Factors Affecting the Health of Caregivers of Children Who Have an Intellectual/Developmental Disability

Effectiveness of Online Programmes for Family Carers of People with Intellectual Disabilities: Systematic Review of the International Evidence Base

This systematic literature review examines the evidence base on the effectiveness of online programmes on the mental health and well-being of family carers of people with intellectual disabilities. Databases (ERIC, Medline, PsycINFO and CINAHL) were searched for intervention studies that considered online interventions for family carers of people with intellectual disabilities. Data were extracted using standardised data extraction tools. Bias was assessed using the Cochrane risk of bias tool for randomised trials (RoB 2). Screening, extraction and assessment of bias were completed independently by two members of the research team. Given the low number of included studies and different outcomes assessed within them, it was not possible to conduct a meta-analysis; therefore, data are presented narratively. Two studies met the criteria to be included in the review. Both studies utilised a feasibility randomised controlled trial methodology. One study found a significant decrease in parental stress, while the other found a significant increase in psychological well-being. Caution must be taken in drawing firm conclusions, given the small sample sizes and low retention rates in both studies. Online programmes seem to offer potential benefits to family carers of people with intellectual disabilities. However, further investigation is needed to examine these programmes, adopting a collaborative approach with family carers.

Social Determinants of Health are Associated with Coping of Informal Caregivers of Adults with Heart Failure

We explored the influence of social determinants of health (SDH) risk on stress and coping style in heart failure (HF) caregivers. In this cross-sectional study, data from 250 caregivers were analyzed. Multivariable linear regression analyses were performed to determine the extent to which SDH risk (measured using a modified PRAPARE tool (National Association of Community Health Centers), range 0-22) predicted stress (Perceived Stress Scale, 0-56) and coping style (active (0-45), avoidance (0-30), and minimization (0-30)) while accounting for caregiver burden (HF Caregiver Questionnaire (HF-CQ) 0-100). Multivariable regression analysis with backwards elimination variable selection approach was used to identify which SDH risk factors best predicted coping styles. SDH risk was significantly associated with avoidance and minimization coping styles. Each unit increase in SDH risk was associated with an increase of 0.6 ± 0.2 units (p = .0008) in avoidance and 0.7 ± 0.2 units (p < .0001) in minimization coping style. Race and "supporting others" significantly predicted avoidance coping style; scores were 3.3 ± 0.8 units greater for caregivers who were not White (p < .0001) and 1.4 ± 0.5 units greater (p < .01) for each additional person whom they supported. Race significantly predicted minimization coping style; scores were 4.4 ± 0.7 units greater for caregivers who were not White (p < .0001). Caregivers with higher SDH risk may avoid and minimize to cope with caregiving challenges.

The health of mothers caring for a child with a disability: a longitudinal study

BACKGROUND

Raising a child with disabilities requires a significant parental investment that is greater than that required by typically developing children. Previous studies have shown that parents caring for a child with a disability experience a range of health problems, particularly the mothers. However, few of these studies have controlled for maternal health prior to birth.

METHODS

This study used a sample from the Norwegian administrative register that comprised all children born between 2009 and 2015. We followed the mothers and their children for 11 years, between 2009 and 2019. The outcome variable was the mothers' physical and mental health, which was assessed using specific ICD-10 diagnoses recorded in the Norwegian Patient Register (NPR). The data included information on the mothers' health before and after the birth of their first child, enabling us to control for maternal health prior to birth in our analysis, in addition to socio-demographic characteristics. The analyses of maternal health were performed using multiple logistic regression, and the results are presented on both a relative scale (odds ratio [OR]) and an absolute scale (average marginal effect [AME]), both with 95% confidence intervals.

RESULTS

Mothers caring for a child with a disability have higher odds of having a diagnosis of a musculoskeletal disorder, depression, anxiety, sleeping disorder or migraines than mothers of children without a disability. The differences between the two groups of mothers decrease after adjusting for the characteristics of the children, mothers and families, but remain significant for musculoskeletal disorder, depression, anxiety and sleeping disorder, although the absolute differences are modest.

CONCLUSION

The findings suggest that mothers caring for a child with a disability are more likely to have health problems than mothers of children without a disability after controlling for maternal health prior to birth. Providing more support for mothers of children with a disability might help to improve their health.

