Thirty Million Words Home Visiting: A Longitudinal RCT
Phase: NA
Conditions: Language Environments of Children of Low-socioeconomic Status
Sponsor: University of Chicago

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THIRTY MILLION WORDS HOME VISITING: A LONGITUDINAL RCT 
 
PROTOCOL TITLE: THIRTY MILLION WORDS HOME VISITING: A LONGITUDINAL RCT 
 
PI: DANA SUSKIND, M.D. 
 
FUNDING: EXTERNAL FUNDING FROM PNC FOUNDATION 
 
SPONSOR: PRIVATE INDUSTRY  
 
TYPE OF RESEARCH:  LONGITUDINAL RANDOMIZED CONTROL TRIAL  
 
INTERVENTION: EXPERIMENTAL TECHNIQUE TO CHANGE BEHAVIOR 
 
PROTOCOL VERSION: 1 
 
PROTOCOL VERSION DATE: 09/06/2023 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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TABLE OF CONTENTS                                                                                                                           PAGE 
 
1. INTRODUCTION ………………………………………………………………….5 
2. STUDY DESIGN…………………………………………………………………..8 
3. STUDY PROCEDURES…………………………………………………………….11 
4. SUBJECT SELECTION AND WITHDRAWAL………………………………………..19 
5. STATISTICAL PLAN AND CONSIDERATIONS……………………………………....21 
6. RISKS AND BENEFITS…………………………………………………………….22 
7. SAFETY AND ADVERSE EVENTS ………………………………………………....22 
8. DATA HANDLING AND RECORD KEEPING ………………………………………..22 
9. FINANCIAL CONSIDERATIONS…………………………………………………….23 
10. ETHICAL CONSIDERATIONS ……………………………………………………....23 
11. CONFLICT OF INTEREST …………………………………………………………..23 
12. PUBLICATION PLAN ………………………………………………………………23 
13. REFERENCES ……………………………………………………………………...24 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    

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STUDY SUMMARY 
TITLE  
Thirty Million Words Home Visiting: A Longitudinal RCT  
SHORT TITLE 
TMW HV RCT  
PROTOCOL NUMBER  
#IRB14-0895 
METHODOLOGY 
Longitudinal randomized control trial  
STUDY DURATION  
5 years 
STUDY CENTER 
Single-center  
OBJECTIVES 
Improve low-SES parents’ understanding of the importance of parent 
language in a child’s development 
 
Increase low-SES parents’ linguistic interaction, responsiveness, and 
overall engagement with their children  
 
Increase low-SES children’s language output 
 
Improve low-SES children’s language acquisition  
 
Improve low-SES children’s social-emotional development  
 
Increase low-SES children’s school readiness upon kindergarten 
entry  
NUMBER OF SUBJECTS  
412 
MAIN INCLUSION CRITERIA 
Low-SES parents with children between the ages of 13-16 months old 
STATISTICAL METHODOLOGY  
Randomized controlled trial, interrupted time series design, Poisson 
regression models on intent-to-treat, and treatment-on-the-treated 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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LIST OF ABBREVIATIONS 
 
BMI 
 
BODY MASS INDEX 
FLE 
 
FAMILY LIFE EVENTS QUESTIONNAIRE  
LENA  
LANGUAGE ENVIRONMENT ANALYSIS 
LWL  
LOOKING WHILE LISTENING 
NORC  
NATIONAL OPINION RESEARCH CENTER AT THE UNIVERSITY OF CHICAGO 
PLS 
 
PRESCHOOL LANGUAGE SCALE 
PPVT  
PEABODY PICTURE VOCABULARY TEST  
RCT 
 
RANDOMIZED CONTROL TRIAL  
RA 
 
RESEARCH ASSISTANT  
SES 
 
SOCIOECONOMIC STATUS 
SPEAK 
SURVEY OF PARENTAL EXPECTATIONS AND KNOWLEDGE  
TMW  
THIRTY MILLION WORDS INITIATIVE 
TOPSE               TOOL TO MEASURE PARENTING SELF-EFFICACY 
WJ 
 
WOODCOCK-JOHNSON PSYCHO-EDUCATIONAL BATTERY 
TOI 
 
THEORIES OF INTELLIGENCE 
ASQ: SE 
AGES AND STAGES QUESTIONNAIRE: SOCIAL-EMOTIONAL 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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1.  INTRODUCTION  
A. 
BACKGROUND AND RATIONALE 
a) 
Background 
A child’s early language exposure is a primary component in language development and in 
ultimate educational and intellectual achievement (Bruner, 1981; Chapman, 2000; Gallaway & 
Richards, 1994; Hart & Risley, 1995; Huttenlocher, Haight, Bryk, Selzer, & Lyons, 1991; Rowe, 
2008).  Betty Hart and Todd Risley (1992) conducted a landmark study that demonstrated the 
tremendous impact of a child’s early language milieu on future learning, revealing a significant 
correlation between the number of words to which a child is exposed between the ages of 0-4 
years and his/her ultimate IQ and academic success (Hart & Risley, 1992; 1995).  Their findings 
were both significant and alarming, demonstrating the critical and time-sensitive role that early 
language exposure plays in a child’s life.  Their follow-up with the same children at 9-10 years 
of age confirmed that preschool and elementary school interventions came too late to alter these 
trajectories; the reverberations of early linguistic deprivation were likely to follow these children 
throughout their lives. 
 
Children born into poverty experience an overwhelming inequality in their early language 
experience.  Hart and Risley’s study revealed a steep socioeconomic gradient in early exposure 
to language.  At the end of their third year of life, children from high-socioeconomic status (SES) 
families heard approximately forty-five million words while children from low-SES backgrounds 
heard only approximately thirteen million.  The tragedy for these children is not unalterable.  It is 
neither genetics nor a lack of potential that lies at the heart of this inequality.  Rather, it is 
inadequate parental knowledge of child language development.  Rowe (2008) demonstrated that 
the relationship between SES and parental communication ability is mediated by parental 
knowledge.  Other studies have corroborated this, showing that the effect of SES on a child’s 
vocabulary was primarily dictated by maternal speech (Hoff, 2003).  Encouragingly, studies have 
also demonstrated that a well-planned parent-directed language intervention may increase low-
SES parents’ use of facilitative language with their children (Oneil-Pirozzi, 2009; Suskind et al., 
2013).  The Thirty Million Words Initiative was founded, in part, to develop and implement such 
an intervention, via the TMW Curriculum. 
 
The TMW Curriculum was developed to address the disparity in low-SES children’s early 
language environments by increasing parent knowledge, impacting beliefs about language, and 
motivating behavior change.  The TMW Curriculum is comprised of 1) 12 educational modules, 
2) animations and videos of real parent-child interactions to teach parents about the science 
behind child brain development, and model strategies for improving parents’ child-directed 
speech, 3) video modeling and collaborative goal setting, and 4) quantitative linguistic feedback 
from Language ENvironment Analysis (LENA) recordings.   
 
The LENA system is a technology that provides day-long audio recordings from a digital 
recorder that is placed in the front pocket of specially-designed children’s clothing. This ‘word 
pedometer’ records all of the child’s vocalizations and everything spoken near the child 
continuously for 16 hours. Audio data are automatically analyzed using speech recognition 
technology, and reports are generated that provide daily and hourly summaries of: 1) the number 
of adult words spoken near the child, 2) the number of turn-taking interactions in which the child 
engaged with an adult, and 3) the amount of television to which the child was exposed.  The 

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processing software also produces a report on the general audio environment, including 
information about the amount of time TV/electronic media was audible in the recording. This 
technology makes it possible to obtain an objective and representative picture of the early 
language experiences of infants and toddlers. Given prior research on the importance of early 
language exposure, the device’s feedback reports can be used as an intervention tool to measure 
and influence parental behavior. Research on the efficacy of the LENA feedback reports, in 
conjunction with information about strategies for language environment enrichment, shows that 
the system may have a substantial effect on parent behavior, influencing them to talk and interact 
more with their children (Gilkerson & Richards, 2008; Suskind et al., 2013).  
 
Although the literature suggests that the LENA technology provides useful quantitative feedback 
to parents, the underlying costs of the technology prevent it from being used on a wide-scale. 
Thus, we seek to develop an innovative mobile word counting application to incorporate into the 
TMW intervention. The Three T’s App is built on completely free open-source speech 
recognition algorithms, and when completed, the mobile application will provide quantitative 
feedback to parents and introduces them to the TMW intervention. This application was 
developed by Luai Zakaria, a medical student in the Pritzker School of Medicine at the 
University of Chicago. The ability to provide accurate quantitative feedback has yet to be 
evaluated. By including this new technology into the intervention, the application can be further 
tested and evaluated.  
 
 
b) 
Past research  
TMW conducted a randomized, controlled feasibility trial with 23 low-SES families to evaluate 
whether the curriculum improved parents’ knowledge of child language development and 
changed the way parents talk with their toddlers. The TMW Curriculum was delivered to 12 
treatment families in eight weekly one-on-one home visits.  Home visits included educational 
module review, video modeling, collaborative goal setting, and quantitative linguistic feedback 
from weekly LENA recordings.  The control condition received a nutrition pamphlet at short 
weekly home visits to control for a possible attentional effect experienced by those in the 
treatment group.   
 
The results of the feasibility trial suggest that the intervention has a significant impact on parent 
knowledge of child language development and parent-child language behavior.  During the 
intervention period, families receiving the TMW Curriculum demonstrated a significant increase 
in 1) parent knowledge of child language development, 2) parent language input, 3) parent-child 
conversational turns, and 4) child vocalizations, as assessed through surveys, coded video 
interactions of parent-child natural play, and LENA recordings.  Taken together, the LENA 
recordings and video-coding results suggest that parent-directed language enrichment 
interventions can change home language environments of children from low-SES backgrounds.  
Posttest assessments revealed a significant increase in parent utterances, word types (unique 
words), and word tokens (all words combined, including repetitions) as well as child word types.  
At a four-month follow-up assessment, intervention effects were significant for parent 
knowledge of child language development.  For all other measures, effects were positive, but not 
statistically significant, possibly due to the small sample size and relatively short follow-up 
period. While we did see an increase in child vocalizations during the intervention period (which 

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were not sustained post-intervention), as well as significant gains in child word types (with a 
marginally significant effect post-intervention), the sample was not sufficiently large, nor was 
the study period sufficiently long to see the long-term effects of the intervention.   
 
The feasibility trial represented a first step toward developing a parent-directed curriculum that 
has the potential to improve the language learning trajectories and subsequent academic 
readiness of low-SES children.  The results indicate the potential to change both parent-child 
language interactions and child language learning trajectories during and immediately after the 
administration of the curriculum.  Overall, the results show that the curriculum can provide 
parents with the tools to successfully enrich their child’s early home language environment, 
thereby reducing academic disparities among low-SES children.  A longitudinal study with a 
sufficiently large population is the next step in determining the effectiveness of the curriculum. 
 
c) 
Rationale for conducting this research 
Thirty Million Words Home Visiting: A Longitudinal RCT is a longitudinal, randomized control 
trial, which is required to confirm whether the parent behavior changes seen during the 
feasibility trial are sustainable, and, critically, whether those changes translate into positive 
impacts on child language outcomes, child social-emotional development, and subsequent school 
readiness.  We will deliver the TMW Curriculum to 100 Treatment families, and we will be 
following the children through kindergarten in order to measure the effects and sustainability of 
the curriculum.  We will deliver a Nutrition Curriculum to 100 Control families in order to 
control for the possible attentional effects experienced by those in the Treatment group. 
Moreover, as an ethical consideration we wish to also provide families in the Control condition 
with valuable education that may enhance their children’s development. 
 
d) 
Rationale for research design and population 
The research design (i.e. a longitudinal, randomized controlled trial) is necessary to determine 
the efficacy and sustainability of the TMW Intervention. Incorporating knowledge gained from 
the feasibility trial, the following changes have been made to the intervention.  First, the 
curriculum was increased from 8 to 12 Educational Modules in response to feedback from our 
participants and other community stakeholders.  Additional modules incorporate concepts such 
as executive function and self-regulation, in response to parent requests for information about 
how they might use their ‘talk’ to shape child behavior. Second, four post-Intervention LENA 
Boosters (Follow ups) will supplement the curriculum.  Allowing parents to continue to monitor 
their language behavior via the LENA language processor after the initial intervention ends 
could help sustain the changes in talk seen during curriculum delivery, analogous to allowing an 
individual in a weight-loss intervention continued access to a scale.  
 
Participants in both the Control and the Treatment condition will receive text messages to remind 
them to complete their LENA recording on the day that they had previously scheduled. For the 
Treatment group only, a text message reminder for a specific goal will be sent as well. This will 
help parents be mindful of their goals at the time that they plan to achieve them by reminding 
parents to engage linguistically with their children. This text reminder portion of the study will 
piggy-back on the goal setting portions in which the parent will set specific, personalized goals. 
Reminders of these goals will be sent to their phones at a day and time that parents choose. Both 

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the Treatment and Control participants will be given the option to opt out of the text messaging if 
they do not wish to receive these messages.  
 
The sample size (i.e. 100 participants in the Treatment group and 100 participants in the Control 
group) was determined based on a power analysis using the -values and effect sizes of the 
feasibility trial results, and adjusting for attrition rates observed during the feasibility trial. The 
population will consist of low-SES families in order to reflect the TMW research team’s intent to 
address the disparity in low-SES children’s early language environments. Additionally, the 
population will consist of families with children between the ages of 13-16 months because 
optimal timing for delivery of the curriculum is estimated at this developmental time point as 
children begin to say single words sometime between 9 and 12 months (Tomasello, 2003) and 
reach a first language development milestone of 10 words between 13 and 15 months (Nelson, 
1973; Fenson, 1993). This suggests that the emergence of children’s measurable linguistic output 
is linked to a key developmental stage during which children’s linguistic environments provide 
the foundation for successful language learning. The TMW intervention aims to foster parental 
behaviors that facilitate children’s language emergence at this developmental stage, and thus will 
be implemented at 13-16 months of age.  
 
B.  OBJECTIVES  
a) 
Hypothesis 
We hypothesize that the primary effects of the TMW Intervention will significantly 1) improve 
low-SES parents’ understanding of the importance of parent language in a child’s development, 
2) increase parents’ linguistic interaction, responsiveness, and overall engagement with their 
children, and 3) increase children’s language output, as measured through LENA (child 
vocalization count, conversational turn count), coded video interaction (number of types, tokens 
and utterances for both children and adults), and a battery of assessments targeting linguistic and 
cognitive development. Furthermore, we hypothesize that increased parental interaction will 
result in 4) an improvement in children’s social-emotional development. Finally, we hypothesize 
that these social-emotional and linguistic gains through early development, along with sustained 
increased parental engagement, will be expressed in 5) increased child school readiness upon 
kindergarten entry as assessed by Woodcock-Johnson Psycho-Educational Battery (WJ).  
 
2.  STUDY DESIGN  
a) 
Type of study, duration of study, and schedule of events  
Thirty Million Words Home Visiting: A Longitudinal RCT is a longitudinal, randomized control 
trial that will take place over the course of five years. The study will consist of two groups, the 
Treatment group and the Control group. Timelines and measurements are consistent across both 
groups. (Please see Study Procedures for a more detailed explanation of each phase.) During the 
Recruitment Phase, a TMW research assistant (RA) will recruit participants for the study. If 
interested in joining the study, participants will complete the Preliminary Enrollment Consent. 
From this point forward, all study activities will take place in the participant’s home. To follow 
the completion of the Preliminary Enrollment Consent, participants will be asked to complete a 
series of baseline measurements over a four-week time period.  RAs will facilitate the collection 
of these measures.  Following satisfactory completion of the baseline measures, participants will 
move on to the Enrollment Phase at which point they will complete the Enrollment Consent. 
Additionally, participants will complete Video 1, administered by an RA. Following the 

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Enrollment Phase, participants will move on to the Intervention Phase. During the Intervention 
Phase, participants will first complete Assessment 1. A fully trained TMW Assessor will conduct 
this and all subsequent assessments. Following Assessment 1, participants will receive 12 bi-
weekly home visits over a six-month period from trained TMW Home Visitors. During the home 
visits, Home Visitors will deliver two different curricula to the respective groups. The Treatment 
group will receive the TMW Curriculum. The Control group will receive the alternative 
Nutrition Curriculum, which provides information about the importance of healthy nutrition for 
child development, strategies for healthy eating, and meal preparation.  
In addition to receiving the home visits, participants will also complete LENA recordings on a 
bi-weekly basis, alternating weeks with the home visiting schedule.  Following the Intervention 
Phase, participants will move on to the 42-month Follow-up Phase. Throughout this phase, 
participants will complete Videos 2-7 with an RA, Assessments 2-7 with a TMW assessor, 
LENA recordings 16-24, and four follow up curricula supplementation ‘Boosters,’ delivered by 
an RA.  
 
