Early Childhood Connections

描述（由申请人提供）：接受儿童福利（CW）服务的幼儿有很高的行为、心理健康和认知延迟率，但这些儿童很少接受幼儿干预（Cicchetti，& Curtis，2005; Jonson-Reid，Drake et al，2004; Leslie et al，2005 a）。由CW服务的父母已知有很高的孕产妇抑郁率（Leschied，Chiodo，Whitehead & Hurley，2005; Wolfe，1999）。然而，在CW父母人群中，典型的育儿计划的辍学率很高（Chaffin，2007），参与心理健康服务的比例很低（Jonson-Reid，Drake，& Kohl，Under Review）。“幼儿联系”（ECC）是社区机构和研究团队合作设计的一种新型服务提供系统。使用随机设计，这个R34测试ECC的能力，以防止儿童发育迟缓和后来的心理健康障碍，防止经常性的虐待，并防止或改善母亲抑郁症和压力的家庭与幼儿服务的CW。ECC通过协调、合作和合用同一地点（CW和ECC联合家访），在这一高风险人群中改进现有服务方面具有创新性。ECC是翻译性的，基于PI先前应用服务R 01（R 01 MH 61733; 2 R 01 MH 061733 - 04 A1）的结果构建，并通过广泛合作和初步可行性测试进一步开发，以评估参与者的接受程度。此R34是必要的下一步，以完善方案，评估参与者的变化，并估计未来有效性和实施R 01的效应量。现有的家访方案侧重于首次父母和初级预防，这意味着它们不包括CW家庭（Rapoport和O 'Brien-Strain，2001年），或者是短期的，对解决父母和儿童的心理健康需求关注有限（Chaffin，2007年）。ECC通过独特的联合家访与CW家庭进行接触，以便与长期育儿和案例管理支持无缝连接。ECC修改了家访筛查，包括母亲抑郁和压力，儿童行为和心理健康，以及养育和社会支持。幼儿保育工作人员接受培训，以更好地了解CW人口以及让他们参与额外服务的手段，如产妇心理健康。ECC家访远远超出了CW服务，为家庭提供长期的育儿和个案管理支持，以便随着时间的推移与其他所需的服务建立联系。幼儿保育试验随机分配了150个有0-3岁儿童的家庭，这些家庭是第一次使用：（a）家庭内CW服务或（B）首次与寄养家庭团聚后的家庭内服务。在基线和18个月时，对儿童认知、行为和心理健康结果、母亲抑郁、压力和社会支持、CW累犯和养育措施进行比较。在ECC条件下，我们增加了9个月的中期筛查，测量ECC家访和其他所需服务的参与度和满意度，以及实施问题，如感知的工人负担。假设结果为阳性，则将结果用于准备全面R 01试验。 公共卫生相关性：因受虐待或忽视而接受家庭服务的幼儿日后发育迟缓和出现心理健康问题的风险很高，在丧失潜力和公共服务系统成本方面都给社会造成了重大损失。目前，这些家庭中很少有家庭与现有的长期幼儿服务相联系，这些服务可能有望防止虐待行为的反复发生，并改善照顾者和儿童的结果。这项R34提案支持一项儿童早期联系（ECC）试点研究，这是一种多层次的创新服务模式，旨在改善受虐待和被忽视儿童的行为和发展结果，并减少其主要照顾者的抑郁和压力。

DESCRIPTION (provided by applicant): Young children served by child welfare (CW) have very high rates of behavioral, mental health, and cognitive delays, yet these children are rarely connected to early childhood intervention (Cicchetti, & Curtis, 2005; Jonson- Reid, Drake et al, 2004; Leslie et al, 2005a). Parents served by CW are known to have a high rate of maternal depression (Leschied, Chiodo, Whitehead & Hurley, 2005; Wolfe, 1999). Among the CW parent population, however, drop-out from typical parenting programs is high (Chaffin, 2007) and participation in mental health services is low (Jonson-Reid, Drake, & Kohl, Under Review). "Early Childhood Connections" (ECC) is a novel service delivery system designed collaboratively by community agencies and the research team. Using a randomized design, this R34 tests ECC's ability to prevent child developmental delay and later mental health disorders, prevent recurrent maltreatment, and prevent or ameliorate maternal depression and stress in families with young children served by CW. ECC is innovative in its modification of existing services through coordination, collaboration and co-location (joint CW and ECC home visit) in this high risk population. ECC is translational, built from findings from the PI's prior applied services R01 (R01 MH61733; 2 R01 MH061733-04A1) and further developed through extensive collaboration and preliminary feasibility testing to assess participant acceptance. This R34 is the necessary next step to refine protocols, assess participant change, and estimate effect sizes for a future effectiveness and implementation R01. Existing home visiting programs focus on first time parents and primary prevention, meaning they exclude CW families (Rapoport & O'Brien-Strain, 2001), or are short-term with limited attention to addressing parent and child mental health needs (Chaffin, 2007). ECC engages CW families through a unique joint home visit so there is seamless connection to long-term parenting and case management support. ECC modifies home visiting screening to include maternal depression and stress, child behavior and mental health, and parenting and social support. ECC workers are trained to better understand the CW population and the means of engaging them in additional services, like maternal mental health. ECC home visiting extends well beyond CW services, providing families longer term parenting and case management support to make connections to other needed services over time. The ECC pilot randomly assigns (Usual care or ECC) 150 families with children 0-3 years who are first time users of either: (a) in-home CW services or (b) in-home services following a first reunification from foster care. Groups are compared at baseline and 18 months on child cognitive, behavioral and mental health outcomes, maternal depression, stress and social support, CW recidivism, and parenting measures. Within the ECC condition we add an interim screening at 9 months, measure engagement in and satisfaction with ECC home visiting and other needed services, and implementation issues like perceived worker burden. Presuming positive results, findings will be used to prepare for a full-scale R01 test. PUBLIC HEALTH RELEVANCE: Young children who receive in-home services for abuse or neglect are at high risk for later developmental delays and mental health problems and represent a significant cost to society both in terms of lost potential and public service system costs. Currently, few of these families are connected to available longer term early childhood services that may hold promise in preventing recurrent maltreatment and improving both caregiver and child outcomes. This R34 proposal supports a pilot study of Early Childhood Connections (ECC), a multi- level, innovative service model to improve behavioral and developmental outcomes for very young abused and neglected children and decrease depression and stress for their primary caregiver.