Community Prevention of Child Maltreatment

社区预防虐待儿童

基本信息

批准号：
10584744
负责人：
KENNETH A DODGE
金额：
$ 80.5万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-04-01 至 2028-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10584744
关键词：
Address Advocacy Advocate Age Behavioral Birth Child Child Abuse Child Abuse and Neglect Child Behavior Child Development Child Rearing Child Welfare Cognitive Color Communities Community Networks Cost Sharing Data Analyses Development Directories Discipline Disparity Disparity population Electronics Emergency Care Emotional Evaluation Family Focus Groups Funding Home visitation Income Infant Infant Mortality Intervention Interview Investigation Knowledge Life Life Cycle Stages Maternal Mortality Mediating Mediation Medical Care Costs Mental Health Modeling Newborn Infant Nurses Outcome Parents Pathway interactions Philanthropic Fund Population Pregnancy Prevention Primary Care Process Psychosocial Assessment and Care Public Health Quasi-experiment Race Randomized Randomized, Controlled Trials Readiness Resources Sampling Scientist Socialization System Testing Time Training Treatment Efficacy United States Visit Woman Work access disparities behavioral outcome brief intervention comparison control cost disparity elimination disparity reduction early childhood improved income disparities innovation kindergarten lower income families matriculation novel outcome disparities programs psychosocial racial disparity screening sobriety social treatment as usual

项目摘要

ABSTRACT The aim of this project is to evaluate the impact of a novel comprehensive approach to improving population outcomes and reducing disparities in early child development, called Community Navigation (CN). CN is based on the MIECHV-approved Family Connects (FC), a universal newborn nurse home visiting program combining alignment of community resources with engagement of families through short-term nurse home visiting to identify family-specific needs, intervene briefly, and match families with tailored community resources. Two randomized controlled trials (RCTs) have shown assignment to FC improves maternal mental health and reduces population rates of child abuse investigations but does not have long-term impact on child behavior. To improve and equalize population outcomes in parenting and child well-being, CN has been developed through piloting as a universal psychosocial system of primary care across early life. Trained navigators reach women during pregnancy, continue with FC at birth, and complete well-family visits at 12, 24, and 36 months of child age to provide support, assess family-specific needs, deliver brief interventions, and connect families with community resources for ongoing needs. With philanthropic support, CN is now being delivered through an RCT with a community sample of 800 families in Durham, NC. 400 families have been assigned to receive CN across the period from pregnancy through kindergarten, and 400 families have been assigned as care-as- usual controls. Data analyses will test four hypotheses: (1) intervention efficacy: compared to controls, CN- assigned families will demonstrate lower rates of child maltreatment, less child emergency medical care utilization, better parent mental health, more positive parenting behaviors, and better child cognitive and behavioral development through age 5; (2) disparity reduction: random assignment to CN will be associated with reduction of race and income disparities, operationalized as positive impact of CN assignment on each group with even stronger impact on low-income families and families of color; (3) intervention mediation: improved parent mental health, parent self-advocacy, and parenting behaviors will account for population impact (mediation) and disparity reduction (mediated moderation) in children’s behavioral outcomes; and (4) how disparities develop: race and income disparities in access to community resources in early life will account for race and income disparities in child outcomes at kindergarten. This proposal offers an urgent, cost-shared opportunity to evaluate the population impact, disparity reduction, and mechanisms of a novel system of primary care for birthing families. The project will contribute to public health by providing empirical knowledge about an affordable, innovative, universal system of primary psychosocial care that aims to improve population outcomes and reduce population disparities in parent mental health, positive parenting behaviors, rates of child maltreatment, and child cognitive and behavioral development, and testing the mechanisms through which disparities develop and this intervention operates to reduce them.

抽象的该项目的目的是评估一种新颖的综合方法对改善人口的影响成果并减少早期儿童发展的差异，称为社区导航 (CN)。经 MIECHV 批准的 Family Connects (FC)，这是一项全民新生儿护士家访计划，结合了通过短期护士之家探访，将社区资源与家庭的参与结合起来确定家庭的具体需求，进行短暂干预，并将家庭与定制的社区资源相匹配两个。随机对照试验 (RCT) 表明，分配 FC 可以改善母亲的心理健康，虐待儿童调查的人口比率，但不会对儿童行为产生长期影响。为了改善和均衡人口在育儿和儿童福祉方面的成果，制定了 CN 通过试点作为贯穿早期生活的普遍心理社会初级保健系统。怀孕期间的女性，在出生时继续进行 FC，并在 12、24 和 36 个月时完成家庭探访儿童年龄提供支持、评估家庭特定需求、提供简短干预并与家庭建立联系在慈善支持下，CN 现在通过社区资源来满足持续需求。一项随机对照试验，以北卡罗来纳州达勒姆市的 800 个家庭为样本，其中 400 个家庭已被分配接受治疗。 CN 覆盖从怀孕到幼儿园的整个时期，400 个家庭已被指定为护理家庭通常的对照数据分析将检验四个假设：（1）干预效果：与对照相比，CN- 指定的家庭将表现出较低的虐待儿童率和较少的儿童紧急医疗护理利用率、更好的父母心理健康、更积极的养育行为以及更好的儿童认知和 5 岁之前的行为发展；(2) 差距缩小：随机分配到 CN 与减少种族和收入差距相关，具体化为 CN 分配的积极影响 (3)干预调解：改善父母心理健康、父母自我倡导和养育行为儿童行为的人口影响（中介）和差距缩小（中介调节）结果；(4) 差异如何发展：获取社区资源方面的种族和收入差异该提案提出，生命早期的种族和收入差异将影响儿童在幼儿园的学习成绩。一个紧急的、费用分摊的机会来评估人口影响、差距缩小和机制该项目将通过提供新的新生儿家庭初级保健系统来促进公共卫生。关于负担得起的、创新的、普遍的初级社会心理护理系统的经验知识，其目标是改善人口结果并减少父母心理健康、积极养育方面的人口差异行为、虐待儿童的比率以及儿童的认知和行为发展，并测试差距产生的机制，而这种干预措施可以减少差距。