A Selected Prevention RCT to Address Parenting in a WIC population

描述（由申请人提供）：虐待儿童是一个主要的公共卫生问题，在美国，每年有超过600万儿童被转介到儿童保护服务机构，超过60万例被证实的案件。一些家访计划已被证明在降低虐待风险、促进积极育儿和改善儿童结局方面有效。然而，这些方案针对的是经过严格挑选的高风险目标人群，需要大量资源，不可能在普遍范围内实施。有必要测试成本相对较低、资源密集程度较低、适合于更大和更普遍的目标人群的育儿干预措施。我们的长期目标是扩大低资源密集型和广泛适应性干预措施的证据基础，这些干预措施有效地针对养育结果，以降低广泛接触环境中儿童身体虐待的风险，例如为WIC或其他儿科人群服务的中心。本研究的目的是测试两个这样的干预措施的有效性，促进有效的养育和减少儿童身体虐待的风险相比，“通常的照顾”的父母在WIC诊所的教育。该人群中有15个月至5岁儿童的父母（n=1200）将被随机分配到3个条件之一：（1）仅Triple P-Level 2（L2）干预，（2）Play Nicely干预，或（3）“常规护理”对照组。这项研究的基本原理是能够为父母服务或为大量父母服务的诊所中心提供信息，这些父母有兴趣采用相对低成本，低资源密集的干预措施，以减少 儿童遭受身体虐待的风险以及对儿童健康和发展的相关风险。我们的具体目标如下：（1）测试简短的基于诊所的干预措施（三重P-L2和玩得好），旨在解决父母在管理困难的儿童行为在选定的家庭人口的有效性。我们的工作假设是，在这些条件下，与控制条件相比，父母的结果将得到改善;（2）确定干预的有效性是否被父母的感知规范所改变。我们的工作假设是，专业人士的父母（例如，儿科医生、心理健康和宗教）支持物理纪律将与干预有效性降低相关。这些低资源密集型的育儿干预措施有望改变育儿态度，自我效能感和与儿童身体虐待风险相关的行为。即使在大规模选定或普遍的目标人群中，这种风险的微小降低也会对整个人群产生巨大的益处（即，预防性骚扰）。降低有问题的父母做法的比率将导致改善儿童的发展和行为。此外，通过减少累积的不良童年经历和早期毒性压力，这些干预措施还有望有助于长期减少健康差距和主要公共卫生问题的风险，如吸烟、肥胖、吸毒、危险性行为、精神健康障碍和心脏病等。

DESCRIPTION (provided by applicant): Child maltreatment is a major public health problem with over 6 million children involved in 3.4 million referrals to Child Protective Services and ove 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 abl 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.