Community Prevention of Child Maltreatment

描述(申请人提供)：这项随机对照试验(RCT)的目的是评估Durham Connects(DC)简明通用护士家访计划对预防虐待儿童和改善儿童福祉的影响和机制。这是有史以来第一个旨在防止整个社区人口中虐待儿童的家访计划的RCT。在2009年7月1日至2010年12月31日期间，达勒姆出生日期为偶数(n=2,329)的婴儿被分配通过达勒姆县卫生局接受DC计划。每个在奇数出生日期出生的婴儿(n=2451)照常接受其他服务，并被分配为对照组。该方案显示了社区层面的高渗透率、对风险因素的可靠评估、家庭与社区服务的成功联系以及家庭-消费者的高满意度。在6个月大时，意向治疗分析表明，随机分配到DC对接受社区资源、良好的婴儿儿科护理、高质量的儿童护理、盲目评价父母的响应性和育儿做法产生了积极影响。这项拟议的研究将跟踪调查孩子的家庭，年龄从30个月到66个月。行政记录将评估随机分配给DC对虐待儿童案件、急诊室虐待相关伤害和儿科护理的影响。家庭访谈和盲目观察将在干预(n=269)和对照(n=280)出生日期的已经招募的具有代表性的随机家庭样本中评估父母的功能和儿童的福祉。人口和代表性样本的数据分析将检验四个假设：1)随机分配到DC项目(即出生在偶数出生日期)将与较低的儿童虐待和急诊科虐待相关伤害的发生率、更好的儿科护理、更好的父母功能和更好的儿童福祉相关联；2)对于高危群体来说，干预效果将更大；3)社区资源使用和增强的家庭功能将中介DC对结果的积极影响；4)控制组在不良父母教养方式和儿童行为方面的发展过程将符合指导项目的模型。这项提议提供了一个紧迫的、时间有限的机会来评估这一创新的普遍家访计划的人口影响和机制，而不需要交付计划或招募样本的财政负担。该项目将通过以下方式促进公共卫生：(1)评估旨在以具有成本效益的方式降低虐待儿童人口比率的普遍家访计划的影响和机制；(2)测试虐待、功能失调的父母养育以及儿童行为和福祉的发展模型。

DESCRIPTION (provided by applicant): The aim of this randomized controlled trial (RCT) is to evaluate the impact and mechanisms of the Durham Connects (DC) brief universal nurse home-visiting program to prevent child maltreatment and improve child well-being. It is the first-ever RCT of a home-visiting program that is designed to prevent child maltreatment in an entire community population. Between July 1, 2009, and December 31, 2010, every infant born in Durham on an even birth date (n = 2,329) was assigned to receive the DC Program through the Durham County Health Department. Every infant born on an odd birth date (n = 2,451) received other services as usual and was assigned as control. The program has shown strong evidence of high penetration at the community level, reliable assessment of risk factors, successful connection of families with community services, and high family- consumer satisfaction. At age 6 months, intent-to-treat analyses indicate positive impact of random assignment to DC on receipt of community resources, well-baby pediatric care, high-quality childcare, blinded ratings of parental responsively, and parenting practices. The proposed study will follow families of children from age 30 months to 66 months. Administrative records will evaluate impact of random assignment to DC on child maltreatment cases, emergency room maltreatment-related injuries, and pediatric care. In-home interviews and blinded observations will assess parental functioning and child well-being in an already-recruited representative random sample of families from intervention (n = 269) and control (n = 280) birth dates. Data analyses of the population and representative samples will test four hypotheses: 1) Random assignment to the DC Program (that is, being born on an even birth date) will be associated with lower rates of child maltreatment and emergency department maltreatment-related injuries, better pediatric care, better parental functioning, and better child well-being than assignment as control (born on an odd birth date); 2) Intervention effect sizes will be larger for higher-risk groups; 3) Communit resource use and enhanced family functioning will mediate the positive impact of DC on outcomes; and 4) Developmental processes in dysfunctional parenting and child behavior among the control group will conform to the model guiding the program. This proposal offers an urgent, time-constrained opportunity to evaluate the population impact and mechanisms of this innovative universal home-visiting program, without the financial burden of program delivery or sample recruitment. The project will contribute to public health by (1) evaluating the impact and mechanisms of a universal home- visiting program that aims to lower the population rate of child maltreatment in a cost-effective way; and (2) testing models of the development of maltreatment, dysfunctional parenting, and child behavior and well-being.