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.

项目概要 反复遭受虐待和忽视会大大增加儿童和成人生活贫困的可能性 结果。然而，当前的儿童福利 (CW) 家庭保护服务 (FPS) 并没有减少 虐待累犯。母亲创伤后应激障碍（PTSD），与贫困有关 亲子互动是减少虐待的一个有前景的干预目标。我们之前的工作表明 接受 FPS 来预防累犯的母亲患有创伤相关疾病的几率很高。高比率 这些母亲中的 PTSD 表明，治疗 PTSD 可能会减少很大一部分高危人群的累犯率。 风险母亲。除了直接增加虐待的风险外，创伤后应激障碍（PTSD）相关的认知缺陷可能会导致 学习养育技能更加困难，导致创伤在代际之间持续存在。假设： 情感和人际调节育儿技能培训（P-STAIR），一项针对母亲的干预措施 与创伤后应激障碍相关的养育缺陷，会减少累犯。我们结合使用 STAIR 来针对不利的情况 PTSD（以及相关抑郁症）对养育子女的影响以及 PCIT 的简化版以改善 育儿技巧。 STAIR 是一种两阶段治疗，可在治疗前改善情绪调节和人际交往能力 暴露治疗。它比单独的暴露疗法更有效，并且可以提高治疗的保留率 与虐待儿童相关的创伤后应激障碍。 PCIT 是一种二元治疗，有望减少 CW 母亲的累犯。 我们增加了对 PTSD 症状如何影响养育和亲子互动技能的关注：P-STAIR。 初步数据：P-STAIR 实施后，母亲新确认的虐待报告发生率降低了 7 倍 (2.7%) 高于纽约市 FPS 总人口 (18.6%)。测量母亲的 PTSD 和抑郁症状 90 天的随访显示，92.3% 的母亲不再符合 PTSD 的诊断标准。独立的 行为观察表明，消极养育行为显着减少，增加 积极的养育行为。试点数据表明P-STAIR是可行的。我们建议进行随机对照试验 评估 P-STAIR 与支持性咨询 (SC) 相比的功效。目标 1：将 P-STAIR 与 SC 进行比较 关于母亲 PTSD/抑郁症状的减轻。目标 2：将 P-STAIR 与 SC 进行比较 养育行为。目标 3：在虐待累犯方面比较 P-STAIR 和 SC。影响：如果 P-STAIR 已被证明有效，将减少高风险 CW 母亲中的虐待累犯， 改善儿童和家庭的生活并减少母亲的耻辱。我们的 CW 合作伙伴的支持信 表明 P-STAIR 有潜力进行 CW 传播，从而改变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