Description:

Psychologists have not achieved population impact on important mental health and well-being outcomes for families and young children, nor have they reduced egregious disparities in outcomes across race, ethnic, and income groups. The traditional Institute of Medicine model of moving from efficacy trials to effectiveness trials to scaling up has not succeeded, partly due to degradation of program quality and impact during scale-up and partly due to a failure to consider system cultural and context issues at the outset. Analysis of barriers to population impact leads to the proposal of a new comprehensive system of care that includes both top-down coordination among community agencies providing services and bottom-up outreach to every family to connect them with family-specific services.

The North Carolina Smart Start Initiative is a top-down approach to improve the community-level quality of early childcare and education services. A natural experiment suggests it improves population indicators of children’s education outcomes. Family Connects is a bottom-up approach that reaches all consenting families giving birth in a community through brief home visits to assess needs and connect families with community resources tailored to their needs. Two randomized controlled trials and a field quasi-experiment reveal that random assignment to Family Connects is associated with increased community connectedness, lower maternal anxiety, reduced emergency health episodes, and lower rates of investigations for child abuse.

Featuring:

Kenneth A. Dodge, PhD
William McDougall Distinguished Professor of Public Policy and Professor of Psychology and Neuroscience
Duke University