Universal strengths-based parenting support in pediatric health care for families with very young children following the Flint Water Crisis

项目概要/摘要 公共卫生灾害对贫困社区的影响尤为严重，其途径增加了 贫困和相关压力源的影响，并在较长时间内发挥作用。非常小的孩子是高度 易受对发展和心理健康的长期影响，但往往得到最少的关注 和资源许多研究都记录了普遍预防性育儿干预的好处， 在贫困和相关压力因素的背景下， 据我们所知，积极育儿的普遍推广以前没有在一次 在这种情况下，很少有关于养育子女和儿童早期发展的研究。 这项建议旨在确定普遍的优势为基础的育儿支持在防止不良的作用， 弗林特水危机（Flint Water Crisis，FWC）后的儿童在FWC中，铅污染 在密歇根州弗林特市，一个拥有世界上最大的 美国最高的长期贫困率和相关的压力因素。家人们一直在担心 铅对儿童的影响，加上被视为危机后的愤怒、不信任和遗弃， 这是可以避免的，被认为是忽视的，根源在于种族和社会经济偏见。 目标将通过视频互动项目（VIP）的随机对照试验实现，该项目以医疗保健为基础， 在灾害发生后，在人口一级，非污名化地获得和使用可能有效的战略，例如， 以关系和优势为基础，以父母的目标为基础。486个家庭将在出生时入组，随机分配至 VIP或常规护理，并随访至3岁，定期评估育儿实践， 亲子关系和跨领域的儿童发展。这项研究中的儿童将被 在水质恢复后怀孕和出生，没有暴露在铅污染的水中， 在环境公共卫生灾难和应对措施的背景下， 毒理学影响。将在危机的不同经历中，并在以下背景下研究贵宾的影响： 种族和社会经济差异，采用创新的多种方法来评估经验; 这些方法将利用正在进行的公共卫生、人口水平倡议的地理空间映射数据 （与你的健康对话[STYH]）利用危机前的数据进行两年一次的社区评估 （2013年），随着危机的展开（2015-2016年）和之后（2017-2018年;进行中）。 研究目标的完成将提供关于普遍育儿支持的作用的新知识， 环境和公共卫生灾难后的幼儿， NICHD儿童发展和行为分支高度优先研究领域。调查结果将为改进提供信息 和规模的VIP，并推广到其他育儿干预措施的背景下，这种灾害。

PROJECT SUMMARY/ABSTRACT Public health disasters have disproportionate impacts on poor communities, through pathways that add to those of poverty and associated stressors, and act over extended periods. Very young children are highly vulnerable to long-term impacts on development and mental health yet frequently receive the least attention and resources. Numerous studies have documented benefits of universal preventive parenting interventions on young children's development and mental health in the context of poverty and associated stressors, but universal promotion of positive parenting has not been previously tested to our knowledge in the aftermath of a disaster, and there are few studies of parenting and early child development in this context more generally. This proposal seeks to determine the role of universal strengths-based parenting support in preventing adverse outcomes for young children in the aftermath of the Flint Water Crisis (FWC). In the FWC, lead contamination of drinking water followed cost-saving changes in water supply in Flint, Michigan, a community with one of the US's highest rates of chronic poverty and associated stressors. Families have had ongoing anxiety about impacts of lead on children, compounded by anger, mistrust, and abandonment following a crisis perceived as avoidable and a response perceived as neglectful and as rooted in racial and socioeconomic bias. Aims will be achieved through an RCT of Video Interaction Project (VIP), which is health-care based for population-level, non-stigmatizing access and uses strategies likely to be effective following disasters, e.g., relationship- and strengths-based, building on parent goals. 486 families will be enrolled at birth, randomized to VIP or routine care, and followed through age 3 years with periodic assessments of parenting practices, parent-child relationships and child development across domains. The children in this study will have been conceived and born after water quality was restored and not exposed to lead contaminated water, allowing us to focus on parenting in the context of an environmental public health disaster and response, rather than its toxicological impacts. VIP impacts will be studied across varying experience of the crisis and in the context of racial and socioeconomic disparities, employing innovative multiple methods to assess experience; one of these methods will utilize geospatially mapped data from an ongoing public health, population-level initiative (Speak to Your Health [STYH]) performing biennial community assessments with data from before the crisis (2013), as the crisis unfolded (2015-2016) and in the aftermath (2017-2018; in progress). Completion of study aims will provide novel knowledge regarding the role of universal parenting support for young children in the aftermath of an environmental, public health disaster compounding poverty, and address NICHD Child Development and Behavior Branch high priority research areas. Findings will inform refinement and scaling of VIP, and generalize to other parenting interventions in the context of such disasters.