- ICH GCP
- 미국 임상 시험 레지스트리
- 임상시험 NCT00373750
Cradling Our Future Through Family Strengthening Study
In-home Prevention of SA Risks for Native Teen Families
연구 개요
상세 설명
American Indians (AIs) in reservation communities have the poorest health, education and socioeconomic status of any racial or ethnic group in the U.S., placing AI youth at increased risk for drug abuse (alcohol, marijuana, tobacco, etc.) and adverse health and behavior outcomes. This study focuses on one of the most vulnerable groups of reservation-based AIs-AI teen mothers and their children.
Over the past two decades a number of research-based health promotion and drug abuse prevention programs for youth have been found to be effective. Of these, parenting interventions have been found to be more effective than other types of interventions. Home visiting programs for young, high-risk mothers have been designed to impact a wide range of outcomes--parenting, child and maternal health and behavior outcomes. More than 40 studies have been published since 1982 supporting the short and long-term efficacy of home visiting programs delivered during pregnancy and early childhood for low-income families. Positive outcomes have been demonstrated for improved parenting and the home environment; increased social support for mothers and children from extended family members and improved maternal health and behavior outcomes; increased birth spacing; improved children's health and behavior outcomes; prevention of child abuse and neglect; and reduced drug use.
AI teen mothers and their offspring are arguably the most vulnerable and underserved population at risk for drug abuse and adverse health and behavior outcomes in the U.S. Given their high-risk status, pregnant AI teens are likely to benefit from a parenting-focused, home visiting intervention. Cultural support for developing individual strengths through a family-based model and the noted cultural relevance of employing AI paraprofessionals are expected to enhance participants' outcomes. As nearly half of AI women begin child-bearing in adolescence, improvement in outcomes of teen mothers and their offspring could substantially impact the public health and welfare of AI communities.
Both nurses and paraprofessionals have been utilized in effective home visiting programs. However, the shortage of indigenous nurses in reservation communities renders an AI nurse-delivered, home visiting intervention unfeasible for the participating communities at this time. Further, young AI women's discomfort with health care delivered by non-Indians and the potential for cultural barriers with non-Indian home visitors provides an additional rationale for AI paraprofessionals as home visitors.
Successful home visiting programs maintain a standard for frequency and dosage of visits, employ strategies for participant retention, provide intensive training, frequent direct supervision and intensive quality assurance measures. For this study, we will maintain the highest standards for dosage, retention strategies, home visitor training and supervision, and quality assurance. The core content of the curriculum is based on American Academy of Pediatrics' comprehensive guidelines for preparing mothers to care for infants and young children, with cultural adaptations derived through guidance from our Native Advisory Board and an iterative process of community input.
연구 유형
등록 (실제)
단계
- 해당 없음
연락처 및 위치
연구 장소
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Arizona
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Fort Defiance, Arizona, 미국, 86540
- Johns Hopkins Center for American Indian Health
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San Carlos, Arizona, 미국, 85550
- Johns Hopkins Center for American Indian Health
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Tuba City, Arizona, 미국, 86045
- Johns Hopkins Center for American Indian Health
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Whiteriver, Arizona, 미국, 85941
- Johns Hopkins Center for American Indian Health
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Maryland
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Baltimore, Maryland, 미국, 21205
- Johns Hopkins Center for American Indian Health
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참여기준
자격 기준
공부할 수 있는 나이
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
설명
Inclusion Criteria:
- Pregnant AI females aged 12 to 19 years old at time of conception.
- Gestational age of 28 weeks or less (in order to complete intervention prior to delivery).
- Parent/guardian consent for youth under 18 years old.
- Reside within 1-hour transportation range (50 miles) of the local Indian Health Service medical facility.
Exclusion Criteria:
- Current participation in other mental or behavior health research project.
- Factors that preclude full participation, identified at baseline and after caseness review, including: unstable and severe medical, psychiatric or drug use problem; acute suicidal or homicidal ideation requiring immediate intervention; recent, severe stressful life event such as physical or sexual abuse, or victim of a violent crime that requires specific and high intensity intervention or out of home placement; or chronic pattern of unstable caretakers or living situation.
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 방지
- 할당: 무작위
- 중재 모델: 병렬 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
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실험적: Family Spirit Intervention
The Family Spirit Intervention included 43 structured lessons and followed a culturally congruent format.
