Enhancing Early Relational Health to Reduce Disparities in Child Health and Development: Addressing ACEs and Promoting PCEs through an Integrated Evidence-based Intervention in Pediatric Primary Care

加强早期关系健康，减少儿童健康和发展方面的差异：通过儿科初级保健中的综合循证干预措施解决 ACE 问题并促进 PCE 问题

• 批准号: 10718071
• 负责人: Caitlin Ford Canfield
• 金额: $ 85.04万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-25 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10718071
• 关键词: Academic skills; Academy; Address; Age; American; Books; Buffers; Caring; Child; Child Development; Child Health; Child Rearing; Childhood; Cities; Cognitive; Developmental Delay Disorders; Disparity; Dissemination and Implementation; Effectiveness; Elements; Evidence based intervention; Family; Feedback; Health; Healthcare; Home environment; Hybrids; Inequality; Informal Social Control; Investments; Knowledge; Life; Link; Longevity; Low income; Mediating; Mental Health; Methods; Modeling; National Institute on Minority Health and Health Disparities; Outcome; Parent-Child Relations; Parents; Pathway interactions; Pediatrics; Play; Population; Poverty; Primary Care; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Reading; Recommendation; Reduce health disparities; Resources; Schools; Services; Site; Stress; Structure; Testing; Time; Toy; Trust; Video Recording; Visit; Well Child Visits; Well in self; adverse childhood events; collaborative care; contextual factors; cost; depressive symptoms; design; disparity reduction; effectiveness evaluation; effectiveness outcome; effectiveness/implementation study; ethnic minority; evidence base; evidence based guidelines; experience; flexibility; health disparity; implementation outcomes; implementation/effectiveness; improved; intervention delivery; learning materials; maternal depression; negative affect; novel; physical conditioning; preference; preventive intervention; programs; racial minority; racism; screening; social; standard of care; stem; therapy design

SUMMARY Poverty and racism are linked to disparities in early child development (ECD), including school readiness (pre- academic skills, self-regulation, social-emotional well-being), which are a core contributor to long-term health and mental health outcomes. These disparities begin early in life, widen as children age, and persist across the lifespan. Poverty and racism also increase the likelihood of adverse childhood experiences (ACEs) and decrease the likelihood of positive childhood experiences (PCEs). Importantly, PCEs are not simply the absence of ACEs; they are factors that are beneficial for children’s development and may be especially important in providing a buffer for the impacts of ACEs. Two interrelated frameworks (Stress and Investment) illustrate how ACEs and PCEs impact ECD through a key common pathway of early relational health (ERH; parent-child relationship quality, structuring the home environment, responsivity/cognitive stimulation). Thus, enhancing ERH by both addressing ACEs and promoting PCEs is critical for mitigating disparities in ECD. Evidence-based preventive interventions (EBPIs) designed to reduce these disparities have increasingly been located in pediatric primary care due to its population-level reach, frequent visits, trusted relationships, and potential for low cost. However, few EBPIs have successfully integrated strategies to concurrently and directly address ACEs and promote PCEs, limiting their capacity to fully address disparities synergistically, particularly for families with fewer resources. Moreover, knowledge gaps related to dissemination and implementation (D&I) of integrated EBPIs represent a key barrier to improving implementation effectiveness and impact. We propose a novel integration of HealthySteps (HS) and Video Interaction Project (VIP), two exemplar, American Academy of Pediatrics (AAP)-recommended EBPIs. HS provides a stepped-care approach with universal screening for ACEs and additional support and referrals for families with increased concerns. HS has been shown to reduce family vulnerabilities and negative relationship quality elements of ERH. However, HS has limited impact on PCEs, suggesting additional strategies may be needed to improve effectiveness of the HS stepped-care approach in enhancing ERH. Integrating VIP may address this gap with its focus on video- recording parents and children interacting with a toy or book provided by the program and real-time, strengths- based feedback. VIP has impacts on parenting assets and responsivity/cognitive stimulation elements of ERH. We will test an integrated HS+VIP model in order to: 1) identify best practice strategies for implementing integrated EBPIs in diverse pediatric care sites; 2) examine effectiveness and implementation outcomes of the HS+VIP model; and 3) examine health disparities mechanisms underlying these outcomes. This integrated model has the potential for population-level reductions in disparities in ECD outcomes by targeting ACEs and PCEs simultaneously and will provide strong support for developing best practices for the D&I of such models.

概括 贫困和种族主义与儿童早期发展（ECD）方面的差异有关，包括入学准备（学前教育）。 学术技能、自我调节、社会情感健康），这是长期健康的核心贡献者 这些差异从生命早期开始，随着儿童年龄的增长而扩大，并在整个社会持续存在。 贫困和种族主义也会增加不良童年经历（ACE）和的可能性。 减少积极童年经历（PCE）的可能性 重要的是，PCE 不仅仅是“积极的童年经历”。 缺乏 ACE；它们是有利于儿童发展的因素，并且可能尤其有益 对于为 ACE 的影响提供缓冲很重要。两个相互关联的框架（压力和投资）。 说明 ACE 和 PCE 如何通过早期关系健康 (ERH；ERH； 亲子关系质量、构建家庭环境、反应能力/认知刺激）。 通过解决 ACE 问题和促进 PCE 来加强 ERH 对于减少 ECD 方面的差异至关重要。 旨在减少这些差异的循证预防干预措施 (EBPI) 已越来越受到重视。 由于其人口水平、频繁就诊、值得信赖的关系以及 然而，很少有 EBPI 成功地将策略​​同时直接整合到一起。 解决 ACE 并促进 PCE，限制了它们协同地充分解决差异的能力，特别是 此外，对于资源较少的家庭来说，还存在与传播和实施相关的知识差距。 综合 EBPI 的 D&I（D&I）是提高实施有效性和影响力的关键障碍。 我们提出了 HealthySteps (HS) 和视频交互项目 (VIP) 的新颖整合，两个范例， 美国儿科学会 (AAP) 推荐的 EBPI 提供了分级护理方法。 ACE 的普遍筛查以及对 HS 问题日益严重的家庭的额外支持和转介。 然而，HS 已被证明可以减少家庭脆弱性和 ERH 的负面关系质量要素。 对 PCE 的影响有限，表明可能需要采取额外的策略来提高 PCE 的有效性 HS 加强 ERH 的阶梯式护理方法可能会通过关注视频来弥补这一差距。 记录父母和孩子与程序提供的玩具或书籍的互动以及实时的优势- 基于 VIP 的反馈对育儿资产和 ERH 的反应/认知刺激要素有影响。 我们将测试集成的 HS+VIP 模型，以便：1）确定实施的最佳实践策略 不同儿科护理场所的综合 EBPI；2) 检查项目的有效性和实施结果 HS+VIP 模型；3) 检查这些结果背后的健康差异机制。 该模型有可能通过针对 ACE 和 PCE 同时进行，将为此类模型的 D&I 开发最佳实践提供强有力的支持。