Treating Maternal PTSD to Enhance Parenting and Reduce Maltreatment Recidivism: Safe Mothers, Safe Children

治疗孕产妇创伤后应激障碍以加强养育并减少虐待累犯：安全的母亲，安全的儿童

• 批准号: 10630070
• 负责人: Michael A. Lindsey
• 金额: $ 62.66万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10630070
• 关键词: 2 arm randomized control trial; Abbreviations; Adult; Adverse effects; Affect; Aftercare; Attitude; Blinded; Brain; Case Management; Child; Child Abuse; Child Abuse and Neglect; Child Rearing; Child Welfare; Clinical; Code; Cognitive deficits; Contingent Negative Variation; Counseling; Crime; Crisis Intervention; Data; Development; Diabetes Mellitus; Disease; Disease remission; Dropout; Enrollment; Ensure; Excision; Exposure to; Family; Health; High Prevalence; Imprisonment; Injury; Intervention; Investments; Learning; Letters; Life; Longevity; Measures; Mediating; Mental Depression; Mental Health; Monitor; Mothers; New York; New York City; Nursery Schools; Outcome; Parent-Child Relations; Participant; Phase; Population; Post-Traumatic Stress Disorders; Probability; Randomized, Controlled Trials; Registries; Regulation; Reporting; Research; Risk; Risk Reduction; Safety; School-Age Population; Services; Standardization; Stroke; Symptoms; Trauma; Work; abuse neglect; active method; attentional control; behavior observation; clinical practice; cost; data registry; depressive symptoms; diagnostic criteria; disability; economic cost; efficacy evaluation; efficacy testing; emotion regulation; follow-up; foster care; high risk; improved; intergenerational; maltreatment; meetings; neglect; novel strategies; physical conditioning; preservation; prevent; programs; recidivism; reduce symptoms; service programs; skills; skills training; social stigma; suicidal risk; young adult

Project Summary Repeated exposure to abuse and neglect substantially increases the likelihood of poor child and adult life outcomes. Current child welfare (CW) family preservation services (FPS), however, do not reduce maltreatment recidivism. Maternal posttraumatic stress disorder (PTSD), which has been associated with poor parent-child interaction, is a promising intervention target to reduce maltreatment. Our prior work showed that mothers receiving FPS to prevent recidivism have a high prevalence of trauma-related disorders. High rates of PTSD among these mothers suggests that treating PTSD may reduce recidivism in a significant subset of high- risk mothers. In addition to directly increasing risk of maltreatment, PTSD-related cognitive deficits may make learning parenting skills more difficult, contributing to intergenerational persistence of trauma. Hypothesis: Parenting Skills Training in Affect and Interpersonal Regulation (P-STAIR), an intervention targeting maternal PTSD-related parenting deficits, will reduce recidivism. We use a combination of STAIR to target the adverse effects of PTSD (and related depression) on parenting and an abbreviated version of PCIT to improve parenting skills. STAIR is a two-phase treatment to improve emotion regulation and interpersonal skills prior to exposure treatment. It is more effective than exposure therapy alone and increases treatment retention for child abuse-related PTSD. PCIT is a dyadic treatment that has promise for reducing recidivism in CW mothers. We added a focus on how PTSD symptoms affect parenting and parent-child interaction skills: P-STAIR. Preliminary Data: Following P-STAIR, mothers had a 7-fold lower rate of new confirmed maltreatment reports (2.7%) than NYC’s FPS population as a whole (18.6%). Maternal PTSD and depression symptoms, measured at 90-day follow-up, show that 92.3% of mothers no longer met diagnostic criteria for PTSD. Independent behavioral observations demonstrated significant reduction of negative parenting behaviors and increased positive parenting behaviors. The pilot data indicate P-STAIR is feasible. We propose to conduct a RCT to evaluate efficacy of P-STAIR compared to supportive counseling (SC). Aim 1: Compare P-STAIR to SC with respect to maternal PTSD/depression symptom reduction. Aim 2: Compare P-STAIR to SC with respect to parenting behaviors. Aim 3: Compare P-STAIR to SC with respect to maltreatment recidivism. Impact: If demonstrated efficacious, P-STAIR will reduce maltreatment recidivism among high-risk CW involved mothers, ameliorating lives of children and families and reducing maternal stigma. Our CW partners’ support letters indicate P-STAIR has potential for ready CW dissemination, thereby altering real-world clinical practice.

项目摘要 反复遭受虐待和忽视大大增加了儿童和成人生活贫困的可能性。 结果。然而，目前的儿童福利（CW）家庭保护服务（FPS）并没有减少 虐待惯犯。母亲创伤后应激障碍（PTSD），这一直与穷人有关， 亲子互动是减少虐待的一个有希望的干预目标。我们之前的研究表明， 接受FPS以防止再犯的母亲有很高的创伤相关疾病患病率。率高 这些母亲中的PTSD表明，治疗PTSD可能会减少一个显着的高风险人群的累犯率。 风险妈妈除了直接增加虐待的风险外，PTSD相关的认知缺陷可能使 学习为人父母的技能更加困难，造成了代际持续的创伤。假设： 情感和人际调节方面的育儿技能培训（P-STAIR），一项针对孕产妇的干预措施 与PTSD相关的养育缺陷，将减少累犯。我们使用楼梯的组合，以针对不利的 PTSD（和相关抑郁症）对养育子女的影响以及PCIT的简化版本，以改善 为人父母的技巧STAIR是一个两阶段的治疗，以改善情绪调节和人际交往能力之前， 暴露治疗它比单独的暴露疗法更有效，并增加了治疗的保留， 与虐待儿童相关的创伤后应激障碍。PCIT是一种有希望减少CW母亲累犯的二元治疗。 我们增加了一个关注PTSD症状如何影响育儿和亲子互动技能的重点：P-STAIR。 初步数据：在P-STAIR之后，母亲新确认的虐待报告率降低了7倍 (2.7%）比纽约市的FPS人口作为一个整体（18.6%）。母亲创伤后应激障碍和抑郁症状，测量 在90天的随访中，显示92.3%的母亲不再符合PTSD的诊断标准。独立 行为观察表明，消极的父母行为显着减少， 积极的育儿行为。试验数据表明P-STAIR是可行的。我们建议进行一项随机试验， 评估P-STAIR与支持性咨询（SC）相比的疗效。目标1：比较P-STAIR与SC， 减少母亲的PTSD/抑郁症状。目标2：比较P-STAIR与SC， 养育行为目标3：比较P-STAIR和SC在虐待累犯方面的情况。影响：如果 经证明有效，P-STAIR将减少高风险CW参与母亲中的虐待累犯， 改善儿童和家庭的生活，减少对母亲的歧视。我们的CW合作伙伴的支持信 这表明P-STAIR具有快速传播CW潜力，从而改变了现实世界的临床实践。

项目成果

A randomized controlled trial to assess the efficacy of Parenting-STAIR in treating maternal PTSD to reduce maltreatment recidivism: protocol for the Safe Mothers, Safe Children study.

• DOI: 10.1186/s13063-022-06354-1
• 发表时间: 2022-05-23
• 期刊: TRIALS
• 影响因子: 2.5
• 作者: Lindsey, Michael;Sullivan, Kathrine;Chemtob, Claude;Ancharski, Kelly;Jaccard, James;Cloitre, Marylene;Urquiza, Anthony;Timmer, Susan;Okosi, Mercedes;Kaplan, Debra
• 通讯作者: Kaplan, Debra