[Show abstract][Hide abstract] ABSTRACT: To test a theoretical model examining processes through which a parent-focused educational-behavioral intervention [Creating Opportunities for Parent Empowerment (COPE)] relates to children's post-hospital adjustment problems.
Mothers (n = 143) and their 2-7-year-old children, unexpectedly hospitalized in two pediatric intensive care units, were randomized to COPE or control conditions. Maternal measures included parental beliefs, anxiety, negative mood, and child adjustment 3 months post discharge. Observers rated maternal support of their children during hospitalization.
Structural equation modeling suggested that the model tested provided a reasonable fit to the data [chi2 (97 df) = 129.43; p = .016; root mean square error of approximation = .048; comparative fit index = .95]. COPE effects on children's post-hospital externalizing behaviors were indirect, via associations with parental beliefs and maternal negative mood state. Furthermore, COPE participation was associated with more maternal support of their children, which was also associated with less internalizing and externalizing behaviors 3 months post discharge.
Implementing COPE may help avert future mental health problems in this high risk population. Understanding the processes by which an already empirically validated program relates to child outcomes is likely to aid clinicians and administrators in the widespread uptake of the COPE program.
[Show abstract][Hide abstract] ABSTRACT: Although low birth weight premature infants and parents are at high risk for adverse health outcomes, there is a paucity of studies that test early NICU interventions with parents to prevent the development of negative parent-infant interaction trajectories and to reduce hospital length of stay. Our objective was to evaluate the efficacy of an educational-behavioral intervention program (ie, Creating Opportunities for Parent Empowerment) that was designed to enhance parent-infant interactions and parent mental health outcomes for the ultimate purpose of improving child developmental and behavior outcomes.
A randomized, controlled trial was conducted with 260 families with preterm infants from 2001 to 2004 in 2 NICUs in the northeast United States. Parents completed self-administered instruments during hospitalization, within 7 days after infant discharge, and at 2 months' corrected age. Blinded observers rated parent-infant interactions in the NICU.
All participants received 4 intervention sessions of audiotaped and written materials. Parents in the Creating Opportunities for Parent Empowerment program received information and behavioral activities about the appearance and behavioral characteristics of preterm infants and how best to parent them. The comparison intervention contained information regarding hospital services and policies.
Parental stress, depression, anxiety, and beliefs; parent-infant interaction during the NICU stay; NICU length of stay; and total hospitalization were measured.
Mothers in the Creating Opportunities for Parent Empowerment program reported significantly less stress in the NICU and less depression and anxiety at 2 months' corrected infant age than did comparison mothers. Blinded observers rated mothers and fathers in the Creating Opportunities for Parent Empowerment program as more positive in interactions with their infants. Mothers and fathers also reported stronger beliefs about their parental role and what behaviors and characteristics to expect of their infants during hospitalization. Infants in the Creating Opportunities for Parent Empowerment program had a 3.8-day shorter NICU length of stay (mean: 31.86 vs 35.63 days) and 3.9-day shorter total hospital length of stay (mean: 35.29 vs 39.19 days) than did comparison infants.
A reproducible educational-behavioral intervention program for parents that commences early in the NICU can improve parent mental health outcomes, enhance parent-infant interaction, and reduce hospital length of stay.
[Show abstract][Hide abstract] ABSTRACT: Increasing numbers of children in the United States (ie, approximately 200 children per 100,000 population) require intensive care annually, because of advances in pediatric therapeutic techniques and a changing spectrum of pediatric disease. These children are especially vulnerable to a multitude of short- and long-term negative emotional, behavioral, and academic outcomes, including a higher risk of posttraumatic stress disorder (PTSD) and a greater need for psychiatric treatment, compared with matched hospitalized children who do not require intensive care. In addition, the parents of these children are at risk for the development of PTSD, as well as other negative emotional outcomes (eg, depression and anxiety disorders). There has been little research conducted to systematically determine the effects of interventions aimed at improving psychosocial outcomes for critically ill children and their parents, despite recognition of the adverse effects of critical care hospitalization on the nonphysiologic well-being of patients and their families. The purpose of this study was to evaluate the effects of a preventive educational-behavioral intervention program, the Creating Opportunities for Parent Empowerment (COPE) program, initiated early in the intensive care unit hospitalization on the mental health/psychosocial outcomes of critically ill young children and their mothers.
