Family Resilience Initiative Research Program

NCT04018404 | Unknown

• 1 other identifier: LB_FRI RESEARCH
• Study Type: interventional
• Target: 400
• Locations: 0 countries
• Sites: N/A

Brief Summary

University Le Bonheur Pediatric Specialists (ULPS) and Le Bonheur Community Health and Well-Being, Maternal Child Department, have started the Family Resilience Initiative (FRI) in the ULPS General Pediatrics Clinic. This clinical program screens children 9 to 48 months of age for Adverse Childhood Experiences (ACEs) and Social Determinants of Health (SDH) at the time of presentation for well child checks. Children with positive screens for ACES and/or SDH, and their adult caregivers, receive community resource referrals with warm handoffs to vetted organizations. In addition, if indicated, psychological services are offered for children based upon the presence of one or more of ACEs and current health, social, and behavioral problems. It is expected that enrollment in FRI will improve quality of life for families through reduction in stress by addressing unmet social needs and providing psychological counseling of children and families with any ACE exposure. The investigators expect that FRI will have a positive impact on the physical health, healthcare utilization, mental health, development, and school readiness of children in the program compared to controls. The investigators will compare changes in weight for height and blood pressure percentiles at enrollment and end of study and the number of unscheduled healthcare visit for illness for children in the FRI clinical program compared to controls, receiving standard of care. Healthcare visits include visits to the clinic and visits to the Le Bonheur Emergency Department. The investigators will also compare pre- and post-treatment scores on the validated Child Behavior Checklist and Parenting Stress Index as a measure of stress reduction. Furthermore, the investigators will measure age appropriate attainment of developmental milestones scores on early, school-based testing (MAP) testing scores obtained through Seeding Success. The investigators will also determine rates of physician-diagnosed early behavioral disorders such as ADHD. The investigators expect that reduced stress and its downstream conditions will lead to decreased healthcare visits, improved attainment of developmental and educational milestones, and lower rates of behavioral disorders.

Conditions

Adverse Childhood Experiences

Outcome Measures

Primary Outcomes (8)

• Change in CBCL score (behavioral measure)

  We will use the CBCL scores (total, internalizing and subscales, externalizing and subscales) to define behavior problems. Since we expect a high rate of loss to follow up during the study, we plan to recruit 195 subjects in each arm to account for up to 50% loss to follow up. Our target population for the primary outcome will therefore be 390.

  after 3 years

• Changes in BMI from baseline

  We will use changes in BMI to classify child as underweight, normal weight, overweight, obese.

  after 3 years

• Change in blood pressure percentile from baseline (health measure)

  We will use changes in blood pressure percentile to determine presence of hypertension.

  after 3 years

• Rate of diagnosis of ADHD (behavioral measure)

  We will use the diagnosis of ADHD to define specific behavioral problems

  after 3 years

• Percentiles on ASQ domains (developmental measure)

  We will use percentiles on ASQ domains to determine achievement of appropriate developmental milestones.

  after 3 years

• Measures of Academic Progress testing score (school age)

  Using the RIT (Rasch Units) to chart the students academic growth from year to year. Will be available once child has entered school and will be used to determine school readiness.

  after 3 years

• Change in Parenting Stress Index score (mother)

  We will use Parenting Stress Index to determine the level of parental stress. The PSI 120 item inventory that focuses on three major domains of stress (child characteristics, parent characteristics, and situational/demographic life stress.

  after 3 years

• Change in flourishing score (mother)

  This scale is used around the world to assess various domains of flourishing, or human well being. We will use changes in flourishing score to determine maternal well being

  after 3 years

Study Arms (2)

Control

NO INTERVENTION

Subjects will be approached for enrollment prior to or following clinic visit with physician. Only children present with a biological mother will be considered for enrollment. Charts of controls will be flagged so that they will not be able to be enrolled in the FRI clinical program if they present to a morning clinic where the program is offered.

Subject

EXPERIMENTAL

Mothers and children will be approached by study personnel (separate from Outreach Coordinators who will obtain consent for use of information to evaluate the FRI Clinical Program) for enrollment in the FRI Research Program following completion of all FRI Clinical Program activities for that day. Both mother and child will be enrolled and contribute data and samples to the FRI Research Program.

Other: FRI CLINICAL PROGRAM

Interventions

FRI CLINICAL PROGRAM OTHER

University Le Bonheur Pediatric Specialists and Le Bonheur Community Health and Well-Being, Maternal Child Department, have started the Family Resilience Initiative (FRI) in the ULPS General Pediatrics Clinic. This clinical program screens children 9 months to less than five years of age for ACES and SDH at the time of presentation for well child checks. There are two outreach coordinators who screen and enroll children attending clinic for a well-child check during morning clinics 3 to 4 days per week. Children with positive screens for ACES and/or SDH, and their adult caregivers, receive community resource referrals with warm handoffs to vetted organizations. In addition, if indicated, psychological services are offered for children based upon the presence of one or more of ACEs and current health and behavioral problems.

