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，导致有害的精神和身体健康结果。具体来说，与神经正常发育儿童的父母相比，LAD儿童的父母承受着更高的压力，精神健康障碍的发生率较高，经历社会孤立，经济困难，并且可能放弃自我照顾的需求。这些弱势父母迫切需要可获得的远程干预措施。因此，我们在R56中建议开发和试点一种针对这些父母需求的完全远程身心弹性组干预，并期望我们随后进入完全随机临床试验。我们开发了一种基于证据的身心弹性干预（压力管理和放松训练：放松反应弹性计划；SMART-3RP），它使用身心结合的方法来增强弹性，并使其适应LAD儿童父母的需求（SMART-LAD）。试点试验结果支持zoom递送组格式、远程递送和剂量的可行性；干预技巧的可接受性；临床效益在于提高弹性及其心理和生理过程，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，我们将进一步在R56和健康教育计划（HEP）中采用SMART-LAD干预措施，并在整个马萨诸塞州的不同父母（或监护人作为父母）中采用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、低收入、农村和其他服务不足的群体。目标是：A1：开展焦点小组，以征求对招聘计划和工具、干预交付（拟议的联合调解人模式）和时间、干预内容（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：1个专业小组，2个英语家长小组（1个SMART-LAD和1个HEP）， 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，以开发适应和翻译的治疗方法。A3：开展4个试验组（SMART-LAD和HEP的英语和西班牙语版本），并完成改编和翻译治疗方案。结果将是可行性（报名的合格家长百分比，课程完成百分比，毛发皮质醇返回百分比）和可接受性（评分和满意度、需求满足、帮助和建议的开放式问题）。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并对讲英语和西班牙语的不同父母群体有用至关重要。下一阶段将是一个完整的随机对照试验，它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，这将促进远程群体身心干预的广泛实施和传播，以促进患有LAD儿童的脆弱父母的心理恢复能力。

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.