The health of primary caregivers of children with cerebral palsy: how does it compare with that of other Canadian caregivers?

The health and psychosocial functioning of caregivers of children with neurodevelopmental disorders

PURPOSE

Children with neurodevelopmental disorders (Neuro) pose complex parenting challenges, particularly if the condition co-occurs with behaviour problems. Such challenges are likely to impact caregiver health and well-being. This study explores the extent to which caregivers of children with both 'Neuro' and behaviour problems differ in their physical and psychosocial outcomes from caregivers of children with either condition or neither condition.

METHOD

The first wave of data collected in the National Longitudinal Survey of Children and Youth in Canada (1994) was used to identify four groups of caregivers of 4 to 11-year-old children: caregivers of children with a 'Neuro' disorder and externalising behaviour problems (Both; n=414), caregivers of children with a 'Neuro' disorder only (Neuro Only; n=750), caregivers of children with an externalising behaviour problem only (Ext Only; n=1067), and caregivers of children with neither health condition (Neither; n=7236).

RESULTS

Caregivers in the 'Both' group were least likely to report excellent or very good health, and more frequently reported chronic conditions such as asthma, arthritis, back problems, migraine headaches, and limitations in activities as compared to the 'Neither' group. This group also exhibited higher depression scores, experienced more problematic family functioning, and reported lower social support than the 'Neither' group. Scores for caregivers in the 'Ext Only' and 'Neuro Only' groups tended to lie between the 'Both' and 'Neither' group scores and often did not differ from one another.

CONCLUSIONS

Caregivers of children with both neurodevelopmental disorders and behaviour problems exhibited a greater number of health and psychosocial problems. While addressing children's behaviour problems, health care professionals should also consider caregiver physical and psychosocial health as this may also have an impact on children's well-being.

The health and psychosocial functioning of caregivers of children with neurodevelopmental disorders

PURPOSE

Children with neurodevelopmental disorders (Neuro) pose complex parenting challenges, particularly if the condition co-occurs with behaviour problems. Such challenges are likely to impact caregiver health and well-being. This study explores the extent to which caregivers of children with both Neuro and behaviour problems differ in their physical and psychosocial outcomes from caregivers of children with either condition or neither condition.

METHOD

The first wave of data collected in the National Longitudinal Survey of Children and Youth in Canada (1994) was used to identify four groups of caregivers of 4- to 11-year-old children: caregivers of children with a Neuro disorder and externalizing behaviour problems (Both; n = 414), caregivers of children with a Neuro disorder only (Neuro Only; n = 750), caregivers of children with an externalizing behaviour problem only (Ext Only; n = 1067), and caregivers of children with neither health condition (Neither; n = 7236).

RESULTS

Caregivers in the Both group were least likely to report excellent or very good health, and more frequently reported chronic conditions such as asthma, arthritis, back problems, migraine headaches, and limitations in activities as compared to the Neither group. This group also exhibited higher depression scores, experienced more problematic family functioning and reported lower social support than the Neither group. Scores for caregivers in the Ext Only and Neuro Only groups tended to lie between the Both and Neither group scores and often did not differ from one another.

CONCLUSIONS

Caregivers of children with both neurodevelopmental disorders and behaviour problems exhibited a greater number of health and psychosocial problems. While addressing children's behaviour problems, health care professionals should also consider caregiver physical and psychosocial health, as this may also have an impact on children's well-being.

Dental caries in cerebral palsied individuals and their caregivers' quality of life

OBJECTIVE

To study the correlation between caries experience in individuals with cerebral palsy (CP) and the quality of life of their primary caregivers.

MATERIALS AND METHODS

Sixty-five non-institutionalized individuals, presenting CP, aged 2-21 years old, were evaluated for caries experience. Their respective caregivers aged 20-74 years old answered the Short Form 36 (SF-36) health survey and Independence Measure for Children. Fifty-eight non-disabled individuals (ND group), aged 2-21 years old, and their respective caregivers, aged 25-56 years old, were submitted to the same evaluation process as the CP group.

RESULTS

Primary caregivers of CP individuals exhibited significantly lower scores than the ND group in all subscales of the SF-36 health survey questionnaire: physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role and mental health. The CP group presented significantly higher values for the Decayed, Missed and Filled (DMF-T) index than the ND group and a significant negative correlation was obtained between the SF-36 and DMF-T index.

CONCLUSION

The results suggest that caregivers of CP individuals exhibited worse quality of life than those of the non-disabled. A negative correlation exists between caries experience of CP individuals and their caregivers' quality of life.

The relationship between caregiver's strain and social support among mothers with intellectually disabled children

AIMS AND OBJECTIVES

To explore caregiver's strain, the relationship between social support and caregiver's strain and the predictors of caregiver's strain among mothers with school-aged intellectually disabled children in Taiwan.

