Promoting Emotional Development Among Young Children Facing Adversity: An Effectiveness Implementation Study in St. Louis Schools

项目摘要 面临逆境的儿童有很高的社会情感和认知结果不良的风险 后来的精神变态学。然而，越来越多的证据表明，这些消极的发展 通过在发育早期加强养育和照顾，轨迹可以得到显著改善。 尽管有许多经验支持的早期干预措施，但这些计划并不容易 大多数美国最有需要的儿童都能接触到。基于此，迫切需要 使这些干预措施可行，并随时可供这些社区使用。为了做到这一点，我们 建议测试一次简短的6次亲子预防干预的有效性 通过视频会议在家庭中进行，并研究两种实现方法 3个高危学区。这项名为“欣欣向荣”的干预是先前测试过的早期父母 在圣路易斯县地区试行的儿童干预被证明是可行的、可接受的和 看起来很有效。符合纳入标准的4.0-6.11岁的照顾者-儿童二人组将 随机进入蓬勃发展的状态或接受类似的在线育儿教育 长度。虽然利用学校作为提供服务的平台将增加可及性，但这 系统对心理健康的实施提出了独特而复杂的挑战 预防。因此，我们将使用混合有效性实现设计来测试 与明智的育儿相比，Thrive的有效性，同时也评估了两种方法的影响 对研究结果的实施形式(辅导与不辅导)。关键字的评估 结果测量，包括儿童行为、社会和情绪功能，儿童 精神病理学、育儿压力、乐观和抑郁症状，以及 父母教养方式与亲子二元关系(使用函数近邻的观察性和神经性 红外光谱的fNIRS)将在基线、治疗后(P1)和12周进行测量 治疗后(P2)。我们还将测试预防性干预如何机械地针对 通过提高照顾者的反应性和敏感度来提高照顾者-儿童关系的质量 通过基线、治疗中期和治疗后(P1)评估。这个项目提供了第一个 通过学校获得并在家中交付的简短亲子早期预防测试 视频会议，只对治疗师进行最低限度的培训，以增强获得护理的机会。它进一步研究了 治疗师指导作为改善实施和临床的一种手段的成本-效果 结果。

Project Summary Children facing adversity are at high risk for poor socio-emotional and cognitive outcomes and later psychopathology. However, there is increasing evidence that these negative developmental trajectories can be significantly improved by enhancing nurturing caregiving early in development. Despite numerous empirically supported early interventions, these programs are not readily accessible to the majority of US children most in need. Based on this, there is an urgent need to make these interventions feasible and readily available to these communities. To do this we propose to test the effectiveness of a brief 6 session parent-child preventive intervention conducted by video conference in the family's home and study two implementation methods within 3 high-risk school districts. The intervention, entitled “THRIVE,” is a previously tested early parent child intervention piloted in a St. Louis county district which proved feasible, acceptable and appeared effective. Caregiver-child dyads aged 4.0-6.11 meeting inclusion criteria will be randomized to a THRIVE condition or an established online parenting education of comparable length. Although the use of schools as a service delivery platform will increase accessibility, this system presents unique and complex challenges for implementation of a mental health prevention. Therefore, we will use a hybrid effectiveness-implementation design to test the effectiveness of THRIVE compared to Parenting Wisely, while also assessing the impact of two forms of implementation (coaching vs. no coaching) on study outcomes. Assessments of key outcome measures, including child behavior, social, and emotional functioning, child psychopathology, parenting stress, optimism, and depressive symptoms, and changes in parenting and the parent-child dyadic relationship (observational and neural using functional near infrared spectroscopy' fNIRS) will be measured at baseline, post-treatment (P1), and 12-weeks post-treatment (P2). We will also test how the preventive intervention mechanistically targets the quality of the caregiver-child relationship by enhancing caregiver responsiveness and sensitivity via baseline, mid-treatment and post-treatment (P1) assessments. This project provides the first test of a brief parent-child early prevention accessed through schools and delivered in home by video conference with minimal therapist training to enhance access to care. It further examines the cost-effectiveness of therapist coaching as a means to improve implementation and clinical outcomes.