MISC-IPV: A Community Based Intervention for Children Traumatized By Intimate Partner Violence

摘要 在美国，每四个孩子中就有一个(26%)接触到亲密伴侣暴力(IPV)，其中 的子女 非裔美国人 女人。IPV暴露构成了严重的创伤应激环境 对儿童心理社会后果的影响。虽然产妇照料被认为是一种 针对创伤对儿童的影响的关键缓冲，目前的IPV育儿干预措施受到 文化性 不敏感 ，以及阻碍可伸缩性的设计和方法限制。我们的科学前提是 IPV创伤对儿童的不良影响可以通过加强母婴传播的干预措施来中断 照顾能力，并由社区准专业个案工作者提供，他们是 已经向受IPV影响的用户提供服务 非裔美国人 女人。此应用程序的目标是 采用既定的照顾者干预计划，即使照顾者敏感的中介干预计划 (MISC)，用于IPV和 非裔美国人 上下文(此后称为MISC-IPV)。将对MISC-IPV进行评估 可接受性、可行性和初步机制和结果，以循证为基础的指导 由三个目标(适应、过程评价、结果/调解人评价)组成的框架。对于目标1， (适应)，我们将通过一个 迭代过程 让定性访谈和焦点小组参与 IPV安置计划中的个案工作者和母亲 直到实现了与上下文相适应 。文化适应 社区咨询委员会将指导适应IPV背景的工作。目标2(执行 和流程评估)，我们将招聘 N=132 通过哈里斯家庭结对的母亲/儿童(7至11岁儿童) 德克萨斯州休斯敦县家庭暴力协调委员会(HCDVCC)协作人。一半将会是 随机分配给TAU+MISC-IPV和TAU。在对个案工作者进行初步培训后，为期一年的双周 (每两周)将举行TAU+MISC-IPV与TAU的干预会议。可行性、坚持性、 将通过持续参与度百分比、个人访谈、基于视频的 观察和基于问卷的评估。对于目标3(成果和调解人)，我们将评估 TAU+MISC-IPV与TAU干预IPV暴露对儿童创伤的影响 在基线、6个月、12个月和18个月时评估儿童的情绪、行为和创伤症状 在AIM 2中招募。将通过视频评估增强照顾能力的中介效果 观察和知识的增长。在这项形成性研究结束时，我们将建立 基础评估和干预，以申请多地点随机对照试验，以全面测试疗效、调解人、 和MISC-IPV的主持人。该项目将使一个具有文化敏感性、发展性的 可移植、可扩展和可持续的基于证据和社区的干预，经过验证的体内干预 变化机制，可作为未来IPV计划的典范，也适用于不同的人群， 同时满足感染IPV的母亲和儿童的需求。

ABSTRACT One in four children (26%) in the U.S. are exposed to intimate partner violence (IPV), with higher rates among children of African American women. IPV exposure constitutes a traumatic stress environment with severe consequences for psychosocial outcomes in children. While maternal caregiving has been identified as a critical buffer against the effects of trauma on children, current IPV parenting interventions suffer from cultural insensitivity , and design and methodological limitations impeding scalability. Our scientific premise is that the adverse effects of IPV trauma on children can be interrupted through an intervention that enhances maternal caregiving capacity, and which is delivered by community-based paraprofessional caseworkers who are already delivering services to IPV-exposed African American women. The objective of this application is to adapt an established caregiver intervention program, Mediational Intervention for Sensitizing Caregivers (MISC), for the IPV and African American context (thereafter named MISC-IPV). MISC-IPV will be evaluated for acceptability, feasibility, and preliminary mechanisms and outcomes, guided by an evidence-based framework consisting of three aims (Adapt, Process Evaluation, Outcome/Mediator Evaluation). For Aim 1, (Adapt), we will adapt MISC through an iterative process involving qualitative interviews and focus groups with caseworkers and mothers in an IPV rehousing program until fit with context is achieved . Cultural adaptation and adaptation for the IPV context will be guided by a Community Advisory Board. For Aim 2 (Implementation and Process Evaluation), we will recruit N = 132 mothers/child pairs (children age 7 to 11) through the Harris County Domestic Violence Coordinating Council (HCDVCC) Collaborative of Houston, TX. Half will be randomly assigned to TAU+MISC-IPV vs. TAU. After initial training of caseworkers, one year of bi-weekly (every two weeks) intervention sessions of TAU+MISC-IPV vs. TAU will be delivered. Feasibility, adherence, and fidelity will be evaluated through percentage of sustained engagement, individual interviews, video-based observations, and questionnaire-based assessment. For Aim 3 (Outcomes and Mediators), we will evaluate the effects of TAU+MISC-IPV vs. TAU to interrupt the traumatizing effects of IPV exposure on children through assessing emotional, behavioral, and trauma symptoms at baseline, 6, 12, and 18 months in the children recruited in Aim 2. The mediational effects of enhanced caregiving capacity will be assessed through video observations and increase in knowledge. At the end of this formative study, we will have established the foundational assessments and intervention to apply for a multi-site RCT to fully test the efficacy, mediators, and moderators of MISC-IPV. This project will make possible a culturally sensitive, developmentally transportable, scalable, and sustainable evidence- and community-based intervention with proven in-vivo mechanisms of change that may serve as a model for future IPV programs also in different populations, that address the needs of IPV-exposed mothers and children simultaneously.