BACKGROUND

Strain is a common condition among mothers who take care of intellectually disabled children; this correspondingly reduces their ability to care for children, thereby affecting the functioning of the entire family. Yet, there have been very few studies on caregivers of intellectually disabled children of school age.

DESIGN

Cross-section correlational design.

METHODS

Data collection consisted of face-to-face interviews combined with a structured questionnaire. Instruments employed were the Caregiver Strain Index, Social Support Scale and three open-ended questions. In total, 127 mothers completed the questionnaire.

RESULTS

Results showed that mothers with intellectually disabled children had a rather high level of strain and received inadequate social support. Social support and strain had a significant and negative correlation. Stepwise regression analysis revealed that mothers' health status, social support and amount of time spent as a caregiver, as well as the intellectually disabled children's dependent degree of daily living activity, were major predictors of caregiver's strain, which accounted for 38.4% of the total variance.

CONCLUSIONS

The results provide a guide for healthcare professionals in designing effective interventions and preventive care to reduce the level of strain in mothers with intellectually disabled children. This, in turn, could improve the quality of life of the mother and her family.

RELEVANCE TO CLINICAL PRACTICE

In Taiwan, care of intellectually disabled children is primarily provided by family members. Therefore, we should emphasise family-centred care to enable healthcare professionals to become more effective as case managers in local clinics, schools and communities.

Parents' perspectives of surgery for a child who has cerebral palsy

INTRODUCTION

This article explores parents' experiences when their child who is disabled with cerebral palsy was going through a surgical procedure. The literature suggests that parents' uncertainty is a consistent concept regarding the families' experiences in postoperative recovery unit.

METHODS

A hermeneutic phenomenological in-depth interview was used, and data are analyzed and interpreted to reflect the words and actions of the participants. Parents of nine children with cerebral palsy were interviewed during recovery or after the children had recovered from the surgery.

RESULTS

The parents reported feeling vulnerable and helpless in a situation where children cannot express their concerns, and parents were fearful of the consequences of surgery, because they were not familiar with what is going on in the hospital. Extreme tiredness is an unrelenting condition in the experience of these parents, being constantly available for the child but also being strong for the child's sake.

DISCUSSION

Parents perceived that health professionals, especially those with limited experience with children with disabilities, did not understand parents or see parents as unique individuals who are linked to their child in a very special way. The importance of being aware of parents' previous experiences and the need to offer both parents and the child emotional support is clear from this study.

Avaliação da sobrecarga do cuidador de crianças com paralisia cerebral através da escala Burden Interview

OBJETIVOS: avaliar fatores que influenciam na sobrecarga dos cuidadores de crianças com paralisia cerebral. MÉTODOS: foram entrevistados 56 cuidadores de crianças com paralisia cerebral com idade entre um e 15 anos. Para avaliar a sobrecarga dos cuidadores foi utilizada a escala Burden Interview e foram coletados dados sobre nível socioeconômico da família, gravidade do comprometimento motor, diagnóstico topográfico e idade das crianças com paralisia cerebral. Para análise dos dados foram utilizados os testes Mann-Whitney e Kruskal-Wallis. RESULTADOS: um menor nível socioeconômico da família (p=0,03) e uma menor gravidade do comprometimento motor (p=0,05) das crianças com paralisia cerebral foram associados com maior sobrecarga do cuidador. Não houve diferença significativa em relação ao diagnóstico topográfico (p=0,71) e à idade das crianças com paralisia cerebral (p=0,35). CONCLUSÕES: o conhecimento de fatores que influenciam a sobrecarga dos cuidadores de crianças com paralisia cerebral é mais um dado a ser agregado no planejamento de atenção e intervenção a esse público específico.

Guatemalan caregivers' perceptions of receiving and using wheelchairs donated for their children

PURPOSE

The purpose of this qualitative study was to explore the experiences, perceptions, and needs of caregivers receiving wheelchairs donated for nonambulatory children in a less-resourced country.

METHODS

A phenomenological research design was used with purposeful sampling of 14 participants living in urban and rural areas of Guatemala. Data were collected primarily by interviews and supplemented with observations in natural settings, photographs, and record reviews.

RESULTS

Eight themes emerged uncovering the meaning and essence of caregivers' experiences: value of the wheelchair, relief for caregivers, enhancement of child participation, wheelchair as a form of "therapy," improvement of learning opportunities, challenges to inadequate disability awareness, impact of contextual barriers, and need for community-based supports.

CONCLUSION

Caregivers in this sample perceived donated wheelchairs as beneficial to themselves and to their children. Support was found for the need to provide wheelchairs in collaboration with local services to support wheelchair use.

