A Selected Prevention RCT to Address Parenting in a WIC population

摘要：虐待儿童是一个主要的公共卫生问题，在3月份有600多万儿童受到虐待 在美国，每年有100万人被转介到儿童保护服务机构，超过60万人被证实为儿童保护机构。一些人 家访计划已被证明在降低虐待风险、促进积极方面是有效的 养育孩子，改善孩子的结果。然而，这样的计划针对的是狭隘的、高风险的 目标人群，是高度资源密集型的，不可能在全球范围内实施。 有必要测试相对低成本、低资源密集型和 适应更大、更普遍的目标人群。我们的长期目标是扩大证据基础 用于低资源密集型和广泛适应性的干预措施，有效地针对育儿结果 在范围广泛的环境中降低儿童身体虐待的风险，例如为WIC或其他儿科提供服务的中心 人口。这项研究的目的是测试两种此类干预措施在促进 有效的育儿方式和降低儿童身体虐待风险与“日常照护”的育儿教育相比 WIC诊所。在这一人群中，有15个月至5岁孩子的父母(n=1200)将随机 分配给3种情况之一：(1)仅限三个P-Level 2(L2)干预，(2)良好干预，或(3)a “常规护理”对照组。这项研究的基本原理是能够为家长服务或诊所的政策提供信息 为有兴趣采用相对低成本、低资源的大量父母提供服务的中心 采取密集干预措施，以减少儿童遭受身体虐待的风险和对儿童健康的相关风险 发展。我们的具体目标如下：(1)测试简要的基于临床的干预措施(Triple P-L2和Play NICELY)旨在解决父母在管理困难儿童行为方面的有效性 家庭人口。我们的工作假设是，这些孩子的育儿效果都会得到改善。 与控制条件相比较的条件；以及(2)确定干预效果是否通过 父母感知到的规范。我们的工作假设是，孩子的父母更强烈地感知到禁制性规范 支持身体纪律的专业人员(如儿科医生、心理健康和宗教)将 与干预效果降低有关。这些低资源密集型育儿干预措施是 期望改变父母的态度、自我效能感和与儿童身体虐待风险有关的行为。连 在大量选定或普遍的目标人群中略微降低这类风险可以带来巨大的好处 整个人口(即预防悖论)。降低有问题的育儿做法的比率将导致 改善儿童发展和行为。此外，通过促进减少累积不利影响 童年经历和早期中毒应激，这些干预措施预计也将有助于长期 减少健康差距和吸烟、肥胖、药物滥用等重大公共卫生问题的风险， 危险的性行为、精神健康障碍和心脏病等。

ABSTRACT: Child maltreatment is a major public health problem with over 6 million children involved in 3.4 million referrals to Child Protective Services and over 600,000 substantiated cases in the US annually. Some home visitation programs have been shown to be effective in reducing risk for abuse, promoting positive parenting, and improving child outcomes. However, such programs are aimed at narrowly selected, high-risk target populations, are high-resource intensive, and are not feasible for implementation on a universal scale. There is a need to test parenting interventions that are relatively low-cost, low-resource intensive, and adaptable to larger and more universal target populations. Our long-term goal is to enlarge the evidence base for low resource-intensive and widely adaptable interventions that effectively target parenting outcomes to reduce risk of child physical abuse in settings with broad reach, such as centers serving WIC or other pediatric populations. The objective of this study is to test the effectiveness of two such interventions in promoting effective parenting and reducing child physical abuse risk as compared with "usual care" parenting education in WIC clinics. Parents (n=1200) in this population with children 15 months to 5 years of age will be randomly assigned to one of 3 conditions: (1) Triple P-Level 2 only (L2) intervention, (2) Play Nicely intervention, or (3) a "usual care" control group. The rationale for this study is to be able to inform policy for parent service or clinic centers serving high-volumes of parents that are interested in adopting relatively low-cost, low-resource intensive interventions in order to reduce risk of child physical abuse and related risks to child health and development. Our specific aims are as follows: (1) Test brief clinic-based interventions (Triple P-L2 and Play Nicely) aimed at addressing parenting effectiveness in managing difficult child behavior in a selected population of families. Our working hypothesis is that parenting outcomes will be improved in each of these conditions as compared to the control condition; and (2) Determine if intervention effectiveness is modified by parents' perceived norms. Our working hypothesis is that stronger perceived injunctive norms by parents of professionals (e.g., pediatricians, mental health, and religious) supportive of physical discipline will be associated with reduced intervention effectiveness. These low-resource intensive parenting interventions are expected to shift parenting attitudes, self-efficacy, and behaviors linked with child physical abuse risk. Even small reductions in such risk across large selected or universal target populations can result in large benefits to the whole population (i.e., Prevention Paradox). Lowered rates of problematic parenting practices will lead to improved child development and behavior. Further, by contributing to a reduction in cumulative adverse childhood experiences and early toxic stress, these interventions are also expected to contribute to a long-term reduction in health disparities and risk for major public health problems such as smoking, obesity, drug abuse, risky sexual behavior, mental health disorders, and heart disease among others.