Child Assessment Tool for Use in Resource Limited Settings

 描述(由申请人提供)：幼儿的神经发育评估可能很复杂，在资源匮乏的情况下，未经培训的非临床工作人员很难使用。此外，几乎没有工具被开发或测试用于不同文化背景的贫困儿童样本。在美国的家庭无家可归者收容所，对儿童的发展评估尤其罕见，尽管他们处于高风险状态。51%的无家可归儿童年龄在5岁以下，其中来自非裔美国人或拉丁裔家庭的比例不成比例，大多数人面临着多种不利的早期生活经历。环境和家庭因素(如贫穷和种族主义、产妇抑郁)对无家可归儿童的发展轨迹产生不利影响。为了解决这些问题，社会创新中心(C4)将开发弱势儿童评估工具(VCAT)：一种在资源有限的情况下使用的工具。VCAT以3至5岁无家可归儿童的不同样本为常态，以生态框架为基础，将使处于低资源环境中的弱势儿童和家庭能够获得神经发育评估。这项研究的第一阶段和第二阶段将使用严格的心理测量学方法来开发一种具有生态意识的工具，该工具具有低认知负担，以衡量不利的童年经历、风险和保护因素以及发育延迟。在第一阶段，将与专家小组一起为每个领域建立一个固定的项目库，并对其进行认知负担、文化反应和管理简便性的审查。第一阶段的家庭将通过住房家庭招募，这是当地的一个无家可归者计划，每天为多达150名无家可归的儿童提供服务。我们将使用认知访谈和心理测量测试，包括项目反应理论(IRT)和内部一致性信度，对20名家长和10名项目工作人员的小样本项目池进行测试。同时，我们将开发一个原型在线平台，并 以60名儿童为样本，对最初的项目进行可行性试验。在第二阶段，我们将使用从全国各地的项目招募的300名无家可归儿童的更大样本来测试工具的有效性和可靠性，并将通过将结果与50名无家可归儿童的子样本的黄金标准临床管理工具相关联来评估工具的有效性。我们将进一步完善基于网络的平台，开发评分算法，并纳入服务干预建议系统，以解决确定的关切。该项目将建立在C4的S创新平台的基础上，用于创建第一个测量创伤知情护理的心理测量学验证工具。使用相同的后端技术，VCAT将使直接服务人员能够将有限的资源集中到儿童、家长和环境层面最需要干预的领域。该工具将填补该领域的一个重大空白，使对低收入、不同种族的儿童更容易受到多种风险因素的影响进行有效和可靠的评估，并成为开发供婴儿或学龄儿童以及其他资源匮乏环境中的儿童使用的工具的样板。

 DESCRIPTION (provided by applicant): Neurodevelopmental assessments of young children can be complex and difficult to use by untrained, non-clinical staff in low resourced settings. Additionally, few instruments have been developed or tested for use with culturally diverse samples of children living in poverty. In family homeless shelters in the United States, developmental assessment of the children is especially rare, despite their high risk status. Fifty one percent of homeless children are under age five and a disproportionate number are from African-American or Latino families, and most are exposed to multiple adverse early life experiences. Environmental and family factors (e.g., poverty and racism, maternal depression) adversely impact the developmental trajectories of homeless children. To address these concerns, the Center for Social Innovation (C4) will develop the Vulnerable Child Assessment Tool (VCAT): An Instrument for Use in Resource Limited Settings. Normed on a diverse sample of homeless children ages three to five and based in an ecological framework, the VCAT will make neurodevelopmental assessment accessible to vulnerable children and families in low resource settings. Phases I and II of this study will use a rigorous psychometric approach to develop an ecologically aware instrument with low cognitive burden to measure adverse childhood experiences, risk and protective factors, and developmental delays. During Phase I, a set item pool for each domain will be developed in conjunction with the expert panel and vetted for cognitive burden, cultural responsiveness, and ease of administration. Phase I families will be recruited through Housing Families, a local homeless program serving up to 150 homeless children a day. We will test the pool of items in a small sample of 20 parents and 10 program staff using cognitive interviews and psychometric tests, including Item Response Theory (IRT) and internal consistency reliability. Concurrently, we will develop a prototype online platform and pilot its use for feasibility with the initial items on a sample of 60 children. In Phase II, we wil test the validity and reliability of the instruments using a larger sample of 300 homeless children recruited from programs around the country, and will assess the validity of the instrument by correlating results with gold standard, clinically administered, instruments on a subsample of 50 homeless children. We will further the refine the web based platform, develop a scoring algorithm, and incorporate a recommendations system for service interventions to address identified concerns. This project will build upon on C4's innovative platform used to create the first psychometrically validated instrument to measure trauma-informed care. Using the same back-end technology, the VCAT will enable direct service staff to target limited resources to the most needed areas for intervention at the child, parent, and environmental levels. The instrument will fill a significant gap in the field making valid and reliable assessment of low income; racially diverse children exposed to multiple risk factors more accessible, and serve as a model to develop tools for use with infants or school aged children, and those in other low resourced environments.