Universal strengths-based parenting support in pediatric health care for families with very young children following the Flint Water Crisis

项目摘要/摘要 公共卫生灾难对贫困社区的影响不成比例，通过增加 贫困和相关的压力因素，并在较长时期内采取行动。非常小的孩子们非常 容易受到对发展和心理健康的长期影响，但往往受到的关注最少 和资源。许多研究都证明了普遍的预防性育儿干预对 在贫困和相关压力因素的背景下幼儿的发展和心理健康，但是 据我们所知，积极育儿的普遍推广在 在这一背景下，关于育儿和早期儿童发展的更广泛的研究寥寥无几。 这项建议旨在确定基于普遍优势的育儿支持在预防不利影响方面的作用。 弗林特水危机(FWC)后对幼儿的影响。在《化学武器公约》中，铅污染 在密歇根州弗林特，一个拥有世界上最大城市之一的社区，在节约成本的供水改革之后，饮用水的供应 美国最高的长期贫困率和相关压力源。家属们一直在担心 铅对儿童的影响，再加上愤怒、不信任和在一场被视为 这是一种可以避免的、被认为是忽视的、根植于种族和社会经济偏见的回应。 目标将通过视频互动项目(VIP)的RCT实现，该项目以医疗保健为基础 在人口一级，非污名化的准入，并使用可能在灾害发生后有效的战略，例如， 基于关系和优势，建立在父母目标的基础上。486个家庭将在出生时登记，随机到 VIP或常规护理，并在3岁时对育儿实践进行定期评估， 跨领域的亲子关系和儿童发展。这项研究中的孩子将会是 在水质恢复后怀孕和出生，没有暴露在受铅污染的水中，允许我们 在环境公共卫生灾难和应对的背景下关注育儿问题，而不是其 毒物学影响。VIP的影响将在危机的不同经历中进行研究，并在 种族和社会经济差异，采用创新的多种方法评估经验； 这些方法将利用正在进行的公共卫生、人口层面倡议的地理空间测绘数据 (与你的健康对话[STYH])利用危机前的数据进行两年一次的社区评估 (2013年)，随着危机的展开(2015-2016年)和之后(2017-2018年；正在进行中)。 学习目标的完成将提供关于普遍育儿支持的作用的新知识 在加剧贫困的环境和公共卫生灾难的后果下的幼儿，并解决 NICHD儿童发展和行为处高度优先的研究领域。调查结果将为改进提供信息 以及VIP的扩展，并推广到此类灾难背景下的其他育儿干预措施。

PROJECT SUMMARY/ABSTRACT Public health disasters have disproportionate impacts on poor communities, through pathways that add to those of poverty and associated stressors, and act over extended periods. Very young children are highly vulnerable to long-term impacts on development and mental health yet frequently receive the least attention and resources. Numerous studies have documented benefits of universal preventive parenting interventions on young children's development and mental health in the context of poverty and associated stressors, but universal promotion of positive parenting has not been previously tested to our knowledge in the aftermath of a disaster, and there are few studies of parenting and early child development in this context more generally. This proposal seeks to determine the role of universal strengths-based parenting support in preventing adverse outcomes for young children in the aftermath of the Flint Water Crisis (FWC). In the FWC, lead contamination of drinking water followed cost-saving changes in water supply in Flint, Michigan, a community with one of the US's highest rates of chronic poverty and associated stressors. Families have had ongoing anxiety about impacts of lead on children, compounded by anger, mistrust, and abandonment following a crisis perceived as avoidable and a response perceived as neglectful and as rooted in racial and socioeconomic bias. Aims will be achieved through an RCT of Video Interaction Project (VIP), which is health-care based for population-level, non-stigmatizing access and uses strategies likely to be effective following disasters, e.g., relationship- and strengths-based, building on parent goals. 486 families will be enrolled at birth, randomized to VIP or routine care, and followed through age 3 years with periodic assessments of parenting practices, parent-child relationships and child development across domains. The children in this study will have been conceived and born after water quality was restored and not exposed to lead contaminated water, allowing us to focus on parenting in the context of an environmental public health disaster and response, rather than its toxicological impacts. VIP impacts will be studied across varying experience of the crisis and in the context of racial and socioeconomic disparities, employing innovative multiple methods to assess experience; one of these methods will utilize geospatially mapped data from an ongoing public health, population-level initiative (Speak to Your Health [STYH]) performing biennial community assessments with data from before the crisis (2013), as the crisis unfolded (2015-2016) and in the aftermath (2017-2018; in progress). Completion of study aims will provide novel knowledge regarding the role of universal parenting support for young children in the aftermath of an environmental, public health disaster compounding poverty, and address NICHD Child Development and Behavior Branch high priority research areas. Findings will inform refinement and scaling of VIP, and generalize to other parenting interventions in the context of such disasters.