An 8th assessment timepoint will be conducted around the time of the child’s 9th birthday to 
measure any sustained impacts of the intervention on the child’s language, math, cognitive, and 
non-cognitive abilities. Participants will sign an addendum to the enrollment consent if they 
agree to participate in this study timepoint. 
 
 
Transcription Service Feasibility Pilot Study 
 
The purpose of this pilot study is to assess the feasibility of using a transcription service to 
transcribe Video Session recordings compared to using University of Chicago research 
personnel. Up to 10 already enrolled participants will be enrolled to participate in the pilot study. 
Each participant in the pilot study will receive an addendum to the study consent document and 
discuss the addendum with a member of the research team prior to their study Video Sessions 
being sent to third-party transcription services to conduct a feasibility study. 
 
Collection of School Data from School District 
 
The purpose of collecting administrative school data from each participant’s child is to assist 
TMW in assessing the effectiveness of the curriculum. If a participant agrees to participate in the 
collection of their child’s data from their child’s school district, the data we will collect are: 
 
1. Standardized test scores from all years that your child completes district or statewide tests 
2. Scores and other information from kindergarten admissions tests and interviews 
3. Scores from other standardized measures utilized in your school district as measures of 
progress or academic success. 
 
This data will be collected starting with preschool and continuing through the end of your child’s 
school participation. Each participant in the study will receive an addendum to the study consent 
document and discuss the addendum with a member of the research team prior to their child’s 
data being requested from their school district. 
 

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b) 
Summary of sequence and duration of all study periods, including follow up 
periods (as applicable) 
The Recruitment Phase will take place in a rolling manner throughout the first year of the study 
and will continue beyond the initial year until the full sample of n=200 is reached. Sequence and 
duration of all study periods are subject to recruitment needs and will be extended accordingly if 
necessary. The Preliminary Consent and Baseline Measures Phase will last at least a year. For 
each individual participant, this phase will take place over a 4-week period before the official 
start of the study. Because of the rolling recruitment, the Enrollment Phase will last at least one 
year. Participants will go through the Enrollment Phase 1 week before the official start of the 
study. The Intervention Phase marks the official start of the study and will take place at 
minimum between months 0-18 of the 5-year duration of the study. Each individual participant 
will receive the intervention for 6 months. The Follow-up Phase will take place between month 6 
and at least month 54 (halfway through Year 5) and will last 42 months for an individual 
participant. Individual participants’ schedules may vary and will be adjusted based on their 
availability. The Data Analysis/Publication Phase begins in Year 5 and will last indefinitely. 
Please see the Phases Table below for an overview.  
 
 
 
Phases Table 
 
 
 
c) 
Discuss randomization processes and use of controls  
Participants (i.e. parent-child dyads) will be randomly assigned to one of two groups: 1) 
Treatment group (i.e. TMW Curriculum) or 2) Control group (i.e. Nutrition Curriculum).  
                   Year 
 
              Phase 
1 
2 
3 
4 
5 
(6) 
Recruitment Phase 
 
 
 
 
 
 
Preliminary Consent & 
Baseline Measures Phase 
 
 
 
 
 
 
Enrollment Phase 
 
 
 
 
 
 
Intervention Phase 
 
 
 
 
 
 
 
 
Follow-up Phase 
 
 
 
 
 
 
 
Data Analysis/Publication  
 
 
 
 
 
Scheduled study 
duration 
Adjusted study 
duration 

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Participants will be randomly assigned to either the Treatment or Control condition as part of a 
matched pair.  Pairs will be matched by 1) age of the child and 2) averaged conversational turn 
counts from the 3 baseline LENA recordings. Assignment to Control or Treatment of each 
member of a pair is decided through a coin flip. Matched pair assignment ensures equal 
representation in each experimental group as well as greater statistical power.  
 
3. STUDY PROCEDURES  
a) Methods and procedures 
The study consists of six phases: Recruitment, Preliminary Consent & Baseline Measures 
(Month 0), Enrollment, Intervention (Month 1 through Month 6), Follow-up (Month 7 through 
Month 48), and Data Analysis/Publication (Month 48 through Month 60). A long term follow up 
phase will occur approximately 8 years after the initial enrollment.  
 
 
1. Recruitment Phase  
 
Recruitment 
A member of Dr. Suskind’s research team will speak with potential participants in person at 
Recruitment Sites (see Appendix C: In-Person Recruitment Script) or over the phone (see 
Appendix D: Outgoing Call Recruitment Script & Appendix E: Incoming Call Recruitment 
Script). (For Recruitment Flyer, see Appendix S). 
 
Additionally, recruitment advertisements will be placed on some Chicago CTA bus and train 
routes. (For CTA advertisement, please see Appendix U.).  Note: the advertisement states that we 
are looking for parents with children ages 9-16 months old. The inclusion age for this study does 
not change. Children will not be consented into the study until 13 months of age. However, as 
recruitment will continue throughout 2015, younger children will be screened into the study, and 
their spot will be held until they reach 13 months of age.  
 
Moreover, we will be placing advertisements through the CommunityRx system. Developed by 
physicians at the University of Chicago Medicine, the CommunityRx system generates patient-
centered e-prescriptions for community services (HealtheRx) via an interface between the 
electronic health records (EHR) and a comprehensive community resource database. Based on a 
patient’s diagnoses, a HealtheRx will be printed automatically at the end of the ambulatory care 
visit and will provide patients with a customized map and list of places in their community that 
provide health and social services (e.g., Weight Watchers, Gold’s Gym, Hyde Park Produce, 
Walgreen’s pharmacy, AA, social service agencies) as well as contact information for a local 
community health worker who can provide limited case management support. Patients are 
eligible to receive a HealtheRx if they live in one of 16 zip codes on the South and West Sides of 
Chicago and visit one of 33 participating clinical sites. The South Side Health and Vitality 
Studies’ CommunityRx program aims to improve the quality and delivery of community 
referrals for health and social services for patients from high poverty communities on Chicago’s 
South Side.   
 
The first HealtheRX advertisement (see Appendix V) will run for two weeks. The second 
HealtheRX advertisement (see Appendix W) will run indefinitely.  
 

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Additionally, we will be using a mass mailing for recruitment purposes. Working with age and 
income targeted list ofaddresses provided by the MSG vendor that are in our target zipcodes, we 
will send out a mass mailing in two waves: 
1. Letter on official University of Chicago Medicine letterhead, with pamphlet further 
explaining the study enclosed 
2. Follow-up letter on official University of Chicago Medicine letterhead 
 
Please see Appendix BB for a copy of these three documents. These letters will be signed by ou 
Director of Research, Christy Leung, instead of the PI, as Dr. Suskind’s name and our research 
are too easy to search on the internet. If found, our pool of applicants would be contaminated. 
 
 
Screening 
If potential participants are interested in participating in the study, a member of the research team 
will obtain verbal consent and administer the Screening Questionnaire (see Appendix F) in order 
to determine eligibility. If potential participants are eligible, they will move on to the Preliminary 
Consent and Baseline Measures Phase (for eligibility requirements, see Subject Selection and 
Withdrawal). 
 
2. Preliminary Consent and Baseline Measures Phase 
Preliminary Informed Consent 
The participant will first complete the Preliminary Informed Consent Form (see Appendix G).  
This form explains the purpose of the study, potential risks and benefits, and the measures taken 
to ensure confidentiality.  
Schedule and Demographics Questionnaire 
The parent will then complete the Schedule and Demographics Questionnaire (see Appendix I). 
This questionnaire gathers information about the participants’ race and ethnicity, the family’s 
childcare schedule, household information (including housing stability and household makeup) 
and contact information. (For participants that answered that they are either married or living 
with their partner, we will be recontacting them with additional demographics questions. See 
Appendix Y for these additional questions.) 
Measurements 
To follow, the parent will complete measurements including the Center for Epidemiologic 
Studies Depression Scale (CESD-10) (see Appendix J), because severe depression may be a 
confounding variable. (However evidence of parental depression will not exclude participants 
from the study.)  
LENA How-to 
A member of Dr. Suskind’s research team will then instruct the parent how to utilize the LENA 
recorder. Additionally, the participant will be given a “LENA Dos & Don’ts” (see Appendix X) 
sheet to reference for LENA instructions, as well as a “LENA Care Sheet” (see Appendix Z). 
that details the importance and care instructions for our LENA devices. 
LENA Baseline Recordings  
Parents will then be given LENA recorders and asked to take three, 10-hour LENA recordings 
within a four-week time period. An RA will collect the LENA from the participant’s home and 
provide the parent with a new LENA device after each recording is completed.  If a participant 
fails to complete the recordings within the designated time period, he/she will be disqualified 
from further participation in the study.  

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3. Enrollment Phase 
Following successful completion of the three, 10-hour LENA Baseline recordings, participants 
will be randomized into either Control or Treatment group as part of a matched pair (see 2c 
above) and move on to the Enrollment Phase of the study. The Enrollment Phase of the study 
will take place in the participant’s home by a member of Dr. Suskind’s research team.  
Enrollment Informed Consent 
The parent will first complete the Enrollment Informed Consent Form (see Appendix H).  
Measures  
The parent will then complete the Family Life Events Questionnaire (FLE) (see Appendix K), 
which collects data regarding adverse events experienced by the child.  
Video 1 
An RA will complete Video 1 in the participant’s home. The parent and child will engage in a 
30-minute videotaped session consisting of Natural Play and Book Read. During Natural Play, 
the parent and child will engage in undirected, unstructured play. During Book Read, the parent 
will read a book to the child. During Video 1 and all subsequent Videos (2-7), the 30-minute 
session will be simultaneously recorded by the new mobile phone application, the Three T’s 
App. The extra recording taken with the Three T’s App will be explained to the participants, 
detailing that “the app” funcitons like the LENA, except it links to a Bluetooth microphone and a 
mobile device, instead of the LENA recorder. The TMW staff member will set up the Three T’s 
App recording, and the participant will not see the application itself or be told the full name of 
the application, as these characteristcs are related to the Treatment condition. 
 
4. Intervention Phase  
Following enrollment, participants will move on to the Intervention Phase, which will last six 
months. The Intervention Phase consists of three components: Assessment 1, Home Visits, and 
LENA recordings. 
Assessment (Survey Meeting) 1  
A TMW Assessor will conduct Assessment 1 in the participant’s home. Assessment 1 will take 
approximately 90 minutes to complete.  
 
 
Assessment 1 Measures 
At this assessment meeting, the parent will complete eight different measures. The parent will 
first complete the Preschool Language Scale (PLS-5), which is an assessment of developmental 
language skills that measures a child’s total language, auditory comprehension, expressive 
communication standard scores, growth scores, percentile rankings, and language age 
equivalents. Next, the parent will complete the Peabody Picture Vocabulary Test (PPVT 4), 
which measures the parent’s receptive (hearing) vocabulary for Standard American English.   
Then the parent will complete the Survey of Parental Expectations and Knowledge (SPEAK), 
which assesses parents’ understanding of children’s learning process. (Appendix L) Afterwards, 
the parent will complete the Tool to Measure Parenting Self-Efficacy (TOPSE), which  addresses 
parents’ beliefs about their efficacy as care givers. Next, the parent will complete the Body Mass 
Index (BMI) for the child, which is calculated based on his or her height and weight. Then the 
parent will complete the Theories of Intelligence (TOI), which assesses parents’ theories about 
children’s intelligence. It asks questions about what an individual thinks a child will be able to 
do, given how much a parent speaks to their child.  Finally, the parent will complete The 

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MacArthur-Bates CDI I: Short Version (MacArthur I), which assesses the child’s vocabulary 
skills through a vocabulary checklist.  
 
Home Visits 
Home Visitors will deliver the TMW Curriculum (Treatment group) or the Nutrition Curriculum 
(Control group) biweekly over the course of the six-month Intervention Phase, for a total of 12 
Home Visits. Visits are scheduled biweekly. TMW Home Visits will last approximately 60 
minutes, and Nutrition Home Visits will last approximately 20 minutes.  
TMW Curriculum: The TMW Curriculum consists of 12 modules, one per home visit, 
and will be implemented in the following way:  
1) The Home Visitor delivers the educational module, one per Home Visit.  
2) The Home Visitor and the parent have a discussion to review and reinforce the 
parent’s understanding of the concepts.  
3) The Home Visitor does the Showtime activity (video modeling) with the parent, 
which demonstrates how to put concepts into practice. During modules 5 through 12 
parents participate in a social network mapping activity during Showtime. During 
Module 5, a specific script will be used (see Appendix T). 
4) The Home Visitor discusses LENA feedback reports with the parent. LENA 
feedback reports are generated based on the previous week’s LENA recordings. 
Based on the report, the parent sets goals for the forthcoming week. In support of 
these goals, the Home Visitor discusses strategies for increasing word counts, 
increasing conversational turns, and reducing TV/electronic media.  
5) The parent and the Home Visitor collaboratively set goals for his/her next week’s 
recording (see Appendix A). Parents will set up a time and day that they would like 
to be reminded of their LENA recording day and their specific goal. This goal and 
recording reminder will then be sent to their phone via text message the day of their 
LENA recording.  
6) The parent will then complete the Fidelity of Implementation Survey (see 
Appendix P) on a computer to assess whether the curriculum is being implemented 
as intended. The Home Visitor will log the participant into the computer, but will 
then explain that all of the answers will be confidential and leave the participant 
alone to complete the survey.  
 
Nutrition Curriculum: The Nutrition Curriculum consists of 12 modules, one per home 
visit, that provide education to parents about the importance of healthy nutrition for child 
development, strategies for healthy eating, and meal preparation. The Nutrition 
Curriculum will be implemented in the following way:  
1) The Home Visitor delivers the module, one per Home Visit. 
2) The Home Visitor and the parent have a discussion to review and reinforce the 
parent’s understanding of the concepts.  
3) The parent and Home Visitor collaboratively set nutritional goals (see Appendix 
B). 
4) Parents will set up a time and day that they would like to be reminded of their 
scheduled LENA recording day. This reminder will then be sent to their phone via 
text message.  

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
15
At Home Visit 6, the Home Visitor will administer a Looking While Listening (LWL) task, 
intended to assess spoken language comprehension by infants and young children. Children will 
watch 2-4 minutes of video showing pictures of familiar words. Two pictures (e.g., book and 
bottle) are presented to the child on the screen and one of the pictures will be labeled, i.e. the 
child hears, e.g., “Look at the book.” Children are recorded on video while watching the videos 
and their eye movements will later be coded in order to establish whether children in the 
Treatment group are faster to fixate on the correct picture than children in the Control group. 
Parents will also be asked to check whether the words used in the study are known to their child. 
The LWL measure will be administered by the Home Visitor and a trained RA in the home 
before and after the scheduled Home Visit. After completing the LWL measure, the RA will 
complete the LWL Questionnaire and the LWL field notes. 
 
LENA Recordings 3-15  
Participants in both groups will complete 12 bi-weekly recordings over the course of the six-
month intervention phase.  Recordings will be 8 hours long each.  Each recording will be 
completed during the week following a Home Visit. 
 
5. Follow-up Phase  
This is the final phase requiring participant involvement.  The Follow-up Phase will last 42 
months. The Follow-up Phase consists of four components: videos, Assessments, LENA 
recordings, and Boosters (Follow ups).  
Video 2  
Videos 2 will be conducted during the Follow-up Phase. An RA will complete Video 2 in the 
participant’s home. The parent and child will engage in a 30-minute videotaped session 
consisting of Natural Play and Book Read. During Natural Play, the parent and child will engage 
in undirected, unstructured play. During Book Read, the parent will read a book to the child. The 
30-minute session will be simultaneously recorded by the new mobile phone application, the 
Three T’s App. The extra recording taken with the Three T’s App will be explained to the 
participants, detailing that “the app” funcitons like the LENA, except it links to a Bluetooth 
microphone and a mobile device, instead of the LENA recorder. The TMW staff member will set 
up the Three T’s App recording, and the participant will not see the application itself or be told 
the full name of the application, as these characteristcs are related to the Treatment condition. 
Assessment (Survey Meeting) 2  
A TMW Assessor will conduct Assessment 2 in the participant’s home. Assessment 2 will take 
approximately 75 minutes to complete.  
 
