Child and adolescent violence remains one of our most pressing public health problems today. Health care providers often serve critical roles when treating the results of violence. As with other injuries, pediatric providers serve as one of the necessary agents for prevention. Consequently, major health organizations have issued guidelines for incorporating violence prevention into routine primary care for children and adolescents. Currently, only limited tools are available to help pediatric clinicians address violence prevention-related issues in a consistent manner during the routine office visit. Moreover, no empirical evidence exists for the effectiveness of such approaches on parents or children's behaviors. Wake Forest University School of Medicine (WFUSM) and the American Academy of Pediatrics (AAP) Center for Child Health Research (CCHR) will collaborate to evaluate the effectiveness of a pediatric clinician's intervention that has been extensively pilot tested. Pediatric Research in Office Settings (PROS), a program of the CCHR, is a national network comprised of practice- based clinicians experienced in research participation. Their membership consists of more than 500 practices and 1500 clinicians across the country. PROS practices will be randomly assigned to either the intervention arm (Safety Check) or the control arm with an attention placebo. Safety Check will address four areas of behavior: media use; parental use of physical disciplining techniques; gun ownership and storage; and family/peer physical fights. Each arm of the study will have 68 practices, 136 providers, and 3,536 patients. The study will aim to gather data on sufficient numbers of Latino and African American patients to evaluate if the intervention has different effects on differing cultures/ethnicities. The intervention consists of 4 components: (1) a community violence prevention worksheet (to guide practices in identifying community specific violence prevention resources), (2) a household behavior survey for patient families with children 2-11 years to complete in the waiting room, identifying problem areas, (3) a recommendation guide that the provider directly utilizes to educate and engage the patient family on these issues, and (4) """"""""tangible tools"""""""" to help the family adhere to provider recommendations. The two primary outcomes evaluated will be the pediatric provider's anticipatory guidance behaviors and the patient family's behaviors, e.g. media use, discipline, gun storage, and family/peer fights. Data will be collected at the baseline visit with patient family follow-up 1 and 6 months later via telephone interviews. Efforts to reduce the social morbidity of youth violence are essential. This study breaks new ground, serving as the first national randomized controlled trial focused on testing the effectiveness of a comprehensive violence prevention program for pediatric providers. As yet, there are no data driving the guidelines issued by major medical organizations; this study will provide scientifically sound data to do so.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD042260-02
Application #
6536447
Study Section
Health Care Quality and Effectiveness Research (HQER)
Program Officer
Feerick, Margaret M
Project Start
2001-09-18
Project End
2005-05-31
Budget Start
2002-06-01
Budget End
2003-05-31
Support Year
2
Fiscal Year
2002
Total Cost
$535,671
Indirect Cost
Name
Wake Forest University Health Sciences
Department
Pediatrics
Type
Schools of Medicine
DUNS #
937727907
City
Winston-Salem
State
NC
Country
United States
Zip Code
27157
Barkin, Shari L; Gesell, Sabina B; Póe, Eli K et al. (2011) Changing overweight Latino preadolescent body mass index: the effect of the parent-child dyad. Clin Pediatr (Phila) 50:29-36
Ip, Edward H; Wasserman, Richard; Barkin, Shari (2011) Comparison of intraclass correlation coefficient estimates and standard errors between using cross-sectional and repeated measurement data: the Safety Check cluster randomized trial. Contemp Clin Trials 32:225-32
Ip, Edward Haksing (2010) Empirically indistinguishable multidimensional IRT and locally dependent unidimensional item response models. Br J Math Stat Psychol 63:395-416
Finch, Stacia A; Barkin, Shari L; Wasserman, Richard C et al. (2009) Effects of local institutional review board review on participation in national practice-based research network studies. Arch Pediatr Adolesc Med 163:1130-4
Barkin, Shari L; Finch, Stacia A; Ip, Edward H et al. (2008) Is office-based counseling about media use, timeouts, and firearm storage effective? Results from a cluster-randomized, controlled trial. Pediatrics 122:e15-25
Finch, Stacia A; Weiley, Victoria; Ip, Edward H et al. (2008) Impact of pediatricians'perceived self-efficacy and confidence on violence prevention counseling: a national study. Matern Child Health J 12:75-82
DuRant, Robert H; Barkin, Shari; Craig, Joseph A et al. (2007) Firearm ownership and storage patterns among families with children who receive well-child care in pediatric offices. Pediatrics 119:e1271-9
Barkin, Shari; Scheindlin, Benjamin; Ip, Edward H et al. (2007) Determinants of parental discipline practices: a national sample from primary care practices. Clin Pediatr (Phila) 46:64-9
Barkin, Shari; Ip, Edward H; Finch, Stacia et al. (2006) Clinician practice patterns: linking to community resources for childhood aggression. Clin Pediatr (Phila) 45:750-6
Barkin, Shari; Ip, Edward; Richardson, Irma et al. (2006) Parental media mediation styles for children aged 2 to 11 years. Arch Pediatr Adolesc Med 160:395-401

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