Behavioral and Socioemotional Outcomes Through Age 5 of the Legacy for Children™ Public Health Approach to Improving Developmental Outcomes among Children Born into Poverty

Mom bathing her baby
Mom bathing her baby

Researchers found that fewer children displayed behavioral and socioemotional problems when their low-income mothers participated in a public health program promoting positive parenting. Results published in the American Journal of Public Health were based on evaluation data from Legacy for ChildrenTM, a public health intervention program designed to improve child outcomes by promoting positive parenting among low-income mothers of infants and young children. Read the articleexternal icon. The findings from this article are summarized below.

Main Study Findings

This paper reports on a study of how mothers’ participation in the Legacy for ChildrenTM intervention (Legacy) improves the health and well-being of children born into poverty. Children of mothers who took part in randomized controlled trials in either Los Angeles or Miami were followed from birth to age 5 years. These children were evaluated on their language and thinking ability, behavior, social skills, and physical health. Children whose mothers participated in Legacy were compared with a group of children whose mothers did not participate in Legacy. This paper focuses on the effect of Legacy on children’s behavior and social skills. Overall, the study found that children benefited from their mothers’ participation in Legacy, although the affected factors differed by site:

Legacy Miami

  • At age 2, only 36% mothers who participated in Legacy reported behavioral concerns (such as problems with attention, aggression and social withdrawal) for their children, while 53% of mothers in the comparison group reported behavioral concerns for their children.
  • At age 4, only 7% of Legacy mothers reported socioemotional problems (such as difficulty with expressing emotions and with adult-child relationships) for their children, while 16% of mothers in the comparison group reported socioemotional problems for their children.
  • From age 2 to age 5, mothers who did not participate in Legacy were 1.8 times more likely to report noticeable behavioral concerns for their children.

Legacy Los Angeles

  • At age 5, only 27% of children of Legacy mothers were likely to have symptoms of Attention Deficit Hyperactivity Disorder (ADHD), compared with 42% of children of comparison mothers – which translates to about 3 fewer children per classroom entering kindergarten with problem levels of hyperactivity, impulsivity, and inattention in high risk communities.

These results show that Legacy had a positive impact on child behavior when mothers participated in the program. The reported effects on behavioral, social, and emotional problems in children of mothers participating in Legacy compare favorably to other well-known early childhood programs (1): Early Head Start (2), the Infant Health and Development Program (3), home visiting (4), family support programs (5), center-based early education (6) and behavioral parent training (7).

Child Development

The early years of a child’s life are very important for his or her health and development. Healthy development means that children are able to grow up where their social, emotional and educational needs are met. CDC conducts research to learn more about healthy child development and to better understand certain conditions that affect children. This information is used to create health education and intervention programs, help communities plan for services, and determine what additional studies are needed.

Investing in our children is investing in our future, because early childhood investment can reduce social costs later (8-10). This includes tangible costs such as special education, foster care, welfare, medical care, law enforcement, social security, and social services, and intangible costs such as physical and emotional pain experienced by children with developmental delays and their families.

Background on Legacy for Children™

The results presented here are from the research study of Legacy for Children™. It is an evidence-based program whose aim is to improve child outcomes by promoting positive parenting among low-income mothers of infants and young children. The Legacy program is based on the belief that parents can have a significant effect on their children’s development, regardless of their circumstances. Research has shown that children’s success later in life is linked consistently with how parents interact with their children. Even children who face various challenges, such as family poverty or poor neighborhoods, are more likely to overcome these challenges when their parents are involved and invested in providing a safe, stable, and nurturing base of support.


Legacy was developed by CDC in collaboration with the University of Miami, UCLA, and RTI International, and designed as a randomized controlled trial to test the idea that the Legacy intervention during early childhood might improve children’s development. Two sites―one in Miami, Florida, the other in Los Angeles, California―were selected to evaluate the intervention and how it could be adapted to their communities.

Legacy was designed as a model that allowed for the two sites to adapt the program to their communities rather than using a single prescribed, standardized program.

Each site recruited low-income mothers and children to participate. The intervention began before birth in Los Angeles and lasted until the child was 3 years of age; it began at birth in Miami and lasted until the child was 5 years of age. Legacy at these sites had both a pilot phase and a main study phase. This study led to the development and implementation of the Legacy curricula and two additional studies to evaluate and implement Legacy.

You can read more about the Legacy program.

  1. Kaminski JW, Perou R, Visser SN, Scott KG, Beckwith L, Howard J, Smith DC & Danielson ML. Behavioral and socioemotional outcomes through age 5 of the Legacy for ChildrenTM public health approach to improving developmental outcomes among children born into poverty. Am J Public Health, 2013;103:1058–1066. doi:10.2105/AJPH.2012.300996.
  2. Love JM, Kisker EE, Ross CM, Schochet PZ, Brooks-Gunn J, Paulsell D, Boller K, Constantine J, Vogel C, Fuligni AS, Brady-Smith C. Making a difference in the lives of infants and toddlers and their families: The impacts of Early Head Start Volume I: Final technical report. Washington, DC: U.S. Department of Health and Human Services, Head Start Bureau; 2002.
  3. Brooks-Gunn J, McCarton CM, Casey PH, et al. Early intervention in low-birth-weight premature infants. Results through age 5 years from the Infant Health and Development Program. JAMA. 1994;272(16):1257-1262.
  4. Sweet MA, Appelbaum MI. Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Dev. 2004;75(5):1435-1456.
  5. Layzer JI, Goodson BD, Bernstein L, Price C. National Evaluation of Family Support Programs, Final Report Volume A: The Meta-Analysis. Cambridge, MA: Abt Associates; 2001.
  6. Camilli G, Vargas S, Ryan S, Barnett WS. (2010). Meta analysis of the effects of early education interventions on cognitive and social development. Teach Coll Rec. 2010;112(3):579-620.
  7. Kaminski JW, Valle LA, Filene JH, Boyle CL. A meta-analytic review of components associated with parent training program effectiveness. J Abnorm Child Psychol. 2008;36(4):567-589.
  8. Heckman JJ. Skill formation and the economics of investing in disadvantaged children. Science. Jun 2006;312(5782):1900-1902
  9. Kilburn MR, Karoly LA. The economics of early childhood policy: What the dismal science has to say about investing in children. Santa Monica, CA: RAND Corporation and Casey Family Programs;2008
  10. Center on the Developing Child at Harvard University, National Forum on Early Childhood Program Evaluation, and National Scientific Council on the Developing Child, A Science-Based Framework for Early Childhood Policy: Using Evidence to Improve Outcomes in Learning, Behavior, and Health for Vulnerable Children, Cambridge, Mass.: Center on the Developing Child, Harvard University, 2007.