Cultural Pride Reinforcement for Childhood Behavior

(CPR4ESR Trial)

Overseen By Michele D Kipke, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Children's Hospital Los Angeles

Disqualifiers: Severe cognitive impairment, CHLA employee, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 15

134 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment Cultural Pride Reinforcement for Early School Readiness, Reach Out and Read?

Research shows that cultural pride reinforcement can reduce anxiety in African American children and buffer against depression in Latina mothers by promoting ethnic pride. This suggests that reinforcing cultural pride may help improve early school readiness by supporting children's emotional well-being. ^{1 2 3 4 5}

Is Cultural Pride Reinforcement safe for children?

There is no specific safety data available for Cultural Pride Reinforcement, but culturally sensitive interventions generally aim to improve psychological health and well-being without known safety concerns. ^{6 7 8 9 10}

How is the Cultural Pride Reinforcement treatment unique for childhood behavior?

Cultural Pride Reinforcement is unique because it focuses on strengthening cultural identity and pride, which can reduce anxiety and improve behavior in children by reinforcing positive cultural messages from parents. This approach is different from other treatments that may not emphasize cultural identity as a key component of early childhood development. ^{1 4 5 11 12}

What is the purpose of this trial?

African American children disproportionately experience racism, which is associated with behavioral health problems and school failure. Behavioral health problems impede learning and are more likely to be chronic, severe, disabling, and untreated in African Americans compared to Whites. Clinic-based interventions that boost cultural pride may improve outcomes related to behavioral health in young African American children. However, little is known about cultural pride interventions in this population. It is important to understand these processes in young children because early childhood is a period during which racial bias may develop and stymie behavioral health and learning, and cultural pride may support it. This project will recruit patients from primary care clinics in Los Angeles. The project will test a cultural pride intervention (Cultural Pride Reinforcement for Early School Readiness (CPR4ESR)) in young African American children. CPR4ESR provides culturally themed children's books and advice at health supervision visits of children enrolled at ages 2-4 years. It is based on a well-established national program called Reach Out and Read (ROR). ROR provides children's books and book-sharing advice at health supervision visits with reports of increased book-sharing behaviors and literacy. The specific aims of the proposed project are to: 1) assess the feasibility and acceptability of CPR4ESR implementation among parents and providers, 2) evaluate the capacity of CPR4ESR to improve cultural pride reinforcement and book-sharing behaviors in caregivers of young African American children, and 3) evaluate the capacity of CPR4ESR to improve behavioral health and literacy in young African American children. The interviews conducted in Aim 1 will guide refinement of the intervention tested in Aims 2 and 3. The mechanism by which CPR4ESR impacts behavioral health and literacy will be evaluated by statistical modeling. We hypothesize that: 1) caregivers who receive CPR4ESR will exhibit more CPR and book-sharing behaviors than those who do not, 2) children who receive CPR4ESR will exhibit better behavioral health and literacy than those who do not, and 3) increases in caregiver CPR and book-sharing behaviors will be associated with enhanced child behavior and literacy. This project will inform the development of interventions that address the negative health impact of racism on young African American children.

Research Team

Ashaunta T Anderson, MD, MPH, MSHS

Principal Investigator

Children's Hospital Los Angeles

Eligibility Criteria

This trial is for legal guardians of African American children aged 2-4 years who speak English. It aims to help these young kids by reinforcing cultural pride and improving behavioral health, potentially reducing the negative impacts of racism on their early development.

Inclusion Criteria

I am the legal guardian of a 2-4 year old African American child.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2 weeks

1 visit (in-person)

Phase 1: Feasibility and Acceptability Evaluation

Evaluation of the feasibility and acceptability of CPR4ESR implementation from the perspectives of caregivers and providers

3 months

Interviews conducted post well child visits

Phase 2: Pilot Randomized Controlled Trial

Pilot RCT of CPR4ESR+ROR versus ROR alone to assess impact on parenting behaviors, child behavioral health, and literacy

15 months

5 intervention visits at 0, 3, 6, 9, and 12 months

Follow-up

Participants are monitored for safety and effectiveness after treatment

3 months

Assessments at 9 and 15 months post-enrollment

Treatment Details

Interventions

• Cultural Pride Reinforcement for Early School Readiness
• Reach Out and Read

Trial Overview The study tests a program called Cultural Pride Reinforcement for Early School Readiness (CPR4ESR), which provides culturally themed books and advice during health visits. It's compared with Reach Out and Read, an established program promoting literacy through book-sharing.

Participant Groups

Group I: Experimental Group Experimental Treatment 2 Interventions

Caregiver-child dyads that receive the Cultural Pride Reinforcement for Early School Readiness (CPR4ESR) intervention

Group II: Treatment-As-Usual Control Group Active Control 1 Intervention

Caregiver-child dyads that receive standard Reach Out and Read intervention without additional emphasis on cultural pride

Who Is Running the Clinical Trial?

Children's Hospital Los Angeles

Lead Sponsor

Trials

257

Recruited

5,075,000+

National Institute on Minority Health and Health Disparities (NIMHD)

Collaborator

Trials

473

Recruited

1,374,000+

Findings from Research

The Little Holy One intervention was successfully adapted for Head Start teachers on the Fort Peck Native American Reservation to address their high stress levels and support needs, using a participatory approach that involved community input from 27 teachers and parents.

This adaptation process, guided by the ADAPT-ITT methodology, emphasizes the importance of cultural relevance in mental health interventions, potentially improving psychological health outcomes for Native Americans who may not typically access traditional psychological services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Pre-implementation Process of Adapting a Culturally Informed Stress Reduction Intervention for Native American Head Start Teachers. Wilson, DH., Nelson, KE., Gresh, A., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Cultural Pride Reinforcement as a Dimension of Racial Socialization Protective of Urban African American Child Anxiety. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Childhood trauma and the role of ethnic pride and interpersonal relationships among Latina mothers. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Culturally Responsive Approaches for Addressing ADHD Within Multi-tiered Systems of Support. [2020]

4. United States pubmed.ncbi.nlm.nih.gov

Parent Cultural Adaptation and Child Functioning in Culturally Diverse, Urban Families of Preschoolers. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Cultural socialization and ethnic pride among Mexican-origin adolescents during the transition to middle school. [2021]

6. Switzerland pubmed.ncbi.nlm.nih.gov

The Pre-implementation Process of Adapting a Culturally Informed Stress Reduction Intervention for Native American Head Start Teachers. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Culturally sensitive interventions and health and behavioral health youth outcomes: a meta-analytic review. [2019]

8. Germany pubmed.ncbi.nlm.nih.gov

Suggestive diagnosis of attention-deficit/hyperactivity disorder in indigenous children and adolescents from the Brazilian Amazon. [2022]

9. Netherlands pubmed.ncbi.nlm.nih.gov

Engaging Mexican origin families in a school-based preventive intervention. [2022]

10. Switzerland pubmed.ncbi.nlm.nih.gov

Preliminary Findings of Culturally Responsive Consultation with Educators. [2020]

11. United States pubmed.ncbi.nlm.nih.gov

The warm glow of kindness: Developmental insight into children's moral pride across cultures and its associations with prosocial behavior. [2023]

12. United States pubmed.ncbi.nlm.nih.gov

Children's recognition of pride. [2019]