Prevention of disparities in child psychosocial development in underserved rural families through promotion of early relational health in pediatric health care

项目摘要/摘要 虽然已作出重大努力，寻求初级预防儿童与贫困有关的差距 在心理社会发展方面，大多数研究都集中在城市地区，在农村环境中的研究很少。 这样的研究至关重要，因为：1)美国农村儿童的比例更高，生活在贫困线以下； 2)在短期和长期指标上，农村贫困与城市贫困相比差距更大 3)有色人种的农村差距加大。理论框架 经验证据表明，早期关系健康(erh；育儿实践/关系质量)是一种 韧性的来源，可以缓冲家庭因贫困和种族主义而产生的不利经历，因此 代表干预的目标。预防性干预，如家访，改善ERH和儿童 农村低收入家庭的结果；然而，成本和其他障碍(能力、距离)导致 触角有限。儿科初级卫生保健(体检)可以通过建立在常规基础上来解决这些障碍 从出生到3岁的家庭联系，提供者关系，以及低成本。虽然接入对一些农村地区来说是一个挑战 在家庭中，这一群体的卫生保健利用率仍然很高。然而，以保健为基础的初级保健 对农村儿童心理社会差异的预防尚未进行研究。视频互动项目(VIP)是 一项示范计划，已在城市环境中使用，以支持医疗保健方面的ERH。它具有潜在的 在农村环境中的有效性归因于1)结合基于优势的战略与文化 解决因农村贫困而加剧的家庭脆弱性的框架，以及2)高度可行性和 对不同人群的影响。VIP(面对面或远程医疗模式)尚未在农村环境中进行研究。 这个应用程序的主要目标是支持Roby博士成为一名独立调查员的目标 其目的是改善1)亲子ERH和2)儿童心理社会发展。这将会实现的 通过来自专家、多学科指导团队和正规课程的培训。她会受益的 1)影响ERH的农村背景因素的高级技能2)远程医疗方法3)定性研究4) 实施科学，以及5)临床试验的领导。本文的研究目标有三个： 在目标1中，Roby博士将使用定性方法来确定儿童参与的促进者/障碍 对农村家庭的初级保健育儿干预，既有广泛的，也有专门针对种族/少数民族群体的。 在目标2中，Roby博士将使用目标1的结果来使VIP适应农村家庭，并测试可接受性、可行性、 以及跨种族/族裔采用/参与调整后的VIP模式。 在目标3中，Roby博士将利用随机对照试验来检查VIP在改善ERH方面的有效性 以及父母(心理健康)和孩子(心理社会)的短期结果。本项目圆满完成 将导致R01应用程序，以在更大范围内测试农村背景下干预措施的有效性。

PROJECT SUMMARY/ABSTRACT While there have been significant efforts seeking primary prevention of poverty-related disparities in child psychosocial development, most research has focused on urban areas, with limited study in rural settings. Such research is critical given that: 1) a higher proportion of children in the rural US live below the poverty line; 2) rural poverty is associated with greater disparities than urban poverty across short- and long-term indicators of psychosocial development; and 3) rural disparities are increased for people of color. Theoretical frameworks and empirical evidence suggest that Early Relational Health (ERH; parenting practices/relationship quality) is a source of resilience that can buffer families’ adverse experiences due to poverty and racism and therefore represents a target for interventions. Preventive interventions such as home visiting, improve ERH and child outcomes in rural low-income families; however cost and other barriers (capacity, distance) have resulted in limited reach. Pediatric primary health care (check-ups) can address these barriers by building on routine family contact from birth to 3, provider relationships, and low cost. While access is a challenge for some rural families, health care utilization in this population is nonetheless high. However, health-care based primary prevention of psychosocial disparities in rural children has not been studied. Video Interaction Project (VIP) is an exemplar program that has been used in urban settings to support ERH in health care. It has potential for effectiveness in rural settings due to 1) incorporation of strengths-based strategies aligned with cultural frameworks that address family vulnerabilities that are exacerbated by rural poverty and 2) high feasibility and impact in diverse populations. VIP (in-person or telehealth models) has not been studied in rural settings. The primary objective of this application is to support Dr. Roby’s goal of becoming an independent investigator with the aim of improving 1) parent-child ERH and 2) child psychosocial development. This will be achieved through training from an expert multidisciplinary mentorship team and formal coursework. She will gain advanced skills in 1) rural contextual factors that impact ERH 2) telehealth methods 3) qualitative research 4) Implementation Science, and 5) leadership of clinical trials. There are 3 research aims: In Aim 1, Dr. Roby will use qualitative methods to identify facilitators/barriers to engagement in a pediatric primary care parenting intervention for rural families, both broadly and specific to racial/ethnic minority groups. In Aim 2, Dr. Roby will use Aim 1 findings to adapt VIP for rural families, and to test acceptability, feasibility, and adoption/engagement in the adapted VIP models across race/ethnicity. In Aim 3, Dr. Roby will utilize a randomized controlled trial to examine the efficacy of VIP in improving ERH and short term parent (mental health) and child (psychosocial) outcomes. Successful completion of this project will lead to an R01 application to test the efficacy of the intervention in the rural context on a larger scale.