A Scalable Video-Coaching Intervention for Opioid-Using Mothers

针对阿片类药物使用母亲的可扩展视频辅导干预

• 批准号: 10677564
• 负责人: Philip A Fisher
• 金额: $ 19.57万
• 依托单位: UNIVERSITY OF OREGON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10677564
• 关键词: 3 year old; Abstinence Syndrome; Address; Affect; Age; American; Area; Attention; Behavior; Caregiver well-being; Caregivers; Cessation of life; Child; Child Development; Child Rearing; Child Welfare; Clinic; Communities; Community Healthcare; Development; Dimensions; Drug usage; Education; Effectiveness; Engineering; Film; Functional Magnetic Resonance Imaging; Health; Home visitation; Individual; Infant Development; Instruction; Intervention; Knowledge; Mediating; Mediator; Mental Health; Methods; Modeling; Mothers; Motivation; Neonatal Abstinence Syndrome; Newborn Infant; Opiate Addiction; Outcome; Overdose; Parents; Participant; Pathway interactions; Personal Satisfaction; Persons; Pharmacologic Substance; Population; Prevention Research; Process; Program Development; Public Policy; Randomized; Recovery; Research; Research Personnel; Research Project Grants; Rewards; Risk; Risk Reduction; Role; Sampling; Science; Self Concept; Services; Social Interaction; Source; Specific qualifier value; Specificity; System; Techniques; Testing; Underserved Population; Well in self; Woman; Work; active control; addiction; aged; behavior measurement; behavioral outcome; biobehavior; caregiving; cognitive load; cost; design; dosage; early childhood; efficacy trial; evidence base; executive function; experience; infancy; innovation; inpatient service; knowledge base; longitudinal design; lower income families; maternal opioid use; neuroimaging; neuromechanism; novel; opioid epidemic; opioid misuse; opioid use; opioid use disorder; opioid user; outpatient programs; prevent; primary caregiver; programs; randomized trial; response; reward circuitry; service delivery; service providers; skills; social stigma; substance use; theories; therapy design; video coaching

7. PROJECT SUMMARY/ABSTRACT Over 2 million Americans have opioid use disorders, and millions more misuse opioids. In communities severely affected by the opioid crisis, as many as 10% of newborns are affected by neonatal opioid withdrawal syndrome, which costs upwards of $1.5 billion annually. A large body of research documents the many negative consequences of being raised by a mother with opioid addiction, especially in infancy and early childhood. In addition, many mothers find that having a child is a strong motivation to seek treatment for their opioid use and/or addiction. For these mothers, there are currently no evidence-based parenting interventions to support them. Moreover, very little is known about mediators and moderators of the effectiveness of early childhood parenting interventions more generally (i.e., what works for whom and why), which limits the ability for researchers to identify how the systems targeted by these programs may be affected by opioid use. The overall objective of the proposed study is to conduct a randomized efficacy trial with a diverse sample of low- income families with children ages 0–36 months whose mothers are in or have been referred to treatment for opioid use and/or addiction. We will work with our Advisory Board and our community partners to adapt the evidence-based, scalable, Filming Interactions to Nurture Development (FIND) program to this treatment context (Aim 1), and then use a longitudinal randomized efficacy 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 inhibitory control (measured behaviorally and with neuroimaging methods) and parent self-concept (Aims 2-3). The rationale for this work is that it simultaneously addresses the unmet needs of a vulnerable, significantly underserved early childhood population and allows for a rigorous test of our conceptual model. We will randomize 200 primary caregivers and their 0- to 3-year-old children to receive FIND or an active control intervention (all participants will receive addiction treatment from their referral source). Aim 2 quantifies the main effects of FIND on changes in responsive parenting and related caregiver and child outcomes immediately after the intervention, and the durability of these effects 6 months later. Aim 3 explores underlying neural mechanisms that mediate associations between FIND-related changes in caregiver behavior and caregiver/child outcomes and the specificity of those mechanisms, and assesses the degree to which these associations are moderated by neonatal opioid withdrawal or abstinence syndrome. Within-group analyses will also examine intervention fidelity and dosage. This information is critical to addressing differential response to early childhood interventions for children ages 0–3, to increase impact and scalability. These outcomes will have a positive impact in that there are currently no evidence-based, early childhood parenting interventions designed to be implemented in a treatment setting. An easily delivered program that can be provided while these parents seek treatment for opioid misuse may facilitate their children's development and reduce risks.

7. 项目概要/摘要 超过 200 万美国人患有阿片类药物使用障碍，还有数百万人在社区滥用阿片类药物。 受阿片类药物危机严重影响，多达10%的新生儿受到新生儿阿片类药物戒断的影响 每年花费超过 15 亿美元的大量研究记录了许多此类疾病。 由患有阿片类药物成瘾的母亲抚养长大的负面后果，尤其是在婴儿期和早期 此外，许多母亲发现生孩子是为她们寻求治疗的强烈动机。 对于这些母亲使用阿片类药物和/或成瘾，目前没有基于证据的育儿干预措施。 此外，人们对早期调解者和调节者的有效性知之甚少。 儿童养育干预更普遍（即什么对谁有效以及为什么有效），这限制了能力 研究人员可以确定这些计划所针对的系统如何受到阿片类药物使用的影响。 拟议研究的总体目标是对低效的不同样本进行随机疗效试验 有 0-36 个月大儿童的收入家庭，其母亲正在接受治疗或已被转介接受治疗 我们将与我们的咨询委员会和社区合作伙伴合作，调整阿片类药物的使用和/或成瘾。 针对这种治疗的基于证据的、可扩展的、拍摄互动促进发展 (FIND) 计划 背景（目标 1），然后使用纵向随机功效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 通过护理人员抑制控制的变化（通过行为和神经影像方法测量）以及 家长自我概念（目标 2-3）。这项工作的基本原理是它同时解决未满足的需求。 弱势群体、服务严重不足的幼儿群体，并允许对我们的 我们将随机抽取 200 名主要看护者及其 0 至 3 岁的孩子接受治疗。 FIND 或主动控制干预（所有参与者都将接受转介的成瘾治疗 目标 2 量化了 FIND 对响应性养育和相关照顾者变化的主要影响。 干预后儿童的结果，以及这些影响在目标 3 后 6 个月的持续时间。 探索介导护理人员 FIND 相关变化之间关联的潜在神经机制 行为和照顾者/儿童的结果以及这些机制的特殊性，并评估程度 这些关联受到新生儿阿片类药物戒断或戒断综合征的调节。 分析还将检查干预保真度和剂量，这些信息对于解决差异至关重要。 对 0-3 岁儿童的早期儿童干预措施做出反应，以提高影响力和可扩展性。 结果将产生积极影响，因为目前还没有基于证据的幼儿养育方法 旨在在治疗环境中实施的干预措施。 当这些父母因阿片类药物滥用而寻求治疗时，提供这些可能会促进他们孩子的发展和 降低风险。