In-home prevention of SA risks for Native teen families

描述（由申请人提供）：美国印第安妇女在青少年时期生育第一个孩子的人数（46%）几乎是美国其他种族或族裔群体（25%）的两倍。保留生活给未成年母亲带来了更大的挑战，并使她们和她们的孩子终生面临滥用药物和其他健康和行为问题的重大风险。二十年的研究支持产前和幼儿期护士上门服务的有效性，为低收入青少年母亲和她们的孩子预防健康和行为问题。考虑到年轻的人工智能家庭面临的风险因素和保留地土著护士的短缺，我们提出了一项随机对照试验，以评估一项文化适应、辅助专业人员提供的、针对保留地人工智能青少年母亲及其子女的家访计划的效果。自1998年以来，在研究社区中选择、调整和试点了全国公认的干预模式。来自四个保留社区的年龄在12-19岁，怀孕28周的符合条件的准青少年（N=320）将被随机（1:1）分配到家庭精神干预(FS) +优化标准护理vs优化标准护理（OSC）单独。FS干预是一项52期的家访计划，由人工智能辅助专业人员提供，从怀孕开始一直持续到孩子24个月大（大约27个月）。OSC参与者可免费乘车前往标准的产前和婴儿健康检查，并获得与青少年母亲有关的书面健康促进材料。蒙面的独立评估人员将在多个时间间隔内评估父母的能力，以及母亲和儿童的健康和行为结果，直到儿童36个月大。这些研究方法已在SAMHSA资助的初步研究中试用。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，与参与的人工智能社区合作已有22年的历史。这项申请的顾问是育儿、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.