A Primary Prevention Trial to Strengthen Child Attachment in a Native Community

加强原住民社区儿童依恋的初级预防试验

基本信息

批准号：
8470019
负责人：
CATHRYN BOOTH-LAFORCE
金额：
$ 50.39万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-18 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8470019
关键词：
Address Adolescence Adolescent Adult Alcohol or Other Drugs use American Indians Area Attitude Behavior Caregivers Child Child Behavior Child Development Child Rearing Childhood Cognitive Collaborations Communities Consultations Control Groups Development Distance Learning Domestic Violence Educational workshop Effectiveness Ego Elderly Emotional Ensure Evidence based program Exhibits Exposure to Family Focus Groups Fostering Gifts Head Start Program Health Health Personnel Homelessness Household Infant Intervention Life Linguistics Link Logistics Low income Measurable Mediating Medicine Mental Health Mental disorders Meta-Analysis Modeling Montana Mothers Outcome Parenting behavior Parents Participant Personal Satisfaction Persons Play Populations at Risk Poverty Prevention program Preventive Intervention Primary Prevention Principal Investigator Provider Qualitative Methods Randomized Controlled Trials Research Reservations Resources Risk Role Rural School Nursing Secure Security Social Workers Substance abuse problem Testing Toddler Training Tribes Trust Universities Vulnerable Populations Washington Work adverse outcome aged base caregiving design early childhood experience foster care improved infancy innovation maltreatment meetings novel physical conditioning primary outcome programs public health relevance resilience self esteem social social skills stressor theories tribal community young adult

项目摘要

DESCRIPTION (provided by applicant): Children are considered gifts and play a central role in American Indian (AI) culture. However, AI children are at elevated risk for experiencing poverty, parental mental health disorders, household exposure to substance use, domestic violence, and maltreatment, all of which increase their risk of poor mental and physical health outcomes as adolescents and adults. Virtually no evidence-based programs exist that can be administered in a resource-poor tribal setting, can be culturally adapted, can be exported, and hold promise for sustainability. The needs of these vulnerable AI children, thus, remain almost entirely unmet. Decades of research have shown that secure attachment in infancy and early childhood is a key developmental building block that predicts adjustment and promotes resilience in children who grow up under stressful circumstances. Because secure attachment develops from caregiver sensitivity and responsiveness, it is critical to address caregiver sensitivity in early childhood. We will, therefore, test the Promoting First Relationships (PFR) program, a theoretically driven, relationship- and strengths-based primary prevention program. Several studies have shown the diverse positive effects of PFR on the caregiver-child relationship for at-risk populations. The University of Washington Partnerships for Native Health have nurtured a strong, long term collaboration with the Fort Peck Tribes, whose reservation lies in a remote area of northeastern Montana. The tribes' Elders Involved Initiative has stated that the health and well-being of children and young adults are their primary concern, recommending a return to traditional parenting values. With our tribal partner, we will adapt PFR to ensure cultural appropriateness, then conduct a randomized, controlled trial to compare the PFR intervention with a control group receiving information on resources and referrals. Our primary purpose is to test the effectiveness of PFR in improving the caregiver's sensitivity to the child (primary outcome). We will also examine child attachment security to the caregiver and the child's social and emotional functioning. Our specific aims are to 1) adapt the PFR intervention using focus groups; 2) assess the adequacy of training by examining the pre- and post-training attitudes and consultation strategies used by community-based PFR providers with caregivers and infants; and 3) compare the PFR and control group on caregivers' sensitivity and responsiveness and children's social and emotional competencies and attachment security. Effective primary preventive interventions are critically needed for AI children who grow up under stressful circumstances. By promoting sensitive caregiving and child attachment security, we can minimize the impact of contextual stressors on children living on the Fort Peck reservation and, foster resilience, and improve their risk outlook.

描述（由申请人提供）：儿童被视为礼物，并在美洲印第安人（AI）文化中起着核心作用。但是，AI儿童患有贫困，父母心理健康障碍，家庭暴露，家庭暴力和虐待的风险较高，所有这些都会增加他们作为青少年和成人的精神和身体健康状况不佳的风险。几乎没有基于证据的计划可以在资源贫乏的部落环境中进行管理，可以在文化上进行适应，可以出口，并对可持续性抱有希望。因此，这些脆弱的AI儿童的需求几乎完全没有满足。数十年的研究表明，婴儿期和幼儿期的安全依恋是一个关键的发展基础，可以预测调整并促进在压力很大的情况下成长的儿童的韧性。因为安全的依恋是从照顾者的敏感性和反应性发展而来的，所以解决儿童早期的护理人员敏感性至关重要。因此，我们将测试促进第一关系（PFR）计划，这是一种理论上驱动的，基于关系和优势的初级预防计划。几项研究表明，PFR对处于危险人群的护理人孩子关系的不同积极影响。华盛顿大学的土著健康伙伴关系与佩克堡部落建立了强大的长期合作，其保留位于蒙大拿州东北部的偏远地区。这些部落的长老倡议指出，儿童和年轻人的健康和福祉是他们的主要关注点，建议重返传统的育儿价值。与我们的部落合作伙伴一起，我们将调整PFR，以确保文化适当性，然后进行随机，对照试验，以将PFR干预与接收有关资源和推荐信息的对照组进行比较。我们的主要目的是测试PFR在改善照料者对儿童敏感性方面的有效性（主要结果）。我们还将检查儿童依恋安全性，以及儿童的社会和情感功能。我们的具体目的是1）使用焦点组调整PFR干预； 2）通过检查基于社区的PFR提供者使用护理人员和婴儿使用的培训前和培训态度和咨询策略来评估培训的充分性； 3）比较PFR和对照组关于看护人的敏感性和响应能力以及儿童的社会和情感能力以及依恋安全性。对于在压力很大的情况下长大的AI儿童至关重要的主要预防性干预措施。通过促进敏感的护理和儿童依恋安全，我们可以最大程度地减少上下文压力源对佩克堡预订的儿童的影响，并增强韧性，并改善其风险前景。