RCT of FIND video coaching intervention for caregivers facing economic adversity

针对面临经济逆境的护理人员的 FIND 视频辅导干预的随机对照试验

基本信息

批准号：
10337033
负责人：
Philip A Fisher
金额：
$ 62.7万
依托单位：
UNIVERSITY OF OREGON
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-02-01 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10337033
关键词：
3 year old Achievement Address Age Behavior Behavioral Mechanisms Brain Buffers Caregiver support Caregiver well-being Caregivers Characteristics Child Child Behavior Child Development Child Rearing Child Welfare Chronic Chronic stress Cognitive Communities Community Health Development Economics Educational process of instructing Effectiveness of Interventions Engineering Enrollment Ensure Evidence based intervention Family Family Characteristics Film Functional Magnetic Resonance Imaging Future Hair Head Start Program Hydrocortisone Infant Instruction Intervention Knowledge Low income Measures Mediating Mediator of activation protein Mission Modeling Morbidity - disease rate National Institute of Child Health and Human Development Outcome Parents Patient Self-Report Personal Satisfaction Population Poverty Process Public Health Randomized Recording of previous events Reporting Research Risk Sampling Science Self Concept Self Efficacy Services Socioeconomic Status Specific qualifier value Specificity Stress Techniques Testing Training Underserved Population Variant Waiting Lists Work active control base behavior measurement behavioral outcome biobehavior caregiver interventions caregiving cognitive load design dosage early childhood efficacy trial evidence base follow-up high risk improved innovation intervention effect longitudinal design lower income families mortality neurobiological mechanism neuroimaging neuromechanism primary caregiver programs promoter randomized effectiveness trial response skills stressor theories therapy design therapy development video coaching

项目摘要

7. Project Summary/Abstract Of the 2.6 million U.S. children under age 3 living at or below the Federal Poverty Threshold, most do not receive services to support healthy development for which they are eligible, because of limited program capacity. Existing evidence-based interventions designed to buffer low-income children in this age range from the negative effects of stressors associated with poverty require high dosage and/or long-duration delivery from trained professionals to achieve only modest effect sizes, and they have high rates of attrition. Moreover, very little is known about mediators and moderators of the effectiveness of these interventions (i.e., what works for whom and why). This is especially true in terms of potentially malleable caregiver and child neurobiological mechanisms that represent mediators of program impact. The overall objective of the proposed study is to conduct a randomized effectiveness trial with a diverse sample of low-income families with children ages 12– 36 months, and who are eligible for Early Head Start (EHS) but cannot be enrolled because of limited program capacity. We will use a longitudinal randomized effectiveness trial to test the central hypothesis that associations between increases in responsive caregiving (the main FIND target), and subsequent caregiver well-being and child developmental and biobehavioral outcomes (secondary targets), will be partially mediated through changes in caregiver neuroimaging-based and behavioral measures of inhibitory control and parent self-concept. We will also examine moderators of hypothesized intervention effects. The rationale for this work is that it simultaneously addresses the unmet needs of a large, significantly underserved early childhood population and allows for a rigorous test of our conceptual model. We will randomize 300 primary caregivers and their 1- to 3-year-old children who are eligible for EHS services but who cannot be served, to receive FIND or an active control intervention. Aim 1 quantifies the main effects of FIND on changes in responsive parenting and related caregiver and child outcomes (including caregiver-reported parenting self-efficacy, objective measures of chronic child stress) immediately after the intervention, and the durability of these effects 6 months later. Aim 2 identifies underlying neural mechanisms that mediate associations between FIND-related changes in caregiver behavior and caregiver/child outcomes and the specificity of those mechanisms. Aim 3 assesses the degree to which these associations are moderated by caregiver and child characteristics (e.g., caregiver history of adversity, family socioeconomic status, child age) and intervention fidelity and dosage. This information is critical to addressing differential response to early childhood interventions for children ages 1–3, to increase impact and scalability. These outcomes will have a positive impact in that the overwhelming majority of families who meet the enrollment criteria for EHS normally do not receive services. An easily delivered program that can be provided while these families remain on the waitlist may facilitate their children's development and reduce risks.

7. 项目总结/摘要在生活在联邦贫困线以下的 260 万 3 岁以下儿童中，大多数没有由于计划有限，接受他们有资格获得的支持健康发展的服务旨在缓冲该年龄段低收入儿童的现有循证干预措施的范围。与贫困相关的压力源的负面影响需要高剂量和/或长时间给药来自训练有素的专业人员的人员只能达到适度的效果，而且他们的流失率很高。对于这些干预措施有效性的中介者和调节者知之甚少（即什么有效）对于谁以及为什么）。对于潜在的可塑性照顾者和儿童神经生物学而言尤其如此。代表计划影响中介的机制拟议研究的总体目标是对有 12 岁儿童的低收入家庭的不同样本进行随机有效性试验 36 个月，并且有资格参加 Early Head Start (EHS)，但因计划有限而无法入学我们将使用纵向随机有效性试验来检验中心假设：响应性护理（主要 FIND 目标）的增加与后续护理人员之间的关联福祉、儿童发育和生物行为结果（次要目标）将得到部分调节通过改变照顾者基于神经影像学的抑制控制和父母的行为测量我们还将研究合作干预效果的调节因素。是它同时解决了大量服务严重不足的幼儿未得到满足的需求人口，并允许对我们的概念模型进行严格测试，我们将随机抽取 300 名主要看护者。及其有资格获得 EHS 服务但无法获得服务的 1 至 3 岁儿童接受 FIND 目标 1 量化 FIND 对响应式养育方式变化的主要影响。以及相关的照顾者和儿童的结果（包括照顾者报告的育儿自我效能感、客观干预后立即采取的慢性儿童压力措施，以及这些影响的持久性6 目标 2 确定介导 FIND 相关之间关联的潜在神经机制。照顾者行为和照顾者/儿童结果的变化以及这些机制的特殊性。评估这些关联受照顾者和儿童特征（例如，照顾者的逆境史、家庭社会经济状况、儿童年龄）以及干预的保真度和剂量。信息对于解决 1-3 岁儿童对幼儿干预措施的差异反应至关重要，提高影响力和可扩展性，这些成果将产生积极的影响。大多数符合 EHS 加入标准的家庭通常不会接受服务。当这些家庭仍在候补名单上时可以提供的计划可能会促进他们的孩子发展，降低风险。