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

项目总结 亲密伴侣暴力(IPV)的发生率高得令人震惊，在以下期间接触IPV的风险最高 怀孕了。在这一关键时刻，IPV与产后抑郁症、创伤后应激、 母婴关系中断，婴儿结局不佳。尽管这些对双方都有有害影响 对于母亲和婴儿来说，缺乏循证干预措施来证明对 这群人。迫切需要一种理论驱动的干预，根植于翻译研究，即 能够有效地满足感染IPV的孕妇的特定发育需求 妇女和她们的孩子。为了回应这一需求，研究小组创造了怀孕的妈妈们的 赋权计划(PMEP)。采用多点随机临床试验设计，具体目标为 本研究旨在评估PMEP计划在以下方面的效果：(1)产妇心理健康， 复原力、再受害和育儿敏感性；(2)婴儿早期发展，包括认知、 语言和社会情感功能。我们还试图评估治疗变化的机制--社会 支持和赋权。参与者将包括230名接触IPV的孕妇，其中一半将 收到PMEP后，其中一半将处于接触等效主动控制状态。女性在两者中都有 有条件的患者将参加以小组为基础的治疗，每周1次，每次2小时，为期5周。 评估将在治疗前、治疗后、产后3个月(即婴儿3 产后12个月(即1岁的婴儿)。评估将包括半结构化 访谈和观察性数据收集。我们希望在怀孕期间提供PMEP干预 将对围产期的母亲和婴儿都有积极的影响，解决消极的问题 IPV的代际效应。我们的中心假设是PMEP，是在以前的基础上发展起来的 实证研究、社区利益相关者焦点小组和试点干预数据将减少 减少受害，改善产妇的心理健康、韧性和育儿敏感度。分析将是 使用多层次和结构方程模型进行；试点数据支持拟议的充分性 样本大小，以检测每个研究目的的治疗效果。该项目既创新地使用了多个 站点，多方法设计，其重要之处在于它满足了弱势群体的需求 可用的治疗资源。它具有改善行为和心理健康结果的潜力 不仅是孕妇，还有她们年幼的孩子，这将减少公共卫生负担 在产前期间精神健康状况差，并改善新妈妈的健康和福祉，他们的 儿童和他们的家人。拟议的研究将通过以下方式解决研究和临床工作中的一个关键差距 创建可在社区护理环境中实施的有效和可持续的干预措施。

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.