Project Summary / Abstract The quality of early language interactions with parents and caregivers in early childhood has long-term implications for a child’s social, economic, and physical heath. Differences in the home language environment (HLE) are well established and cross all sociodemographic characteristics, although disparities disproportionately affect infants and toddlers growing up in under-resourced communities. Although several decades of research have identified evidence-based strategies that enhance the HLE and improve child outcomes, they have failed to reduce population-level disparities in child language development and long-term outcomes. The study proposed here utilizes Talk With Me Baby (TWMB) as a novel tool to increase language- building interactions between parent/caregiver and child. Because TWMB is delivered in the primary care setting (which reaches up to 98% of families with infants and toddlers), it is scalable, low-cost, and universal. With TWMB, healthcare providers can embed evidence-based language promotion into their well-child care (WCC) anticipatory guidance for all children age 0-3 years. TWMB builds on decades of well-controlled language intervention efficacy trials and has been deployed clinically for 8+ years. Here we propose a type 1 hybrid effectiveness implementation trial to measure the impact of TWMB on gains in the HLE and subsequent child language outcomes. The trial is both randomized and controlled across 2 sites: a TWMB intervention group (8 clinics) and a care-as-usual control group (8 clinics). In TWMB clinics, providers and care teams will be trained to deliver TWMB during all 2-24 month WCC visits. Across TWMB and control clinics, we will enroll 25 parent-child dyads in each clinic (n=400 total) prior to their 2-month WCC visit and follow them through their 24-month WCC visit. For Aim 1, we will measure the impact of TWMB on the HLE and child language development using Language Environment Analysis (LENA, “talk pedometer” recordings), home video recordings of parent-child interactions during daily routines, and standardized child language measures (including parent-report and direct assessments that are available in English and Spanish). For Aim 2, we will examine characteristics that moderate the efficacy of the language promotion intervention (TWMB) for families, including family strengths and sociodemographic characteristics. We will also examine HLE dosage and parent language promotion knowledge as mediators of child language outcomes. For Aim 3, guided by the Consolidated Framework for Implementation Research (CFIR), we will use a mixed methods approach to examine factors relevant for TWMB implementation. Providers and care team members will complete validated surveys to assess the constructs of feasibility, acceptability and appropriateness, and then participate in semi- structured interviews to provide qualitative data. We expect successful completion of these aims will result in knowled...