Community Prevention of Child Maltreatment

摘要 这项随机对照试验（RCT）的目的是评价长期的 家庭联系（FC）的人口影响和机制，简短的普遍护士家访计划 旨在防止整个社区人口中的儿童虐待。2009年7月1日至 2010年12月31日，每一个出生在达勒姆的婴儿在偶数出生日期（n=2,329出生）被分配到 接受FC计划，所有奇数出生日期出生的婴儿（n= 2，450例出生）照常接受服务。 对执行情况的评价表明，普及率很高（80.0%的新生儿同意参加）， 对模型的忠实性（84%的依从性），以及对风险因素评分的高可靠性（α =0.69）。Intent-to-treat 对干预组（n=269）和对照组（n=280）代表性随机样本进行影响评价 数据表明，随机分配到FC的家庭获得更多的社区资源， 焦虑和更好的育儿行为。医院记录显示，FC家庭的紧急医疗 24个月内的护理访问和在医院过夜，儿童保护服务记录表明 60个月内虐待儿童的调查率降低39%。拟定的研究将 继续跟踪参与现有影响评估研究的9至12岁儿童的家庭。 行政记录将评估随机分配到FC对虐待儿童案件的影响， 急诊室虐待相关伤害和教育结果。家庭和电话访谈 与父母和孩子，以及盲法观察，将评估父母的功能和儿童良好- 存在。教师调查将评估儿童的学习成绩和社会情绪适应能力。数据分析 将测试五个假设：1）随机分配到FC程序（即，出生在同一个出生日期） 将与儿童虐待率和急诊室利用率降低相关， 与对照组相比，学业成绩、父母功能和儿童幸福感更好; 2）FC 将产生积极的效益成本比，如健康，心理健康，社会和 接受的教育服务; 3）高风险群体的干预效应量较大; 4）社区 资源使用和增强家庭功能将介导FC对结果的积极影响;以及5） 在控制组中，功能失调的父母和儿童行为的发展过程将符合 引导程序的模型。这项建议提供了一个紧迫、时间有限的机会， 这一创新的普遍家访方案的长期人口影响和机制。项目 将通过评估一项计划的长期影响和机制，为公共卫生做出贡献，该计划旨在 以具有成本效益的方式，并通过测试 虐待的发展，功能失调的父母，以及儿童行为和福祉。

Abstract The aim of this randomized controlled trial (RCT) competing continuation is to evaluate the long-term population impact and mechanisms of Family Connects (FC), brief universal nurse home-visiting program designed to prevent child maltreatment in an entire community population. Between July 1, 2009, and December 31, 2010, every infant born in Durham on an even birth date (n=2,329 births) was assigned to receive the FC Program, and all infants born on an odd birth date (n=2,450 births) received services-as-usual. Evaluation of implementation indicated high penetration (80.0% of all births consented to participate), high fidelity to the model (84% adherence), and high reliability of scoring risk factors (Κ=0.69). Intent-to-treat impact evaluation with a representative random sample from intervention (n=269) and control (n=280) birth dates indicated that families randomly assigned to FC accessed more community resources and exhibited less anxiety and better parenting behavior. Hospital records indicated FC families had fewer emergency medical care visits and overnights in the hospital through age 24 months, and child protective service records indicated 39% lower rates of investigations for child maltreatment through age 60 months. The proposed study will continue to follow families participating in the existing impact evaluation study from child ages 9 to 12 years. Administrative records will evaluate impact of random assignment to FC on child maltreatment cases, emergency room maltreatment-related injuries, and education outcomes. In-home and telephone interviews with parents and children, as well as blinded observations, will assess parental functioning and child well- being. Teacher surveys will assess child academic performance and social-emotional adjustment. Data analyses will test five hypotheses: 1) Random assignment to the FC program (that is, being born on an even birth date) will be associated with lower rates of child maltreatment and emergency department utilization, better academic outcomes, better parental functioning, and better child well-being than assignment as control; 2) FC will produce a positive benefit-cost ratio, as measured by outcomes in health, mental health, social, and education services received; 3) Intervention effect sizes will be larger for higher-risk groups; 4) Community resource use and enhanced family functioning will mediate the positive impact of FC on outcomes; and 5) Developmental processes in dysfunctional parenting and child behavior among the control group will conform to the model guiding the program. This proposal offers an urgent, time-constrained opportunity to evaluate the long-term population impact and mechanisms of this innovative universal home-visiting program. The project will contribute to public health by evaluating the long-term impact and mechanisms of a program that aims to lower the population rate of child maltreatment in a cost-effective way and by testing models of the development of maltreatment, dysfunctional parenting, and child behavior and well-being.