Embedding Mental Health Consultation Within Prenatal Home Visiting to Prevent Child Maltreatment and Violence Exposure

将心理健康咨询纳入产前家访，防止儿童遭受虐待和暴力

• 批准号: 10237847
• 负责人: Stephanie Hart Parade
• 金额: $ 35万
• 依托单位: EMMA PENDLETON BRADLEY HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2022-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10237847
• 关键词: Embedding; Mental; Health; Consultation; Within

Abstract Adverse childhood experiences (ACES) is a major public health problem that exacts tremendous cost to the United States each year. Exposure to ACES during infancy, including child maltreatment and child exposure to adult intimate partner violence, undermines health across the lifespan. Infants are at greatest risk for fatality resulting from maltreatment in the first week of life, and nearly a third of infants who experience maltreatment in the first year have been maltreated by one week postpartum. Thus, intervening in the postpartum period to prevent maltreatment and exposure to intimate partner violence is too late. Furthermore, mothers with their own history of adversity or trauma are much more likely to experience risk factors in the postpartum period for perpetrating violence. Intervening prenatally to support mothers into the postpartum transition, particularly mothers with their own trauma history, is critical to reducing maltreatment and violence exposure in children. Home visiting programs, with their emphasis on maternal-child health, are an important bridge to support mothers with a trauma history across the perinatal transition, and an ideal setting for primary prevention of child maltreatment and violence exposure. The proposed research will focus on RFA Objective #3: Effectiveness research to evaluate a primary prevention strategy that incorporates a dual-generation approach. Through close collaboration with the Rhode Island Department of Health (RIDOH) and the Rhode Island Department of Children, Youth, and Families (RI DCYF), we will capitalize on established infrastructure to innovate and enhance a statewide short-term home visiting program. Our primary prevention program, Enhanced First Connections, will draw upon an infant mental health perspective to provide prenatal infant and early childhood mental health consultation in the context of the home visiting program. We will focus on a selected high-risk population, mothers with a history of adversity or trauma, with the goal of preventing ACES exposure among infants. Primary outcomes of the proposed randomized control trial (RCT) will include the prevention of child maltreatment (child abuse and neglect) and exposure to adult intimate partner violence. Secondary outcomes of the proposed RCT will include increases in family engagement in longer- term evidence based home visiting programs, increases in family engagement in specialized support services to address maternal adversity and trauma, reductions in maternal risk factors, and the promotion of positive parenting and the parent-child relationship. We will use gold-standard assessments to measure our outcome variables including review of child protection records, interview and observational assessments, and review of home visiting records. Our focus on infant and early childhood mental health consultation is highly innovative as no prior research has empirically tested this strategy for the primary prevention of child maltreatment and child exposure to adult intimate partner violence. Results will be of high interest given the national focus on supporting infant and early childhood mental health consultation within home visiting.

抽象的 不良童年经历（ACES）是一个重大的公共卫生问题，给人们带来巨大的损失。 美国每年。婴儿期接触 ACES，包括虐待儿童和儿童接触 成人亲密伴侣的暴力行为会损害整个生命周期的健康。婴儿死亡风险最大 出生后第一周内受到虐待造成的，近三分之一的婴儿遭受过虐待 第一年在产后一周内受到虐待。因此，产后干预 防止虐待和遭受亲密伴侣暴力为时已晚。此外，妈妈们带着自己的 自己的逆境或创伤史更有可能在产后经历危险因素 实施暴力。产前干预以支持母亲进入产后过渡，特别是 有自己的创伤史的母亲对于减少儿童遭受虐待和暴力至关重要。 以母婴健康为重点的家访项目是支持的重要桥梁 在围产期过渡期间有创伤史的母亲，以及一级预防的理想环境 儿童虐待和暴力暴露。拟议的研究将重点关注 RFA 目标#3： 评估包含双代的一级预防策略的有效性研究 方法。通过与罗德岛州卫生部 (RIDOH) 和罗德岛州卫生局的密切合作 岛屿儿童、青少年和家庭部 (RI DCYF)，我们将利用现有的基础设施 创新和加强全州短期家访计划。我们的初级预防计划， 增强型第一连接将利用婴儿心理健康的视角，为产前婴儿和 家访计划中的幼儿心理健康咨询。我们将重点关注一个 选定的高危人群、有逆境或创伤史的母亲，目的是预防 ACES 婴儿之间的暴露。拟议的随机对照试验（RCT）的主要结果将包括 预防虐待儿童（虐待和忽视儿童）和接触成年亲密伴侣 暴力。拟议的随机对照试验的次要结果将包括家庭参与度的增加 基于长期证据的家访计划，增加家庭对专业支持服务的参与 解决孕产妇的逆境和创伤，减少孕产妇危险因素，并促进积极的 养育子女和亲子关系。我们将使用黄金标准评估来衡量我们的成果 变量包括儿童保护记录审查、访谈和观察评估以及审查 家访记录。我们对婴儿和幼儿心理健康咨询的关注具有高度创新性 因为之前没有研究对这一战略进行虐待儿童一级预防的实证检验， 儿童遭受成人亲密伴侣的暴力。鉴于国家重点关注，结果将引起高度关注 支持家访中的婴儿和幼儿心理健康咨询。