Embedding Mental Health Consultation Within Prenatal Home Visiting to Prevent Child Maltreatment and Violence Exposure

将心理健康咨询纳入产前家访，防止儿童遭受虐待和暴力

• 批准号: 10023242
• 负责人: Stephanie Hart Parade
• 金额: $ 35万
• 依托单位: EMMA PENDLETON BRADLEY HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2021-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10023242
• 关键词: Embedding; Mental; Health; Consultation; Within

Abstract Adverse childhood experiences (ACES) is a major public health problem that exacts tremendous cost to the United States each year. Exposure to ACES during infancy, including child maltreatment and child exposure to adult intimate partner violence, undermines health across the lifespan. Infants are at greatest risk for fatality resulting from maltreatment in the first week of life, and nearly a third of infants who experience maltreatment in the first year have been maltreated by one week postpartum. Thus, intervening in the postpartum period to prevent maltreatment and exposure to intimate partner violence is too late. Furthermore, mothers with their own history of adversity or trauma are much more likely to experience risk factors in the postpartum period for perpetrating violence. Intervening prenatally to support mothers into the postpartum transition, particularly mothers with their own trauma history, is critical to reducing maltreatment and violence exposure in children. Home visiting programs, with their emphasis on maternal-child health, are an important bridge to support mothers with a trauma history across the perinatal transition, and an ideal setting for primary prevention of child maltreatment and violence exposure. The proposed research will focus on RFA Objective #3: Effectiveness research to evaluate a primary prevention strategy that incorporates a dual-generation approach. Through close collaboration with the Rhode Island Department of Health (RIDOH) and the Rhode Island Department of Children, Youth, and Families (RI DCYF), we will capitalize on established infrastructure to innovate and enhance a statewide short-term home visiting program. Our primary prevention program, Enhanced First Connections, will draw upon an infant mental health perspective to provide prenatal infant and early childhood mental health consultation in the context of the home visiting program. We will focus on a selected high-risk population, mothers with a history of adversity or trauma, with the goal of preventing ACES exposure among infants. Primary outcomes of the proposed randomized control trial (RCT) will include the prevention of child maltreatment (child abuse and neglect) and exposure to adult intimate partner violence. Secondary outcomes of the proposed RCT will include increases in family engagement in longer- term evidence based home visiting programs, increases in family engagement in specialized support services to address maternal adversity and trauma, reductions in maternal risk factors, and the promotion of positive parenting and the parent-child relationship. We will use gold-standard assessments to measure our outcome variables including review of child protection records, interview and observational assessments, and review of home visiting records. Our focus on infant and early childhood mental health consultation is highly innovative as no prior research has empirically tested this strategy for the primary prevention of child maltreatment and child exposure to adult intimate partner violence. Results will be of high interest given the national focus on supporting infant and early childhood mental health consultation within home visiting.

摘要 儿童不良经历（ACES）是一个主要的公共卫生问题，它给儿童带来了巨大的损失。 美国每年。婴儿期接触ACES，包括儿童虐待和儿童接触 成年人亲密伴侣的暴力行为会损害整个生命周期的健康。婴儿死亡风险最大 在出生后的第一周内，近三分之一的婴儿遭受虐待， 在第一年被虐待了一个星期产后。因此，在产后期间进行干预， 防止虐待和遭受亲密伴侣暴力为时已晚。此外，母亲与他们的 自己的逆境或创伤史更有可能在产后期间经历危险因素， 实施暴力产前干预以支持母亲进入产后过渡期，特别是 有自身创伤史的母亲，对减少儿童遭受虐待和暴力至关重要。 家庭访问计划，其重点是母婴健康，是支持的重要桥梁 在围产期过渡期有创伤史的母亲，以及一级预防的理想环境， 儿童虐待和暴力曝光。拟议的研究将侧重于RFA目标#3： 进行有效性研究，以评价一项包含两代疫苗的初级预防战略 approach.通过与罗得岛卫生部（RIDOH）和罗德岛州卫生部的密切合作， 岛屿儿童、青年和家庭部（RI DCYF），我们将利用现有的基础设施 创新和加强全州范围内的短期家访计划。我们的初级预防计划， 加强第一次连接，将借鉴婴儿心理健康的角度，提供产前婴儿和 在家访方案中提供幼儿心理健康咨询。我们将集中在一个 选择高危人群，有逆境或创伤史的母亲，目的是预防ACES 婴儿的暴露。拟议的随机对照试验（RCT）的主要结局将包括 防止虐待儿童（虐待和忽视儿童）和接触成年亲密伴侣 暴力拟议随机对照试验的次要结果将包括在较长时间内家庭参与的增加， 长期基于证据的家访计划，增加家庭参与专业支持服务 解决产妇逆境和创伤，减少产妇风险因素，促进积极的 养育子女和亲子关系。我们将使用黄金标准评估来衡量我们的成果 变量包括审查儿童保护记录、访谈和观察评估，以及审查 家访记录我们对婴幼儿心理健康咨询的关注具有很强的创新性 由于先前没有研究对这一儿童虐待初级预防战略进行过实证检验， 儿童遭受成人亲密伴侣暴力的风险。考虑到国家的重点，结果将引起高度关注 在家访中支持婴幼儿心理健康咨询。