Implementation and Scale-Up of a Caregiver Intervention for Mothers who have Survived Intimate Partner Violence: the Mediational Intervention for Sensitizing Caregivers

项目摘要 接触亲密伴侣暴力（IPV）构成了一种创伤性应激环境， 对母亲生育和儿童心理健康结果的影响。接触IPV的儿童 更有可能发展出各种精神病理学敏感和反应灵敏的广告一直是 被认为是一个重要的保护因素，可以缓冲IPV暴露的负面影响。的 对敏感照顾者的中介干预（MISC）已证明对以下方面有积极的治疗效果： 儿童心理健康问题，目前正在申办者的RCT中进行调整和评估 （R 01 HD 102436; PI：Sharp）在一个社区合作组织的 重新安置计划。虽然MISC为这一人群带来了希望，但尚未收集任何数据来评估 MISC是否适合在社区组织环境中扩大交付。这种平移 研究差距是显着的，因为IPV暴露在非洲裔美国人家庭的高患病率（1/4 在美国的非洲裔美国儿童暴露于IPV），以及缺乏相关因素的可用数据， to the adoption采用of IPV-parenting IPV育儿interventions干预.与国家精神卫生研究所的战略目标3（预防 精神疾病）和4（公共卫生影响），拟议的研究将评估基于证据的MISC 父母干预措施， 混合方法论 综合框架》的执行情况 实施研究（CFIR）的规模扩大在两个IPV社区组织设置。该项目将 确定实施MISC的主要障碍和促进因素，并将其纳入未来的规模扩大工作 和评估项目中的一个额外的研究建议。使用CFIR结构 在一个平行收敛 设计 ，以下 混合法 目标将完成。对于目标1，我们将确定MISC特性， 使用定性访谈（N=10）与MISC-Implementation专家（个案工作者和 在申办者的RCT中，在其IPV组织中实施MISC的行政领导）。采访 将重点关注对MISC的看法以及如何将其融入现有的工作量。对于目标2，我们将评估 通过对利益相关者（N=50）的定量调查， IPV字段。调查将侧重于推动IPV举措的政策和激励措施。对于目标3，我们将评估内部 通过与IPV个案工作者（N=20）的焦点小组，在两个社区合作机构设置特征， 探索与工作量和文化相关的因素。 每个目标都将确定突出的障碍和促进因素， 与每个CFIR结构相关的实施和综合建议将根据 这些研究结果用于未来的规模扩大。 该拟议项目将首先评估能力和可行性 在IPV社区组织环境中采用循证护理干预措施， 扩展文献，考虑在实施社区干预措施时的多层次因素。

PROJECT SUMMARY Exposure to intimate partner violence (IPV) constitutes a traumatic stress environment and incurs profound impacts on both mothers’ caregiving and children’s’ mental health outcomes. Children who are exposed to IPV are more likely to develop a variety of psychopathology. Sensitive and responsive caregiving has been identified as an important protective factor that may buffer the negative impact of IPV exposure. The Mediational Intervention for Sensitizing Caregivers (MISC) has demonstrated positive treatment effects on child mental health problems and is currently being adapted and evaluated in the sponsor’s RCT (R01HD102436; PI: Sharp) for African American IPV-exposed mothers in a community partner organization’s rehousing program. While MISC holds promise for this population, no data has yet been collected to evaluate whether MISC is amenable to scale-up for delivery in community organization settings. This translational research gap is significant because of the high prevalence of IPV exposure in African American families (1 in 4 African American children in the U.S. are exposed to IPV) and the paucity of available data on factors related to the adoption of IPV-parenting interventions. Consistent with the NIMH’s strategic objectives 3 (prevention of mental illness) and 4 (public health impact), the proposed research will evaluate the evidence-based MISC parenting intervention for implementation using mixed methodology and the Consolidated Framework for Implementation Research (CFIR) for scale-up in two IPV-community organization settings. This project will identify key barriers and facilitators to the implementation of MISC that will be incorporated in a future scale-up and evaluation project in an additional research proposal. Using CFIR constructs in a parallel convergent design , the following mixed method aims will be completed. For Aim 1, we will identify MISC Characteristics for scale-up suitability using qualitative interviews (N=10) with MISC-Implementation experts (caseworkers and administrative leaders who are implementing MISC in their IPV organization in the sponsor’s RCT). Interviews will focus on the perception of MISC and how it may fit into their existing workload. For Aim 2, we will assess outer setting characteristics for MISC scale-up suitability via quantitative survey of stakeholders (N=50) in the IPV field. Surveys will focus on policies and incentives that drive IPV initiatives. For Aim 3, we will assess inner setting characteristics at two community partner agencies via focus groups with IPV caseworkers (N=20) to explore factors related to workload and culture. Each aim will identify salient barriers and facilitators to implementation related to each CFIR construct and comprehensive recommendations will be created based on these findings for future scale-up. The proposed project will be the first to evaluate the capacity and feasibility of adoption of an evidence-based caregiver intervention in an IPV-community organization setting and will extend the literature to consider multi-level factors in implementing community-based interventions.