title: Using a web-based game to prevent posttraumatic stress in children following medical events: design of a randomized controlled trial.
abstract: BACKGROUND
  Medical events including acute illness and injury are among the most common potentially traumatic experiences for children. Despite the scope of the problem, only limited resources are available for prevention of posttraumatic stress symptoms (PTSS) after pediatric medical events. Web-based programs provide a low-cost, accessible means to reach a wide range of families and show promise in related areas of child mental health.
  
  
  OBJECTIVE
  To describe the design of a randomized controlled trial that will evaluate feasibility and estimate preliminary efficacy of Coping Coach, a web-based preventive intervention to prevent or reduce PTSS after acute pediatric medical events.
  
  
  METHODS
  Seventy children and their parents will be randomly assigned to either an intervention or a waitlist control condition. Inclusion criteria require that children are aged 8-12 years, have experienced a medical event, have access to Internet and telephone, and have sufficient competency in the English language to complete measures and understand the intervention. Participants will complete baseline measures and will then be randomized to the intervention or waitlist control condition. Children in the intervention condition will complete module 1 (Feelings Identification) in the hospital and will be instructed on how to complete modules 2 (Appraisals) and 3 (Avoidance) online. Follow-up assessments will be conducted via telephone at 6, 12, and 18 weeks after the baseline assessment. Following the 12-week assessment, children in the waitlist control condition will receive instructions for completing the intervention.
  
  
  RESULTS
  Primary study outcomes include data on intervention feasibility and outcomes (child appraisals, coping, PTSS and health-related quality of life).
  
  
  CONCLUSIONS
  Results will provide data on the feasibility of the implementation of the Coping Coach intervention and study procedures as well as estimations of efficacy to determine sample size for a larger study. Potential strengths and limitations of this design are discussed.
authors.affiliation: Child and Adolescent Psychiatry and Behavioral Science, The Children's Hospital of Philadelphia, Philadelphia, PA, USA ; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Meghan L
authors.initials: ML
authors.lastname: Marsac
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Kohser
authors.forename: Flaura K
authors.initials: FK
authors.lastname: Winston
authors.forename: Justin
authors.initials: J
authors.lastname: Kenardy
authors.forename: Sonja
authors.initials: S
authors.lastname: March
authors.forename: Nancy
authors.initials: N
authors.lastname: Kassam-Adams
keywords: Internet; PTSD; Trauma; early intervention; prevention
references.citation: J Am Acad Child Adolesc Psychiatry. 2010 Jun;49(6):616-25, 625.e1-4
references.pmid: 20494271
references.citation: Depress Anxiety. 2009;26(1):65-72
references.pmid: 18828141
references.citation: J Child Psychol Psychiatry. 2009 Apr;50(4):432-40
references.pmid: 19338628
references.citation: Med Care. 1999 Feb;37(2):126-39
references.pmid: 10024117
references.citation: Child Psychiatry Hum Dev. 2006 Spring;36(3):351-68
references.pmid: 16362238
references.citation: Behav Res Ther. 1996 Aug;34(8):669-73
references.pmid: 8870294
references.citation: J Pediatr Psychol. 2009 Jan-Feb;34(1):14-21
references.pmid: 17890286
references.citation: J Abnorm Psychol. 2009 Nov;118(4):778-87
references.pmid: 19899847
references.citation: Eur J Psychotraumatol. 2011;2:
references.pmid: 22893814
references.citation: J Pediatr Psychol. 2009 Jun;34(5):495-510
references.pmid: 19029142
references.citation: Future Child. 2000 Spring-Summer;10(1):23-52
references.pmid: 10911687
references.citation: J Pediatr Psychol. 2009 Jun;34(5):530-8
references.pmid: 18772228
references.citation: J Trauma Stress. 2006 Feb;19(1):129-39
references.pmid: 16568466
references.citation: Eur J Psychotraumatol. 2011;2:
references.pmid: 22893824
references.citation: Pediatrics. 2005 May;115(5):1261-7
references.pmid: 15867033
references.citation: Br J Clin Psychol. 2001 Jun;40(2):197-208
references.pmid: 11446241
references.citation: J Pers. 1996 Dec;64(4):923-58
references.pmid: 8956518
references.citation: Behav Res Ther. 2007 Oct;45(10):2502-7
references.pmid: 17560541
references.citation: Pediatrics. 2006 Sep;118(3):1002-9
references.pmid: 16950991
references.citation: Acta Paediatr. 2002;91(9):954-60
references.pmid: 12412872
references.citation: J Pediatr Psychol. 2009 Jun;34(5):474-87
references.pmid: 18794187
references.citation: J Clin Child Psychol. 2001 Sep;30(3):376-84
references.pmid: 11501254
references.citation: J Trauma Stress. 2007 Dec;20(6):1075-9
references.pmid: 18157890
references.citation: J Child Psychol Psychiatry. 2006 Dec;47(12):1219-27
references.pmid: 17176377
references.citation: Aust N Z J Psychiatry. 2009 Aug;43(8):746-53
references.pmid: 19629796
references.citation: J Pediatr. 2005 Mar;146(3):349-54
references.pmid: 15756218
references.citation: Arch Pediatr Adolesc Med. 2008 Jul;162(7):642-8
references.pmid: 18606935
references.citation: Behav Res Ther. 2003 Jan;41(1):1-10
references.pmid: 12488116
references.citation: Br J Clin Psychol. 2007 Jun;46(Pt 2):203-10
references.pmid: 17524213
references.citation: J Pediatr Psychol. 1998 Dec;23(6):357-66
references.pmid: 9824924
references.citation: J Consult Clin Psychol. 2006 Jun;74(3):614-21
references.pmid: 16822117
references.citation: J Consult Clin Psychol. 2011 Oct;79(5):629-42
references.pmid: 21744945
references.citation: Child Adolesc Ment Health. 2008 Nov;13(4):158-162
references.pmid: 32847188
references.citation: Pediatrics. 2006 Jan;117(1):130-8
references.pmid: 16396870
references.citation: J Pediatr Psychol. 2010 Jul;35(6):581-92
references.pmid: 19906829
references.citation: J Trauma. 2005 Apr;58(4):764-9; discussion 769-71
references.pmid: 15824653