Early Childhood Connections

描述(由申请人提供)：儿童福利机构(CW)服务的幼儿有很高的行为、心理健康和认知延迟的比率，但这些儿童很少与儿童早期干预有关(Cicchetti&Curtis，2005；Jonson-Reid，Drake等人，2004；Leslie等人，2005a)。众所周知，由CW服务的父母有很高的母亲抑郁率(Lesched，Chiodo，Whitehead&Hurley，2005；Wolfe，1999)。然而，在CW家长群体中，典型的育儿计划的辍学率很高(Chaffin，2007)，而心理健康服务的参与率很低(Jonson-Reid，Drake&Kohl，在审查中)。早期儿童连接(ECC)是由社区机构和研究团队共同设计的一种新型服务提供系统。使用随机设计，该R34测试ECC的能力，以防止儿童发育迟缓和后来的精神健康障碍，防止反复虐待，并防止或改善母亲的抑郁和压力，在有CW服务的幼儿的家庭中。ECC在通过协调、协作和共址(联合CW和ECC家访)在这一高危人群中修改现有服务方面具有创新性。ECC是翻译的，根据PI以前的应用服务R01(R01 MH61733；2 R01 MH061733-04A1)的结果构建，并通过广泛的协作和初步可行性测试进一步发展，以评估参与者的接受程度。此R34是细化协议、评估参与者变更以及估计未来有效性和实施R01的效果大小所必需的下一步。现有的家访计划侧重于首次父母和初级预防，这意味着它们排除了CW家庭(Rapoport&O‘Brien-Stress，2001)，或者是短期的，对满足父母和孩子的心理健康需求的关注有限(Chaffin，2007)。ECC通过独特的联合家访让CW家庭参与进来，因此与长期育儿和案例管理支持无缝连接。ECC修改了家访筛查，将母亲的抑郁和压力、儿童行为和心理健康以及育儿和社会支持包括在内。ECC工作人员接受了培训，以更好地了解CW人口以及让他们参与额外服务的手段，如产妇心理健康。ECC家访远远超出了CW服务的范围，为家庭提供长期的育儿和病例管理支持，以便随着时间的推移与其他需要的服务建立联系。幼儿保育中心试点随机分配150个有0-3岁儿童的家庭，他们是第一次使用以下服务之一：(A)居家CW服务或(B)第一次从寄养中心重新团聚后的居家服务。在基线和18个月时，比较两组儿童的认知、行为和心理健康结果、母亲抑郁、压力和社会支持、CW累犯率和育儿措施。在ECC条件下，我们增加了9个月的中期筛查，衡量对ECC家访和其他所需服务的参与度和满意度，以及实施问题，如感知的工人负担。假设结果为阳性，结果将被用于准备全面的R01测试。 与公共健康相关：因虐待或疏忽而接受家庭服务的幼儿，日后发生发育迟缓和精神健康问题的风险很高，在丧失潜力和公共服务系统成本方面都是社会的一大代价。目前，这些家庭中没有几个与可用的长期幼儿服务有联系，这些服务可能在防止再次发生虐待和改善照顾者和儿童结果方面有希望。这项R34提案支持对早期儿童联系(ECC)的试点研究，这是一种多层次的创新服务模式，旨在改善非常年幼的受虐和被忽视儿童的行为和发展结果，并减少他们的主要照顾者的抑郁和压力。

DESCRIPTION (provided by applicant): Young children served by child welfare (CW) have very high rates of behavioral, mental health, and cognitive delays, yet these children are rarely connected to early childhood intervention (Cicchetti, & Curtis, 2005; Jonson- Reid, Drake et al, 2004; Leslie et al, 2005a). Parents served by CW are known to have a high rate of maternal depression (Leschied, Chiodo, Whitehead & Hurley, 2005; Wolfe, 1999). Among the CW parent population, however, drop-out from typical parenting programs is high (Chaffin, 2007) and participation in mental health services is low (Jonson-Reid, Drake, & Kohl, Under Review). "Early Childhood Connections" (ECC) is a novel service delivery system designed collaboratively by community agencies and the research team. Using a randomized design, this R34 tests ECC's ability to prevent child developmental delay and later mental health disorders, prevent recurrent maltreatment, and prevent or ameliorate maternal depression and stress in families with young children served by CW. ECC is innovative in its modification of existing services through coordination, collaboration and co-location (joint CW and ECC home visit) in this high risk population. ECC is translational, built from findings from the PI's prior applied services R01 (R01 MH61733; 2 R01 MH061733-04A1) and further developed through extensive collaboration and preliminary feasibility testing to assess participant acceptance. This R34 is the necessary next step to refine protocols, assess participant change, and estimate effect sizes for a future effectiveness and implementation R01. Existing home visiting programs focus on first time parents and primary prevention, meaning they exclude CW families (Rapoport & O'Brien-Strain, 2001), or are short-term with limited attention to addressing parent and child mental health needs (Chaffin, 2007). ECC engages CW families through a unique joint home visit so there is seamless connection to long-term parenting and case management support. ECC modifies home visiting screening to include maternal depression and stress, child behavior and mental health, and parenting and social support. ECC workers are trained to better understand the CW population and the means of engaging them in additional services, like maternal mental health. ECC home visiting extends well beyond CW services, providing families longer term parenting and case management support to make connections to other needed services over time. The ECC pilot randomly assigns (Usual care or ECC) 150 families with children 0-3 years who are first time users of either: (a) in-home CW services or (b) in-home services following a first reunification from foster care. Groups are compared at baseline and 18 months on child cognitive, behavioral and mental health outcomes, maternal depression, stress and social support, CW recidivism, and parenting measures. Within the ECC condition we add an interim screening at 9 months, measure engagement in and satisfaction with ECC home visiting and other needed services, and implementation issues like perceived worker burden. Presuming positive results, findings will be used to prepare for a full-scale R01 test. PUBLIC HEALTH RELEVANCE: Young children who receive in-home services for abuse or neglect are at high risk for later developmental delays and mental health problems and represent a significant cost to society both in terms of lost potential and public service system costs. Currently, few of these families are connected to available longer term early childhood services that may hold promise in preventing recurrent maltreatment and improving both caregiver and child outcomes. This R34 proposal supports a pilot study of Early Childhood Connections (ECC), a multi- level, innovative service model to improve behavioral and developmental outcomes for very young abused and neglected children and decrease depression and stress for their primary caregiver.