Maternal parenting stress and its correlates in families with a young child with cerebral palsy

OBJECTIVE

To investigate factors predicting parenting stress in mothers of pre-school children with cerebral palsy.

METHOD

Eighty mothers and children participated. Mothers completed the Parenting Stress Index (PSI) and the following measures of family functioning: family support, family cohesion and adaptability, coping strategies, family needs and locus of control. Children were assessed using the Griffiths Scales and the Gross Motor Function measure. The child's home environment was assessed using Home Observation for Measuring the Environment.

RESULTS

Mothers had higher mean total PSI scores than the means for the typical sample; 43% had total PSI scores above the threshold for clinical assessment. Cluster analysis demonstrated five distinct clusters of families, more than half of whom were coping well. High stress items were role restriction, isolation and poor spouse support, and having a child who was perceived as less adaptable and more demanding. Lower stress items indicated that this sample of mothers found their children emotionally reinforcing and had close emotional bonds. Regression analysis showed that the factors most strongly related to parenting stress levels were high family needs, low family adaptability and cognitive impairment in the child.

CONCLUSIONS

The results confirmed the individuality of families, and that individual characteristics of coping and feeling in control, together with family support and cohesion, are associated with variation in amount of stress experienced in parenting a child with cerebral palsy.

Health among caregivers of children with health problems: findings from a Canadian population-based study

OBJECTIVES

We used population-based data to evaluate whether caring for a child with health problems had implications for caregiver health after we controlled for relevant covariates.

METHODS

We used data on 9401 children and their caregivers from a population-based Canadian study. We performed analyses to compare 3633 healthy children with 2485 children with health problems. Caregiver health outcomes included chronic conditions, activity limitations, self-reported general health, depressive symptoms, social support, family functioning, and marital satisfaction. Covariates included family (single-parent status, number of children, income adequacy), caregiver (gender, age, education, smoking status, biological relationship to child), and child (age, gender) characteristics.

RESULTS

Logistic regression showed that caregivers of children with health problems had more than twice the odds of reporting chronic conditions, activity limitations, and elevated depressive symptoms, and had greater odds of reporting poorer general health than did caregivers of healthy children.

CONCLUSIONS

Caregivers of children with health problems had substantially greater odds of health problems than did caregivers of healthy children. The findings are consistent with the movement toward family-centered services recognizing the link between caregivers' health and health of the children for whom they care.

Incapacidade funcional associada à lombalgia em cuidadores de crianças com paralisia cerebral grave

O objetivo deste estudo foi analisar a contribuição de variáveis físicas, psicossociais e sociodemográficas para a ocorrência de incapacidade funcional associada à dor lombar entre cuidadores de crianças com paralisia cerebral grave. A amostra foi composta de 45 cuidadores com lombalgia crônica. Foram coletados dados sociodemográficos e aplicados instrumentos sobre intensidade da dor, satisfação com a vida e incapacidade funcional. Os dados foram tratados estatisticamente e o nível de significância fixado em p<0,05. As variáveis que apresentaram correlação significativa com incapacidade (p<0,05) foram inseridas no modelo de regressão linear múltipla. A média de intensidade da dor foi 5,67±2,23; os escores médios de satisfação com a vida foram de 18,9±6,64 e de incapacidade, 9±5,35. Apenas a correlação entre intensidade de dor e incapacidade foi significativa (r=0,34; p=0,021). A análise de regressão linear múltipla confirmou a intensidade da dor como o maior preditor de incapacidade e explicou 11% da incapacidade (r=0,36; p<0,05). A intensidade da dor lombar é pois um preditor moderado de incapacidade, mas não foi encontrada interferência das variáveis sociodemográficas e satisfação com a vida no grau de incapacidade funcional dos cuidadores de crianças com paralisia cerebral.

Hidden consequences of success in pediatrics: parental health-related quality of life--results from the Care Project

CONTEXT

The number of parents who care for a chronically ill child is increasing. Because of advances in medical care, parental caring tasks are changing. A detailed description of parental health-related quality of life will add to the understanding of the impact of caring for a chronically ill child. This will contribute to pediatric family care.

OBJECTIVE

Our goal was to determine the health-related quality of life of parents of chronically ill children compared with parents of healthy schoolchildren.

DESIGN, SETTING, AND PARTICIPANTS

A survey of 533 parents of children with chronic conditions (10 diagnosis groups, children aged 1-19 years, diagnosed >1 year ago, living at home) and 443 parents of schoolchildren was conducted between January 2006 and September 2007. Parents were approached through Emma Children's Hospital (which has a tertiary referral and a regional function) and through parent associations. The comparison group included parents of healthy schoolchildren. Health-related quality of life was assessed with the TNO-AZL Questionnaire for Adult's Health Related Quality of Life.

