Enhancing Ugandan HIV-Affected Child Development with Caregiver Training

描述(由申请人提供)：旨在改善儿童健康和福祉的以家庭为基础的育儿计划已在一系列结果中证明是成功的。然而，通过父母态度和行为的改变，家庭中的其他儿童在多大程度上也从这些计划中受益，还没有得到严格的调查。这一专题对于促进青年的积极发展和预防情绪和行为问题具有深远的影响，特别是在家庭规模大、儿童经常面临重大逆境、获得精神健康服务的机会极其有限的低资源环境中。一项针对弱势人群的随机对照试验--敏感照顾者中介干预(MISC)--已经得到资助，该试验为弱势人群提供了看护人培训干预，以调查干预措施对艾滋病毒感染者和受艾滋病毒影响的幼儿(2-5岁)的神经发育、心理和社会结局的影响(MPI：BASS，Boivin：1R01HD070723-01)。研究方法平均有2.7名12岁以下的儿童居住在我们的研究之家，我们预计招募大约170名MISC家庭的儿童和170名对照家庭的儿童，以调查MISC计划对家庭中其他儿童的分散效应，使用受HIV影响的研究队列。将调查的具体儿童结果包括：马伦的发展成果、执行功能行为评定表(Brief)、照顾者管理的Achenbach CBCL版本、生长和发育的身体健康衡量标准以及学校参与度。作为本补充资料的一部分，将调查的家庭水平结果包括使用麦克马斯特家庭评估工具(FAD)评估的家庭功能、家庭规模，以及通过使用家庭图评估的家庭关系。这项补充补助金的具体目的是：目标1：评估MISC家庭中非R01学习儿童的照顾者培训是否比对照家庭中非R01学习儿童在功能上有更大的改善。目的2：评估照顾者培训和非R01研究儿童结局之间关系的潜在中介因素。目的3：评估照顾者培训和非R01研究儿童结果之间关系的潜在调节因素，包括儿童年龄、儿童性别、照顾者健康和家庭规模。创新和影响这款补充品通过严格测试MISC干预措施造福家庭中多个孩子的潜力，在父母R01之外进行了创新。考虑到乌干达相对较大的家庭规模和严重的财政和人力资源限制，照顾者干预可以改善多个孩子的福祉，这是一个在全国范围内推广的有希望的计划。通过探索调解人和主持人获得的信息将允许进一步的干预适应，以最大限度地提高干预对不止一个被研究儿童的有效性。总体而言，这项研究是对最近提出的创新战略的响应，以解决被称为“全球精神健康危机”的问题。在这种危机中，精神健康的需求远远超过了在资源匮乏的环境中提供的服务。因此，这些发现具有在国际上应用于其他高危人群的令人兴奋的潜力。

DESCRIPTION (provided by applicant): Home-based parenting programs aimed at improving a child's health and well-being have demonstrated success across a range of outcomes. However, the degree to which other children in the home also benefit from these programs via changes in parental attitudes and behaviors has not been rigorously investigated. This topic has far-reaching implications for promoting positive youth development and preventing emotional and behavioral problems, particularly in low-resource settings in which family sizes are large, children often face significant adversity, and access to mental health services is extremely limited. A randomized controlled trial with a promising caregiver training intervention for vulnerable populations, the Mediational Intervention for Sensitizing Caregivers (MISC), has already been funded to investigate the intervention impact on neurodevelopmental, psychological and social outcomes (MPI: Bass, Boivin: 1R01HD070723-01) among HIV-infected and HIV-affected young children (ages 2-5). Study Methods With on average 2.7 children under age 12 years living in our study homes, we expect to recruit approximately 170 children in the MISC homes and 170 children in the control homes to investigate dispersion effects of the MISC program to other children in the home, using the HIV-affected study cohort. The specific child outcomes that will be investigated include: development gains on the Mullen, the Behavior Rating Inventory of Executive Functioning (BRIEF), and the caregiver administered version of the Achenbach CBCL, physical health measures of growth and development, and school participation. Family level outcomes that will be investigated include as part of this supplement include family functioning assessed using the McMaster Family Assessment Device (FAD), family size, and familial relationships through the use of a household diagram. The specific aims of this supplement grant are: Aim 1: To evaluate whether caregiver training produces greater improvements in functioning among non-R01 study children in the MISC homes compared with non-R01 study children in the control homes. Aim 2: To assess potential mediators of the association between caregiver training and non-R01 study child outcomes. Aim 3: To assess potential moderators of the association between caregiver training and outcomes in the non-R01 study children, including child age, child sex, caregiver health, and family size. Innovation and impact This supplement innovates beyond the parent R01 by rigorously testing the MISC intervention's potential to benefit multiple children in the home. Given relatively large family sizes in Uganda and severe financial and human resource limitations, a caregiver intervention that improves the well-being of multiple children is a promising program for nation-wide scale up. Information gained through the exploration of mediators and moderators will allow further intervention adaptation to maximize intervention effectiveness to more than just a single study child. Broadly, this study is responsive to recent calls for innovative strategies to address what has been termed a "global mental health crisis" in which mental health needs far outpace available services in low-resource settings. As such, findings have exciting potential for application with other high-risk populations internationally.