Prevention of Childhood Maltreatment in Families With Young Children

Study Overview
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Brief Summary
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This study will examine the efficacy of Enhanced First Connections, which is a short-term perinatal home visiting program that includes infant and early childhood mental health consultation. Mothers with a history of adversity or trauma will be the focus of this research. Hypothesized outcomes of Enhanced First Connections include the prevention of child maltreatment (child abuse and neglect), prevention of child exposure to adult intimate partner violence, increases in family engagement in longer-term evidence based home visiting programs, increases in family engagement in specialized support services to address maternal adversity and trauma, reductions in maternal risk factors, and the promotion of positive parenting and the parent-child relationship.

Official Title
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Embedding Mental Health Consultation Within Prenatal Home Visiting to Prevent Child Maltreatment and Violence Exposure

Conditions
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Child Maltreatment, Child Exposure to Intimate Partner Violence

Intervention / Treatment
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* Behavioral: Enhanced First Connections


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pregnant women Recruited in the second or third trimester of pregnancy Eligible for the Supplemental Nutrition Program for Women, Infants, and Children (WIC) At least one self-reported experience of adversity or trauma English or Spanish speaking Exclusion Criteria: - Does not meet all inclusion criteria above
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Enhanced First Connections<br>Enhanced First Connections is a short-term risk assessment and response home visiting referral program. The goal of Enhanced First Connections is to identify family needs and link families to community resources, including evidence based home visiting models. Enhanced First Connections includes prenatal identification and engagement of women with an adversity or trauma history, and infant and early childhood mental health consultation. Women who enroll in Enhanced First Connections are expected to receive between four and eight home visits before being referred to other community resources. | Behavioral: Enhanced First Connections<br>* Enhanced First Connections is a short-term home visiting program that includes prenatal identification and engagement of women with an adversity or trauma history, and infant and early childhood mental health consultation.<br>|
| No Intervention: Treatment as Usual<br>Women who receive Treatment as Usual will follow the usual course of clinical care throughout their pregnancy and into the postpartum period, and will be eligible for the typical array of community services that may be offered to them. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Child Maltreatment Status | Child protection record review | 6-months postpartum | 
| Child Exposure to Intimate Partner Violence | Child protection record review | 6-months postpartum | 
| Maternal Report of Intimate Partner Violence | Maternal report: Conflict Tactics Scales | 6-months postpartum | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Family engagement in evidence based home visiting programs | Home visiting record review | 6-months postpartum | 
| Contextual stress exposure | Maternal report: Contextual Stress Interview | 6-months postpartum | 
| Maternal depressive symptoms | Maternal report: Patient Health Questionnaire-9 | 6-months postpartum | 
| Maternal anxiety symptoms | Maternal report: Generalized Anxiety Disorder 7-item scale | 6-months postpartum | 
| Maternal PTSD symptoms | Maternal report: Short Post-Traumatic Stress Disorder Rating Interview | 6-months postpartum | 
| Maternal alcohol use | Maternal report: Alcohol Use Disorders Test | 6-months postpartum | 
| Maternal substance use | Maternal report: Drug Abuse Screening Test | 6-months postpartum | 
| Maternal parenting stress | Maternal report: Parenting Stress Index | 6-months postpartum | 
| Maternal sensitivity | Observation of free play interaction coded using Parent Caregiver Involvement Scales and Emotional Availability Scales | 6-months postpartum | 
| Maternal hostility | Observation of free play interaction coded using Emotional Availability Scales | 6-months postpartum | 
| Maternal non-responsiveness | Maternal report: Maternal Responsiveness Questionnaire | 6-months postpartum | 
| Home environment | Home Observation for Measurement of the Environment | 6-months postpartum | 
| Mother-infant relationship | Maternal report: Postpartum Bonding Questionnaire | 6-months postpartum |