MAIN OUTCOME MEASURE

Health-related quality of life measures gross and fine motor function, cognitive functioning, sleep, pain, social functioning, daily activities, sexuality, vitality, positive and depressive emotions, and aggressiveness. The health-related quality of life of the study group was compared with that of the comparison group, and effect sizes were estimated. The percentages of parents at risk for a low health-related quality of life were compared with the 25th percentile scores of the comparison group. RESULTS. Parents of chronically ill children had a significantly lower health-related quality of life. Subgroup analysis showed lower health-related quality of life on sleep, social functioning, daily activities, vitality, positive emotions, and depressive emotions in disease-specific groups. On average, 45% of the parents were at risk for health-related quality-of-life impairment.

CONCLUSIONS

Parents of chronically ill children report a seriously lower health-related quality of life, which should receive attention and supportive care if necessary. A family-centered approach in pediatrics is recommended.

The relationship between proxy reported health-related quality of life and parental distress: gender differences

OBJECTIVE

Although primary caregiver proxy reports of health-related quality of life (HRQOL) are often used for healthcare decision making when child self-reports are unable to be collected (because of a variety of reasons such as child illness, disability or age), we have little understanding of the correlates of parent-proxy reports. The aim of this study was to examine the relationship between parental depression and parent-proxy reported QOL for primary caregivers (mothers and fathers), using a multidimensional HRQOL instrument. It was hypothesized that maternal depression would be negatively correlated with maternal reported HRQOL, but that paternal depression would not be correlated with paternal reported HRQOL.

METHODS

Data were from parents of children aged 4-5 years (n = 4983) involved in the Longitudinal Study of Australian Children. A questionnaire assessing parental depression (Kessler-6) and proxy reported HRQOL (Pediatric Quality of Life Inventory) was completed by the primary caregiver.

RESULTS

For maternal primary caregivers, maternal depression was negatively correlated with all domains of maternal proxy reports of HRQOL (r = -0.24 to r = -0.36). For paternal primary caregivers, there was no relationship between paternal depression and paternal proxy reports of HRQOL. Multiple regression analyses demonstrated that maternal depression was a significant predictor of total HRQOL, accounting for 12% of the variance. For paternal mental health, depression did not predict parent-proxy reported total HRQOL.

CONCLUSION

These results highlight the importance of assessing maternal mental health when measuring proxy reported QOL. Further research is needed in this area to examine the relationship between parental depression and proxy reported HRQOL (including both mothers and fathers, where possible), as well as child self-reported HRQOL.

Relação entre desempenho funcional de crianças com paralisia cerebral e qualidade de vida relacionada à saúde de seus cuidadores

Cuidadores de crianças com paralisia cerebral (PC), ao lidar com as incapacidades da criança, são suscetíveis a detrimento de sua saúde física e bem-estar psicológico, o que pode ter impacto em sua qualidade de vida relacionada à saúde (QV). O objetivo deste estudo foi verificar se há correlação entre o desempenho funcional de crianças com PC e a QV de seus cuidadores, verificando também eventual correlação entre o nível de função motora e o desempenho funcional em crianças com PC. A QV de 17 cuidadores de crianças com PC foi avaliada pelo questionário Short-Form Health Survey (SF-36); a função motora e o desempenho funcional das respectivas crianças foram avaliados pelo Gross Motor Function Classification System (GMFCS) e pelo Inventário de Avaliação Pediátrica de Disfunção (PEDI). Os dados foram tratados estatisticamente. Nenhuma correlação significativa foi encontrada entre a classificação no GMFCS ou o escore no PEDI e os escores dos cuidadores no SF-36. Foi encontrada forte correlação negativa entre os escores das crianças no PEDI e os níveis do GMFCS. A qualidade de vida de cuidadores de crianças com PC não foi pois influenciada pelo grau de limitação funcional de suas crianças. No entanto, o GMFCS mostrou-se um bom preditor de funcionalidade em crianças com paralisia cerebral.

Labor market productivity costs for caregivers of children with spina bifida: a population-based analysis

BACKGROUND

Caregiver productivity costs are an important component of the overall cost of care for individuals with birth defects and developmental disabilities, yet few studies provide estimates for use in economic evaluations.

OBJECTIVE

This study estimates labor market productivity costs for caregivers of children and adolescents with spina bifida.

METHODS

Case families were recruited from a state birth defects registry in Arkansas. Primary caregivers of children with spina bifida (N = 98) reported their employment status in the past year and demographic characteristics. Controls were abstracted from the Current Population Survey covering the state of Arkansas for the same time period (N = 416). Estimates from regression analyses of labor market outcomes were used to calculate differences in hours worked per week and lifetime costs.

