Identification of Newborns at High Risk for the Occurrence of Preventable Child Maltreatment

摘要 儿童期虐待（CM）对人类发展具有高度有害的影响，可以说是最严重的虐待。 在美国，婴儿和幼儿是持久的精神病理学的有影响力的，可预防的原因。 虐待和忽视造成身体伤害的风险特别高，占所有虐待儿童事件的60%以上。 死亡人数越来越多的研究指出，通过估计 根据出生记录中现成的变量，在出生时确定个人特有的风险。的 根据现有风险指标实时识别新生儿CM风险的前景 产科设置能够有针对性的预防是令人兴奋的，但可行性和预测性的实证测试， 方法的实用性是将其整合到美国产科或新生儿临床中的任何系统尝试的关键。 服务例如，出生记录指数仍然表明，有相当多的儿童没有继续上学， 经验的CM，使其重要的是试图优化特异性（保留灵敏度）与额外的 在广泛实施之前进行简要的临床筛选或管理数据预测风险建模。此外，委员会认为， 由于筛查的价值取决于其可操作性，因此了解筛查结果是否 在摄取所需的预防性干预，反过来，这是否会减少实际CM。在400个样本中， 家庭丰富的风险，为未来的CM，我们对比了三种类型的新生儿筛查的预测效用， 未来CM官方报告的风险，包括：a）仅出生记录风险变量（BRRV）; B）BRRV加简短 临床筛查产妇心理健康和物质使用状况，儿童创伤和/或当前亲密关系 伴侣暴力;以及c）检索和分析一组医疗记录和保险索赔变量（用于 每个家庭）的基础上，包括在一个单独的顶点中心项目的大规模PRM工作， 学习期间。这项研究的一个随机对照试验（RCT）试验组将探索一个简短的个性化教育在多大程度上 针对主要照顾者的协议增强了他/她对干预的参与，而不是像往常一样照顾。第二 该项目的主要目的是促进对风险与结果之间关系的科学理解。 尽管CM和精神病理学之间的联系已经建立，但相关的路径和机制 仍在确定中，需要进行更多的纵向调查，以期确定可改变的因素 在预防工作不成功时，可以有针对性地进行干预。我们将首先确定 CM报告（作为主要结局）受参与服务和/或可修改风险变化的影响 在生命的前6个月，接下来，我们将探讨婴儿发育结果的程度， 不仅受到CM的调节，而且受到其不利影响的早期心理生物学指标的影响 后果该项目响应了Capstone RFA（RFA-HD-18-012）的几个优先事项， 儿童虐待政策、研究和培训创新中心的使命是预防CM， 促进虐待和忽视受害者的健康发展。

ABSTRACT Childhood maltreatment (CM) has highly deleterious effects on human development and is arguably the most influential, preventable cause of enduring psychopathology in the U.S. Infants and young children are at particularly high risk for physical harm from abuse and neglect, comprising over 60% of all child maltreatment fatalities. An increasing number of studies point to the ability to target prevention of CM by estimating individual-specific risk at the time of birth, on the basis of readily-available variables in birth records. The prospect of real-time identification of newborns at risk for CM on the basis of risk indicators available in obstetrical settings to be able to target prevention is exciting, but empirical testing of feasibility and predictive utility of methods are key to any systematic attempt to integrate this in U.S. obstetric or newborn clinical services. For example, birth record indices still identify a substantial number of children who do not go on to experience CM, making it important to attempt to optimize specificity (preserving sensitivity) with additional brief clinical screens or administrative data predictive risk modeling prior to broad implementation. Moreover, since screening is only as valuable as its actionability, it is important to understand whether screening results in uptake of needed preventive intervention and, in turn, whether this decreases actual CM. In a sample of 400 families enriched for risk for future CM, we contrast the predictive utility of three types of newborn screening for risk of future official-report of CM involving: a) birth record risk variables (BRRV) only; b) BRRV plus a brief clinical screen for maternal mental health and substance use status, childhood trauma and/or current intimate partner violence; and c) retrieval and analysis of a set of medical record and insurance claims variables (for each family) based on those included in a large-scale PRM effort of a separate Capstone center project during the study period. A RCT pilot arm of the study will explore the extent to which a brief, personalized education protocol for the primary caregiver enhances his/her engagement in intervention over care as usual. A second major aim of the project is to advance scientific understanding of the relationship between risk and outcome. Despite the established association between CM and psychopathology, the associated paths and mechanisms are still being identified, calling for more longitudinal investigation with the hope of identifying modifiable factors that can be targeted for intervention when prevention efforts are not successful. We will first determine whether CM report (as a primary outcome) is moderated by participation in services and/or changes in modifiable risk factors over the first 6 months of life. Next we will explore the extent to which infant developmental outcomes are moderated not only by CM, but by early psychobiological indices of vulnerability to its adverse consequences. The project responds to several priorities of the Capstone RFA (RFA-HD-18-012) as well as the mission of Center for Innovation in Child Maltreatment Policy, Research, and Training to prevent CM and promote healthy development of victims of abuse and neglect.