing research team. In addition to our staff, this summer we saw an influx of 32 undergraduate and graduate students from across the country who brought a wonderful energy to our lab. They used their talents on 13 projects ranging from formatively testing our new TMW-Pediatrics curriculum, to advancing work on our upcoming community-wide demonstration project, and developing our tech platform. Their contributions were immense and we would be remiss not to thank them.

As always, thanks to you, too, for your continued interest and support of our work.  Let’s change the world!

Warmest regards,

Dana and John

We welcome you to the inaugural issue of the TMW Center for Early Learning + Public Health Newsletter!

The TMW Center is a merging of disciplines, marrying fields as diverse as economics and medicine, developmental psychology and public policy, and neuroscience and anthropology.

As we navigate our first year, there is much to be excited about. A key distinction of our reimagination of early childhood education revolves around developing a public health approach to early learning. Most of our time so far has been spent building the foundation for a community-wide rollout of TMW’s integrated suite of evidenced-based interventions in a single community’s existing health, education, and social service systems. After a successful RFP announcement, the team is in the process of reviewing applications and planning the crucial next steps in the effort to select the first TMW Community later this summer. Here, using science to guide us, we will seek to understand how to bring best practices and interventions that work to scale. Our goal is to foster a community in which parents will be empowered to take control of their child’s development, from day 1, if not earlier!

In addition to sharing updates from the TMW Center, we’ll be looking to the broader early childhood landscape and beyond for inspiration. We start in this issue with a snapshot of some intriguing research out of the McGovern Institute at MIT, which beautifully links the role of conversation with brain activation and child outcomes. This is yet another example of good science pointing to the critical import of parents and the central role they play in their children’s early education.

We, along with our team, look forward to collaborating, learning from, and continuing the conversation with you as we all work to support parents and caregivers in the critical role of raising our next generation.

Warmest regards,

Dana & John

Co-Directors, TMW Center for Early Learning + Public Health
Dr. Dana Suskind, Professor of Surgery and Pediatrics and Director of the Pediatric Cochlear Implant Program
John List, Kenneth C. Griffin Distinguished Service Professor in Economics and the Chairman of the Department of Economics

Meet TMW Power Parent Erika

Recent TMW graduate Erika has a lot going on in her life. In addition to being a single mom to 2-year-old Gabriel, she’s a full-time student and helps to care for her 94-year-old grandmother. Even with so much on her plate, Erika found time to participate in TMW-Home Visiting and she was kind enough to share some of her experiences with us.

“The most important thing l learned,” says Erika, “is that using my words more often can make a huge difference in both my child’s life and my own. I never thought that providing my son with the words to describe his feelings as well as the toys he plays with would be so beneficial. Now he can let me know when he is upset and why, which makes it easier for me to know how to handle the situation.”

A First Look at TMW-Home Visiting Results

The longitudinal study of TMW-Home Visiting is fully enrolled and we’re excited to share some of what we’re learning.

Preliminary results show that after receiving the 12-module intervention, low-SES caregivers demonstrated increased knowledge of early childhood cognitive and language development. These caregivers provided more enriched home language environments for their toddlers including more back-and-forth conversational interactions. They also used more praise, explanations, and open-ended questions, as well as less criticism, physical control, and intrusiveness with their children.

“These findings are particularly promising,” says Director of TMW Research Christy Leung, “because these are the behaviors that have been shown to promote young children’s cognitive development and language learning.”

The active intervention stage of our longitudinal study is on track to end in June of this year, with assessments ongoing through December, 2021. We will continue to share updates as they become available.

More Than Idle Talk: The Value of Conversation

New research[1] from the McGovern Institute at MIT has reinforced the notion that quality, back-and-forth language interaction between parent and child is critical to a child’s learning and development.

Using functional magnetic resonance imaging (fMRI), researchers identified differences in the brain’s response to language that correlated with the number of conversational turns a child is exposed to. In children who experienced more conversation, Broca’s area, a part of the brain involved in speech production and language processing, was much more active while they listened to stories. More conversational turns boosted brain activity irrespective of parent education or family income.