RESULTS

Caregivers of children with spina bifida worked an annual average of 7.5 to 11.3 hours less per week depending on the disability severity. Differences in work hours by caregivers of children with spina bifida translated into lifetime costs of $133,755 in 2002 dollars using a 3% discount rate and an age- and sex-adjusted earnings profile. Including caregivers' labor market productivity costs in prevention effectiveness estimates raises the net cost savings per averted case of spina bifida by 48% over the medical care costs alone.

CONCLUSIONS

Information on labor market productivity costs for caregivers can be used to better inform economic evaluations of prevention and treatment strategies for spina bifida. Cost-effectiveness calculations that omit caregiver productivity costs substantially overstate the net costs of the intervention and underestimate societal value.

Students with chronic diseases: nature of school physician support

BACKGROUND

To educate children with chronic diseases in the least restrictive environment, schools must prevent, recognize, and react appropriately to symptom exacerbations. Schools are often pushed to their limits of knowledge, resources, and comfort level. This study determined the health conditions of students for whom districts seek school physician consultation and the nature of school physician consultants' involvement.

METHODS

A retrospective record review was performed on 250 of the most recent records of school-elicited referrals from an academic center that provides physician consultation to school districts. Referrals were sent from 8 school districts in southern California (July 1996 to October 2006). Data collected were nature of student's special health need, the school physician consultant's intervention required to satisfy schools' needs, student grade level, enrollment in special education, and health-related excessive absenteeism.

RESULTS

No single chronic condition, symptom, or special health care need predominated. Six types of school physician consultant activities were used to overcome hurdles schools faced when accommodating students with special health care needs. The 3 most common were direct communication with students' own physicians (70% of students), recommending an appropriate level of school health services when this was a matter of controversy (42%), and formulating portions of students' individualized school health plans (38%).

CONCLUSIONS

A portion of students with special health care needs benefited from district referral to a school physician consultant. Whether some of these referrals can be avoided if school personnel and students' own physicians are supported and trained to communicate more effectively with one another needs to be explored.

Parenting stress in mothers and fathers of a child with a hemiparesis: sources of stress, intervening factors and long-term expressions of stress

BACKGROUND

In a substantial minority of children with a hemiparesis, motor impairments are accompanied by behavioural problems. This combination confronts parents with several persistent, frequently intense, sources of stress. At the same time, it is likely to reduce the effectiveness of psychosocial resources, such as feelings of competence, which would normally buffer the impact of the stressors. Aim To investigate the association between motor and behavioural problems in children with a hemiparesis and symptoms of stress in their parents, with particular attention to psychosocial factors which may mediate between the child's problems and parents' symptoms of stress.

METHOD

Questionnaires assessing the medical, functional and behaviour problems of the child, and the parents' experience of stress were completed by the mothers and fathers of 108 children with a hemiparesis who were members of the Association for the Motor Handicapped in the Netherlands.

RESULTS

Both parents reported (extremely) high levels of long-term stress significantly more frequently than parents in a normative sample. Indices of long-term stress were associated with the child's behavioural problems and, less strongly, with dysfunctionality in daily life. However, behavioural problems and dysfunctionality also reduced parents' feelings of competence and social support. A mediation analysis showed that feelings of incompetence and social isolation mediated between the child's problems and the parents' symptoms of stress. Fathers and mothers did not differ in level of reported stress, or in the associations between the child's problems and degree of experienced stress.

CONCLUSION

Both parents of a child with a hemiparesis experience high levels of stress, which are strongly associated with feelings of incompetence and social isolation. This suggests that one focus of intervention should be the alleviation of parenting stress with particular attention to increasing perceived competence in the parenting role and reducing feelings of social isolation.

Developing a literature base to understand the caregiving experience of parents of children with cancer: a systematic review of factors related to parental health and well-being

GOAL OF WORK

This paper describes a literature review conducted to identify important factors that have been investigated as explanations of variability in the health and well-being of parents of children with cancer. Our purpose was to build a literature base that could be used to guide and direct future research.

MATERIALS AND METHODS

Medline, Cinahl, EMBASE, PsycINFO, and Sociological Abstracts were searched from 1980 to 2005 using the keywords neoplasms; child(ren) aged 0-18 years; parent(s), caregiver(s), mother(s), or father(s). For papers that met the study inclusion criteria, sample characteristics and information about factors related to caregiver health, or the relationship between such factors, were extracted. The findings were organized according to the six main constructs that form the caregiving process and caregiver burden model: background/context variables; child characteristics; caregiver strain; self-perception; coping factors; and caregiver physical and psychological health.

