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)儿童的父母面临着持续的压力，这会导致有害的心理和身体健康结果。具体地说，与神经发育不良儿童的父母相比，患有法律性精神障碍儿童的父母承受的压力更大，精神健康障碍的发生率更高，经历社会孤立，经济困难，并可能放弃自我照顾需求。对于这些脆弱的父母来说，迫切需要可获得的远程干预。因此，在本R56中，我们建议开发和试点针对这些父母的需求的完全远程心身弹性小组干预，并期望我们随后将转向完全随机的临床试验。我们开发了基于证据的心身复原力干预(压力管理和放松训练：松弛反应复原力计划；SMART-3RP)，它使用精神和身体相结合的方法来提高复原力，并对其进行调整，以适应患有LAD儿童(SMART-LAD)的父母的需求。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；以及改善复原力及其心理和生理过程的临床益处，包括压力应对、心理健康、身体健康和健康行为。与特殊需要儿童联合会(FCSN)合作，我们将进一步调整R56和健康教育计划(HEP)中的智能儿童干预措施，在整个马萨诸塞州为不同的父母(或作为父母的监护人)提供关注匹配控制干预措施，包括BIPOC(黑人、土著和有色人种)、拉丁裔以及低收入、农村和其他服务不足的群体。目标是：A1：领导重点小组，就招聘计划和工具、干预交付(拟议的共同协调人模式)和时机、干预内容(SMART-LAD和HEP)以及文化和西班牙语修改征求反馈。将举办5个现场视频焦点小组：1个专业小组、2个英语家长小组(1个Smart-Lad和1个HEP)和2个西班牙语家长小组(1个Smart-Lad和1个Hep)。A2：整合焦点小组的研究结果，以开发适应和转换的治疗方法。A3：进行4个试点小组(英语和西班牙语的SMART-LAD和HEP)，并最终确定适应和翻译的治疗方法。结果将是可行性(登记的合格父母的百分比，完成的疗程百分比，返还的头发皮质醇百分比)和可接受性(评分和开放式问题，如满意度、需求得到满足、帮助和建议)。最后的适应步骤将是与我们的社区合作伙伴FCSN领导层会面。这项工作对于确保这些干预措施适用于说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研究，它将建立在强大的初步数据和与社区伙伴的可持续合作的基础上，这将促进广泛实施和传播远程团体心身干预措施，以促进患有精神障碍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.