1. LEGACY FOR CHILDREN™: ENHANCING THE USER-
FRIENDLINESS OF THE MIAMI CURRICULUM
BY AMANDA VASI
THE FINDINGS AND CONCLUSIONS IN THIS PRESENTATION ARE THOSE OF THE AUTHORS AND DO NOT
NECESSARILY REPRESENT THE VIEWS OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION
November 2016
2. Objectives
Background
Overview of Legacy for Children™ (Legacy)
Curriculum resource guide project
Final outcomes and materials
Conclusion
4. Poverty in Children
• 21% of children live in
poverty²
• Associated with
health and
developmental
outcomes¹᾽⁵
• Increases risk for
unemployment and
adult poverty¹᾽⁵
• Costs the U.S. about
$500 billion per year³
Academic
Performance
Emotional &
Behavior
Outcomes
Cognitive
Abilities and
Development
Poverty
7. Program Overview
Legacy is an evidence-based, parent-focused intervention approach
aimed at improving child outcomes by fostering positive parenting
among low-income mothers of infants and young children.
The goals of Legacy are to:
Promote the mother’s responsibility for, investment in, and devotion of
time and energy to her child
Promote responsive, sensitive mother–child relationships
Support mothers as guides in their children’s behaviors
Promote each mother’s sense of community
Promote each mother’s ability to influence her children’s verbal and
brain development
8. Philosophy
Assumptions
Goals
Core Elements & Activities
Model Elements
• Adherence to the five Legacy goals
• Delivery of a developmentally appropriate
early childhood-focused parenting curriculum,
consistent with intervention assumptions
• Group-based format
• Reinforce curriculum content one-on-one
• Strategies to ensure attendance &
participation
Parents can
successfully parent,
regardless of life
circumstances
Legacy
mechanisms:
• Mother-child
interactions
• Promoting sense
of community
• Enhancing self-
efficacy
Mothers can have a
significant, positive
influence
Promoting positive
parenting requires
time and is a dynamic
process
Mother-child
relationship is more
important than any
one experience
Mothers’
commitment &
sense of
responsibility is
important
Mothers can be
positive parents
best when
supported
There are multiple
pathways to positive
mother-child
relationships
Promote maternal
responsibility,
investment, & devotion
of time and energy
Promote responsive,
sensitive mother-child
relationships
Support mothers as
guides to their children’s
behavioral & emotional
regulation
Promote mothers’
facilitation of children’s
verbal and cognitive
development
Promote mothers’ sense
of community
All children deserve
an opportunity to
reach their full
potential
Intervention Activities
• Mother and mother-child group sessions
• 1-on-1 sessions
• Community events and activities
8
Legacy Model
8
9. Legacy Curricula
Timed according to developmental age
Themes repeated across years
Attachment
Health and safety
Social Skills
Language/Play
Discipline
Literacy
Interactive, multi-media, hands-on
Curriculum text provides a guide for the session
Information is shared through facilitated discussion
9
10. UCLA Miami
Child Age Prenatal to 3 years 6 weeks to 5 years
Session Recurrence Each year, 3 Blocks of 10 week-long
sessions; during breaks, make home
visits
Weekly
Group Size Approximately 10 mothers
Curriculum • Based on Legacy goals
• Sequential and developmentally-ordered
• Repeated coverage of the same topic varies by developmental stage
Session Length 2 hours 1.5 hours
Parent-child
Component
Alternating mother-only with
mother-baby days
Children involved in a component
of every session
Community Building FUN Club Building Sense of Community
Session Structure (Rotating components)
• Main Session Topic
• FUN Club or Mother Child
Interaction Time
(Each session)
• Building Sense of Community
• Main Session Topic
• Parent-Child Time Together
10
11. Outcomes
Set of randomized controlled trials in
Los Angeles (LA) and Miami
Children of Legacy mothers experienced
fewer behavior problems²
Data on promising cognitive and mother-child interaction
findings through third grade are forthcoming
11
13. Purpose
Increasing the user-friendliness
• Resource List Categorization
• Listing Materials Needed
Ensuring the availability of the best
evidence-based knowledge
• Video List Categorization
• Eventual Search for Newer Versions
Enhancing the Miami curriculum
• Eventual redesign of reference list
• Updated curriculum videos
14. Methodology
1. Reviewed the Miami Curriculum Years 0-5
2. Recorded and organized the resources on a chart in
Word by session
3. Created an Excel spreadsheet for the videos
Review Reorganize Reconsider
16. Outcomes
134-page resource list for Years 0-5
Separated into five categories:
Resources to Find Out More
DVDs
Materials NeededHandouts/Brochures
References
19. Outcomes2
14-page Excel spreadsheet for videos from Years 0-5
Separated into six sections:
Title
Session
Theme/Main Idea
Instructions
Have?
