Preventing Child Abuse--Community Pediatrians' Role

描述(改编自申请人S摘要)：虐待儿童(CM)和亲密伴侣暴力(IPV)危害许多儿童和家庭的健康和安全。人们的注意力主要集中在“事后”解决这些问题上。有必要对预防战略进行严格评估。该项目旨在加强儿科初级保健，以帮助预防CM，并解决IPV。儿科初级保健提供了一个绝佳的机会：定期进行“体检”，目的是防止受伤和疾病。据推测，模范护理将帮助儿科医生解决CM的风险因素(例如，IPV、产妇抑郁)，从而降低其可能性，并改善儿童的健康和安全。拟议的项目将在马里兰州的20个儿科私人诊所进行，涉及大约80名儿科医生。这些做法覆盖了不同的患者群体；大约三分之一的人是低收入者，三分之一的人是少数族裔。第一个组成部分涉及培训儿科医生，以识别和帮助患有CM的高危家庭。第二个组成部分涉及模范关怀，包括：1)在学龄前儿童体检时对父母进行筛查，2)评估问题，3)初步的儿科和/或社会工作干预，以及4)转介社区资源。这一模式代表着对现有儿童保健制度的适度但重要的修改。通过随机分配，一半的人将接受培训，以实施模范护理。对照组将提供标准护理。研究人员将评估培训对儿科医生的态度、知识、舒适度、能力和实践的影响；还将评估模式护理的有效性：1)筛查实践，2)识别CM的风险因素，3)风险因素是否得到解决，4)风险因素的患病率和严重程度，以及5)CM和IPV的比率和严重程度。 该项目具有创新性，符合“健康人群2010”和“疾病预防控制中心研究议程”的目标。它运用合理的理论和临床经验，关注常见的心理社会问题。它有可能对知识和实践做出重要贡献。如果确定了风险因素，这将导致问题得到有效解决，这将证明复制该模型是合理的。模范护理方法可以复制，对美国儿科实践的性质具有深远的影响。

DESCRIPTION (adapted from applicant(s abstract): Child maltreatment (CM) and intimate partner violence (IPV) jeopardize the health and safety of many children and families. Attention has primarily focused on addressing these problems "after the fact." There is a need for rigorously evaluated prevention strategies. This project aims to enhance pediatric primary care to help prevent CM, and to address IPV. Pediatric primary care offers an excellent opportunity: regular "check-ups" aim to prevent injury and disease. It is hypothesized that the Model Care will help pediatricians address risk factors for CM (e.g., IPV, maternal depression), thus diminishing its likelihood, and improving children's health and safety. The proposed project will take place in 20 pediatric private practices in Maryland, involving approximately 80 pediatricians. These practices cover a diverse patient population; approximately one-third are low income, and one-third are minority. The first component involves training pediatricians to identify and assist families at high risk for CM. The second component involves the Model Care, including: 1) screening parents at their preschooler check-ups, 2) assessing problems, 3) initial pediatric and/or social work intervention, and 4) referral to community resources. This model represents a modest but important modification of the existing child health care system. Via random assignment, half will be trained to implement the Model Care. The control group will provide standard care. The investigators will evaluate the impact of training on pediatricians' attitudes, knowledge, comfort, competence, and practice; and also evaluate the effectiveness of the Model Care upon: 1) screening practices, 2) identifying risk factors for CM, 3) whether risk factors are addressed, 4) the prevalence and severity of risk factors, and 5) rates and severity of CM and IPV. This project is innovative and fits with the goals of "Healthy People 2010" and "CDC's Research Agenda". It applies sound theory and clinical experience, attending to common psychosocial problems. It has the potential to make an important contribution to knowledge and practice. If the risk factors are identified, and this leads to the problems being effectively addressed, this will justify replicating the model. The Model Care approach could be replicated with far-reaching implications for the nature of pediatric practice in the U.S.