A reproducible educational-behavioral intervention program for parents that commences early in the NICU can improve parent mental health outcomes, enhance parent-infant interaction, and reduce hospital length of stay.

ABSTRACT. Objective. Increasing numbers of children in the United States (ie, ϳ200 children per 100 000 population) require intensive care annually, because of advances in pediatric therapeutic techniques and a changing spectrum of pediatric disease. These children are especially vulnerable to a multitude of short-and long-term negative emotional, behavioral, and academic outcomes, including a higher risk of posttraumatic stress disorder (PTSD) and a greater need for psychiatric treatment, compared with matched hospitalized children who do not require intensive care. In addition, the parents of these children are at risk for the development of PTSD, as well as other negative emotional outcomes (eg, depression and anxiety disorders). There has been little research conducted to systematically determine the effects of interventions aimed at improving psychosocial outcomes for critically ill children and their parents, despite recognition of the adverse effects of critical care hospitalization on the nonphysiologic well-being of patients and their families. The purpose of this study was to evaluate the effects of a preventive educational-behavioral intervention program, the Creating Opportunities for Parent Empowerment (COPE) program, initiated early in the intensive care unit hospitalization on the mental health/ psychosocial outcomes of critically ill young children and their mothers.Design. A randomized, controlled trial with follow-up assessments 1, 3, 6, and 12 months after hospitalization was conducted with 174 mothers and their 2-to 7-year-old children who were unexpectedly hospitalized in the pediatric intensive care units (PICUs) of 2 children's hospitals. The final sample of 163 mothers ranged in age from 18 to 52 years, with a mean of 31.2 years. Among the mothers reporting race/ethnicity, the sample included 116 white (71.2%), 33 African American (20.3%), 3 Hispanic (1.8%), and 2 Indian (1.2%) mothers. The mean age of the hospitalized children was 50.3 months. Ninetynine children (60.7%) were male and 64 (39.3%) were female. The major reasons for hospitalization were respiratory problems, accidental trauma, neurologic problems, and infections. Fifty-seven percent (n ‫؍‬ 93) of the children had never been hospitalized overnight, and none had experienced a previous PICU hospitalization.Interventions. Mothers in the experimental (COPE) group received a 3-phase educational-behavioral intervention program 1) 6 to 16 hours after PICU admission, 2) 2 to 16 hours after transfer to the general pediatric unit, and 3) 2 to 3 days after their children were discharged from the hospital. Control mothers received a structurally equivalent control program. The COPE intervention was based on self-regulation theory, control theory, and the emotional contagion hypothesis. The COPE program, which was delivered with audiotapes and matching written information, as well as a parent-child activity workbook that facilitated implementing the audiotaped information, focused on increasing 1) parents' knowledge and understanding of ...

The purpose of this pilot study was to evaluate the effectiveness of a parent-focused intervention program (COPE) on infant cognitive development and maternal coping. A randomized clinical trial was conducted with 42 mothers of low-birth-weight (LBW) premature infants hospitalized in a neonatal intensive care unit (NICU), with follow-up at 3 months' and 6 months' corrected ages. COPE mothers received the four-phase educational-behavioral program that began 2-4 days postbirth and continued through 1 week following discharge from the NICU. Comparison mothers received audiotaped information during the same four time frames. Results indicated that COPE infants had significantly higher mental development scores at a 3 months' corrected age (M = 100.3) than did the comparison infants (M = 93.9), and this difference widened at 6 months' corrected age, with COPE infants scoring 14 points higher. COPE mothers were significantly less stressed by the NICU sights and sounds and had significantly stronger beliefs about what behaviors and characteristics to expect from their premature infants. Findings from this study support the need for further testing of early NICU interventions with parents to determine their effectiveness on parental coping and infant developmental outcomes.

This study evaluated the effectiveness of a 16-week preventive intervention for 52 second-and thirdgrade urban children of divorce. The program extended the Children of Divorce Intervention Program (CODIP), a school-based program originally developed for fourth-sixth-grade suburban children. CODIP'S main goal is to mitigate the behavioral and emotional problems that occur in the wake of divorce. The program promotes support, helps children identify and express divorce-related feelings, clarifies divorce-related concepts and misconceptions, and develops relevant coping skills as well as positive self-and family perceptions. Participants were compared with 52 divorce controls and 81 demographically matched children from intact families on child, parent, and teacher measures of adjustment. The experimental group improved significantly more than nonprogram groups from multiple perspectives, suggesting that the intervention enhanced children's ability to cope with the stressful experiences often associated with parental divorce.The stressful impact of marital disruption on family members has been amply documented (Emery, 1982;Hodges, 1986).Such effects, which touch on diverse aspects of people's psychological and physical well-being, are often serious and enduring.These heavy human and social costs highlight the practical question of what can be done to avert such unfortunate sequelae. One needed alternative is to develop preventive interventions to minimize people's risk and enhance their adaptation. This point has not gone unrecognized. Indeed, paralleling the rapid growth of divorce as a social phenomenon (Select Committee on Children, Youth, and Families, 1983) has been a proliferation of formal and informal therapy and support groups to help people who experience divorce. Because these approaches are powered by pressing service needs, the main evidence of their "efficacy" comes from the global impressions of people who conduct and participate in them. Thus, although this development may have helped people, knowledge gained from it has not been sufficiently additive, due both to great variation in the practices used and the fact that these diverse approaches lack formal evaluation. Hence, it is difficult to match the operations of an intervention with specific outcomes or to understand what does and does not work in a program. The absence of such information hampers extension of effective programs to new groups that might profit from them.