RANDOMIZED, CONTROLLED TRIAL TO PREVENT CHILD VIOLENCE

儿童和青少年暴力仍然是我们今天最紧迫的公共卫生问题之一。卫生保健提供者在处理暴力后果时往往发挥着关键作用。与其他伤害一样，儿科提供者是预防的必要代理人之一。因此，各大卫生组织发布了将预防暴力纳入儿童和青少年日常初级保健的指导方针。目前，只有有限的工具可用于帮助儿科临床医生在常规办公室访问期间以一致的方式解决与暴力预防有关的问题。此外，没有经验证据表明这些方法对父母或孩子的行为是否有效。维克森林大学医学院（WFUSM）和美国儿科学会（AAP）儿童健康研究中心（CCHR）将合作评估儿科临床医生干预的有效性，该干预已进行了广泛的试点测试。儿科办公室研究（PROS）是CCHR的一个项目，是一个由参与研究的临床医生组成的全国性网络。他们的成员包括全国500多家诊所和1500名临床医生。PROS实践将被随机分配到干预组（安全检查）或使用注意力安慰剂的对照组。安全检查将涉及四个方面的行为：媒体使用；父母使用体罚技术；枪支所有权和储存；以及家庭/同伴之间的肢体冲突。研究的每一组将有68个实践，136个提供者和3,536名患者。该研究旨在收集足够数量的拉丁裔和非裔美国患者的数据，以评估干预是否对不同文化/种族有不同的影响。干预包括4个部分：(1)社区暴力预防工作表（用于指导识别社区特定暴力预防资源的实践），(2)针对有2-11岁儿童的患者家庭的家庭行为调查，在候诊室完成，确定问题区域，(3)提供者直接使用的建议指南，以教育和参与这些问题的患者家庭，以及(4)“有形工具”来帮助家庭坚持提供者的建议。评估的两个主要结果将是儿科医生的预期指导行为和患者家属的行为，例如媒体使用、纪律、枪支储存和家庭/同伴打架。数据将在基线访问时收集，并在1个月和6个月后通过电话访谈对患者家属进行随访。必须努力减少青年暴力的社会发病率。这项研究开辟了新的领域，作为第一个全国性的随机对照试验，重点是测试儿科提供者综合暴力预防计划的有效性。到目前为止，还没有数据驱动主要医疗机构发布的指导方针；这项研究将为此提供科学可靠的数据。

Child and adolescent violence remains one of our most pressing public health problems today. Health care providers often serve critical roles when treating the results of violence. As with other injuries, pediatric providers serve as one of the necessary agents for prevention. Consequently, major health organizations have issued guidelines for incorporating violence prevention into routine primary care for children and adolescents. Currently, only limited tools are available to help pediatric clinicians address violence prevention-related issues in a consistent manner during the routine office visit. Moreover, no empirical evidence exists for the effectiveness of such approaches on parents or children's behaviors. Wake Forest University School of Medicine (WFUSM) and the American Academy of Pediatrics (AAP) Center for Child Health Research (CCHR) will collaborate to evaluate the effectiveness of a pediatric clinician's intervention that has been extensively pilot tested. Pediatric Research in Office Settings (PROS), a program of the CCHR, is a national network comprised of practice- based clinicians experienced in research participation. Their membership consists of more than 500 practices and 1500 clinicians across the country. PROS practices will be randomly assigned to either the intervention arm (Safety Check) or the control arm with an attention placebo. Safety Check will address four areas of behavior: media use; parental use of physical disciplining techniques; gun ownership and storage; and family/peer physical fights. Each arm of the study will have 68 practices, 136 providers, and 3,536 patients. The study will aim to gather data on sufficient numbers of Latino and African American patients to evaluate if the intervention has different effects on differing cultures/ethnicities. The intervention consists of 4 components: (1) a community violence prevention worksheet (to guide practices in identifying community specific violence prevention resources), (2) a household behavior survey for patient families with children 2-11 years to complete in the waiting room, identifying problem areas, (3) a recommendation guide that the provider directly utilizes to educate and engage the patient family on these issues, and (4) "tangible tools" to help the family adhere to provider recommendations. The two primary outcomes evaluated will be the pediatric provider's anticipatory guidance behaviors and the patient family's behaviors, e.g. media use, discipline, gun storage, and family/peer fights. Data will be collected at the baseline visit with patient family follow-up 1 and 6 months later via telephone interviews. Efforts to reduce the social morbidity of youth violence are essential. This study breaks new ground, serving as the first national randomized controlled trial focused on testing the effectiveness of a comprehensive violence prevention program for pediatric providers. As yet, there are no data driving the guidelines issued by major medical organizations; this study will provide scientifically sound data to do so.