Prevention of disparities in child psychosocial development in underserved rural families through promotion of early relational health in pediatric health care

项目概要/摘要 虽然已经作出了重大努力，寻求对与贫困有关的儿童不平等现象进行初级预防， 关于心理社会发展，大多数研究集中在城市地区，对农村环境的研究有限。 这样的研究是至关重要的，因为：1）美国农村地区生活在贫困线以下的儿童比例较高; 2)在短期和长期指标方面，农村贫穷与城市贫穷的差距更大有关 社会心理发展; 3）有色人种在农村的差距加大。理论框架 经验证据表明，早期关系健康（ERH;育儿实践/关系质量）是一个重要的因素。 复原力的来源，可以缓冲家庭因贫困和种族主义而遭受的不利经历， 是干预的目标。预防性干预措施，如家访，改善ERH和儿童 农村低收入家庭的结果;然而，费用和其他障碍（能力，距离）导致 范围有限。儿科初级卫生保健（检查）可以通过建立在常规基础上来解决这些障碍 从出生到3岁的家庭联系，提供者关系，以及低成本。虽然对一些农村地区来说，获得服务是一个挑战， 尽管如此，这一人群的医疗保健利用率仍然很高。然而，基于保健的初级保健 尚未对预防农村儿童的心理社会差异进行研究。视频互动项目（VIP）是 这是一个在城市环境中用于支持ERH医疗保健的示范计划。它有潜力 在农村环境中的有效性，原因是：1）纳入基于优势的战略， 解决因农村贫困而加剧的家庭脆弱性的框架，以及2）高度可行性和 影响不同人群。尚未在农村环境中研究VIP（面对面或远程保健模式）。 本申请的主要目的是支持罗比博士成为一名独立调查员的目标 目的是改善1）亲子ERH和2）儿童心理社会发展。完成这项工作的方法是 通过专家多学科指导团队的培训和正式课程。增重将会 1）影响ERH的农村背景因素2）远程保健方法3）定性研究4） 实施科学，和5）临床试验的领导。有三个研究目标： 在目标1中，Roby博士将使用定性方法来确定参与儿科研究的促进者/障碍。 对农村家庭的初级保健养育干预，既广泛地针对少数种族/族裔群体，也针对少数种族/族裔群体。 在目标2中，Roby博士将利用目标1的研究结果，使VIP适应农村家庭，并测试可接受性、可行性， 和采用/参与适应的VIP模型跨越种族/民族。 在目标3中，Roby博士将利用随机对照试验来检查VIP在改善ERH方面的疗效 以及短期父母（心理健康）和儿童（心理社会）结果。成功完成该项目 将导致R 01应用程序，以测试在农村背景下更大规模的干预措施的有效性。

PROJECT SUMMARY/ABSTRACT While there have been significant efforts seeking primary prevention of poverty-related disparities in child psychosocial development, most research has focused on urban areas, with limited study in rural settings. Such research is critical given that: 1) a higher proportion of children in the rural US live below the poverty line; 2) rural poverty is associated with greater disparities than urban poverty across short- and long-term indicators of psychosocial development; and 3) rural disparities are increased for people of color. Theoretical frameworks and empirical evidence suggest that Early Relational Health (ERH; parenting practices/relationship quality) is a source of resilience that can buffer families’ adverse experiences due to poverty and racism and therefore represents a target for interventions. Preventive interventions such as home visiting, improve ERH and child outcomes in rural low-income families; however cost and other barriers (capacity, distance) have resulted in limited reach. Pediatric primary health care (check-ups) can address these barriers by building on routine family contact from birth to 3, provider relationships, and low cost. While access is a challenge for some rural families, health care utilization in this population is nonetheless high. However, health-care based primary prevention of psychosocial disparities in rural children has not been studied. Video Interaction Project (VIP) is an exemplar program that has been used in urban settings to support ERH in health care. It has potential for effectiveness in rural settings due to 1) incorporation of strengths-based strategies aligned with cultural frameworks that address family vulnerabilities that are exacerbated by rural poverty and 2) high feasibility and impact in diverse populations. VIP (in-person or telehealth models) has not been studied in rural settings. The primary objective of this application is to support Dr. Roby’s goal of becoming an independent investigator with the aim of improving 1) parent-child ERH and 2) child psychosocial development. This will be achieved through training from an expert multidisciplinary mentorship team and formal coursework. She will gain advanced skills in 1) rural contextual factors that impact ERH 2) telehealth methods 3) qualitative research 4) Implementation Science, and 5) leadership of clinical trials. There are 3 research aims: In Aim 1, Dr. Roby will use qualitative methods to identify facilitators/barriers to engagement in a pediatric primary care parenting intervention for rural families, both broadly and specific to racial/ethnic minority groups. In Aim 2, Dr. Roby will use Aim 1 findings to adapt VIP for rural families, and to test acceptability, feasibility, and adoption/engagement in the adapted VIP models across race/ethnicity. In Aim 3, Dr. Roby will utilize a randomized controlled trial to examine the efficacy of VIP in improving ERH and short term parent (mental health) and child (psychosocial) outcomes. Successful completion of this project will lead to an R01 application to test the efficacy of the intervention in the rural context on a larger scale.