Community Prevention of Child Maltreatment

摘要 该项目的目的是评估一种新的综合方法对改善人口状况的影响 社区导航(CN)是一种名为“社区导航”的儿童早期发展项目，旨在减少儿童早期发展的差距。CN的基础是 关于MIECHV批准的家庭连接(FC)，这是一项普遍的新生儿护士家访计划，结合了 通过短期护士家访使社区资源与家庭的参与相一致 确定特定于家庭的需求，进行简短干预，并将家庭与定制的社区资源相匹配。二 随机对照试验(RCT)显示，分配给FC可以改善产妇的心理健康和 降低虐待儿童调查的人口比率，但不会对儿童行为产生长期影响。 为了改善和平等人口在育儿和儿童福祉方面的结果，已制定了CN 通过试点将其作为贯穿早期生活的普遍的初级保健心理社会系统。训练有素的导航员到达 怀孕期间的妇女，在出生时继续进行FC，并在12、24和36个月时完成健康家庭探视 提供支持，评估特定家庭的需求，提供简短的干预措施，并联系家庭 拥有满足持续需求的社区资源。在慈善支持下，CN现在正在通过 以北卡罗来纳州达勒姆的800个家庭为社区样本的随机对照研究。已有400个家庭被分配到 从怀孕到幼儿园，有400个家庭被指定为 通常的控制。数据分析将检验四个假设：(1)干预效果：与对照组相比，CN- 被分配的家庭将证明虐待儿童的比率更低，儿童紧急医疗护理更少 利用度，更好的父母心理健康，更积极的父母行为，以及更好的儿童认知和 通过5岁的行为发展；(2)缩小差距：随机分配到CN 与缩小种族和收入差距有关，作为CN分配的积极影响而运作 对每个群体影响更大的是低收入家庭和有色人种家庭；(3)干预 调解：改善父母的心理健康、父母的自我倡导和育儿行为 儿童行为的群体影响(中介)和差异缩小(中介调节) 结果；以及(4)差距如何发展：在获得社区资源方面的种族和收入差距 在早期生活中，种族和收入差距将会影响幼儿园儿童的学习成绩。这项提议提供了 一个紧急的、费用分摊的机会，以评估人口影响、缩小差距和 为生育家庭提供初级保健的新制度。该项目将通过提供 关于负担得起的、创新的、普遍的初级心理社会保健系统的经验性知识，旨在 为了改善人口结果和减少人口在父母心理健康方面的差距，积极的育儿方式 行为，虐待儿童的比率，以及儿童认知和行为发展，并测试 发展差距的机制，这种干预的作用是缩小差距。

ABSTRACT The aim of this project is to evaluate the impact of a novel comprehensive approach to improving population outcomes and reducing disparities in early child development, called Community Navigation (CN). CN is based on the MIECHV-approved Family Connects (FC), a universal newborn nurse home visiting program combining alignment of community resources with engagement of families through short-term nurse home visiting to identify family-specific needs, intervene briefly, and match families with tailored community resources. Two randomized controlled trials (RCTs) have shown assignment to FC improves maternal mental health and reduces population rates of child abuse investigations but does not have long-term impact on child behavior. To improve and equalize population outcomes in parenting and child well-being, CN has been developed through piloting as a universal psychosocial system of primary care across early life. Trained navigators reach women during pregnancy, continue with FC at birth, and complete well-family visits at 12, 24, and 36 months of child age to provide support, assess family-specific needs, deliver brief interventions, and connect families with community resources for ongoing needs. With philanthropic support, CN is now being delivered through an RCT with a community sample of 800 families in Durham, NC. 400 families have been assigned to receive CN across the period from pregnancy through kindergarten, and 400 families have been assigned as care-as- usual controls. Data analyses will test four hypotheses: (1) intervention efficacy: compared to controls, CN- assigned families will demonstrate lower rates of child maltreatment, less child emergency medical care utilization, better parent mental health, more positive parenting behaviors, and better child cognitive and behavioral development through age 5; (2) disparity reduction: random assignment to CN will be associated with reduction of race and income disparities, operationalized as positive impact of CN assignment on each group with even stronger impact on low-income families and families of color; (3) intervention mediation: improved parent mental health, parent self-advocacy, and parenting behaviors will account for population impact (mediation) and disparity reduction (mediated moderation) in children’s behavioral outcomes; and (4) how disparities develop: race and income disparities in access to community resources in early life will account for race and income disparities in child outcomes at kindergarten. This proposal offers an urgent, cost-shared opportunity to evaluate the population impact, disparity reduction, and mechanisms of a novel system of primary care for birthing families. The project will contribute to public health by providing empirical knowledge about an affordable, innovative, universal system of primary psychosocial care that aims to improve population outcomes and reduce population disparities in parent mental health, positive parenting behaviors, rates of child maltreatment, and child cognitive and behavioral development, and testing the mechanisms through which disparities develop and this intervention operates to reduce them.