This paper describes the Smart Beginnings Integrated Model, an innovative, tiered approach for addressing school readiness disparities in low-income children from birth to age 3 in the United States through universal engagement of low-income families and primary prevention in pediatric primary care integrated with secondary/tertiary prevention in the home. We build on both public health considerations, in which engagement, cost and scalability are paramount, and a developmental psychopathology framework (Cicchetti & Toth, Journal of Child Psychology and Psychiatry, and Allied Disciplines 50:16–25, 2009), in which the child is considered within the context of the proximal caregiving environment. Whereas existing early preventive models have shown promise in promoting children’s school readiness, the Smart Beginnings model addresses three important barriers that have limited impacts at the individual and/or population level: (1) identification and engagement of vulnerable families; (2) the challenges of scalability at low cost within existing service systems; and (3) tailoring interventions to address the heterogeneity of risk among low-income families. Smart Beginnings takes advantage of the existing platform of pediatric primary care to provide a universal primary prevention strategy for all families (Video Interaction Project) and a targeted secondary/tertiary prevention strategy (Family Check-Up) for families with additional contextual factors. We describe the theory underlying the Smart Beginnings model, some initial findings from its recent application in two cities, and implications for changing social policy to promote school readiness beginning during very early childhood.

本文介绍了智能起点综合模型，这是一种创新的分层方法，通过低收入家庭的普遍参与和儿科初级保健中的初级预防，解决美国从出生到 3 岁的低收入儿童的入学准备差异在家中进行二级/三级预防。我们建立在公共卫生考虑和发展精神病理学框架（Cicchetti & Toth, Journal of Child Psychology and Psychiatry, and Allied Disciplines 50:16–25, 2009）和发展精神病理学框架（其中参与、成本和可扩展性是最重要的）的基础上，其中孩子被考虑在最近的看护环境的范围内。鉴于现有的早期预防模式已显示出促进儿童入学准备的前景，智能起点模型解决了在个人和/或人口层面影响有限的三个重要障碍：（1）弱势家庭的识别和参与；(2) 现有服务系统中低成本可扩展性的挑战；(3) 量身定制干预措施以解决低收入家庭风险的异质性。Smart Beginnings 利用现有的儿科初级保健平台，为所有家庭提供通用的初级预防策略（视频互动项目），并为有额外背景因素的家庭提供有针对性的二级/三级预防策略（家庭检查）。我们描述了智能起点模型背后的理论，以及最近在两个城市应用的一些初步发现，