Resilient Families (R-FAM): A dyadic resiliency intervention for parents of babies in neonatal intensive care

项目总结 这份K23提案详细说明了一项为期5年的培训计划，该计划将帮助我开始作为一名独立临床研究员的职业生涯 世卫组织为管理有压力的生殖生活事件的家庭制定、测试、调整和实施复原力干预措施。 我提出了一项与我的职业发展目标相一致的创新和具有临床意义的研究和培训计划。 背景：每年有40万名美国新生儿进入新生儿重症监护病房(NICU)，其中高达50%的新生儿 父母在住院期间和之后经历情绪困扰(抑郁、焦虑、创伤后应激)。情绪化 痛苦会对夫妻和家庭的调整产生负面影响，进而影响儿童的健康和发展。构建弹性 在NICU之旅中及早照顾父母是改善家庭和儿童结局的关键。具体目标和研究设计： 我的目标是开发、改进和测试一种创新的弹性干预的可行性和可接受性 家庭；“R-FAM”，用于在NICU中有婴儿的父母二人(夫妇)。为了实现这一目标，我的目标有三个：(1) 利用与父母二人组的访谈(N=20)和与NICU工作人员的焦点小组(N=4)的访谈，利用利益相关者的意见制定R-FAM； (2)通过开放试点(N=5个DUAD)优化R-FAM，并进行事前/事后评估和离职访谈；以及(3)测试R-FAM 通过R-FAM的先导性随机临床试验与最低限度的 增强的日常控制(MEUC)。研究结果将为随后的R01混合疗效-有效性试验(R-FAM与 MEUC)和未来的R01机械性、适应性和实施试验。培训和指导：我的研究目标 有三个培训目标支持：(1)定性方法，包括纵向访谈、二元访谈和焦点小组； (2)采用混合方法进行干预设计和优化；(3)进行二元随机临床试验。我的 支持研究和培训目标的有：(1)专家导师(Vranceanu和Lerou)和顾问(Patterson、Kaimal和 (2)丰富和支持性的制度环境；(3)有针对性的课程作业、科学会议、培训和 计划中的出版物。与NICHD的相关性。这一K23直接与NICHD改善治疗的资金优先顺序一致 妇女和经历与怀孕有关的高危疾病的家庭的健康(战略计划3)。影响： 这个K23奖项将为我提供研究经验、合作、指导和培训，我需要成为一个 在围产期和新生儿健康方面独立和成功的临床调查员。我希望开发、适应、测试和实现 旨在改善围产期新生儿情绪困扰和家庭关系的复原力干预 句号。如果成功，这项工作可以帮助为R-FAM(R01)的未来适应提供信息，以满足不同 家庭，如单亲父母、应对失落的父母、非浪漫的二人组以及来自不同文化背景的家庭 背景。R-FAM有可能为NICU的心理社会护理设定一个新的标准--从而改善结果 以及全球这些医疗机构的文化。

PROJECT SUMMARY This K23 proposal details a 5-year training program that will help launch my career as an independent clinical investigator who develops, tests, adapts, and implements resiliency interventions for families managing stressful reproductive life events. I propose an innovative and clinically meaningful research and training plan consistent with my career development goals. Background: With 400,000 U.S. newborns admitted to Neonatal Intensive Care Units (NICU) annually, up to 50% of their parents experience emotional distress (depression, anxiety, posttraumatic stress) during and after hospitalization. Emotional distress can negatively impact couple and family adjustment, and in turn, child health and development. Building resiliency in parents early during the NICU journey is key to improve family and child outcomes. Specific aims and research design: My goal is to develop, refine, and test the feasibility and acceptability of an innovative, resiliency intervention (“Resilient Families;” R-FAM) for parental dyads (couples) with babies in the NICU. To achieve this goal, my aims are three-fold: (1) develop R-FAM using stakeholder input from interviews with parent dyads (N=20) and focus groups with NICU staff (N=4); (2) optimize R-FAM through an open pilot (N=5 dyads) with pre/post assessments and exit interviews; and (3) test R-FAM for feasibility and acceptability (N=50 dyads) through a pilot randomized clinical trial of R-FAM compared with a minimally enhanced usual control (MEUC). Findings will inform a subsequent R01 hybrid efficacy-effectiveness trial (R-FAM versus MEUC) and future R01 mechanistic, adaptation, and implementation trials. Training and mentoring: My research aims are supported by three training goals: (1) qualitative methods, including longitudinal, dyadic interviews and focus groups; (2) intervention design and optimization using mixed methods; and (3) conduct dyadic randomized clinical trials. My research and training goals are supported by: (1) expert mentors (Vranceanu & Lerou) and advisors (Patterson, Kaimal, & Parker); (2) a rich and supportive institutional environment; and (3) targeted coursework, scientific meetings, trainings, and planned publications. Relevance to NICHD. This K23 directly aligns with NICHD’s funding priorities to improve treatment and wellness of women and families who experience high-risk pregnancy-related morbidities (Strategic Plan 3). Impact: This K23 award will provide me with the research experience, collaborations, mentorship, and training I need to become an independent and successful clinical investigator in perinatal-neonatal health. I hope to develop, adapt, test, and implement resiliency interventions that aim to improve emotional distress and relationships in families during the perinatal-neonatal period. If successful, this work can help inform future adaptations of R-FAM (R01s) that meet the unique needs of different families, such as single parents, parents coping with loss, non-romantic dyads, and families from diverse cultural backgrounds. R-FAM has the potential to set a new standard of NICU psychosocial care—therefore improving the outcomes and culture of these healthcare units across the globe.