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A randomized, controlled trial of a community-based support program for families of children with chronic illness:
Robin G Chernoff1, Henry T Ireys, Katherin A DeVet
1Department of Pediatrics, School of Medicine, John Hopkins University, 600 N Broadway, Baltimore, MD 21287, USA. rchernof@jhmi.edu
Insights
A community-based family support intervention improved adjustment in children with chronic illnesses, reducing maladjustment rates. The program showed positive effects, particularly for children with low physical self-esteem.
Area of Science:
- Pediatric Psychology
- Child Health Interventions
- Family Support Systems
Background:
- Children with chronic illnesses face increased risks for mental health issues.
- Early intervention is crucial for managing adjustment problems in pediatric chronic conditions.
Purpose of the Study:
- To evaluate a 15-month community-based family support intervention for children (aged 7-11) with diabetes, sickle cell anemia, cystic fibrosis, or severe asthma.
- To reduce risks of poor adjustment and mental health problems in these children and their mothers.
Main Methods:
- Randomized controlled trial involving 136 mother-child dyads.
- Intervention delivered by experienced mothers and child life specialists via phone, visits, and events.
- Mental health outcomes assessed using validated scales (e.g., Children's Depression Inventory).
Main Results:
- Experimental group showed improved adjustment scores, while the control group's scores decreased.
- Significant positive effect of the intervention on post-intervention adjustment (P=.01).
- Maladjustment rates decreased from 19% to 10% in the intervention group, versus an increase from 15% to 21% in the control group.
Conclusions:
- The family support intervention demonstrated modest positive effects on the adjustment of children with chronic illnesses.
- Inclusion of child life specialists was beneficial, especially for children with low physical self-esteem.
- The intervention's success across diagnostic groups suggests broad applicability in pediatric settings.
Background:
Children with chronic illnesses have a heightened risk for mental health problems.
Objectives:
To develop, implement, and evaluate child outcomes of a 15-month, community-based, family-support intervention designed to reduce risk for poor adjustment and mental health problems in children with 1 of 4 chronic illnesses (diabetes mellitus, sickle cell anemia, cystic fibrosis, or moderate to severe asthma) and their mothers.
Design:
Randomized, controlled clinical trial design with multiple measures of mental health based on both child and parent reports taken 1 year apart.
Setting:
Community-based intervention linked to subspecialty and general pediatric clinics and practices in Baltimore, Md.
Participants:
One hundred thirty-six mothers and children aged 7 to 11 years with diabetes mellitus, sickle cell anemia, cystic fibrosis, or moderate to severe asthma.
Intervention:
The program, provided by "experienced mothers" and child life specialists, included telephone contacts, face-to-face visits, and special family events.
Main Outcome Measures:
Outcomes were measured using the following instruments: the Personal Adjustment and Role Skills Scale III, the Children's Depression Inventory, the Revised Children's Manifest Anxiety Scale, and the Self-Perception Profile for Children.
Results:
The experimental group's mean adjustment score increased over the intervention period while the control group's mean adjustment score decreased. Analysis of variance demonstrated that the intervention had a significant main effect on postintervention adjustment controlling for baseline scores (P =.01). Using a cutoff score indicating maladjustment, the percentage of experimental group children in the maladjustment range fell from 19% at baseline to 10% after the intervention; the percentage of control group children in the maladjustment range rose from 15% at baseline to 21% after the intervention. The effect of the intervention was more pronounced for children who had low physical self-esteem than for those who had moderate to high physical self-esteem at the beginning of the program.
Conclusions:
Our results demonstrate modest positive effects of a family support intervention in promoting the adjustment of children with selective chronic health conditions. Including child life specialists in a community-based intervention may be especially salient for children with chronic illnesses who have low physical self-esteem. The intervention had a similar outcome for all diagnostic groups, suggesting that it could be effective for children with any chronic illness and implemented in a variety of pediatric settings.