MAIN RESULTS

Articles meeting the inclusion criteria totaled 57. We found substantial research showing that certain child characteristics (e.g., child behavior; time since diagnosis) and indicators of coping (e.g., family cohesion, social support, stress management) are related to parental psychological health. Other aspects of the caregiving process (e.g., parental self-perception, family-centered care, and physical health) have received less research attention.

CONCLUSION

Various limitations and gaps in the current literature were identified in our review. Future research to understand the complex interrelationships between factors involved in the caregiving process should examine hypotheses that are guided by a theoretical framework and tested using advanced statistical techniques.

Physical and mental health problems in parents of adolescents with burns--a controlled, longitudinal study

OBJECTIVE

Caregiving has been described in the literature as a risk factor for ill health in the carer. This controlled, prospective study examines the course of physical and mental health problems in parents of adolescent survivors of a mass burn incident.

METHODS

Health information was extracted from electronic medical records. Continuous data were available for 1 year before and 4 years after the fire. Cohorts comprised 273 parents of survivors with burns, 199 parents of survivors without burns, and 1756 controls. Post-fire increases in health problems were compared by means of logistic regression.

RESULTS

Parents of burn victims were more likely to present mental health problems during the first 2 years after the incident, when compared to the baseline. Moreover, they were more likely to present cardiovascular health problems in every year following the disaster, compared to the baseline. Increases observed in mental and cardiovascular health problems were significantly larger in parents of burn victims compared to controls. Risk factors for presenting mental health problems were female gender of the parent and a large burn size in the child. Lower socioeconomic status and female gender of the parent predicted cardiovascular health problems.

CONCLUSION

Evidence gained in longitudinal studies informs on which health problems are most likely to develop in parental caregivers. In the interest of both parent and child, a family-oriented approach is proposed.

Impact of caring for children with cerebral palsy on the general health of their caregivers in an African community

Caring for children with physical disabilities such as cerebral palsy can have an impact on the health of their caregivers. Records show a dearth of literature on the health impact of caring for children with cerebral palsy (CP) in Africa. This study compared the general health of caregivers of children with cerebral palsy (CGCP) with that of caregivers of age-matched children without cerebral palsy (CGNCP). The relationship between severities of motor disorder in children with CP and the general health of their caregivers was also investigated. Participants comprised 71 CGCP and 70 CGNCP in the Yoruba community of South-Western Nigeria. The General Health Questionnaire was administered to all participants and the severity of motor disorder was assessed in children with cerebral palsy using the Gross Motor Function Measure-66. Results showed significantly higher General Health Questionnaire scores in the caregivers of children with cerebral palsy than in the caregivers of age-matched children without cerebral palsy group (U=1237.5, P=0.00). No significant correlation was found between the Gross Motor Function Measure and General Health Questionnaire scores of the caregivers of children with cerebral palsy (rho=-0.104). Caring for children with cerebral palsy apparently had a negative impact on the health of their caregivers when compared with the health of caregivers of children without cerebral palsy. It seemed that severity of motor disorder in cerebral palsy had no direct bearing on the health status of caregivers.

The health of caregivers for children with disabilities: caregiver perspectives

BACKGROUND

There are an estimated 5.9 million children with severe disabilities in the USA, and most of them are cared for at home by their parents and families. Indirect evidence suggests that poor caregiver health may contribute to recurrent hospitalizations and out-of-home placements for children with chronic conditions and disabilities. Greater knowledge of caregiver health-related needs would allow for the improvement of existing services and the development of new strategies to sustain caregivers in their vital roles. This study explores caregiver perspectives of the health implications of long-term informal caregiving for children with disabilities.

METHODS

Forty parents/caregivers of children with disabilities residing in urban, suburban and rural regions of Utah completed questionnaires and participated in focus groups that explored their feelings regarding their current physical and emotional health and the factors that they viewed as either impairing or promoting their health. The sessions were audiotaped and transcribed. Summary statistics were generated for the questionnaire responses. Focus group content was analysed according to emerging themes and patterns in clusters of information.

RESULTS

The caregiving experience was captured by five themes: (i) stress of caregiving; (ii) negative impact on caregiver health; (iii) sharing the burden; (iv) worry about the future; and (v) caregiver coping strategies. Forty-one per cent of the caregivers reported that their health had worsened over the past year, and attributed these changes to a lack of time, a lack of control and decreased psychosocial energy.

CONCLUSIONS

Caregivers of children with disabilities describe negative physical, emotional and functional health consequences of long-term, informal caregiving. They have important insights regarding those aspects of caregiving that have positive and negative influences on their health. Interventions that address these issues may have the potential to positively impact caregiver health.

Keeping It Together: an information KIT for parents of children and youth with special needs

BACKGROUND

Provision and use of information about their children is a major concern to families who have a child with a disability. Strategies or systems to influence parents' abilities to receive, give and use information in a way that is satisfying to them have not been well validated.

