Embedding Mental Health Consultation Within Prenatal Home Visiting to Prevent Child Maltreatment and Violence Exposure

摘要 儿童不良经历(ACEs)是一个主要的公共卫生问题，给 美国每年都有。在婴儿期接触ACEs，包括虐待儿童和儿童接触 成人亲密伴侣的暴力行为会破坏人的一生健康。婴儿死亡的风险最大 在出生的第一周就受到虐待，近三分之一的婴儿遭受虐待 在第一年被虐待的产后一周。因此，在产后期进行干预以 防止虐待和暴露于亲密伴侣的暴力行为为时已晚。此外，母亲们带着她们的 自身有逆境或创伤病史的人在产后更有可能经历危险因素 实施暴力。产前干预以支持母亲进入产后过渡，特别是 母亲有自己的创伤病史，对于减少儿童遭受虐待和暴力接触至关重要。 家访方案的重点是母婴健康，是支持 有围产期创伤史的母亲，以及初级预防高血压的理想环境 虐待儿童和暴力曝光。拟议的研究将侧重于RFA目标3： 评估包括两代人在内的初级预防战略的有效性研究 接近。通过与罗德岛州卫生部(RIDOH)和罗德岛 岛屿儿童、青年和家庭部(RI DCYF)，我们将利用现有的基础设施 创新和加强全州范围内的短期家访计划。我们的一级预防计划， 加强首次联系，将从婴儿心理健康的角度为产前婴儿和 在家访计划背景下的幼儿心理健康咨询。我们将专注于一个 选定的高危人群，有逆境或创伤病史的母亲，目标是预防ACES 婴儿之间的接触。拟议的随机对照试验(RCT)的主要结果包括 防止虐待儿童(虐待儿童和忽视儿童)和接触成人亲密伴侣 暴力。拟议的RCT的次要成果将包括增加家庭在更长时间- 基于定期证据的家访计划，增加家庭对专门支持服务的参与度 应对产妇的逆境和创伤，减少产妇的风险因素，并促进积极的 父母教养和亲子关系。我们将使用金本位评估来衡量我们的结果 变量包括审查儿童保护记录、访谈和观察性评估，以及审查 家访记录。我们专注于婴幼儿心理健康咨询，具有很强的创新性 由于没有先前的研究对这一战略进行了实证检验，这一战略可作为虐待儿童的一级预防措施， 儿童接触成人亲密伴侣暴力。结果将引起高度关注，因为全国关注 在家访中支持婴幼儿心理健康咨询。

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.