A randomized, controlled trial with follow-up assessments 1, 3, 6, and 12 months after hospitalization was conducted with 174 mothers and their 2- to 7-year-old children who were unexpectedly hospitalized in the pediatric intensive care units (PICUs) of 2 children's hospitals. The final sample of 163 mothers ranged in age from 18 to 52 years, with a mean of 31.2 years. Among the mothers reporting race/ethnicity, the sample included 116 white (71.2%), 33 African American (20.3%), 3 Hispanic (1.8%), and 2 Indian (1.2%) mothers. The mean age of the hospitalized children was 50.3 months. Ninety-nine children (60.7%) were male and 64 (39.3%) were female. The major reasons for hospitalization were respiratory problems, accidental trauma, neurologic problems, and infections. Fifty-seven percent (n = 93) of the children had never been hospitalized overnight, and none had experienced a previous PICU hospitalization.
Mothers in the experimental (COPE) group received a 3-phase educational-behavioral intervention program 1) 6 to 16 hours after PICU admission, 2) 2 to 16 hours after transfer to the general pediatric unit, and 3) 2 to 3 days after their children were discharged from the hospital. Control mothers received a structurally equivalent control program. The COPE intervention was based on self-regulation theory, control theory, and the emotional contagion hypothesis. The COPE program, which was delivered with audiotapes and matching written information, as well as a parent-child activity workbook that facilitated implementing the audiotaped information, focused on increasing 1) parents' knowledge and understanding of the range of behaviors and emotions that young children typically display during and after hospitalization and 2) direct parent participation in their children's emotional and physical care. The COPE workbook, which was provided to parents and children after transfer from the PICU to the general pediatric unit, contained 3 activities to be completed before discharge from the hospital, ie, 1) puppet play to encourage expression of emotions in a nonthreatening manner, 2) therapeutic medical play to assist children in obtaining some sense of mastery and control over the hospital experience, and 3) reading and discussing Jenny's Wish, a story about a young child who successfully copes with a stressful hospitalization.
Primary outcomes included maternal anxiety, negative mood state, depression, maternal beliefs, parental stress, and parent participation in their children's care, as well as child adjustment, which was assessed with the Behavioral Assessment System for Children (parent form). RESn (parent form).
COPE mothers reported significantly less parental stress and participated more in their children's physical and emotional care on the pediatric unit, compared with control mothers, as rated by nurses who were blinded with respect to study group. In comparison with control mothers, COPE mothers reported less negative mood state, less depression, and fewer PTSD symptoms at certain follow-up assessments after hospitalization. In addition, COPE mothers reported stronger beliefs regarding their children's likely responses to hospitalization and how they could enhance their children's adjustment, compared with control mothers. COPE children, in comparison with control children, exhibited significantly fewer withdrawal symptoms 6 months after discharge, as well as fewer negative behavioral symptoms and externalizing behaviors at 12 months. COPE mothers also reported less hyperactivity and greater adaptability among their children at 12 months, compared with control mothers. One year after discharge, a significantly higher percentage of control group children (25.9%) exhibited clinically significant behavioral symptoms, compared with COPE children (2.3%). In addition, 6 and 12 months after discharge, significantly higher percentages of control group children exhibited clinically significant externalizing symptoms (6 months, 14.3%; 12 months, 22.2%), compared with COPE children (6 months, 1.8%; 12 months, 4.5%).
The findings of this study indicated that mothers who received the COPE program experienced improved maternal functional and emotional coping outcomes, which resulted in significantly fewer child adjustment problems, in comparison with the control group. With the increasing prevalence of attention-deficit/hyperactivity disorder and externalizing problems among children and the documented lack of mental health screening and early intervention services for children in this country, the COPE intervention could help protect this high-risk population of children from developing these troublesome problems. As a result, the mental health status of children after critical care hospitalization could be improved. With routine provision of the COPE program in PICUs throughout the country, family burdens and costs associated with the mental health treatment of these problems might be substantially reduced.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this pilot study was to evaluate the effectiveness of a parent-focused intervention program (COPE) on infant cognitive development and maternal coping. A randomized clinical trial was conducted with 42 mothers of low-birth-weight (LBW) premature infants hospitalized in a neonatal intensive care unit (NICU), with follow-up at 3 months' and 6 months' corrected ages. COPE mothers received the four-phase educational-behavioral program that began 2-4 days postbirth and continued through 1 week following discharge from the NICU. Comparison mothers received audiotaped information during the same four time frames. Results indicated that COPE infants had significantly higher mental development scores at a 3 months' corrected age (M = 100.3) than did the comparison infants (M = 93.9), and this difference widened at 6 months' corrected age, with COPE infants scoring 14 points higher. COPE mothers were significantly less stressed by the NICU sights and sounds and had significantly stronger beliefs about what behaviors and characteristics to expect from their premature infants. Findings from this study support the need for further testing of early NICU interventions with parents to determine their effectiveness on parental coping and infant developmental outcomes.
