Introduction Problems and Research Objective The target population consists of children ages eight to sixteen in the middle of a long-term hospital stay

Introduction

Problems and Research Objective
The target population consists of children ages eight to sixteen in the middle of a long-term hospital stay. In the midst of a long-term hospital stay children can face many emotional problems. There are many interventions that have been researched and proven to help decrease depression in hospitalized children. Among all of those interventions researched, the one that was selected to be shown was Animal-Assisted Therapy. We will learn that providing animal-assisted therapy will decrease depression levels among younger children that are housed in hospitals for longer periods of time.

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In this paper, I will propose to conduct research to evaluate the effectiveness of animal-assisted therapy on decreasing depression in children who are hospitalized long-term. This research looks over a course of four weeks at the client’s depression when using Animal-Assisted Therapy when enduring a hospital stay long-term. The next sections will show the problems, and specific interventions that will help guide this research study. The measurement tools and data collected will be later discussed in detail. As well as the implications of the proposed research with an overview of the findings from the long-term research will be provided.

Literature Review and Proposed Intervention
Problem
Throughout hospitalization, many children became diagnosed with a chronic or life-threatening illness and there are multiple causes of depression in children from hospitalized stays. In a recent study, the Agency for Healthcare Research and Quality stated, “there were nearly 5.9 million hospital stays for children in the United States” (Agency for Healthcare Research and Quality, 2014). One major cause of depression in children from long-term hospitalization is having cancer. Depression is rising in cancer patients because they fear  the cancer reoccurring once they have survived it or are close to be a survivor (Li, 2013.) Another cause of depression could be the lack of freedom and loneliness. If a younger client is stuck inside and in a hospital atmosphere for an extended period of time, that increases the risk of having depression while in the hospital. If the problem was not treated adequately there would be many consequences or risk factors. If left untreated it could affect the mental state the child thinks from that time on. The child’s thoughts of positivity will begin to decrease when feeling down about being in the hospital for so long.

A severe consequence if the depression goes untreated would be suicidal thoughts or different thoughts that would cause negative harm to the child if left ignored like depression. If the child feels that they cannot interact with peers and others outside of a hospital setting because of their illness, they will more than likely have a higher chance of these depressed thoughts. Therefore, depression is not a consequence it is more of a risk factor (Rudolph, 2010).
Many children focus on the negativity of what they are going through and do not see the positive outlook past their illness. The child then is at a higher risk of having depression while hospitalized rather than it being a consequence that they live with (Rudolph, 2010). The children are now at a health risk because of letting the depression feel like a consequence to them when in reality it is actually making them more mentally unstable. The prevalence of depression in young children is slowly increasing.

Potential Interventions
There are many interventions that are proven to help children who are depressed from extended hospital stays. Chronic illness plays a major role in the cause of depression in hospitalized children. Children that are hospitalized often face difficulties physically and mentally. Going through multiple procedures and treatments, and changes in relationships with the environment around them can have a major impact on the child’s mental status which will lead to a depressed mental state.
Digital games are becoming more useful for interaction between not only the child’s peers but healthcare. Society is increasing technology use among the youth and it is becoming more prevalent where ever you go. A three-dimensional multi-computer for inside hospital rooms can help children who have undergone a chronic or life-threatening illness share their experiences and fight isolation (Bers, 2001). The children simply create the game inside of the computer system that would be provided to them when they have become a long term patient in the hospital.

Children this young usually become interested in games they can create or games that have been created for them. In the first implementation of the system, it was created as a user-friendly system that was not cognitively demanding to the child which means that the child did not have to think very hard in order to create or learn the tasks presented on the screen. Therefore, the child’s level of depression could decrease because they are interested in the screen instead of sitting and thinking about what they are going through while having a long-term hospital stay. Anything related to hospital stays was not presented in this system (Bers, 2001). Children’s motivation plays a huge role in the determination of this intervention being successful.
The second intervention is Animal-Assisted Therapy which involves a child being introduced to an animal with an expectation that the individual will benefit while the animal is physically present with the child (Friedmann and Tsai 2006). It has been proven that animal-assisted therapy promotes not only positive emotions to a child but decreases loneliness, depression, and physical pain responses (Calvert 1989; Barker and Dawson 1998; Churchill et al. 1999; Friedmann, Thomas and Eddy 2000; Friedmann and Son 2009). The children are split into two different groups in this program and two different sessions. In one session the children are introduced to an animal and another session was a limited time puzzle. Each session was taken place in the client’s specified hospital room. AAT (Animal-Assisted Therapy) has been shown to have many positive differences and increases in psychological responses.

