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

项目摘要 亲密伴侣暴力（IPV）的发生率高得惊人， 怀孕在这个关键时刻，IPV与产后抑郁症、创伤后应激有关， 母婴关系的破坏，以及婴儿的不良后果。尽管这些有害的影响， 对于母亲和婴儿，缺乏证据为基础的干预措施，已证明有效， 这个人口。一个关键的需要存在的理论驱动的干预，植根于转化研究， 可以证明有效地解决特定的，发展需要的IPV暴露孕妇 妇女和她们的孩子为了满足这一需求，研究小组创建了怀孕妈妈的 增强权能方案。采用多中心、随机临床试验设计， 本研究旨在评估PMEP项目在解决（1）孕产妇心理健康， 弹性，再次受害，和父母的敏感性和（2）早期婴儿发展，包括认知， 语言和社会情感功能。我们还寻求评估治疗变化的机制-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 接收PMEP，并且其中一半将处于接触等效主动控制状态。妇女在 条件将参加以小组为基础的治疗期间，每周1，2小时的会议，为5周。 将在治疗前、治疗后、产后3个月（即，婴儿3 月龄）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。我们期望在妊娠期间提供PMEP干预 将在整个围产期对母亲和婴儿产生积极影响， IPV的代际效应。我们的中心假设是，PMEP，开发的基础上，以前 经验研究、社区利益相关者的重点小组和试点干预数据将减少重新评估。 受害者和改善产妇的心理健康，复原力和育儿敏感性。分析将 使用多层次和结构方程模型进行;试点数据支持建议的充分性 样本量，以检测每个研究目的的治疗效果。这个项目是创新的，在其使用的多- 它的重要性在于，它解决了一个弱势群体的需要， 现有的治疗资源。它有可能改善行为和心理健康结果 不仅在孕妇中，而且在她们的幼儿中，这将减少 产前心理健康状况不佳，并改善新母亲的健康和福祉， 孩子和他们的家人。拟议的研究将通过以下方式解决研究和临床工作中的关键差距： 创建一个有效和可持续的干预措施，可以随时在社区护理环境中实施。

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.