A Scalable Video-Coaching Intervention for Opioid-Using Mothers

针对阿片类药物使用母亲的可扩展视频辅导干预

• 批准号: 10430036
• 负责人: Philip A Fisher
• 金额: $ 39.16万
• 依托单位: UNIVERSITY OF OREGON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10430036
• 关键词: 3 year old; Abstinence Syndrome; Address; Affect; Age; American; Area; Attention; Behavior; Caregiver well-being; Caregivers; Cessation of life; Child; Child Development; Child Rearing; Child Welfare; Clinic; Communities; Community Healthcare; Development; Dimensions; Drug usage; Effectiveness; Engineering; Film; Functional Magnetic Resonance Imaging; Health; Home visitation; Individual; Infant Development; Instruction; Intervention; Knowledge; Mediating; Mediator of activation protein; Mental Health; Methods; Modeling; Mothers; Motivation; Neonatal Abstinence Syndrome; Newborn Infant; Opiate Addiction; Outcome; Overdose; Parents; Participant; Pathway interactions; Personal Satisfaction; Persons; Pharmacologic Substance; Population; Prevention Research; Process; Program Development; Public Policy; Randomized; Recovery; Research; Research Personnel; Research Project Grants; Rewards; Risk; Role; Sampling; Science; Self Concept; Services; Source; Specific qualifier value; Specificity; System; Techniques; Testing; Underserved Population; Well in self; Woman; Work; active control; addiction; aged; behavior measurement; behavioral outcome; biobehavior; caregiving; cognitive load; cost; design; dosage; early childhood; efficacy trial; evidence base; executive function; experience; infancy; innovation; inpatient service; knowledge base; longitudinal design; lower income families; maternal opioid use; neuroimaging; neuromechanism; novel; opioid epidemic; opioid misuse; opioid use; opioid use disorder; opioid user; outpatient programs; prevent; primary caregiver; programs; randomized trial; response; reward circuitry; service delivery; service providers; skills; social stigma; substance use; theories; therapy design; video coaching

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.

7.项目摘要/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。在社区中 受阿片类药物危机严重影响，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。一大堆研究文件 由阿片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，许多母亲发现生孩子是她们寻求治疗的强烈动机 阿片类药物的使用和/或成瘾。对于这些母亲来说，目前还没有基于证据的育儿干预措施 来支持他们。此外，人们对早期干预的调解人和主持人的有效性知之甚少。 更普遍的儿童育儿干预(即，什么对谁有效，为什么)，这限制了能力 研究人员可以确定这些计划所针对的系统可能会如何受到阿片类药物使用的影响。这个 这项拟议研究的总体目标是进行一项随机疗效试验，该试验采用不同的低、中、低剂量药物样本。 有0-36个月大孩子的收入家庭，其母亲正在接受或已被转介接受治疗 阿片类药物的使用和/或成瘾。我们将与我们的咨询委员会和社区合作伙伴合作，以适应 循证、可扩展、可拍摄的互动，以培育这种治疗的发展(FIND)计划 上下文(目标1)，然后使用纵向随机疗效试验来检验中心假设 响应性照顾者(主要发现目标)的增加与后续照顾者之间的关联 福祉和儿童发展和生物行为结果(次级目标)将部分起到调节作用 通过改变照顾者抑制控制(测量行为和神经成像方法)和 父母自我概念(目标2-3)。这项工作的基本原理是它同时解决了未得到满足的需求 脆弱的、服务严重不足的幼儿人口，并允许对我们的 概念模型。我们将随机选择200名主要照顾者和他们0到3岁的孩子接受 寻找或主动控制干预(所有参与者将从他们的转介中接受成瘾治疗 来源)。目标2量化Find对响应性父母教养方式和相关照顾者变化的主要影响 干预后即刻的儿童结局，以及6个月后这些影响的持久性。目标3 探索潜在的神经机制，调节照顾者Find相关变化之间的关联 行为和照顾者/儿童结果以及这些机制的特殊性，并评估 这些关联可以通过新生儿阿片类药物戒断或戒断综合征来缓解。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化问题至关重要 对0-3岁儿童的儿童早期干预措施作出反应，以增加影响和可扩展性。这些 结果将产生积极影响，因为目前还没有基于证据的幼儿育儿方式 旨在治疗环境中实施的干预措施。一个易于交付的程序，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育和 降低风险。