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

摘要 新兴的实证研究和理论表明，儿童早期发展和发育的差异 贫困和种族主义造成的调整预计将在 COVID-19 带来的额外压力。然而，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， 包括父母适应和亲子关系健康，或 2) 增强复原力的潜力 在 COVID-19 之前实施的预防性干预措施有效地针对这些核心机制。 基于在 COVID-19 之前进行的广泛的发展和预防研究，我们开发了一种 创新的、分层的出生到 3 年预防模型（Smart Beginnings [SB]），整合了普遍性、初级性 医疗保健领域的预防（视频互动项目 [VIP]）和有针对性的二级/三级预防 （家庭检查 [FCU]）通过家访进行，以促进人口层面的参与和 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希望 资助（HD076390）随机对照试验（RCT）和正在进行的竞争性延续，具有有益的 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，以解决知识方面的关键差距 COVID-19 对拉丁裔和黑人低收入家庭（这两个群体受到不成比例的影响）的影响 受大流行影响），他们分别在纽约市和宾夕法尼亚州匹兹堡注册。招生 （每个中心约 200 个，总共 403 个）出生后不久进行随机化，并对父母进行后续评估 在 COVID-19 发生前 6、18 和 24 个月完成的调整、关系健康和儿童发展，以及 主要在大流行爆发后的 4 年和 6 年进行。在本次修订中，我们将添加详细信息， 在疫情爆发后的 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审查：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 对在新冠肺炎爆发之前收集的与贫困和种族主义相关的一系列家庭风险进行调整，以及 2) SB 对 COVID-19 影响的潜在缓冲，包括在种族/民族和家庭风险的背景下。 研究结果将为设计和扩大干预措施提供必要的普遍知识，以期 防止 COVID-19 对有幼儿的高度脆弱的有色人种家庭产生潜在的终生影响。在 研究受这一流行病影响最严重但也是研究最多的家庭， 此修订与 NICHD 对此 NOSI 的特定兴趣高度一致，如 NOT-OD-20-097 中所述。

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.