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200万美国人患有绿氧化物疾病，数以百万计的opioids。在社区中 受Oioid危机的严重影响，多达10％的新生儿受到新生儿Oioid戒断的影响 综合征，每年的费用高达15亿美元。大量研究记录了许多 由阿片类药物成瘾的母亲抚养的负面后果，尤其是在婴儿期和早期 童年。此外，许多母亲发现生孩子是为自己寻求治疗的强大动力 阿片类药物使用和/或成瘾。对于这些母亲，目前尚无基于证据的育儿干预措施 支持他们。此外，关于早期有效性的调解人和主持人知之甚少 更普遍的童年育儿干预措施（即，对谁和原因有效），这限制了能力 为了使研究人员确定这些程序针对的系统如何受阿片类药物使用的影响。 拟议的研究的总体目的是进行一项随机效率试验，并使用多种多样的低 - 有儿童的收入家庭为0-36个月，母亲正在或已转介给治疗 Oopioid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，以适应 循证，可扩展的拍摄相互作用以培养这种处理的开发（查找）计划 上下文（AIM 1），然后使用纵向随机效率试验来检验中心假设 响应式护理（主要发现目标）的增加与随后的护理人员之间的关联 幸福感，儿童发育和生物行为结果（次要目标）将部分介导 通过看护人抑制性控制的变化（行为和神经成像方法测量）和 父母自我概念（目标2-3）。这项工作的理由是它只是满足了未满足的需求 一个脆弱的，服务不足的早期人口，并允许对我们进行严格的考验 概念模型。我们将将200名主要护理人员及其0至3岁的孩子随机接收 查找或主动控制干预措施（所有参与者都将从推荐中接受成瘾治疗 来源）。 AIM 2量化发现对响应式育儿和相关护理人员的变化的主要影响 干预后的儿童结局以及6个月后这些影响的持久性。目标3 探索基本的神经机制，这些神经机制介导与发现相关的护理人员之间的关联 行为和照顾者/儿童结果以及这些机制的特异性，并评估 这些关联是由新生儿阿片类药物戒断或戒酒综合征调节的。集团内 分析还将检查干预保真度和剂量。此信息对于解决差异至关重要 对0-3岁儿童的幼儿干预措施的反应，以提高影响和可伸缩性。这些 结果将产生积极的影响，因为目前没有循证的，幼儿育儿的育儿 旨在在治疗环境中实施的干预措施。一个易于交付的程序，可以 在这些父母寻求治疗阿片类药物滥用时提供的提供，可能会促进其子女的成长和 降低风险。