A Brief Intervention to Enhance Supportive Parenting and Treatment Engagement Among Families Waiting for Trauma-Focused Services

项目总结 超过三分之二的儿童经历过创伤事件，如虐待儿童、暴力或突然或 惨烈的损失。其中许多儿童患有严重的情感和发育困难，包括精神创伤。 症状、攻击性和自杀倾向。从理论上讲，来自照顾者的情感支持可以缓冲 创伤的影响；然而，许多照顾者缺乏自我效能和技能来有效地支持他们的孩子，或者 在创伤后的紧张时期，努力运用这些技能。不幸的是，为 儿童创伤后的照顾者很少。现有干预措施耗时较长(持续8-20次会议)和结果 排在长长的等待名单上的家庭。这项提议断言，儿童创伤的不良影响是可以中断的 通过一个简短的干预(项目支持正面育儿模块)来加强支持性育儿 -通过远程医疗向等待创伤服务的家庭提供服务。候选人收集的飞行员数据 提示这种干预可以由准专业人员提供，提高父母的自我效能感和情绪 支持，并增加后来以创伤为重点的治疗就诊次数。然而，提供商特征(例如， 知识、经验)，以及内部(如组织支持)和外部(如病人需求、态度) 影响创伤服务等待名单上的家庭接受短暂干预的背景因素是 未知。目标1和目标2包括K99指导研究阶段，目标3包括R00独立 研究阶段。具体目标包括：1)检查通过以下方式提供项目支持的障碍和促进者 与n=20名照顾者和n=10名治疗提供者进行远程医疗；2)检查以下项目的可行性和可接受性 在n=30个家庭等待的混合方法概念验证试点试验中，通过远程医疗提供项目支持 以创伤为重点的服务和n=4个治疗提供者；以及3)评估项目的初步效果 在n=100个等待的家庭中进行的随机对照试验(项目支持与照常治疗)中的支持 提供专注于创伤的服务。拟议的研究活动与培训同时进行，将支持 候选人向独立调查员的转变。在K99阶段，候选人将通过以下途径接受培训 课程、讲习班和咨询：(1)实施科学框架和传播 战略；(2)定性和混合方法；(3)赠款和科学交流。 来自儿童创伤、照顾者与儿童关系、实施科学的专家的指导和咨询， 定性方法和统计分析将确保实现培训目标。这项提议将支持 候选人的长期职业目标是成为一名独立资助的终身教职员工 儿童创伤研究领域，通过研究儿童创伤暴露和发展的后果和 为创伤受害者及其家人测试以育儿为基础的创新干预。这是K99/R00 机制是获得实现这一目标所必需的经验和独立性的关键一步。

PROJECT SUMMARY Over two-thirds of children experience traumatic events such as child maltreatment, violence, or sudden or violent loss. Many of these children sustain significant emotional and developmental difficulties including trauma symptoms, aggression, and suicidality. Emotional support from a caregiver is theorized to buffer against the effects of trauma; however, many caregivers lack the self-efficacy and skills to effectively support their child, or struggle to apply these skills during the stressful time following trauma. Unfortunately, programs designed for caregivers following child trauma are scarce. Existing interventions are lengthy (lasting 8-20 sessions) and result in families placed on long waitlists. This proposal asserts the adverse effects of child trauma can be interrupted though a brief intervention (the Project Support Positive Parenting Module) that enhances supportive parenting – delivered via telehealth to families on waitlists for trauma-focused services. Pilot data collected by the candidate suggests this intervention can be delivered by paraprofessionals, improve parenting self-efficacy and emotional support, and increase later trauma-focused treatment attendance. However, the provider characteristics (e.g., knowledge, experiences), as well as inner (e.g., organizational support) and outer (e.g., patient needs, attitudes) contextual factors that influence uptake of a brief intervention for families on the waitlist for trauma services is unknown. Aims 1 and 2 comprise the K99 Mentored Research Phase and Aim 3 comprises the R00 Independent Research Phase. Specific Aims include: 1) examine barriers and facilitators to delivering Project Support via telehealth with n = 20 caregivers and n = 10 treatment providers; 2) examine the feasibility and acceptability of Project Support via telehealth in a mixed-methods proof-of-concept pilot trial with n = 30 families waiting for trauma-focused services and n = 4 treatment providers; and 3) evaluate the preliminary efficacy of Project Support in a randomized controlled trial (Project Support vs. treatment as usual) among n = 100 families waiting for trauma-focused services. The proposed research activities coincide with training that will support the candidate’s transition to an independent investigator. In the K99 phase the candidate will receive training via coursework, workshops, and consultation in: (1) implementation science frameworks and dissemination strategies, (2) qualitative and mixed methodology, and (3) grantsmanship and scientific communication. Mentorship and consultation from experts in child trauma, caregiver-child relationships, implementation science, qualitative methods, and statistical analyses will ensure training goals are met. This proposal will support the candidate’s long-term career goal to become an independently funded tenure track faculty who advances the field of child trauma research by studying the consequences of children’s trauma exposure and developing and testing innovative parenting-based interventions for victims of trauma and their families. This K99/R00 mechanism is a critical step to obtaining the experience and independence necessary to obtain this goal.