A Primary Prevention Trial to Strengthen Child Attachment in a Native Community

描述(由申请者提供)：儿童被认为是天赋，在美国印第安人(AI)文化中扮演着核心角色。然而，人工智能儿童经历贫困、父母心理健康障碍、家庭暴露于药物使用、家庭暴力和虐待的风险增加，所有这些都增加了他们在青少年和成年后心理和身体健康结果不良的风险。几乎没有基于证据的项目可以在资源匮乏的部落环境中管理，可以适应文化，可以出口，并具有可持续性的希望。因此，这些易受伤害的人工智能儿童的需求几乎完全得不到满足。几十年的研究表明，婴儿期和幼儿期的安全依恋是儿童在压力环境下成长的关键发展基石，可以预测他们的适应能力，并提高他们的适应能力。由于安全依恋是由照顾者的敏感度和反应性发展而来的，因此在儿童早期解决照顾者的敏感度是至关重要的。因此，我们将测试促进第一关系(PFR)计划，这是一个理论上驱动的、基于关系和优势的初级预防计划。一些研究表明，PFR对高危人群的照顾者-儿童关系具有不同的积极影响。华盛顿大学原住民健康伙伴关系与佩克堡部落建立了牢固的长期合作关系，佩克堡部落的保留地位于蒙大拿州东北部的一个偏远地区。部落的长老参与倡议表示，儿童和年轻人的健康和福祉是他们的首要关切，建议回归传统的育儿价值观。与我们的部落伙伴一起，我们将调整PFR以确保文化适当性，然后进行一项随机对照试验，将PFR干预与接受资源和转诊信息的对照组进行比较。我们的主要目的是测试PFR在改善照顾者对儿童的敏感性方面的有效性(主要结果)。我们还将检查儿童对照顾者的依恋安全性以及儿童的社会和情感功能。我们的具体目标是：1)使用焦点小组调整PFR干预；2)通过检查社区PFR提供者在培训前后对照顾者和婴儿使用的态度和咨询策略来评估培训的充分性；以及3)比较PFR和对照组在照顾者的敏感性和反应性以及儿童的社会和情感能力和依恋安全方面的差异。对于在压力环境中长大的AI儿童来说，迫切需要有效的初级预防干预措施。通过促进敏感的照料和儿童依恋安全，我们可以最大限度地减少背景压力对居住在派克堡保留地的儿童的影响，并培养复原力，改善他们的风险前景。

DESCRIPTION (provided by applicant): Children are considered gifts and play a central role in American Indian (AI) culture. However, AI children are at elevated risk for experiencing poverty, parental mental health disorders, household exposure to substance use, domestic violence, and maltreatment, all of which increase their risk of poor mental and physical health outcomes as adolescents and adults. Virtually no evidence-based programs exist that can be administered in a resource-poor tribal setting, can be culturally adapted, can be exported, and hold promise for sustainability. The needs of these vulnerable AI children, thus, remain almost entirely unmet. Decades of research have shown that secure attachment in infancy and early childhood is a key developmental building block that predicts adjustment and promotes resilience in children who grow up under stressful circumstances. Because secure attachment develops from caregiver sensitivity and responsiveness, it is critical to address caregiver sensitivity in early childhood. We will, therefore, test the Promoting First Relationships (PFR) program, a theoretically driven, relationship- and strengths-based primary prevention program. Several studies have shown the diverse positive effects of PFR on the caregiver-child relationship for at-risk populations. The University of Washington Partnerships for Native Health have nurtured a strong, long term collaboration with the Fort Peck Tribes, whose reservation lies in a remote area of northeastern Montana. The tribes' Elders Involved Initiative has stated that the health and well-being of children and young adults are their primary concern, recommending a return to traditional parenting values. With our tribal partner, we will adapt PFR to ensure cultural appropriateness, then conduct a randomized, controlled trial to compare the PFR intervention with a control group receiving information on resources and referrals. Our primary purpose is to test the effectiveness of PFR in improving the caregiver's sensitivity to the child (primary outcome). We will also examine child attachment security to the caregiver and the child's social and emotional functioning. Our specific aims are to 1) adapt the PFR intervention using focus groups; 2) assess the adequacy of training by examining the pre- and post-training attitudes and consultation strategies used by community-based PFR providers with caregivers and infants; and 3) compare the PFR and control group on caregivers' sensitivity and responsiveness and children's social and emotional competencies and attachment security. Effective primary preventive interventions are critically needed for AI children who grow up under stressful circumstances. By promoting sensitive caregiving and child attachment security, we can minimize the impact of contextual stressors on children living on the Fort Peck reservation and, foster resilience, and improve their risk outlook.