Integrating a Parenting Intervention for Mothers with Opioid Use Disorders into Child Development Services

项目总结 在过去的15年里，患有阿片类药物使用障碍(Ouds)的母亲所生的婴儿数量增加了两倍多。 产后第一年是产妇服药过量和死亡的极高风险时期。一个联邦政府 儿童发展计划系统，称为早期干预，为许多人提供家庭支持服务 在新生儿出生的第一年，受ODS影响的家庭。然而，针对患有疾病的父母的针对性干预措施 OID不是所提供服务的标准要素。从里到外为人母就是证据- 对患有药物使用障碍的父母进行的基础干预被证明可以降低复发率和 改善亲子互动。这种干预目前是通过成瘾治疗中心进行的。 由学士和硕士级别的辅导员为11个月以上儿童的父母提供咨询。然而，以诊所为基础 众所周知，产后妇女很难获得心理健康服务，这增加了风险 处于恢复期的妇女在孩子出生后面临着困难。我建议利用基础设施和现有的 通过早期干预计划建立的治疗关系，以进行循证干预， 从里到外哺乳，产后患有产后ODS的妇女更容易接触到。在一个 KL2奖，我采取了社区参与的方法来制定详细的干预适应和 这一新环境的整合战略，称为通过以下方式促进照顾者-儿童依恋和康复 早期干预(PCARE)。我们目前正在对培训和部署进行Beta测试 PCARE有6名早期干预提供者和10名正在从ODS中恢复的母亲。此K23应用程序 详细说明了进一步完善和测试pCARE的可接受性和可行性的战略方法。我的研究 计划将利用测试版测试后来自一大批关键利益相关者的迭代反馈来完善 PCARE干预(目标1)。然后我们将评估pCARE的可行性、可接受性和保真度(目标2)， 并在一项试点可行性试验中探索父母功能的变化(目标3)，40名母亲被随机分配到 接受pCARE或标准的早期干预服务。我的工作是由我的专业知识指导的 优秀的导师团队和社区合作伙伴。在我导师的支持下，我可以实现我的目标 通过以下目标成为行为干预研究人员的教育目标：获得内容 以孕妇和产后妇女为重点的成瘾医学专业知识；开发基础知识 具备行为干预理论和研究知识，并获得临床试验设计方面的高级培训 以及与前瞻性临床试验相关的统计方法。在这个奖项的最后，我将有一个完整的 一揽子计划，包括完善的干预措施、优化的研究程序以及对如何进一步 提高了pCARE的可接受性和可行性，以供进一步测试。我将做好测试干预的准备 在一项完全有效的试验中，并开始缩小研究与实践之间的差距 弱势群体。

PROJECT SUMMARY The number of infants born to mothers with opioid use disorders (OUDs) has more than tripled in the past 15 years and the first year postpartum is an extremely high-risk time for maternal overdose and death. A federal system of child development programs, called Early Intervention, provides in-home support services to many families affected by OUDs in the first year of a newborn's life. However, targeted interventions for parents with OUDs are not a standard element of the services provided. Mothering from the Inside Out is an evidence- based intervention for parents with substance use disorders proven to decrease the rate of relapse and improve parent-child interactions. This intervention is currently delivered through addiction treatment centers by bachelor- and master- level counselors to parents of children over 11 months of age. Yet, clinic-based mental health services are notoriously difficult for postpartum women to access, adding to the heightened risk women in recovery face following the birth of a child. I propose harnessing the infrastructure and existing therapeutic relationships developed by Early Intervention programs to make the evidence-based intervention, Mothering from the Inside Out, more readily accessible to postpartum women with OUDs. With the support of a KL2 award, I have taken a community-engaged approach to develop detailed intervention adaptation and integration strategies for this new setting, called Promoting Caregiver-child Attachment and Recovery through Early Intervention (pCARE). We are currently in the process of beta-testing the training and deployment of pCARE with six Early Intervention providers and 10 mothers in recovery from OUDs. This K23 application details a strategic approach to further refine and test the acceptability and feasibility of pCARE. My research plan will utilize iterative feedback from a wide group of key stakeholders following the beta-test to refine the pCARE intervention (Aim 1). We will then assess the feasibility, acceptability, and fidelity of pCARE (Aim 2), and explore changes in parental functioning (Aim 3) in a pilot feasibility trial with 40 mothers randomized to receive either pCARE or standard Early Intervention services. My work is guided by the expertise of my outstanding mentorship team and community partners. With the support of by my mentors, I can achieve my educational goal to become a behavioral intervention researcher through the following objectives: gain content expertise in addiction medicine with a focus on pregnant and postpartum women; develop foundational knowledge of behavioral intervention theory and research; and obtain advanced training in clinical trial design and statistical methods relevant to prospective clinical trials. At the end of this award, I will have a complete package including a refined intervention, optimized study procedures, and an understanding of how to further improve the acceptability and feasibility of pCARE for further testing. I will be positioned to test the intervention in a fully powered effectiveness trial and begin closing the research-to-practice gap that exists for this vulnerable population.