Project 1

摘要研究项目1 研究项目1整合到转化中心，推动下一代研究 虐待儿童，将研究结果转化为临床和预防措施，并传播 为不同的利益相关者提供研究和最佳实践。在发展精神病理学的启发下，这项研究 在一个生命周期框架内整合了多个级别的分析。不断增长的最优方法知识 对于提供母婴双重预防干预在预防中具有至关重要的公共卫生意义 虐待儿童。项目1涉及一项随机对照试验，以评估是否扩大一个社区 卫生工作者(CHW)外展模式，增加了亲子心理治疗(CPP)，这是一种强化干预 将重点放在有虐待儿童风险的家庭的亲子关系上，提高对 改善母子关系，更敏感的育儿，更健康的儿童发展，以及虐待 预防。CPP的有效性已在虐待和其他高危人群中得到证明。 通过使用四个干预武器，评估将评估更密集的干预是否更好 与单独的CHW支持相比，保护儿童免受虐待，并将确定最佳时机 在这些干预措施中(即从产前或产后开始)，服务的最佳持续时间(即6对12 几个月)、影响机制(中介分析)，以及哪种干预策略对母亲最有效 不同的风险因素(主持人分析)。孕妇(N=300)及其婴儿出生后将 参与进来。纵向评估将在怀孕的最后三个月进行，在婴儿3岁时 9个月，12个月时进行干预后随访。每次所得的量度- 这一点构成了对孕产妇和儿童随时间的运作的丰富的多层次视角，以应对 干预措施。母亲的育儿行为、表征模型、认知和生理反应， 并将对婴儿的健康和发育进行纵向评估。CPP小组被假设为改善 敏感和反应灵敏的父母教养和安全依恋，相对于CHW单独的家访，因此 减少虐待儿童的风险。在母亲依恋表征、育儿方面的改进 认知和应激反应被认为是调节治疗结果的因素。主持人，包括 母亲的精神创伤史、精神病病史和亲密伴侣暴力史将提高对 对CHW和CPP的不同响应(什么对谁有效？为什么？)并允许量身定做 预防策略。确定提供服务的时间、剂量和强度，以及结果 调解人和主持人具有创新性，将促进制定有针对性的预防和干预措施 支持育儿和减少对这一弱势群体虐待儿童的战略。

ABSTRACT RESEARCH PROJECT 1 Research Project 1 is integrated into the TRANSFORM Center to promote the next generation of research on child maltreatment, translate research findings into clinical and preventive interventions, and disseminate research and best practice to varied stakeholders. Informed by developmental psychopathology, the research incorporates multiple levels of analysis within a lifespan framework. Increasing knowledge of optimal methods for delivering dual mother and child preventive intervention has crucial public health significance in preventing child maltreatment. Project 1 involves a randomized control trial to evaluate whether expanding a Community Health Worker (CHW) outreach model, by adding Child-Parent Psychotherapy (CPP), an intensive intervention that focuses on parent-infant relationships for families at risk for child maltreatment, increases efficacy for improved mother-child relationships, more sensitive parenting, healthier child development, and maltreatment prevention. The efficacy of CPP has been demonstrated with maltreated and other high-risk populations. Through the use of four intervention arms, the evaluation will assess whether more intensive intervention better protects against child maltreatment compared with CHW support alone, and will determine the optimal timing of these interventions (i.e., beginning prenatally or postnatally), the optimal duration of services (i.e., 6 vs. 12 months), mechanisms of effect (mediator analyses), and which intervention strategy works best for mothers with varying risk factors (moderator analyses). Pregnant women (N = 300) and their infants after birth will participate. Longitudinal assessments will occur during the third trimester of pregnancy, at infant's ages of 3 and 9 months, and a post-intervention follow-up at 12 months old. The measurements obtained at each time- point constitute a rich multi-level perspective of maternal and child functioning over time in response to the interventions. Maternal parenting behaviors, representational models, cognitions, and physiological reactivity, and infants' health and development will be assessed longitudinally. CPP groups are hypothesized to improve sensitive and responsive parenting and secure attachment, relative to CHW home visitation alone, thereby reducing risks for child maltreatment. Improvements in maternal attachment representations, parenting cognitions, and stress reactivity are hypothesized to mediate treatment outcomes. Moderators, including maternal histories of trauma, psychopathology, and intimate partner violence, will advance determination of differential responsiveness to CHW and CPP (what works for whom and why?) and allow for tailored preventive strategies. Identification of timing, dosage, and intensity of service delivery, along with outcome mediators and moderators is innovative and will facilitate development of targeted prevention and intervention strategies that support parenting and decrease child maltreatment for this vulnerable population.