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: 10237847
• 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 2022-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10237847
• 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.

抽象的 不利的童年经历（ACE）是一个主要的公共卫生问题 每年美国。婴儿期暴露于ACE，包括儿童虐待和儿童接触 成人亲密的伴侣暴力，破坏了整个生命周期的健康。婴儿的死亡风险最大 由于生命的第一周虐待，造成近三分之一的婴儿遭受虐待 在第一年，产后一周虐待。因此，在产后介入 防止虐待和接触亲密伴侣暴力，为时已晚。此外，母亲和 自己的逆境或创伤病史更有可能在产后遇到风险因素 暴力行为。在产前介入以支持母亲进入产后过渡，特别是 具有自己创伤历史的母亲对于减少儿童的虐待和暴力暴露至关重要。 家庭访问计划着重于母子健康，是支持的重要桥梁 围产期过渡的创伤历史的母亲，也是主要预防的理想环境 儿童虐待和暴力暴露。拟议的研究将重点介绍RFA目标＃3： 有效性研究以评估结合双产的主要预防策略 方法。通过与罗德岛卫生部（RIDOH）和罗德的密切合作 岛儿童，青年和家庭（RI DCYF），我们将利用既定的基础设施 创新和增强全州短期家庭访问计划。我们的主要预防计划， 增强的第一连接将利用婴儿心理健康的观点，以提供产前婴儿和 在家庭访问计划的背景下，幼儿心理健康咨询。我们将专注于 选定的高风险人口，具有逆境或创伤史的母亲，目的是防止ACE 婴儿之间的暴露。拟议的随机对照试验（RCT）的主要结果将包括 预防儿童虐待（虐待和忽视儿童）以及对成人亲密伴侣的曝光 暴力。拟议的RCT的次要结果将包括增加家庭参与的较长次数 基于证据的家庭访问计划，家庭参与专业支持服务的增加 为了解决孕产妇的逆境和创伤，孕产妇危险因素的减少以及促进阳性 育儿和亲子关系。我们将使用金标准评估来衡量我们的结果 变量，包括审查儿童记录，访谈和观察评估以及审查 家庭访问记录。我们对婴儿和幼儿心理健康咨询的关注是高度创新的 由于先前的研究尚未经验测试了这一策略，以预防儿童虐待和 儿童接触成人亲密伴侣暴力。鉴于国家对 在家庭访问中支持婴儿和幼儿心理健康咨询。