Refining and Pilot Testing a Meaning-Centered and Cognitive-Behavioral Intervention to Improve the Emotional Well-Being of Family Caregivers of Children with Medical Complexity - Children with medical complexity (CMC) live with severe chronic health conditions and experience the highest risks for poor health outcomes among all children. Now ~1% of our nation’s pediatric population (>1 million children), CMC account for over one-third of annual pediatric health care expenditures. As most CMC live at home, family caregivers are responsible for providing and arranging the majority of CMC care. Given the uncertain and demanding nature of this care, many CMC caregivers experience clinically significant reductions in their emotional well-being, which can hinder their ability to care and advocate for their child. Despite CMC caregivers’ essential role in pediatric health systems, however, few evidence-based strategies specifically designed to improve their emotional well-being exist. Therefore, the overall objective of this application is to refine and pilot trial a psychological intervention aiming to improve CMC caregivers’ emotional well-being by enhancing their sense of meaning and coping abilities. This aligns with Dr. Yu’s long-term goal of becoming a leader in developing palliative care interventions to improve the well-being of CMC and their families. Dr. Yu will first conduct preliminary testing of a psychological intervention combining components of meaning-centered psychotherapy (MCP) and cognitive-behavioral therapy (CBT) among CMC family caregivers. Using human-centered design methods, Dr. Yu will collaborate with CMC caregivers and clinicians to iteratively refine the MCP-CBT intervention prototype using feedback form preliminary testing (Aim 1). Dr. Yu will then conduct a feasibility and acceptability pilot randomized controlled trial of the refined MCP-CBT intervention with 60 CMC caregivers (Aim 2). This project will enable Dr. Yu to gain the hands-on experience and focused training necessary for his career development in: (1) foundational principles in behavioral change theory and psychotherapeutic practice, (2) developing and refining psychological interventions, and (3) designing and conducting behavioral clinical trials. To achieve these goals, Dr. Yu has assembled a committed, multidisciplinary mentorship team with a history of collaboration, success in mentoring junior faculty to independence, and essential content and methodological expertise. This proposal is significant and innovative because (1) it addresses a national research priority of better supporting CMC family caregivers, and (2) will produce one of the first psychological interventions specifically designed for CMC caregivers. At the conclusion of this career development award, Dr. Yu will be well-positioned to transition to research independence, lead an R01-funded efficacy trial of the MCP-CBT intervention, and emerge as a leader in the intersecting fields of pediatric palliative care and complex care.
