Building Social Support to Enhance Home Visitation

身体虐待和忽视儿童的问题仍然是一个棘手的公共卫生问题，每年有超过500万儿童被怀疑是美国的受害者，除了直接的医疗后遗症，身体虐待和忽视儿童预测一些社会最棘手的社会问题，包括晚年暴力犯罪的倾向。在这种情况下，早期家访服务已成为一种有希望的初级预防战略，旨在避免儿童遭受身体虐待和忽视及其以后的后果。虽然先前的研究表明，这类服务总体上产生了积极影响，但越来越多的证据表明，社会背景因素，尤其是父母的社交网络的质量，长期以来一直被认为在儿童身体虐待和忽视的病因学中发挥着关键作用，在决定这类服务成功防止虐待的程度方面也发挥着重要作用。鉴于此，为了响应CDC对“暴力相关伤害预防研究”申请的要求，本研究提出了研究社交网络的功效。 加强家庭探访服务。初步试点工作已经产生了一个手动干预，显示出非常有希望的初步趋势，虐待儿童代理，社会网络的质量，父母的压力，和相关因素。本研究提出了一个交叉候补控制组的设计，即200个家庭将被随机分配到一个家访加社交网络增强条件，或家庭只接受家访服务的候补控制组4个月后，接受社交网络增强组件。将在基线、3个月和9个月随访时收集关于儿童身体虐待和忽视风险、社交网络、父母控制感、家访参与度和相关其他因素的数据。这项研究将由一个儿童虐待预防调查小组领导， 哥伦比亚大学与纽约市的两个主要家访项目密切合作，作为试点，多米尼加联盟的最佳开端和纽约弃婴医院的健康家庭斯塔滕岛。

The problem of physical child abuse and neglect remains an intractable public health concern, with over five million children per year suspected as victims in the U.S. In addition to immediate medical sequelae, physical child abuse and neglect predicts some of society's most intractable social problems, including propensity for later life violence perpetration. In this context, early home visitation services have emerged as one promising primary prevention strategy that aims to avert physical child abuse and neglect and its later consequences. Although prior research indicates the generally positive impact of such services, growing evidence indicates that social contextual factors, and most especially qualities of parents' social networks, long identified as playing a key role in the etiology of physical child abuse and neglect, also play a substantial role in shaping the degree to which such services succeed in preventing maltreatment. Given this, in response to the CDC Request for Applications for "Violence-Related Injury Prevention Research," the present study proposes to examine the efficacy of a social networking enhancement integrated within home visitation services. Initial pilot work has yielded a manualized intervention that has showing highly promising preliminary trends on child maltreatment proxies, social network qualities, parenting stress, and related factors. The present study proposes a cross-over waitlist control group design, whereby 200 families will be randomly assigned to either a home visitation plus social network enhancement condition, or a wait-list control group of families only receiving home visitation services for 4 months, later to receive the social networking enhancement component. Data on physical child abuse and neglect risk, social networks, parents sense of control, participation in home visitation, and associated other factors will be collected at baseline and at 3 month and 9 month follow-up points. This study will be led by a team of child maltreatment prevention investigators at Columbia University, in close collaboration with two of the major home visitation programs in New York City that served as pilotsites, Best Beginnings of Alianza Dominicana, and Healthy Families Staten Island of the New York Foundling Hospital.