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 贫穷和种族主义造成的调整预计将在以下背景下得到放大 新冠肺炎带来的额外压力。然而，对以下两种情况的研究都非常有限：1) 新冠肺炎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，或者2)从 在新冠肺炎之前提供的有效针对这些核心机制的预防性干预措施。 在新冠肺炎之前进行的广泛的发展和预防研究的基础上，我们制定了 创新的分级出生到3年预防模式(Smart Begings[SB])，整合了普遍的、初级的 在医疗保健中提供预防(视频互动项目[VIP])和有针对性的二级/三级预防 (家庭体检[FCU])通过家访提供，以促进人口层面的参与和 应对风险中的异质性。SB在NICHD的影响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继续试验，有益 新冠肺炎治疗前对父母适应、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这一正在进行的区域工作队的范围，以解决在以下方面的严重知识差距 新冠肺炎对拉美裔和黑人低收入家庭(这两个群体的比例不成比例)的影响 受疫情影响)，他们分别在纽约市和宾夕法尼亚州匹兹堡注册。招生 (每个地点约200人，总共403人)，并在出生后不久进行随机化，并对父母进行后续评估 在新冠肺炎之前6个月、18个月和24个月完成调整、关系健康和儿童发展，以及 主要在大流行开始后的4年和6年内进行。在这次修订中，我们将添加详细的、 在新冠肺炎发病后的两个时间点对家庭健康和经济影响的远程评估 新冠肺炎(定量在9-12个月，定性/混合方法在18-24个月)。 利用SB队列将提供一个独特的机会来批判性地检查：1)短期和长期 新冠肺炎对父母适应、亲子关系健康和儿童发展的影响 对在COVID发病前收集的与贫困和种族主义有关的家庭风险的连续统一体进行调整，以及 2)SB在新冠肺炎影响上的潜在缓冲，包括在种族/族裔和家庭风险的背景下。 调查结果将提供设计和扩展干预措施所需的概括性知识 防止新冠肺炎对有幼儿的高度脆弱的有色人种家庭产生潜在的终身影响。在……里面 研究的家庭是受疫情影响最严重的家庭，但也是研究最少的家庭之一， 这一修订与NICHD在NOT-OD-20-097中描述的NICHD对此NOT-OD-20-097中描述的特定利益密切相关。

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.