Intervening during the Prenatal Period with Women Exposed to Intimate Partner Violence to Improve Maternal Functioning and Infant Adjustment

项目概要 亲密伴侣暴力 (IPV) 的发生率高得惊人，在以下时期接触 IPV 的风险最高： 怀孕。这一关键时刻的 IPV 与产后抑郁症、创伤后应激障碍、 母婴关系破裂，婴儿结局不佳。尽管对双方都有这些有害影响 对于母亲和婴儿来说，缺乏已证明有效的循证干预措施 这个人口。迫切需要根植于转化研究的理论驱动的干预措施， 可以证明在满足 IPV 暴露孕妇的特定发育需求方面的有效性 妇女和她们的孩子。针对这一需求，研究团队创建了“怀孕妈妈” 赋权计划（PMEP）。采用多中心、随机临床试验设计，具体目标 当前的研究旨在评估 PMEP 计划在解决 (1) 孕产妇心理健康方面的功效， (2) 婴儿早期发育，包括认知、 语言和社会情感功能。我们还寻求评估治疗改变的机制——社会 支持和赋权。参与者将包括 230 名暴露于 IPV 的孕妇，其中一半将 获得PMEP，其中一半将处于接触等效主动控制状态。两者中的女性 病情将参加每周 1、2 小时的分组治疗，为期 5 周。 评估将在治疗前、治疗后、产后 3 个月（即婴儿 3 个月大）和产后 12 个月（即婴儿 1 岁）。评估将包括半结构化 访谈和观察数据收集。我们期望在怀孕期间提供 PMEP 干预 将对整个围产期的母亲和婴儿产生积极影响，解决负面影响 IPV 的代际效应。我们的中心假设是，PMEP 是在之前的基础上开发的 实证研究、社区利益相关者的焦点小组以及试点干预数据将减少重新 受害并改善产妇心理健康、复原力和养育子女的敏感性。分析将是 使用多级和结构方程建模进行；试点数据支持拟议方案的充分性 用于检测每个研究目标的治疗效果的样本量。该项目的创新之处在于它使用了多 站点，多方法设计，其重要性在于它满足了缺乏资源的弱势群体的需求 可用的治疗资源。它有可能改善行为和心理健康结果 不仅包括孕妇，还包括她们的幼儿，这将减轻公众健康负担 产前期间心理健康状况不佳，并改善新妈妈及其母亲的健康和福祉 儿童及其家人。拟议的研究将通过以下方式解决研究和临床工作中的关键差距 创建一种有效且可持续的干预措施，可以在社区护理环境中轻松实施。

PROJECT SUMMARY Intimate partner violence (IPV) occurs at alarmingly high rates, with the highest risk of IPV exposure during pregnancy. IPV during this critical juncture is associated with postpartum depression, posttraumatic stress, disruption to the mother-infant relationship, and poor infant outcomes. Despite these deleterious effects to both the mother and infant, there is a lack of evidence-based interventions that have demonstrated effectiveness for this population. A critical need exists for a theoretically-driven intervention, rooted in translational research, that can demonstrate effectiveness in addressing the specific, developmental needs of IPV-exposed pregnant women and their children. In response to this need, the research team has created the Pregnant Moms’ Empowerment Program (PMEP). Using a multi-site, randomized clinical trial design, the specific objectives of the current study are to evaluate the efficacy of the PMEP program in addressing (1) maternal mental health, resilience, re-victimization, and parenting sensitivity and (2) early infant development, including cognitive, language, and socioemotional functioning. We also seek to evaluate mechanisms of treatment change – social support and empowerment. Participants will include 230 IPV-exposed pregnant women, half of whom will receive the PMEP and half of whom will be in a contact equivalent active control condition. Women in both conditions will participate in group-based treatment during 1, 2-hour session each week, for 5 weeks. Assessments will be administered at pre-treatment, post-treatment, 3 months postpartum (i.e., infants 3 months old), and 12 months postpartum (i.e., infants 1 year old). Assessments will include semi-structured interviews and observational data collection. We expect that providing the PMEP intervention during pregnancy will have positive effects for both mothers and infants across the perinatal period, addressing the negative intergenerational effects of IPV. Our central hypothesis is that the PMEP, developed based on previous empirical research, focus groups of community stakeholders, and pilot intervention data, will reduce re- victimization and improve maternal mental health, resilience, and parenting sensitivity. Analyses will be conducted using multilevel and structural equation modeling; pilot data support the adequacy of the proposed sample size to detect treatment effects for each study aim. This project is both innovative in its use of a multi- site, multi-method design and significant in that it addresses the needs of a vulnerable population that has few available treatment resources. It has the potential to improve both behavioral and mental health outcomes among not only pregnant women, but also their young children, which will reduce the public health burden of poor mental health during the prenatal period and improve the health and well-being of new mothers, their children, and their families. The proposed study will address a critical gap in both research and clinical work by creating an effective and sustainable intervention that can be readily implemented in community care settings.