Parent-focused primary prevention of child sexual abuse: An Effectiveness-Implementation Hybrid Trial

摘要 儿童性虐待(CSA)是一个全球公共卫生问题，每5个女孩中就有1个受到影响，每12个男孩中就有1个受到影响 18.父母在保护孩子免受CSA伤害方面处于独特的地位，但父母在很大程度上被忽视了 CsA初级预防努力和少数确实存在的努力并未显示出对 保护行为。家长教育(PE)计划为家长提供与孩子相关的基本技能 发展、亲子沟通和安全。这些基本技能可以在逻辑上扩展到 与预防CSA相关的教学：健康的性发展，父母交流的策略 他们的孩子和其他人关于性话题和性行为，并创造身体和在线 安全的环境，不受潜在的开发，并识别梳理行为。我们的团队开发了Smart 家长-安全健康的孩子(聪明的父母)作为单一课程，以技能为基础，以家长为重点的CSA 预防模块，将这些关键的CSA特定预防概念添加到体育计划课程中。利用 体育基础技能，聪明的父母为家长提供CSA预防知识，以增加他们的 与CSA相关的态度和感知的规范以及练习保护性行为技能的机会。一个 最近的整群随机临床试验初步证明在提高家长意识方面是有效的 当父母作为教师(PAT)时，增加他们使用CSA保护行为的意愿， 这是一个以证据为基础的体育项目，得到大多数州儿童福利体系的支持。拟议的研究旨在 扩大聪明父母有效性的实证证据并探索其实施 可能促进或阻碍采用率、保真度和可扩展性的因素，建议的研究使用类型2混合 有效性--实施设计。我们将进行阶梯式楔形-整群随机试验(N=400) 确定智能家长添加到PAT(PAT+智能家长)对CSA相关的有效性(Aim1) 使用CsA保护行为的意识和意向与接受PAT治疗的父母相比 通常(PAT-TAU。我们将在12个月和24个月时对这两种情况下的参与父母进行跟踪调查，以确定 保持认识(即知识和态度)和实际使用保护行为(目标2)。至 描述对未来的传播和执行工作有希望的因素(目标3)，我们将：评估 智能父母有效性的家长、提供者和组织级别的主持人；进行成本分析； 并对智能父母提供商(N=100)和具有关键PE的焦点小组进行结构化访谈 利益攸关方(N=25)，以确定可能影响未来传播和执行的因素。通过 利用国家支持的家庭服务提供商使用的现有体育中传授的基本技能 美国--并通过《家庭优先预防服务法》等联邦政策支持-- 将聪明的父母融入体育项目不仅效率高，成本效益高，而且构成了一种 全系统、真实世界、以社区为基础的初级CSA预防的可持续模式。

ABSTRACT Child sexual abuse (CSA) is a global public health problem affecting 1 in 5 girls and 1 in 12 boys before age 18. Parents are uniquely positioned to protect children from CSA, yet parents have largely been ignored in CSA primary prevention efforts and the few that do exist have not demonstrated a significant effect on protective behaviors. Parent education (PE) programs provide parents with foundational skills related to child development, parent-child communication, and safety. These foundational skills can be logically extended into didactics relevant to CSA prevention: healthy sexual development, strategies for parents to communicate with their children and others about sexual topics and sexual behaviors, and creating physical and online environments safe from potential exploitation and recognizing grooming behaviors. Our team developed Smart Parents – Safe and Healthy Kids (Smart Parents) as a single session, skills-based, parent-focused CSA prevention module that adds these key CSA-specific prevention concepts to PE program curricula. Leveraging the PE foundational skills, Smart Parents provides parents with CSA-prevention knowledge to increase their CSA-related attitudes and perceived norms as well as the opportunity to practice protective behavioral skills. A recent cluster randomized clinical trial demonstrated preliminary to be effective in raising parents' awareness and increasing their intention to use of CSA protective behaviors when added to Parents as Teachers (PAT), an evidence-based PE program supported by most state child welfare systems. The proposed study seeks to expand the empirical evidence for the effectiveness of Smart Parents and to explore the implementation factors that might promote or hinder adoption, fidelity, and scalability, the proposed study uses a type 2 hybrid effectiveness-implementation design. We will conduct a stepped wedge-cluster randomized trial (N = 400) To determine effectiveness (Aim1) of Smart Parents when added to PAT (PAT+Smart Parents) on CSA-related awareness and intention to use CSA protective behaviors compared to parents receiving PAT treatment as usual (PAT-TAU. We will follow-up participating parents in both conditions at 12- and 24-months to determine retention of awareness (i.e., knowledge and attitudes) and actual use of protective behaviors (Aim 2). To describe factors that hold promise for future dissemination and implementation efforts (Aim 3), we will: assess parent, provider, and organizational-level moderators of Smart Parents effectiveness; conduct a cost analysis; and conduct structured interviews with Smart Parents providers (N = 100) and focus groups with key PE stakeholders (N = 25) to identify factors that may impact future dissemination and implementation. By leveraging the foundational skills taught in existing PE used by state-supported family service providers across the US—and supported through federal policy such as the Family First Prevention Services Act—the integration of Smart Parents into PE programs is not only efficient and cost-effective, but constitutes a sustainable model of system-wide, real-world, community-based implementation of primary CSA prevention.