TRANSLATING EFFECTIVE MALTREATMENT INTERVENTION INTO THE COMMUNITY

描述（由申请人提供）：目前的提案旨在开发和测试以证据为基础的育儿干预措施转化为以社区为基础的计划，旨在减少虐待儿童。具体来说，我们建议翻译游戏和学习策略计划（帕尔斯;兰德里和史密斯，1996年;史密斯，等2000年;兰德里，等，2001年），一个以证据为基础的计划证明，增加响应式养育，从而促进健康的婴儿社会情感发展。该帕尔斯计划已被证明在一个人，一对一，母亲教练的关系与忠诚和有效性。然而，在这种有效性的证据，教练的作用仍然在研究范围内。试图更广泛地传播这一计划到社区遇到了许多障碍的有效性;特别是那些有关提供必要的培训和支持，以社区为基础的教练，以服务于家庭的水平，研究教练以前已经证明（格拉斯哥，马库斯，公牛，威尔逊，2004年）。通过我们之前的工作（Infant Net;费勒，Baggett，Davis，et al，2008），我们已经为帕尔斯计划开发了一个基于互联网的交付系统，该系统利用互联网的力量促进社区父母和训练有素的帕尔斯教练之间的有效联系。通过利用Infant Net交付平台，我们有机会通过将社区服务组织内的家访者直接与经过专业培训的帕尔斯计划顾问联系起来，解决关键的传播障碍，以便提供有效实施基于社区的计划所需的必要培训和持续支持。正是在这一背景下，与2010年“健康人”关于健康婴幼儿的目标相一致，我们将追求以下目标：目标1）在社区实施的准备过程中，我们将进行为期6个月的开发阶段，在此阶段，我们将调整现有的婴儿净帕尔斯材料，使其适应必要的环境，通过以下方式将方案实施转化为不同的社区：a）调整现有的培训和辅导材料，以更好地反映社区家庭访问者与计划顾问的支持关系;以及B）将帕尔斯计划的现有西班牙语翻译覆盖到计算机交付平台上，以增加计划对语言多样化社区的覆盖;和目标2）在我们为社区机构家访工作人员提供带有“眼球”摄像头的笔记本电脑，并在每个还没有无线互联网接入的社区机构安装无线互联网接入后，我们将继续实施我们的社区适应干预措施，家庭访客婴儿网（婴儿网HV），在堪萨斯州13个县的9个健康家庭（HF）方案中。我们的实现方法将采用3波迭代实现设计的形式，其中每个波都将提供反馈，以通知后续的波实现。在这三个阶段，我们将在9个HF站点、18个家庭访问者和270个高危家庭中实施。将评估社区适应的循证计划的可翻译性，以了解已知的传播障碍对计划覆盖范围、吸收、可行性、忠诚度的影响，以及由此产生的次级母婴健康结果。还将对该计划进行初步成本分析，以便向社区网站提供这些信息，供其查看与自己的运营预算和先前干预工作相关的信息。所有项目信息都将提交给健康家庭领导层，并评估其在随后与婴儿净HV方案的维持和可持续性有关的政策支持方面的潜力。为了进一步支持维护和可持续性工作，来自每一波实施的迭代社区反馈，包括“不起作用”的文档，将被总结并放入社区实施手册中，以伴随项目结果。 公共卫生相关性：

DESCRIPTION (provided by applicant): The current proposal seeks to develop and test the translatability of an evidence-based parenting intervention into a community-based program aimed at reducing child maltreatment. Specifically, we propose to translate the Play and Learning Strategies program (PALS; Landry & Smith, 1996; Smith, et al 2000; Landry, et al, 2001), an evidence-based program demonstrated to increase responsive parenting and thereby promote healthy infant social emotional development. The PALS program has been demonstrated to operate with fidelity and effectiveness within an in-person, one-to-one, mother-coach relationship. However, within this effectiveness evidence, the role of coach has remained within the research context. Attempts to more broadly disseminate this program into the community have met with many barriers to effectiveness; particularly those related to the provision of training and support necessary for community-based coaches to serve families at the level that research coaches have previously demonstrated (Glasgow, Marcus, Bull, & Wilson, 2004). Through our prior work (Infant Net; Feil, Baggett, Davis, et al, 2008), we have developed an internet-based delivery system for the PALS program, one that harnesses the power of the internet to facilitate efficient connections between the community parents and trained PALS coaches. By utilizing the Infant Net delivery platform, we have the opportunity to address critical dissemination barriers through linking home visitors within community service organizations directly to professionally-trained PALS program consultants in order to provide the necessary training and ongoing support required for effective community-based program implementation. It is within this context, consistent with Healthy People 2010 goals pertaining to Healthy Infants and toddlers, that we will pursue the following: Objective 1) In preparation of community implementation, we will conduct a 6-month development phase in which we will adapt existing Infant Net PALS materials into the necessary context to translate program implementation into diverse communities by: a) adapting existing training and coaching materials to better reflect a community home visitor-program consultant support relationship; and b) overlaying the existing Spanish translation of the PALS program onto the computer-delivery platform to increase program reach to linguistically diverse communities; and Objective 2) Following our provision of laptops with "eye-ball" cameras to community agency home visiting staff and installation of wireless Internet access in each community agency who does not already have it, we will proceed with implementation of our community-adapted intervention, Infant Net for Home Visitors (Infant Net-HV), within nine Healthy Families (HF) programs spanning a 13-county region in the state of Kansas. Our implementation approach will take the form of a 3-wave, iterative implementation design in which each wave will provide feedback to inform subsequent wave implementations. Across the 3 waves, we will implement with nine HF sites, 18 home visitors, and 270 at-risk families. Translatability of the community-adapted, evidence-based program will be assessed relative to the impact of known barriers to dissemination on program reach, uptake, feasibility, fidelity and, by virtue, secondary mother and infant health outcomes. An initial cost analysis of the program will also be performed in order to provide this information to community sites for viewing relative to their own operating budgets and prior intervention efforts. All project information will be presented to Healthy Families leadership and assessed as to its potential for subsequent policy support related to maintenance and sustainability of the Infant Net-HV program. In further support of maintenance and sustainability efforts, iterative community feedback from each wave of implementation, including the documentation of things that "didn't work", will be summarized and placed into a Community Implementation Manual to accompany project results. PUBLIC HEALTH RELEVANCE: