Evidence Based Treatment Models

Despite growing evidence regarding the short- and long-term consequences of traumatic stress experiences for patients and family members enduring pe-diatric critical care, little research has systematically examined the effectiveness of mental health interventions targeting these populations. Recently, however, the utility of several treatment models has been empirically supported. The Creating Opportunities for Parent Empowerment (COPE) program is a parent-focused educational and behavioral intervention that aims to improve the mental health outcomes of parents and, indirectly, their children (Melnyk et al. 2004, 2007). COPE is predicated on several theoretical premises: self-regulation theory (concrete, objective information facilitates the development of a cognitive schema, which in turn enhances coping by reducing the discrepancy between what is expected and what actually happens), control theory (in the face of discrepancy between one's typical behavior patterns and current circumstances, the discrepancy motivates return to standard behavior), and the emotional contagion hypothesis (emotional states are transferred between individuals through modeling and by virtue of being in the presence of others) (Melnyk et al. 2007). At the onset of a PICU admission, immediately following transfer to the medical floor, and several days after hospital discharge, the COPE program focuses on increasing parents'

knowledge and understanding regarding typical responses of children during and after PICU hospital-ization. The program provides parents with suggested activities to increase direct participation in the medical and emotional care of their children while hospitalized. Results of a randomized, controlled trial supported associations between COPE intervention and stronger parenting confidence, decreased maternal negative mood state, higher levels of parental support of children, and reduced internalizing and externalizing adjustment problems in children following hospitalization (Melnyk et al. 2007). Of note, the clinical benefits to children were indirect, because the direct COPE intervention targeted parents only.

Curley (1988; Curley and Wallace 1992) found support for the clinical utility of a parent-supportive nursing intervention in the PICU, the Nursing Mutual Participation Model of Care, which also holds promise for mental health professionals in this setting. This intervention is based on the premises that parenting in the PICU has many stressful aspects and that individual variation in coping, adjustment, and perceptions of stress must be considered in supportive work with families. The model includes several steps. First, parents are asked open-ended questions to build rapport and establish a caring atmosphere. Next, direct questioning helps determine parents' goals, objectives, and expectations regarding their role in their child's treatment and recovery; their perceptions regarding the child's illness and its seriousness; and their beliefs and attitudes about health and adjustment in general. Finally, parents' suggestions and preferences regarding their child's care, as well as their own participation in that care, are invited. The elicited information is used to increase parental knowledge regarding and participation in their child's care. Results from a controlled quasi-experimental design (Curley 1988) and a replication of the original study (Curley and Wallace 1992) suggest diminished levels of perceived parent stress both during hospitalization and following discharge.

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