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

描述（由申请人提供）：在美国，超过25%的低收入家庭有一个有特殊医疗需求（CSHCN）的孩子，其定义为存在慢性身体、情感或行为健康状况。在这一人群中，儿童遭受虐待的风险高得不成比例。忽视是一种特殊形式的虐待，被定义为不能满足儿童的基本需要，这种虐待占虐待案件的大多数。本申请描述了一项为期四年的指导研究和教育计划，重点是确定CSHCN遭受虐待的高风险时期，并通过提高父母解决问题的技能、痛苦容忍和情绪调节来试点测试一种干预措施，以防止儿童被忽视。基于辩证行为治疗的原则，这种选择性预防干预将提供给那些最初因忽视儿童而被转介到儿童保护服务的家庭。这类家庭是高危人群，易于识别，特别适合采取选择性预防策略。我的K23研究计划侧重于低收入的CSHCN，最初的未经证实的忽视报告。具体的研究目的是：1)使用国家儿童虐待和忽视数据系统进行回顾性队列研究，以检查首次转诊为未经证实的忽视和重新转诊到儿童保护服务之间的时间间隔；2)进行选择性预防干预的随机对照试验（n = 60），以现场测试研究机制，使用已建立的质量改进方法优化干预交付，并获得研究参数的经验估计，这将为后续干预模型的全动力试验计划提供信息。我的教育目标是在以下方面获得进一步的培训和经验：1)干预适应科学的原理，包括干预的制定、实施和评估；2)使用已建立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基础中介；3)行为干预研究的设计与实施；4)对弱势群体进行临床研究的伦理问题。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。这项提案中的研究直接建立在我之前的工作基础上，我的工作重点是发展一种基于理论的干预措施，以防止高风险家庭中的儿童被忽视。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有竞争力的R01拨款，以进行干预措施的全面疗效试验，并使我成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.