In-home prevention of SA risks for Native teen families

描述(由申请人提供)：美国印第安人(Al)妇女在十几岁时生第一个孩子的比例(46%)几乎是美国任何其他种族或民族(25%)的两倍。保留生活增加了青少年母亲的挑战，并将她们和她们的孩子置于药物滥用和其他健康和行为问题的巨大终身风险中。二十年的研究支持产前和早期儿童护士提供的有效性，家访计划，以防止低收入者、十几岁的母亲及其子女的健康和行为问题。鉴于年轻的Al家庭面临的风险因素和保留地土著护士的短缺，建议进行一项随机对照试验，以评估针对保留地Al青少年母亲及其子女的文化适应、准专业人员提供的家访计划的有效性。自1998年以来，国家验证的干预模式在研究社区内进行了选择、调整和试点。来自四个保留社区的符合条件的准Al青少年(N=320)，年龄12-19岁，怀孕长达28周-将被随机(1：1)分配到家庭精神干预(FS)+优化标准护理与单独优化标准护理(OSC)。FS干预是一个52个疗程的家访计划，由Al准专业人员提供，从怀孕开始，一直持续到孩子24个月大(大约27个月)。OSC参与者可以免费前往标准的产前和健康婴儿探视，以及与青少年母亲有关的书面健康促进材料。蒙面独立评估者将以多个间隔评估父母的能力以及母婴健康和行为结果，直到孩子36个月大。这些研究方法已经在SAMHSA资助的初步研究中进行了试点。约翰霍普金斯美国印第安人健康中心是申请机构和协调中心，与参与的阿勒颇社区合作已有22年的历史。这一应用程序的顾问是育儿、家访干预和儿童早期评估方面的专家。

DESCRIPTION (provided by applicant): Nearly twice as many American Indian (Al) women have their first child during their teenage years (46%) than any other racial or ethnic group in the United States (25%). Reservation life compounds challenges for Al teen mothers, and places them and their children at significant lifetime risk for drug abuse and other health and behavior problems. Two decades of research support the efficacy of prenatal and early childhood nurse delivered, home visiting programs to prevent health and behavior problems for low income, teen mothers and their children. Given the risks factors confronting young Al families and the shortage of indigenous nurses on reservations, a randomized controlled trial is proposed to assess the efficacy of a culturally-adapted, paraprofessional delivered, home visiting program for reservation-based Al teen mothers and their children. The nationally proven intervention model was selected, adapted, and piloted within the study communities since 1998. Eligible expectant Al teens (N=320), ages 12-19 and up to 28 weeks gestation from four reservation communities-will be randomized (1:1) to the Family Spirit Intervention (FS) + Optimized Standard Care vs. Optimized Standard Care (OSC) alone. The FS intervention is a 52-session home visiting program, delivered by Al paraprofessionals, beginning in pregnancy and continuing until the child is 24 months old (approximately 27 months). OSC participants receive free transportation to standard prenatal and well baby visits and written health promotion materials relevant to teen mothers. Masked independent evaluators will assess parental competence, and mother and child health and behavior outcomes at multiple intervals until the child is 36 months old. The study methods have been piloted in preliminary studies funded by SAMHSA. The Johns Hopkins Center for American Indian Health, the applicant institution and coordinating center, has a 22-year history of working with the participating Al communities. Consultants to this application are expert in parenting, home visiting interventions and early childhood assessment.