Proposed Evidence-Based Intervention
The intervention that is best suited for my client would be animal-assisted therapy. The feelings of loneliness and depression is normal from a long-term stay. The intervention is better than the digital three-dimensional computer because animal therapy makes sure to promote multiple positive emotions while decreasing negative feelings around what children are thinking and feeling. It helps them destress and forget about what they are physically doing at the hospital. Depression consists of many feelings suppressed into one big feeling. It has been proven that a child’s psychological depression and stress levels decreased when a dog was present with a specified child (Hansen, n.d.). The feelings of an individual that is provided with animal therapy will help their mental state decreasing the levels of depression within the long-term hospitalization stay. Another reason this intervention being the best for my client population would be the cost of purchasing the computer systems for each client participating in the study.

Research Question and Hypothesis
Is Animal-Assisted Therapy effective at helping to lower depression among children that are hospitalized? The independent variable (IV) of this research would be the Animal Assisted Therapy Program. The dependent variable (DV) would be depression. Animal-Assisted Therapy will be an effective way to help decrease depressed hospitalized children. The dependent variabable is what is present in the child’s long-term stay.

If Animal-Assisted Therapy is put into place during a child’s hospital stay for specified weeks, then the depression levels and some of the problems from long term stays may decrease. Animal-Assisted Therapy has been very useful and has been supported by numerous studies. By supporting clients during this study in a specified time frame, the child may have a positive reaction to the therapy which should decrease their depression levels. The animal therapy would have to still provide resources after the research has been completed.

Methods
Measurement
The How I Feel scale is an effective way help depressed hospitalized children. A measurement tool that will be used to measure depression in the client’s would be a scale. We would assess the level or seriousness of the target problem which happens to be depression of the clients by allowing them to fill out a scaled questionnaire on how they are feeling mentally. Specifically, if they are depressed more than usual while being hospitalized. Before clients are admitted into the hospital for a long-term stay, they will fill out a scale asking different questions of how they are feeling. Most of the questions are aimed at depression but some are specifically aimed at their feelings. We will access them one other time and look at whether the scale answers are different from one another. That is how I will measure the depression level of my clients. I can also see their actions and how they are developing over time in this long-term facility.

When a child has depression, there are red flags that a rise and are simple to spot. An existing scale as mentioned above the How I Feel Scale from Cororan ; Fisher (2013a; 013b) reference book and is intended to measure depression. This scale is the first step in seeing if the client is depressed and if the test comes back positive then we look into animal assisted therapy to help cope with the depression. Clients are asked to answer questions and rate themselves and how they feel on a scale from one to five. One meaning not at all true of me, two meaning a little true of me, three meaning somewhat true of me, four meaning pretty true of me, and five meaning very true of me. There are 30 questions asked, but this will give us a thorough and more in-depth concept of whether depression is within this long-term hospitalized client.
I chose this measure among others because this was a measuring scale that children would be able to understand and fill out to the best of their knowledge. This gives the parents and the child the ability to go through each question together and verify the clarity of each scale numbers. Often times parents see a difference in their child developing depression before the social worker or medical staff would because the parents know their child best in most cases. Reliability in this scale would be very efficient and is consistent overtime (Cororan ; Fisher (2013 a; 013b). The questions asked are very clear and are asked in ways that children are able to understand. In the How I Feel scale they worded the sentences in a question that a younger child would be able to comprehend. “I was happy very often” is a sentence pulled directly from the scale. The scale has been proven to show validity in many aspects. It gives options that the client can correlate their feelings with and it demonstrates fantastic validity while showing several measures with in the scale How I Feel.

Looking at this scale for the first time shows that the material can be read by a younger eye. The other measurement tools were very difficult to understand and were not at an appropriate comprehension level for the target age range. Depression is the dependent variable in this proposed research and this measurement tool shows the levels of depressed children before and after the interventions. Administering the test before and after would give this research the most accurate results.

Study Participants
I am a hospital social worker that works for the Children’s Hospital of Wisconsin. I will first recruit the members by approaching the patients one-on-one once they are admitted and fully into our system as a patient. I will simply create a handout also that talked more about the research study that they will possibly be a part of if they consent. The handout will provide more general information, contact information, and date to decide if they want to be a part of this study or not. I will take the first 25 individuals who agree to this study which will be considered Group One. Group Two will be the 25 individuals who did not want to participate but agreed to be recognized in this study. The research will need a comparison group and I have chosen the Nonequivalent Comparison Groups Design. When using Nonequivalent Comparison Groups Design it is very unlikely that the person administering the test can pick out the children who will and will not be able to participate in this study therefore you will have two separate randomized groups. Meaning that the selected 25 participants have been one hundred percent been chosen randomly.