The Relationship Between Solution-Focused Communication Skills and Perceived Social Support: A Descriptive Levels of Study of the Perceptions of Turkish Parents with of Children with Developmental Disabilities

PURPOSE

This descriptive, correlational study examined the relationship between solution-focused communication skills and perceived level of social support for parents of children with developmental disabilities.

METHOD

One hundred and sixty one parents of children with developmental disabilities completed a researcher developed personal information form, the Solution Focality in Communication Scale, and the Revised Parental Social Support Scale. Data were analyzed using ANOVA, in independent groups, t tests, and correlation tests.

RESULTS

Findings included a positive correlation between the Solution Focality in Communication Scale and the perceived level of social support of the Revised Parental Social Support Scale and the perceived social support satisfaction level sub-dimensions (p < .001).

CONCLUSION

This descriptive study found a correlation between the level of solution-focused communication skills reported by parents of children with developmental disabilities, and the parent's improved perceptions of social support. In addition, parents reported increased satisfaction with the social support they had received as their solution-focused communication skills improved.

Phenomenological Study on the Lived Experiences of Mothers Caring for Their Pubescent Children with Developmental Disabilities

PURPOSE

This phenomenological study explored and revealed the mothers' lived experiences of caring for pubescent children with developmental disabilities (DDs) in Korea.

METHODS

Data were collected from semistructured individual in-depth interviews with nine mothers. This study adopted Giorgi's phenomenological analysis, through which a general structure of mothers' caregiving experiences with their pubescent adolescents with DDs was formulated.

RESULTS

The lived experiences of mothers caring for pubescent children with DDs were clustered into four themes and nine subthemes from 19 meaning units: (1) not being allowed to take delight in child's growth due to unbalanced growth pace; (2) feeling marginalized along with the disabled child; (3) feeling like being kicked out of society slowly and permanently; and (4) rearrangement of care direction and purpose.

CONCLUSIONS

This qualitative study captured vivid experiences of mothers who care for pubescent children with DDs by illustrating these mothers' detailed physical, emotional, and relational difficulties in their caring. Most importantly, this study found that it is puberty that these mothers come to clearly understand that their children and their disabilities are inseparable and change the purpose and direction of childcare. The findings of this study can help health professionals better understand that these mothers are in urgent need for emotional support and need to be included in nursing care. And this study can be used as base data for increasing disability awareness for both healthcare workers and public in general.

Significance of Selected Environmental and Biological Factors on the Risk of FASD in Women Who Drink Alcohol during Pregnancy

Prenatal alcohol exposure (PAE), which refers to alcohol consumption by pregnant women, is associated with the risk of numerous severe complications during fetal development. The State Agency for Alcohol Problem Solving reports that the incidence of fetal alcohol spectrum disorder (FASD) in Poland's general population is over 1.7%, and the incidence of fetal alcohol syndrome (FAS) is estimated at more than 0.5%. This study aimed to evaluate the significance of alcohol exposure and focused on the pattern of alcohol intoxication exhibited by the mother during pregnancy and other environmental factors of the maternal environment contributing to the development of FASD. The study covered 554 subjects, including 251 mothers and 303 children (213 girls and 90 boys). The mother's drinking problem was determined based on the information obtained from the case history. All children qualified for the study fulfilled the h-PAE (high alcohol exposure) criteria during their fetal life. The clinical diagnosis of FAS and pFAS (occurrence of morphological symptoms of fetal alcohol syndrome) was made using a four-digit diagnostic questionnaire validated in the Polish version of the Washington Questionnaire for the assessment of the spectrum of alcohol-related neurodevelopmental disorders or alcohol-related cognitive impairment (ARND/C). Statistical analysis of the obtained research results was developed using statistical software-STATISTICA PL, version 13.1 (StatSoft, Inc., Szczecin, Poland 2016, STATISTICA-data analysis software system, version 13.1). The most destructive drinking behaviors are compulsive intoxication (BD, binge drinking) during the first 6 weeks of pregnancy and chronic addiction throughout its duration (CHD, chronic drinking). Chronic alcohol intoxication (CHD) leads to a poorer nutritional status in mothers, which is reflected in a lower body mass index (BMI) (<18 kg/m2).

The prevalence of obesity and lifestyle behaviors of parents of youth with intellectual and developmental disabilities

BACKGROUND

Parents of youth with intellectual and developmental disabilities (IDD) may have a higher prevalence of overweight and obesity and poorer weight management behaviors compared to the general population.

