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

加强原住民社区儿童依恋的初级预防试验

• 批准号: 8874009
• 负责人: CATHRYN BOOTH-LAFORCE
• 金额: $ 50.41万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-18 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8874009
• 关键词: Address; Adolescence; Adolescent; Adult; Alcohol or Other Drugs use; American Indians; Area; Attitude; Behavior; Caregivers; Child; Child Behavior; Child Development; Child Rearing; Childhood; Cognitive; Collaborations; Communities; Consultations; Control Groups; Development; Distance Learning; Domestic Violence; Educational workshop; Effectiveness; Ego; Elderly; Emotional; Ensure; Evidence based program; Exhibits; Exposure to; Family; Focus Groups; Fostering; Gifts; Head Start Program; Health; Health Personnel; Homelessness; Household; Infant; Intervention; Life; Linguistics; Link; Logistics; Low income; Measurable; Mediating; Medicine; Mental Health; Mental disorders; Meta-Analysis; Modeling; Montana; Mothers; Outcome; Parents; Participant; Personal Satisfaction; Persons; Play; Populations at Risk; Poverty; Prevention program; Prevention trial; Preventive Intervention; Primary Prevention; Principal Investigator; Provider; Qualitative Methods; Randomized Controlled Trials; Research; Reservations; Resources; Risk; Role; Rural; School Nursing; Secure; Security; Social Workers; Substance abuse problem; Testing; Toddler; Training; Tribes; Trust; Universities; Vulnerable Populations; Washington; Work; adverse outcome; aged; base; caregiving; design; early childhood; experience; foster care; improved; infancy; innovation; maltreatment; meetings; novel; physical conditioning; primary outcome; programs; public health relevance; resilience; self esteem; social; social skills; stressor; theories; tribal community; young adult

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.

描述（由申请人提供）：儿童被视为礼物，在美洲印第安人 (AI) 文化中发挥着核心作用。然而，人工智能儿童经历贫困、父母心理健康障碍、家庭物质使用、家庭暴力和虐待的风险较高，所有这些都增加了他们作为青少年和成年人的心理和身体健康状况不佳的风险。事实上，不存在能够在资源匮乏的部落环境中实施、能够适应文化、能够出口并有望实现可持续性的基于证据的计划。因此，这些弱势人工智能儿童的需求几乎完全没有得到满足。数十年的研究表明，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成长的儿童的适应能力并提高其适应能力。由于安全依恋是从照顾者的敏感性和反应能力发展而来的，因此在幼儿期解决照顾者的敏感性至关重要。因此，我们将测试促进第一关系（PFR）计划，这是一个理论驱动的、基于关系和优势的一级预防计划。多项研究表明，PFR 对高危人群的照护者与儿童的关系具有多种积极影响。华盛顿大学土著健康合作伙伴关系与佩克堡部落建立了强有力的长期合作关系，该部落的保留地位于蒙大拿州东北部的偏远地区。部落的“老年人参与倡议”表示，儿童和年轻人的健康和福祉是他们最关心的问题，建议回归传统的育儿价值观。我们将与我们的部落合作伙伴一起调整 PFR 以确保文化适当性，然后进行随机对照试验，将 PFR 干预措施与接收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 在提高看护者对孩子的敏感性方面的有效性（主要结果）。我们还将检查儿童对照顾者的依恋安全感以及儿童的社交和情感功能。我们的具体目标是 1) 利用焦点小组调整 PFR 干预措施； 2) 通过检查社区 PFR 提供者对护理人员和婴儿的培训前和培训后态度以及咨询策略来评估培训的充分性； 3) 比较 PFR 和对照组看护者的敏感性和反应性以及儿童的社交和情感能力以及依恋安全性。对于在压力环境下成长的人工智能儿童来说，迫切需要有效的初级预防干预措施。通过促进敏感的护理和儿童依恋安全，我们可以最大限度地减少环境压力源对佩克堡保留地儿童的影响，并培养适应力，改善他们的风险前景。