Early Intervention to Promote Cardiovascular Health of Mothers and Children (ENRICH) Multisite Resource and Coordinating Center

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Poor cardiovascular health (CVH) contributes to high levels of morbidity and mortality in the United States, with profound health disparities by race/ethnicity, socioeconomic status, and geography. Sustained improvement in CVH requires 2-generation strategies in settings where those at elevated risk for poor CVH already receive care. Evidence-based home visiting (HV) provides an ideal setting to reduce health disparities, reduce maternal morbidity, and promote CVH in infants and children in ways that can be continued across the life course. Prior studies of CVH intervention effectiveness have not tested interventions across HV models, incorporated emerging technologies such as mHealth and telehealth, combined HV with services in other settings where mothers and children receive care, acknowledged mediators and moderators of effectiveness, nor used individual and composite maternal and child CVH metrics to assess outcomes. The Early Intervention to Promote Cardiovascular Health of Mothers and Children (ENRICH) program aims to address these limitations. It will test a common implementation-ready intervention to promote maternal and child CVH and reduce CVH disparities in the context of multiple evidence-based HV models. The success of ENRICH requires a Resource and Coordinating Center (RCC) with sophisticated content and methods expertise and resources to support study design and implementation of a common intervention and research protocol attuned to heterogeneity in individual, family, and community context. The Johns Hopkins RCC multidisciplinary team combines the expertise of the Home Visiting Applied Research Collaborative (HARC), the Johns Hopkins Center for Clinical Trials and Evidence Synthesis (CCTES) and the Johns Hopkins Center for Health Equity. This RCC team offers an unparalleled combination of a national HV platform, expertise in health equity, and clinical trials infrastructure to create new management strategies, organization concepts and impactful analyses to assure that ENRICH achieves its potential. Our RCC includes: (1) stakeholder-built HV Precision Paradigm; (2) content expertise and leadership in HV and CVH; (3) state of the art methods to design and implement a common protocol, analyze data, disseminate results, and translate for policy and practice (4) advanced methods to assess “What works best, for whom, in which contexts, why and how?” and assess ideal CVH metrics for both mothers and children; (5) tight linkage with HV and CVH stakeholders; and (6) expertise in engaging and training Early Stage Investigators and HV staff professionals. The RCC will apply the strengths of three JHU divisions (Public Health, Medicine and Nursing) to ENRICH to generate impactful evidence on effectiveness of the ENRICH intervention and powerful data on generalizability to enhance translation. The RCC will assure that ENRICH achieves its full potential and generates rigorous, innovative, timely and actionable new knowledge to reduce maternal morbidity, promote CVH and reduce CVH disparities in mothers and young children.