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

项目摘要 这份K23建议书详细介绍了一个为期5年的培训计划，这将有助于我作为一名独立的临床研究者开展职业生涯 世卫组织制定、测试、调整和实施应对压力性生殖生活事件的家庭复原力干预措施。 我提出了一个创新的和临床意义的研究和培训计划符合我的职业发展目标。 背景：美国每年有40万新生儿入住新生儿重症监护室（NICU），其中高达50%的新生儿 父母在住院期间和住院后经历情绪困扰（抑郁、焦虑、创伤后压力）。情感 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。建设复原力 在新生儿重症监护室的早期阶段对父母进行干预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、完善和测试一种创新的弹性干预（“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组（夫妇）。为了实现这个目标，我有三个目标：（1） 使用来自父母二人组（N=20）和NICU工作人员焦点小组（N=4）的访谈的利益相关者输入开发R-FAM; (2)通过开放式试点（N=5对），通过前/后评估和离职面谈优化R-FAM;（3）测试R-FAM 通过R-FAM的初步随机临床试验与最低限度 增强型常规控制（MEUC）。研究结果将为随后的R 01混合疗效-有效性试验（R-FAM与 MEUC）和未来的R 01机制，适应和实施试验。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，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 研究和培训目标得到以下人员的支持：（1）专家导师（Vranceanu和Lerou）和顾问（Patterson，Kaimal，& 帕克）;（2）丰富和支持性的机构环境;（3）有针对性的课程，科学会议，培训， 计划出版物。与NICHD相关。这K23直接与NICHD的资金优先事项，以改善治疗 为患有与怀孕有关的高风险疾病的妇女和家庭提供健康和福利（战略计划3）。影响： 这个K23奖将为我提供研究经验，合作，指导和培训，我需要成为一个 独立和成功的围产期-新生儿健康临床研究者。我希望开发、调整、测试和实施 旨在改善围产期-新生儿期家庭情绪困扰和关系的弹性干预措施 期如果成功，这项工作可以帮助告知未来的适应R-FAM（R 01），以满足不同的独特需求。 家庭，如单亲，父母应对损失，非浪漫的夫妇，以及来自不同文化背景的家庭 背景R-FAM有可能为新生儿重症监护室的心理社会护理制定新的标准，从而改善结果 和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.