OBJECTIVE

To describe the prevalence of overweight/obesity and related socioeconomic and lifestyle factors including diet quality, physical activity, and reported health habits in parents of youth with IDD.

METHODS

We assessed: BMI (kg/m2), moderate-to-vigorous physical activity (MVPA), fruit and vegetable intake (FVI), parental diet and physical activity habits, and socioeconomic characteristics. Associations of BMI on MVPA and FVI were assessed with Spearman's correlation; differences in BMI by parental diet and physical activity habits were assessed with Kruskall-Wallis tests; and the relationships of BMI to household income, race, and education were assessed with Kendall Tau-b and Mann Whitney U tests.

RESULTS

Data was obtained from 110 parents (97.3% female) who were study partners for their adolescents/young adults with IDD participating in a weight loss clinical trial. Approximately 81% of parents were overweight or obese (25.7% overweight, 55.1% obese), with 46.3% and 20% meeting the recommended U.S. guidelines for MVPA and FVI, respectively. Higher FVI and higher income were significantly associated with lower parent BMI. BMI was significantly lower in parents who reported to be physically active and choose healthy food.

CONCLUSION

We observed a high prevalence of overweight/obesity, low FVI and low levels of MVPA in parents of adolescents with IDD. These observations suggest that interventions designed to address these factors have the potential to improve the health and wellbeing of both parents and adolescents with IDD.

CLINICAL TRIALS NUMBER

NCT02561754.

Oral health status and quality of life of the parental caregivers of children with Down syndrome: A case-control study

The aim of this study was to investigate the oral health status and quality of life (QOL) of the parental caregivers of individuals with Down syndrome (DS), and to evaluate whether there is an association between these variables. The sample of this cross-sectional study was composed by parental caregivers of children with DS (CCDS) and parental caregivers of children without DS (CNDSC). Oral examination was undertaken and a questionnaire was given to participants. QOL was evaluated by WHOQOL-Bref. CCDS presented a higher number of dental prosthesis users and higher gingival bleeding index compared to CNDSC. When oral health was associated with QOL, the use of dental prosthesis was associated with physical domain and the variables having chronic disease and family income were associated with the social domain for both caregivers. The results suggest that caregivers of children with DS have similar oral health and QOL compared to caregivers of children without DS. In both caregivers, oral health status is associated with QOL.

Development and evaluation of the psychometric properties of the caregiver burden scale for parents of children who stutter (CBS-PCWS)

PURPOSE

Caring for a child who stutters can impose excessive pressure on parents. Caregiver burden affects many aspects of parents' lives. Paying attention to parents in the treatment of children who stutter (CWS) is important because parents play a key role in the treatment of CWS. The aim of the study was to develop the Caregiver Burden Scale for Parents of Children Who Stutter (CBS-PCWS) and investigate the psychometric properties of the CBS-PCWS.

METHOD

The CBS-PCWS was developed using interviews with 15 parents of CWS and a literature review. The content validity, face validity, construct validity using exploratory factor analysis (EFA), and reliability of the CBS-PCWS were investigated. The content validity was evaluated using 10 experts' opinions. Face validity was determined using interviews with 10 parents of CWS. The reliability of the CBS-PCWS was evaluated through internal consistency and test-retest reliability.

RESULTS

The scale development resulted in the creation of 137 items. During an expert panel with the presence of the research team, 51 similar items were eliminated. During the qualitative content validity stage, nine items were added to the initial scale. After determining the content and face validity, the number of CBS-PCWS items was reduced to 52 items. In the construct validity stage using EFA with responses from 364 parents, eight items of the CBS-PCWS were removed due to low factor loadings. The results of the EFA indicated that the CBS-PCWS contained five factors: psychological and emotional, personal and physical, support for caregiving, culpability, and socio-communicative. The Cronbach's alpha values of the scale domains were in the 0.78-0.94 range. In addition, the ICC test-retest coefficient for the total score of the CBS-PCWS was 0.93 and for its domains was in 0.91-0.99 range.

CONCLUSION

The CBS-PCWS has 44 items with five domains and is a valid and reliable scale that can be used for clinical or research purposes. More studies are required to evaluate further psychometric properties of the CBS-PCWS.

