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Toward Population Impact From Early Childhood Psychological Interventions

机译：对幼儿心理干预措施的人口影响

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Acting alone, psychologists rarely achieve population impact on important mental health and well-being outcomes for families and young children. The traditional Institute of Medicine model of moving from efficacy trials to effectiveness trials to scaling up has not succeeded, partly due to degradation of program quality and impact during scale-up and partly due to a failure to consider system-context issues at the outset. Analysis of barriers to population impact leads to the proposal of a new comprehensive system of care that includes both top-down coordination among community agencies providing services and bottom-up out-reach to every family to connect them with services. The North Carolina Smart Start Initiative is a top-down approach to improving the community-level quality of early childcare and education services. A natural experiment demonstrates that it improves population indicators of children's education outcomes. Family Connects is a bottom-up approach that reaches all families giving birth in a community through brief home visits to assess needs and connect families with community resources. A randomized controlled trial reveals increased community connectedness, lower maternal anxiety, reduced emergency health episodes, and lower rates of investigations for child abuse. These initiatives point toward the promise of population impact through psychological interventions in early life that are delivered in a collaborative system of care.
机译：单独行动，心理学家很少达到人口对家庭和幼儿的重要心理健康和幸福的影响。传统的医学研究所从疗效试验中的效力试验到缩放的效果试验没有成功，部分原因是由于计划质量和扩展过程中的影响，部分是由于未能考虑开始的系统 - 上下问题。分析人口影响的障碍导致建议新的综合护理制度，包括社区机构的自上而下的协调，为每个家庭提供服务和自下而上，将其与服务联系起来。北卡罗来纳智能启动计划是一种自上而下的方法，可以提高早期儿童保育和教育服务的社区级别。自然实验表明，它提高了儿童教育成果的人口指标。家庭连接是一种自下而上的方法，通过简短的家庭访问来达到社区分娩的所有家庭，以评估需求并与社区资源连接家庭。随机对照试验揭示了社区关联，降低母体焦虑，减少应急卫生事件，以及较低的儿童虐待调查率。这些举措通过在一名合作护理系统中提供的早期生命中的心理干预来指出人口影响的承诺。

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