Adaptation of virtual group interventions to promote resilience among English and Spanish speaking parents of children with Learning and Attentional Disabilities (LAD)

患有学习和注意力障碍（LAD）的儿童的父母面临持续的压力，导致有害的心理和身体健康结果。具体而言，与神经发育正常的儿童的父母相比，患有LAD的儿童的父母经历了更高水平的压力，精神健康障碍的发生率较高，经历了社会孤立，经济困难，并且可能放弃自我护理需求。这些脆弱的父母迫切需要可持续的远程干预。因此，我们在R56中建议开发和试点一个完全远程的身心弹性小组干预，针对这些父母的需求，期望我们将进入一个完全随机的临床试验。我们开发了一种以证据为基础的身心弹性干预（压力管理和放松训练：放松反应弹性计划; SMART-3RP），它使用身心方法的组合来增强弹性，并使其适应LAD儿童父母的需求（SMART-LAD）。试点试验结果支持Zoom交付的小组形式、远程交付和剂量的可行性;干预技能的可接受性;以及改善弹性及其心理和身体过程的临床益处，包括压力应对、心理健康、身体健康和健康行为。与有特殊需要的儿童联合会（FCSN）合作，我们将在整个马萨诸塞州，包括BIPOC（黑人、土著人和有色人种）、拉丁裔以及低收入、农村和其他服务不足群体的不同父母（或作为父母的监护人）中，进一步调整R56中的SMART-LAD干预措施和健康教育计划（HEP）注意力匹配控制干预措施。其目标是：答一：开展焦点小组活动，以征求对招募计划和工具、干预措施实施（拟议的共同主持人模式）和时间安排、干预措施内容（SMART-LAD和HEP）以及文化和西班牙语修改的反馈。五个现场视频焦点小组将运行：1个专业组，2个讲英语的家长组（1个SMART-LAD和1个HEP），和2个讲西班牙语的家长组（1个SMART-LAD和1个HEP）。A2：整合焦点小组的研究结果，以开发适应和翻译的治疗方法。A3：开展4个试点小组（英语和西班牙语的SMART-LAD和HEP），并最终确定经过改编和翻译的治疗方法。结果将是可行性（符合条件的父母注册的百分比，完成的课程百分比，返回头发皮质醇的百分比）和可接受性（满意度，满足需求，帮助和建议的评级和开放式问题）。最后的适应步骤将是与我们的社区合作伙伴FCSN领导层举行会议。这项工作对于确保这些干预措施适应讲英语和西班牙语的不同父母群体并对其有用至关重要。下一阶段将是一个全面的随机对照试验，该试验将建立在强有力的初步数据和与社区伙伴的可持续合作的基础上，这将有助于广泛实施和传播远程团体身心干预，以提高患有左前降支疾病儿童的弱势父母的心理复原力。

Parents of children with learning and attentional disabilities (LAD) face ongoing stress that leads to deleterious mental and physical health outcomes. Specifically, parents of children with LAD experience higher levels of stress compared to parents of neurotypically developing children, have high rates of mental health disorders, experience social isolation, financial distress, and are likely to forego self-care needs. Accessible remote interventions are critically needed for these vulnerable parents. Thus, we propose in this R56 to develop and pilot a fully remote mind-body resiliency group intervention that is targeted to the needs of these parents with an expectation that we will then move to a full randomized clinical trial. We developed an evidence-based mind-body resiliency intervention (Stress Management and Relaxation Training: Relaxation Response Resiliency Program; SMART-3RP), which uses a combination of mind and body approaches to enhance resiliency and adapted it to the needs of parents of children with LAD (SMART-LAD). Pilot trial findings supported the feasibility of the Zoom-delivered group format, remote delivery, and dose; acceptability of the intervention skills; and clinical benefit for improving resiliency and its psychological and physical processes, including stress coping, mental health, physical health, and healthy behaviors. Partnering with the Federation for Children with Special Needs (FCSN) we will further adapt the SMART-LAD intervention in this R56 and the Health Education Program (HEP) attention matched control intervention with diverse parents (or guardians as parents) throughout Massachusetts, including BIPOC (Black, Indigenous, and People Of Color), Latinx, and low-income, rural, and other underserved groups. The aims are: A1: To conduct focus groups to elicit feedback on recruitment plan and tool, intervention delivery (proposed co-facilitator model) and timing, intervention content (SMART-LAD and HEP), and cultural and Spanish language modifications. Five live video-based focus groups will be run: 1 professional group, 2 English speaking parent groups (1 SMART-LAD and 1 HEP), and 2 Spanish speaking parent groups (1 SMART-LAD and 1 HEP). A2: To integrate focus group findings to develop adapted and translated treatments. A3: To conduct 4 pilot groups (SMART-LAD and HEP in English and Spanish) and finalize adapted and translated treatments. Outcomes will be Feasibility (% eligible parents who enroll, % sessions completed, % returned hair cortisol) and Acceptability (rating and open-ended questions of satisfaction, needs met, helpfulness and recommendations). The final adaptation step will be a meeting with our community partner, FCSN, leadership. This work is critical in assuring that these interventions are adapted to and useful to diverse English and Spanish speaking parent populations. The next phase would be a full RCT which would be built upon strong preliminary data and a sustainable collaboration with community partners which would facilitate widespread implementation and dissemination of a remote group mind-body intervention to promote psychological resilience of vulnerable parents of children with LAD.