A Scalable Video-Coaching Intervention for Opioid-Using Mothers

7.项目总结/摘要 超过200万美国人患有阿片类药物使用障碍，还有数百万人滥用阿片类药物。社区 受阿片类药物危机的严重影响，多达10%的新生儿受到新生儿阿片类药物戒断的影响 综合症，每年花费超过15亿美元。大量的研究记录了 由患有阿片类药物成瘾的母亲抚养的负面后果，特别是在婴儿期和早期 童年.此外，许多母亲发现，有一个孩子是一个强大的动机，寻求治疗， 阿片类药物使用和/或成瘾。对于这些母亲，目前还没有基于证据的育儿干预措施 来支持他们此外，很少有人知道的调解人和主持人的有效性，早期 儿童养育干预更普遍（即，什么对谁有效，为什么有效），这限制了 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。的 拟议研究的总体目标是进行一项随机有效性试验， 有0-36个月子女的收入家庭，其母亲正在接受或已经接受过 阿片类药物使用和/或成瘾。我们将与我们的顾问委员会和社区合作伙伴合作， 基于证据的，可扩展的，拍摄互动培养发展（FIND）计划，以这种治疗 背景（目标1），然后使用纵向随机疗效试验来检验中心假设， 反应性睡眠增加（主要FIND目标）与随后的照顾者之间的关联 幸福和儿童发育和生物行为结果（次要目标），将部分介导 通过看护者抑制控制的变化（通过行为和神经成像方法测量）， 父母自我概念（目标2-3）。这项工作的理由是，它同时解决未满足的需求 一个脆弱的，严重缺乏服务的幼儿人口，并允许我们的一个严格的考验， 概念模型我们将随机分配200名主要照顾者及其0至3岁的孩子接受 FIND或主动控制干预（所有参与者都将接受转介的成瘾治疗 来源）。目的2量化FIND对父母反应和相关照顾者变化的主要影响 和干预后立即的儿童结果，以及6个月后这些影响的持久性。目标3 探讨了潜在的神经机制，介导之间的关联发现相关的变化，照顾者 行为和照顾者/儿童的结果和这些机制的特异性，并评估程度， 新生儿阿片类药物戒断或戒断综合征可缓解这些相关性。组内 分析还将检查干预的保真度和剂量。此信息对于解决差异 对0-3岁儿童的幼儿干预措施作出反应，以增加影响和可扩展性。这些 结果将产生积极的影响，因为目前还没有基于证据的幼儿养育方法 在治疗环境中实施的干预措施。一个容易交付的程序，可以 如果这些父母寻求阿片类药物滥用的治疗，可能会促进他们的孩子的发展， 降低风险。

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.