Research in Nursing & Health 11/2001; 24(5):373-89. DOI:10.1002/nur.1038 · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Critically ill young children and their parents are subjected to multiple stressors during hospitalization, which may predispose them to short- and long-term negative outcomes. Nurses who care for children who are critically ill and their families during and following their intensive care unit stay must be knowledgeable of the impact of a child's critical illness on the family and factors influencing adjustment to the stressful experience. Knowledge of these issues is essential in planning effective intervention strategies to enhance coping outcomes in this population. This article (a) discusses how young children and their parents are affected by critical illness; (b) outlines major sources of stress for families; (c) identifies factors influencing coping outcomes; and (d) describes the COPE program, a newly devised early intervention program for critically ill young children and their parents.
[Show abstract][Hide abstract] ABSTRACT: Implemented and evaluated a preventive intervention for kindergarten and first grade children of divorce. Structure and content of the 12 session Children of Divorce Intervention Program (CODIP) was tailored to the developmental characteristics of 5 and 6 year olds. Pre-post comparisons of demographically matched groups of 37 CODIP participants, 26 non-program divorce controls and 39 children from non-divorced families yielded improvements for the experimental group on teacher, parent, child and group leader measures of adjustment. Limitations of the study and directions for future research, including a follow up study, are discussed.
The Journal of Primary Prevention 08/1997; 18(1):5-23. DOI:10.1023/A:1024601421020 · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Divorce is a stressful multistage process that can have long-lasting negative outcomes for parents and children. Pediatric nurse practitioners are often the first health care professionals to be informed of family transitions. Therefore they must be knowledgeable of the impact of divorce on parents and children to implement appropriate interventions to enhance coping outcomes in this population. This article discusses the effects of divorce on parents and children and identifies intervention strategies that can be used by nurse practitioners when dealing with separated families. Description of the COPE Program, an intervention program recently implemented with parents and young children experiencing marital separation, is also highlighted.
Journal of Pediatric Health Care 07/1997; 11(4):165-74. DOI:10.1016/S0891-5245(97)90123-1 · 1.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to pilot test the effects of a theoretically driven intervention program (COPE = Creating Opportunities for Parent Empowerment) on the coping outcomes of critically ill children and their mothers. Thirty mothers of 1- to 6-year-old children in a pediatric intensive care unit (PICU) were randomly assigned to receive COPE or a comparison program. Mothers who received the COPE program: (a) provided more support to their children during intrusive procedures; (b) provided more emotional support to their children; (c) reported less negative mood state and less parental stress related to their children's emotions and behaviors; and (d) reported fewer post-traumatic stress symptoms and less parental role change four weeks following hospitalization. Results indicate the need to educate parents regarding their children's responses as they recover from critical illness and how they can assist their children in coping with the stressful experience.
Research in Nursing & Health 03/1997; 20(1):3-14. · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Marital separation and divorce are stressful transitions for families. Due to the multitude of stressors imposed, parents and children are at risk for negative emotional, behavioral, and psychological outcomes. Advanced practice nurses are in an excellent position to provide early interventions to separated families that may prevent the need for mental health services that are costly to families and communities. This article discusses the effects of divorce on children and parents and provides guidelines for assessment and intervention with separated families. A description of the Creating Opportunities for Parent Empowerment (COPE) program, a newly developed intervention program for separated parents and their young children, is also included.
Advanced practice nursing quarterly 02/1997; 2(4):35-43.
[Show abstract][Hide abstract] ABSTRACT: The major purpose of this pilot study is to determine the feasibility of implementing a reproducible, preventive intervention program to enhance coping outcomes with mothers and their young children following marital separation. A two-group experiment was used with 21 mothers experiencing recent marital separation and their 3 to 6-year-old children. Experimental group mothers received the Creating Opportunitiesfor Parent Empowerment (COPE) Intervention Program, which consisted of audiotaped information and behavioral activities to enhance parenting effectiveness and coping outcomes in their children. Comparison group mothers received information and activities related to normal growth and development of preschool children. Trends in the data and effect sizes revealed positive short-term outcomes over a 3½-month study period on nearly all measures for mothers and children who received the COPE Intervention Program. Afull-scale study is now being planned to determine both short and long-term effects of the COPE Intervention Program.
