The COPE PICU Program

For Parents of 2-to 7-year-old Critically Ill Children

The COPE (Creating Oppor­tunities for Parent Empowerment) Pediatric Intensive Care Unit (PICU) Program is an evidence-based educational-behavioral intervention program for parents whose 2 to 7 year old children are admitted to the PICU. It is designed to begin shortly after admission to the PICU and extends to 2-3 days after discharge from the hospital. The program is designed to ease adjustment to hospitalization and help prevent parent and/or child mental health problems.

COPE Program Materials Empower Parents

The program consists of an audio CD and a 32-page professionally printed workbook with educational information and activities for parents and their children to perform. Information and parent/child activities are organized in a phased sequence from soon after PICU admission until time after discharge: Phase One: 6–16 hours after admission to the PICU; Phase Two: 2–16 hours after transfer to the Pediatric Unit; Phase Three: After being home.

Onsite Training of PICU Staff

We provide onsite training workshops designed to prepare personnel who are involved in delivering COPE PICU Parent Program to families with critically ill hospitalized children. In addition, staff receive implementation consultations by phone and a copy of the COPE PICU Program Implementation Training Manual.

Supported by Randomized Controlled Trials

Findings from a randomized controlled trial with 174 parents and their young critically ill children showed positive outcomes for parents that included: less stress during hospitalization, stronger beliefs/confidence in their ability to care for their hospitalized children, greater participation in their children's care, and less depressive and post-traumatic stress disorder symptoms after hospitalization. Children of parents who received the COPE program had fewer behavior problems, less hyperactivity and more adaptive behaviors up to 12 months after hospitalization than children of parents who did not receive the COPE program.

Improved Child Outcomes

  • Fewer withdrawal symptoms at 6 months after discharge
  • Fewer overall negative behavioral symptoms and externalizing behaviors (including decreased hyperactivity) exhibited at 12 months after discharge
  • Fewer clinically significant behavioral symptoms exhibited at 12 months after discharge
  • Fewer clinically significant externalizing symptoms exhibited at 6 and 12 months after discharge
  • Greater adaptability of children at 12 months after discharge

Improved Parent Outcomes

  • Less stress in the pediatric unit
  • Greater parental anticipation in their children's physical and emotional care on the pediatric unit
  • Stronger belief in and confidence of their abilities by knowing what children's likely responses to hospitalization are and knowing how to enhance their children's adjustment on the pediatric unit
  • Less parental negative mood after hospitalization
  • Less depression after hospitalization
  • Fewer parental PTSD symptoms after hospitalization

COPE PICU Parent Program Trial References

Melnyk, B., Crean, H., Feinstein, N. F., Fairbanks, E., & Alpert-Gillis, L. October 24, 2006. 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. Journal of Pediatric Psychology. doi:10.1093/jpepsy/js1033.

Melnyk, B.M., Alpert-Gillis, L., Feinstein, N., Crean, H., Johnson, J.E., Fairbanks, E., et al. (2004). Creating Opportunities for Parent Empowerment: Program effects on the mental health/coping outcomes of critically ill young children and their mothers. Pediatrics (Electronic Pages), 113, e597-607. *

Melnyk, B. M., & Feinstein, N. F. (2001). Mediating functions of maternal anxiety and participation in care on young children’s post-hospital adjustment. Research in Nursing & Health, 24, 18-26.*

Melnyk, B.M., & Alpert-Gillis, L.J. (1998). The COPE program: A strategy to improve outcomes of critically ill young children and their parents. Pediatric Nursing, 24, 521-527.

Melnyk, B.M., Alpert-Gillis, L.J., Hensel, P.B., Cable- Beiling, R.C., & Rubenstein, J.S. (1997). Helping mothers cope with a critically ill child: A pilot test of the COPE intervention. Research in Nursing and Health, 20, 3-14.*

Melnyk, B.M. (1995). Coping with unplanned childhood hospitalization: The mediating functions of parental beliefs. Journal of Pediatric Psychology, 20, 299-312.*

Melnyk, B.M. (1995). Parental coping with childhood hospitalization: A theoretical framework to guide research and clinical interventions. Maternal Child Nursing Journal, 23, 123-131.

Melnyk, B.M. (1994). Coping with unplanned childhood hospitalization: effects of informational interventions on mothers and children. Nursing Research, 50-55.*

Vulcan, B.M [Melnyk], & Nikulich-Barrett, M. (1988). The effect of selected information on mothers’ anxiety levels during their children’s hospitalizations. Journal of Pediatric Nursing, 3, 97-102*

Vulcan, B. (1984). Major coping behaviors of a hospitalized 3-year-old boy. Maternal Child Nursing Journal, 13, 113-123.*

Other Pertinent COPE Pediatric and PICU References

Melnyk, B.M., & Feinstein, N.F. (2009). Reducing hospital expenditures with the COPE (Creating Opportunities for Parent Empowerment) program for parents and premature infants: An analysis of direct healthcare neonatal intensive care unit costs and savings. Nursing Administration Quarterly, 33(1), 32- 37.*

Melnyk, B.M., Crean, H., Feinstein, N.F., Fairbanks, E. (2008). Maternal anxiety and depression following a premature infants’ discharge from the NICU: Explanatory effects of the COPE Program. Nursing Research. 57(6), 383-394.*

Melnyk, B.M., Feinstein, N.F., Alpert-Gillis, L., Fairbanks, E., Crean, H., Sinkin, R.A., et al. (2006). Reducing premature infants’ length of stay and improving parents’ mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) Neonatal Intensive Care Unit Program: A randomized controlled trial. Pediatrics, 118, e414-e1437. *

Melnyk, B.M., Feinstein, N.F., & Fairbanks, E. (2006). Two decades of evidence to support implementation of the COPE program as standard of practice with parents of young hospitalized/critically ill children and premature infants. Pediatric Nursing, 32, 475-481.

Melnyk, B.M., Feinstein, N. F., & Fairbanks, E. (2002). Effectiveness of informational/behavioral interventions with parents of low birth weight (LBW) premature infants: an evidence base to guide clinical practice. Pediatric Nursing, 28, 511-516.

Melnyk, B.M., Feinstein, N.F., Alpert-Gillis, L., Fairbanks, E., Crean, H., Sinkin, R.A., et al. (2001). Improving cognitive development of low-birth-weight premature infants with the COPE program: A pilot study of the benefit of early NICU intervention with mothers. Research in Nursing & Health, 24, 373- 389.*

* Randomized Controlled Trials