Assessment 2 Measures 
For this Assessment meeting, Parents will complete nine different measures. As in Assessment 1, 
the parent will complete the PLS, SPEAK, TOPSE, BMI, Nutrition Questionnaire, and TOI. 
Additionally, the parent will also complete the Ages & Stages Questionnaire: Social-Emotional 
(ASQ: SE), which is used to assess a child’s social and emotional development. After, the parent 
will fill out the Family Life Events Questionnaire (FLE), which collects data regarding adverse 
events experienced by the child. Finally, the parent will complete the Center for Epidemiologic 
Studies Depression Scale (CESD-10), which screens for parental depression.  
 
LENA Recording 16  

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
16
           Booster (Follow up) 1  
Four post-intervention Boosters will supplement the curricula. In order to provide quantitative 
linguistic feedback, each Booster refers to the LENA recording obtained immediately prior to the 
Booster visit. At Booster session 1, LENA recording 16 will be reviewed. An RA will conduct 
Boosters in the participant’s home.  Booster sessions will differ between the Treatment and 
Control groups. For the Treatment group, an RA will review curriculum content with the parent, 
discuss LENA feedback reports from the parent’s preceding recording, and review strategies for 
increasing word and turn counts and reducing TV/electronic media.  This will allow parents to 
continue to monitor their language behavior via LENA reports after the Intervention Phase ends. 
For the Control group, the RA and the parent will discuss parental knowledge regarding nutrition 
and healthy eating practices.  The Control group will receive these Booster sessions in order to 
control for the possible attentional effects experienced by the Treatment group as a result of the 
Boosters.  At Boosters 2, 3, and 4, the RA will also administer LWL to both the Treatment and 
Control groups. At each Booster time point, parents will complete the Booster Parent Fidelity 
Survey. 
LENA Recording 17  
Booster (Follow up) 2  
At Booster 2, LENA recording 17 will be reviewed. An RA will complete the Booster visit. At 
this Booster, the RA will administer LWL. After completing the LWL measure, the RA will 
complete the LWL Questionnaire and the LWL field notes. Additionally, the parent will 
complete the MacArthur CDI II: Short Version which is a vocabulary checklist that is 
appropriate for children 16-30 months of age.  
Video 3  
Videos 3 will be conducted during the Follow-up Phase. Videos will record children as they 
complete tasks (i.e. Gift/Bow, Snack Delay) that measure specific developmental gains (i.e. 
executive functioning skills, including the ability to exercise inhibition and delay gratification). 
Tasks will be introduced at time points that match normative child developmental gains.  
An RA will complete Video 3 in the participant’s home. The parent and child will engage in a 
45-minute videotaped session consisting of Natural Play, Book Read, Gift/Bow, and Snack 
Delay. The Gift/Bow task assesses a child’s executive functioning skills, specifically his/her 
ability to delay gratification. An RA will place a colorful gift bag in front of the child. The child 
will be asked to wait and to not touch the bag until the RA returns with a bow.  The RA will 
leave the room for three minutes. Upon returning, the child is allowed to open the bag. The 
Snack Delay task assesses a child’s ability to regulate their behavior. In this task, a gummy bear 
is placed under a transparent plastic cup in front of the child and the child is asked to wait until 
the RA rings a bell before eating it. The 45-minute session will be simultaneously recorded by 
the new mobile phone application, the Three T’s App. The extra recording taken with the Three 
T’s App will be explained to the participants, detailing that “the app” funcitons like the LENA, 
except it links to a Bluetooth microphone and a mobile device, instead of the LENA recorder. 
The TMW staff member will set up the Three T’s App recording, and the participant will not see 
the application itself or be told the full name of the application, as these characteristcs are related 
to the Treatment condition. 
Assessment (Survey Meeting) 3  
A TMW Assessor will conduct Assessment 3 in the participant’s home. Assessment 3 will take 
approximately 75 minutes to complete.  
 
 
Assessment 3 Measures 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
17
At this assessment meeting, the parent will complete six assessment measures: PLS, SPEAK, 
BMI, FLE, Nutrition and TOI.  
LENA Recording 18  
Booster (Follow up) 3  
At Booster 3, LENA recording 18 will be reviewed. An RA will complete the Booster visit.  
Video 4  
An RA will complete Video 4 in the participant’s home. The parent and child will engage in a 
45-minute videotaped session consisting of Natural Play, Book Read, Gift/Bow, and Snack 
Delay. The 45-minute session will be simultaneously recorded by the new mobile phone 
application, the Three T’s App. The extra recording taken with the Three T’s App will be 
explained to the participants, detailing that “the app” funcitons like the LENA, except it links to 
a Bluetooth microphone and a mobile device, instead of the LENA recorder. The TMW staff 
member will set up the Three T’s App recording, and the participant will not see the application 
itself or be told the full name of the application, as these characteristcs are related to the 
Treatment condition. 
Assessment (Survey Meeting) 4  
A TMW Assessor will conduct Assessment 4 in the participant’s home. Assessment 4 will take 
approximately 50 minutes to complete.  
 
 
Assessment 4 Measures 
At this assessment meeting, the parent will complete six measures: PLS, BMI, FLE, TOI, 
Nutrition and CESD-10.   
LENA Recordings 19  
Booster (Follow up) 4  
At Booster 4, LENA recording 19 will be reviewed. An RA will complete the Booster visit. At 
this Booster, the RA will administer LWL. After completing the LWL measure, the RA will 
complete the LWL Questionnaire and the LWL field notes. 
Video 5  
An RA will complete Video 5 in the participant’s home. The parent and child will engage in a 
45-minute videotaped session consisting of Natural Play, Book Read, Bear/Dragon, Gift/Bow, 
and Snack Delay.   
The Bear/Dragon task assesses a child’s executive functioning skills, specifically his/her ability 
to exercise inhibition. A child will be instructed to do as they are told by the nice bear (e.g., 
touch your ears), but not as they are told by the mean dragon (e.g. wink your eye). Video coders 
will score the task. The 45-minute session will be simultaneously recorded by the new mobile 
phone application, the Three T’s App. The extra recording taken with the Three T’s App will be 
explained to the participants, detailing that “the app” funcitons like the LENA, except it links to 
a Bluetooth microphone and a mobile device, instead of the LENA recorder. The TMW staff 
member will set up the Three T’s App recording, and the participant will not see the application 
itself or be told the full name of the application, as these characteristcs are related to the 
Treatment condition. 
Assessment (Survey Meeting) 5  
A TMW Assessor will conduct Assessment 5 in the participant’s home. Assessment 5 will take 
approximately 80 minutes to complete.  
 
 
Assessment 5 Measures 
At Assessment 5, the parent will complete six measures: PLS, SPEAK, ASQ: SE, BMI, FLE, 
Nutrition and TOI. Additionally, the child will complete the Peabody Picture Vocabulary Test-

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
18
Child (PPVT-Child), which measures the child’s receptive (hearing) vocabulary for Standard 
American English 
LENA Recording 20  
Video 6  
An RA will complete Video 6 in the participant’s home. The parent and child will engage in a 
45-minute videotaped session consisting of Natural Play, Book Read, Give-N Task and 
Bear/Dragon. The 45-minute session will be simultaneously recorded by the new mobile phone 
application, the Three T’s App. The extra recording taken with the Three T’s App will be 
explained to the participants, detailing that “the app” funcitons like the LENA, except it links to 
a Bluetooth microphone and a mobile device, instead of the LENA recorder. The TMW staff 
member will set up the Three T’s App recording, and the participant will not see the application 
itself or be told the full name of the application, as these characteristcs are related to the 
Treatment condition.  
Assessment (Survey Meeting) 6  
A TMW Assessor will conduct Assessment 6 in the participant’s home. Assessment 6 will take 
approximately 80 minutes to complete.  
 
Assessment 6 Measures 
For Assessment 6, the parent will complete eight measures: PLS, SPEAK, TOPSE, BMI, FLE, 
TOI, ASQ:SE, and CESD-10. Additionally, the child will complete the PPVT-Child.  
LENA Recording 21  
Video 7  
An RA will complete Video 7 in the participant’s home. The parent and child will engage in a 
30-minute videotaped session consisting of Natural Play, Give-N Task, and Book Read.  The 30-
minute session will be simultaneously recorded by the new mobile phone application, the Three 
T’s App. The extra recording taken with the Three T’s App will be explained to the participants, 
detailing that “the app” funcitons like the LENA, except it links to a Bluetooth microphone and a 
mobile device, instead of the LENA recorder. The TMW staff member will set up the Three T’s 
App recording, and the participant will not see the application itself or be told the full name of 
the application, as these characteristcs are related to the Treatment condition.  
A trained TMW assessor will complete three subscales of the Woodcock Johnson 
measure. The Woodcock Johnson (WJ) assesses a child’s school readiness.  It measures 
cognitive abilities, scholastic aptitude, and performance in the areas of reading, mathematics, and 
written language.  
Assessment (Survey Meeting) 7  
A TMW Assessor will conduct Assessment 7 in the participant’s home. Assessment 7 will take 
approximately 120 minutes to complete. This marks the final stage of participant’s involvement. 
 
 
Assessment 7 Measures 
For Assessment 7, the parent will complete seven measures: PLS, SPEAK, ASQ; SE, 
BMI, FLE, TOI, CESD.Finally, the child will complete the PPVT-Child and the the Head Toes 
Knees Shoulders Task (HTKS). Children are asked to play a game in which they are told to do 
the opposite of what the assessor asks them to do. For example, if the assessor says “touch your 
head” the child should respond by touching their toes and if the assessor says “touch your 
shoulders” the child should touch their knees. This activity measures inhibitory control, working 
memory, and attention focusing. 
 
Assessment 8 (9-year old follow up) 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
19
 
Participants will complete a follow up assessment time points when the child is between 
9-10 years old. There are three parts to Assessment 8: 1.) Parents or participating caregivers will 
complete the a battery of child assessment questionnaires including the Strenths and Difficulties 
Questionnaire (SDQ) P4-10, SPEAK, demographics, and the Parental Investments Survey. These 
will be done electronically using REDCap. 2.) Children will be asked to complete the PPVT, 5 
subtests of the Woodcock Johnson, 3 subtests of the NIH toolbox, and a brief measure of grit 
(see section 6b for additional details about each of these measures). These assessments will be 
completed in the child’s school. We will complete the assessments at the child’s home if the 
parent’s prefer. 3.) Finally, we will video record the participating caregiver and child interacting 
together for about 10-15 minutes while using age-appropriate toys.  
 
Participants who are in the Follow Up phase (assessment 8) will be given the opportunity to 
complete the parent measures online if they are unable to complete their Video Session. This will 
only be used in extenuating circumstances and the study team will do everything in its power to 
complete all study activities in person. If a participant needs to use the remote data collection 
option for their Video Session, they will complete the activity with a trained member of the 
TMW research team over a Zoom video call, which the researcher will record. The parent and 
child will be asked to play with toys that they already have in the home that are similar to the 
standardized toys TMW would have brought to the session.  
 
 
6. Data Analysis/Publication  
Dr. Dana Suskind will serve as the PI. Dr. Suskind and her research team will publish the 
primary findings of the initiative. Dr. Suskind and her research team will co-author publications 
with select collaborators. These collaborators will include Dr. Marc Hernandez at NORC, Dr. 
Susan Landry at The University of Texas, Dr. Flavio Cunha at Rice University, Dr. Casey Lew-
Williams at Princeton University, and Dr. Will Aldridge at the University of North Carolina at 
Chapel Hill.   
 
b) Scales, Assessments & Questionnaires 
The following Scales, Assessments & Questionnaires will be used throughout the course of the 
study:  
 
Center for Epidemiologic Studies Depression Scale (CESD-10): The CESD-10 screens for 
parental depression.  
   Tool to Measure Parenting Self-Efficacy (TOPSE): The TOPSE assesses parent’s beliefs 
about their efficacy as care givers.  
 
Family Life Events Questionnaire (FLE): The FLE collects data regarding adverse events 
experienced by the child.  
 
Preschool Language Scale (PLS): The PLS is an interactive assessment of developmental 
language skills that measures a child’s total language, auditory comprehension, expressive 
communication standard scores, growth scores, percentile rankings, and language age 
equivalents.  
 
Peabody Picture Vocabulary Test-Parent (PPVT): The PPVT measures an individual's 
receptive (hearing) vocabulary for Standard American English.   
 
Survey of Parental Expectations And Knowledge (SPEAK): SPEAK is a questionnaire that 
assesses parents’ understanding of children’s learning process. 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
20
 
Body Mass Index (BMI): BMI is a measure of body fat based on an individual’s height and 
weight. 
 
Woodcock-Johnson Psycho-Educational Battery (WJ): The WJ assesses a child’s school 
readiness.  It measures cognitive abilities, scholastic aptitude, and performance in the areas of 
reading, mathematics, and written language.  
 
Theories of Intelligence (TOI): The TOI assesses a parent’s theories about intelligence for 
children. It asks questions about what an individual thinks a child will be able to do, given how 
much a parent speaks to their child. 
 
Nutrition Questionnaire: The Nutrition Questionnaire assesses parents’ understanding 
about healthy eating habits and healthy nutrition for children. 
 
MacArthur-Bates CDI I: Short Version (MacArthur I): The MacArthur CDI I: Short 
Version is a vocabulary checklist that is appropriate for children 8-16 months of age. 
 
MacArthur-Bates CDI II: Short Version (MacArthur II): The MacArthur CDI II: Short 
Version is a vocabulary checklist that is appropriate for children 16-30 months of age. 
 
Child Behavior Checklist (CBCL): The CBCL is used to detect behavioral and emotional 
problems in children or adolescents. The version designed for ages 6-18 year old children will be 
used in this study. 
 
Parental Investments Survey: Asks parents to report how often they and their child do 
certain activities, as well as their opinion about future educational attainment for their child. 
 
Duckworth Grit Scale: The Grit Scale measures a child’s tendency to sustain interest in and 
effort toward long-term goals. Grit is a trait that predicts achievement. This study will use an 
adaptation of the 8-item scale designed to be more easily understood by younger children. 
 
NIH toolbox: NIH Toolbox for Assessment of Neurological and Behavioral Function, a 
standard set of valid, reliable and royalty-free tools for assessing cognitive, emotional, motor and 
sensory function. This measure is conducted in an app-based format through which the child 
responds to prompts on a tablet.  
 
Ages & Stages Questionnaire: Social-Emotional (ASQ: SE): The Ages & Stages 
Questionnaire: Social-Emotional is a series of questions that aims to identify any social or 
emotional problems in a developing child.  
 
 
        Video Recordings:  
Natural Play: The parent and child will engage in natural play. 
Book Read: The parent will read a book to the child. 
Bear/Dragon: The Bear/Dragon task assesses inhibition. Children will be instructed to 
do as they are told by the nice bear (e.g., touch your ears), but not as they are told by the 
mean dragon (e.g. wink your eye).  
Gift/Bow: The Gift/Bow task assesses delayed gratification.  An RA will place a colorful 
gift bag in front of the child. The child will be asked to wait and to not touch the bag 
until the RA comes back with a bow.  The RA will leave the room for 3 minutes.  
Snack Delay: The Snack Delay task assesses a child’s ability to regulate their behavior. 
In this task, a gummy bear is placed under a transparent plastic cup in front of the child 
and the child is asked to wait until the RA rings a bell before eating it.  
Give-N Task: This task measures a child’s emerging math and counting skills. A child 
will be asked by the TMW assessor to put a specific number of toy fish into a plastic 
bowl. This task will be repeated multiple times asking for a different target number of 
fish each time. 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
21
          Looking While Listening (LWL): LWL is a measure that assesses spoken language 
comprehension by infants and young children. After completing the LWL measure, the RA will 
complete the LWL Questionnaire and the LWL field notes.  
 
