Community Prevention of Child Maltreatment

摘要 该项目的目的是评估一种新的综合方法对改善人口状况的影响。 结果和减少早期儿童发展的差距，称为社区导航（CN）。CN基于 在MIECHV批准的家庭连接（FC），一个普遍的新生儿护士家访计划，结合 通过短期护士之家访问，将社区资源与家庭的参与结合起来， 确定家庭的具体需要，进行简短干预，并为家庭提供有针对性的社区资源。两 随机对照试验（RCT）显示，分配至FC可改善产妇的心理健康， 降低了儿童虐待调查的人口比率，但对儿童行为没有长期影响。 为了改善和平衡人口在养育子女和儿童福祉方面的成果， 通过试点，作为一个贯穿生命早期的普遍初级保健心理社会系统。训练有素的领航员 妊娠期间的女性，出生时继续FC，并在12、24和36个月时完成良好的家庭访视 提供支持，评估家庭的具体需求，提供简短的干预措施，并连接家庭 社区资源来满足持续的需求。在慈善机构的支持下，CN现在通过 一项随机对照试验，在北卡罗来纳州达勒姆的800个家庭的社区样本。400个家庭被分配到 CN从怀孕到幼儿园，400个家庭被指定为照顾， 常规控制。数据分析将检验四个假设：（1）干预效果：与对照组相比，CN- 分配的家庭将显示出较低的儿童虐待率，较少的儿童紧急医疗护理， 利用率，更好的父母心理健康，更积极的养育行为，更好的儿童认知和 行为发展到5岁;（2）差异减少：随机分配到CN， 与减少种族和收入差距有关，作为CN分配的积极影响而运作 对低收入家庭和有色人种家庭的影响更大;（3）干预 调解：改善父母的心理健康，父母的自我宣传，和养育行为将占 儿童行为的人口影响（中介）和差异减少（中介缓和） 结果;（4）差异如何发展：在获得社区资源方面的种族和收入差异 在早期生活中，种族和收入差异会导致儿童在幼儿园的成绩。该提案提供 这是一个紧迫的、成本分摊的机会，可以评估人口影响、缩小差距和 一个为生育家庭提供初级保健的新系统。该项目将通过提供 关于负担得起的、创新的、普遍的初级心理社会护理系统的经验知识， 改善人口结果，减少父母心理健康方面的人口差距，积极的养育 行为，儿童虐待率，儿童认知和行为发展，并测试 通过这些机制，不平等现象得以发展，而这种干预措施的作用是减少不平等现象。

ABSTRACT The aim of this project is to evaluate the impact of a novel comprehensive approach to improving population outcomes and reducing disparities in early child development, called Community Navigation (CN). CN is based on the MIECHV-approved Family Connects (FC), a universal newborn nurse home visiting program combining alignment of community resources with engagement of families through short-term nurse home visiting to identify family-specific needs, intervene briefly, and match families with tailored community resources. Two randomized controlled trials (RCTs) have shown assignment to FC improves maternal mental health and reduces population rates of child abuse investigations but does not have long-term impact on child behavior. To improve and equalize population outcomes in parenting and child well-being, CN has been developed through piloting as a universal psychosocial system of primary care across early life. Trained navigators reach women during pregnancy, continue with FC at birth, and complete well-family visits at 12, 24, and 36 months of child age to provide support, assess family-specific needs, deliver brief interventions, and connect families with community resources for ongoing needs. With philanthropic support, CN is now being delivered through an RCT with a community sample of 800 families in Durham, NC. 400 families have been assigned to receive CN across the period from pregnancy through kindergarten, and 400 families have been assigned as care-as- usual controls. Data analyses will test four hypotheses: (1) intervention efficacy: compared to controls, CN- assigned families will demonstrate lower rates of child maltreatment, less child emergency medical care utilization, better parent mental health, more positive parenting behaviors, and better child cognitive and behavioral development through age 5; (2) disparity reduction: random assignment to CN will be associated with reduction of race and income disparities, operationalized as positive impact of CN assignment on each group with even stronger impact on low-income families and families of color; (3) intervention mediation: improved parent mental health, parent self-advocacy, and parenting behaviors will account for population impact (mediation) and disparity reduction (mediated moderation) in children’s behavioral outcomes; and (4) how disparities develop: race and income disparities in access to community resources in early life will account for race and income disparities in child outcomes at kindergarten. This proposal offers an urgent, cost-shared opportunity to evaluate the population impact, disparity reduction, and mechanisms of a novel system of primary care for birthing families. The project will contribute to public health by providing empirical knowledge about an affordable, innovative, universal system of primary psychosocial care that aims to improve population outcomes and reduce population disparities in parent mental health, positive parenting behaviors, rates of child maltreatment, and child cognitive and behavioral development, and testing the mechanisms through which disparities develop and this intervention operates to reduce them.