Positive parenting lessons were focused on reducing behaviors (i.e., poor monitoring; coercive interactions;harsh, unresponsive, or rejecting parenting; and abuse/ neglect) associated with early childhood behavior problems, including externalizing, internalizing, and dysregulation problems.
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The Family Spirit Intervention was developed over a decade through community-based participatory research.The intervention content included 43 structured lessons and followed a culturally congruent format.
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간섭 없음: Optimized Standard Care Control Group
Optimized standard care consisted of transportation to recommended prenatal and well-baby clinic visits, pamphlets about child care and community resources, and referrals to local services.
It also addressed access barriers to health care for young mothers and children, and it overcame concerns that home-visiting programs have operated in parallel, not in partnership, with pediatric care.
Family health liaisons conducted the optimized standard care and were not trained in the Family Spirit intervention, to avoid contamination of the control condition.
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
기간 |
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Increase in parental competence at nine intervals over 39 month study period
기간: birth-3 year postpartum
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birth-3 year postpartum
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2차 결과 측정
결과 측정 |
기간 |
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Differences in social and emotional competence, and internalizing, externalizing and regulatory problems for children between ages 12-36 months
기간: birth-3 year postpartum
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birth-3 year postpartum
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Moderators and mediators of intervention response for mothers and children.
기간: birth-3 year postpartum
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birth-3 year postpartum
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Increase in maternal outcomes at nine intervals over 39 month study period
기간: birth-3 year postpartum
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birth-3 year postpartum
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Improved childhood outcomes at nine intervals over 39 month study period
기간: birth-3 year postpartum
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birth-3 year postpartum
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공동 작업자 및 조사자
수사관
- 수석 연구원: John Walkup, MD, Johns Hopkins University
- 연구 책임자: Allison Barlow, MA, MPH, Johns Hopkins Center for American Indian Health
간행물 및 유용한 링크
일반 간행물
- Barlow A, Varipatis-Baker E, Speakman K, Ginsburg G, Friberg I, Goklish N, Cowboy B, Fields P, Hastings R, Pan W, Reid R, Santosham M, Walkup J. Home-visiting intervention to improve child care among American Indian adolescent mothers: a randomized trial. Arch Pediatr Adolesc Med. 2006 Nov;160(11):1101-7. doi: 10.1001/archpedi.160.11.1101.
- Haroz EE, Ingalls A, Kee C, Goklish N, Neault N, Begay M, Barlow A. Informing Precision Home Visiting: Identifying Meaningful Subgroups of Families Who Benefit Most from Family Spirit. Prev Sci. 2019 Nov;20(8):1244-1254. doi: 10.1007/s11121-019-01039-9.
- Barlow A, Mullany B, Neault N, Goklish N, Billy T, Hastings R, Lorenzo S, Kee C, Lake K, Redmond C, Carter A, Walkup JT. Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial. Am J Psychiatry. 2015 Feb 1;172(2):154-62. doi: 10.1176/appi.ajp.2014.14030332. Epub 2014 Oct 31.
- Barlow A, Mullany B, Neault N, Compton S, Carter A, Hastings R, Billy T, Coho-Mescal V, Lorenzo S, Walkup JT. Effect of a paraprofessional home-visiting intervention on American Indian teen mothers' and infants' behavioral risks: a randomized controlled trial. Am J Psychiatry. 2013 Jan;170(1):83-93. doi: 10.1176/appi.ajp.2012.12010121.
연구 기록 날짜
연구 주요 날짜
연구 시작
기본 완료 (실제)
연구 완료 (실제)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (추정)
연구 기록 업데이트
마지막 업데이트 게시됨 (추정)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .
Family Spirit Intervention에 대한 임상 시험
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IWK Health CentreCanadian Institutes of Health Research (CIHR)완전한
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IWK Health CentreMcGill University; Canadian Institutes of Health Research (CIHR); University of Alberta; Child-Bright...모집하지 않고 적극적으로
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Emory UniversityNational Institute of Nursing Research (NINR); National Institute on Aging (NIA)완전한
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University of Oxford완전한무작위 대조 시험의 발표된 연구 프로토콜의 적절한 보고영국
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Seung-Jung ParkCardioVascular Research Foundation, Korea모병
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University of AarhusAarhus University Hospital Skejby; TrygFonden, Denmark; Aarhus Kommune모집하지 않고 적극적으로
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Children's Hospital Medical Center, CincinnatiEunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); Penn State University완전한