The Three T’s App Recordings: The Three T’s App is an educational tool for parents 
participating in the Thirty Million Words Initiative. The application is being developed, tested, 
and evaluated by Luai Zakaria, a student of the Pritzker School of Medicine at the University of 
Chicago. In this study, the application will only be used by TMW researchers to take an 
additional recording of all families at all Video Sessions (1-7) to further evaluate and test the 
recording and results capacity of the application. The name of the application will not be 
disclosed to participants, as it directly relates to the treatment condition. Additionally, only a 
trained TMW staff member will be able to set up the recording device and connect it to the 
application, as the interface of the application contains features directly related to the treatment 
condition, such as a note that says “Research shows that the more words your child hears, the 
smarter they will be!” For all participants, the Three T’s App will only be referred to as “the 
app” and that “the app” functions like the LENA device, but the recording is taken using a 
Bluetooth microphone headset that links to a mobile device instead of the LENA recorder. Only 
the recording and results features of the application will be used by the TMW staff to further 
evaluate and test the Three T’s App. The other features of the application are still in 
development, but more information can be found in Appendix AA. 
c) 
Contact between study visits 
Participants in both the Treatment and Control group will be able to contact members of Dr. 
Suskind’s research team between study visits in order to reschedule visits as needed.  Moreover, 
the research team will send periodic postcards and make periodic phone calls to both the 
Treatment and Control Group in an effort to maintain engagement with participants, thereby 
reducing attrition.  
d) 
Future contact regarding research studies  
We will request permission from participants to keep their contact information on file in order to 
contact them about their participation in this study and to inform them about future research 
opportunities.  At the final assessment (Assessment 7), we will get consent from participants to 
obtain administrative data from the child’s school district at the end of kindergarten.  We will 
seek further consent for administrative data at 3rd, 8th, and 12th grade in accordance with the 
University of Chicago’s IRB and Chicago Public Schools’ Research Review Board procedures. 
 
4.  SUBJECT SELECTION AND WITHDRAWAL  
a) 
Number of subjects 
The study will consist of 412 participants. ‘Participants’ refers to the parent/child dyad. 
Participants will be randomly assigned to the Treatment group and the Control group.  
b) 
Gender of subjects 
Participants of all genders will be accepted into the study.  
c) 
Age of subjects 
Children will be between the ages of 13-16 months old at the start of the study. Parents will be 
older than 18 years old.  
d) 
Racial and Ethnic Origin 
Participants of all racial and ethnic origins will be accepted into the study.  
e) 
Inclusion Criteria 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
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Inclusion criteria includes 1) participants (i.e. parents and their children) who live below 200% 
of the federal poverty line and 2) parents with children between the ages of 13-16 months old.  
f) 
Exclusion Criteria 
Exclusion criteria is as follows: 1) participants (i.e. parents and their children) who live over 
200% of the federal poverty line, 2) parents under the age of 18, 3) children younger than 13 
months old or older than 16 months old (at start of study), 3) parents who do not have legal 
custody of their child, 4) parents whose child does not live with them, 5) parents who are not 
with their child at least two full days per week, 6) parents who are unable to commit to the 
intervention requirements, 7) foster parents, 8) children with significant cognitive or physical 
impairments, (specifically Autism Spectrum Disorder, Epilepsy, Cerebral Palsy, hearing 
impairment, Down Syndrome and blindness), 9) parents who have earned or are currently 
working toward a graduate or professional degree (e.g. M.A., M.S., M.B.A), and 10) parents who 
speak less than 80% English to their children. There will be one exception to this exclusion 
criteria for a single case to allow a participant to join our study who is the foster parent of the 
child and the child is therefore still a ward of the state. The parent has already finalized the 
adoption on the child’s sibling and this adoption is in the process of being finalized and will be 
by the end of the year, but the process likely won’t be complete before the child becomes too old 
to start our study. 
g) 
Subject Identification & Recruitment 
412 low-SES participants in the Chicago area will be recruited for the study from City of 
Chicago Early Head Start and early childhood learning sites, Chicago Public Schools’ Prevention 
Initiative, Children’s Home + Aid Early Head Start and early childhood learning sites, other 
Chicagoland early childhood learning sites, and other community sites in the Chicagoland area. 
Recruitment will take place 1) in person at these early learning sites with the help of a 
recruitment video explaining the study 2) via fliers (see Appendix S) distributed at early learning 
sites with the TMW phone number listed (see Incoming Call Recruitment Script), 3) via 
outgoing calls to potential participants (see Outgoing Call Recruitment Script), and 4) via CTA 
advertisements (see Appendix U). 
h) 
Location where research is to be conducted (building, floor, clinic/suite number) 
The TMW Curriculum, Booster (Follow up) sessions, video recordings and Assessments will be 
conducted in participants’ homes or another agreed location (i.e., community sites) if family is 
unable to meet in their home. Data analysis will occur at the TMW office and the National 
Opinion Research Center (NORC).  
The TMW office is located at: 
University of Chicago Medical Center 
5841 S. Maryland Ave, MC 1035 
Lying-in Hospital, Room L161 
Chicago, IL 60637 
  The NORC office is located at: 
1155 East 60th Street 3rd Floor 
Chicago, IL 60637 
 
i) As applicable, the coordination of any interdepartmental faculty, and where necessary, 
the inclusion of those faculty as participants 
TMW will collaborate with the following individuals and organizations: 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
23
Center for Research Informatics (CRI) at the University of Chicago: CRI will host, 
maintain, and support the web platform that hosts the TMW Curriculum, facilitates intervention 
delivery, and securely stores intervention and assessment data.  The web platform has been built 
by One-Six Solutions, an outside vendor, and is built to industry standards for data security and 
HIPAA compliance. 
National Opinion Research Center at the University of Chicago (NORC): NORC is the 
primary subcontract recipient of the grant. NORC will conduct analyses and provide consultation 
on study design and evaluation. 
City of Chicago Department of Family & Support Services (DFSS) Early Head Start 
and early childhood learning sites: TMW will collaborate with DFSS Early Head Start Sites to 
recruit.  
Children’s Home + Aid (CH+A): TMW will collaborate with CH+A Early Head Start 
and early childhood learning sites to recruit participants.   
Chicago Public Schools (CPS): TMW will collaborate with CPS Prevention Initiative 
early childhood programs to recruit participants and will establish a data-sharing agreement with 
CPS at the end of the study in order to follow children’s academic progress. Accordingly, an 
amendment to this protocol will be submitted when this data-sharing agreement is established. 
Dr. Flavio Cunha (Rice University): Dr. Cunha will receive de-identified data from 
TMW. Dr. Cunha will conduct data analyses and provide consultation to TMW. 
Dr. Casey Lew-Williams (Princeton University): Dr. Lew-Williams will receive de-
identified data from TMW. Dr. Lew-Williams will conduct data analyses and provide 
consultation to TMW.  
Dr. Will Aldridge (University of North Carolina at Chapel Hill): Dr. Aldridge will 
receive de-identified data from TMW. Dr. Aldridge will conduct data analyses and provide 
consultation to TMW.  
Jenessa Malin (University of Maryland, College Park): Jenssa Malin will watch 
unidentified participant videos through screen sharing with a member of the TMW team. Jenessa 
will conduct training on a coding scheme and provide consultation to TMW.  
j) 
Describe plans for remuneration to subject, as applicable: 
Participants in the Treatment and Control groups will be compensated equally. Participants can 
receive up to a total of $1,200. If participants complete the study, they are guaranteed at least 
$1,000 in cash ($25 post-Preliminary Consent and Baseline Measures Phase, $25 post- 
Assessment 1, $50 post-Home Visit 6, $25 post-Video Session 2, $75 post-Assessment 2, $75 
post-Video Session 3, $75 post-Assessment 3, $75 post-Video Session 4, $75 post-Assessment 4, 
$50 post-Video Session 5, $50 post-Assessment 5, $25 post-LENA recording 20, $75 post-Video 
Session 6, $75 post-Assessment 6, $50 post-LENA Recording 21, $80 post-Video Session 7,  
and $95 post-Assessment 7). In the last two years of the study, participants will be eligible to 
receive up to $100 in ‘bonus’ gift cards for staying in contact with TMW staff ($50 between 
Assessments 5 and 6 and $50 between Assessments 6 and 7). Participants who consent to allow 
cloud based processing on their LENA recordings will be paid $25 in gift card or cash. 
Participants will be paid cash for all study payments (with the exception of the ‘bonus’ gift cards 
and payment for allowing cloud based processing) when possible. For participants who are 
unable to meet in-person for video sessions and/or assessment meetings, gift cards will be used 
as back up option when hand delivery of a cash payment is not possible (i.e. during the 
restrictions placed by the university during the COVID-19 pandemic): Participants who need to 
complete remote assessment data collection due to extenuating circumstances will be paid for 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
24
completeing all surveys through cash or a $50 electronic gift-card. If circumstances change and 
the participant is later able to meet in person, the research team will conduct all remaining 
assessment measures with the parent and child in their home and the participant will receive the 
full cash compensation amount for the assessment meeting as outlined above. Participants who 
need to complete remote video session data collection due to extenuating circumstances will be 
paid $50 in cash or electronic gift-card for completing the Natural Play and Book Share 
activities. If circumstances change and the participant is later able to meet in person, the research 
team will conduct all remaining video session measures with the parent and child in their home, 
and the participant will receive the full cash compensation amount for the video session meeting 
as outlined above. 
 
At the assessment 8 timepoint: Parents will receive up to $75 in gift cards after completing the 
session and the child will be able to choose a small prize (such as pencils, stickers, etc – valued 
at approximately $5) for doing the study activities. Parents will receive $25 when the child 
assessment is completed and participating caregivers (in the rare cases when these are 
individuals who are not the primary guardian) will receive $50 when they complete the video 
session and assessment surveys. Transportation vouchers ($10 gas cards) will be provided to 
families who express transportation needs to get to the community center for the video recording 
portion of the study.  
 
k) 
Informed consent process 
The participant will be given written consent forms and taken through the informed consent 
process with a member of the research team.  The member of the research team will verbally 
review the written consent form with the participant prior to signing. Participants will be given 
ample time to review the consent form and ask the member of the research team any questions 
before they decide to participate in the study. Participants will first complete the Preliminary 
Informed Consent Form.  If he/she continues past the Preliminary Phase to enroll in the full 
study, the participant will then complete the Enrollment Informed Consent Form. Both informed 
consents explain the purpose of the study, potential risks and benefits, and the measures taken to 
ensure confidentiality.  
 
Addendum to consent to allow for cloud-based LENA processing: After the conclusion of their 
participation of the study, participants will be asked for additional permission to allow 
processing of their LENA recordings on distributed computing networks external to University 
of Chicago servers. Trained members of the research team will discuss the addendum to the 
enrollment consent, including risks and benefits, measures taken to protect their data, and the 
optional nature of the addendum with the participant. This may occur in person at the conclusion 
of their Assessment 7 meeting or over the phone at a later date. After discussing the consent 
document with staff, participants will be able to view the addendum to the enrollment consent on 
Redcap via a survey link sent to their phone or email. They will be asked to mark whether they 
do or do not allow for this additional processing, and type their name and the date to 
acknowledge their understanding and agreement to the addendum.  
 
Addendum to Enrollment Consent for Assessment 8: An additional assessment time point is 
being added to our study starting in the summer of 2023. Participating children will be aged 9-10 
years of age at the time of the additional assessment time point.  

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
25
 
Communications and Outreach: Trained members of the research team will use recently updated 
contact information provided by participants during recent conversations (see Amendment 50) to 
invite them to participate in Assessment 8. If interested, they will be scheduled to meet with a 
home visitor to complete the new time point. The reconsent information will be sent to 
participants electronically for their review/records with a note that will state: "You will have an 
opportunity to discuss this information with our team during the visit before signing these 
documents. This information is for your review."  
 
Trained member of the research team will review and discuss any questions pertaining to the 
consent  over the phone for Assessment 8 and also screen the adults to ensure they continue to be 
the legal guardinas of the participating child. We will obtain written re-consent from the 
participant once all questions have been addressed and discussed prior to commencing any of the 
Assessment 8 steps. Participants will receive a copy of the reconsent form for their records.  
 
l)       Method of withdrawing participants before completion (i.e., early termination) 
Participants will be removed from the study at the discretion of the Principal Investigator after 
demonstration of repeated nonadherance to study protocol (i.e.: multiple incomplete or 
unsuccessful LENA recordings; multiple unsuccessfully completed Home Visits or Assessments; 
unable to contact after significant effort by research team).  If participants choose to no longer be 
in the study and do not want any of their future health information to be used, participants can 
inform the research team in writing.  
 
5.  STATISTICAL PLAN AND CONSIDERATIONS   
An interrupted time series design (i.e. regression discontinuity) will be used to analyze data from 
this study. The goal of the statistical analyses will be to assess the effects of the TMW 
Curriculum. The interrupted time series design will allow us to model children’s growth as a 
function of time and development while modeling the independent effects of receiving the 
intervention.  
 
The outcome measures (LENA, assessments, video) will be entered into a regression that 
includes children’s demographic variables as covariates (e.g. child age in months) as well as 
dummy variables for each time point data was obtained. Separate analyses will be carried out for 
parents and children because some data will only be collected on parents and some data will only 
be collected on children.  
 
Further, because some data are only collected at pre- and post-intervention, separate repeated 
measures ANOVAs and paired tests will be carried out on these data. The aim of these analyses 
will be to 1) examine within-subject change from pre to post-intervention in the Treatment and 
Control conditions and 2) compare change in the Treatment condition with change in the Control 
condition. 
 
The new mobile phone application, the Three T’s App, linguistic feedback data will be 
statistically compared to the manual transcription of all video recording sessions. The exact 
number of words and turns transcribed will be correlated with the amount estimated by the 
mobile phone application. An average error rate and a linear regression for the mobile 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
26
application will be calculated. This will allow us to further evaluate and develop the Three T’s 
App. 
 
Several scripts and functions will be invoked on a local TMW Center computer to interact with a 
distributed computing network and deep learning models to transform LENA audio-recordings into 
transcripts. No data will be transmitted to cloud based computing networks until appropriate approvals 
and contracts for the systems to be used are in place. To guard against session time-outs (instances in 
which the data being processed, uploaded, or downloaded from a remote source becomes 
unresponsive), each LENA audio recording will be preprocessed and segmented into discrete 15 minute 
chunks before being transformed. Moreover, all LENA audio recordings will be encrypted locally at rest 
and in transit. These segmented chunks will be randomly assigned numerical IDs to protect participant 
privacy paired with their experimental grouping. No TMW Center researcher or third-party collaborator 
will listen to the raw audio contained on the LENA devices or examine the outputted transcripts. 
Instead, our team will employ a customized ensemble of different machine learning models used in 
conjunction to transform the transcription data into quantitative values contained in a CSV file. 
Quantitative values generated and contained within this CSV file will include frequency counts of 
different parts-of-speech, types of speech, and normalized values ranging from -1 to 1 or 0 to 1. This 
package of ensemble models will programmatically receive data from the deep learning model as each 
LENA-audio recording is processed. Following the completion of this automated transcription and data 
analysis process, all data processed on the distributed computing network will be systematically deleted. 
No qualitative data will be retained and the researchers will effectively remain blind to the input source 
data. Participants will provide additional consent to allow their LENA audio recording to be shared with 
these distributed computing networks after conclusion of their participation in the study. If they do not 
consent to this additional processing, LENA recording data will remain on secure University of Chicago 
Servers and their processing will be limited to only those analytical techniques that can be completed 
locally. Paired t-tests will be used to analyze total speech scores before, after, and during the TMW 
Longitudinal Home Visiting Program. ANOVAs will be used to evaluate differences in outcomes based on 
SES and other variables in intervention vs. control group. Furthermore, the TMW Center will build 
predictive regression models by examining which aspects of a child’s language environment is predictive 
of school readiness 
 
 
6.  RISKS AND BENEFITS 
a) 
Risks associated with study intervention and any study procedures  
Given the nature of this research, minimal risks are anticipated. All audio data on the LENA 
recording device is encrypted so confidentiality will not be breached even if the recorder is lost 
or stolen. Data remains encrypted until processed using the LENA System software.  Risks 
include a theoretical loss of confidentiality related to recording language via the LENA 
recordings. However, the LENA audio data from the 21 home audio recordings will not be 
listened to by any member of the research staff. LENA audio data collected during the Video 
Session meetings may be listened to by members of the research team. Unlike the Home Audio 
LENA Recordings, which measure the child’s home language environment, the purpose of the 
Video Session LENAs is to act as a duplicate safeguard to ensure that we have clearly captured 
all audio from the recorded video session. Because the LENAs completed during the Video 
Sessions will record the same language output that has also been recorded on the video camera, 
parents implicitly understand that the audio will be heard by members of the research team and 
there is no loss of privacy. It will be kept for 7 years past the end of the study for possible re-

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
27
analysis with improved analytical algorithms. Non-audio data will be kept indefinitely. Risks 
also include a theoretical loss of confidentiality related to Home Visitors, TMW assessors, and 
RAs entering participants’ homes.  To minimize these risks, all research personnel will be trained 
to maintain the utmost confidentiality.  Moreover, data will be carefully monitored to ensure the 
privacy of participants is protected. Data will be kept in a locked cabinet with the participant 
names replaced with numerical codes.  LENA Recording audio and data files will be stored on a 
password-protected computer in a locked office.  Master lists of participant names, consent 
forms, and the key to the numerical codes will also be kept under lock and key. 
 
