Community Prevention of Child Maltreatment

描述（由申请人提供）：本随机对照试验（RCT）的目的是评估达勒姆连接（DC）简短的通用护士家访计划的影响和机制，以防止儿童虐待和改善儿童福祉。这是有史以来第一个旨在防止整个社区人口虐待儿童的家访计划的RCT。2009年7月1日至2010年12月31日期间，达勒姆出生的每一个偶数出生日期的婴儿（n = 2,329）都被分配通过达勒姆县卫生部门接受DC计划。每名出生日期为奇数的婴儿（n = 2，451）照常接受其他服务，并被指定为对照组。该方案已显示出强有力的证据，表明其在社区一级的渗透率很高，对风险因素的评估可靠，成功地将家庭与社区服务联系起来，家庭-消费者满意度很高。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、高质量的儿童保育、父母反应的盲法评级和育儿实践产生了积极影响。拟议的研究将跟踪30个月至66个月的儿童家庭。行政记录将评估随机分配到DC对儿童虐待病例、急诊室虐待相关伤害和儿科护理的影响。家庭访谈和盲法观察将在已经招募的干预（n = 269）和对照（n = 280）出生日期的家庭代表性随机样本中评估父母功能和儿童福祉。对总体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程序（即，出生日期相同）将与较低的儿童虐待和急诊室虐待相关伤害率，更好的儿科护理，更好的父母功能和更好的儿童福祉相关。（出生在一个奇怪的出生日期）; 2）干预效果大小将更大的高风险群体; 3）社区资源的使用和增强的家庭功能将介导DC对结果的积极影响;和4）控制组中功能失调的父母和儿童行为的发展过程将符合指导该计划的模型。这项提案提供了一个紧迫的，时间有限的机会，以评估人口的影响和机制，这一创新的普遍家访计划，没有方案交付或样本招募的财政负担。该项目将通过以下方式促进公共卫生：（1）评估普遍家访方案的影响和机制，该方案旨在以具有成本效益的方式降低儿童受虐待的人口比例;（2）测试虐待、父母养育功能失调以及儿童行为和福祉的发展模式。

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.