Empowered Relief for Caregivers

Background and Rationale: Chronic pain is common in youth and is associated with significant long-term physical and mental health consequences, yet it remains under-recognized and undertreated. Cognitive behavioral therapy (CBT) is an effective treatment, but access barriers limit its reach, leaving a gap for scalable, accessible interventions. Empowered Relief (ER) is a single-session, skills-based intervention that has produced outcomes comparable to multi-session CBT in adults; a youth adaptation (ER-Y) has shown strong feasibility, acceptability, and effectiveness. At the same time, caregiver distress, including anxiety and depressive symptoms, is associated with worse child pain outcomes, but few brief, accessible interventions exist to support caregivers themselves. To address this gap, the investigators co-designed Empowered Relief for Caregivers (ER-CY), a brief virtual intervention for caregivers of youth with chronic pain, and designed this study to evaluate its feasibility, acceptability, and preliminary effectiveness.

Objectives: The study has two aims. Aim 1 is to assess the feasibility and acceptability of ER-CY, indexed by participant attendance and ratings of credibility and satisfaction. Aim 2 is to evaluate preliminary effectiveness, indexed by caregiver distress, caregiver behavior in response to their child's pain, and parent-reported youth pain interference. The investigators hypothesize that ER-CY will demonstrate strong feasibility and acceptability and that caregivers will show reduced distress and reduced unhelpful responses to pain, along with improvements in youth pain-related functioning over time.

Design and Procedures: This is a single-group study enrolling up to 80 caregivers of youth with chronic pain, conducted at the Pediatric Pain Management Clinic at Stanford Medicine Children's Health. Caregivers identified through the clinic complete an eligibility questionnaire, a screening call, and informed consent, and then complete baseline surveys via REDCap. Participants attend one approximately two-hour ER-CY class delivered virtually via Zoom and complete post-class surveys immediately afterward. Within one to two weeks, participants complete a semi-structured qualitative interview, which is audio- and video-recorded for analysis. Outcome and monitoring assessments are repeated at 1, 2, and 3 months following the intervention. Changes over time will be examined using mixed-effects models, and no interim analysis is planned.

• Adult Responses to Children's Symptoms (ARCS) - Protect Subscale [Time frame: Pre-class, 1 month, 2 months, and 3 months post class]
• Bath Adolescent Pain Parental Impact Questionnaire [Time frame: Pre-class, 1 month, 2 months, and 3 months post class]
• Child Activity Limitations Interview-9 [Time frame: Pre-class, 1 month, 2 months, and 3 months post class]
• Generalized Anxiety Disorder-2 [Time frame: Pre-class, 1 month, 2 months, and 3 months post class]
• Pain Catastrophizing Scale - Parent [Time frame: Pre-class, 1 month, 2 months, and 3 months post class]
• Pain Catastrophizing Scale [Time frame: Pre-class, 1 month, 2 months, and 3 months post class]
• Patient Health Questionnaire-2 [Time frame: Pre-class, 1 month, 2 months, and 3 months post class]
• Parent Psychological Flexibility Questionnaire - 10 [Time frame: Pre-class, 1 month, 2 months, and 3 months post class]
• Parent Risk and Impact Screening Measure - 12 [Time frame: Pre-class, 1 month, 2 months, and 3 months post class]