Treating Maternal PTSD to Enhance Parenting and Reduce Maltreatment Recidivism: Safe Mothers, Safe Children

项目摘要 反复遭受虐待和忽视大大增加了贫穷的儿童和成人生活的可能性 结果。然而，目前的儿童福利(CW)家庭保护服务(FPS)并没有减少 虐待累犯。母亲创伤后应激障碍(PTSD)，与贫穷有关 亲子互动，是减少虐待的一个很有前途的干预目标。我们之前的工作表明 接受FPS以防止再次犯罪的母亲有很高的创伤相关障碍患病率。高比率 这些母亲中的创伤后应激障碍表明，治疗创伤后应激障碍可能会显著降低高危人群的再犯罪率。 风险母亲。除了直接增加虐待的风险外，与创伤后应激障碍相关的认知缺陷可能会使 学习育儿技能更加困难，助长了代际持续的创伤。假设： 情感和人际调节方面的育儿技能培训(P-STAIR)，一种针对母亲的干预 与创伤后应激障碍相关的育儿缺陷，将减少再犯罪率。我们使用组合楼梯来瞄准不利的 创伤后应激障碍(及相关抑郁)对父母教养方式的影响及简化版PCIT的改进 养育孩子的技巧。楼梯是两个阶段的治疗，在治疗前改善情绪调节和人际交往技能 暴露治疗。它比单独暴露疗法更有效，并增加了治疗保留时间 与虐待儿童有关的创伤后应激障碍。PCIT是一种二联疗法，有望减少CW母亲的再犯罪率。 我们增加了对创伤后应激障碍症状如何影响父母养育和亲子互动技能的关注：P-STAIR。 初步数据：在P-STAIR之后，母亲们新确认的虐待报告率降低了7倍 (2.7%)超过纽约市FPS人口的整体(18.6%)。测量母亲的创伤后应激障碍和抑郁症状 在90天的随访中，显示92.3%的母亲不再符合创伤后应激障碍的诊断标准。独立的 行为观察显示，负面育儿行为显著减少，而增加 积极的育儿行为。试验数据表明P-STAIR是可行的。我们建议进行一项RCT，以 评估P-STAIR与支持性咨询(SC)的疗效。目标1：比较P级楼梯和SC级楼梯 关于母亲创伤后应激障碍/抑郁症状的减轻。目标2：将P-楼梯与SC在以下方面进行比较 育儿行为。目的3：比较P-STAIR和SC在虐待再犯罪率方面的差异。影响：如果 P-STAIR被证明是有效的，将减少涉及CW的高危母亲的虐待再次犯罪率， 改善儿童和家庭的生活，减少母亲的耻辱。我们CW合作伙伴的支持信 表明P-STAIR具有随时传播CW的潜力，从而改变了现实世界的临床实践。

Project Summary Repeated exposure to abuse and neglect substantially increases the likelihood of poor child and adult life outcomes. Current child welfare (CW) family preservation services (FPS), however, do not reduce maltreatment recidivism. Maternal posttraumatic stress disorder (PTSD), which has been associated with poor parent-child interaction, is a promising intervention target to reduce maltreatment. Our prior work showed that mothers receiving FPS to prevent recidivism have a high prevalence of trauma-related disorders. High rates of PTSD among these mothers suggests that treating PTSD may reduce recidivism in a significant subset of high- risk mothers. In addition to directly increasing risk of maltreatment, PTSD-related cognitive deficits may make learning parenting skills more difficult, contributing to intergenerational persistence of trauma. Hypothesis: Parenting Skills Training in Affect and Interpersonal Regulation (P-STAIR), an intervention targeting maternal PTSD-related parenting deficits, will reduce recidivism. We use a combination of STAIR to target the adverse effects of PTSD (and related depression) on parenting and an abbreviated version of PCIT to improve parenting skills. STAIR is a two-phase treatment to improve emotion regulation and interpersonal skills prior to exposure treatment. It is more effective than exposure therapy alone and increases treatment retention for child abuse-related PTSD. PCIT is a dyadic treatment that has promise for reducing recidivism in CW mothers. We added a focus on how PTSD symptoms affect parenting and parent-child interaction skills: P-STAIR. Preliminary Data: Following P-STAIR, mothers had a 7-fold lower rate of new confirmed maltreatment reports (2.7%) than NYC’s FPS population as a whole (18.6%). Maternal PTSD and depression symptoms, measured at 90-day follow-up, show that 92.3% of mothers no longer met diagnostic criteria for PTSD. Independent behavioral observations demonstrated significant reduction of negative parenting behaviors and increased positive parenting behaviors. The pilot data indicate P-STAIR is feasible. We propose to conduct a RCT to evaluate efficacy of P-STAIR compared to supportive counseling (SC). Aim 1: Compare P-STAIR to SC with respect to maternal PTSD/depression symptom reduction. Aim 2: Compare P-STAIR to SC with respect to parenting behaviors. Aim 3: Compare P-STAIR to SC with respect to maltreatment recidivism. Impact: If demonstrated efficacious, P-STAIR will reduce maltreatment recidivism among high-risk CW involved mothers, ameliorating lives of children and families and reducing maternal stigma. Our CW partners’ support letters indicate P-STAIR has potential for ready CW dissemination, thereby altering real-world clinical practice.