Desmond Runyan - US grants

This study's overall objective is to contribute to a collaborative network in investigating how family factors influence child-well being, and in turn how certain societal interventions can interact with these factors in influencing a child's development, by capitalizing on an existing dataset of The Longitudinal Studies in Child Abuse and Neglect (LONGSCAN). the LONGSCAN project is a consortium of cohort studies examining the impact of maltreatment and social service intervention on children's level of functioning over time. LONGSCAN's involvement would bring to the NICHD consortium a database and research perspective from what is the largest and most ambitious longitudinal effort in the area of child maltreatment. The LONGSCAN project is identifying families of young children who have been maltreated or are at risk for maltreatment. Focusing on these high risk families will allow for a more intensive examination of many of the potential risk factors and mediating variables that influence the psychological and social outcomes in children. The study's specific aims are to: 1) examine the impact of family structure, poverty, parenting attitudes, family satisfaction, spousal relationships and social service interventions on child well-being among a group of families identified as at high risk for child maltreatment, 2) define which domains within the broader context of family functioning are most important as mediators of child well-being in high risk maltreating families, 3) validate the importance of the selected domains within the concept of family functioning through the selective investigation of data from other datasets, 4) obtain guidance from the NICHD consortium to challenge and assist individual LONGSCAN investigators at their respective sites to examine the impact of social service interventions through longitudinal data analysis, and 5) determine the best measure or conglomeration of measures of family functioning to be used in future research studies and later data points within LONGSCAN. This study will involve a three phased approach to our cooperation with the Consortium. In phase 1 existing cross-sectional data from LONGSCAN will be analyzed in a case-control manner to identify the functioning domains most associated with indicators of child well-being. In phase 2 the study will seek validation of the domains from other NICHD consortium members. In phase 3 this study group will institute such changes as are appropriate in the measures used by LONGSCAN to capture the domains determined most relevant to subsequent child well-being. Finally, because of the ongoing data collection proceeding a part of LONGSCAN during our involvement with the NICHD Consortium, this study will be able to examine the relationships between new instruments or domains and instruments previously used by LONGSCAN to assess family functioning. This final step is likely to proceed after completion of the proposed five year involvement with the NICHD Consortium.

This application examines the impact of neglect on adolescent mental health, delinquency, and substance abuse using an existing longitudinal sample of 1435 at-risk and maltreated children being followed by the LONGSCAN consortium of studies. In addition, the application would supplement LONGSCAN with a new wave of data collected on the oldest subjects when they turn 14. The LONGSCAN sites will enter into a consortium agreement under the direction of the Principal Investigator at the University of North Carolina at Chapel Hill. Longitudinal data from multiple sources, including child protective service report narratives, parents/caregivers, teachers, and child self-reports will be used. The specific aims of the study are to: 1) examine alternative definitions of neglect and separate the characterization of the experience of neglect from official determinations of neglect; 2) examine the social, behavioral health, and health consequences of childhood neglect on adolescents; and 3) examine the nature and impact of neglect experienced during adolescence. Methods will involve the use of diagnostic test methodologies, relative risk determinations with stratified analysis and mixed mathematical models. Comparable data from two other national studies will be used. This study will provide new information about the relationships between neglect, supervision of teens, and adolescent outcomes.