There is a low possibility for loss of privacy when the audio recordings are transmitted from the 
TMW Center’s servers to the distributed computing network for analysis. The research team will 
take all necessary precautions in order to protect the participant’s confidentiality. This includes 
using randomly generated numerical codes for all audio segments that are transmitted to the 
distributed computing network so that the files cannot be tied back to an individual participant.  
 
All of the audio data recorded by the mobile phone application will be on encrypted iPod 
Touches owned by the Thirty Million Words Initiative. Thus, these recordings will be handled in 
the exact same way as the LENA audio recordings have been handled in the past. All audio data 
and devices used to record the data will be stored in the aforementioned locked office. 
 
There is one instance in which confidentiality will not be maintained.  In the consent form, 
participants are notified of the legal responsibility of Dr. Suskind and members of her research 
team to report any suspicion of child abuse or neglect to DCFS.  Every member of Dr. Suskind’s 
research team who will have contact with participants will complete the DCFS Mandated 
Reporter online training (https://www.dcfstraining.org/manrep/index.jsp) prior to interaction 
with participants.  The abuse reporting hotline (1-800-25-ABUSE) will be made readily available 
to the research team at all times. 
 
b) 
Potential direct benefits to participant 
Benefits will include increased parental knowledge regarding healthy child development.  
Moreover, we hope the information learned from this study will benefit other low-SES children 
and families in the future. 
 
c) 
Describe how the benefits in this research justify the potential risks. 
The benefits to both individual participants and, potentially, the broader low-SES population, 
outweigh the minimal risks involved in the study.  
 
7.  SAFETY AND ADVERSE EVENTS 
Adverse events and safety information will be monitored and analyzed on an ongoing basis. 
Serious and unexpected adverse events will be immediately reported to the IRB. Given the 
educational nature of this study, there is a low likelihood of adverse events.  
 
8. DATA HANDLING AND RECORD KEEPING  
Data will be carefully monitored on an ongoing basis to ensure the privacy of participants is 
protected. Data will be kept in a locked cabinet with the participant names replaced with 
numerical codes.  LENA Recording audio and data files will be stored on a password-protected 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
28
computer in a locked office. When these files are transmitted to distributed computing networks 
for deeper analysis, they are segmented and each segment is given a random numerical ID 
number so that the participant who completed that recording cannot be identified by the third-
party server. LENA audio data from the 21 home audio recordings will not be listened to by any 
member of the research staff. LENA audio data collected during the Video Session meetings 
may be listened to by members of the research team. Unlike the Home Audio LENA Recordings, 
which measure the child’s home language environment, the purpose of the Video Session 
LENAs is to act as a duplicate safeguard to ensure that we have clearly captured all audio from 
the recorded video session. Because the LENAs completed during the Video Sessions will record 
the same language output that has also been recorded on the video camera, parents implicitly 
understand that the audio will be heard by members of the research team and there is no loss of 
privacy.It will be kept for 7 years past the end of the study for possible re-analysis with improved 
analytical algorithms. Non-audio data will be kept indefinitely.  Master lists of participant names, 
consent forms, and the key to the numerical codes will also be kept under lock and key. 
Depending on the measurement, data will be collected in both paper and electronic form. 
Electronic data will be entered via the TMW Web Platform, REDcap, or the NIH toolbox app. 
Storing data, which includes child name and birthdate, in the NIH toolbox app is necessary to 
conduct the measure because the stimulus is dependent on age. Data will be regularly 
downloaded from the NIH toolbox app, saved to BSD/CRI servers, and the child information 
removed from the app. Both the TMW research team and NORC will manage and have access to 
the data.  
All audio data from the new mobile phone application will be stored with the exact same 
precautions as the LENA audio recordings. 
Video files that are created as part of the remote video session contingency procedures will be 
recorded by the researcher in Zoom, saved to TMW’s BSD server and any local copies will be 
deleted from Zoom immediately after the session.  
 
At the end of their participation in the studies, parents may request access to their study records, 
including copies of the files created during the video sessions and their child’s scores on the 
developmental measures. Parents who request the video files may choose whether they would 
like to receive a hard copy of the video, via flash drive or DVD, or electronic file transfer, via 
UChicago Box. Hard copy files will be given to the participant directly. Participants who choose 
to receive the files via Box will be given an individualized link to a private folder on Box, and 
instructed to download the video(s) to their personal device using the link. The files will be 
deleted from Box within 7 days of upload or once participant confirms they have downloaded it, 
whichever comes sooner. Results from the developmental measures may be shared by email or 
verbally with the participant. 
 
9.  FINANCIAL CONSIDERATIONS 
a) 
Remuneration to subject 
Participants in the Treatment and Control groups will be compensated equally. Participants can 
receive up to a total of $1,200. If participants complete the study, they are guaranteed at least 
$1,000 in cash ($25 post-Preliminary Consent and Baseline Measures Phase, $25 post- 
Assessment 1, $50 post-Home Visit 6, $25 post-Video Session 2, $75 post-Assessment 2, $75 
post-Video Session 3, $75 post-Assessment 3, $75 post-Video Session 4, $75 post-Assessment 4, 
$50 post-Video Session 5, $50 post-Assessment 5, $25 post-LENA recording 20, $75 post-Video 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
29
Session 6, $75 post-Assessment 6, $50 post-LENA Recording 21, $80 post-Video Session 7 and 
$95 post-Assessment 7). In the last two years of the study, participants will be eligible to receive 
up to $100 in ‘bonus’ gift cards for staying in contact with TMW staff ($50 between 
Assessments 5 and 6 and $50 between Assessments 6 and 7). Participants who consent to allow 
cloud based processing on their LENA recordings will be paid $25 in gift card or cash. 
 
At the assessment 8 timepoint: Parents will receive up to $75 in gift cards after completing the 
session and the child will be able to choose a small prize (such as pencils, stickers, etc – valued 
at approximately $5) for doing the study activities. Parents will receive $25 when the child 
assessment is completed and $50 when they complete the video session and parent assessment 
survey. Transportation vouchers ($10 gas cards) will be provided to families who express 
transportation needs to get to the community center for the video recording portion of the study.  
 
 
Participants will be paid cash for all study payments (with the exception of the ‘bonus’ gift cards 
,payment for allowing cloud based processing, and Assessment 8) when possible. For 
participants who are unable to meet in-person for video sessions and/or assessment meetings, gift 
cards will be used as back up option when hand delivery of a cash payment is not possible (i.e. 
during the restrictions placed by the university during the COVID-19 pandemic): Participants 
who need to complete remote assessment data collection due to extenuating circumstances will 
be paid for completeing all surveys through cash or a $50 electronic gift-card. If circumstances 
change and the participant is later able to meet in person, the research team will conduct all 
remaining assessment measures with the parent and child in their home and the participant will 
receive the full cash compensation amount for the assessment meeting as outlined above. 
Participants who need to complete remote video session data collection due to extenuating 
circumstances will be paid $50 in cash or electronic gift-card for completing the Natural Play 
and Book Share activities. If circumstances change and the participant is later able to meet in 
person, the research team will conduct all remaining video session measures with the parent and 
child in their home, and the participant will receive the full cash compensation amount for the 
video session meeting as outlined above. 
 
b) 
Costs to subject 
There are no financial costs to participants.  
 
10.  ETHICAL CONSIDERATIONS 
 
a) Confidentiality 
Data will be carefully monitored to ensure the privacy of participants is protected. Data will be 
kept in a locked cabinet with the participant names replaced with numerical codes.  LENA 
Recording audio and data files will be stored on a password-protected computer in a locked 
office.  Master lists of participant names, consent forms, and the key to the numerical codes will 
also be kept under lock and key. Depending on the measurement, data will be collected in both 
paper and electronic form. Electronic data will be entered via the TMW Web Platform or Redap. 
Both the TMW research team and NORC will manage and have access to the data. 
 
There is one instance in which confidentiality will not be maintained.  In the consent form, 
participants are notified of the legal responsibility of Dr. Suskind and members of her research 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
30
team to report any suspicion of child abuse or neglect to DCFS.  Every member of Dr. Suskind’s 
research team who will have contact with participants will complete the DCFS Mandated 
Reporter online training (https://www.dcfstraining.org/manrep/index.jsp) prior to interaction 
with participants.  The abuse reporting hotline (1-800-25-ABUSE) will be made readily available 
to the research team at all times.  
 
11.  CONFLICT OF INTEREST    
There is no COI with regard to the conduct of this study.  
 
12.  PUBLICATION PLAN   
Discuss the following in detail: 
a) Who expects to publish results from this research? 
Dr. Dana Suskind will serve as the PI. Dr. Suskind and her research team will publish the 
primary findings of the initiative. Dr. Suskind and her research team will co-author publications 
with select collaborators. These collaborators will include Dr. Marc Hernandez at NORC, Dr. 
Susan Landry at The University of Texas, Dr. Flavio Cunha at Rice University, Dr. Casey Lew-
Williams at Princeton University, and Dr. Will Aldridge at the University of North Carolina at 
Chapel Hill.   
b) When are results expected to be submitted for publication? 
First results will be submitted for publication during or after the fifth year of the study.  
 
 
13.  REFERENCES  
 
Bruner, J. S. (1981). The social context of language acquisition. Language & Communication, 1, 
155–178. 
 
Chapman, R. (2000). Children’s language learning: An interactionist perspective. Journal of 
Child Psychology and Psychiatry, 41, 33–54. 
 
Fenson, L., Dale, P.S., Reznick, J.S., Thal, D., Bates, E., Hartung, J.P., Pethick, S., & Reilly, J.S. 
(1993). The MacArthur Communicative Development Inventories: User’s Guide and 
Technical Manual. Baltimore : Paul H. Brokes Publishing Co. 
Gallaway, C. & Richards, B. J. (1994). Input and interaction in language acquisition. 
Cambridge, England: Cambridge University Press. 
 
Gilkerson, J., & Richards, J.A. (2008c). The Power of Talk: 2nd Edition. (Infoture Technical 
Report ITR-01-2). Retrieved from Infoture, Inc.: 
http://www.infoture.org/TechReport.aspx/PowerOfTalk/ITR-01-2 
 
Hart, B., & Risley, T. R. (1995). Meaningful differences in the everyday experience of young 
American children.  Baltimore, MD: Brookes. 
 
Hart, B., & Risley, T. R. (1992). American parenting of language learning children: Persisting 
differences in family child interaction observed in natural home environments. 
Developmental Pyschology, 28, 1096–1105. 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
31
 
Hoff, E. (2012). Interpreting the early language trajectories of children from low-SES and 
language minority homes: implications for closing achievement gaps. Developmental 
Psychology, 49(1), 4-14. 
 
Hoff, E. (2013). Proceedings from White House meeting on “Bridging the Thirty-Million-Word 
Gap.” Early language gaps: Sources and solutions. Washington, DC. 
 
Hoff, E., & Tian, C. (2005). Socioeconomic status and cultural influences on language. Journal 
of Communication Disorders, 38(4), 271-278. doi: 10.1016/j.jcomdis.2005.02.003 
 
Huttenlocher, J., Haight, W., Bryk, A., Selzer, M., & Lyons, T. (1991). Early vocabulary growth: 
Relation to language input and gender. Development Psychology, 27, 236–248. 
 
Nelson, K. (1973). Structure and strategy in learning to talk. Monographs of the Society for 
Research in Child Development, 38, 1-135.    
 
Rowe, R. L. (2008). Child-directed speech: relation to socioeconomic status, knowledge of child 
development and child vocabulary skill. Journal of Child Language, 35, 185–205 
 
Rowe, M. L., & Goldin-Meadow, S. (2009). Differences in early gesture explain SES disparities 
in child vocabulary size at school entry. Science, 323(5916), 951-953. doi: 
10.1126/science.1167025 
 
Suskind, D., Leffel, K. R., Hernandez, M. W., Sapolich, S. G., Suskind, E., Kirkham, E., & 
Meehan, P. (2013) An exploratory study of “Quantitative Linguistic Feedback”: Effect of 
LENA Feedback on Adult Language Production. Communication Disorders Quarterly. 
34(4) 199-209. 
Doi: 10.1177/1525740112473146 
 
Tomasello, M. (2003). Constructing a Language: A Usage-Based Theory of Language 
Acquisition. Harvard University Press. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
32
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
15.  APPENDICES 
 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
33
A. TREATMENT GROUP GOAL SHEET 
 
 
 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
34
B. CONTROL GROUP GOAL SHEET 
 
 
 
 
 
 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
35
 
C. SCHEDULE AND DEMOGRAPHICS QUESTIONNAIRE  
 
Schedule and Demographics Survey 
 
DEMOGRAPHICS 
 
Are you Hispanic or Latino?  
 No 
 Yes 
 Prefer not to answer 
 
What is your race? (Choose any that apply.) 
 White 
 Black or African American 
 Asian or Pacific Islander 
 Native American or Alaska Native 
 Other: ____________________ 
 Prefer not to answer  
 
Is @CHILD Hispanic or Latino? 
 No 
 Yes 
 Prefer not to answer  
 
What is @CHILD’s race? (Choose any that apply.) 
 White 
 Black or African American 
 Asian or Pacific Islander 
 Native American or Alaska Native 
 Other: ____________________ 
 Prefer not to answer

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
36
CHILDCARE 
 
Let’s talk about @CHILD’s schedule last week.  Please tell me about last week, even if it was an 
unusual week.  I’ll ask you about your usual schedule later on. 
 
Last week, who took care of @CHILD? (check all that apply) 
 
@PARENT 
 
Spouse/partner 
 
Child’s grandparent 
 
Child’s sibling 
 
Child’s uncle/aunt 
 
Friend or neighbor 
 
Babysitter in the home 
 
Childcare center (e.g., 
Head Start, Early Learning 
center)  
 
Home or group-home 
daycare (e.g., providers care for 
groups of children in licensed 
home settings)  
 
Other___________ 
 
Who took care of @CHILD on Sunday?  During what times?  Who took care of @CHILD next? 
 
 
5a 6a 7a 8a 9a 10a 11a 12p 1p 2p 3p 4p 5p 6p 7p 8p 9p 10p 11p 
Sun 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mon  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Tue 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Wed  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Thu 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fri 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sat 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Thinking about @CHILD’s schedule last week, was any day’s schedule the same as last Sunday?  
 Monday 
 Tuesday 
 Wednesday 
 Thursday 
 Friday 
 Saturday 
 
Who took care of @CHILD on Monday?  During what times?  Who took care of @CHILD next? 
[continue until week’s grid is complete] 
 
Was last week’s childcare schedule for @CHILD a usual schedule for him/her?  
 No 
 Yes 
 
IF NO: 
In a typical week, who takes care of @CHILD? (check all that apply) 
 
@P
ARE
NT 
 
Spou
se/p
artne
r 
 
Chil
d’s 
gran
dpar
ent 
 
Chil
d’s 
sibli
ng 
 
Chil
d’s 
uncl
e/au
nt 
 
Frie
nd 
or 
neig
hbor 
 
Babysitter in 
the home 
 
Childcare 
center (e.g., 
Head Start, 
Early 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
37
Learning 
center) 
 
Home or 
group-home 
daycare (e.g., 
providers 
care for 
groups of 
children in 
licensed 
home 
settings) 
 
Other
 
Who takes care of @CHILD on typical Sundays?  During what times?  Who takes care of @CHILD 
next? 
 
 
5a 6a 7a 8a 9a 10a 11a 12p 1p 2p 3p 4p 5p 6p 7p 8p 9p 10p 11p 
Sun 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mon  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Tue 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Wed  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Thu 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fri 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sat 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Thinking about @CHILD’s typical schedule, is any day’s schedule the same as Sunday?  
 Monday 
 Tuesday 
 Wednesday 
 Thursday 
 Friday 
 Saturday 
 
Who takes care of @CHILD on typical Mondays?  During what times?  Who takes care of @CHILD 
next? [continue until week’s grid is complete] 
 
Is @CHILD enrolled in Head Start or Early Head Start? 
 No 
 Yes 
If yes, what program is @CHILD enrolled in? 
 
