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Bruton L, Storey M, Gentile J, Smith TL, Bhatti P, Davis MM, Cartland J, Foster C. Access to Home- and Community-Based Services for Children with Disability: Academic Institutions' Role and Areas for Improvement. Acad Pediatr 2024; 24:596-604. [PMID: 37939827 PMCID: PMC11056305 DOI: 10.1016/j.acap.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE This project sought to describe provider- and parent-identified needs and barriers to obtaining home- and community-based services (HCBS) for children with disability (CWD) and to determine ways pediatric health care institutions can improve access to HCBS services. METHODS In this exploratory sequential mixed methods evaluation, semi-structured interviews and focus groups were conducted with multidisciplinary providers and staff from an independent children's hospital, followed by a survey of English and Spanish-speaking parents of CWD. Data from interviews and surveys were then triangulated for overarching common themes regarding how pediatric health care institutions can better support access to HCBS. RESULTS Among 382 parent respondents, 74.1% reported that their child needed a HCBS, most commonly physical/occupational/speech therapies, school-based support, and case management services. Two-thirds of parents reported at least one barrier to accessing HCBS and one-third experience >3 barriers. While multiple current institutional strengths were noted, internal weaknesses included lack of provider knowledge, staffing difficulties, and lack of protocols for identifying and tracking patients needing or receiving HCBS. External threats included requirements to entry for HCBS and transfer of care, with opportunities for improvement involving dissemination of information, funding support, and connection between providers/support staff and services. CONCLUSIONS Parents of CWD identified HCBS as necessary for the health of this population, but multiple barriers to HCBS were identified by both parents and providers. Multiple internal and external opportunities for improvement relative to pediatric health care institutions were identified, suggesting a need for a comprehensive approach to ensure that CWD receive necessary HCBS.
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Affiliation(s)
- Lucas Bruton
- Division of Advanced General Pediatrics and Primary Care (L Bruton, MM Davis, and C Foster), Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics (L Bruton, MM Davis, and C Foster), Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Margaret Storey
- Ann and Robert H. Lurie Children's Hospital of Chicago Family Advisory Board (M Storey), Chicago, Ill
| | - Jennifer Gentile
- Tulane University School of Social Work (J Gentile), Tulane University, New Orleans, La
| | - Tracie L Smith
- Department of Data Analytics and Reporting (TL Smith), Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Punreet Bhatti
- Mary Ann and J. Milburn Smith Child Health Outcomes (P Bhatti, MM Davis, J Cartland, and C Foster), Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care (L Bruton, MM Davis, and C Foster), Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics (L Bruton, MM Davis, and C Foster), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann and J. Milburn Smith Child Health Outcomes (P Bhatti, MM Davis, J Cartland, and C Foster), Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Medical Social Sciences (MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Departments of Medicine and Preventive Medicine (MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jenifer Cartland
- Mary Ann and J. Milburn Smith Child Health Outcomes (P Bhatti, MM Davis, J Cartland, and C Foster), Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Carolyn Foster
- Division of Advanced General Pediatrics and Primary Care (L Bruton, MM Davis, and C Foster), Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics (L Bruton, MM Davis, and C Foster), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann and J. Milburn Smith Child Health Outcomes (P Bhatti, MM Davis, J Cartland, and C Foster), Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
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Da Costa IGR, Brugnaro BH, Lima CRG, Kraus de Camargo O, Fumincelli L, Pavão SL, Rocha NACF. Perceived Social Support and Quality of Life of Children with and without Developmental Disabilities and Their Caregivers during the COVID-19 Pandemic in Brazil: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4449. [PMID: 36901463 PMCID: PMC10001514 DOI: 10.3390/ijerph20054449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Social support and Quality of life (QoL) are important aspects of life and should be explored during the specific scenario of the pandemic. AIMS (i) to compare the perceived social support (PSS) in caregivers and the domains of QoL of the caregiver and the child with developmental disabilities (DD) and typical development (TD); (ii) to verify the existence of the association, in each group, between the PSS, and the domain of QoL of the caregiver and the child. METHODS AND PROCEDURES 52 caregivers of children with DD and 34 with TD participated remotely. We assessed PSS (Social Support Scale), children's QoL (PedsQL-4.0-parent proxy) and caregivers' QoL (PedsQL-Family Impact Module). The groups were compared for the outcomes using the Mann-Whitney test, and Spearman's test evaluated the correlation between the PSS and the QoL (child and caregiver) in each of the groups. OUTCOMES AND RESULTS There was no difference between groups for PSS. Children with DD presented lower values in PedsQL total, psychosocial health, physical health, social activities, and school activity. Caregivers of children with TD presented lower values in PedsQL family total, physical capacity, emotional aspect, social aspect, daily activities, and higher value in communication. In the DD group, we found a positive relationship between PSS with child: Psychosocial Health (r = 0.350) and Emotional Aspect (r = 0.380), and with family: Total (r = 0.562), Physical Capacity (r = 0.402), Emotional Aspect (r = 0.492), Social Aspect (r = 0.606), Communication (r = 0.535), Concern (r = 0.303), Daily Activities (r = 0.394) and Family Relationships (r = 0.369). In the TD group, we found that PSS was positively associated with Family: Social Aspect (r = 0.472) and Communication (r = 0.431). CONCLUSIONS AND IMPLICATIONS During the COVID-19 pandemic, despite both groups presenting similar PSS, there are important differences in QoL between them. For both groups, greater levels of perceived social support are associated with greater caregiver-reported in some domains of the child's and caregiver's QoL. These associations are more numerous, especially for the families of children with DD. This study provides a unique view into the relationships between perceived social support and QoL during the "natural experiment" of living through a pandemic.