METHODS

This paper reports on the development and evaluation of a Parent Information KIT ('Keeping It Together') information management system and child advocacy tool. The KIT was designed to assist parents in giving, getting and organizing information in an effective way. The KIT was evaluated by a sample of 440 parents, with outcomes of use, utility, impact and perceptions of family-centred care measured at baseline, and after 6 months, and 15 months.

RESULTS

Parents' perceptions of their ability, confidence and satisfaction when using information improved significantly after using the KIT. Parents' perceptions of care, as measured with the Measure of Processes of Care, also improved significantly in the areas of 'Enabling/Partnership' and 'Providing General Information'. Parents' ratings of the use and utility of the KIT were associated with increased impact and, in turn, predicted improved perceptions of care.

CONCLUSION

Parents who received and actively used the Parent Information KIT experienced significant increases in their perception of their ability and self-confidence in getting, giving and using information to assist their child with a disability. Strategies for improving the use of the KIT among parents are discussed.

Health-related quality of life in parents of school-age children with Asperger Syndrome or High-Functioning Autism

BACKGROUND

The estimated prevalence rate of Pervasive Developmental Disorders (PDD) in children is 6 per 1.000. Parenting children who are intellectually impaired and have PDDs is known to be linked to the impaired well-being of the parents themselves. However, there is still little available data on health-related quality of life (HRQL) in parents of children with Asperger Syndrome (AS) and High-Functioning Autism (HFA), or other PDD diagnoses in children of normal intelligence. The present study aimed to evaluate aspects of HRQL in parents of school-age children with AS/HFA and the correlates with child behaviour characteristics.

METHODS

The sample consisted of 31 mothers and 30 fathers of 32 children with AS/HFA and 30 mothers and 29 fathers of 32 age and gender matched children with typical development. Parental HRQL was surveyed by the use of the 12 Item Short Form Health Survey (SF-12) which measures physical and mental well-being. The child behaviour characteristics were assessed using the structured questionnaires: The High-Functioning Autism Spectrum Screening Questionnaire (ASSQ) and The Strengths and Difficulties Questionnaire (SDQ).

RESULTS

The mothers of children with AS/HFA had lower SF-12 scores than the controls, indicating poorer physical health. The mothers of children with AS/HFA also had lower physical SF-12 scores compared to the fathers. In the AS/HFA group, maternal health was related to behaviour problems such as hyperactivity and conduct problems in the child.

CONCLUSION

Mothers but not fathers of children with AS/HFA reported impaired HRQL, and there was a relationship between maternal well-being and child behaviour characteristics.

The autonomy of professionals and the involvement of patients and families

PURPOSE OF REVIEW

The involvement of patients/service users and their families/caregivers in the field of mental health has been of interest for several years. It is timely to review what has been learned about involvement; to understand where and how involvement has been implemented; and to explore factors which influence the effectiveness of implementation. Recent literature on user involvement and its implications for professional practice forms the focus of this review. Material is drawn largely from Europe, North America and Australasia, since this reflects where there is most interest in this topic. Papers outside of mental health are included where they further illuminate issues under discussion.

RECENT FINDINGS

The involvement of users/patients and their caregivers is an important aspect of the care and treatment of mental illness extending across health and social care. Involvement has implications for professional practice including the negotiation of treatment, the coordination of care and communication strategies. Tensions may emerge during the process of effectively implementing patient/family involvement, but the autonomy of professionals is not usually a factor.

SUMMARY

There is no singular definition of involvement. There has been growth in the levels of user/caregiver involvement, particularly in community-based provision and within transition processes from hospital to community-based treatment. There is no suggestion that involvement is widespread. Implementation of involvement should be underpinned by effective communication on the part of professionals and recognition of service users and caregivers as partners in processes of treatment and recovery. Implementation is most effective when supported by appropriate organizational policies and integrated into the education of health professionals.

Hospitalist care of the medically complex child

The nature of inpatient pediatrics is changing. Over the past decade, several factors have converged to influence the kinds of children currently being hospitalized. There has been a shift in the relative proportion of otherwise healthy children with acute illnesses being hospitalized to children with increasing medical complexity. This article focuses on hospitalist care of medically complex children and provides an overview on (1) the challenges in defining this population, (2) the unique issues surrounding their inpatient care (using a family-centered care approach that includes coordinated care, minimizing secondary complications, nutritional needs, functional limitations, transdisciplinary collaboration, and primary care issues), (3) technology devices commonly found, and (4) a proposal for a research agenda regarding medically complex children.