Year
22. Conclusions
Having resources listed clearly may enhance user-
friendliness
Ensuring curricula contain the most up-to-date
information may enhance outcomes
Future research could explore the quality
improvement implications before and after the
update
24. More Information on Legacy
Legacy website
http://www.cdc.gov/ncbddd/childdevelopment/research.html
Papers
Perou, R., Elliott, M.N., Visser, S.N., Claussen, A.H., Scott, K.G., Beckwith, L.H., Howard,
J., Katz, L.F., Smith, D.C., 2012. Legacy for Children™: a pair of randomized controlled
trials of a public health model to improve developmental outcomes among children in
poverty. BMC Public Health 12, 691. (http://www.biomedcentral.com/1471-
2458/12/691/abstract)
Kaminski, J. Perou, R., Visser, S., Scott, K., Beckwith, L., Howard, J. Smith, D. C., &
Danielson, M., 2013. Behavioral and Socioemotional Outcomes through Age 5 of the
Legacy for Children™ Public Health Approach to Improving Developmental Outcomes
among Children Born into Poverty. American Journal of Public Health.
(http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.300996)
Legacy Dissemination Point of Contact
Lara Robinson (Lrobinson1@cdc.gov)
24
25. References
1. Brooks-Gunn, J., & Duncan, G. J. (1997). The effects of poverty on
children. (PDF, 283KB). Future of Children, 7(2), 55-71.
2. Kaminski, J., Perou, R., Visser, S., Scott, K., Beckwith, L., Howard, J.
Smith, D. C., & Danielson , M., 2013. Behavioral and Socioemotional
Outcomes through Age 5 of the Legacy for Children™ Public Health Approach
to Improving Developmental Outcomes among Children Born into Poverty.
American Journal of Public Health.
3. National Center for Children in Poverty Child poverty. (2016). Children in
Poverty. Retrieved from http://www.nccp.org/topics/childpoverty.html
4. National Center for Birth Defects and Developmental Disabilities. (2016).
About Us. Retrieved from https://www.cdc.gov/ncbddd/aboutus/index.html
5. Robinson, L. R., Perou, R., & Leeb, R. T. (2014). News from CDC: the
Legacy for Children TM parenting model, partnering to translate research to
practice for children in poverty. Translational Behavioral Medicine, 4(3), 232–
233. http://doi.org/10.1007/s13142-014-0266-z
Hi, my name is Amanda Vasi, and today I will be presenting one of my summer projects I completed during my internship at the CDC’s National Center on Birth Defects and Developmental Disabilities, titled “Legacy For Children: Enhancing the Evidence-Base Foundation and User-Friendliness of the Miami Curriculum.
First, I will briefly provide an overview of my internship site and the Legacy for Children, or Legacy, program. I will then introduce my curriculum resource guide project and showcase my final outcomes and materials. I will then end with a final conclusion on what I accomplished and learned from my internship.
More than one in five children are living below the poverty line
Association found between childhood poverty and health and developmental outcomes, such as poor academic performance, emotional and behavior problems, and learning and developmental disabilities.
Related to the lack of supportive, nurturing, and intellectually stimulating environments in childhood
Impacts of poverty often continue on into a cycle by decreasing the chances of employment and opportunities for adults. Due to its cyclical effects, childhood poverty as a whole is estimated to cost the U.S. about $500 billion per year from loss of full potential and productivity. With these health and economic burdens, addressing the impacts of poverty is a public health priority.
Child poverty (2016). National Center for Children in Poverty. Retrieved from http:
//www.nccp.org/topics/childpoverty.html.
Brooks-Gunn, J., & Duncan, G. J. (1997). The effects of poverty on children. (PDF, 283KB). Future of Children, 7(2), 55-71.
Robinson, L. R., Perou, R., & Leeb, R. T. (2014). News from CDC: the Legacy for ChildrenTM parenting model, partnering to translate research to practice for children in poverty. Translational Behavioral Medicine, 4(3), 232–233. http://doi.org/10.1007/s13142-014-0266-z
Included in one of many of its programs, NCBDDD has taken a lead role in tackling this issue with the development of the Legacy for Children™ public health initiative, falling under its mission in helping children and adults with developmental disabilities and blood disorders reach their full potential. Legacy is the only governmentally funded program that directly deals with poverty.
Now I will begin to get into the Legacy program.
Due to the correlation between a lack of nurturing, parental relationships and poor health and developmental outcomes, Legacy strives to fill in the gap many children in poverty face by increasing positive parenting behaviors among mothers. Positive parenting behaviors have been found to be protective against the negative effects of poverty. Legacy is based on this evidence-based knowledge, creating a group-based intervention for low-income mothers and their children designed to promote the mother’s responsibility for, investment in, and devotion of time and energy to her child, promote responsive, sensitive mother–child relationships, support mothers as guides in their children’s behaviors and emotions, promote each mother’s ability to influence her children’s verbal and brain development, and promote each mother’s sense of community.
This slides describes Legacy quite literally in a nutshell. CDC developed the Legacy model and then contracted with 2 sites (UCLA, Miami) to develop an intervention based on the philosophy, assumptions and goals of Legacy. The Legacy philosophy contends that mothers can successfully parent and have a positive influence on their child’s life, regardless of life circumstances and other challenges in their lives.
