The unique and combined effects of prenatal and early childhood programming on child maltreatment: Examining mechanisms of change - PROJECT SUMMARY/ABSTRACT Child maltreatment occurs at alarmingly high rates and represents a serious threat to children’s healthy development, with negative ramifications lasting into adulthood. Exposure to intimate partner violence (IPV), child abuse, and neglect are particularly detrimental and frequently co-occur. IPV, which typically has an onset during women’s childbearing years, is one of the single largest risk factors for subsequent child maltreatment. Therefore, preventing child IPV exposure is critical for child maltreatment prevention and may be effectively targeted in programming during pregnancy. In order to promote a healthy parent-child relationship, enhancing maternal sensitivity is another key process that should be targeted in prevention approaches for child maltreatment. In this project, we propose an innovative approach that combines efforts to address IPV and to support the mother-child relationship in two developmental periods to prevent child maltreatment. Using a multi-site, randomized controlled trial design, the proposed project aims to assess the individual and combined contributions of prenatal and postnatal programming to prevent child maltreatment. We will evaluate the Pregnant Moms’ Empowerment Program (PMEP), a 5-session group program for women exposed to IPV that is delivered during pregnancy, and the Reminiscing and Emotion Training (RET) program as an additional preventative program delivered when children are 3-6 years old. In addition to testing the independent and synergistic effects of the programs in preventing child maltreatment, we will evaluate mechanisms of treatment change. Participants will include 300 mother-child dyads drawn from an ongoing randomized controlled trial of PMEP (n=230; R01HD098092, MPIs Miller-Graff & Howell) and newly recruited pregnant, IPV-exposed women who will complete the identical PMEP randomized controlled trial protocol at the beginning of the current grant period (n=70). The PMEP trial arm includes randomization to PMEP or prenatal control conditions, and 4 assessments (baseline [T1], post-test [T2], 3-month [T3] and 12-month [T4] post-partum follow-ups). When the children of women who participated in the PMEP trial arm are 3-6 years old, dyads will be re-randomized to receive RET or early childhood control conditions. Families will complete 4 additional assessments during the RET trial arm (baseline [T5], post-test [T6], 3-month [T7] and 6-month [T8] follow-ups). Thus, the study is a 2x2 randomized factorial design (i.e., PMEP in pregnancy (Y/N) x RET in early childhood (Y/N)). Our central hypothesis is that the PMEP and RET programs will each prevent child maltreatment. We anticipate that the effect of PMEP will be mediated by change in IPV and maternal sensitivity, while the effect of RET will be mediated by change in maternal sensitivity. We further expect that the effects of RET on child maltreatment will be magnified for women who participated in PMEP, such that RET is more effective in the context of PMEP- related reductions in IPV and enhancement of maternal sensitivity. This project is innovative in its use of a multi-site, multi-method design and significant in addressing the needs of a vulnerable population.