[unreadable] DESCRIPTION (provided by applicant): We propose to test whether a statewide primary preventive intervention, preparing parents of newborns to deal safely and explicitly with infant crying, can reduce hospital admissions and deaths from abusive head trauma (AHT). We plan to both educate parents and facilitate a cultural change in understanding the nature of, and appropriate responses to, infant crying. We will examine mediators and moderators affecting this intervention, conduct process evaluation, and assess the program's effectiveness and cost. [unreadable] This proposal is important and unique in a number of ways. One, we have strong baseline data; we measured the rates of AHT among young children in North Carolina (NC) in 2000 and 2001, before hospitals around the state and country began explicit prevention efforts. Two, we have behavioral data from a NC survey that elicited anonymous self-reports of shaking by parents of young children. Three we are collaborating with the research team that developed the intervention and has conducted a randomized trial of the intervention of over 3000 parents to assess changes in knowledge and attitudes. Dr. Ron Barr, a developmental pediatrician [unreadable] at the University of British Colombia and Ms. Marilyn Barr, Director of the National Center on Shaken Baby Syndrome and their colleagues carefully designed the intervention and the video and print materials. Dr. Barr, Ms. Barr and Dr. Fred Rivara at the University of Washington have provided preliminary data, for this application. Four, a state Leadership Committee that is representative of a broad cross-section of agencies concerned with child well being in NC is guiding our intervention. This group has been planning a statewide AHT prevention program for a year. They offer technical expertise and in-kind support. Five, we have already engaged with two foundations, the Doris Duke Charitable Foundation and the Duke Endowment, to help [unreadable] support the statewide initiative, an intervention more ambitious than NCIPC funding alone would permit. Their funding decisions are pending and their staff are encouraging (see letters of support). [unreadable] [unreadable] Our proposal's importance derives from evidence that shaking is both common and a leading cause of infant mortality. In North and South Carolina, 2.6% of the parents of children less than 2 report having shaken a child for "discipline" (Theodore, et al. 2005). Other data confirm that the highest risk period for abusive head trauma (AHT) occurs in the first year of life (29.7/100,000 live births in year 1 and 3.8/1000,000 children in year 2 (Keenan, et al., 2003). The highest risk period for AHT in infants (2-4 months of age) coincides with the period in which crying in normal infants can last over 5 hours per day (Keenan, et al. 2003; Agran et al. 2003; [unreadable] Barr, et al. 2006). Finally, the proposal is significant in examining implementation, impact, and estimated costs relative to benefits for an entire state. We propose to reach every parent of a newborn in NC (~125,000 births/ year) and educate him and her about infant crying patterns, responding to crying, and the hazards of shaking. Every parent will receive a specific intervention, a program called "The Period of PURPLE Crying." The program includes hospital and health care provider-based parent education, and a 10-minute video and a carefully designed 11-page booklet to take home and share with new partners or childcare providers about responding to crying. The adoption of shaken baby syndrome (SBS) prevention efforts have begun in many states and hospitals following the publication by Dias, et al. (2005). Sixteen states [CA, FL, IL, IN, MA, MN, MO, NE, NY, PA, RI, TN, TX, VA, WA, WI] have legislation requiring hospitals to provide some form of SBS education (written materials or [unreadable] video) cover 2,395,813 births - 58% of all US births. The four additional states with pending legislation will bring this to 64% of births (George Lithco, personal communication). It is no longer possible to develop a randomized clinical trial. We propose an interrupted time-series design, a process evaluation, and a case-control study of children who still experience AHT despite the efforts of this program. In addition, we will examine program costs to estimate the economic benefits of our approach. [unreadable] [unreadable] The specific aims of this study are: 1) Collaborate with a consortium in public health, child care, health care, child advocacy organizations, and military health services, led by the Center for Child and Family Health-NC and the NC Partnership for Children, to evaluate the delivery of a specific AHT prevention program, The Period of PURPLE Crying, to the parents of every newborn baby in the state. Research questions: A) What is the success in maintaining fidelity to the program delivery approach in all North Carolina maternity care hospitals over 4 years? [unreadable] B) What are the obstacles to delivering the program, with fidelity, to every mother of a newborn?; 2) Conduct, after program implementation, a telephone survey of new parents to ascertain their exposure to the PURPLE intervention and the media campaign, their recollection and understanding of the messages, their self-reported behaviors about caring for their child during The Period of PURPLE Crying, and their dissemination of PURPLE materials and messages to other caregivers. [unreadable] [unreadable] [unreadable]

The Kempe Graduate Summer Program in Child Abuse and Neglect There is a substantial paucity of research and research capacity in the field of child abuse and neglect (CA&N), a problem that impacts more than 3 million children each year in the US and an estimated 15% of the world?s children (about 285 million each year) around the globe To address this gap, we propose unique training for clinicians and for social science and public health researchers to stimulate new research in CA&N, with special focus on issues of disparities and prevention. Our training, to be led by seasoned researchers and educators at the Kempe Center and the Colorado School of Public Health, will be tailored to three specific audiences: clinicians familiar with CA&N diagnosis and treatment but lacking research training; social science and public health researchers unfamiliar with the problem of CA&N; and scholars seeking knowledge of the principles of designing and evaluating primary prevention projects. Throughout, we will give special emphasis to addressing issues of disparities and the complex legal and ethical elements of CA&N research. For all participants, we will facilitate trainees working on their own projects directly with successful investigators as part of an action learning approach. Training will begin by inviting applicants to propose a concept for a research project they hope to develop further during a one week graduate summer session, followed by individualized mentoring with a senior scholar. We propose four specific aims: 1) attract and prepare child abuse pediatrics fellows and other clinicians in advanced training to be able to conduct clinical epidemiology, health services, or population-based research addressing the screening, diagnosis, treatment, and prevention of CA&N; 2) attract and prepare ethnically, disciplinary, and socially diverse graduate students and postdoctoral fellows already trained in the social sciences and/or public health research, but naïve to the field of CA&N to explore and address critical issues with a special focus on unique legal and ethical issues of research in this field; 3) prepare clinicians, social scientists and public health professionals already trained in CA&N to address primary prevention and attend to the issues of disparities; and 4) build research collaborations among junior and senior clinicians, public health and social scientists. We will evaluate the success of the training through pre-training, immediate post-training, and longer term follow-up of trainees. We will assess: 1) success of recruitment into the program, with special emphasis on enrolling minority scholars; 2) perceived quality of the training experience; 3) changes in participants? confidence and intent to develop CA&N research; 4) participant satisfaction with each element of the training and suggested improvements; 5) participant research trajectories over a one year period through measures of continued contact with peers, instructors and mentors and documentation of the nature of research initiated, proposed for funding, funded and/or completed. Results of the evaluation will enable continuous quality improvement of recruitment and training strategies.