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Affiliation(s)
- Isabelle Gansella Rocha Da Costa
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil
| | - Beatriz Helena Brugnaro
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil
| | - Camila Resende Gâmbaro Lima
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil
| | - Olaf Kraus de Camargo
- CanChild, Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Lais Fumincelli
- Department of Nursing, Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil
| | - Silvia Letícia Pavão
- Department of Prevention and Rehabilitation in Physical Therapy, Federal University of Paraná (UFPR), Curitiba 80060-000, PR, Brazil
| | - Nelci Adriana Cicuto Ferreira Rocha
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil
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Shi L, Granlund M, Wang L, Huus K. Barriers and facilitators to participation in everyday activities for children with intellectual disabilities in China. Child Care Health Dev 2023; 49:346-356. [PMID: 36001483 PMCID: PMC10087295 DOI: 10.1111/cch.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with intellectual disabilities (IDs) are vulnerable and participate less in everyday activities compared to their peers with typical development. This study aimed to identify barriers and facilitators related to the participation in everyday activities of children with IDs in China. METHODS Twenty semi-structured interviews were conducted with primary caregivers of children with IDs from special schools in Tianjin, China. The data were transcribed and analysed using inductive qualitative content analysis. RESULTS Four categories of barriers to participation in everyday activities for children with IDs were identified: insufficient knowledge, attitudes and skills in primary caregivers; ID-related characteristics of children; stigma and Chinese culture; and lack of support from society. Four categories describing facilitators of participation in everyday activities for children with IDs were also identified: the optimistic attitude of the primary caregiver; adequate family support; active environment in school and policy; and attractive characteristics of children with IDs. CONCLUSIONS The findings in this study add knowledge on important barriers and facilitators affecting the participation of children with IDs in everyday activities in China. The primary caregivers' voices need to be heard by government and society. Appropriate and effective changes in family-oriented services and the legal, social, political and economic context of the child welfare management system for the scale-up of improving participation should be implemented for children with IDs.
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Affiliation(s)
- Linjun Shi
- CHILD Research group, Swedish Institute of Disability Research, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,School of Nursing, Tianjin Medical University, Tianjin, China
| | - Mats Granlund
- CHILD Research group, Swedish Institute of Disability Research, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Lan Wang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Karina Huus
- CHILD Research group, Swedish Institute of Disability Research, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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The Impact of a Family-Centred Intervention for Parents of Children with Developmental Disabilities: A Model Project in Rural Ireland. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020175. [PMID: 36832304 PMCID: PMC9954624 DOI: 10.3390/children10020175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
The greater risk of poor mental health and social isolation, experienced by parents of children with developmental disabilities, is compounded by family circumstances and living in rural settings. Often parents receive little personal support. Family-centred interventions have been recommended internationally for promoting children's development, as well as boosting parental wellbeing. Yet, in many countries, current service provision is predominately child-focused and clinic-centred. An innovative, family-centred support service was designed and evaluated in a rural county of Ireland. Support staff visit the family home every month for around one year with regular check-ins by phone. The service aims included setting developmental goals for the child that were agreed with parents, alongside actions to address the personal needs of parents and siblings. In addition, community activities are identified or created to promote the social inclusion of the child and family in local communities, as well as locating opportunities for social activities for mothers. To date, 96 families with 110 children have been involved and three monthly reviews have been undertaken of each child's progress. Baseline measures on parents' mental health and social isolation were gathered and repeated when parents had completed their involvement with the project, along with qualitative information regarding the parents' experiences. Most children attained their learning targets, alongside those selected as personal goals by parents; in particular, parents reported their child's greater involvement in community activities, increased knowledge and skills, and with more confidence and resilience. Significant increases in parental well-being scores were reported, but there was a limited impact on their social participation and that of their child. This evidence-based model of provision is an example of how current social care provision for families who have a child with developmental disabilities could be cost-effectively re-envisioned even in rural areas.
