Promoting Emotional Development Among Young Children Facing Adversity: An Effectiveness Implementation Study in St. Louis Schools

项目摘要 面对逆境的儿童有很高的社会情感和认知结果不佳的风险， 后来的精神病理学。然而，越来越多的证据表明，这些负面的发展 通过在发育早期加强培育，可以显著改善发展轨迹。 尽管有许多经验支持的早期干预，这些计划并不容易 为大多数最需要帮助的美国儿童提供服务。基于此，迫切需要 使这些干预措施切实可行，并随时提供给这些社区。为此我们 建议测试一个简短的6节亲子预防干预的有效性 通过视频会议在家庭的家中进行，并研究两种实施方法内 3个高危学区。这项名为“茁壮成长”的干预措施是一项先前经过测试的早期父母 在圣路易斯县的一个地区进行了儿童干预试点，证明是可行的、可接受的， 似乎很有效。符合入选标准的4.0-6.11岁的看护者-儿童配对将 随机分配至THRIVE条件或具有可比性的既定在线育儿教育 长度虽然利用学校作为提供服务的平台将增加无障碍环境， 系统提出了独特的和复杂的挑战，为实施心理健康 预防因此，我们将使用混合有效性-实现设计来测试 有效性THRIVE相比，养育明智，同时也评估了两个影响 研究成果的实施形式（辅导与不辅导）。关键评估 结果测量，包括儿童行为，社会和情感功能，儿童 精神病理学，养育压力，乐观和抑郁症状，以及 父母教养和亲子二元关系（观察和神经使用功能近 将在基线、治疗后（P1）和12周时测量红外光谱（fNIRS） 后处理（P2）。我们还将测试预防性干预如何机械地针对 通过提高照顾者的反应能力和敏感性来提高父母与子女关系的质量 通过基线、治疗中期和治疗后（P1）评估。该项目提供了第一个 测试通过学校获得并在家中提供的简短亲子早期预防， 视频会议，最低限度的治疗师培训，以增加获得护理。它进一步审查了 治疗师辅导的成本效益作为一种手段，以改善实施和临床 结果。

Project Summary Children facing adversity are at high risk for poor socio-emotional and cognitive outcomes and later psychopathology. However, there is increasing evidence that these negative developmental trajectories can be significantly improved by enhancing nurturing caregiving early in development. Despite numerous empirically supported early interventions, these programs are not readily accessible to the majority of US children most in need. Based on this, there is an urgent need to make these interventions feasible and readily available to these communities. To do this we propose to test the effectiveness of a brief 6 session parent-child preventive intervention conducted by video conference in the family's home and study two implementation methods within 3 high-risk school districts. The intervention, entitled “THRIVE,” is a previously tested early parent child intervention piloted in a St. Louis county district which proved feasible, acceptable and appeared effective. Caregiver-child dyads aged 4.0-6.11 meeting inclusion criteria will be randomized to a THRIVE condition or an established online parenting education of comparable length. Although the use of schools as a service delivery platform will increase accessibility, this system presents unique and complex challenges for implementation of a mental health prevention. Therefore, we will use a hybrid effectiveness-implementation design to test the effectiveness of THRIVE compared to Parenting Wisely, while also assessing the impact of two forms of implementation (coaching vs. no coaching) on study outcomes. Assessments of key outcome measures, including child behavior, social, and emotional functioning, child psychopathology, parenting stress, optimism, and depressive symptoms, and changes in parenting and the parent-child dyadic relationship (observational and neural using functional near infrared spectroscopy' fNIRS) will be measured at baseline, post-treatment (P1), and 12-weeks post-treatment (P2). We will also test how the preventive intervention mechanistically targets the quality of the caregiver-child relationship by enhancing caregiver responsiveness and sensitivity via baseline, mid-treatment and post-treatment (P1) assessments. This project provides the first test of a brief parent-child early prevention accessed through schools and delivered in home by video conference with minimal therapist training to enhance access to care. It further examines the cost-effectiveness of therapist coaching as a means to improve implementation and clinical outcomes.