A Medical Home-Based Intervention to Prevent Child Neglect in High-Risk Families

项目总结 美国超过25%的低收入家庭有一个有特殊医疗需求的孩子 (CSHCN)，定义为存在慢性身体、情感或行为健康状况。确实有 使低收入的CSHCN处于被忽视的高风险的特定压力源，包括有限的父母社会 支持困难，难以驾驭复杂的医疗服务，照顾者负担沉重。以前的工作 已经证明，这样的压力会削弱父母对孩子的持续反应的能力 需要并干扰遵守推荐的、通常是复杂的医疗护理。我们的建议 干预策略的前提是优化父母的功能-通过减少 被日常问题压得喘不过气来的感觉，提高自我效能，缓冲 生活压力源对情绪的影响-最终可以防止CSHCN中的忽视。这份申请概述了一个为期3年的 研究计划进行预防虐待儿童问题解决的随机对照疗效试验 (CAPPS)，一项旨在解决低收入父母面临的特定压力源的有针对性的干预措施 CSHCN和加强家庭力量以前被证明可以降低虐待的风险。我们 建议对250名CSHCN的父母进行一项多中心随机对照试验，该试验在7人的网络中进行 城市以病人为中心的医疗院。具体的研究目标是：1)减少儿童的转介 为疏忽提供保护性服务，并增加对推荐医疗护理的坚持；以及2)减少 感觉到的社会孤立，难以驾驭复杂的服务，以及照顾者的负担和加强家庭 优势，包括父母的适应能力、社会关系、在需要时获得支持的机会以及知识 父母教养和儿童发展的关系。我们假设，通过我们的Capps干预，低收入父母 CSHCN将培养更强的解决问题的技能，这种技能将导致较少的感知压力 以及更强的主人翁意识。我们假设干预措施的父母将会在 这将增强家庭的力量，并将能够更好地对子女的复杂需求做出一致的反应。通过 针对虐待的已知风险和保护因素，我们的目标是防止CSHCN的疏忽。如果 我们的干预模式是成功的，拟议试验的结果可能有助于显著 改善防止虐待儿童的服务。我们的最终目标是传播一种有效的 以医疗家庭为基础的干预措施侧重于促进家庭力量和解决低收入家庭的需求 患有CSHCN的收入家庭。

PROJECT SUMMARY More than 25% of low-income families in the United States have a child with special health care needs (CSHCN), defined by the presence of a chronic physical, emotional, or behavioral health condition. There are specific stressors that place low-income CSHCN at high risk for neglect, including limited parental social supports, difficulty navigating complex medical services, and high levels of caregiver burden. Previous work has demonstrated that such stressors can impair parents' ability to respond consistently to their children's needs and interfere with adherence to recommended, and often complex, medical care. Our proposed intervention strategy is based on the premise that optimizing parental functioning – by decreasing the perception of being overwhelmed by one's daily problems, increasing self-efficacy, and buffering the impact of life stressors on mood – can ultimately prevent neglect among CSHCN. This application outlines a 3-year research plan to conduct a randomized controlled efficacy trial of Child Abuse Prevention Problem Solving (CAPPS), a targeted intervention designed to address specific stressors faced by low-income parents of CSHCN and to enhance family strengths previously been shown to reduce the risk of maltreatment. We propose a multi-center randomized controlled trial of 250 parents of CSHCN, conducted within a network of 7 urban patient-centered medical homes. The specific research aims are to: 1) Decrease referrals to child protective services for neglect and increase adherence to recommended medical care; and 2) Decrease perceived social isolation, difficulty navigating complex services, and caregiver burden and enhance family strengths, including parental resilience, social connections, access to support in times of need, and knowledge of parenting and child development. We hypothesize that through our CAPPS intervention, low-income parents of CSHCN will develop stronger problem solving skills and that such skills will result in less perceived stress and a greater sense of mastery. We hypothesize that intervention parents will experience an improvement in family strengths and will be better able to respond consistently to their children's complex needs. By addressing known risk and protective factors for maltreatment, we aim to prevent neglect among CSHCN. If our intervention model is successful, the results of the proposed trial could contribute to significant improvements in child maltreatment prevention services. Our ultimate goal is dissemination of an effective medical home-based intervention focused on promoting family strengths and addressing the needs of low- income families with CSHCN.