Community Prevention of Child Maltreatment

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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.