Journal of Family Nursing 08/1996; 2(3):266-285. DOI:10.1177/107484079600200304 · 1.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study evaluates the efficacy of the Children of Divorce Intervention Program (CODIP), a preventive intervention based on social support and coping skills, for 4th-6th grade urban children of divorce. Structure and content of the 14 group sessions were tailored to the developmental level and sociocultural make-up of the target sample. Pre-post comparisons of demographically matched groups of 57 CODIP participants, 38 non-program divorce controls and 93 children from non-divorced families revealed improvements on parent, child and group leader measures of adjustment. Limitations of the study and directions for future research are discussed.
The Journal of Prevention 12/1992; 13(2):115-130. DOI:10.1007/BF01325070
[Show abstract][Hide abstract] ABSTRACT: In a sample of 102 4th-6th grade urban children of divorce, low to moderate relationships were found between perceived support and child adjustment. This relationship held for several sources of support and across several types of adjustment measures. It was strongest when adjustment was assessed through child self-ratings. Thus, children of divorce who perceived themselves as having more overall support had lower scores on measures of post-divorce difficulties, anxiety, and worry, and higher scores on measures of openness about the divorce and positive resources. The relationships found between support and adjustment among children of divorce suggest a potentially useful role for support in developing preventive interventions for such youngsters.
Journal of Child Psychology and Psychiatry 08/1990; 31(5):727-35. DOI:10.1111/j.1469-7610.1990.tb00813.x · 6.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Compared 49 second- and third-grade children of divorce with a demographically matched sample of 83 children from intact families on several teacher-rated, parent-rated, and self-report measures of anxiety and depression. Across rater sources, children of divorce were judged to have higher levels of anxiety and depression than comparison subjects, and also to be experiencing more school adjustment problems in general. These findings point to the need for preventive interventions with young children of divorce that take into account their susceptibility to anxiety and depression.
Journal of clinical child psychology 03/1990; 19(1):26-32. DOI:10.1207/s15374424jccp1901_4
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the effectiveness of a 16-week preventive intervention for 52 second- and third-grade urban children of divorce. The program extended the Children of Divorce Intervention Program (CODIP), a school-based program originally developed for fourth–sixth-grade suburban children. CODIP's main goal is to mitigate the behavioral and emotional problems that occur in the wake of divorce. The program promotes support, helps children identify and express divorce-related feelings, clarifies divorce-related concepts and misconceptions, and develops relevant coping skills as well as positive self- and family-perceptions. Participants were compared with 52 divorce controls and 81 demographically matched children from intact families on child, parent, and teacher measures of adjustment. The experimental group improved significantly more than nonprogram groups from multiple perspectives, suggesting that the intervention enhanced children's ability to cope with the stressful experiences often associated with parental divorce. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Journal of Consulting and Clinical Psychology 09/1989; 57(5):583-589. DOI:10.1037/0022-006X.57.5.583 · 4.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined direct and moderating influences of gender and sex-role orientations on children's general self-esteem. Moderating influences of these variables on the prediction of self-esteem were examined with respect to two sets of competence beliefs regarding school achievement: perceived capacities and perceived strategies for doing well in school. One hundred nineteen fourth-, fifth-, and sixth-grade children were assessed using the Perceived Competence Scale for Children (Harter, 1982), the Multidimensional Measure of Children's Perceptions of Control (Connell, 1985), and the Children's Personal Attributes Questionnaire (Hall & Halberstadt, 1980). Correlational and hierarchical multiple regression analyses indicated that upper elementary schoolchildren's general self-esteem is (a) marginally related to biological gender, with boys showing a slight advantage; (b) significantly related to masculinity and androgyny; and (c) predicted more strongly by perceived capacities to do schoolwork in girls than in boys, and by perceived (lack of) strategies for academic success in nontraditionally sex-typed children than in traditionally sex-typed children. Of the two nontraditionally sex-typed groups, androgynous children were found to have more positive school competence beliefs than were undifferentiated children.
Journal of Personality 03/1989; 57(1):97-114. DOI:10.1111/j.1467-6494.1989.tb00762.x · 2.44 Impact Factor