Elsevier

The Journal of Pediatrics

Volume 143, Issue 3, September 2003, Pages 386-393
The Journal of Pediatrics

A community-based intervention for siblings and parents of children with chronic illness or disability: the ISEE study

https://doi.org/10.1067/S0022-3476(03)00391-3Get rights and content

Abstract

Objective

Siblings of children with chronic illness or disability have been reported to have a 1.6 to 2.0 risk for behavioral and mental health problems. Our objective was to examine the effects of an intervention for siblings (age 7–15 years) of children with chronic illness or disability.

Method

A randomized, three-group repeated-measures design was used: full intervention (n = 79), partial intervention (n = 71), and a waiting list control group (n = 102). Outcomes were sibling knowledge about illness, behavior problems, social support, self-esteem, attitude, and mood measured over four postintervention periods. Covariates were family cohesion, maternal mood, socioeconomic status, and well sibling age. The full intervention included structured teaching and psychosocial sessions at a 5-day residential summer camp. The partial intervention included camp only. Treatment effects were estimated by using generalized estimating equation panel analyses.

Results

The full treatment group showed significant improvements on all six outcomes over most periods, the partial treatment group on three outcomes, and the control group on two outcomes. Improvements in outcomes ranged from 5% to 25% increases over baseline measures.

Conclusions

A dose-response relationship to intervention was found. Treatment gains were sustained over a period of 12 months.

Section snippets

Study design

The study was a randomized, three-group, repeated-measures (panel) design consisting of assessments of the performance of groups at baseline and at four postintervention periods: 5 days, 4 months, 9 months, and 12 months after baseline. Outcomes were measured on 6 interval scales: Sibling Knowledge About Illness (SKNOW), Sibling Social Support (SSUP), Sibling Self-Esteem (SSELF), Sibling Mood (SMOOD), Sibling Behavior Problems (SBEHV), and Sibling Attitude Towards Illness (SATT).

The full

Sample characteristics at baseline

Parent–sibling dyads (n = 292) were entered into the study, with 252 completing all periods of observation and data collection. Seven of the 40 withdrawals occurred because the same parent did not accompany the sibling to all five data collection sessions. No statistically significant differences were found between subjects withdrawn from the study and those subjects who remained.

A total of 79, 71, and 102 siblings were in the full treatment, partial treatment, and control groups, respectively.

Discussion

These findings must be used cautiously when reference is made to low-income socioeconomic status minority populations, because they were not well represented in this study. Further studies are needed on these populations. Findings of the current study, however, do indicate that the full intervention had anticipated treatment effects on the subjects.

These effects were strongest in the full intervention group relative to the partial intervention and control groups in the transmission of sibling

Acknowledgements

Invaluable assistance was provided to the project by Stephanie Schwartz, MPH, CNS, CDE, RN, of the Children's Mercy Hospital, Diabetes Clinic, Kansas City, MO; Anne Guthrie, MEd; Catherine DeVoge, MSN, RN; and Ubolrat Piamjariyakul, PhD, RN, of the University of Kansas School of Nursing. The Missouri Association for Social Welfare acted as subcontractor for the maintenance of study databases. Tom Gould, MPA, Western Regional Coordinator, Missouri Association for Social Welfare, assisted in the

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