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

描述（由申请人提供）：儿童被认为是礼物，在美国印第安人（AI）文化中扮演着核心角色。然而，人工智能儿童面临贫困、父母精神健康障碍、家庭接触药物使用、家庭暴力和虐待的风险较高，所有这些都增加了他们在青少年和成年人时期精神和身体健康状况不佳的风险。事实上，在资源贫乏的部落环境中，没有一种基于证据的项目可以管理，可以适应文化，可以输出，并具有可持续性的承诺。因此，这些脆弱的人工智能儿童的需求几乎完全没有得到满足。几十年的研究表明，婴儿期和幼儿期的安全依恋是一个关键的发展基石，可以预测在压力环境下长大的孩子的适应能力，并促进他们的恢复能力。因为安全依恋是从照顾者的敏感性和反应性发展而来的，所以在儿童早期解决照顾者的敏感性是至关重要的。因此，我们将测试促进第一关系（PFR）项目，这是一个理论驱动的、以关系和优势为基础的初级预防项目。几项研究表明，PFR对高危人群的照顾者-儿童关系有多种积极影响。华盛顿大学土著健康伙伴关系与位于蒙大拿州东北部偏远地区的派克堡部落建立了强有力的长期合作关系。部落的“长者参与倡议”指出，儿童和年轻人的健康和福祉是他们最关心的问题，并建议恢复传统的养育价值观。与我们的部落合作伙伴一起，我们将调整PFR以确保文化适宜性，然后进行随机对照试验，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在提高照顾者对儿童的敏感性方面的有效性（主要结局）。我们还将研究儿童对照顾者的依恋安全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提供者对照顾者和婴儿的培训前后态度和咨询策略来评估培训的充分性；3)比较PFR组和对照组在照顾者敏感性和反应性、儿童社会情感能力和依恋安全方面的差异。对于在压力环境下长大的人工智能儿童来说，迫切需要有效的初级预防干预措施。通过促进敏感的照顾和儿童依恋安全，我们可以最大限度地减少环境压力源对生活在佩克堡保留地的儿童的影响，培养适应能力，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.