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 ...

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Posttraumatic stress disorder (PTSD) is a chronic and debilitating disorder that affects the lives of 7-8% of adults in the U.S. Although several interventions demonstrate clinical effectiveness for treating PTSD, many patients continue to have residual symptoms and ask for a variety of treatment options. Complementary health approaches, such as meditation and yoga, hold promise for treating symptoms of PTSD. This meta-analysis evaluates the effect size (ES) of yoga and meditation on PTSD outcomes in adult patients. We also examined whether the intervention type, PTSD outcome measure, study population, sample size, or control condition moderated the effects of complementary approaches on PTSD outcomes. The studies included were 19 randomized control trials with data on 1,173 participants. A random effects model yielded a statistically significant ES in the small to medium range (ES = −.39, p < .001, 95% CI [−.57, −.22]). There were no appreciable differences between intervention types, study population, outcome measures, or control condition. There was, however, a marginally significant higher ES for sample size ≤ 30 (ES = −.78, k = 5). These findings suggest that meditation and yoga are promising complementary approaches in the treatment of PTSD among adults and warrant further study.

Background-Understanding the processes through which interventions work for mothers of premature infants is necessary for the advancement of science and the translation of efficacious interventions into clinical practice settings.

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This study examined the joint association between mothers' and adolescents' ratings of parental behavioral control and adolescents' and observers' ratings of mother-adolescent communication with adolescent problem behaviors in a sample of 86 middle-class African American early adolescent boys and girls (age: M ϭ 13.08 years, SD ϭ 1.32) and their mothers. Consistent with hypotheses, greater adolescent-rated parental behavioral control and better observer-rated mother -adolescent communication were associated with lower levels of adolescent problem behavior, as examined using structural equation modeling. Furthermore, interrelationships between age and adolescent problem behavior were partially mediated by adolescents' reports of parental behavioral control and observers' ratings of positive mother-adolescent communication, which both decreased with adolescents' age. Although the sample was primarily middle class, higher socioeconomic status was associated with more positive mother-adolescent communication, as rated by observers. Problem behavior was greater among boys than girls, but the hypothesized indirect effect of gender on problem behavior through associations with parenting was not observed. The findings demonstrate the utility of conceptually distinguishing between parenting and parent-adolescent relationships, and suggest that both have unique influences on middle-class African American adolescents' problem behavior.Requests for reprints should be sent to Judith G. Smetana,

Purpose Teenage girls in low-income urban settings are at elevated risk for HIV, sexually transmitted infections (STIs), and unintended pregnancies. The purpose of this study was to evaluate the efficacy of a sexual risk-reduction intervention, supplemented with post-intervention booster sessions, targeting low-income, urban, sexually active teenage girls. Method Randomized controlled trial in which sexually-active urban adolescent girls (n=738) recruited in a mid-size, northeastern U. S. city were randomized to a theory-based, sexual risk reduction intervention or to a structurally-equivalent health promotion control group. Assessments and behavioral data were collected using ACASI at baseline, then at 3, 6 and 12-months post-intervention. Both interventions included four small group sessions and two booster sessions. Results Relative to girls in the control group, girls reciving the sexual risk-reduction intervention were more likely to be sexually abstinent; if sexually active, they showed decreases in (a) total episodes of vaginal sex at all followups, (b) number of unprotected vaginal sex acts at 3 and 12-months, and (c) total number of sex partners at 6 months. Medical record audits for girls recruited from a clinical setting (n=322) documented a 50% reduction in positive pregnancy tests at 12-months. Conclusions Theory-based, behavioral interventions tailored to adolescent girls can help to reduce sexual risk and may also reduce unintended pregnancies. Although sexually active at enrollment, many of the girls receiving the intervention were more likely to practice secondary abstinence. Continued refinement of sexual risk-reduction interventions for girls are needed to ensure they are feasible, appealing, and effective.