The goals of the Legacy model are : 1) promote maternal responsibility, maternal investment, and maternal devotion of time and energy; 2) promote responsive, sensitive mother-child relationships; 3) support mothers as guides to their children’s behavioral and emotional regulation; 4) promote each mother’s facilitation of their children’s verbal and cognitive development; 5) and promote mothers’ sense of community. Legacy goals are achieved through intervention core elements and activities that include mother and mother-child group sessions, 1-1 sessions to reinforce content and community events; we will go into more detail on these throughout the presentation.
Legacy is firmly grounded in the philosophy that there is no one right way to parent and parents can develop and sustain a healthy commThe Legacy sessions are timed according to the developmental age of the child to foster community amongst mothers of children experiencing similar things. The curricula consist of themes that are revisited across development such as attachment, health and safety, child social skills development, play, language, and discipline. As mentioned before, sessions are not “taught” to the mothers but instead a group leader facilitates discussion on these topics with an interactive, multi-media approach so each mother can choose the best approach for her individual child. itment to their children’s development best when supported by a community of their peers.
To date, two curricula/implementations have been tested that support the Legacy model: one was developed by the University of Miami and the other by UCLA.
Both curricula were designed to address the core components
Adherence to the five Legacy goals
Developmentally appropriate early childhood-focused parenting curriculum, consistent with intervention assumptions
Group-based format
Reinforce curriculum content one-on-one
Strategies to ensure attendance & participation
Weekly parenting meetings of mothers
7-10 mothers per group with children of similar ages
1½ - 2 hour sessions
Components: main session topic, parent-child time together/mother-child time, community building activities
Prenatal into early childhood
Now that you have a little better sense of what Legacy looks like, we would like to talk about how we evaluated Legacy and some of the outcomes we have seen.
Legacy was rigorously evaluated with a set of randomized controlled trials. At CDC, we love data so we collected extensive data (including outcome, process, and cost). Results from the randomized controlled trials revealed that children of Legacy mothers experienced fewer behavior problems and had higher IQs. In addition, mother-child interactions within the intervention group were more positive. In the following slides we will talk in more detail about the socieomotional and IQ findings.
These results for the LA sample demonstrate that at age 5, at 2 years post-intervention, the intervention had a statistically significant impact on hyperactivity that persisted through 3rd grade
Legacy Miami – By age 5, children whose mothers did not participate in Legacy were 80% more likely to have noticeable behavioral concerns. At age 2, only 36% of children whose mothers participated in Legacy had behavioral concerns, while 53% of children of mothers in the comparison group had behavioral concerns.
Legacy Los Angeles - At age 5, only 27% of children of Legacy mothers were likely to meet diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), compared with 42% of children of comparison mothers
Now having an overview of Legacy, I will go over the the project I completed with the Legacy Miami curriculum.
At current, the resources listed at the end of each session are all grouped together and therefore, it is unclear which are actual cited references from those that are there to find out more information or handout or show in the session. By organizing these resources into separate categories, the user-friendliness of the curriculum could be enhanced. Because the intervention was designed and tested over the last 20 years, some of the videos used in the sessions are needing updates. I developed a spreadsheet with all the videos and their publication dates so the next steps could be taken to find more recent yet equivalent videos.
To complete this project, I reviewed the Miami curriculum years 0-5, recorded and organized the resources listed at the end of each session on a Word Chart document, and created a separate Excel spreadsheet for the session videos.. In short, my project involved a process of review, reorganization, and reconsideration.
My final outcomes and materials of my project was a 134-page resource list for Miami Legacy curriculum Years 0-5. Due to the organization of how the reference list at the end of each section had been already arranged, I separated the list out into five categories: resources to find out more, references, handouts/brochures, DVDs, and materials needed. References were for items are were cited sources, resources to find out more were citations of materials for ISs to utilize to increase their knowledge, DVDs and handouts/brochures were for the citations of any media or paper sources used or handed out during the session, and materials needed were listed items the ISs needed in order to complete the activities a part of the session.
I composed a 14-page Excel spreadsheet of the videos used throughout the Miami curriculum and described each by their title, session #, theme/main idea, video instructions, current availability, and year of publication. This spreadsheet will provide assistance in finding equivalent videos that are more up-to-date on the evidence-base. The title section was for the title of the video, the session section was for the session #, the theme/main idea section was to describe the primary lesion behind the video(s), the instructions section was to list the video activity instructions listed for ISs, the Have? section served to inventory whether the video(s) were provided by the NCBDDD, and the Year section listed the publication year of the video(s).
By having updated required resources clear to ISs and videos in their most updated form, it is possible the user-friendliness and effectiveness of programs like Legacy could be enhanced. Once the Legacy update has been made, future research could explore the quality improvement implications before and after to serve as a model to other national, community-based programs.
CDC Team
Susanna Visser, Camille Smith, Melissa Danielson, Angelika Claussen, Jennifer Kaminski,
Los Angeles Site
Judy Howard, Leila Beckwith, Dane Fitzmorris
Miami Site
Keith Scott, Lynne Katz, Rosalie Miller, Awilda Gonzalez
Original Legacy Staff
Additional resources on Legacy can be found on our website, in our published papers, by contacting Ruth or myself.
