RCT of FIND video coaching intervention for caregivers facing economic adversity

针对面临经济逆境的护理人员的 FIND 视频辅导干预的随机对照试验

• 批准号: 10089226
• 负责人: Philip A Fisher
• 金额: $ 61.41万
• 依托单位: UNIVERSITY OF OREGON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10089226
• 关键词: 3 year old; Achievement; Address; Age; Behavior; Behavioral Mechanisms; Brain; Buffers; Caregiver support; Caregiver well-being; Caregivers; Characteristics; Child; Child Behavior; Child Development; Child Rearing; Child Welfare; Chronic; Chronic stress; Cognitive; Communities; Community Health; Development; Economics; Educational process of instructing; Effectiveness of Interventions; Engineering; Enrollment; Ensure; Evidence based intervention; Family; Family Characteristics; Film; Functional Magnetic Resonance Imaging; Future; Hair; Head Start Program; Hydrocortisone; Infant; Instruction; Intervention; Knowledge; Low income; Measures; Mediating; Mediator of activation protein; Mission; Modeling; Morbidity - disease rate; National Institute of Child Health and Human Development; Outcome; Parents; Patient Self-Report; Personal Satisfaction; Population; Poverty; Process; Public Health; Randomized; Recording of previous events; Reporting; Research; Risk; Sampling; Science; Self Concept; Self Efficacy; Services; Socioeconomic Status; Specific qualifier value; Specificity; Stress; Techniques; Testing; Training; Underserved Population; Variant; Waiting Lists; Work; active control; base; behavior measurement; behavioral outcome; biobehavior; caregiver interventions; caregiving; cognitive load; design; dosage; early childhood; efficacy trial; evidence base; follow-up; high risk; improved; innovation; intervention effect; longitudinal design; lower income families; mortality; neurobiological mechanism; neuroimaging; neuromechanism; primary caregiver; programs; promoter; randomized effectiveness trial; response; skills; stressor; theories; therapy design; therapy development

7. Project Summary/Abstract Of the 2.6 million U.S. children under age 3 living at or below the Federal Poverty Threshold, most do not receive services to support healthy development for which they are eligible, because of limited program capacity. Existing evidence-based interventions designed to buffer low-income children in this age range from the negative effects of stressors associated with poverty require high dosage and/or long-duration delivery from trained professionals to achieve only modest effect sizes, and they have high rates of attrition. Moreover, very little is known about mediators and moderators of the effectiveness of these interventions (i.e., what works for whom and why). This is especially true in terms of potentially malleable caregiver and child neurobiological mechanisms that represent mediators of program impact. The overall objective of the proposed study is to conduct a randomized effectiveness trial with a diverse sample of low-income families with children ages 12– 36 months, and who are eligible for Early Head Start (EHS) but cannot be enrolled because of limited program capacity. We will use a longitudinal randomized effectiveness trial to test the central hypothesis that associations between increases in responsive caregiving (the main FIND target), and subsequent caregiver well-being and child developmental and biobehavioral outcomes (secondary targets), will be partially mediated through changes in caregiver neuroimaging-based and behavioral measures of inhibitory control and parent self-concept. We will also examine moderators of hypothesized intervention effects. The rationale for this work is that it simultaneously addresses the unmet needs of a large, significantly underserved early childhood population and allows for a rigorous test of our conceptual model. We will randomize 300 primary caregivers and their 1- to 3-year-old children who are eligible for EHS services but who cannot be served, to receive FIND or an active control intervention. Aim 1 quantifies the main effects of FIND on changes in responsive parenting and related caregiver and child outcomes (including caregiver-reported parenting self-efficacy, objective measures of chronic child stress) immediately after the intervention, and the durability of these effects 6 months later. Aim 2 identifies underlying neural mechanisms that mediate associations between FIND-related changes in caregiver behavior and caregiver/child outcomes and the specificity of those mechanisms. Aim 3 assesses the degree to which these associations are moderated by caregiver and child characteristics (e.g., caregiver history of adversity, family socioeconomic status, child age) and intervention fidelity and dosage. This information is critical to addressing differential response to early childhood interventions for children ages 1–3, to increase impact and scalability. These outcomes will have a positive impact in that the overwhelming majority of families who meet the enrollment criteria for EHS normally do not receive services. An easily delivered program that can be provided while these families remain on the waitlist may facilitate their children's development and reduce risks.

7.项目总结/摘要 在260万生活在联邦贫困线或以下的3岁以下的美国儿童中，大多数没有 接受服务，以支持健康发展，他们有资格，因为有限的计划， 容量现有的旨在缓冲这一年龄段低收入儿童的循证干预措施包括 与贫困有关的压力因素的负面影响需要高剂量和/或长期提供 从受过训练的专业人士，以实现只有适度的效果大小，他们有很高的流失率。此外，委员会认为， 关于这些干预的有效性的中介者和调节者知之甚少（即，什么可行 为谁和为什么）。这在潜在的可塑性照顾者和儿童神经生物学方面尤其如此 代表项目影响的中介的机制。拟议研究的总体目标是 对有12岁孩子的低收入家庭的不同样本进行随机有效性试验， 36个月，并且有资格参加Early Head Start（EHS），但由于计划有限而无法入学 容量我们将使用纵向随机有效性试验来检验中心假设， 反应性睡眠增加（主要FIND目标）与随后的照顾者之间的关联 幸福和儿童发育和生物行为结果（次要目标），将部分介导 通过改变照顾者的神经成像和行为措施的抑制控制和父母 自我概念我们还将研究假设的干预效果的主持人。这项工作的基本原理 它同时满足了大量未得到充分服务的幼儿的需求， 人口，并允许我们的概念模型进行严格的测试。我们将随机抽取300名主要照顾者 及其符合EHS服务条件但无法获得服务的1至3岁子女， 或主动控制干预。目标1量化了FIND对反应性父母教育变化的主要影响 和相关的照顾者和儿童的结果（包括父母报告的养育自我效能，客观 慢性儿童压力的措施），以及这些影响的持久性6 月后目的2识别介导FIND相关神经元之间关联的潜在神经机制。 照顾者行为和照顾者/儿童结果的变化以及这些机制的特异性。目标3 评估这些关联受照顾者和儿童特征调节的程度（例如， 照顾者的逆境史，家庭社会经济地位，儿童年龄）和干预的忠诚度和剂量。这 信息对于解决1-3岁儿童对幼儿干预措施的不同反应至关重要， 以提高影响力和可扩展性。这些结果将产生积极影响，因为压倒性的 大多数符合环境健康服务登记准则的家庭通常不会接受服务。一个容易 当这些家庭仍在等待名单上时，可以提供的已交付计划可能会促进他们的孩子 发展，降低风险。