What is the name of @CHILD’s childcare center?

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
38
 
HOUSEHOLD INFORMATION 
 
Do you have a permanent home? 
 No 
 Yes 
 
How many times have you moved over the past 5 years? ______ times.  
 
Do you have an eviction notice? 
No 
Yes 
 
 Are you living with friends or relatives? 
No 
Yes 
 
Are you currently residing in a shelter? 
 No 
 Yes 
 
Are you currently staying in a domestic violence shelter? 
 No 
 Yes 
 
Are you currently homeless? 
 No 
 Yes 
 
How many people (including you and your child) live in your home? _____ 
 
How many adults OTHER THAN YOU live in your home? (Anyone who is over 18 and 
regularly stays in your home):  ______ adults 
 
1. First adult age: ______ 
 Male     
 Female   
Relation to @CHILD: 
 Parent (biological or adoptive) 
 Stepparent 
 Grandparent 
 Foster parent 
 Other relative (e.g., uncle/aunt, cousin) 
 Other nonrelative 
 
 
 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
39
2. Second adult age: ______ 
 Male     
 Female   
Relation to @CHILD: 
 Parent (biological or adoptive) 
 Stepparent 
 Grandparent 
 Foster parent 
 Other relative (e.g., uncle/aunt, cousin) 
 Other nonrelative 
 
3. Third adult age: ______ 
 Male     
 Female   
Relation to @CHILD: 
 Parent (biological or adoptive) 
 Stepparent 
 Grandparent 
 Foster parent 
 Other relative (e.g., uncle/aunt, cousin) 
 Other nonrelative
 
4. Fourth adult age: ______ 
 Male     
 Female   
Relation to @CHILD: 
 Parent (biological or adoptive) 
 Stepparent 
 Grandparent 
 Foster parent 
 Other relative (e.g., uncle/aunt, cousin) 
 Other nonrelative 
 
5. Fifth adult age: ______ 
 Male     
 Female   
Relation to @CHILD: 
 Parent (biological or adoptive) 
 Stepparent 
 Grandparent 
 Foster parent 
 Other relative (e.g., uncle/aunt, cousin) 
 Other nonrelative 
 
 
 
 

ID: __________ 
 
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL 
 
 
40
How many children (under age 18) live in your home, not including @CHILD?        
_____ children 
 
1. First child age: ______ 
 Male     
 Female   
Relation to @CHILD: 
 Sibling (biological or adoptive) 
 Step-sibling 
 Foster sibling 
 Other relative (e.g., uncle/aunt, cousin) 
 Other nonrelative 
 
2. Second child age: ______ 
 Male     
 Female   
Relation to @CHILD: 
 Sibling (biological or adoptive) 
 Step-sibling 
 Foster sibling 
 Other relative (e.g., uncle/aunt, cousin) 
 Other nonrelative 
 
3. Third child age: ______ 
 Male     
 Female   
Relation to @CHILD: 
 Sibling (biological or adoptive) 
 Step-sibling 
 Foster sibling 
 Other relative (e.g., uncle/aunt, cousin) 
 Other nonrelative 
 
4. Fourth child age: ______ 
 Male     
 Female   
Relation to @CHILD: 
 Sibling (biological or adoptive) 
 Step-sibling 
 Foster sibling 
 Other relative (e.g., uncle/aunt, cousin) 
 Other nonrelative

 
5. Fifth child age: ______ 
 Male     
 Female   
Relation to @CHILD: 
 Sibling (biological or adoptive) 
 Step-sibling 
 Foster sibling 
 Other relative (e.g., uncle/aunt, cousin) 
 Other nonrelative 
 
FUTURE CONTACT INFORMATION 
 
In case we are unable to reach you at any point in time during the duration of the study (for example you 
unexpectedly move or you loose your phone) we’d like the names of two individuals who are likely to know 
how we can get in contact with you. 
 
Name of individual: _______________________ 
Relationship to you: _______________________ 
Phone number: ___________________________ 
Email (if known):__________________________  
 
Name of individual: _______________________ 
Relationship to you: _______________________ 
Phone number: ___________________________ 
Email (if known):__________________________  
 
 
Thank you. You have completed the survey.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

42 
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permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
D. CENTER FOR EPIDEMIOLOGIC STUDIES DEPRESSION SCALE (CESD-10) 
 
To follow is a list of some of the ways you may have felt or behaved. Please indicate how often you have 
felt this way during the past week: 
 
1. I was bothered by things that usually don’t bother me 
 
             0 
 
         1  
 
           2 
 
  
           3 
Rarely or none 
                  Some or a 
 
Occasionally or  
  
 All of the time 
     of the time 
             little of the time 
            a moderate amount  
 
 
 
 
 
 
 
    of the time 
 
2. I had trouble keeping my mind on what I was doing 
 
             0 
 
         1  
 
           2 
  
             
3 
Rarely or none 
                  Some or a 
 
Occasionally or  
 
  All of the time 
     of the time 
             little of the time 
            a moderate amount  
 
 
 
 
 
 
 
    of the time 
 
3. I felt depressed 
 
             0 
 
         1  
 
           2 
 
    
           3 
Rarely or none 
                  Some or a 
 
Occasionally or  
 
  All of the time 
     of the time 
             little of the time 
            a moderate amount  
 
 
 
 
 
 
 
    of the time 
 
4. I felt that everything I did was an effort 
 
             0 
 
         1  
 
           2 
 
  
           3 
Rarely or none 
                  Some or a 
 
Occasionally or  
 
  All of the time 
     of the time 
             little of the time 
            a moderate amount  
 
 
 
 
 
 
 
    of the time 
 
5. I felt hopefully about the future 
 
             0 
 
         1  
 
           2 
 
  
           3 
Rarely or none 
                  Some or a 
 
Occasionally or  
   
All of the time 
     of the time 
             little of the time 
            a moderate amount  
 
 
 
 
 
 
 
    of the time 
 
6. I felt fearful 
 
             0 
 
         1  
 
           2 
 
  
           3 
Rarely or none 
                  Some or a 
 
Occasionally or  
   
All of the time 
     of the time 
             little of the time 
            a moderate amount  
 
 
 
 
 
 
 
    of the time 
 
 
 
 
 

43 
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permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
7. My sleep was restless 
 
             0 
 
         1  
 
           2 
 
  
           3 
Rarely or none 
                  Some or a 
 
Occasionally or  
  
 All of the time 
     of the time 
             little of the time 
            a moderate amount  
 
 
 
 
 
 
 
    of the time 
8. I was happy 
 
             0 
 
         1  
 
           2 
 
  
           3 
Rarely or none 
                  Some or a 
 
Occasionally or  
  
 All of the time 
     of the time 
             little of the time 
            a moderate amount  
 
 
 
 
 
 
 
    of the time 
9. I felt lonely 
 
             0 
 
         1  
 
           2 
 
  
           3 
Rarely or none 
                  Some or a 
 
Occasionally or  
   
All of the time 
     of the time 
             little of the time 
            a moderate amount  
 
 
 
 
 
 
 
    of the time 
10. I could not ‘get going’ 
 
             0 
 
         1  
 
           2 
 
  
           3 
Rarely or none 
                  Some or a 
 
Occasionally or  
 
  All of the time 
     of the time 
             little of the time 
            a moderate amount  
 
 
 
 
 
 
 
    of the time 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

44 
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permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
E. FAMILY LIFE EVENTS QUESTIONNAIRE 
 
Family Life Events Questionnaire 
 
Think about what has happened in your household in the past @six months/one year.  All of your 
information will be kept confidential.  
 
In the past @six months/one year: 
1. Did you get married or become engaged to be married? 
 No 
 Yes 
2. Did you get divorced or separate from your partner (spouse, girl/boyfriend), even though you may be back 
together now? 
 No 
 Yes 
3. Did a family member leave your house (older child moved out, child went to live with a relative)? 
 No 
 Yes 
4. Did you gain a new family member (through birth, adoption, fostering, someone moving in)? 
 No 
 Yes 
5. Was there a death of someone important in your child’s life? 
 No 
 Yes 
6. Was there a major change in your living conditions (moving, losing or being kicked out of your home, 
remodeling, deterioration of home or neighborhood)? 
 No 
 Yes 
7. Have you or a family member been the victim of a violent crime? 
 No 
 Yes 
8. Has your child been a witness to a violent crime, domestic violence or abuse? 
 No 
 Yes 
9. Has your child lived with someone else other than you? 
 No 
 Yes 
10. Have you or a family member had a serious illness? 
 No 
 Yes 
11. Has your child had a serious illness? 
 No 
 Yes 
12. Have you or a family member had significant depression, mental illness, or attempted suicide? 
 No 
 Yes 

45 
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permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
13. Have you or a family member been jailed or in prison? 
 No 
 Yes 
14. Has your child changed schools or childcare? 
 No 
 Yes 
[If select Yes] 
Where does your child now get childcare? 
Where does your child now go to school? 
15. Has your child had trouble with a teacher at school or childcare? 
 No 
 Yes 
16. Has your child lived with someone who had a problem with alcohol or used drugs? 
 No 
 Yes 
17. Has there been a change in you or your partner’s work (new job, lost job, change in location)? 
 No 
 Yes 
18. Has there been a substantial change in your income (increase, decrease, went deeply into debt)? 
 No 
 Yes 
19. Have circumstances this year made it extremely difficult to have enough to eat, get medical care, or keep 
you and your child(ren) safe?  
 No 
 Yes 
20. Have there been any other events that you think have affected you or your child in the past year?  
 No 
 Yes 
[If select Yes] 
Please explain: ___________________________ 
21. Did you enroll in a school program? 
 No 
 Yes 
[If select Yes] 
If YES, what program? ___________________________ 
22. Did you enroll in a job training program? 
 No 
 Yes 
[If select Yes] 
If YES, what program? ___________________________ 
 
 
 
 

46 
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permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
 
 
F. SURVEY OF PARENTAL EXPECTATIONS AND KNOWLEDGE  (SPEAK): 
The Thirty Million Words® Initiative 
  SPEAK Survey of Parental Expectations And Knowledge 
 

47 
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permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
Survey Instructions: 
 
Today we are going to ask what you think about young children and how they learn.  
 
We will ask about learning at different ages.  
 
Think about infants (age 0-6 months), babies (age 6-12 months), toddlers (age 1-3 years), preschoolers 
(age 3-5 years), and Kindergarteners (age 5-6 years).

48 
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For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
1.  When do you think a child is ready to be exposed to things like words, reading, and math? 
Choose one answer  
 
 
A. When do you think a child is ready to be exposed to words? 
 
1 
As an infant (0 to 6 months) 
 
2 
As a baby (6 to 12 months) 
 
3 
As a toddler (1 to 3 years) 
 
4 
In preschool (3 to 5 years) 
 
5 
In Kindergarten (5 to 6 years) 
 
6 
In elementary school (6 years and up) 
 
 
B.  When do you think a child is ready to be exposed to reading and books? 
 
1 
As an infant (0 to 6 months) 
 
2 
As a baby (6 to 12 months) 
 
3 
As a toddler (1 to 3 years) 
 
4 
In preschool (3 to 5 years) 
 
5 
In Kindergarten (5 to 6 years) 
 
6 
In elementary school (6 years and up) 
 
 
C.  When do you think a child is ready to be exposed math? 
 
1 
As an infant (0 to 6 months) 
 
2 
As a baby (6 to 12 months) 
 
3 
As a toddler (1 to 3 years) 
 
4 
In preschool (3 to 5 years) 
 
5 
In Kindergarten (5 to 6 years) 
 
6 
In elementary school (6 years and up) 
 

49 
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For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
2.  Think about 0 to 12 month old infants and babies.  
How much do you agree or disagree with each statement? 
Choose one answer  
 
 
 
Strongly 
agree  
Somewhat 
agree 
Neither 
agree nor 
disagree 
Somewhat 
disagree 
Strongly 
disagree 
 
A. Infants learn very little about language in the first six 
months of their life. 
1 
2 
3 
4 
5 
 
B. Responding to an infant every time he or she cries will 
only end up spoiling him or her. 
1 
2 
3 
4 
5 
 
C. How smart a baby will become depends mostly on his or 
her genetics. 
1 
2 
3 
4 
5 
 
D. 
When babies babble, sometimes they’re practicing how to 
have a conversation.  
1 
2 
3 
4 
5 
  
 
 
 

50 
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For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
3.  Think about 0 to 12 month old infants and babies.  
How much do you agree or disagree with each statement? 
Choose one answer  
 
 
Strongly 
agree  
Somewhat 
agree 
Neither 
agree nor 
disagree 
Somewhat 
disagree 
Strongly 
disagree 
 
A. Overhearing conversations is a great way for an infant 
to pick up on new words 
1 
2 
3 
4 
5 
 
B. Waiting to talk to an infant until he or she can say words 
is harmful for learning how to talk. 
1 
2 
3 
4 
5 
 
C. Letting babies play with picture books is the first step in 
teaching them how to read.. 
1 
2 
3 
4 
5 
 
D. 
Talking to an infant in a playful or exaggerated voice 
will better help the infant learn how to talk. 
1 
2 
3 
4 
5 
 
 
 

51 
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For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
4.  Think about 1 to 3 year old toddlers. 
How much do you agree or disagree with each statement? 
Choose one answer  
 
 
Strongly 
agree  
Somewhat 
agree 
Neither 
agree nor 
disagree 
Somewhat 
disagree 
Strongly 
disagree 
 
A. Toddlers learn more when they are told exactly what to 
do instead of given choices. 
1 
2 
3 
4 
5 
 
B. Talking about things that have already happened (like a 
trip from last week) is too confusing for toddlers. 
1 
2 
3 
4 
5 
 
C. It’s helpful when parents respond to the toddler’s points 
and gestures just like they were spoken words. 
1 
2 
3 
4 
5 
 
D. When toddlers can follow directions like “Go get your 
shoes” this means they can also say those words out loud. 
1 
2 
3 
4 
5 
 

52 
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prior written permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
5 Think about 1 to 3 year old toddlers. 
How much do you agree or disagree with each statement? 
Choose one answer  
 
 
Strongly 
agree  
Somewhat 
agree 
Neither 
agree 
nor 
disagree 
Somewhat 
disagree 
Strongly 
disagree 
 A
If a toddler makes grammar 
mistakes (like saying “I eated” 
instead of “I ate”) it’s a sign he 
or she has learning problem. 
1 
2 
3 
4 
5 
 B
Answering only if a toddler uses 
words instead of just pointing 
better helps the toddler learn 
how to talk. 
1 
2 
3 
4 
5 
 C
Toddlers can learn more from 
watching educational TV than 
they can from being read to by 
their parents. 
1 
2 
3 
4 
5 
 D
Answering only if a toddler 
uses correct words for things 
instead of baby words (like 
“blanket” instead of “ba-ba”) 
better helps the toddler learn 
how to talk. 
1 
2 
3 
4 
5 
 
 
 
 
 
 
 
 

53 
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prior written permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
 
6 Think about reading with young children 0-5years old.  
How much do you agree or disagree with each statement? 
Choose one answer . 
 
 
Strongly 
agree  
Somewhat 
agree 
Neither 
agree 
nor 
disagree 
Somewhat 
disagree 
Strongly 
disagree 
 A. 
Letting a toddler move 
around while listening to 
a story teaches the 
toddler bad listening 
skills. 
1 
2 
3 
4 
5 
 B. 
Adding in descriptions 
and other words when 
reading a story helps 
toddlers understand the 
story. 
1 
2 
3 
4 
5 
 C. 
Letting a toddler skip 
words and pages teaches 
the toddler bad reading 
habits. 
1 
2 
3 
4 
5 
 D. 
Reading the same book 
over and over will keep 
toddlers from learning 
new words. 
1 
2 
3 
4 
5 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
7. When do you think a child is ready to be exposed to the following things? 

54 
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prior written permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
Choose one answer  
A. When do you think a child is ready to be exposed to adding and subtracting? 
 
