PROJECT SUMMARY
Growing up in poverty is associated with emotion regulation (ER) problems, which increase risk for
psychopathology and disease as children age. High quality early care and education (ECE) programs were
designed to prevent the negative effects of poverty and its associated stressors by strengthening young
children’s ER capacity, through responsive and nurturing relationships with teachers and evidence-based
teaching practices and curriculum. However, real-world ECE programs lack the internal support to sustain best
practices that are linked to positive child outcomes. Teachers are trained to use evidence-based skills by external
consultants or interventionists, but then drift from these practices once those supports are no longer available.
Thus, the public health need to increase quality of support for teachers within an ECE program cannot be
overstated, especially given findings that lack of support from program directors is associated with reduced use of
evidence-based practices over time, and teacher stress, burnout, and turnover, which leads to poor
socioemotional environments for children. Therefore, the proposed study aims to train ECE directors to use
Reflective Practice and Supervision (RP/S), a relationship-based, culturally responsive model of supervision, with
their teachers to improve teaching quality and increase use of evidence-based skills to promote adaptive ER in
children. This innovative research will be conducted in two phases: an open trial and a fully powered cluster
randomized controlled trial (CRT). The goal of the Aim 1 open trial is to assess feasibility, acceptability, and
implementation barriers and facilitators. Quantitative and qualitative data will be used to refine RP/S prior to the
CRT. The second phase will test RP/S against a waitlist control condition (i.e., standard administrative
supervision). Aim 2 will determine whether RP/S is associated with increases in teaching quality and teacher use
of evidence-based skills from pre- to post, and at 3-month follow-up. Aim 3 will determine whether RP/S is
associated with increases in adaptive ER among children, measured with a multi-method assessment battery.
This will be the first rigorous evaluation of RP/S as an enhancement to ECE programming, and results will be of
high interest to local and national stakeholders. A highly structured training plan will ensure achievement of the
proposed research aims. Specifically, the PI will receive specialized training in (1) infant mental health, (2)
implementation within ECE systems, (3) pragmatic CRT development, delivery, and evaluation, (4) clinical trial
and multilevel modeling methods, and (5) mentoring and leadership skills. Training will be guided by an
outstanding mentorship team with highly relevant expertise and outstanding track records of mentorship and
collaboration. The proposed research and training plan is further supported by the rich training environment in the
Brown Medical School and Bradley Hospital. Through this K23, the PI will launch her career as an independent
clinical scientist focused on developing and evaluating systems-based preventive interventions in community
settings to improve emotion regulation in young children exposed to adversity.
