Identification of Newborns at High Risk for the Occurrence of Preventable Child Maltreatment

识别发生可预防的儿童虐待的高风险新生儿

• 批准号: 10475106
• 负责人: JOHN N. CONSTANTINO
• 金额: $ 27.67万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10475106
• 关键词: Affect; Age; Birth; Birth Records; Caring; Child; Child Abuse and Neglect; Child Development; Childhood; Clinical; Clinical Services; Consent; Data; Development; Discipline of obstetrics; Education; Family; Future; General Population; Health; Healthcare; Human Development; Individual; Infant; Influentials; Insurance Coverage; Intervention; Investigation; Life; Marital Status; Maternal Age; Medical Records; Mental Health; Methods; Mission; Modeling; Monitor; Neonatal Screening; Newborn Infant; Out-Migrations; Outcome; Parents; Patients; Policies; Policy Research; Population; Predictive Value; Pregnancy; Prenatal care; Prevention; Protocols documentation; Psychopathology; Readiness; Recording of previous events; Records; Reporting; Research; Research Training; Retrieval; Risk; Risk Assessment; Risk Factors; Sampling; Scientific Advances and Accomplishments; Screening Result; Sensitivity and Specificity; Services; Siblings; Smoking; Specificity; System; Testing; Time; Training; abortion; abuse neglect; abuse victim; advanced analytics; adverse outcome; arm; base; clinical care; cohort; early childhood; experience; feasibility testing; health record; high risk; indexing; innovation; insurance claims; intimate partner violence; maltreatment; maternal depression; modifiable risk; pediatric trauma; preservation; prevent; preventive intervention; primary care setting; primary caregiver; primary outcome; prospective; psychobiologic; response; screening; substance use; uptake

ABSTRACT Childhood maltreatment (CM) has highly deleterious effects on human development and is arguably the most influential, preventable cause of enduring psychopathology in the U.S. Infants and young children are at particularly high risk for physical harm from abuse and neglect, comprising over 60% of all child maltreatment fatalities. An increasing number of studies point to the ability to target prevention of CM by estimating individual-specific risk at the time of birth, on the basis of readily-available variables in birth records. The prospect of real-time identification of newborns at risk for CM on the basis of risk indicators available in obstetrical settings to be able to target prevention is exciting, but empirical testing of feasibility and predictive utility of methods are key to any systematic attempt to integrate this in U.S. obstetric or newborn clinical services. For example, birth record indices still identify a substantial number of children who do not go on to experience CM, making it important to attempt to optimize specificity (preserving sensitivity) with additional brief clinical screens or administrative data predictive risk modeling prior to broad implementation. Moreover, since screening is only as valuable as its actionability, it is important to understand whether screening results in uptake of needed preventive intervention and, in turn, whether this decreases actual CM. In a sample of 400 families enriched for risk for future CM, we contrast the predictive utility of three types of newborn screening for risk of future official-report of CM involving: a) birth record risk variables (BRRV) only; b) BRRV plus a brief clinical screen for maternal mental health and substance use status, childhood trauma and/or current intimate partner violence; and c) retrieval and analysis of a set of medical record and insurance claims variables (for each family) based on those included in a large-scale PRM effort of a separate Capstone center project during the study period. A RCT pilot arm of the study will explore the extent to which a brief, personalized education protocol for the primary caregiver enhances his/her engagement in intervention over care as usual. A second major aim of the project is to advance scientific understanding of the relationship between risk and outcome. Despite the established association between CM and psychopathology, the associated paths and mechanisms are still being identified, calling for more longitudinal investigation with the hope of identifying modifiable factors that can be targeted for intervention when prevention efforts are not successful. We will first determine whether CM report (as a primary outcome) is moderated by participation in services and/or changes in modifiable risk factors over the first 6 months of life. Next we will explore the extent to which infant developmental outcomes are moderated not only by CM, but by early psychobiological indices of vulnerability to its adverse consequences. The project responds to several priorities of the Capstone RFA (RFA-HD-18-012) as well as the mission of Center for Innovation in Child Maltreatment Policy, Research, and Training to prevent CM and promote healthy development of victims of abuse and neglect.

摘要 儿童期虐待(CM)对人类发展具有极大的有害影响，可以说是最严重的 在美国，有影响力的、可预防的持久精神病理学的原因。婴幼儿在 虐待和忽视造成身体伤害的风险特别高，占所有虐待儿童的60%以上 死亡事故。越来越多的研究指出，通过估计有针对性地预防CM 出生时个体特有的风险，基于出生记录中现成的变量。这个 基于可用风险指标实时识别CM高危新生儿的前景 产科设置能够有针对性地预防是令人兴奋的，但经验检验的可行性和预测性 方法的实用性是任何系统性尝试将其整合到美国产科或新生儿临床的关键 服务。例如，出生记录索引仍然确定了相当数量的儿童不会继续 体验CM，因此尝试通过额外的 在广泛实施之前，简要介绍临床筛查或管理数据预测性风险建模。此外， 由于筛查的价值取决于其可操作性，因此了解筛查结果是否有意义是很重要的 在接受所需的预防性干预方面，反过来，这是否会降低实际的CM。在400个样本中 我们对比了三种新生儿筛查对未来CM风险增加的预测效用 未来官员的风险--CM的报告涉及：a)仅出生记录风险变量(BRRV)；b)BRRV加一份简报 母亲心理健康和药物使用状况、童年创伤和/或当前亲密关系的临床筛查 伴侣暴力；c)检索和分析一套医疗记录和保险索赔变量(用于 每个家庭)基于包括在一个单独的Capstone中心项目的大规模PRM工作中的那些 学习期间。这项研究的一个RCT试点机构将探索简短的个性化教育在多大程度上 主要照顾者的协议加强了他/她参与干预而不是照常照顾。一秒钟 该项目的主要目的是促进对风险和结果之间关系的科学理解。 尽管CM和精神病理学之间已经建立了联系，但相关的途径和机制 仍在确定，需要进行更多的纵向调查，希望确定可修改的因素 当预防努力不成功时，可以有针对性地进行干预。我们将首先确定是否 CM报告(作为主要结果)通过参与服务和/或可更改风险的变化进行调整 在生命的前6个月中的因素。接下来，我们将探索婴儿发育结果的程度 不仅受到CM的影响，还受到对其不利影响的早期心理生物学指标的影响 后果。该项目响应了Capstone RFA(RFA-HD-18-012)的几个优先事项以及 儿童虐待政策、研究和培训创新中心的使命是预防CM和 促进虐待和忽视受害者的健康发展。