The health and well-being of caregivers of children with cerebral palsy

OBJECTIVE

Most children enjoy healthy childhoods with little need for specialized health care services. However, some children experience difficulties in early childhood and require access to and utilization of considerable health care resources over time. Although impaired motor function is the hallmark of the cerebral palsy (CP) syndromes, many children with this development disorder also experience sensory, communicative, and intellectual impairments and may have complex limitations in self-care functions. Although caregiving is a normal part of being the parent of a young child, this role takes on an entirely different significance when a child experiences functional limitations and possible long-term dependence. One of the main challenges for parents is to manage their child's chronic health problems effectively and juggle this role with the requirements of everyday living. Consequently, the task of caring for a child with complex disabilities at home might be somewhat daunting for caregivers. The provision of such care may prove detrimental to both the physical health and the psychological well-being of parents of children with chronic disabilities. It is not fully understood why some caregivers cope well and others do not. The approach of estimating the "independent" or "direct" effects of the care recipient's disability on the caregiver's health is of limited value because (1) single-factor changes are rare outside the context of constrained experimental situations; (2) assumptions of additive relationships and perfect measurements rarely hold; and (3) such approaches do not provide a complete perspective, because they fail to examine indirect pathways that occur between predictor variables and health outcomes. A more detailed analytical approach is needed to understand both direct and indirect effects simultaneously. The primary objective of the current study was to examine, within a single theory-based multidimensional model, the determinants of physical and psychological health of adult caregivers of children with CP.

METHODS

We developed a stress process model and applied structural equation modeling with data from a large cohort of caregivers of children with CP. This design allowed the examination of the direct and indirect relationships between a child's health, behavior and functional status, caregiver characteristics, social supports, and family functioning and the outcomes of caregivers' physical and psychological health. Families (n = 468) of children with CP were recruited from 19 regional children's rehabilitation centers that provide outpatient disability management and supports in Ontario, Canada. The current study drew on a population available to the investigators from a previous study, the Ontario Motor Growth study, which explored patterns of gross motor development in children with CP. Data on demographic variables and caregivers' physical and psychological health were assessed using standardized, self-completed parent questionnaires as well as a face-to-face home interview. Structural equation modeling was used to test specific hypotheses outlined in our conceptual model. This analytic approach involved a 2-step process. In the first step, observed variables that were hypothesized to measure the underlying constructs were tested using confirmatory factor analysis; this step led to the so-called measurement model. The second step tested hypotheses about relationships among the variables in the structural model. All of the hypothesized paths in the conceptual model were tested and included in the structural model. However, only paths that were significant were shown in the final results. The direct, indirect, and total effects of theoretical constructs on physical and psychological health were calculated using the structural model.

RESULTS

The most important predictors of caregivers' well-being were child behavior, caregiving demands, and family function. A higher level of behavior problems was associated with lower levels of both psychological (beta = -.22) and physical health (beta = -.18) of the caregivers, whereas fewer child behavior problems were associated with higher self-perception (beta = -.37) and a greater ability to manage stress (beta = -.18). Less caregiving demands were associated with better physical (beta = .23) and psychological (beta = .12) well-being of caregivers, respectively. Similarly, higher reported family functioning was associated with better psychological health (beta = .33) and physical health (beta = .33). Self-perception and stress management were significant direct predictors of caregivers' psychological health but did not directly influence their physical well-being. Caregivers' higher self-esteem and sense of mastery over the caregiving situation predicted better psychological health (beta = .23). The use of more stress management strategies was also associated with better psychological health of caregivers (beta = .11). Gross income (beta = .08) and social support (beta = .06) had indirect overall effects only on psychological health outcome, whereas self-perception (beta = .22), stress management (beta = .09), gross income (beta = .07), and social support (beta = .06) had indirect total effects only on physical health outcomes.

CONCLUSIONS

The psychological and physical health of caregivers, who in this study were primarily mothers, was strongly influenced by child behavior and caregiving demands. Child behavior problems were an important predictor of caregiver psychological well-being, both directly and indirectly, through their effect on self-perception and family function. Caregiving demands contributed directly to both the psychological and the physical health of the caregivers. The practical day-to-day needs of the child created challenges for parents. The influence of social support provided by extended family, friends, and neighbors on health outcomes was secondary to that of the immediate family working closely together. Family function affected health directly and also mediated the effects of self-perception, social support, and stress management. In families of children with CP, strategies for optimizing caregiver physical and psychological health include supports for behavioral management and daily functional activities as well as stress management and self-efficacy techniques. These data support clinical pathways that require biopsychosocial frameworks that are family centered, not simply technical and short-term rehabilitation interventions that are focused primarily on the child. In terms of prevention, providing parents with cognitive and behavioral strategies to manage their child's behaviors may have the potential to change caregiver health outcomes. This model also needs to be examined with caregivers of children with other disabilities.