Identification of Newborns at High Risk for the Occurrence of Preventable Child Maltreatment: Phase 3 of Project 3 in the Overall Center for Innovation in Child Maltreatment Policy, Research, and Training (CICM), a Capstone Centers Grant.

Sample: The sample will be recruited from the Washington University School of Medicine Obstetrical Service within the Barnes Jewish Christian (BJC) Health System, on which there are over 3000 Missouri childbirths per year, serving an urban population of families that are disproportionately affected by poverty. Fifty-five per cent of patients report a family income less than $20,000, 65% of the mothers are unemployed, and the majority of the newborns are on Medicaid or are Medicaid-eligible. In preliminary screening efforts, over one third of the mothers reported their own childhood histories of maltreatment, and approximately one half score in the clinical range for depressive symptomatology.

Methods: A schematic summarizing study enrollment, participant randomization, and ascertainment of outcomes is provided in Figure 1.

Study Approach and Design: N=400 families are in the process of being enrolled in the parent longitudinal study. Among those who fall in an elevated risk category (upper 50% of the sample for total count of established risk factors) we will randomize 150 families 2:1 to Personalized Education Regarding Clinical and Community Supports (PERCCS) versus Usual Care. Risk counts are calculated by the total number of established predictors of risk for CM (itemized in Table 1) ascertained from birth records and: i) a screen for maternal depression, ii) a screen for maternal childhood trauma, and iii) a screen for active intimate partner violence. Utilization of community-based evidence-informed support services will be ascertained at baseline and quarterly thereafter for all study participants. Official-report Child Maltreatment data from Missouri state administrative data will be individually linked with participant research records when the children reach 18 months of age.

PERCCS involves i) a review with the mother of all family CM risks ascertained in the context of their own individual screening ii) recommendations of community and clinical interventions which substantively respond to those risks and are available to the subject (on the basis of each individual subject's zip code, insurance, and eligibility for the interventions), collectively the personalized family resource plan, iii) facilitation of contact between the subject and the respective provider agencies to initiate enrollment; and iv) authorization for the research team to share the personalized risk profile and support recommendations with the infant's outpatient primary care provider.

The community and clinical supports responsive to specific risk factors are listed in Table 1, which summarizes the array of evidence-informed preventions that will be presented to the families, and the correspondence with each to specific CM risks ascertained within a family. Table 2 depicts the set of scripts which are used by the study team to standardize all aspects of the review of endorsed risks, their potential adverse effects on parenting, and the opportunities for mitigation through evidence-informed intervention.