A Selected Prevention RCT to Address Parenting in a WIC population

摘要：儿童虐待是一个严重的公共卫生问题，2014年有超过600万儿童受到虐待

ABSTRACT: Child maltreatment is a major public health problem with over 6 million children involved in 3.4 million referrals to Child Protective Services and over 600,000 substantiated cases in the US annually. Some home visitation programs have been shown to be effective in reducing risk for abuse, promoting positive parenting, and improving child outcomes. However, such programs are aimed at narrowly selected, high-risk target populations, are high-resource intensive, and are not feasible for implementation on a universal scale. There is a need to test parenting interventions that are relatively low-cost, low-resource intensive, and adaptable to larger and more universal target populations. Our long-term goal is to enlarge the evidence base for low resource-intensive and widely adaptable interventions that effectively target parenting outcomes to reduce risk of child physical abuse in settings with broad reach, such as centers serving WIC or other pediatric populations. The objective of this study is to test the effectiveness of two such interventions in promoting effective parenting and reducing child physical abuse risk as compared with "usual care" parenting education in WIC clinics. Parents (n=1200) in this population with children 15 months to 5 years of age will be randomly assigned to one of 3 conditions: (1) Triple P-Level 2 only (L2) intervention, (2) Play Nicely intervention, or (3) a "usual care" control group. The rationale for this study is to be able to inform policy for parent service or clinic centers serving high-volumes of parents that are interested in adopting relatively low-cost, low-resource intensive interventions in order to reduce risk of child physical abuse and related risks to child health and development. Our specific aims are as follows: (1) Test brief clinic-based interventions (Triple P-L2 and Play Nicely) aimed at addressing parenting effectiveness in managing difficult child behavior in a selected population of families. Our working hypothesis is that parenting outcomes will be improved in each of these conditions as compared to the control condition; and (2) Determine if intervention effectiveness is modified by parents' perceived norms. Our working hypothesis is that stronger perceived injunctive norms by parents of professionals (e.g., pediatricians, mental health, and religious) supportive of physical discipline will be associated with reduced intervention effectiveness. These low-resource intensive parenting interventions are expected to shift parenting attitudes, self-efficacy, and behaviors linked with child physical abuse risk. Even small reductions in such risk across large selected or universal target populations can result in large benefits to the whole population (i.e., Prevention Paradox). Lowered rates of problematic parenting practices will lead to improved child development and behavior. Further, by contributing to a reduction in cumulative adverse childhood experiences and early toxic stress, these interventions are also expected to contribute to a long-term reduction in health disparities and risk for major public health problems such as smoking, obesity, drug abuse, risky sexual behavior, mental health disorders, and heart disease among others.