“Often when people think about trying to close the word gap, all they think about is the quantity of child-directed speech, and this can result in a sort of ‘word dump’ onto the child,” says Rachel Romeo, lead researcher on this study. “But our research suggests that children’s brains care less about the sheer number of words, and more about meaningful, back-and-forth conversational turn-taking between the child and adults. It seems that during these exchanges is when learning really takes place.”

The TMW Center is excited about this research for a variety of reasons. The importance of engaging children in conversation, what we call Take Turns, is a core component of our curricula. The McGovern Institute’s work is a critical reminder that it’s not the quantity of words that matter, rather the parent-child relationship and the interaction it promotes. These findings also support one of TMW’s foundational tenets: within every parent, regardless of education or income, lies the ability to build their child’s brain and shape their future.

We plan to include this research in TMW-Pediatrics, a scalable, technology-based continuing medical education (CME) program we’ll begin piloting this summer. Many parents report having unmet needs related to the type information they desire during pediatric visits. In a survey administered by TMW to 420 parents in Chicago-area clinics and FQHCs, the majority of parents reported discussing traditional preventive topics at the first 6 months of well-child visits, including, feeding (79%) and baby’s weight (67%). Significantly fewer parents reported receiving information about brain growth (32%), how babies learn (21%), and learning to talk (17%). The goal of TMW-Pediatrics is to build on the unique positioning pediatricians have to intervene early and have a lasting impact on a child’s future health and well-being by educating parents about the importance of a rich early language environment. By doing so, physicians can help prevent disparities before they start.

 

(1) R. R. Romeo, J. A. Leonard, S. T. Robinson, M.R. West, A. P. Mackey, M. L. Rowe, and J.D.E. Gabrieli. Forthcoming. “Beyond the “30 million word gap:” Children’s conversational exposure is associated with language-related brain function.” Psychological Science.

Exciting Research from MIT’s McGovern Institute

New research[1] from the McGovern Institute at MIT has reinforced the notion that quality, back-and-forth language interaction between parent and child is critical to a child’s learning and development.

Using functional magnetic resonance imaging (fMRI), researchers identified differences in the brain’s response to language that correlated with the number of conversational turns a child is exposed to.  In children who experienced more conversation, Broca’s area, a part of the brain involved in speech production and language processing, was much more active while they listened to stories. More conversational turns boosted brain activity irrespective of parent education or family income.

“Often when people think about trying to close the word gap, all they think about is the quantity of child-directed speech, and this can result in a sort of “word dump” onto the child,” says Rachel Romeo, lead researcher on this study.  “But our research suggests that children’s brains care less about the sheer number of words, and more about meaningful, back-and-forth conversational turn-taking between the child and adults. It seems that during these exchanges is when learning really takes place.”

The TMW Center is excited about this research for a variety of reasons. The importance of engaging a child in conversation, what we call Take Turns, is a core component of our curricula.  These findings also support a foundational tenet of our work: the belief that within every parent, regardless of education or income, lies the ability to build their child’s brain and shape their future.

We plan to include this research in TMW-Pediatrician, a scalable, technology-based continuing medical education (CME) program we’ll begin piloting this summer. Our goal is to improve doctor-parent communication related to early learning and early brain development by highlighting strategies and tools for sharing information and demonstrating behaviors. Pediatricians, along with other healthcare professionals, are uniquely positioned to intervene early and have a lasting impact on a child’s future health and well-being. Through educating parents about the importance of a rich early language environment, they can help prevent disparities before they start.

(1) R. R. Romeo, J. A. Leonard, S. T. Robinson, M.R. West, A. P. Mackey, M. L. Rowe, and J.D.E. Gabrieli. Forthcoming. “Beyond the “30 million word gap:” Children’s conversational exposure is associated with language-related brain function.” Psychological Science.