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健康需要(CSHCN)的孩子，其定义是存在慢性身体、情感或行为健康状况。在这些人群中，虐待儿童的风险高得不成比例。忽视是虐待的一种具体形式，定义为未能满足儿童的基本需要，占虐待案件的大部分。本申请描述了一项为期四年的有指导的研究和教育计划，重点是确定CSHCN经历的虐待的高风险时期，并试点测试一种干预措施，通过促进父母解决问题的技能、承受痛苦和情绪调节来防止儿童疏忽。根据辩证行为疗法的原则，这种选择性预防干预将提供给那些最初因疏忽而被转介到儿童保护服务机构而没有确凿证据的家庭。这类家庭是特别容易接受选择性预防战略的高危、容易识别的人群。我的K23研究计划专注于低收入的CSHCN，最初没有得到证实的疏忽报告。具体的研究目标是：1)使用国家虐待和忽视儿童数据系统进行一项回溯性队列研究，以检查最初因未经证实的忽视而转诊到儿童保护服务机构之间的时间段；以及2)进行选择性预防干预的试点随机对照试验(n=60)，以实地测试研究机制，使用已建立的质量改进方法来优化干预交付，并获得研究参数的经验估计，这些参数将为随后的全面干预模式试验的规划提供参考。我的教育目标是在以下方面获得进一步的培训和经验：1)干预适应科学的原则，包括干预的制定、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)，作为潜在的基于理论的干预中介；3)行为干预研究的设计和实施；以及4)对弱势人群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，能够可靠地提供给高危家庭，以降低忽视儿童的风险。这项建议中的研究直接建立在我之前的工作基础上，我之前的工作重点是开发一种基于理论的干预措施，以防止高危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竞争性的R01拨款，以进行一项全面的干预疗效试验，并确立我作为一名独立研究者的地位。

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.