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Journal of Pediatric Psychology Advance Access originally published online on October 14, 2006
Journal of Pediatric Psychology 2007 32(4):463-474; doi:10.1093/jpepsy/jsl033
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© The Author 2006. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Testing the Theoretical Framework of the COPE Program for Mothers of Critically Ill Children: An Integrative Model of Young Children's Post-Hospital Adjustment Behaviors

Bernadette Mazurek Melnyk1, Hugh F. Crean2, Nancy Fischbeck Feinstein2, Eileen Fairbanks2 and Linda J. Alpert-Gillis3

1Arizona State University College of Nursing & Healthcare Innovation, 2University of Rochester School of Nursing, 3University of Rochester School of Medicine & Dentistry

All correspondence concerning this article should be addressed to Bernadette Mazurek Melnyk, Arizona State University College of Nursing & Healthcare Innovation, 500 North 3rd Street, Mail Code 3020, Phoenix, AZ 85004. E-mail: bernadette.melnyk{at}asu.edu.


  Abstract

Objective To test a theoretical model examining processes through which a parent-focused educational–behavioral intervention [Creating Opportunities for Parent Empowerment (COPE)] relates to children's post-hospital adjustment problems. Methods Mothers (n = 143) and their 2–7-year-old children, unexpectedly hospitalized in two pediatric intensive care units, were randomized to COPE or control conditions. Maternal measures included parental beliefs, anxiety, negative mood, and child adjustment 3 months post discharge. Observers rated maternal support of their children during hospitalization. Results Structural equation modeling suggested that the model tested provided a reasonable fit to the data [{chi}2 (97 df) = 129.43; p = .016; root mean square error of approximatio n = .048; comparative fit index = .95]. COPE effects on children's post-hospital externalizing behaviors were indirect, via associations with parental beliefs and maternal negative mood state. Furthermore, COPE participation was associated with more maternal support of their children, which was also associated with less internalizing and externalizing behaviors 3 months post discharge. Conclusion Implementing COPE may help avert future mental health problems in this high risk population. Understanding the processes by which an already empirically validated program relates to child outcomes is likely to aid clinicians and administrators in the widespread uptake of the COPE program.

Key words: coping; critically ill children; mental health; parental beliefs; parents; PICU; structural equation modeling.

Received November 22, 2005; revision received April 29, 2006; revision received July 28, 2006; accepted September 8, 2006


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