Design and Collect Data
The Nonequivalent Comparison Groups Design is the research design that I feel is most appropriate for my client population. The process of this research design is finding two groups that seem to be similar to each other which in this study is Group One (Experimental group) and Group Two (Comparison Group). I want to make sure each group is comparable to each other. One way to make sure they are comparable to each other would be among those who did not agree to participate in the program but still agree to be a part of the research, include common characteristics like gender or age to the treatment group. I will give the intervention I chose to Group One at the beginning of their stay in their long-term hospitalization. I would give each of the groups a pretest as well as a post-test to see if the intervention was successful. I will have two other social workers provide information to each client, so it is not bias.
In the How I Feel Intervention, I would test this for four weeks in order to obtain accurate information because it may take that long to develop depression when you are hospitalized long-term. There is a single measurement with this intervention. This is a scale that individuals participating rate on a scale how they are feeling in that exact moment. Each number represents different measures on how they are feeling. In order to obtain accurate information, I will have other social workers gain and obtain the information that was provided by the participant.

The reason for choosing the Nonequivalent Comparison Groups Design is because in order to determine if depression is within children you have to administer a pretest and a posttest to get the most accurate results in the population selected for this research. If you provide a pretest to the individuals when they arrive, you get a sense of whether the younger child has depression when they first arrived at the hospital or if they have no depression. A posttest will validate whether or not the child has increased depression from before or if they developed depression within their hospitalized stay.
Having the comparison group can help tell the effectiveness of the program better because it shows data from before the measurements at the beginning and it shows the data collected after the measurement tools have been completed by the data collection. The limitations for the Nonequivalent Comparison Groups Design would be are they really comparable groups? The population of the clients would share most of the same similar characteristics therefore, they would be comparable still which leads this research design to be the best fit out of all the other options.
Implications of the Proposed Research
To summarize, there are younger aged clients in the Children’s Hospital of Wisconsin who have depression resulting from a long-term hospital stay. The chosen intervention that was best suited for the client population would be the Animal-Therapy Intervention. This intervention was chosen to be the best for this population because it will be very effective at reducing depression from the long-term stay.
The success of the intervention would be measured from the findings of the Nonequivalent Comparison Groups Design. The child’s score from the How I Feel measurement scale should improve after the animal therapy intervention because the younger client feels accepted, loved, and noticed by a animal that provides unconditional love to an individual no matter the circumstances they may be in. This would be a great intervention to bring to the agency because it provides validation on the decreasing of depression from how positive the animal-assisted therapy could change the lives of the children and decrease depression levels from the pretest to posttest.

References
Agency for Healthcare Research & Quality. (n.d.). Retrieved from https://www.ahrq.gov/
Li, H. W., Lopez, V., Chung, O. J., Ho, K. Y., & Chiu, S. (2013). The impact of cancer on the physical, psychological and social well-being of childhood cancer survivors. European Journal of Oncology Nursing, 17(2), 214-219. doi:10.1016/j.ejon.2012.07.010

Mccullough, A., Jenkins, M. A., Ruehrdanz, A., Gilmer, M. J., Olson, J., Pawar, A., . . . O’Haire, M. E. (2018). Physiological and behavioral effects of animal-assisted interventions on therapy dogs in pediatric oncology settings. Applied Animal Behaviour Science, 200, 86-95. doi:10.1016/j.applanim.2017.11.014

Rudolph, K. D., Troop-Gordon, W., Lambert, S. F., ; Natsuaki, M. N. (2014). Long-term consequences of pubertal timing for youth depression: Identifying personal and contextual pathways of risk. Development and Psychopathology, 26(4pt2), 1423-1444. doi:10.1017/s0954579414001126
Tsai, C., Friedmann, E., ; Thomas, S. A. (2010). The Effect of Animal-Assisted Therapy on Stress Responses in Hospitalized Children. Anthrozoös, 23(3), 245-258. doi:10.2752/175303710×12750451258977
Tsuei, M., ; Chin, J. (2011). The multi-mode digital game-based learning for elementary children with chronic illness. 2011 International Conference on Electrical and Control Engineering. doi:10.1109/iceceng.2011.605696