A Theory-Based Intervention to Prevent Child Neglect in High-Risk Families

在美国，超过25%的低收入家庭有一个孩子有特殊的医疗保健需求（CSHCN），定义为慢性身体，情绪或行为健康状况的存在。在这一人群中，虐待儿童的风险高得惊人。虐待的一种具体形式是不满足儿童的基本需要，占虐待案件的大多数。该应用程序描述了一个为期四年的指导研究和教育计划，重点是确定高风险时期的虐待经历的CSHCN和试点测试的干预措施，以防止儿童忽视，促进父母解决问题的技能，痛苦的容忍度，情绪调节。根据辩证行为疗法的原则，这种选择性预防干预措施将提供给最初因忽视儿童而被转介到儿童保护服务机构的家庭。这些家庭是高风险、容易识别的人群，特别适合选择性预防战略。我的K23研究计划侧重于低收入的CSHCN与忽视的初步未经证实的报告。具体的研究目标是：1）利用全国虐待儿童和儿童虐待数据系统进行一项回顾性队列研究，以检查因未经证实的忽视而初次转诊到重新转诊到儿童保护服务机构之间的时间段; 2）进行选择性预防干预的试点随机对照试验（n = 60），以现场测试stuy力学，使用已建立的质量改进方法来优化干预措施的实施，并获得研究参数的经验估计值，这些参数将为干预模型的后续全功效试验的规划提供信息。我的教育目标是获得以下方面的进一步培训和经验：1）干预适应科学的原则，包括干预的开发，实施和评估; 2）使用既定的访谈技术来评估父母的反思能力（父母对自己和孩子的行为、思想和情绪的理解）作为干预的潜在理论中介; 3）行为干预研究的设计和实施; 4）对弱势群体进行临床研究的伦理。我的长期目标是开发一种可复制的干预措施，可以可靠地提供给高风险家庭，以减少儿童被忽视的风险。本提案中的研究直接建立在我以前的工作基础上，该工作侧重于开发基于理论的干预措施，以防止高风险家庭中的儿童忽视。我已经确定了一个经验丰富的指导团队和一个支持性的研究环境，这将确保我将实现我的近期和长期目标。这项工作的结果将使我能够提交一份具有竞争力的R 01资助，以进行一项完全有效的干预疗效试验，并将自己确立为一名独立的研究者。

DESCRIPTION (provided by applicant): More than 25% of low-income families in the United States have a child with special health care needs (CSHCN), defined by the presence of a chronic physical, emotional, or behavioral health condition. Among this population, the risk of child maltreatment is disproportionally high. Neglect, a specific form of maltreatment defined as the failure to provide for a child's basic needs, accounts for the majority of maltreatment cases. This application describes a four-year mentored research and education plan that focuses on identifying high-risk periods for maltreatment experienced by CSHCN and pilot testing an intervention to prevent child neglect by promoting parental problem solving skills, distress tolerance, and emotional regulation. Based on the principles of dialectical behavioral therapy, this selective prevention intervention will be delivered to families who have had an initial unsubstantiated referral to child protective services for neglect. Such families represent a high- risk, readily identifiable population particularly amenable to a selective prevention strategy. My K23 research plan focuses on low-income CSHCN with an initial unsubstantiated report of neglect. The specific research aims are to 1) conduct a retrospective cohort study using the National Child Abuse and Neglect Data System to examine the time period between initial referral for unsubstantiated neglect and re- referral to child protective services; and 2) conduct pilot randomized controlled trial (n = 60) of a selective prevention intervention to field test stuy mechanics, use established quality improvement methods to optimize intervention delivery, and obtain empiric estimates of study parameters that will inform the planning of a subsequent fully-powered trial of the intervention model. My educational objectives are to gain further training and experience in 1) the principles of intervention adaptation science, including intervention development, implementation, and evaluation; 2) the use of established interview techniques to evaluate parental reflective capacity (parents' understanding of their own and their child's behavior, thoughts, and emotions) as a potential theory-based mediator of the intervention; 3) the design and conduct of behavioral intervention research; and 4) the ethics of conducting clinical research with vulnerable populations. My long-term goal is to develop a replicable intervention that can be reliably delivered to high-risk families to decrease the risk of child neglect. The research in this proposal builds directly on my prior work, which has focused on the development of a theory-based intervention to prevent child neglect in high-risk families. I have identified an experienced mentoring team and a supportive research environment, which will ensure that I will attain my immediate and long-term goals. The results from this work will position me to submit a competitive R01 grant to conduct a fully-powered efficacy trial of the intervention and establish myself as an independent investigator.