Child-Adult Relationship Enhancement in Primary Care: Effectiveness Trial of a Primary Care Based Parenting Intervention to Prevent Child Maltreatment

项目摘要/摘要 虐待儿童(CM)是一个普遍存在的公共卫生问题，迫切需要简短、有效、 可扩展的预防干预措施。有问题的亲子关系是CM的核心。父母 虐待他们的孩子更有可能有惩罚性的教养方式，其特点是负面率很高 过度依赖惩罚的互动和无效的纪律策略。严厉、被动的育儿方式可能 有助于儿童行为问题的发展，进而增加父母的压力和 导致负面育儿行为的升级，包括虐待和疏忽的育儿。因此，养育子女 加强亲子关系的干预措施，教授积极的管教技巧，减少苛刻 养育子女和减少儿童行为问题是CM预防策略的希望所在。面临的挑战 父母参与，特别是低收入和少数族裔父母，以及缺乏关于有效的知识 然而，实施战略极大地限制了育儿干预的覆盖范围和影响。至 为了应对这些挑战，我们来自北卡罗来纳大学和儿童基金会的跨学科团队 费城医院合作实施和评估儿童成人关系增强 初级保健(PriCARE)/Criando Niños con Cariño。PriCARE/Cariño不同于其他方案，因为它 (1)开发和反复适应来自不同种族和民族的家庭的投入，包括低- 收入家庭和(2)专门为在初级保健中实施而设计，并纳入了以下战略 与日常护理工作流程保持一致，以增加吸收和留存。在随机对照试验(RCT)中， PriCARE在让父母参与、促进积极育儿、减轻父母压力、 以及改善儿童行为。本项目的目标是在小学加强儿童与成人之间的关系 护理：以初级护理为基础的父母干预预防虐待儿童的有效性试验 在1932名家长和他们的2名家长中进行一项关于PriCARE/Cariño加普通护理与普通护理的多点随机对照试验- 6岁儿童，有医疗补助/芯片/没有6家诊所的保险。我们将审查以下措施的有效性 PriCARE/Cariño关于减少可疑心肌梗死，以及减少与近期心肌梗死相关的结果(儿童 行为问题、父母压力、苛刻/疏忽的养育方式)。通过测试近期结果，除了 这项研究将有助于阐明CM的变化机制，促进CM的远期结局 预防心肌炎的科学。最后，在本研究中，我们还将确定PriCARE/Cariño实施 并审查它们与执行成果的关系。如果成功，结果将用于 寻求国家机构和支付者的资金，以维持初级保健中的PriCARE/Cariño，同时继续 完善和研究执行和传播战略，最终目标是实现 暴露量足以打破CM的代际传播。包括纵向同意书 数据收集将有助于今后纵向研究PriCARE/Cariño对其他成果的影响。

Project Summary/Abstract Child maltreatment (CM) is a pervasive public health problem and there is a critical need for brief, effective, scalable prevention interventions. Problematic parent-child relationships lie at the heart of CM. Parents who maltreat their children are more likely to have punitive parenting styles characterized by high rates of negative interaction and ineffective discipline strategies with over-reliance on punishment. Harsh, reactive parenting can contribute to the development of child behavioral problems which, in turn, can increase parental stress and lead to escalation of negative parenting behaviors, including abusive and neglectful parenting. Thus, parenting interventions that strengthen parent-child relationships, teach positive discipline techniques, decrease harsh parenting, and decrease child behavioral problems hold promise as CM prevention strategies. Challenges in engaging parents, particularly low-income and minority parents, and a lack of knowledge regarding effective implementation strategies, however, have greatly limited the reach and impact of parenting interventions. To address these challenges, our interdisciplinary team from the University of North Carolina and Children’s Hospital of Philadelphia collaborated in implementing and evaluating, Child Adult Relationship Enhancement in Primary Care (PriCARE)/Criando Niños con Cariño. PriCARE/Cariño is distinct from other programs because it was (1) developed and iteratively adapted with input from racially and ethnically diverse families, including low- income families and (2) designed specifically for implementation in primary care with inclusion of strategies to align with usual-care work flow to increase uptake and retention. In randomized controlled trials (RCTs), PriCARE has demonstrated success in engaging parents, promoting positive parenting, reducing parent stress, and improving child behaviors. The objective of this project “Child-Adult Relationship Enhancement in Primary Care: Effectiveness Trial of a Primary Care Based Parenting Intervention to Prevent Child Maltreatment” is to conduct a multi-site RCT of PriCARE/Cariño plus Usual Care vs. Usual Care among 1932 parents and their 2- 6-year-old children with Medicaid/CHIP/no insurance from 6 clinics. We will examine the effectiveness of PriCARE/Cariño on reducing suspected CM, in addition to reducing proximal CM related outcomes (child behavior problems, parent stress, harsh/neglectful parenting). By testing proximal outcomes in addition to the more distal outcome of CM, this study will help to elucidate the mechanisms of change and advance the science of CM prevention. Finally, in this study we will also identify PriCARE/Cariño implementation determinants and examine their relationship to implementation outcomes. If successful, results will be used to seek funding from state agencies and payers to sustain PriCARE/Cariño in primary care, while continuing to refine and study implementation and dissemination strategies, with the ultimate goal of achieving levels of exposure sufficient for breaking the intergenerational transmission of CM. Inclusion of consent for longitudinal data collection will facilitate future longitudinal studies of the impact of PriCARE/Cariño on additional outcomes.