Maximizing the Impact of Preventive Interventions: Identifying Responders and Non-Responders of an Evidence-Based Intervention for Low-Income Families Using a Person-Centered Approach

项目摘要/摘要 关于谁能从预防性干预中受益，谁不能从中受益，这些文献没有定论。更少的是 了解影响低收入人群计划有效性的参与者风险因素的独特组合 家人。这些是需要解决的关键差距，因为经济困难家庭的水平和 他们所经历的逆境模式；这些逆境可能会影响他们对干预的反应。一 在为数不多的专门为满足经济上弱势群体的需要而设计的预防性干预措施中 家庭是父亲、关系和婚姻教育(FRAME)，它结合了 两个循证计划：婚前教育计划和家庭应对经济问题 紧张。平均而言，家庭受益于框架，但其中一部分家庭没有经历预期的情况 收获。该项目将检查某些类型或组合的预先存在的风险因素，例如 经济压力和父母抑郁影响对框架的反应。此信息对于确定 规划应答者和非应答者，告知量身定制的干预方法并最大限度地提高疗效 以及为遭受各种逆境的未得到充分服务的家庭提供预防方案的成本效益。 利用对低收入家庭(N=301个母亲-父亲-孩子三人组)的框架研究的现有数据， 这项研究的长期目标是提高以家庭为基础的干预的有效性，以促进 应对逆境与健康人2030年S倡议，加强全民健康福祉。 作为初步分析，我们进行了基线潜在类别分析(LCA)，并确定了四个家族风险 类别：仅工作不稳定(除工作不稳定外的所有风险因素都较低；14%)，经济压力，抑郁 父母(高经济压力和父母抑郁；41%)，极端家庭功能障碍(所有高 风险因素；33%)和处于风险中的母亲(母亲受害程度高；12%)。因此，这一总体目标是 为期两年的R03是为了测试这些家庭风险类别对家庭心理健康结果和干预的影响 有效性(即家庭对框架干预的反应)。具体目标是：(A)模拟影响 家庭风险类别对纵向家庭结果的影响，(B)确定家庭风险类别对家庭的影响 参与和应对干预措施；以及(C)审查家庭风险类别中的种族和性别差异 以及家庭对干预的反应。这项研究将使用一种新的方法(即潜在类别分析和 BCH方法)以了解风险过程并检验不同的干预效果。这些贡献是 意义重大，因为它们可以为最大限度地提高预防方案的成本效益提供信息 通过确保大多数人从干预中受益，为经济上处于不利地位的家庭提供援助。

Project Summary/Abstract The literature is inconclusive about who does and does not benefit from preventive interventions. Even less is known about the unique combinations of participant risk factors that impact program effectiveness for low-income families. These are crucial gaps to address, given that economically disadvantaged families vary in the level and pattern of adversities they experience; and, these adversities may influence their response to intervention. One of the few preventive interventions designed specifically to meet the needs of economically disadvantaged families is Fatherhood, Relationship, and Marriage Education (FRAME), which combines the core elements of two evidence-based programs: Premarital Relationship Education Program and Families Coping with Economic Strain. On average, families benefitted from FRAME, but a portion of them did not experience the expected gains. This project will examine whether certain types or combinations of pre-existing risk factors, such as economic strain and parental depression, impacted response to FRAME. This information is critical for identifying program responders and non-responders to inform tailored intervention approaches and maximize the efficacy and cost-effectiveness of prevention programs for underserved families experiencing various types of adversity. Using existing data from the FRAME study with low-income families (N = 301 mother-father-child triads), the long-term goal of this study is to improve the effectiveness of family-based interventions to promote resilience to adversity and address the Healthy People 2030’s initiative to strengthen the health and well-being of all people. As a preliminary analysis, we conducted baseline latent class analysis (LCA) and identified four family risk classes: Job Instability Only (low on all risk factors except job instability; 14%), Economic Stress, Depressed Parents (high on economic stressors and parental depression; 41%), Extreme Family Dysfunction (high on all risk factors; 33%), and Mothers At Risk (high mother victimization; 12%). Therefore, the overall objective of this two-year R03 is to test the effects of these family risk classes on family mental health outcomes and intervention effectiveness (i.e., families’ response to the FRAME intervention). The specific aims are to: (a) model the effects of family risk classes on longitudinal family outcomes, (b) identify the effects of family risk classes on families’ engagement and response to intervention, and (c) examine racial and gender differences in family risk classes and families’ response to intervention. This study will use a novel approach (i.e., latent class analysis and the BCH method) to understand risk processes and test differential intervention effects. These contributions are significant because they can inform efforts to maximize the cost-effectiveness of prevention programs for economically disadvantaged families by ensuring that the most people benefit from the intervention.