1 
As an infant (0 to 6 months) 
 
2 
As a baby (6 to 12 months) 
 
3 
As a toddler (1 to 3 years) 
 
4 
In preschool (3 to 5 years) 
 
5 
In Kindergarten (5 to 6 years) 
 
6 
In elementary school (6 years and up) 
 
 
 
B. When do you think a child is ready to be exposed to numbers and counting? 
 
1 
As an infant (0 to 6 months) 
 
2 
As a baby (6 to 12 months) 
 
3 
As a toddler (1 to 3 years) 
 
4 
In preschool (3 to 5 years) 
 
5 
In Kindergarten (5 to 6 years) 
 
6 
In elementary school (6 years and up) 
 
 
 
C. When do you think a child is ready to be exposed to shapes and sizes? 
 
1 
As an infant (0 to 6 months) 
 
2 
As a baby (6 to 12 months) 
 
3 
As a toddler (1 to 3 years) 
 
4 
In preschool (3 to 5 years) 
 
5 
In Kindergarten (5 to 6 years) 
 
6 
In elementary school (6 years and up) 
 
 
 

55 
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prior written permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
 
8 Think about young children age 0 to 5 years old before they go to school. 
How much do you agree or disagree with each statement. 
Choose one answer  
 
 
Strongly 
agree  
Somewhat 
agree 
Neither 
agree 
nor 
disagree 
Somewhat 
disagree 
Strongly 
disagree 
 A
The things a young child learns 
before he or she goes to 
Kindergarten matter very little in 
the long run. 
1 
2 
3 
4 
5 
 B
Teaching a young child about 
math is as easy as talking about 
big and small or long and short. 
1 
2 
3 
4 
5 
C
How well a young child will do in 
school depends mostly on the 
natural intelligence he or she is 
born with. 
1 
2 
3 
4 
5 
 
 
 

56 
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prior written permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
9 Think about young children age 0 to 5 years old before they go to school. 
How much do you agree or disagree with each statement. 
Choose one answer  
 
 
Strongly 
agree  
Somewhat 
agree 
Neither 
agree 
nor 
disagree 
Somewhat 
disagree 
Strongly 
disagree 
D
It’s best for young children to 
start learning things like math and 
reading from teachers when they 
get to school. 
1 
2 
3 
4 
5 
E
Parents who have trouble reading 
themselves can still help their 
young child learn to read. 
1 
2 
3 
4 
5 
F
Parents who struggled with math 
in school might confuse their 
young child if they talk about 
math. 
1 
2 
3 
4 
5 
 
 

57 
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prior written permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
1 Some young children, age 0 to 5 years old, have parents that speak more than one 
language.  
How much do you agree or disagree with each statement? 
Choose one answer  
 
 
Strongly 
agree 
Somewhat 
agree 
Neither 
agree 
nor 
disagree 
Somewhat 
disagree 
Strongly 
disagree 
 A
Even if it’s very difficult, parents 
should always try to talk to their 
young child using the language 
that will be spoken in school. 
1 
2 
3 
4 
5 
B
Young children should learn only 
one language at a time so they 
don’t get confused. 
1 
2 
3 
4 
5 
C
Talking a lot with a young child 
in any language will help them in 
school later on. 
1 
2 
3 
4 
5 
D
Young children who learn to 
speak more than one language 
will have an advantage later in 
life. 
1 
2 
3 
4 
5 
 
 

58 
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prior written permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
1 Think about TV watching for young children age 0 to 5 years old. 
How much do you agree or disagree with each statement? 
Choose one answer  
 
 
Strongly 
agree 
Somewhat 
agree 
Neither 
agree 
nor 
disagree 
Somewhat 
disagree 
Strongly 
disagree 
 A
Children 0 to 2 years old can learn 
just as many words from 
educational TV as they can from 
their parents. 
1 
2 
3 
4 
5 
 B
Leaving the TV on in the 
background is a great way to 
give 0 to 2 year olds extra 
chances to learn words. 
1 
2 
3 
4 
5 
 C
For preschoolers 3 to 5 years 
old, watching educational TV is 
the next best thing for learning 
besides learning at school. 
1 
2 
3 
4 
5 
 
 

59 
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prior written permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
G. THEORIES OF INTELLIGENCE (TOI): 
 
H. TOI 
 
This questionnaire has been designed to investigate ideas about intelligence. There are no right or 
wrong answers. We are interested in your ideas. Please indicate the extent to which you agree or 
disagree with each of the following statements but choosing the number that corresponds to your 
opinion.  
 
 
1. People have a certain amount of intelligence, and they can’t really do much to change it: 
 
1 
 
     2 
 
 
3 
 
 
4 
 
 
5 
       Strongly       
Disagree 
Neither agree  
          Agree 
 
     Strongly 
      Disagree 
 
 
 
 nor disagree  
 
 
        
        Agree 
 
2. Someone’s intelligence is something about them that they can’t change very much. 
1 
 
     2 
 
 
3 
 
 
4 
 
 
5 
       Strongly       
Disagree 
Neither agree  
          Agree 
 
     Strongly 
      Disagree 
 
 
 
 nor disagree  
 
 
        
        Agree 
 
3. To be honest, someone can’t really change how intelligent they are. 
1 
 
     2 
 
 
3 
 
 
4 
 
 
5 
       Strongly       
Disagree 
Neither agree  
          Agree 
 
     Strongly 
      Disagree 
 
 
 
 nor disagree  
 
 
        
        Agree 
 
4. A person can learn new things, but they can’t really change their basic intelligence.  
1 
 
     2 
 
 
3 
 
 
4 
 
 
5 
       Strongly       
Disagree 
Neither agree  
          Agree 
 
     Strongly 

60 
© 2014 University of Chicago. All rights reserved.  This survey may not be reproduced, displayed, modified or distributed without the express 
prior written permission of The University of Chicago.  
For permission, contact Dana Suskind: dsuskind@surgery.bsd.uchicago.edu 
 
      Disagree 
 
 
 
 nor disagree  
 
 
        
        Agree 
 
5. Someone’s spatial ability (e.g. navigating, doing puzzles) is something about them that they can’t 
change very much. 
1 
 
     2 
 
 
3 
 
 
4 
 
 
5 
       Strongly       
Disagree 
Neither agree  
          Agree 
 
     Strongly 
      Disagree 
 
 
 
 nor disagree  
 
 
        
        Agree 
 
6. Someone’s math ability is something about them that they can’t change very much.  
1 
 
     2 
 
 
3 
 
 
4 
 
 
5 
       Strongly       
Disagree 
Neither agree  
          Agree 
 
     Strongly 
      Disagree 
 
 
 
 nor disagree  
 
 
        
        Agree 
 
7. Someone’s reading ability is something about them that they can’t change very much. 
1 
 
     2 
 
 
3 
 
 
4 
 
 
5 
       Strongly       
Disagree 
Neither agree  
          Agree 
 
     Strongly 
      Disagree 
 
 
 
 nor disagree  
 
 
        
        Agree 
 
8. Someone’s writing ability (e.g. writing essays) is something about them they can’t change very 
much.  
1 
 
     2 
 
 
3 
 
 
4 
 
 
5 
       Strongly       
Disagree 
Neither agree  
          Agree 
 
     Strongly 
      Disagree 
 
 
 
 nor disagree  
 
 
        
        Agree 

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I. NUTRITION QUESTIONNAIRE: 
 
Nutrition Questionnaire 
 
Please read each statement and select true or false. 
 
The serving size on a food’s nutrition label represents the amount of food you will actually eat. 
 
______ False 
______ True 
 
At fast food restaurants, substituting mustard for mayo or water for soda can make a big difference 
in the amount of calories you are consuming. 
______ False 
______ True 
 
Fruit juice is a perfectly good substitute for fruit as long as it is 100% fruit juice. 
 
______ False 
______ True 
 
My child’s teeth haven’t grown in yet, so it won’t affect him/her if I don’t do anything about his/her 
oral hygiene 
 
______ True 
______ False 
 
The numbers on a nutrition label are based off of (Choose ONE answer) 
 
______ An adult’s daily nutritional needs 
______ A child’s daily nutritional needs 
______ Both - an adult’s daily nutritional needs and a child’s daily nutritional needs  
______ None of the above  
 
What are ways to avoid overeating? (Check ALL that apply). 
 
______ Looking at the food you plan to eat while sitting at the dinner table 
______ Turning off the TV during meals and snack time 
______ Eating when you’re bored 
______ Eating when you’re feeling sad 
______ Choosing a smaller plate to hold your food 
 
 
 
 

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Some fats are actually very good for you and your child; they give you and your child energy 
throughout the day and help you feel fuller longer. What are some foods that contain healthy fats? 
(Check ALL that you feel apply). 
 
______ Avocados 
______ Olive oil 
______ Lard  
______ Nuts 
______ Vegetable shortening  
______ Eggs 
 
 
Which of the following cooking options is the least healthy? (Choose ONE answer) 
 
______ Broiled 
______ Fried 
______ Steamed 
______ Grilled 
 
 
How much physical activity do toddlers need daily? (Choose ONE answer) 
 
______ 10 minutes 
______ 20 minutes 
______ 30 minutes 
______ 1 hour 
______ 2 hours 
 
 
Your child’s first visit to the dentist should be around (Choose ONE answer) 
 
______ 5 months old 
______ 1 year old 
______ 3 years old 
______ 5 years old 
______ 7 years old 
 
 
Reducing which of the following can help your child’s dental health? (Choose ONE answer) 
 
______ Added fiber 
______ Added vitamin A 
______ Added sugar 
______ Added vitamin D 
______ Added Calcium 
 
 

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You can tell if there is a lot of an ingredient in a food if on the nutrition label it is  (Choose ONE 
answer) 
 
______ One of the first ingredients listed 
______ One of the last ingredients listed 
______ You can’t tell how much of a certain ingredient there is in a food 
______ I don’t know  
 
 
How much do you agree or disagree with each statement? (Circle ONE answer per statement) 
 
Raw eggs in foods like 
cookie dough are perfectly 
safe to eat as long as you 
don’t have too much. 
Agree Somewhat 
Agree 
Neither 
agree nor 
disagree 
Somewhat 
disagree 
Disagree 
It is important to keep an 
eye on your young child 
while he/she is eating. 
Agree 
Somewhat 
Agree 
Neither 
agree nor 
disagree 
Somewhat 
disagree 
Disagree 
When transitioning from 
breastmilk or formula, you 
should start your child on 
solid foods that are softer. 
Agree 
Somewhat 
Agree 
Neither 
agree nor 
disagree 
Somewhat 
disagree 
Disagree 
Children need energy on the 
go. There is no need to 
make them sit down while 
eating. 
Agree Somewhat 
Agree 
Neither 
agree nor 
disagree 
Somewhat 
disagree 
Disagree 
 
 
 
Do you think health experts recommend that people should be eating more or less of these foods? 
(Choose ONE answer per food) 
 
More 
Less 
Not sure  
Vegetables  
 
 
 
Sugary foods 
 
 
 
Starchy foods  
 
 
 
Fatty foods  
 
 
 
High fiber foods 
 
 
 
Fruit 
 
 
 
Salty foods  
 
 
 
 
 
 

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Do you think these are high or low in fat? (Choose ONE answer per food) 
 
High 
Low 
Not Sure 
Apple sauce  
 
 
 
French Fries  
 
 
 
Bacon 
 
 
 
Honey 
 
 
 
Eggs 
 
 
 
Butter 
 
 
 
 
Do you think these are high or low in salt? (Choose ONE answer per food) 
 
High 
Low 
Not Sure 
Hot Dogs 
 
 
 
Soy Sauce 
 
 
 
Apples  
 
 
 
Cheese 
 
 
 
Canned Soup 
 
 
 
Broccoli  
 
 
 
 
Think about your habits at the grocery store. How much do you agree or disagree with each 
statement? (Choose ONE answer per statement) 
 
I make an effort to avoid 
grocery shopping when I’m 
hungry. 
Agree 
Somewhat 
Agree 
Neither 
agree nor 
disagree 
Somewhat 
disagree 
Disagree 
I try to bag fruits and 
vegetables myself instead of 
buying prepackaged bags. 
Agree 
Somewhat 
Agree 
Neither 
agree nor 
disagree 
Somewhat 
disagree 
Disagree 
I prefer to buy name brand 
foods instead of store 
brand foods. 
Agree Somewhat 
Agree 
Neither 
agree nor 
disagree 
Somewhat 
disagree 
Disagree 
I make a grocery list of 
what I need before I go to 
the store.  
Agree 
Somewhat 
Agree 
Neither 
agree nor 
disagree 
Somewhat 
disagree 
Disagree 
At the grocery store, I look 
at a food’s unit price to 
help me decide which 
option is cheapest. 
Agree Somewhat 
Agree 
Neither 
agree nor 
disagree 
Somewhat 
disagree 
Disagree 
 
 
 

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J. FIDELITY PARENT SURVEY (TREATMENT ONLY) 
 
Participant Assessment  
Please answer all questions, thinking only of your MOST RECENT home visit.  
 
YOUR HOME VISIT 
For these questions, think about your most recent home visit and interaction with your home 
visitor. 
1. Where did your home visit take place? 
a. My home 
b. Family’s or friend’s home 
c. Childcare center 
d. Community center (church, library, etc.) 
e. TMW offices  
f. Other  
2. If other, please specify: 
 
3. My home visitor asked me questions about my child.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
4. My home visitor asked for my ideas during the home visit.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
5. My home visitor asked me questions about the animations and videos in the module.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
6. My home visitor welcomed my questions about the module.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
7. My home visitor answered my questions in a way that made sense to me.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 

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8. My home visitor talked about things my child likes and dislikes during our module 
review.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
 
INSERT INDIVIDUAL MODULE QUESTIONS HERE (see below for Individual Module Questions) 
 
 
YOU AND YOUR HOME VISITOR 
For these questions, think about your relationship and interaction with your Home Visitor. 
9. My home visitor was interested in me and my child.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
10. My home visitor wanted to help me reach my goals.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
11. My home visitor believes that I know my child best.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
12. I felt like a partner during the home visit.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
 
SHOWTIME 
For these questions, think about the Showtime activity, when you and your Home Visitor 
practiced your skills on video. 
13. My home visitor explained the skills we would practice during the Showtime activity.  
 
5 
4 
3 
2 
1 
Strongly agree 
Agree 
Neither agree 
nor disagree 
Disagree 
Strongly 
disagree 
 

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14. I understood what I was supposed to learn from the Showtime activity.  
 
5 
4 
3 
2 
1 
Strongly agree 
Agree 
Neither agree 
nor disagree 
Disagree 
Strongly 
disagree 
 
15. My home visitor pointed out how I used my new skills and the 3Ts when we reviewed 
the Showtime activity.  
 
5 
4 
3 
2 
1 
Strongly agree 
Agree 
Neither agree 
nor disagree 
Disagree 
Strongly 
disagree 
 
 
LENA AND GOAL SETTING 
For these questions, think about reviewing your LENA recording numbers and setting goals with 
your Home Visitor. 
16. My home visitor gave me suggestions when we talked about ways to practice my skills 
and meet my goals.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
17. My home visitor explained my LENA report.  
 
5 
4 
3 
2 
1 
Strongly agree 
Agree 
Neither agree 
nor disagree 
Disagree 
Strongly 
disagree 
 
18. I understood my LENA report.  
 
5 
4 
3 
2 
1 
Strongly agree 
Agree 
Neither agree 
nor disagree 
Disagree 
Strongly 
disagree 
 
19. My home visitor suggested ways I can use my 3Ts and new skills in daily activities to 
meet my goals.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
 
 

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INDIVIDUAL MODULE QUESTIONS 
MODULE 1  
Please check all of the topics you and your home visitor discussed: 
 Hart and Risley’s research (30 million word gap) 
 Brain development and the Critical Language Period  
 The 3Ts 
 Don’t just do it; talk him/her through it! 
 
