RANDOMIZED, CONTROLLED TRIAL TO PREVENT CHILD VIOLENCE

儿童和青少年暴力仍然是我们今天最紧迫的公共卫生问题之一。 在处理暴力后果时，保健提供者往往发挥关键作用。与其他伤害一样，儿科提供者是预防的必要代理人之一。 因此，主要的卫生组织发布了将预防暴力纳入儿童和青少年日常初级保健的准则。 目前，只有有限的工具可用于帮助儿科临床医生在日常办公室访问期间以一致的方式解决暴力预防相关问题。此外，没有经验证据表明这种方法对父母或儿童行为的有效性。维克森林大学医学院（WFUSM）和美国儿科学会（AAP）儿童健康研究中心（CCERN）将合作评估儿科临床医生干预的有效性，该干预已被广泛的试点测试。 儿科研究在办公室设置（PROS），一个计划的candle，是一个国家网络组成的实践为基础的临床医生在研究参与经验丰富。 他们的成员包括全国500多个实践和1500名临床医生。 将PROS实践随机分配至干预组（安全性检查）或使用注意力安慰剂的对照组。 安全检查将涉及四个方面的行为：媒体使用;父母使用的身体纪律技术;枪支拥有和储存;和家庭/同龄人的身体战斗。 研究的每个分支将有68个实践，136个提供者和3，536名患者。 该研究旨在收集足够数量的拉丁美洲和非洲裔美国患者的数据，以评估干预是否对不同文化/种族产生不同影响。 干预措施包括4个组成部分：（1）社区暴力预防工作表（指导查明社区具体预防暴力资源的做法），（2）对有2-11岁儿童的病人家庭进行家庭行为调查，在候诊室完成，查明问题领域，（3）提供者直接利用的建议指南，以教育和参与患者家属对这些问题，以及（4）“有形的工具”，以帮助家庭坚持提供者的建议。 评估的两个主要结果将是儿科提供者的预期指导行为和患者家庭的行为，例如媒体使用，纪律，枪支存储和家庭/同伴打架。 将在基线访视时收集数据，并在1个月和6个月后通过电话访谈对患者家属进行随访。必须努力减少青年暴力的社会发病率。 这项研究开辟了新的天地，作为第一个全国性的随机对照试验，重点是测试一个全面的暴力预防计划的儿科提供者的有效性。 到目前为止，还没有数据驱动主要医疗组织发布的指南;这项研究将提供科学合理的数据。

Child and adolescent violence remains one of our most pressing public health problems today. Health care providers often serve critical roles when treating the results of violence. As with other injuries, pediatric providers serve as one of the necessary agents for prevention. Consequently, major health organizations have issued guidelines for incorporating violence prevention into routine primary care for children and adolescents. Currently, only limited tools are available to help pediatric clinicians address violence prevention-related issues in a consistent manner during the routine office visit. Moreover, no empirical evidence exists for the effectiveness of such approaches on parents or children's behaviors. Wake Forest University School of Medicine (WFUSM) and the American Academy of Pediatrics (AAP) Center for Child Health Research (CCHR) will collaborate to evaluate the effectiveness of a pediatric clinician's intervention that has been extensively pilot tested. Pediatric Research in Office Settings (PROS), a program of the CCHR, is a national network comprised of practice- based clinicians experienced in research participation. Their membership consists of more than 500 practices and 1500 clinicians across the country. PROS practices will be randomly assigned to either the intervention arm (Safety Check) or the control arm with an attention placebo. Safety Check will address four areas of behavior: media use; parental use of physical disciplining techniques; gun ownership and storage; and family/peer physical fights. Each arm of the study will have 68 practices, 136 providers, and 3,536 patients. The study will aim to gather data on sufficient numbers of Latino and African American patients to evaluate if the intervention has different effects on differing cultures/ethnicities. The intervention consists of 4 components: (1) a community violence prevention worksheet (to guide practices in identifying community specific violence prevention resources), (2) a household behavior survey for patient families with children 2-11 years to complete in the waiting room, identifying problem areas, (3) a recommendation guide that the provider directly utilizes to educate and engage the patient family on these issues, and (4) "tangible tools" to help the family adhere to provider recommendations. The two primary outcomes evaluated will be the pediatric provider's anticipatory guidance behaviors and the patient family's behaviors, e.g. media use, discipline, gun storage, and family/peer fights. Data will be collected at the baseline visit with patient family follow-up 1 and 6 months later via telephone interviews. Efforts to reduce the social morbidity of youth violence are essential. This study breaks new ground, serving as the first national randomized controlled trial focused on testing the effectiveness of a comprehensive violence prevention program for pediatric providers. As yet, there are no data driving the guidelines issued by major medical organizations; this study will provide scientifically sound data to do so.