Buffering effects of a tiered preventive model on parent adjustment, parent-child relational health, and child psychosocial development post COVID-19

摘要 新出现的经验研究和理论表明，儿童早期发展和 贫困和种族主义造成的调整预计将在全球化背景下扩大， COVID-19带来的额外压力。然而，对以下方面的研究非常有限：1） COVID-19对核心心理社会机制的影响可能与贫困和种族主义的影响相同， 包括父母的调整和亲子关系的健康，或2）增加弹性的潜力， 在COVID-19之前实施的有效针对这些核心机制的预防性干预措施。 在COVID-19之前进行的广泛发展和预防研究的基础上，我们开发了一个 创新的、从出生到3岁的分层预防模式（Smart Beginnings [SB]）， 保健提供的预防（视频互动项目[VIP]）和有针对性的二级/三级预防 （家庭健康检查[FCU]），通过家访提供，以促进人口层面的参与， 解决风险的异质性。SB在NICHD的影响力和可扩展性方面表现出了巨大的潜力- 资助的（HD 076390）随机对照试验（RCT）和正在进行的竞争性继续试验， COVID-19之前对父母适应、关系健康和儿童心理社会发展的影响。 拟议的修订旨在扩大正在进行的随机对照试验的范围，以解决在以下方面的知识差距： 2019冠状病毒病对拉丁裔和黑人低收入家庭的影响（这两个群体的收入不成比例 受大流行影响），分别在纽约市和宾夕法尼亚州匹兹堡市登记。招生 （每个研究中心约200例，共403例），出生后不久进行随机化，并对父母进行随访评估 在COVID-19前6个月、18个月和24个月完成的适应、关系健康和儿童发展，以及 主要是在大流行开始后的第4年和第6年进行中。在这次修订中，我们将增加详细的， 在发病后的2个时间点对COVID-19家庭健康和经济影响进行远程评估 COVID-19（9-12个月时定量，18-24个月时定性/混合方法）。 利用SB队列将提供一个独特的机会来批判性地研究：1）短期和长期 COVID-19对父母适应、亲子关系健康和儿童发展的影响， 在COVID爆发前收集的与贫困和种族主义相关的家庭风险连续体中进行调整，以及 2)SB对COVID-19影响的潜在缓冲，包括种族/民族和家庭风险。 调查结果将为设计和扩大干预措施提供必要的可推广知识， 防止COVID-19对有幼儿的高度脆弱的有色人种家庭的潜在终身影响。在 研究受流行病影响最严重但研究最少的家庭， 该修订与NOT-OD-20-097中所述的NICHD对NOSI的具体兴趣密切相关。

ABSTRACT Emerging empirical research and theory suggests that disparities in children’s early development and adjustment resulting from poverty and racism would be expected to be magnified in the context of the additional stressors engendered by COVID-19. However, there has been very limited study either of: 1) COVID-19 impacts on core psychosocial mechanisms likely to be shared with those of poverty and racism, including parent adjustment and parent-child relational health, or 2) the potential for increased resilience from preventive interventions delivered prior to COVID-19 that effectively target these core mechanisms. Building on extensive developmental and prevention research conducted prior to COVID-19, we developed an innovative, tiered birth to 3 year preventive model (Smart Beginnings [SB]) integrating universal, primary prevention delivered in health care (Video Interaction Project [VIP]) and targeted, secondary/tertiary prevention (Family Check-Up [FCU]) delivered through home visiting to facilitate population-level engagement and address heterogeneity in risk. SB has shown tremendous promise for both impact and scalability in an NICHD- funded (HD076390) randomized controlled trial (RCT) and ongoing competing continuation, with beneficial effects prior to COVID-19 on parent adjustment, relational health, and child psychosocial development. The proposed revision seeks to expand the scope of this ongoing RCT to address critical gaps in knowledge of impacts of COVID-19 for Latinx and Black low-income families (two groups that have been disproportionately affected by the pandemic), who were enrolled in New York City and Pittsburgh, PA, respectively. Enrollment (~200 per site, 403 total) and randomization took place shortly after birth, with follow-up assessments of parent adjustment, relational health and child development completed at 6, 18 and 24 months prior to COVID-19, and in progress at 4 and 6 years primarily following onset of the pandemic. In this revision, we will add detailed, remote assessments of COVID-19 family health and economic impacts at 2 time points following the onset of COVID-19 (quantitative at 9-12 months and qualitative/mixed methods at 18-24 months). Leveraging the SB cohort will provide a unique opportunity to critically examine: 1) the short and long-term impacts of COVID-19 on parent adjustment, parent-child relational health, and child development and adjustment across a continuum of family risk related to poverty and racism collected prior to COVID onset, and 2) potential buffering of SB on COVID-19 impacts, including in the context of race/ethnicity and family risk. Findings will provide generalizable knowledge necessary for design and scaling of interventions seeking to prevent potentially lifelong impacts of COVID-19 for highly vulnerable families of color with young children. In studying families who are among the most affected by the pandemic yet also among the most understudied, this revision is strongly aligned with NICHD’s specific interests for this NOSI as described in NOT-OD-20-097.