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. There are specific stressors that place low-income CSHCN at high risk for neglect, including limited parental social supports, difficulty navigating complex medical services, and high levels of caregiver burden. Previous work has demonstrated that such stressors can impair parents' ability to respond consistently to their children's needs and interfere with adherence to recommended, and often complex, medical care. Our proposed intervention strategy is based on the premise that optimizing parental functioning ? by decreasing the perception of being overwhelmed by one's daily problems, increasing self-efficacy, and buffering the impact of life stressors on mood ? can ultimately prevent neglect among CSHCN. This application outlines a 3-year research plan to conduct a randomized controlled efficacy trial of Child Abuse Prevention Problem Solving (CAPPS), a targeted intervention designed to address specific stressors faced by low-income parents of CSHCN and to enhance family strengths previously been shown to reduce the risk of maltreatment. We propose a multi-center randomized controlled trial of 250 parents of CSHCN, conducted within a network of 7 urban patient-centered medical homes. The specific research aims are to: 1) Decrease referrals to child protective services for neglect and increase adherence to recommended medical care; and 2) Decrease perceived social isolation, difficulty navigating complex services, and caregiver burden and enhance family strengths, including parental resilience, social connections, access to support in times of need, and knowledge of parenting and child development. We hypothesize that through our CAPPS intervention, low-income parents of CSHCN will develop stronger problem solving skills and that such skills will result in less perceived stress and a greater sense of mastery. We hypothesize that intervention parents will experience an improvement in family strengths and will be better able to respond consistently to their children's complex needs. By addressing known risk and protective factors for maltreatment, we aim to prevent neglect among CSHCN. If our intervention model is successful, the results of the proposed trial could contribute to significant improvements in child maltreatment prevention services. Our ultimate goal is dissemination of an effective medical home-based intervention focused on promoting family strengths and addressing the needs of low- income families with CSHCN.
Child maltreatment, particularly neglect, disproportionally affects low-income children with special health care needs and has serious short and long-term consequences. Currently, few evidence-based preventive services exist for such families, particularly within the context of the patient-centered medical home. Child Abuse Prevention Problem Solving (CAPPS), a targeted intervention that addresses key risk and protective factors for child neglect, has the potential to improve key parenting skills and overall wellbeing, ultimately improving outcomes for high-risk children.
