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Journal of Pediatric Psychology Advance Access published online on October 14, 2006
Journal of Pediatric Psychology, doi:10.1093/jpepsy/jsl033
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© The Author 2006. Published by Oxford University Press on behalf of the Society of Pediartic Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org
Received November 22, 2005
Accepted September 8, 2006

Original Papers

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 Melnyk 1 *, Hugh F. Crean 2, Nancy Fischbeck Feinstein 2, Eileen Fairbanks 2, and Linda J. Alpert-Gillis 3

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

* To whom correspondence should be addressed.
Bernadette Mazurek Melnyk, 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.

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