Factors influencing quality of life in caregivers of adolescents with developmental disabilities

OBJECTIVES

Caring for adolescents with developmental disabilities (DD) is stressful and challenging, and mothers usually provide care for these children in Korea. This study aimed to identify factors influencing quality of life (QoL) in mothers of adolescents with DD.

METHODS

A predictive design was used. Data were collected from a web-based survey administered to a convenience sample of 154 mothers of adolescents with DD from October to November 2020. Data were analyzed using the t-test, analysis of variance, Pearson correlation coefficients, and multiple regression.

RESULTS

Perceived health, depression, and family strength were significantly correlated with QoL. Multiple regression showed that family strength, perceived health, depression, and monthly household income influenced the participants' QoL, and these factors accounted for 69.2% of variance in QoL. Family strength was the factor most strongly affecting QoL (β=0.39).

CONCLUSION

The study results indicate that health professionals and policy-makers need to pay attention to the overall QoL and physical and psychological health of mothers of adolescents with DD. Since our findings raise the importance of family strength in the QoL of this population, programs to improve family strength need to be implemented and strengthened. Interventions to improve perceived health and decrease depression should be applied, and knowledge on adolescent characteristics and changes should be delivered to caregivers when providing education and consultations. The findings will be helpful for developing educational and counseling programs for this population.

The prevalence of health problems and their association with physical activity in caregivers of children with disabilities: 2018 National Health Interview Survey

BACKGROUND

Caregivers of children with disabilities often experience poor health. One way for caregivers to promote their own health may be to participate in physical activity (PA).

AIMS

The purpose of this study was to examine the association between PA and psychological and physical health problems in caregivers of children with disabilities.

METHODS

The 2018 National Health Interview Survey (NHIS) data were used, and 890 household representatives were identified as caregivers of children with disabilities. Based on the national PA guidelines, caregivers were classified into three groups: inactive (IA), aerobically active (AA), and aerobically and muscularly active (AMA).

RESULTS

Multivariable logistic regression indicated that the AMA group had a lower likelihood of reporting depression compared to the IA group (OR: 0.73 [95% confidence interval: 0.54, 0.98]). The AMA group also had a lower likelihood of reporting back pain and obesity compared to the IA group (OR:0.69 [95% confidence interval: 0.56, 0.84] and OR:0.63 [95% confidence interval: 0.52, 0.76], respectively).

CONCLUSIONS

The results of the current study suggest that caregivers of children with disabilities may benefit from PA, especially from the combination of aerobic and muscle-strengthening PA.

'We have been in lockdown since he was born': a mixed methods exploration of the experiences of families caring for children with intellectual disability during the COVID-19 pandemic in the UK

OBJECTIVES

This study aimed to explore the experiences of parents caring for children with intellectual and developmental disabilities (IDD) during the UK national lockdown in spring 2020, resulting from the COVID-19 pandemic.

DESIGN

Participants were identified using opportunity sampling from the IMAGINE-ID national (UK) cohort and completed an online survey followed by a semistructured interview. Interviews were analysed using thematic analysis.

SETTING

Interviews were conducted over the telephone in July 2020 as the first UK lockdown was ending.

PARTICIPANTS

23 mothers of children with intellectual and developmental disabilities aged 5-15 years were recruited.

RESULTS

Themes reported by parents included: managing pre-existing challenges during a time of extreme change, having mixed emotions about the benefits and difficulties that arose during the lockdown and the need for appropriate, individualised support.

CONCLUSIONS

Our findings confirm observations previously found in UK parents of children with IDD and provide new insights on the use of technology during the pandemic for schooling and healthcare, as well as the need for regular check-ins.

Associations Between Hyperphagia, Symptoms of Sleep Breathing Disorder, Behaviour Difficulties and Caregiver Well-Being in Prader-Willi Syndrome: A Preliminary Study

Prader-Willi syndrome (PWS) is a rare genetic disorder characterised by neurodevelopmental delays, hyperphagia, difficulties with social communication and challenging behaviours. Individuals require intensive supervision from caregivers which may negatively affect caregiver quality of life. This study used data collected in the Australasian PWS Registry (n = 50, mean age 11.2 years) to evaluate associations between child behaviours and caregiver mental well-being. Symptoms of sleep-related breathing disorder, child depression and social difficulties were associated with poorer caregiver mental and physical well-being. Growth hormone therapy use was associated with better caregiver mental and physical well-being. Optimising management of problematic behaviours and sleep disturbances have the potential to support caregivers who are the most vital network of support for individuals affected by PWS.

