Identification of Newborns at High Risk for the Occurrence of Preventable Child Maltreatment

识别发生可预防的儿童虐待的高风险新生儿

• 批准号: 10475106
• 负责人: JOHN N. CONSTANTINO
• 金额: $ 27.67万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10475106
• 关键词: Affect; Age; Birth; Birth Records; Caring; Child; Child Abuse and Neglect; Child Development; Childhood; Clinical; Clinical Services; Consent; Data; Development; Discipline of obstetrics; Education; Family; Future; General Population; Health; Healthcare; Human Development; Individual; Infant; Influentials; Insurance Coverage; Intervention; Investigation; Life; Marital Status; Maternal Age; Medical Records; Mental Health; Methods; Mission; Modeling; Monitor; Neonatal Screening; Newborn Infant; Out-Migrations; Outcome; Parents; Patients; Policies; Policy Research; Population; Predictive Value; Pregnancy; Prenatal care; Prevention; Protocols documentation; Psychopathology; Readiness; Recording of previous events; Records; Reporting; Research; Research Training; Retrieval; Risk; Risk Assessment; Risk Factors; Sampling; Scientific Advances and Accomplishments; Screening Result; Sensitivity and Specificity; Services; Siblings; Smoking; Specificity; System; Testing; Time; Training; abortion; abuse neglect; abuse victim; advanced analytics; adverse outcome; arm; base; clinical care; cohort; early childhood; experience; feasibility testing; health record; high risk; indexing; innovation; insurance claims; intimate partner violence; maltreatment; maternal depression; modifiable risk; pediatric trauma; preservation; prevent; preventive intervention; primary care setting; primary caregiver; primary outcome; prospective; psychobiologic; response; screening; substance use; uptake

ABSTRACT Childhood maltreatment (CM) has highly deleterious effects on human development and is arguably the most influential, preventable cause of enduring psychopathology in the U.S. Infants and young children are at particularly high risk for physical harm from abuse and neglect, comprising over 60% of all child maltreatment fatalities. An increasing number of studies point to the ability to target prevention of CM by estimating individual-specific risk at the time of birth, on the basis of readily-available variables in birth records. The prospect of real-time identification of newborns at risk for CM on the basis of risk indicators available in obstetrical settings to be able to target prevention is exciting, but empirical testing of feasibility and predictive utility of methods are key to any systematic attempt to integrate this in U.S. obstetric or newborn clinical services. For example, birth record indices still identify a substantial number of children who do not go on to experience CM, making it important to attempt to optimize specificity (preserving sensitivity) with additional brief clinical screens or administrative data predictive risk modeling prior to broad implementation. Moreover, since screening is only as valuable as its actionability, it is important to understand whether screening results in uptake of needed preventive intervention and, in turn, whether this decreases actual CM. In a sample of 400 families enriched for risk for future CM, we contrast the predictive utility of three types of newborn screening for risk of future official-report of CM involving: a) birth record risk variables (BRRV) only; b) BRRV plus a brief clinical screen for maternal mental health and substance use status, childhood trauma and/or current intimate partner violence; and c) retrieval and analysis of a set of medical record and insurance claims variables (for each family) based on those included in a large-scale PRM effort of a separate Capstone center project during the study period. A RCT pilot arm of the study will explore the extent to which a brief, personalized education protocol for the primary caregiver enhances his/her engagement in intervention over care as usual. A second major aim of the project is to advance scientific understanding of the relationship between risk and outcome. Despite the established association between CM and psychopathology, the associated paths and mechanisms are still being identified, calling for more longitudinal investigation with the hope of identifying modifiable factors that can be targeted for intervention when prevention efforts are not successful. We will first determine whether CM report (as a primary outcome) is moderated by participation in services and/or changes in modifiable risk factors over the first 6 months of life. Next we will explore the extent to which infant developmental outcomes are moderated not only by CM, but by early psychobiological indices of vulnerability to its adverse consequences. The project responds to several priorities of the Capstone RFA (RFA-HD-18-012) as well as the mission of Center for Innovation in Child Maltreatment Policy, Research, and Training to prevent CM and promote healthy development of victims of abuse and neglect.

抽象的 儿童虐待（CM）对人类发展具有高度有害的影响，可以说是最大的 在美国婴儿和幼儿中，有影响力的，可预防的持久心理病理学原因 特别是虐待和忽视受到身体伤害的高风险，占所有儿童虐待的60％ 死亡。越来越多的研究表明，通过估计靶向预防CM的能力 在出生时，根据出生记录中易于可用的变量的个人风险。这 根据可用的风险指标，实时确定有CM风险的新生儿的前景 能够靶向预防的产科环境令人兴奋，但是可行性和预测性的经验测试 方法的效用是将其整合到美国产科或新生儿临床中的任何系统尝试的关键 服务。例如，出生记录指数仍然确定了大量不继续的儿童 体验CM，使尝试优化特异性（保持灵敏度）很重要 在广泛实施之前，简短的临床屏幕或行政数据预测风险建模。而且， 由于筛查仅与其可行性一样有价值，因此重要的是要了解筛查结果是否结果 在采用所需的预防性干预时，并且反过来是否会减少实际CM。在400个样本中 为未来CM风险丰富的家庭，我们将三种新生儿筛查的预测效用与 CM的未来正式报告风险：a）仅出生记录风险变量（BRRV）； b）BRRV加简要 孕妇心理健康和药物使用状况，儿童创伤和/或当前亲密的临床筛查 伴侣暴力； c）检索和分析一组病历和保险索赔变量（用于 每个家庭）基于在一个单独的顶峰中心项目的大规模PRM努力中包括 研究期。研究的RCT飞行员部门将探索简短的个性化教育的程度 主要照顾者的协议可以像往常一样加强他/她参与干预。第二 该项目的主要目的是提高对风险与结果之间关系的科学理解。 尽管CM与心理病理学之间建立了关联，但相关的路径和机制 仍在确定，要求进行更纵向的调查，以期确定可修改的因素 当预防努力不成功时，这可能是针对干预的。我们将首先确定是否 CM报告（作为主要结果）通过参与服务和/或可修改风险的变化来调节 在生命的前6个月中的因素。接下来，我们将探讨婴儿发育成果的程度 不仅由CM进行调节，还通过早期的心理生物学指数来脆弱 结果。该项目回应了Capstone RFA（RFA-HD-18-012）的几个优先事项 儿童虐待政策，研究和培训中创新中心的使命，以防止CM和 促进虐待和忽视受害者的健康发展。