MODULE 2 
Please check all of the topics you and your home visitor discussed: 
 Talk More 
 Talking about the Here and Now 
 Talking about the Past and Future 
 Talking about Thoughts and Feelings  
 Taking ‘it’ out of your vocabulary 
 
MODULE 3 
Please check all of the topics you and your home visitor discussed: 
 Tune In 
 How technology distracts us from Tuning In 
 Reading your child’s communication clues 
 Getting on your child’s level 
 Child-directed speech/Baby Talk 
 
MODULE 4 
Please check all of the topics you and your home visitor discussed: 
 Take Turns 
 Ways your child can Take Turns without using words 
 How to Tune In to your child’s communication clues and Take Turns  
 
MODULE 5 
Please check all of the topics you and your home visitor discussed: 
 Spreading the Words 
 The domino effect of Spreading the Words 
 
SPREAD THE WORDS CONFIDENCE SURVEY 
 Question 1: How confident do you feel about your ability to share information about 
TMW with others? 
  
 |------------------------|------------------------|------------------------|------------------------| 
 1 
 
        2  
            3 
 
      4                         5 
 Very 
 
      Pretty 
       Not sure     
 Not really 
       Not at all   
 
 

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  
  
 Question 2: Will you share what you know about TMW with people you know? 
 |------------------------|------------------------|------------------------|------------------------| 
 1 
 
      2  
            3 
 
      4                         5 
          Definitely             Probably 
        Not sure      Probably won’t       Definitely 
won’t 
  
  
  
 Question 3: Do you feel nervous about your ability to accurately share information about 
TMW with others? 
  
 |------------------------|------------------------|------------------------|------------------------| 
 1 
 
      2  
            3 
 
      4                         5 
       Not at all      
    Not really 
      Not sure 
 
   Pretty 
 
Very 
 
 
MODULE 6 
Please check all of the topics you and your home visitor discussed: 
 Self-regulation 
 Children have to learn self-regulate throughout childhood  
 Children have to learn to use their “red light” to ‘stop and think’ 
 Giving children limited choices helps them learn to self-regulate 
 Children learn to self-regulate by watching their parents do it and hearing them narrate 
it 
 
MODULE 7 
Please check all of the topics you and your home visitor discussed: 
 Directives 
 Explain to build your child’s brain 
 Having consistent routines 
 Using a positive tone 
 Telling your child what you want him to do instead of what not to do 
 
MODULE 8 
Please check all of the topics you and your home visitor discussed: 
 Encouragements 
 Avoiding person-based encouragements 
 Using process-based encouragements 
 Catch your child being good 
 Encouragements can improve self-esteem and make your child become a hard-worker 
 
MODULE 9 
Please check all of the topics you and your home visitor discussed: 
 Book sharing 
 Having a conversation about a book rather than reading every word 

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 Tuning In to your child’s pace and focus during book sharing 
 Using the 3Ts when book sharing 
 
 
MODULE 10 
Please check all of the topics you and your home visitor discussed: 
 Storytelling 
 Encouraging your child to participate in storytelling 
 Telling stories about routine activities and your child’s favorites 
 Retelling stories to help your child learn 
 Using storytelling to make sense of difficult situations 
 
 
MODULE 11 
Please check all of the topics you and your home visitor discussed: 
 Math Talk 
 Counting and shapes 
 Addition and subtraction 
 Talking about comparing and contrasting 
 Math is everywhere: talking about math using songs, books, and daily activities 
 
 
 
 
MODULE 12 
Please check all of the topics you and your home visitor discussed: 
 Technology Diet 
 Limiting your child’s screen time 
 Your child learns more from you than from educational TV 
 Using the 3Ts during screen time 
 
SPREAD THE WORDS CONFIDENCE SURVEY 
Question 1: How confident do you feel about your ability to share information about TMW with 
others? 
 
|------------------------|------------------------|------------------------|------------------------| 
1 
 
        2  
            3 
 
      4                         5 
Very 
 
      Pretty 
       Not sure     
 Not really 
       Not at all   
 
 
 
 
Question 2: Will you share what you know about TMW with people you know? 
|------------------------|------------------------|------------------------|------------------------| 

71 
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1 
 
      2  
            3 
 
      4                         5 
         Definitely             Probably 
        Not sure      Probably won’t       Definitely won’t 
 
 
 
Question 3: Do you feel nervous about your ability to accurately share information about TMW 
with others? 
 
|------------------------|------------------------|------------------------|------------------------| 
1 
 
      2  
            3 
 
      4                         5 
      Not at all      
    Not really 
      Not sure 
 
   Pretty 
 
Very 
 
 
 
 

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K. BOOSTER FIDELITY PARENT SURVEY (TREATMENT ONLY) 
 
Participant Assessment – BOOSTER  
Please answer all questions, thinking only of your MOST RECENT home visit.  
 
YOUR HOME VISIT 
For these questions, think about your most recent home visit and interaction with your home 
visitor. 
1. Where did your home visit take place? 
a. My home 
b. Family’s or friend’s home 
c. Childcare center 
d. Community center (church, library, etc.) 
e. TMW offices  
f. Other  
2. If other, please specify: 
 
3. My home visitor asked me questions about my child.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
4. My home visitor asked for my ideas during the home visit.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
5. My home visitor asked me questions about the animations and videos in the module.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
6. My home visitor welcomed my questions about the module.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
7. My home visitor answered my questions in a way that made sense to me.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 

73 
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8. My home visitor talked about things my child likes and dislikes during our module 
review.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
 
YOU AND YOUR HOME VISITOR 
For these questions, think about your relationship and interaction with your Home Visitor. 
9. My home visitor was interested in me and my child.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
10. My home visitor wanted to help me reach my goals.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
11. My home visitor believes that I know my child best.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
12. I felt like a partner during the home visit.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
 
LENA AND GOAL SETTING 
For these questions, think about reviewing your LENA recording numbers and setting goals with 
your Home Visitor. 
13. My home visitor gave me suggestions when we talked about ways to practice my skills 
and meet my goals.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
 
 
 

74 
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14. My home visitor explained my LENA report.  
 
5 
4 
3 
2 
1 
Strongly agree 
Agree 
Neither agree 
nor disagree 
Disagree 
Strongly 
disagree 
 
15. I understood my LENA report.  
 
5 
4 
3 
2 
1 
Strongly agree 
Agree 
Neither agree 
nor disagree 
Disagree 
Strongly 
disagree 
 
16. My home visitor suggested ways I can use my 3Ts and new skills in daily activities to 
meet my goals.  
 
5 
4 
3 
2 
1 
Always 
Often 
Sometimes 
Rarely 
Never 
 
 
 
 
 

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L. MEASUREMENT SCHEDULE 
 
Measurement Schedule 
 
Event Name 
Items Completed 
Conducted 
By 
Child’s Age 
(in months) 
Number of 
Months into the 
Study 
Screening 
Screening 
Questionnaire 
TMW 
13-16 
0 
Preliminary 
Consent 
Preliminary Consent 
Schedule, 
Demographics, 
LENA How-To, 
CESD-10 
TMW 
13-16 
0 
Enrollment 
Enrollment Consent, 
FLE 
TMW 
14-17 
1 
Video 1 
Natural Play, 
Book Read 
TMW 
14-17 
1 
Assessment 1 
PLS, 
PPVT-Parent, 
SPEAK, 
TOPSE, 
BMI, 
TOI, 
Nutrition 
Questionnaire, 
MacArthur I 
TMW 
14-17 
1 
Home Visit 1 
Fidelity Parent,  
Fidelity Home 
Visitor 
TMW 
14-17 
1 
Home Visit 2 
Fidelity Parent,  
Fidelity Home 
Visitor 
TMW 
15-18 
1 
Home Visit 3 
Fidelity Parent,  
Fidelity Home 
Visitor 
TMW 
15-18 
2 
Home Visit 4 
Fidelity Parent, 
Fidelity Home 
Visitor 
TMW 
16-19 
2 
Home Visit 5 
Fidelity Parent,  
Fidelity Home 
Visitor 
TMW 
16-19 
3 

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Home Visit 6 
LWL Questionnaire, 
Fidelity Parent,  
Fidelity Home 
Visitor 
TMW 
17-20 
3 
Home Visit 7 
Fidelity Parent, 
Fidelity Home 
Visitor 
TMW 
17-20 
4 
Home Visit 8 
Fidelity Parent,  
Fidelity Home 
Visitor 
TMW 
18-21 
4 
Home Visit 9 
Fidelity Parent, 
Fidelity Home 
Visitor 
TMW 
18-21 
5 
Home Visit 10 
Fidelity Parent,  
Fidelity Home 
Visitor 
TMW  
19-22 
5 
Home Visit 11 
Fidelity Parent,  
Fidelity Home 
Visitor 
TMW 
19-22 
6 
Home Visit 12 
Fidelity Parent,  
Fidelity Home 
Visitor 
TMW 
20-23 
6 
Video 2 
Natural Play, 
Book Read 
TMW 
20-23 
6 
Assessment 2 
PLS, 
SPEAK, 
TOPSE, 
ASQ: SE, 
BMI, 
FLE, 
Nutrition, 
TOI, 
CESD-10 
TMW 
20-23 
6 
Booster 1 
Booster Fidelity 
Parent,  
Booster Fidelity 
Home Visitor 
TMW 
21-24 
7 
Booster 2 
Booster Fidelity 
Parent, 
Booster Fidelity 
Home Visitor, 
MacArthur II, 
LWL Questionnaire 
TMW 
25-28 
11 
Video 3 
Natural Play, 
Book Read, 
Gift Wrapping/ 
Waiting for Bow,  
TMW 
26-29 
12 
 

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Snack Delay 
Assessment 3 
PLS, 
SPEAK, 
BMI, 
FLE, 
Nutrition 
Questionnaire 
TOI 
TMW 
26-29 
12 
Booster 3 
Booster Fidelity 
Parent, 
Booster Fidelity 
Home Visitor 
TMW 
31-34 
17 
Video 4 
Natural Play, 
Book Read,  
Gift Wrapping/ 
Waiting for Bow, 
Snack Delay 
TMW 
32-35 
18 
Assessment 4 
PLS, 
BMI, 
FLE, 
TOI, 
CESD-10, 
Nutrition 
Questionnaire 
TMW 
32-35 
18 
Booster 4 
Booster Fidelity 
Parent,  
Booster Fidelity 
Home Visitor,  
LWL Questionnaire 
TMW 
37-40 
23 
Video 5 
Natural Play, 
Book Read, 
Gift Wrapping/ 
Waiting for Bow, 
Snack Delay, 
Bear/Dragon 
TMW 
38-41 
24 
Assessment 5 
PLS, 
PPVT-Child, 
SPEAK, 
ASQ: SE, 
BMI,  
FLE, 
Nutrition 
Questionnaire, 
TOI 
TMW 
38-41 
24 
Video 6 
Natural Play, 
Book Read,  
Bear/Dragon, 
Give-N 
TMW 
50-53 
36 

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Assessment 6 
PLS, 
PPVT-Child, 
SPEAK, 
TOPSE, 
BMI, 
FLE, 
TOI, 
Nutrition 
Questionnaire, 
CESD-10 
TMW 
50-53 
36 
Video 7 
Natural Play, 
Book Read, 
HTKS 
Give-N 
TMW 
62-65 
48 
Assessment 7 
PLS, 
PPVT-Child, 
SPEAK, 
ASQ: SE, 
BMI, 
FLE, 
TOI, 
Nutrition 
Questionnaire, 
Woodcock-Johnson 
TMW 
62-65 
48 
 
Note: The Fidelity of Implementation Surveys & Booster Fidelity of Implementation Surveys for 
both parents and home visitors will only be completed for participants within the Treatment 
group.  
 
 
 
 
 
T: Module 5 Spread the Words Mapping worksheet  
 

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Module 5: Spread the Words Interview Protocol 
Module 5 – Showtime Activity 
(START VIDEO AT BEGINNING OF EXERCISE) 
 
Warm-up  
 
1. Today we talked about Spreading the Words, what do you think about this 
idea?  
2. Remember Jessica and Sammy from the videos? They Spread the Words to the 
people in their lives who talk a lot with their children and/or have young 
children of their own. Who in your life could you share TMW information 
with? 
 
I. 
If the participant is uncomfortable or reticent, give the option of 1) 
completing a Spread the Words Mapping activity OR 2) continuing on to 
LENA Reports 
 
Spread the Words Mapping Activity 

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The point of this activity is to identify the people who talk and interact most with your 
child, the people who can help build his/her brain using the 3Ts and other TMW strategies. 
 
Today you’ll create a diagram – we call it a map – to document these people.  We will check 
in at future home visits to see what, if anything, you share with them about TMW.  
Knowing who helps with your child and how you might share information about TMW 
with others will help us learn more about our program.   
 
I. 
Mapping Exercise 
 
We’ll use this map to identify people who talk and interact most with [CHILD]. 
 
• There are 2 circles.  Let’s start by writing [CHILD]’s first name in the center 
circle.   
 
Now let’s fill in the outer circle with the names of people who talk and interact most 
with [CHILD], for example relatives, neighbors, day care workers, and friends. 
We’ll show how much time they spend with [CHILD] by putting their name closer 
or farther from [CHILD]’s name. 
 
 
o Refer to mock-up of map as an example.   
 
• Which of these people have young children of their own who could benefit? 
Please   circle  these people. 
 
 
III. Sharing Information about TMW  
 
• Who on this map would you like to talk with about TMW?   
•     Why would you like ______________ to know about TMW? 
• What would you tell ______________ about TMW? 
 
 
 

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U. LENA Dos & Don’ts 
 
 
 

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V. Additional Spouse/Partner Demographic Questions 
 
If you identified as married or living with a partner, please answer the following 
questions about your spouse/partner. 
 
 
1. What is the highest level of education your spouse/partner has ever completed? 
  8th grade or less 
  9th-12th grade, no diploma 
  High school graduate 
  GED completed 
 Postsecondary non-degree program (e.g. nursing assistant, hairstylist programs) 
 Some college credit but no degree 
  What is the name of his/her school:_______________________________________ 
  Associate Degree - AA, AS (e.g. dental hygienist, mechanical drafter programs) 
  What is the name of his/her school:_______________________________________ 
Bachelors Degree - BA, BS 
  What is the name of his/her school:_______________________________________ 
  Graduate or professional degree - MA, MS, MD, JD, PhD 
 
2. Is your spouse/partner currently a student? 
 NO  
 YES 
   If yes, is he/she attending: 
Part-time 
Full-time 
  What type of program is your spouse/partner attending? 
  High school diploma or GED 
 Postsecondary non-degree program (e.g. nursing assistant, hairstylist 
programs) 
 What is the name of his/her school:_____________________________________ 
  Associate Degree - AA, AS (e.g. dental hygienist, mechanical drafter 
programs) 
  What is the name of his/her school:_____________________________________ 
  Bachelors Degree - BA, BS 
  What is the name of his/her school:_____________________________________ 
  Graduate or professional degree - MA, MS, MD, JD, PhD 

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12. Is your spouse/partner currently employed? 
 NO  
 YES   
 If yes, how many jobs is he/she currently working? ___________ 
 1 
  In your first job, is he/she working: 
   Part-time 
   Full-time 
  Type of work for first job: ________________________________________ 
 
 2 
  In your second job, is he/she working: 
   Part-time 
   Full-time 
  Type of work for second job: ________________________________________ 
 3 
   
  In your third job, is he/she working: 
   Part-time 
   Full-time 
  Type of work for third job: ________________________________________ 
 4 
  In your fourth job, is he/she working: 
   Part-time 
   Full-time 
  Type of work for fourth job: ________________________________________ 
 

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W. LENA Care Sheet 
 
 
Help us take care of the LENAs! 
 
• The LENA devices are very valuable to our 
study. 
 
• We only have a limited number of LENAs. 
 
• Please treat the LENAs like you would a cell 
phone.  
 
• They cannot get wet, and are expensive to fix or 
replace. 
 
• While you are borrowing these LENAs, please treat them with care.  
 
We really appreciate your help. Thank you! 
 
 

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The Three T’s Application Guide 
 
The Three T’s application is an educational tool for parents participating in the 
Thirty Million Words Initiative. The application encourages parents to learn and 
practice the “Three T’s” (Tune In, Talk More, and Take Turns). Shown below are 
three representative screen shots demonstrating the three key features of the 
application.  
 
[1] Tutorial Mode and Modules: The tutorial mode simply explains that The Three T’s 
App is a tool that works like a pedometer, but instead of counting steps it counts words. It also 
features a “modules mode” which directs the user to the “Three T’s Module”, an important 
module within the TMW curriculum. 
 
[2] Recording Sessions: The main feature of the Three T’s App is the recording session mode. It 
allows the user to record the audio environment of a child wearing a Bluetooth Audio 
Microphone clipped to the child’s t-shirt. 
 
[3] Goal Setting and Results: After a recording session, the Three T’s App processes the audio 
recording and users can view the number of adult words that were spoken to the child in the 
entire recording session. Users can track their adult word count (AWC) progress and set goals to 
improve over time. 
 
 
 
 
 
   

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Y.