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。在治疗暴力后果时，卫生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因素之一。因此，各大卫生组织发布了将预防暴力纳入儿童和青少年常规初级保健的指导方针。目前，只有有限的工具可用来帮助儿科临床医生在例行的办公室访问期间以一致的方式解决与预防暴力有关的问题。此外，没有经验证据表明这种方法对父母或孩子的行为是有效的。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(CCHR)将合作评估经过广泛试点测试的儿科临床医生干预的有效性。儿科办公室环境研究(PROS)是CCHR的一个项目，是一个由在研究参与方面经验丰富的实践型临床医生组成的全国性网络。他们的成员包括全国500多家诊所和1500名临床医生。专业实践将被随机分配到干预组(安全检查)或使用注意安慰剂的控制组。安全检查将解决四个行为领域：媒体使用；父母使用身体训练技术；枪支拥有和储存；以及家庭/同龄人的肢体冲突。这项研究的每个分支都将有68个诊所、136个提供者和3536名患者。这项研究的目的是收集足够数量的拉丁裔和非裔美国人患者的数据，以评估干预措施是否对不同的文化/种族产生不同的影响。干预措施由4部分组成：(1)社区暴力预防工作表(指导确定社区特定暴力预防资源的做法)；(2)针对有2-11岁子女的患者家庭的家庭行为调查，在候诊室完成，找出问题领域；(3)建议指南，提供者直接利用该指南就这些问题对患者家属进行教育和参与；以及(4)帮助患者家庭遵守提供者建议的“有形工具”。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属的行为，例如媒体使用、纪律、枪支储存和家庭/同龄人打架。数据将在基线访问时收集，患者家属将在1个月和6个月后通过电话采访进行随访。努力减少青少年暴力的社会发病率至关重要。这项研究取得了新的突破，成为第一个专注于测试针对儿科提供者的全面暴力预防计划的有效性的全国性随机对照试验。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可靠的数据来做到这一点。

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.