Resourcefulness Intervention for Mothers of Technology-Dependent Children

项目概要/摘要： 依赖技术的儿童，那些依赖医疗设备，如机械通气或 在家中进行日常护理的喂食管，是最生病和最脆弱的儿童群体， 复杂的慢性病他们占从医院出院回家的所有儿童的20%， 占儿童医疗保健支出的61%，每年高达1100亿美元。估计有60万儿童 在美国，大多数人依赖技术，住在家里，主要由父母照顾。 这些父母比其他照顾者群体报告了更高水平的抑郁症状和压力。在 此外，这些照顾者报告说，他们的心理和身体健康状况不佳，影响了他们的生活 增加急诊室的使用，以满足儿童的护理需求。尽管有这些 尽管存在不利后果，但没有任何干预措施来满足这些照料者及其子女的需要。 足智多谋训练（认知行为自我管理干预）已被证明可以改善 心理和身体的结果，调解压力的影响，并加强提供护理- 受惠人士它将在一项随机试验中与只注意力的对照组进行测试。 接受干预，其中包括：面对面的会议，以教授社会（寻求帮助）和个人 （自助）足智多谋的技能;持续访问技术依赖者护理人员的视频片段 儿童描述日常生活中的机智技能应用; 4周的技能强化，每天使用 日志写作;前4周每周电话;术后2个月和4个月的助推器会议 招生注意力控制组将在前4周以及第2周和第4周每周接受电话呼叫 入组后3个月加上任何常规护理。本研究的目的是：（1）确定是否 足智多谋训练与注意力控制可以改善心理（一般心理健康， 抑郁认知、抑郁症状、评估的压力、负担）和身体结果 （一般身体健康，慢性压力[头发皮质醇]）和家庭功能超过6个月的父母 在控制了父母的种族/民族、性别、家庭收入、 和儿童的功能状态;和2）确定是否在心理和身体的变化 结果和家庭功能是通过父母的足智多谋水平的变化来介导的 （个人和社会）。我们的研究将是第一个测试这一照顾者的足智多谋干预 人口，包括男性和女性照顾者。这种干预的独特之处在于它使用网络， 电话和日记的组成部分，以供参考-而不是多次面对面的访问，可以是劳动 密集。如果证明是有效的，它可以很容易地复制与其他人群具有很强的潜力， 转化为实践。

Project Summary/Abstract: Technology-dependent children, those who rely on medical equipment such as mechanical ventilation or feeding tubes for daily care at home, are among the sickest and most vulnerable subset of children with complex chronic conditions. They comprise 20% of all children discharged from the hospital to home, yet account for 61% of healthcare spending for children, up to $110 billion annually. An estimated 600,000 children in the United States are technology dependent and live at home, and are cared for primarily by their parents. These parents report greater levels of depressive symptoms and stress than other caregiver groups. In addition, these caregivers report poor psychological and physical health that compromise their caregiving capacity and increase their use of emergency rooms (ER) for their children's care needs. Despite these adverse consequences, there are no interventions to meet the needs of these caregivers and their children. Resourcefulness Training, (cognitive-behavioral self-management intervention) has been shown to improve psychological and physical outcomes, mediate the effects of stress, and enhance the care provided to care- recipients. It will be tested in a randomized trial against an attention-only control arm. The intervention arm will receive an intervention that includes: a face-to-face session for teaching social (help-seeking) and personal (self-help) resourcefulness skills; ongoing access to video vignettes of caregivers of technology-dependent children describing resourcefulness skill application in daily life; 4 weeks of skills' reinforcement using daily journal writing; weekly phone calls for the first 4 weeks; and booster sessions at 2 and 4 months post enrollment. The Attention Control arm will receive weekly phone calls for the first 4 weeks and at 2 and 4 months post enrollment plus any usual care. The aims of the study are to: 1) Determine whether Resourcefulness Training versus Attention Control improves psychological (general mental health, depressive cognitions, depressive symptoms, appraised stress, burden) and physical outcomes (general physical health, chronic stress [hair cortisol]) and family functioning over 6 months in parents of technology-dependent children, after controlling for the parents' race/ethnicity, sex, family income, and children's functional status; and 2) Determine whether changes in psychological and physical outcomes and family functioning are mediated by changes in parents' levels of resourcefulness (personal and social). Our study will be the first to test a resourcefulness intervention for this caregiver population and to include male as well as female caregivers. This intervention is distinctive in that it uses web, telephone, and journal components for reinforcement—not multiple face-to-face visits that can be labor intensive. If shown to be efficacious, it can be easily replicated with other populations with strong potential for translation into practice.