# Child-Adult Relationship Enhancement in Primary Care: Effectiveness Trial of a Primary Care Based Parenting Intervention to Prevent Child Maltreatment

> **NIH NIH R01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2021 · $713,607

## Abstract

Project Summary/Abstract
Child maltreatment (CM) is a pervasive public health problem and there is a critical need for brief, effective,
scalable prevention interventions. Problematic parent-child relationships lie at the heart of CM. Parents who
maltreat their children are more likely to have punitive parenting styles characterized by high rates of negative
interaction and ineffective discipline strategies with over-reliance on punishment. Harsh, reactive parenting can
contribute to the development of child behavioral problems which, in turn, can increase parental stress and
lead to escalation of negative parenting behaviors, including abusive and neglectful parenting. Thus, parenting
interventions that strengthen parent-child relationships, teach positive discipline techniques, decrease harsh
parenting, and decrease child behavioral problems hold promise as CM prevention strategies. Challenges in
engaging parents, particularly low-income and minority parents, and a lack of knowledge regarding effective
implementation strategies, however, have greatly limited the reach and impact of parenting interventions. To
address these challenges, our interdisciplinary team from the University of North Carolina and Children’s
Hospital of Philadelphia collaborated in implementing and evaluating, Child Adult Relationship Enhancement in
Primary Care (PriCARE)/Criando Niños con Cariño. PriCARE/Cariño is distinct from other programs because it
was (1) developed and iteratively adapted with input from racially and ethnically diverse families, including low-
income families and (2) designed specifically for implementation in primary care with inclusion of strategies to
align with usual-care work flow to increase uptake and retention. In randomized controlled trials (RCTs),
PriCARE has demonstrated success in engaging parents, promoting positive parenting, reducing parent stress,
and improving child behaviors. The objective of this project “Child-Adult Relationship Enhancement in Primary
Care: Effectiveness Trial of a Primary Care Based Parenting Intervention to Prevent Child Maltreatment” is to
conduct a multi-site RCT of PriCARE/Cariño plus Usual Care vs. Usual Care among 1932 parents and their 2-
6-year-old children with Medicaid/CHIP/no insurance from 6 clinics. We will examine the effectiveness of
PriCARE/Cariño on reducing suspected CM, in addition to reducing proximal CM related outcomes (child
behavior problems, parent stress, harsh/neglectful parenting). By testing proximal outcomes in addition to the
more distal outcome of CM, this study will help to elucidate the mechanisms of change and advance the
science of CM prevention. Finally, in this study we will also identify PriCARE/Cariño implementation
determinants and examine their relationship to implementation outcomes. If successful, results will be used to
seek funding from state agencies and payers to sustain PriCARE/Cariño in primary care, while continuing to
refine and study implementation and dissem...

## Key facts

- **NIH application ID:** 10100243
- **Project number:** 1R01HD103902-01
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Samantha S Schilling
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $713,607
- **Award type:** 1
- **Project period:** 2021-08-01 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10100243

## Citation

> US National Institutes of Health, RePORTER application 10100243, Child-Adult Relationship Enhancement in Primary Care: Effectiveness Trial of a Primary Care Based Parenting Intervention to Prevent Child Maltreatment (1R01HD103902-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10100243. Licensed CC0.

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