Child-Adult Relationship Enhancement in Primary Care: Effectiveness Trial of a Primary Care Based Parenting Intervention to Prevent Child Maltreatment

初级保健中儿童与成人关系的增强：基于初级保健的育儿干预措施预防儿童虐待的有效性试验

• 批准号: 10456012
• 负责人: Samantha S Schilling
• 金额: $ 68.48万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10456012
• 关键词: 6 year old; Address; Adult; Age; Child; Child Abuse and Neglect; Child Behavior; Child Development; Child Rearing; Childhood; Chronic Disease; Clinic; Complex; Computerized Medical Record; Consent; Data Collection; Development; Discipline; Distal; Dose; Ecology; Economic Burden; Economics; Effectiveness; Emotional; Enrollment; Evaluation; Family; Foundations; Funding; Future; Goals; Health; Heart; High Prevalence; Hispanic; Individual; Insurance; Intervention; Knowledge; Lead; Longitudinal Studies; Low income; Mediating; Medicaid; Mental Depression; Mental Health; Methods; Minority; Monitor; National Institute of Child Health and Human Development; North Carolina; Not Hispanic or Latino; Outcome; Parent-Child Relations; Parents; Pediatric Hospitals; Penetration; Philadelphia; Prevention; Prevention strategy; Prevention trial; Primary Health Care; Problem behavior; Process; Productivity; Provider; Public Health; Punishment; Randomized; Randomized Controlled Trials; Recording of previous events; Reporting; Research; Risk; Science; Site; Stress; Techniques; Testing; Uninsured; Universities; Work; abuse neglect; base; child protective service; design; disability; dissemination strategy; effectiveness evaluation; effectiveness trial; ethnic diversity; high risk; implementation barriers; implementation determinants; implementation evaluation; implementation outcomes; implementation strategy; improved; intergenerational; intervention participants; lower income families; maltreated children; neglect; pediatric trauma; physical abuse; prevent; preventive intervention; primary care setting; programs; racial diversity; scale up; skills; social; social stigma; societal costs; success; therapy design; transmission process; treatment as usual; uptake

Project Summary/Abstract Child maltreatment (CM) is a pervasive public health problem and there is a critical need for brief, effective, scalable prevention interventions. Problematic parent-child relationships lie at the heart of CM. Parents who maltreat their children are more likely to have punitive parenting styles characterized by high rates of negative interaction and ineffective discipline strategies with over-reliance on punishment. Harsh, reactive parenting can contribute to the development of child behavioral problems which, in turn, can increase parental stress and lead to escalation of negative parenting behaviors, including abusive and neglectful parenting. Thus, parenting interventions that strengthen parent-child relationships, teach positive discipline techniques, decrease harsh parenting, and decrease child behavioral problems hold promise as CM prevention strategies. Challenges in engaging parents, particularly low-income and minority parents, and a lack of knowledge regarding effective implementation strategies, however, have greatly limited the reach and impact of parenting interventions. To address these challenges, our interdisciplinary team from the University of North Carolina and Children’s Hospital of Philadelphia collaborated in implementing and evaluating, Child Adult Relationship Enhancement in Primary Care (PriCARE)/Criando Niños con Cariño. PriCARE/Cariño is distinct from other programs because it was (1) developed and iteratively adapted with input from racially and ethnically diverse families, including low- income families and (2) designed specifically for implementation in primary care with inclusion of strategies to align with usual-care work flow to increase uptake and retention. In randomized controlled trials (RCTs), PriCARE has demonstrated success in engaging parents, promoting positive parenting, reducing parent stress, and improving child behaviors. The objective of this project “Child-Adult Relationship Enhancement in Primary Care: Effectiveness Trial of a Primary Care Based Parenting Intervention to Prevent Child Maltreatment” is to conduct a multi-site RCT of PriCARE/Cariño plus Usual Care vs. Usual Care among 1932 parents and their 2- 6-year-old children with Medicaid/CHIP/no insurance from 6 clinics. We will examine the effectiveness of PriCARE/Cariño on reducing suspected CM, in addition to reducing proximal CM related outcomes (child behavior problems, parent stress, harsh/neglectful parenting). By testing proximal outcomes in addition to the more distal outcome of CM, this study will help to elucidate the mechanisms of change and advance the science of CM prevention. Finally, in this study we will also identify PriCARE/Cariño implementation determinants and examine their relationship to implementation outcomes. If successful, results will be used to seek funding from state agencies and payers to sustain PriCARE/Cariño in primary care, while continuing to refine and study implementation and dissemination strategies, with the ultimate goal of achieving levels of exposure sufficient for breaking the intergenerational transmission of CM. Inclusion of consent for longitudinal data collection will facilitate future longitudinal studies of the impact of PriCARE/Cariño on additional outcomes.

项目概要/摘要 虐待儿童 (CM) 是一个普遍存在的公共卫生问题，迫切需要采取简短、有效、 可扩展的预防干预措施。有问题的亲子关系是 CM 的核心。父母谁 虐待他们的孩子更有可能采取惩罚性教养方式，其特点是负面比率高 互动和无效的纪律策略，过度依赖惩罚。严厉、反应性的养育方式可能会 导致儿童行为问题的发展，反过来又会增加父母的压力和 导致消极养育行为升级，包括虐待和疏忽养育。因此，养育孩子 加强亲子关系、教授正面管教技巧、减少严厉的干预措施 养育子女和减少儿童行为问题有望成为 CM 预防策略。挑战 家长，特别是低收入和少数族裔家长的参与，以及缺乏有效的知识 然而，实施战略极大地限制了育儿干预措施的范围和影响。到 为了应对这些挑战，我们来自北卡罗来纳大学和儿童医院的跨学科团队 费城医院合作实施和评估“儿童成人关系增强”项目 初级保健 (PriCARE)/Criando Niños con Cariño。 PriCARE/Cariño 与其他计划不同，因为它 (1) 根据不同种族和族裔家庭（包括低收入家庭）的意见进行开发和迭代调整 收入家庭和 (2) 专门为初级保健的实施而设计，其中包括以下战略： 与常规护理工作流程保持一致，以提高吸收率和保留率。在随机对照试验 (RCT) 中， PriCARE 在吸引家长、促进积极养育、减轻家长压力、 并改善儿童行为。该项目的目标是“增强小学儿童与成人的关系” 护理：基于初级护理的育儿干预预防儿童虐待的有效性试验”的目的是 对 1932 名父母及其 2 名儿童进行了 PriCARE/Cariño 加常规护理与常规护理的多中心随机对照试验 6 家诊所有 Medicaid/CHIP/无保险的 6 岁儿童。我们将检验其有效性 PriCARE/Cariño 除了减少近端 CM 相关结局（儿童 行为问题、父母压力、严厉/疏忽的养育方式）。通过测试近期结果 CM 的更远端结果，这项研究将有助于阐明变化的机制并推进 CM 预防科学。最后，在本研究中，我们还将确定 PriCARE/Cariño 的实施 决定因素并检查它们与实施结果的关系。如果成功，结果将用于 向国家机构和付款人寻求资金，以维持初级保健中的 PriCARE/Cariño，同时继续 完善和研究实施和传播策略，最终目标是达到 暴露足以打破 CM 的代际传播。纳入纵向同意书 数据收集将有助于未来对 PriCARE/Cariño 对其他结果影响的纵向研究。