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）简短的普遍护士家访计划对预防儿童虐待和改善儿童福祉的影响和机制。这是有史以来第一个家访项目的随机对照试验，旨在防止整个社区的儿童受到虐待。在2009年7月1日至2010年12月31日期间，在达勒姆出生的每个婴儿（n = 2,329）都被分配通过达勒姆县卫生局接受DC方案。每个在奇数出生日期出生的婴儿（n = 2,451）照常接受其他服务，并被指定为对照组。强有力的证据表明，该项目在社区层面的渗透率很高，对风险因素进行了可靠的评估，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，随机分配给DC对获得社区资源、良好的婴儿儿科护理、高质量的儿童保育、父母反应性的盲法评分和育儿实践都有积极影响。这项拟议的研究将跟踪30个月到66个月大的孩子的家庭。行政记录将评估随机分配到DC对儿童虐待案件、急诊室虐待相关伤害和儿科护理的影响。家庭访谈和盲法观察将评估来自干预（n = 269）和对照（n = 280）出生日期的已招募的具有代表性的随机家庭样本的父母功能和儿童福祉。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计划（即出生在偶数日期）将与较低的儿童虐待率和急诊部门虐待相关伤害，更好的儿科护理，更好的父母功能和更好的儿童福祉相关比分配作为对照（出生在奇数出生日期）；2)高危人群的干预效应值更大；3)社区资源利用和增强的家庭功能将中介社区发展对结果的积极影响；4)控制组的失调性父母教养和儿童行为的发展过程符合本项目的指导模式。该提案提供了一个紧迫的、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，而不需要项目实施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)评估旨在以具有成本效益的方式降低儿童虐待发生率的普遍家访方案的影响和机制；(2)虐待发展、功能失调父母、儿童行为与幸福感的检验模型。

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.