title: 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.
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 [chi2 (97 df) = 129.43; p = .016; root mean square error of approximation = .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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Arizona State University College of Nursing & Healthcare Innovation, 500 North 3rd Street, Mail Code 3020, Phoenix, AZ 85004, USA. bernadette.melnyk@asu.edu
authors.forename: Bernadette Mazurek
authors.initials: BM
authors.lastname: Melnyk
authors.forename: Hugh F
authors.initials: HF
authors.lastname: Crean
authors.forename: Nancy Fischbeck
authors.initials: NF
authors.lastname: Feinstein
authors.forename: Eileen
authors.initials: E
authors.lastname: Fairbanks
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Alpert-Gillis
mesh_terms: D000223:Adaptation, Psychological; D000275:Adjustment Disorders / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D001521:Behavior Therapy; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D009035:Mothers / Q000523:psychology*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D016730:Program Development; D015397:Program Evaluation; D011582:Psychological Theory; D012917:Social Adjustment