Enhancing Early Relational Health to Reduce Disparities in Child Health and Development: Addressing ACEs and Promoting PCEs through an Integrated Evidence-based Intervention in Pediatric Primary Care

加强早期关系健康，减少儿童健康和发展方面的差异：通过儿科初级保健中的综合循证干预措施解决 ACE 问题并促进 PCE 问题

• 批准号: 10718071
• 负责人: Caitlin Ford Canfield
• 金额: $ 85.04万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-25 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10718071
• 关键词: Academic skills; Academy; Address; Age; American; Books; Buffers; Caring; Child; Child Development; Child Health; Child Rearing; Childhood; Cities; Cognitive; Developmental Delay Disorders; Disparity; Dissemination and Implementation; Effectiveness; Elements; Evidence based intervention; Family; Feedback; Health; Healthcare; Home environment; Hybrids; Inequality; Informal Social Control; Investments; Knowledge; Life; Link; Longevity; Low income; Mediating; Mental Health; Methods; Modeling; National Institute on Minority Health and Health Disparities; Outcome; Parent-Child Relations; Parents; Pathway interactions; Pediatrics; Play; Population; Poverty; Primary Care; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Reading; Recommendation; Reduce health disparities; Resources; Schools; Services; Site; Stress; Structure; Testing; Time; Toy; Trust; Video Recording; Visit; Well Child Visits; Well in self; adverse childhood events; collaborative care; contextual factors; cost; depressive symptoms; design; disparity reduction; effectiveness evaluation; effectiveness outcome; effectiveness/implementation study; ethnic minority; evidence base; evidence based guidelines; experience; flexibility; health disparity; implementation outcomes; implementation/effectiveness; improved; intervention delivery; learning materials; maternal depression; negative affect; novel; physical conditioning; preference; preventive intervention; programs; racial minority; racism; screening; social; standard of care; stem; therapy design

SUMMARY Poverty and racism are linked to disparities in early child development (ECD), including school readiness (pre- academic skills, self-regulation, social-emotional well-being), which are a core contributor to long-term health and mental health outcomes. These disparities begin early in life, widen as children age, and persist across the lifespan. Poverty and racism also increase the likelihood of adverse childhood experiences (ACEs) and decrease the likelihood of positive childhood experiences (PCEs). Importantly, PCEs are not simply the absence of ACEs; they are factors that are beneficial for children’s development and may be especially important in providing a buffer for the impacts of ACEs. Two interrelated frameworks (Stress and Investment) illustrate how ACEs and PCEs impact ECD through a key common pathway of early relational health (ERH; parent-child relationship quality, structuring the home environment, responsivity/cognitive stimulation). Thus, enhancing ERH by both addressing ACEs and promoting PCEs is critical for mitigating disparities in ECD. Evidence-based preventive interventions (EBPIs) designed to reduce these disparities have increasingly been located in pediatric primary care due to its population-level reach, frequent visits, trusted relationships, and potential for low cost. However, few EBPIs have successfully integrated strategies to concurrently and directly address ACEs and promote PCEs, limiting their capacity to fully address disparities synergistically, particularly for families with fewer resources. Moreover, knowledge gaps related to dissemination and implementation (D&I) of integrated EBPIs represent a key barrier to improving implementation effectiveness and impact. We propose a novel integration of HealthySteps (HS) and Video Interaction Project (VIP), two exemplar, American Academy of Pediatrics (AAP)-recommended EBPIs. HS provides a stepped-care approach with universal screening for ACEs and additional support and referrals for families with increased concerns. HS has been shown to reduce family vulnerabilities and negative relationship quality elements of ERH. However, HS has limited impact on PCEs, suggesting additional strategies may be needed to improve effectiveness of the HS stepped-care approach in enhancing ERH. Integrating VIP may address this gap with its focus on video- recording parents and children interacting with a toy or book provided by the program and real-time, strengths- based feedback. VIP has impacts on parenting assets and responsivity/cognitive stimulation elements of ERH. We will test an integrated HS+VIP model in order to: 1) identify best practice strategies for implementing integrated EBPIs in diverse pediatric care sites; 2) examine effectiveness and implementation outcomes of the HS+VIP model; and 3) examine health disparities mechanisms underlying these outcomes. This integrated model has the potential for population-level reductions in disparities in ECD outcomes by targeting ACEs and PCEs simultaneously and will provide strong support for developing best practices for the D&I of such models.

摘要 贫穷和种族主义与儿童早期发展(ECD)方面的不平等有关，包括入学准备(学前教育 学术技能、自我调节、社会情绪健康)，这些都是长期健康的核心因素 和心理健康结果。这些差异开始于生命的早期，随着儿童年龄的增长而扩大，并持续到 寿命。贫穷和种族主义也增加了儿童不良经历(ACE)和 减少积极童年经历(PCE)的可能性。重要的是，PCE不仅仅是 没有王牌；它们是有利于儿童发展的因素，特别是 在为ACE的影响提供缓冲方面很重要。两个相互关联的框架(压力和投资) 说明ACE和PCE如何通过早期关系健康的关键共同途径影响ECD(ERH； 亲子关系质量、构建家庭环境、响应性/认知刺激)。因此， 通过解决ACEs和促进PCE来提高ERH对于减少幼儿发展方面的差异至关重要。 旨在减少这些差距的循证预防干预措施(EBPI)越来越多地被 位于儿科初级保健，因为其人口水平的覆盖范围，频繁的访问，值得信赖的关系，以及 低成本的潜力。然而，很少有EBPI成功地将战略整合到同时和直接 处理王牌和促进PCE，限制它们协同充分解决差距的能力，特别是 适用于资源较少的家庭。此外，与传播和执行有关的知识差距 综合EBPI(D&I)是提高执行效力和影响的主要障碍。 我们提出了一种新的Healthy Steps(HS)和Video Interaction Project(VIP)的集成，两个范例， 美国儿科学会(AAP)-推荐的EBPI。HS提供分步护理方法，包括 对王牌进行普遍筛查，并为有更多关切的家庭提供额外支持和转介。房协有 已被证明可以减少ERH的家庭脆弱性和负面关系质量因素。不过，房协 对PCE的影响有限，这表明可能需要更多的战略来提高 循序渐进的护理方法，以加强紧急医疗服务。整合VIP可能会将重点放在视频上，从而弥补这一差距 记录父母和孩子与该计划提供的玩具或书籍的互动，以及实时、强项- 基于反馈。VIP对ERH的育儿资产和责任性/认知刺激因素有影响。 我们将测试集成的HS+VIP模式，以便：1)确定实施 综合EBPI在不同的儿科护理地点；2)检查有效性和实施结果 HS+VIP模型；以及3)检查这些结果背后的健康差异机制。这一集成 MODEL有可能通过以ACEs和ACEs为目标来减少人口水平的ECD结果差异 该中心将同时开展个人计算机系统，并将为开发此类模型的最佳做法提供强有力的支持。