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

• 批准号: 10089226
• 负责人: Philip A Fisher
• 金额: $ 61.41万
• 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: 2019-02-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10089226
• 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

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。项目摘要/摘要 在联邦贫困门槛以下或以下的260万美国3岁以下的美国儿童中，大多数没有 由于计划有限，因此接收服务以支持其符合条件的健康发展 容量。现有的基于证据的干预措施旨在缓冲该年龄段的低收入儿童 与贫困相关的压力源的负面影响需要高剂量和/或长期递送 从训练有素的专业人员到仅实现适度的效果大小，并且它们的流失率很高。而且， 关于这些干预措施有效性的调解人和主持人，知之甚少（即什么有效 为谁和原因）。就潜在可延展的护理人和儿童神经生物学而言，尤其如此 代表计划影响的调解人的机制。拟议研究的总体目的是 对具有12- –儿童的低收入家庭的潜水员样本进行随机有效性试验 36个月，谁有资格获得早期开始（EHS），但由于计划有限而无法入学 容量。我们将使用纵向随机有效性试验来检验中心假设 响应式护理（主要发现目标）的增加与随后的护理人员之间的关联 幸福感，儿童发育和生物行为结果（次要目标）将部分介导 通过改变护理人员神经影像学的基于抑制性控制和父母的行为度量 自我概念。我们还将检查假设干预效应的主持人。这项工作的理由 是它只是解决了一个较大的，服务不足的幼儿的未满足需求 人口并允许对我们的概念模型进行严格的测试。我们将随机分组300名主要护理人员 以及他们有资格获得EHS服务但无法提供服务的1至3岁孩子 或主动控制干预。 AIM 1量化发现对响应式育儿变化的主要影响 以及相关的照顾者和儿童成果（包括护理人员报告的育儿自我有效，客观 干预后立即采取慢性儿童压力的措施，以及这些影响的持久性6 几个月后。 AIM 2标识了介导与发现相关的关联的潜在神经机制 护理人员行为和照料者/儿童结果以及这些机制的特异性的变化。目标3 评估照顾者和儿童特征调节这些关联的程度（例如 照料者的广告历史，家庭社会经济地位，儿童年龄）和干预保真度和剂量。这 信息对于解决对1-3岁儿童幼儿干预措施的不同反应至关重要 提高影响和可伸缩性。这些结果将产生积极的影响，因为 符合EHS入学标准的大多数家庭通常不会获得服务。很容易 这些家庭留在候补名单上时可以提供的计划可以促进其子女的 开发和降低风险。