Evaluation of the First Pathways Game on Parent-child Interactions and Development for Vulnerable Children
Condition: Internet-Based Intervention
Study type: Interventional

Summary: 
      Children's brains develop quickly in the first three years of life and are particularly
      sensitive to their environment. Adverse experiences, such as exposure to abuse and neglect,
      can increase children's risk for behavioral, mental health (e.g., depression, anxiety), and
      developmental struggles. Fortunately, supportive, nurturing parents can help protect children
      from these poor health and developmental outcomes. In-person parenting programs have been
      shown to improve parents' interactions with their children. However, many parents struggle to
      access these programs due to competing life demands and accessibility barriers (e.g., lack of
      transportation and childcare). The First Pathways Game is a free, online tool that was
      created by an expert in brain development to provide parents with games and activities for
      playtime with their child, based on their child's age. The investigators plan to study the
      impact of the First Pathways Game on parent-child interactions and development of children
      aged 3-36 months. The investigators will recruit families in Calgary that are experiencing
      adversity, such as poverty and homelessness. Parent-child pairs will be randomly assigned to
      the (1) First Pathways group that is reminded to play the First Pathways Game daily for a
      month or (2) wait-list control group, to allow for comparisons. Before, immediately after,
      and 2 months after the month-long program, the investigators will collect information on
      parent-child interactions and children's development with reliable and valid tools to examine
      the effectiveness of the First Pathways Game. This free, online tool has the potential to
      empower parents in supporting their children's health and development and could be ideal for
      families experiencing vulnerability, due to its accessibility. If found effective, this tool
      could improve both short- and long-term health outcomes for children with experiences of
      adversity.
    

Detailed description: 
      Background and Rationale: Exposure to early adverse childhood experiences (ACEs), such as
      abuse and neglect, increase children's risk for detrimental health (e.g., physical, mental,
      behavioral) and developmental (e.g., milestones, academic) consequences. Since children's
      brains develop rapidly within the first few years of life, they are remarkably sensitive to
      ACEs, yet positive parent-child interactions can buffer the impacts of early adversities.
      Although numerous, efficacious in-person parenting interventions are available, barriers
      (e.g., transportation, childcare) limit accessibility. Recent research has shown that
      families are interested in accessing parenting and child development information online, and
      over 80% of low-income families have internet access and internet-enabled devices.
      Furthermore, online interventions are of particular importance during the novel coronavirus
      (COVID-19) pandemic when limited in-person resources are available. The First Pathways Game
      (www.firstpathwaysgame.com) is a free online tool aimed at improving parent-child
      interactions and children's development by providing parents with age-appropriate,
      interactive activities. The First Pathways Game was developed by neuroscientist Dr. Judy
      Cameron to promote parent-child interactions and children's development by sharing
      neuroscience knowledge and age-appropriate game ideas for parents and children to play
      together. A pilot study of 16 low-income families in Pittsburgh showed improved parent-child
      interaction scores for children at the highest risk, offering evidence of promise as a
      feasible intervention.

      Objective: The investigators will examine the effect of the First Pathways Game on
      parent-child interactions and children's developmental milestones for disadvantaged (e.g.,
      low-income) families with children aged 3-36 months in Calgary, Alberta.

      Methods: The investigators will conduct a multi-center, two-arm, parallel-group, superiority
      randomized controlled trial with a 1:1 allocation ratio. Parent-child pairs will be recruited
      from Calgary agencies that provide services for families facing adversity, such as families
      who have experienced domestic violence and low-income families. Data collection will be
      facilitated by REDCap with integrated computer-aided block randomization. Both groups will be
      assessed at baseline, and one and two months later with observational and parent-reported
      questionnaire measures. Participants will be randomized to the First Pathways group or
      wait-list control group after the baseline data assessment is complete. Parents in the First
      Pathways group will receive their choice of daily reminders (e.g., phone call, email, text
      message) to access the First Pathways website daily for the first month and their game
      utilization will be tracked by their device (phone, tablet, computer) for the two-month study
      duration. Parent-child pairs in the wait-list control group will receive access to the First
      Pathways website after the final two-month assessment.
    

Intervention name(s): First Pathways Game
Intervention type(s): Other
Intervention description(s): The First Pathways Game is a free, online parenting education program. Parents watch short videos (approximately 30 seconds) on the First Pathways Game website to receive neuroscience knowledge and ideas for age-appropriate game ideas to play with their child. The game ideas employ common household items, such as measuring cups and paper.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: randomized controlled trial; digital parenting intervention; parent-child interactions; children's developmental milestones; adverse childhood experiences; vulnerable population; infants/young children; health promotion; community-based research