RCT of FIND video coaching intervention for caregivers facing economic adversity

7.项目摘要/摘要 在生活在联邦贫困线或以下的260万3岁以下美国儿童中，大多数人不是 由于计划有限，接受服务以支持他们有资格获得的健康发展 容量。现有的旨在缓冲这个年龄段的低收入儿童的循证干预措施包括 与贫困相关的压力源的负面影响需要高剂量和/或长时间的分娩 从训练有素的专业人员那里只能达到适度的效果规模，而且他们有很高的流失率。此外， 对这些干预措施有效性的调解人和调解人(即，什么是有效的)知之甚少 为谁和为什么)。在潜在的可塑性照顾者和儿童神经生物学方面尤其如此 代表计划影响的调解人的机制。拟议研究的总体目标是 对有12岁子女的低收入家庭进行随机有效性试验 36个月，并且有资格参加提前启动计划(EHS)，但由于计划有限而无法注册 容量。我们将使用纵向随机有效性试验来检验中心假设 响应性照顾者(主要发现目标)的增加与后续照顾者之间的关联 福祉和儿童发展和生物行为结果(次级目标)将部分起到调节作用 通过改变照顾者的神经成像和抑制控制和父母的行为测量 自我概念。我们还将检查假设干预效果的主持人。这项工作的基本原理 它同时解决了大量未得到满足的儿童早期需求 并允许对我们的概念模型进行严格的测试。我们将随机抽查300名主要照顾者 以及符合EHS服务资格但不能获得服务的1至3岁儿童，可获得 或者是主动控制干预。目标1量化Find对响应性父母教养方式变化的主要影响 以及相关的照顾者和儿童结果(包括照顾者报告的父母自我效能、客观 儿童慢性压力的测量)，以及这些影响的持久性6 几个月后。目标2确定了调解与发现相关的关联的潜在神经机制 照顾者行为和照顾者/儿童结果的变化以及这些机制的特殊性。目标3 评估这些关联在多大程度上受到照顾者和儿童特征的影响(例如， 照料者的逆境史、家庭社会经济状况、儿童年龄)以及干预的忠诚度和剂量。这 信息对于解决1-3岁儿童对儿童早期干预的不同反应至关重要， 以提高影响力和可扩展性。这些结果将产生积极的影响，因为压倒性的 大多数符合EHS注册标准的家庭通常不会得到服务。轻而易举地 在这些家庭仍在等待名单上的同时提供的交付计划可能会促进他们的孩子 发展，降低风险。

7. Project Summary/Abstract Of the 2.6 million U.S. children under age 3 living at or below the Federal Poverty Threshold, most do not receive services to support healthy development for which they are eligible, because of limited program capacity. Existing evidence-based interventions designed to buffer low-income children in this age range from the negative effects of stressors associated with poverty require high dosage and/or long-duration delivery from trained professionals to achieve only modest effect sizes, and they have high rates of attrition. Moreover, very little is known about mediators and moderators of the effectiveness of these interventions (i.e., what works for whom and why). This is especially true in terms of potentially malleable caregiver and child neurobiological mechanisms that represent mediators of program impact. The overall objective of the proposed study is to conduct a randomized effectiveness trial with a diverse sample of low-income families with children ages 12– 36 months, and who are eligible for Early Head Start (EHS) but cannot be enrolled because of limited program capacity. We will use a longitudinal randomized effectiveness trial to test the central hypothesis that associations between increases in responsive caregiving (the main FIND target), and subsequent caregiver well-being and child developmental and biobehavioral outcomes (secondary targets), will be partially mediated through changes in caregiver neuroimaging-based and behavioral measures of inhibitory control and parent self-concept. We will also examine moderators of hypothesized intervention effects. The rationale for this work is that it simultaneously addresses the unmet needs of a large, significantly underserved early childhood population and allows for a rigorous test of our conceptual model. We will randomize 300 primary caregivers and their 1- to 3-year-old children who are eligible for EHS services but who cannot be served, to receive FIND or an active control intervention. Aim 1 quantifies the main effects of FIND on changes in responsive parenting and related caregiver and child outcomes (including caregiver-reported parenting self-efficacy, objective measures of chronic child stress) immediately after the intervention, and the durability of these effects 6 months later. Aim 2 identifies underlying neural mechanisms that mediate associations between FIND-related changes in caregiver behavior and caregiver/child outcomes and the specificity of those mechanisms. Aim 3 assesses the degree to which these associations are moderated by caregiver and child characteristics (e.g., caregiver history of adversity, family socioeconomic status, child age) and intervention fidelity and dosage. This information is critical to addressing differential response to early childhood interventions for children ages 1–3, to increase impact and scalability. These outcomes will have a positive impact in that the overwhelming majority of families who meet the enrollment criteria for EHS normally do not receive services. An easily delivered program that can be provided while these families remain on the waitlist may facilitate their children's development and reduce risks.