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Wang Z, Wang L, Chang S, Wang H. The Mediating Effect of Parenting Stress on the Relationship Between Social Support and Quality of Life in Parents of Children With Autistic Spectrum Disorder: A Meta-Analytic Structural Equation Modeling. Front Psychiatry 2022; 13:713620. [PMID: 35250654 PMCID: PMC8891381 DOI: 10.3389/fpsyt.2022.713620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/17/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of the present study is to investigate whether parenting stress mediate the relationship between social support and quality of life in parents of children with Autistic Spectrum Disorder. In addition, we examined what other variables moderate the relationships in this mediation model. METHODS Using the two-stage meta-analytic structural equation modeling approach (MASEM), 44 correlation matrices were synthesized from 28 empirical studies (N = 13,270) and fitted to the hypothesized mediation model. RESULTS There is a significant partial mediation effect of parenting stress on the relationship between social support and quality of life. Subgroup analysis through the first stage analysis suggested that social support measurements, parental role, and child's age moderated the relationship between social support and parenting stress, and that the focus of quality of life moderated the relationship between social support and quality of life. Subgroup analysis through the second stage analysis indicated that parenting stress had a significantly stronger predictive effect on quality of life in Western culture, while the predictive effect of social support on quality of life was significantly stronger in Eastern culture. CONCLUSION Having more social support can reduce parents' stress and then improving their quality of life, which can help them cope more positively and effectively with their autistic children.
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Affiliation(s)
- Zhidan Wang
- School of Education Science, Jiangsu Normal University, Xuzhou, China
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Van Keer I, Van Leeuwen K, Maes B. 'We can't do it alone': Perceived social support in parents of children with a significant cognitive and motor developmental delay. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:531-536. [PMID: 34845791 DOI: 10.1111/jar.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/26/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is generally acknowledged that parent social support is an important target for intervention. To explore the specific needs of parents of young children with a significant cognitive and motor developmental delay (SDD), we aim to chart the sources and perceived sufficiency of the social support they receive. METHOD Within the context of a broader project, 42 parents of a young child with SDD filled out a questionnaire on contextual factors, including information on social support. RESULTS The majority of parents reported to receive (more than) sufficient support. Insufficiency is primarily reported with regard to practical support. Apart from the partner, grandparents of the child were the most common source of support. CONCLUSIONS This study confirms the importance of professional support and work-life balance within this specific target group. Specific attention for practical support needs seems warranted considering the high basic care needs of these children.
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Affiliation(s)
- Ines Van Keer
- Faculty of Psychology and Educational Sciences, Research Unit Parenting and Special Education, University of Leuven, Leuven, Belgium
| | - Karla Van Leeuwen
- Faculty of Psychology and Educational Sciences, Research Unit Parenting and Special Education, University of Leuven, Leuven, Belgium
| | - Bea Maes
- Faculty of Psychology and Educational Sciences, Research Unit Parenting and Special Education, University of Leuven, Leuven, Belgium
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Baldini PR, Lima BJD, Pina JC, Okido ACC. Mães de crianças que necessitam de cuidados contínuos e complexos: fatores associados ao apoio social. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo analisar os fatores associados ao apoio social às mães de crianças que necessitam de cuidados contínuos e complexos. Método estudo observacional, analítico e transversal, de abordagem quantitativa. A coleta de dados ocorreu nos ambulatórios de um hospital pediátrico localizado no interior do estado de São Paulo. Participaram do estudo 36 mães, que responderam a um instrumento de caracterização e ao Medical Outcomes Study- Social Support Survey. Para análise estatística foram utilizados os testes Mann-Whitney, Kruskal-Wallis e Correlação de Spearman. Seguiram-se os preceitos éticos de pesquisas que envolvem seres humanos. Resultados o apoio social afetivo, material e de interação social apresentaram escores satisfatórios (acima de 80 pontos). Os escores das dimensões informação e emocional foram 78,06 e 78,33, respectivamente. A variável idade materna apresentou correlação negativa com o apoio social emocional (0,040) e de informação (0,009). Conclusão e implicações para a prática as mães, em especial as mais velhas, recebem menos apoio de pessoas que possam lhe orientar e dar conselhos, bem como de alguém de confiança para falar sobre seus problemas. Tal resultado pode subsidiar o planejamento de estratégias de intervenção com famílias, a fim de fortalecer o apoio social.
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The Role of Social Support in Participation Perspectives of Caregivers of Children with Intellectual Disabilities in India and South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186644. [PMID: 32933056 PMCID: PMC7558089 DOI: 10.3390/ijerph17186644] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/21/2022]
Abstract
Caregivers are an intrinsic component of the environment of children with intellectual disabilities. However, caregivers’ capacity to support children’s participation may be linked to the social support that they, as caregivers, receive. Social support may increase participation, educational, psychological, medical and financial opportunities. However, there is a lack of information on social support in middle-income countries. The current study described and compared the social support of caregivers of children with intellectual disabilities by using the Family Support Survey (FSS) in India and South Africa. The different types of social support were subsequently considered in relation to participation, using the Children’s Assessment of Participation and Enjoyment (CAPE). One hundred caregiver–child dyads from India and 123 from South Africa participated in this study. The data were analysed using non-parametric measures. Indian caregivers reported greater availability of more helpful support than did the South African caregivers. Social support was associated with children’s participation diversity (India) and intensity (South Africa). The child-/caregiver-reported participation data showed different associations with participation. Results from this study suggest that perceived social support of caregivers differs between countries and is associated with their child’s participation. These factors need to be considered when generalising results from different countries.
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