Legacy for ChildrenTM: a pair of randomized controlled trials of a public health model to improve developmental outcomes among children in poverty.
BACKGROUND
One 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
The 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.


CONCLUSIONS
The 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.


BACKGROUND
NCT00164697.
Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA. rperou@cdc.gov
Ruth
R
Perou
Marc N
MN
Elliott
Susanna N
SN
Visser
Angelika H
AH
Claussen
Keith G
KG
Scott
Leila H
LH
Beckwith
Judy
J
Howard
Lynne F
LF
Katz
D Camille
DC
Smith
D000328:Adult; D003266:Continuity of Patient Care / Q000592:standards*; D005260:Female; D005431:Florida; D006798:Housing / Q000191:economics; D006801:Humans; D015141:Los Angeles; D008297:Male; D008423:Maternal Age; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D011203:Poverty / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D015397:Program Evaluation; D011634:Public Health / Q000379:methods*; D012107:Research Design; D018401:Sample Size; D012959:Socioeconomic Factors; D055815:Young Adult