More than 25% of low-income families in the United States have a child with special health care needs (CSHCN), defined by the presence of a chronic physical, emotional, or behavioral health condition. Among this population, the risk of child maltreatment is disproportionally high. Neglect, a specific form of maltreatment defined as the failure to provide for a child's basic needs, accounts for the majority of maltreatment cases. This application describes a four-year mentored research and education plan that focuses on identifying high-risk periods for maltreatment experienced by CSHCN and pilot testing an intervention to prevent child neglect by promoting parental problem solving skills, distress tolerance, and emotional regulation. Based on the principles of dialectical behavioral therapy, this selective prevention intervention will be delivered to families who have had an initial unsubstantiated referral to child protective services for neglect. Such families represent a high- risk, readily identifiable population particularly amenable to a selective prevention strategy. My K23 research plan focuses on low-income CSHCN with an initial unsubstantiated report of neglect. The specific research aims are to 1) conduct a retrospective cohort study using the National Child Abuse and Neglect Data System to examine the time period between initial referral for unsubstantiated neglect and re- referral to child protective services;and 2) conduct pilot randomized controlled trial (n = 60) of a selective prevention intervention to field test stuy mechanics, use established quality improvement methods to optimize intervention delivery, and obtain empiric estimates of study parameters that will inform the planning of a subsequent fully-powered trial of the intervention model. My educational objectives are to gain further training and experience in 1) the principles of intervention adaptation science, including intervention development, implementation, and evaluation;2) the use of established interview techniques to evaluate parental reflective capacity (parents'understanding of their own and their child's behavior, thoughts, and emotions) as a potential theory-based mediator of the intervention;3) the design and conduct of behavioral intervention research;and 4) the ethics of conducting clinical research with vulnerable populations. My long-term goal is to develop a replicable intervention that can be reliably delivered to high-risk families to decrease the risk of child neglect. The research in this proposal builds directly on my prior work, which has focused on the development of a theory-based intervention to prevent child neglect in high-risk families. I have identified an experienced mentoring team and a supportive research environment, which will ensure that I will attain my immediate and long-term goals. The results from this work will position me to submit a competitive R01 grant to conduct a fully-powered efficacy trial of the intervention and establish myself as an independent investigator.

Public Health Relevance

Child maltreatment, particularly neglect, disproportionally affects low-income children with special health care needs and has serious short and long-term effects. The principles of dialectical behavioral therapy, including problem solving, distress tolerance, and emotional regulation, have the potential to improve key parenting skills and address the factors that place children at risk. The investigations in this career development application initiate the process of optimizing and pilot testing a DBT-based intervention to prevent child neglect among low-income children with special health care needs and aim to identify a novel, replicable approach to child maltreatment prevention in a high-risk population.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
Application #
Study Section
Developmental Biology Subcommittee (CHHD)
Program Officer
Esposito, Layla E
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Boston Medical Center
United States
Zip Code
Kistin, Caroline J; Tompson, Martha C; Cabral, Howard J et al. (2016) Subsequent Maltreatment in Children With Disabilities After an Unsubstantiated Report for Neglect. JAMA 315:85-7
Kistin, Caroline; Silverstein, Michael (2015) Pilot Studies: A Critical but Potentially Misused Component of Interventional Research. JAMA 314:1561-2