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Promoting positive adjustment to medical events in children

促进儿童医疗事件的积极适应

基本信息

批准号：
8464383
负责人：
Nancy Kassam-Adams
金额：
$ 20万
依托单位：
CHILDREN'S HOSP OF PHILADELPHIA
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-04-20 至 2015-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8464383
关键词：
Acute Age American Area Blinded Child Child Psychology Child health care Childhood Clinical Cognitive Control Groups Development Diagnosis Effectiveness Effectiveness of Interventions Emergency Care Emotional Etiology Evaluation Event Family Feedback Future Goals Health Healthy People 2020 Impaired health Injury International Internet Intervention Link Measures Medical Medicine Mental Health Methods Modification Online Systems Organ Transplantation Outcome Pain Parents Personal Satisfaction Persons Prevention Prevention program Preventive Preventive Intervention Psychosocial Assessment and Care Quality of life Randomized Reaction Recovery Research Resources Risk School-Age Population Secondary Prevention Services Severities Social Work Social support Symptoms Testing Translating Translational Research Trauma Treatment Efficacy Work Youth avoidance behavior base biological adaptation to stress cancer diagnosis coping cost effective intervention efficacy testing evidence base experience follow-up functional outcomes health related quality of life improved innovation multidisciplinary post-traumatic stress programs psychologic psychological trauma randomized trial theories tool treatment as usual web site

项目摘要

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.

描述（由申请人提供）：医疗事件是美国儿童最常见的创伤经历之一：每年，近900万人因受伤而接受紧急护理，超过10,000人接受新的癌症诊断或接受器官移植，还有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良好，但有相当一部分人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受损（HRQOL）。社会心理支持的资源有限，因此以创新方式提供有效干预措施至关重要。互联网为广大儿童和家庭提供了一种有前途的、可访问的手段。我们开发了一种创新的以儿童为中心的网络干预，以创伤后心理反应病因学的证据为基础，并以强有力的概念框架为指导。“应对教练”透过互动游戏式活动，以评估和应对（例如回避、寻求支持）为目标，促进健康的适应和康复。目的：1)评估并最大化干预的可行性；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（pilot RCT）； 3)完善概念框架，优化干预效果；准备进行严格的大规模随机对照试验。方法1)专家评审：专家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），因近期急性医疗事件住院，将使用应对教练。观察和反馈（6周随访）将评估可接受性、参与度和障碍。3)细化干预：我们会根据需要，在专家评审和可行性测试的基础上，对应对教练进行修改。4)在试点随机试验中评估疗效：70名儿童（标准相同）完成基线测量，然后随机分配到应对教练或常规护理组。基线评估和盲法随访（6周和12周）将评估评估、应对、HRQOL和心理反应。5)确定进一步完善干预措施和概念框架的需要：根据试点RCT结果，计划修改并准备应对教练进行进一步测试。本项目通过探索应对教练的作用机制和初步效果评估，为更严格地评价应对教练奠定基础，并为儿童情绪和心理康复提供基础理论。我们的转化研究项目开发创新的、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，即改善家庭健康和福祉，以及健康人2020的目标，即促进高质量、与健康相关的网站和提供循证临床预防服务。