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

项目摘要 在过去的15年里，患有阿片类药物使用障碍（OUD）的母亲所生的婴儿数量增加了两倍多。 产后第一年是产妇用药过量和死亡的极高风险时期。联邦 一个名为“早期干预”的儿童发展项目系统为许多儿童提供家庭支持服务。 在新生儿生命的第一年受到OUD影响的家庭。然而，针对有以下问题的父母的有针对性的干预措施 OUD不是所提供服务的标准元素。从内到外的母性是一个证据- 对患有物质使用障碍的父母进行基于基础的干预，以降低复发率， 改善亲子互动。这种干预目前通过成瘾治疗中心提供 由学士和硕士水平的顾问向11个月以上儿童的父母提供。然而，基于临床的 众所周知，产后妇女很难获得心理健康服务， 恢复期妇女在分娩后面临的问题。我建议利用基础设施和现有的 早期干预项目开发的治疗关系，以进行循证干预， 由内而外的母亲，更容易获得产后妇女与OUD。并辅之以有效的 KL 2奖，我采取了社区参与的方法来制定详细的干预适应， 这一新环境的整合战略，称为促进照顾者-儿童依恋和恢复， 早期干预（PCARE）。我们目前正在对训练和部署 pCARE与6名早期干预提供者和10名从OUD中恢复的母亲。K23应用 详细介绍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 该计划将利用beta测试后来自广泛的关键利益相关者的反复反馈， 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）， 并在一项可行性试验中探索父母功能的变化（目标3）， 接受pCARE或标准早期干预服务。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。在导师们的支持下，我可以实现我的目标。 教育目标通过以下目标成为行为干预研究者：获得内容 专注于孕妇和产后妇女的成瘾医学专业知识;发展基础医学 行为干预理论和研究的知识;并获得临床试验设计的高级培训 以及与前瞻性临床试验相关的统计学方法。在这个奖项结束时，我将有一个完整的 一套包括完善的干预措施，优化的研究程序，并了解如何进一步 提高pCARE进一步测试的可接受性和可行性。我将在那里测试 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.