Subject

Eligibility Criteria

• Age: 18 Months - 36 Months
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• \- 1. Children born at 32 weeks or greater between the ages of 18 to 36 months and their biological mothers.
• \. Present to a morning ULPS General Pediatric clinic for a well-child check and newly enrolled that day into the FRI Clinical program (requires at least one ACE or SDH disclosed on screening of child and agrees to clinical program) 3. Mother English speaking

You may not qualify if:

• \. Previously enrolled in FRI Clinical Program 2. Previously enrolled as a control in an afternoon clinic 3. Previously identified serious chronic health problems (e.g. complex congenital heart disease)
• Children born at 32 weeks or greater between the ages of 18 to 36 months and their biological mothers.
• Presenting to an afternoon ULPS General Pediatric clinic for a well- child check
• Has at least one ACE or SDH on pre-enrollment screening
• Mother English speaking
• \. Previously enrolled in FRI Clinical Program 5. Previously identified serious chronic health problems (e.g. complex congenital heart disease)

Sponsors & Collaborators

• Le Bonheur Children's Hospital: lead

Related Publications (11)

• Beck AF, Klein MD. Moving From Social Risk Assessment and Identification to Intervention and Treatment. Acad Pediatr. 2016 Mar;16(2):97-8. doi: 10.1016/j.acap.2016.01.001. Epub 2016 Jan 11. No abstract available.

  PMID: 26791277 BACKGROUND

• Bick J, Naumova O, Hunter S, Barbot B, Lee M, Luthar SS, Raefski A, Grigorenko EL. Childhood adversity and DNA methylation of genes involved in the hypothalamus-pituitary-adrenal axis and immune system: whole-genome and candidate-gene associations. Dev Psychopathol. 2012 Nov;24(4):1417-25. doi: 10.1017/S0954579412000806.

  PMID: 23062307 BACKGROUND

• Bright MA, Knapp C, Hinojosa MS, Alford S, Bonner B. The Comorbidity of Physical, Mental, and Developmental Conditions Associated with Childhood Adversity: A Population Based Study. Matern Child Health J. 2016 Apr;20(4):843-53. doi: 10.1007/s10995-015-1915-7.

  PMID: 26694043 BACKGROUND

• Bright MA, Thompson L, Esernio-Jenssen D, Alford S, Shenkman E. Primary Care Pediatricians' Perceived Prevalence and Surveillance of Adverse Childhood Experiences in Low-Income Children. J Health Care Poor Underserved. 2015 Aug;26(3):686-700. doi: 10.1353/hpu.2015.0080.

  PMID: 26320905 BACKGROUND

• Chung EK, Siegel BS, Garg A, Conroy K, Gross RS, Long DA, Lewis G, Osman CJ, Jo Messito M, Wade R Jr, Shonna Yin H, Cox J, Fierman AH. Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians. Curr Probl Pediatr Adolesc Health Care. 2016 May;46(5):135-53. doi: 10.1016/j.cppeds.2016.02.004. Epub 2016 Apr 18.

  PMID: 27101890 BACKGROUND

• Denhardt DT. Effect of stress on human biology: Epigenetics, adaptation, inheritance, and social significance. J Cell Physiol. 2018 Mar;233(3):1975-1984. doi: 10.1002/jcp.25837. Epub 2017 Apr 27.

  PMID: 28158904 BACKGROUND

• Gottlieb L, Hessler D, Long D, Amaya A, Adler N. A randomized trial on screening for social determinants of health: the iScreen study. Pediatrics. 2014 Dec;134(6):e1611-8. doi: 10.1542/peds.2014-1439. Epub 2014 Nov 3.

  PMID: 25367545 BACKGROUND

• Gottlieb LM, Hessler D, Long D, Laves E, Burns AR, Amaya A, Sweeney P, Schudel C, Adler NE. Effects of Social Needs Screening and In-Person Service Navigation on Child Health: A Randomized Clinical Trial. JAMA Pediatr. 2016 Nov 7;170(11):e162521. doi: 10.1001/jamapediatrics.2016.2521. Epub 2016 Nov 7.

  PMID: 27599265 BACKGROUND

• Gottlieb LM, Wing H, Adler NE. A Systematic Review of Interventions on Patients' Social and Economic Needs. Am J Prev Med. 2017 Nov;53(5):719-729. doi: 10.1016/j.amepre.2017.05.011. Epub 2017 Jul 5.

  PMID: 28688725 BACKGROUND

• Jimenez ME, Wade R Jr, Lin Y, Morrow LM, Reichman NE. Adverse Experiences in Early Childhood and Kindergarten Outcomes. Pediatrics. 2016 Feb;137(2):e20151839. doi: 10.1542/peds.2015-1839. Epub 2016 Jan 14.

  PMID: 26768347 BACKGROUND

• Argentieri MA, Nagarajan S, Seddighzadeh B, Baccarelli AA, Shields AE. Epigenetic Pathways in Human Disease: The Impact of DNA Methylation on Stress-Related Pathogenesis and Current Challenges in Biomarker Development. EBioMedicine. 2017 Apr;18:327-350. doi: 10.1016/j.ebiom.2017.03.044. Epub 2017 Apr 4.

  PMID: 28434943 RESULT

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 10, 2019
• First Posted: July 12, 2019
• Study Start: July 15, 2019
• Primary Completion: June 1, 2022
• Study Completion: June 1, 2024
• Last Updated: July 17, 2019

Record last verified: 2019-07

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR, ANALYTIC CODE
• Time Frame: Until the study is complete
• Access Criteria: The data will only be given to others to do the research, to study the results, and to see if the research was done correctly.