Promotion of Successful Parenting
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/7/2019 |
| Start Date: | February 21, 2019 |
| End Date: | August 31, 2023 |
| Contact: | Jody T Manly, Ph.D. |
| Email: | Jody.manly@rochester.edu |
| Phone: | 15852752991 |
TRANSFORM: Translational Research That Adapts New Science FOR Maltreatment Prevention
Home visitation by community health workers is a commonly utilized approach to support
families and prevent child maltreatment. At times, however, more intensive intervention is
needed to address familial trauma, depression, or other challenges. This preventive treatment
evaluation study evaluates whether adding Child-Parent Psychotherapy (CPP) to a Community
Health Worker (CHW) outreach model improves positive parenting and parent-child relationships
above CHW alone. The efficacy of CPP has been demonstrated with maltreated and other
high-risk populations. This evaluation will examine optimal timing of CPP (beginning
prenatally or postnatally) and optimal duration of services (6 vs. 12 months). Additionally,
how and for whom CPP is most effective and why will be examined. Assessments of parenting,
maternal sensitivity, representational models, cognitions, physiological reactivity, and
physical health indicators will be assessed prenatally, and at children's age of 3, 9, and 12
months.
families and prevent child maltreatment. At times, however, more intensive intervention is
needed to address familial trauma, depression, or other challenges. This preventive treatment
evaluation study evaluates whether adding Child-Parent Psychotherapy (CPP) to a Community
Health Worker (CHW) outreach model improves positive parenting and parent-child relationships
above CHW alone. The efficacy of CPP has been demonstrated with maltreated and other
high-risk populations. This evaluation will examine optimal timing of CPP (beginning
prenatally or postnatally) and optimal duration of services (6 vs. 12 months). Additionally,
how and for whom CPP is most effective and why will be examined. Assessments of parenting,
maternal sensitivity, representational models, cognitions, physiological reactivity, and
physical health indicators will be assessed prenatally, and at children's age of 3, 9, and 12
months.
PROMISE is integrated into the TRANSFORM Capstone Center to promote the next generation of
research on child maltreatment, translate research findings into clinical and preventive
interventions, and disseminate research and best practice to varied stakeholders. Informed by
developmental psychopathology, the research incorporates multiple levels of analysis within a
lifespan framework. Increasing knowledge of optimal methods for delivering dual mother and
child preventive intervention has crucial public health significance in preventing child
maltreatment. PROMISE involves a randomized control trial to evaluate whether expanding a
Community Health Worker (CHW) outreach model, by adding Child-Parent Psychotherapy (CPP), an
intensive intervention that focuses on parent-infant relationships for families at risk for
child maltreatment, increases efficacy for improved mother-child relationships, more
sensitive parenting, healthier child development, and maltreatment prevention. The efficacy
of CPP has been demonstrated with maltreated and other high-risk populations. Through the use
of four intervention arms, the evaluation will assess whether more intensive intervention
better protects against child maltreatment compared with CHW support alone, and will
determine the optimal timing of these interventions (i.e., beginning prenatally or
postnatally), the optimal duration of services (i.e., 6 vs. 12 months), mechanisms of effect
(mediator analyses), and which intervention strategy works best for mothers with varying risk
factors (moderator analyses). Pregnant women (N = 300) and their infants after birth will
participate. Longitudinal assessments will occur during the third trimester of pregnancy, at
infant's ages of 3 and 9 months, and a post-intervention follow-up at 12 months old. The
measurements obtained at each timepoint constitute a rich multi-level perspective of maternal
and child functioning over time in response to the interventions. Maternal parenting
behaviors, representational models, cognitions, and physiological reactivity, and infants'
health and development will be assessed longitudinally. CPP groups are hypothesized to
improve sensitive and responsive parenting and secure attachment, relative to CHW home
visitation alone, thereby reducing risks for child maltreatment. Improvements in maternal
attachment representations, parenting cognitions, and stress reactivity are hypothesized to
mediate treatment outcomes. Moderators, including maternal histories of trauma,
psychopathology, and intimate partner violence, will advance determination of differential
responsiveness to CHW and CPP (what works for whom and why?) and allow for tailored
preventive strategies. Identification of timing, dosage, and intensity of service delivery,
along with outcome mediators and moderators is innovative and will facilitate development of
targeted prevention and intervention strategies that support parenting and decrease child
maltreatment for this vulnerable population.
research on child maltreatment, translate research findings into clinical and preventive
interventions, and disseminate research and best practice to varied stakeholders. Informed by
developmental psychopathology, the research incorporates multiple levels of analysis within a
lifespan framework. Increasing knowledge of optimal methods for delivering dual mother and
child preventive intervention has crucial public health significance in preventing child
maltreatment. PROMISE involves a randomized control trial to evaluate whether expanding a
Community Health Worker (CHW) outreach model, by adding Child-Parent Psychotherapy (CPP), an
intensive intervention that focuses on parent-infant relationships for families at risk for
child maltreatment, increases efficacy for improved mother-child relationships, more
sensitive parenting, healthier child development, and maltreatment prevention. The efficacy
of CPP has been demonstrated with maltreated and other high-risk populations. Through the use
of four intervention arms, the evaluation will assess whether more intensive intervention
better protects against child maltreatment compared with CHW support alone, and will
determine the optimal timing of these interventions (i.e., beginning prenatally or
postnatally), the optimal duration of services (i.e., 6 vs. 12 months), mechanisms of effect
(mediator analyses), and which intervention strategy works best for mothers with varying risk
factors (moderator analyses). Pregnant women (N = 300) and their infants after birth will
participate. Longitudinal assessments will occur during the third trimester of pregnancy, at
infant's ages of 3 and 9 months, and a post-intervention follow-up at 12 months old. The
measurements obtained at each timepoint constitute a rich multi-level perspective of maternal
and child functioning over time in response to the interventions. Maternal parenting
behaviors, representational models, cognitions, and physiological reactivity, and infants'
health and development will be assessed longitudinally. CPP groups are hypothesized to
improve sensitive and responsive parenting and secure attachment, relative to CHW home
visitation alone, thereby reducing risks for child maltreatment. Improvements in maternal
attachment representations, parenting cognitions, and stress reactivity are hypothesized to
mediate treatment outcomes. Moderators, including maternal histories of trauma,
psychopathology, and intimate partner violence, will advance determination of differential
responsiveness to CHW and CPP (what works for whom and why?) and allow for tailored
preventive strategies. Identification of timing, dosage, and intensity of service delivery,
along with outcome mediators and moderators is innovative and will facilitate development of
targeted prevention and intervention strategies that support parenting and decrease child
maltreatment for this vulnerable population.
Inclusion Criteria:
- Participants will be low-income pregnant adult women eligible for Medicaid and who
have been referred to the Baby Love CHW program based on their high psychosocial risk
status.
Exclusion Criteria:
- Mothers will be excluded if they have significant cognitive limitations, severe
psychiatric disorders requiring a higher level of care (e.g., imminent suicidal
ideation requiring hospitalization, psychotic features), non-English proficiency, age
less than 18, or a physical disability that impedes ability to complete study
procedures. Mothers whose psychiatric needs or substance use requires inpatient
treatment will be excluded. Mothers will be excluded if they terminate their pregnancy
or do not deliver a live birth.
We found this trial at
1
site
Rochester, New York 14608
Principal Investigator: Sheree Toth, PhD
Phone: 585-275-2991
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