MISC-IPV: A Community Based Intervention for Children Traumatized By Intimate Partner Violence

摘要 在美国，四分之一的儿童（26%）遭受亲密伴侣暴力（IPV）， 子女 非裔美国人 妇女IPV暴露构成了严重的创伤性应激环境， 对儿童心理社会后果的影响。虽然产妇分娩已被确定为一种 关键缓冲创伤对儿童的影响，目前的IPV育儿干预遭受 文化 不敏感 以及设计和方法上的局限性阻碍了可扩展性。我们的科学前提是 IPV创伤对儿童的不良影响可以通过干预来中断， 社区的准专业个案工作者提供服务， 已经向暴露于IPV的 非裔美国人 妇女本申请的目的是 调整既定的护理人员干预计划，提高护理人员敏感性的中介干预 （MISC），用于IPV， 非裔美国人 上下文（此后称为MISC-IPV）。将评价MISC-IPV 可接受性、可行性、初步机制和结果，以基于证据的 该框架包括三个目标（适应、过程评价、结果/调解人评价）。对于目标1， （适应），我们将通过一个 迭代过程 涉及定性访谈和焦点小组， IPV安置计划中的个案工作者和母亲 直到与上下文相适应 .文化适应 和适应IPV环境将由社区咨询委员会指导。目标2（执行 和过程评估），我们将招募 N = 132 母亲/儿童对（7至11岁的儿童）通过哈里斯 德克萨斯州休斯顿县家庭暴力协调理事会（HCDVCC）协作组织。一半将 随机分配至TAU+MISC-IPV vs. TAU。在对个案工作者进行初步培训后， （每两周）将提供TAU+MISC-IPV与TAU的干预会议。可行性，坚持性， 忠诚度将通过持续参与的百分比，个人访谈，视频 观察，以及基于数据的评估。对于目标3（结果和中介者），我们将评估 TAU+MISC-IPV与TAU在中断IPV暴露对儿童的创伤性影响方面的效果， 评估儿童在基线、6个月、12个月和18个月时的情绪、行为和创伤症状 在Aim 2中招募。将通过录像评估增强宣传能力的调解效果 观察和增加知识。在这项形成性研究结束时，我们将建立 基础评估和干预，以申请多中心RCT，全面测试疗效、介质， 和MISC-IPV的主持人。该项目将使一个具有文化敏感性的、发展性的 可运输、可扩展和可持续的基于证据和社区的干预措施， 变化机制，可作为未来IPV计划的模型，也适用于不同人群， 同时满足暴露于IPV的母亲和儿童的需求。

ABSTRACT One in four children (26%) in the U.S. are exposed to intimate partner violence (IPV), with higher rates among children of African American women. IPV exposure constitutes a traumatic stress environment with severe consequences for psychosocial outcomes in children. While maternal caregiving has been identified as a critical buffer against the effects of trauma on children, current IPV parenting interventions suffer from cultural insensitivity , and design and methodological limitations impeding scalability. Our scientific premise is that the adverse effects of IPV trauma on children can be interrupted through an intervention that enhances maternal caregiving capacity, and which is delivered by community-based paraprofessional caseworkers who are already delivering services to IPV-exposed African American women. The objective of this application is to adapt an established caregiver intervention program, Mediational Intervention for Sensitizing Caregivers (MISC), for the IPV and African American context (thereafter named MISC-IPV). MISC-IPV will be evaluated for acceptability, feasibility, and preliminary mechanisms and outcomes, guided by an evidence-based framework consisting of three aims (Adapt, Process Evaluation, Outcome/Mediator Evaluation). For Aim 1, (Adapt), we will adapt MISC through an iterative process involving qualitative interviews and focus groups with caseworkers and mothers in an IPV rehousing program until fit with context is achieved . Cultural adaptation and adaptation for the IPV context will be guided by a Community Advisory Board. For Aim 2 (Implementation and Process Evaluation), we will recruit N = 132 mothers/child pairs (children age 7 to 11) through the Harris County Domestic Violence Coordinating Council (HCDVCC) Collaborative of Houston, TX. Half will be randomly assigned to TAU+MISC-IPV vs. TAU. After initial training of caseworkers, one year of bi-weekly (every two weeks) intervention sessions of TAU+MISC-IPV vs. TAU will be delivered. Feasibility, adherence, and fidelity will be evaluated through percentage of sustained engagement, individual interviews, video-based observations, and questionnaire-based assessment. For Aim 3 (Outcomes and Mediators), we will evaluate the effects of TAU+MISC-IPV vs. TAU to interrupt the traumatizing effects of IPV exposure on children through assessing emotional, behavioral, and trauma symptoms at baseline, 6, 12, and 18 months in the children recruited in Aim 2. The mediational effects of enhanced caregiving capacity will be assessed through video observations and increase in knowledge. At the end of this formative study, we will have established the foundational assessments and intervention to apply for a multi-site RCT to fully test the efficacy, mediators, and moderators of MISC-IPV. This project will make possible a culturally sensitive, developmentally transportable, scalable, and sustainable evidence- and community-based intervention with proven in-vivo mechanisms of change that may serve as a model for future IPV programs also in different populations, that address the needs of IPV-exposed mothers and children simultaneously.