Enhancing Ugandan HIV-Affected Child Development with Caregiver Training

描述（由申请人提供）：以家庭为基础的育儿计划，旨在改善儿童的健康和福祉，已证明在一系列成果的成功。然而，家庭中的其他儿童通过改变父母的态度和行为也从这些方案中受益的程度还没有得到严格的调查。这一主题对促进青年积极发展和预防情绪和行为问题具有深远的影响，特别是在家庭规模大、儿童往往面临重大逆境、获得心理健康服务的机会极其有限的低资源环境中。一项针对弱势人群的有希望的护理人员培训干预措施的随机对照试验，即敏化护理人员的中介干预措施（MISC），已经获得资助，以调查干预措施对HIV感染和受HIV影响的幼儿（2-5岁）的神经发育，心理和社会结局的影响（MPI：Bass，Boivin：1 R 01 HD 070723 -01）。平均2.7名12岁以下的儿童生活在我们的研究之家，我们预计将招募约170名儿童在MISC家庭和170名儿童在对照家庭调查分散影响的MISC计划，以其他儿童在家里，使用受艾滋病毒影响的研究队列。将调查的具体儿童结果包括：马伦的发展收益，执行功能的行为评定量表（BRIEF），和照顾者管理版本的Achenbach CBCL，生长和发育的身体健康措施，和学校参与。将调查的家庭层面的结果包括作为本补充的一部分，包括使用麦克马斯特家庭评估装置（FAD）评估的家庭功能，家庭规模和家庭关系，通过使用家庭图。该补助金的具体目标是：目标1：评估与对照家庭中的非R 01研究儿童相比，MISC家庭中的非R 01研究儿童的护理人员培训是否能更好地改善其功能。目的2：评估护理人员培训与非R 01研究儿童结局之间相关性的潜在介质。目标3：评估护理人员培训与非R 01研究儿童结局之间相关性的潜在调节因素，包括儿童年龄、儿童性别、护理人员健康状况和家庭规模。创新和影响该补充剂通过严格测试MISC干预措施使家中多个儿童受益的潜力，超越了父母R 01的创新。鉴于乌干达的家庭规模相对较大，财政和人力资源严重有限，改善多子女福祉的照顾者干预措施是一个有希望在全国范围内推广的方案。通过探索调解人和主持人获得的信息将允许进一步的干预调整，以最大限度地提高干预效果，而不仅仅是一个单一的研究儿童。总的来说，这项研究是响应最近呼吁创新战略，以解决所谓的“全球心理健康危机”，其中心理健康的需求远远超过现有的服务，在低资源环境。因此，研究结果具有令人兴奋的潜力，可用于国际上其他高风险人群。

DESCRIPTION (provided by applicant): Home-based parenting programs aimed at improving a child's health and well-being have demonstrated success across a range of outcomes. However, the degree to which other children in the home also benefit from these programs via changes in parental attitudes and behaviors has not been rigorously investigated. This topic has far-reaching implications for promoting positive youth development and preventing emotional and behavioral problems, particularly in low-resource settings in which family sizes are large, children often face significant adversity, and access to mental health services is extremely limited. A randomized controlled trial with a promising caregiver training intervention for vulnerable populations, the Mediational Intervention for Sensitizing Caregivers (MISC), has already been funded to investigate the intervention impact on neurodevelopmental, psychological and social outcomes (MPI: Bass, Boivin: 1R01HD070723-01) among HIV-infected and HIV-affected young children (ages 2-5). Study Methods With on average 2.7 children under age 12 years living in our study homes, we expect to recruit approximately 170 children in the MISC homes and 170 children in the control homes to investigate dispersion effects of the MISC program to other children in the home, using the HIV-affected study cohort. The specific child outcomes that will be investigated include: development gains on the Mullen, the Behavior Rating Inventory of Executive Functioning (BRIEF), and the caregiver administered version of the Achenbach CBCL, physical health measures of growth and development, and school participation. Family level outcomes that will be investigated include as part of this supplement include family functioning assessed using the McMaster Family Assessment Device (FAD), family size, and familial relationships through the use of a household diagram. The specific aims of this supplement grant are: Aim 1: To evaluate whether caregiver training produces greater improvements in functioning among non-R01 study children in the MISC homes compared with non-R01 study children in the control homes. Aim 2: To assess potential mediators of the association between caregiver training and non-R01 study child outcomes. Aim 3: To assess potential moderators of the association between caregiver training and outcomes in the non-R01 study children, including child age, child sex, caregiver health, and family size. Innovation and impact This supplement innovates beyond the parent R01 by rigorously testing the MISC intervention's potential to benefit multiple children in the home. Given relatively large family sizes in Uganda and severe financial and human resource limitations, a caregiver intervention that improves the well-being of multiple children is a promising program for nation-wide scale up. Information gained through the exploration of mediators and moderators will allow further intervention adaptation to maximize intervention effectiveness to more than just a single study child. Broadly, this study is responsive to recent calls for innovative strategies to address what has been termed a "global mental health crisis" in which mental health needs far outpace available services in low-resource settings. As such, findings have exciting potential for application with other high-risk populations internationally.