Promoting positive adjustment to medical events in children

医疗事件是美国儿童最常见的创伤经历之一：每年有近900万人因受伤接受紧急护理，超过10，000人接受新的癌症诊断或接受器官移植，更多的人经历破坏性和痛苦的医疗事件。虽然许多年轻人恢复得很好，但有一个重要的子集经历了持续的心理症状（例如，创伤后应激[PTS]反应）和健康相关生活质量（HRQOL）受损。用于心理社会支助的资源有限，因此必须以创新方式提供有效的干预。互联网提供了一种有希望的、可利用的手段，可以接触到各种各样的儿童和家庭。我们开发了一种创新的以儿童为中心的网络干预，基于创伤后心理反应病因学的证据基础，并以强大的概念框架为指导。通过互动游戏式的活动，“应对教练”的目标是评估和应对（例如，避免，寻求支持），以促进健康的适应和恢复。目的：1）评估并最大限度地提高干预可行性，2）对近端结局（评估、应对）和后续儿童健康结局（PTS反应、HRQOL）进行初步疗效测试（试点RCT），3）完善概念框架，优化干预有效性;为严格的大规模RCT做准备。方法1）专家评审：专家将评审应对教练与概念框架和目标的一致性。2)评估可行性：10名儿童（8-12岁），住院治疗最近的急性医疗事件，将利用应对教练。观察和反馈（6周随访）将评估可接受性、参与度和障碍。3)完善干预：我们将根据专家评审和可行性测试，根据需要修改应对教练。4)在初步随机试验中评估疗效：70名儿童（标准相同）将完成基线测量，然后随机接受应对教练或常规护理。基线评估和设盲随访（第6周和第12周）将评估评估、应对、HRQOL和心理反应。5)确定是否需要进一步完善干预措施和概念框架：根据试点RCT结果，制定修改计划，并准备应对教练进行进一步测试。重要性通过探索行动机制和评估初步疗效，该项目奠定了应对教练更严格的评估基础，并告知有关儿童情绪和心理恢复的基本理论。我们的转化研究计划开发创新的，有理论基础的二级预防工具，以改善儿童的健康结果，推进NICHD的目标，以改善家庭的健康和福祉和健康的人2020年的目标，以促进高质量，健康相关的网站和提供循证临床预防服务。

DESCRIPTION (provided by applicant): Medical events are among the most common traumatic experiences for American children: each year, nearly 9 million receive emergency care for injury, more than 10,000 receive a new cancer diagnosis or undergo organ transplantation, and many more experience disruptive and painful medical events. While many youth recover well, a significant subset experience persistent psychological symptoms (e.g., posttraumatic stress [PTS] reactions) and impaired health-related quality of life (HRQOL). Resources for psychosocial support are limited, making innovative delivery of effective interventions essential. The Internet provides a promising, accessible means to reach a wide range of children and families. We have developed an innovative child-focused web intervention, grounded in the evidence base regarding etiology of post-trauma psychological reactions, and guided by a strong conceptual framework. Via interactive game-like activities, "Coping Coach" targets appraisals and coping (e.g., avoidance, support-seeking) to promote healthy adaptation and recovery. Aims: 1) Assess and maximize intervention feasibility, 2) Conduct initial efficacy testing (pilot RCT) for proximal outcomes (appraisals, coping) and subsequent child health outcomes (PTS reactions, HRQOL), 3) Refine conceptual framework and optimize intervention effectiveness; prepare for rigorous large-scale RCT. Method 1) Expert review: Experts will review Coping Coach for congruence with the conceptual framework and targets. 2) Evaluate feasibility: 10 children (ages 8-12), hospitalized for a recent acute medical event, will utilize Coping Coach. Observations and feedback (6 week follow-up) will assess acceptability, engagement, and barriers. 3) Refine intervention: We will modify Coping Coach as needed, based on expert review and feasibility testing. 4) Assess efficacy in pilot randomized trial: 70 children (same criteria) will complete baseline measures, and then be randomized to Coping Coach or usual care. Baseline assessments and blinded follow-ups (at 6 and 12 weeks) will assess appraisals, coping, HRQOL, and psychological reactions. 5) Determine need for further refinement of intervention and conceptual framework: Based on pilot RCT results, plan modifications and prepare Coping Coach for further testing. Importance By exploring mechanisms of action and estimating initial efficacy, this project lays the groundwork for more rigorous evaluation of Coping Coach, and informs underlying theory regarding children's emotional and psychological recovery. Our translational research program develops innovative, theoretically-grounded secondary prevention tools to improve health outcomes in children, advancing NICHD's goal to improve health and well-being of families and Healthy People 2020 goals to promote high-quality, health-related Web sites and the delivery of evidence-based clinical preventive services.