Dishion Thomas J, Mun Chung Jung, Drake Emily C, Tein Jenn-Yun, Shaw Daniel S, Wilson Melvin
Arizona State University.
University of Pittsburgh.
Dev Psychopathol. 2015 Nov;27(4 Pt 2):1647-60. doi: 10.1017/S0954579415001005.
This study examined the hypothesis that a brief, strengths-based home visiting strategy can promote positive engagement between caregiver and child and thereby reduce various forms of early childhood neglect. A total of 731 low-income families receiving services through the Women, Infants, and Children nutritional supplement program were randomized to the Women, Infants, and Children as usual or the Family Check-Up intervention. Assessments and intervention services were delivered in the home environment at ages 2, 3, 4, and 5. During the assessments, staff videotaped caregiver-child interactions and rated various features of the home environment, including the physical appropriateness of the home setting for children. Trained observers later coded the videotapes, unaware of the family's intervention condition. Specific caregiver-child interaction patterns were coded and macroratings were made of the caregiver's affection, monitoring, and involvement with the child. An intention to treat design revealed that randomization to the Family Check-Up increased duration of positive engagement between caregivers and children by age 3, which in turn was prognostic of less neglect of the child at age 4, controlling for family adversity. It was also found that family adversity moderated the impact of the intervention, such that the families with the most adverse circumstances were highly responsive to the intervention. Families with the highest levels of adversity exhibited the strongest mediation between positive engagement and reduction of neglect. Findings are discussed with respect to developmental theory and their potential implications for a public health approach to the prevention of early childhood maltreatment.
一种简短的、基于优势的家访策略能够促进照顾者与儿童之间的积极互动，从而减少各种形式的幼儿期忽视。共有731个通过妇女、婴儿和儿童营养补充计划接受服务的低收入家庭被随机分为接受常规妇女、婴儿和儿童服务组或家庭检查干预组。评估和干预服务在孩子2岁、3岁、4岁和5岁时在家庭环境中提供。在评估过程中，工作人员对照顾者与儿童的互动进行录像，并对家庭环境的各种特征进行评分，包括家庭环境对儿童的适宜程度。训练有素的观察员随后对录像进行编码，且不知道家庭的干预情况。对特定的照顾者与儿童互动模式进行编码，并对照顾者对孩子的关爱、监督和参与情况进行宏观评分。一项意向性分析显示，随机分配到家庭检查组的家庭，到孩子3岁时，照顾者与孩子之间积极互动的持续时间增加，这反过来又预示着在控制家庭逆境的情况下，孩子在4岁时受到的忽视会减少。研究还发现，家庭逆境会调节干预的效果，即情况最不利的家庭对干预的反应最为积极。逆境程度最高的家庭在积极互动与减少忽视之间表现出最强的中介作用。本文将结合发展理论对研究结果进行讨论，并探讨其对预防幼儿期虐待的公共卫生方法的潜在影响。
