A randomized, controlled trial of a community-based support program for families of children with chronic illness: Pediatric outcomes

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 I 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 111, 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.