TRANSLATING EFFECTIVE MALTREATMENT INTERVENTION INTO THE COMMUNITY

描述（由申请人提供）：目前的提案旨在开发和测试将基于证据的育儿干预转化为旨在减少儿童虐待的社区项目的可翻译性。具体来说，我们建议翻译游戏和学习策略项目（PALS; Landry & Smith, 1996； Smith等人2000；Landry等人2001），这是一个以证据为基础的项目，被证明可以提高反应性育儿，从而促进健康的婴儿社会情感发展。PALS计划已被证明在一对一的母亲-教练关系中运作得忠实而有效。然而，在这些有效性证据中，教练的作用仍然停留在研究范围内。更广泛地向社区传播这一方案的努力遇到了许多影响效果的障碍；特别是那些与社区教练提供必要的培训和支持有关的培训和支持，以达到研究教练先前证明的水平（Glasgow, Marcus, Bull, & Wilson, 2004）。通过我们之前的工作（Infant Net; Feil, Baggett, Davis, et al, 2008），我们为PALS项目开发了一个基于互联网的交付系统，该系统利用互联网的力量促进社区家长和训练有素的PALS教练之间的有效联系。通过利用婴儿网交付平台，我们有机会通过将社区服务组织内的家庭访问者直接与经过专业培训的PALS项目顾问联系起来，从而解决关键的传播障碍，以便为有效的社区项目实施提供必要的培训和持续的支持。在这一背景下，与“2010年健康人”有关健康婴幼儿的目标相一致，我们将实现以下目标：目标1)在准备社区实施的过程中，我们将开展为期6个月的发展阶段，在此阶段，我们将根据必要的背景调整现有的“婴儿网络PALS”材料，通过以下方式将方案的实施推广到不同的社区：A)调整现有的培训和指导材料，以更好地反映社区家访和项目顾问的支持关系；b)将现有的PALS项目的西班牙语翻译覆盖到计算机交付平台上，以增加项目在语言多样化社区的覆盖范围；目标2)在我们向社区机构家访人员提供带有“眼球”摄像头的笔记本电脑，并在每个尚未安装无线互联网的社区机构安装无线互联网接入后，我们将继续在堪萨斯州13个县的9个健康家庭（HF）项目中实施我们的社区适应干预措施——家访婴儿网（Infant Net- hv）。我们的实现方法将采用三波迭代实现设计的形式，其中每一波都将提供反馈，以通知后续的波实现。在三个阶段，我们将在9个HF站点、18名家庭访问者和270个有风险的家庭中实施。将根据已知传播障碍对方案覆盖面、吸收、可行性、保真度以及由此产生的母婴二级健康结果的影响，评估适应社区的循证方案的可译性。还将对该计划进行初步成本分析，以便向社区站点提供相关信息，以查看其自身的运营预算和先前的干预工作。所有项目信息都将提交给“健康家庭”领导，并评估其在后续政策支持方面的潜力，这些政策支持与“婴儿艾滋病毒网络”方案的维持和可持续性有关。为了进一步支持维护和可持续性工作，来自每一波实施的迭代社区反馈，包括“不起作用”的文档，将被总结并放入社区实施手册中，与项目结果一起发布。

DESCRIPTION (provided by applicant): The current proposal seeks to develop and test the translatability of an evidence-based parenting intervention into a community-based program aimed at reducing child maltreatment. Specifically, we propose to translate the Play and Learning Strategies program (PALS; Landry & Smith, 1996; Smith, et al 2000; Landry, et al, 2001), an evidence-based program demonstrated to increase responsive parenting and thereby promote healthy infant social emotional development. The PALS program has been demonstrated to operate with fidelity and effectiveness within an in-person, one-to-one, mother-coach relationship. However, within this effectiveness evidence, the role of coach has remained within the research context. Attempts to more broadly disseminate this program into the community have met with many barriers to effectiveness; particularly those related to the provision of training and support necessary for community-based coaches to serve families at the level that research coaches have previously demonstrated (Glasgow, Marcus, Bull, & Wilson, 2004). Through our prior work (Infant Net; Feil, Baggett, Davis, et al, 2008), we have developed an internet-based delivery system for the PALS program, one that harnesses the power of the internet to facilitate efficient connections between the community parents and trained PALS coaches. By utilizing the Infant Net delivery platform, we have the opportunity to address critical dissemination barriers through linking home visitors within community service organizations directly to professionally-trained PALS program consultants in order to provide the necessary training and ongoing support required for effective community-based program implementation. It is within this context, consistent with Healthy People 2010 goals pertaining to Healthy Infants and toddlers, that we will pursue the following: Objective 1) In preparation of community implementation, we will conduct a 6-month development phase in which we will adapt existing Infant Net PALS materials into the necessary context to translate program implementation into diverse communities by: a) adapting existing training and coaching materials to better reflect a community home visitor-program consultant support relationship; and b) overlaying the existing Spanish translation of the PALS program onto the computer-delivery platform to increase program reach to linguistically diverse communities; and Objective 2) Following our provision of laptops with "eye-ball" cameras to community agency home visiting staff and installation of wireless Internet access in each community agency who does not already have it, we will proceed with implementation of our community-adapted intervention, Infant Net for Home Visitors (Infant Net-HV), within nine Healthy Families (HF) programs spanning a 13-county region in the state of Kansas. Our implementation approach will take the form of a 3-wave, iterative implementation design in which each wave will provide feedback to inform subsequent wave implementations. Across the 3 waves, we will implement with nine HF sites, 18 home visitors, and 270 at-risk families. Translatability of the community-adapted, evidence-based program will be assessed relative to the impact of known barriers to dissemination on program reach, uptake, feasibility, fidelity and, by virtue, secondary mother and infant health outcomes. An initial cost analysis of the program will also be performed in order to provide this information to community sites for viewing relative to their own operating budgets and prior intervention efforts. All project information will be presented to Healthy Families leadership and assessed as to its potential for subsequent policy support related to maintenance and sustainability of the Infant Net-HV program. In further support of maintenance and sustainability efforts, iterative community feedback from each wave of implementation, including the documentation of things that "didn't work", will be summarized and placed into a Community Implementation Manual to accompany project results. PUBLIC HEALTH RELEVANCE: