Testing the Efficacy of Early Head Start in Preventing Child Maltreatment: A Fift

描述（由申请人提供）：拟议研究的目的是通过对早期开端（EHS）对儿童虐待和忽视的影响进行严格研究来推进暴力预防科学。EHS是针对低收入婴幼儿及其家庭的初级预防项目。虽然EHS已被证明对与虐待有关的风险和保护因素有积极影响，但其在预防虐待和忽视方面的有效性尚未得到充分研究。拟议的项目通过以下方式解决了预防虐待科学方面的关键空白：(a)采用随机实验设计；(b)纵向跟踪大型研究样本（从出生到15岁），以评估长期预防结果；(c)利用记录在案的虐待报告作为衡量方案有效性的标准；(d)确定后期虐待的主要短期方案调解人；(e)区分项目对不同类型虐待（忽视、身体虐待和性虐待）的影响。虐待和忽视儿童对公共卫生的巨大影响、社会成本以及有害的短期和长期健康后果都有很好的记录，确定有效的虐待预防计划是疾病预防控制中心的优先领域。作为国内最大的服务于高危婴幼儿的项目之一，本研究的结果通过提供证据证明EHS项目可以减少危险和昂贵的儿童虐待，具有重大的政策影响潜力。如今，EHS仅为5%符合条件的儿童提供服务；对其有效性的进一步支持将有助于扩大和宣传工作，从而大大减少该国受虐待儿童的数量。此外，接受健康卫生服务的幼童最容易受到与虐待有关的伤害和死亡，因此最需要有效的循证预防服务。本研究将解决五个研究问题：(1)EHS是否有效减少参与研究的儿童和家庭中的儿童虐待？(2) EHS对早期儿童和父母结局的正向影响是否能中介后期项目对儿童虐待的影响？(3) EHS在防止特定儿童或家庭的虐待方面是否更有效？(4) EHS项目的哪些特点与更好的预防效果相关？(5) EHS组和对照组的儿童在遭受虐待的时间、类型、严重程度和/或长期性方面有何不同？本研究将使用在最近的试点研究中测试过的方法，以获得17个EHS项目中3001名儿童及其照顾者的儿童福利记录，这些儿童参加了1996年开始的项目影响的全国随机临床试验。该研究将把虐待数据与国家EHS研究中收集的广泛结果数据（访谈、观察和儿童14、24、36和60个月大时的直接儿童评估）联系起来。来自儿童福利案件档案的定性数据将使这项研究能够解决妨碍先前关于防止虐待和忽视儿童的研究的方法问题。

DESCRIPTION (provided by applicant): The purpose of the proposed research is to advance the science of violence prevention by conducting a rigorous study of the impact of Early Head Start (EHS) on child abuse and neglect. EHS is a primary prevention program for low-income infants, toddlers, and their families. Although EHS has been shown to positively impact risk and protective factors associated with maltreatment, its effectiveness in preventing abuse and neglect has not been well-studied. The proposed project addresses critical gaps in maltreatment prevention science by: (a) using a randomized experimental design; (b) following a large study sample longitudinally (birth to age 15) to assess long-term prevention outcomes; (c) utilizing documented reports of maltreatment as a measure program effectiveness; (d) identifying key short term program mediators of later maltreatment; and (e) differentiating program impacts for different types of abuse (neglect, physical abuse, and sexual abuse). The considerable public health impact, societal costs, and detrimental short and long-term health consequences of child abuse and neglect are well documented, and the identification of effective maltreatment prevention programs is a priority area for the CDC. As one of the largest programs serving at-risk infants and toddlers in the country, results from this study have significant potential for policy impact by providing evidence that the EHS program can reduce dangerous and costly child maltreatment. Today, EHS serves only 5% of eligible children; further support for its effectiveness will lend weight to expansion and advocacy efforts that could significantly reduce the number of children maltreated in this country. Further, the very young children served by EHS are most vulnerable to injury and death related to maltreatment, and thus most in need of effective evidence based prevention services. The present study will address five research questions: (1) Is EHS effective in reducing child maltreatment among participating children and families? (2) Do the positive impacts of EHS on early child and parent outcomes mediate later program effects on child maltreatment? (3) Is EHS more effective in preventing maltreatment for specific subgroups of children or families? (4) What characteristics of EHS programs are associated with better prevention outcomes? (5) How do children in EHS and the control group differ with regard to the timing, type, severity and/or chronicity of maltreatment experienced? This study will use methodology tested in a recent pilot study to obtain child welfare records for 3001 children and their caregivers in 17 EHS programs who participated in a national randomized clinical trial of program impacts starting in 1996. The study will link maltreatment data with the extensive outcome data collected in the national EHS study (interviews, observations, and direct child assessments when children were 14, 24, 36, and 60 months old). Qualitative data from child welfare case files will allow the study to address methodological issues that have hampered prior research on the prevention of child abuse and neglect.