Community Prevention of Child Maltreatment

摘要 这项随机对照试验(RCT)竞争性继续试验的目的是评估长期疗效。 家庭联系(FC)对人口的影响和机制，简要介绍全民护士家访计划 旨在防止在整个社区人口中虐待儿童。2009年7月1日至 2010年12月31日，在达勒姆出生的每个双数出生的婴儿(n=2329名)都被分配到 接受FC计划，所有在奇数出生日期出生的婴儿(n=2450名)都像往常一样接受服务。 对实施情况的评估表明，普及率很高(80.0%的新生儿同意参与)， 对模型的忠诚度(84%)，以及对危险因素评分的高可靠性(Κ=0.69)。治疗意向 用干预(n=269)和对照(n=280)出生的代表性随机样本进行影响评估 日期表明，随机分配到FC的家庭访问更多的社区资源，表现出更少的资源 焦虑和更好的育儿行为。医院记录显示，FC家庭的急救医疗较少 24个月的护理探视和在医院过夜，以及儿童保护服务记录表明 60个月内虐待儿童的调查率降低39%。拟议的研究将 继续跟踪参加现有影响评估研究的家庭，年龄从9岁到12岁。 行政记录将评估随机分配给功能界别对虐待儿童案件的影响， 急诊室虐待相关伤害和教育结果。上门采访和电话采访 与父母和孩子一起，以及盲目观察，将评估父母的功能和孩子的健康- 是存在的。教师调查将评估儿童的学习成绩和社会情绪适应情况。数据分析 我将检验五个假设：1)随机分配给FC计划(即出生在偶数出生日期) 将与较低的虐待儿童和急诊科使用率相关，更好 作为对照，学业成绩、父母功能更好、孩子的幸福感更好；2)FC 将产生正的收益-成本比，以健康、心理健康、社会和社会方面的结果衡量 接受教育服务；3)高危人群的干预效果将更大；4)社区 资源使用和增强的家庭功能将调解FC对结果的积极影响；和5) 控制组中的不良父母教养和儿童行为的发展过程将符合 到指导节目的模型。这项提案提供了一个紧迫的、时间有限的机会来评估 这一创新的普遍家访计划对人口的长期影响和机制。该项目 将通过评估旨在实现以下目标的计划的长期影响和机制来促进公共卫生 以具有成本效益的方式降低虐待儿童的人口比率，并通过测试 发展虐待、不正常的父母教养方式以及儿童行为和幸福。

Abstract The aim of this randomized controlled trial (RCT) competing continuation is to evaluate the long-term population impact and mechanisms of Family Connects (FC), brief universal nurse home-visiting program designed to prevent child maltreatment in an entire community population. Between July 1, 2009, and December 31, 2010, every infant born in Durham on an even birth date (n=2,329 births) was assigned to receive the FC Program, and all infants born on an odd birth date (n=2,450 births) received services-as-usual. Evaluation of implementation indicated high penetration (80.0% of all births consented to participate), high fidelity to the model (84% adherence), and high reliability of scoring risk factors (Κ=0.69). Intent-to-treat impact evaluation with a representative random sample from intervention (n=269) and control (n=280) birth dates indicated that families randomly assigned to FC accessed more community resources and exhibited less anxiety and better parenting behavior. Hospital records indicated FC families had fewer emergency medical care visits and overnights in the hospital through age 24 months, and child protective service records indicated 39% lower rates of investigations for child maltreatment through age 60 months. The proposed study will continue to follow families participating in the existing impact evaluation study from child ages 9 to 12 years. Administrative records will evaluate impact of random assignment to FC on child maltreatment cases, emergency room maltreatment-related injuries, and education outcomes. In-home and telephone interviews with parents and children, as well as blinded observations, will assess parental functioning and child well- being. Teacher surveys will assess child academic performance and social-emotional adjustment. Data analyses will test five hypotheses: 1) Random assignment to the FC program (that is, being born on an even birth date) will be associated with lower rates of child maltreatment and emergency department utilization, better academic outcomes, better parental functioning, and better child well-being than assignment as control; 2) FC will produce a positive benefit-cost ratio, as measured by outcomes in health, mental health, social, and education services received; 3) Intervention effect sizes will be larger for higher-risk groups; 4) Community resource use and enhanced family functioning will mediate the positive impact of FC on outcomes; and 5) Developmental processes in dysfunctional parenting and child behavior among the control group will conform to the model guiding the program. This proposal offers an urgent, time-constrained opportunity to evaluate the long-term population impact and mechanisms of this innovative universal home-visiting program. The project will contribute to public health by evaluating the long-term impact and mechanisms of a program that aims to lower the population rate of child maltreatment in a cost-effective way and by testing models of the development of maltreatment, dysfunctional parenting, and child behavior and well-being.