To examine the effects of PlayReadVIP, a pediatric primary care intervention promoting early relational health, on child behaviors.

A factorial randomized controlled trial enrolled mother-child dyads postpartum. PlayReadVIP was delivered in 2 phases: birth to 3 years (PlayReadVIP 0-3) and 3-5 years (PlayReadVIP 3-5). At enrollment, dyads were assigned to PlayReadVIP 0-3 or control. At age 3, dyads were rerandomized to PlayReadVIP 3-5 or control. Analyses included dyads with a second randomization and complete data on the mediators and child outcomes. In PlayReadVIP, dyads attended one-on-one sessions with a parent coach, in which they received child development information, learning materials, and real-time, strengths-based feedback on brief video recordings of parent-child interactions. Cognitive stimulation and harsh discipline were reported by mothers. Child behaviors were assessed using the Behavior Assessment System for Children, Second Edition.

A total of 143 dyads, primarily immigrant, Latino/Hispanic, and low-socioeconomic status, comprised the analytic sample. Mothers in PlayReadVIP vs control had higher cognitive stimulation at 54 months, which resulted in reduced problem behaviors (aggression and attention problems) and better social skills in their children in second grade. No significant indirect effects through harsh discipline were found.

PlayReadVIP leads to sustained but small improvements in child behaviors by enhancing maternal cognitive stimulation, emphasizing the potential of early intervention in pediatric primary care for promoting child mental health in disadvantaged populations.