The Role of Social Support in Participation Perspectives of Caregivers of Children with Intellectual Disabilities in India and South Africa

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.

Psychological well-being of fathers with and without a child with intellectual disability: a population-based study

BACKGROUND

Few studies have explored the well-being of fathers of children with intellectual disability (ID), despite the significant role that they play in their children's lives. The current study compared fathers of children with and without a child with ID on measures of psychological well-being (life satisfaction, work-family balance and general health) and dimensions of parenting (parenting self-efficacy and parent-child closeness) and then examined whether the presence of a child with ID in the family was a significant predictor of paternal well-being when controlling for a number of father (age, education, employment and residency), child (ID status, gender, behavioural and emotional problems) and family (income poverty and number of children in the household) variables.

METHODS

Data were drawn from the third wave of the Millennium Cohort Study, a UK population-representative and cohort study, where the cohort child was 5 years of age; 256 fathers were identified as having a child with ID, with data available for 10 187 fathers without a child with ID. Fathers were compared on the four well-being and parenting outcomes and then multiple regression models were conducted to explore associations between these outcomes and variables identified as potential correlates of well-being.

RESULTS

Initial group comparisons showed that there were differences in the well-being of fathers, with fathers of children with ID reporting poorer life satisfaction and general health. However, these differences were small. Regression analyses showed that child behavioural and emotional problems, living in income poverty and paternal employment were more important than disability status in predicting fathers' well-being.

CONCLUSIONS

These works add to the limited amount of research on fathers using population-representative data. The current findings are consistent with rejecting a general simplistic and negative narrative that raising a child with ID puts fathers at risk of poorer outcomes. However, some fathers, such as those with children with behavioural problems and living in poverty, may require greater support. Future longitudinal research that explores the impact of paternal well-being on the long-term outcomes of children with and without ID is warranted.

Caregiving burden among informal caregivers of people with disability

OBJECTIVE

Chinese informal caregivers experience burden due to their caregiving responsibilities that violate their belief of reciprocal parent-child relationship, but little is known about this burden and coping processes among Chinese. It is believed that internal coping (i.e., self-reliance) and external coping (i.e., seeking help from others) better captured cultural characteristics of coping styles observed among Chinese. Thus, the aim of this study was to estimate the prevalence of mental ill health, identify correlates, investigate the impact of caregiving burden on mental health, and explore the potentially moderating role of two coping strategies.

DESIGN

A purposive sample of 234 informal caregivers of family with intellectual or mental disability in Macao (SAR), China, from August to September 2018 was investigated.

METHODS

DASS-21, Caregiving Burden Inventory (CBI), Perceived Difficulty Scale (PD), and a modified Chinese Coping Scale were used. Multiple regression analyses were conducted.

RESULTS

CBI and PD were associated with depression, anxiety, and stress. Whereas internal coping buffered the effect of PD on depression and anxiety, external coping exacerbated the effect of PD on anxiety and the effect of CBI on depression and anxiety.

CONCLUSION

Poor mental health among caregivers is associated with greater caregiving challenges and burdens. Internal coping helped to buffer but external coping worsened the effect of burdens on mental health outcomes. Interventions that improve internal coping and mental health might be helpful for ageing informal caregivers.

Physical inactivity among parents of children with and without Down syndrome: the National Health Interview Survey

BACKGROUND

Emerging evidence suggests that parents of children with intellectual disabilities have poorer physical health than parents of typically developing children. However, it is unclear why. The purpose of this study was to examine differences in physical inactivity among a population-based sample of parents of children with and without Down syndrome.

METHODS

Data for this analysis come from 11 waves (2005-2016) of the National Health Interview Survey, a U.S. nationally representative survey. Minutes per week of leisure-time physical activity were ascertained by self-report with physical inactivity defined as reporting no leisure-time physical activity. Parents were classified as (1) parents of typically developing children, (2) parents of children with Down syndrome, (3) parents of children with a developmental disability that had a high functional impact (autism, cerebral palsy, vision impairment or hearing impairment), (4) parents of children with an intellectual or developmental disability, but who did not have Down syndrome or a high-impact developmental disabilities, and (5) parents of children with other special health care needs.

RESULTS

Parents of children with Down syndrome were more likely to be physically inactive compared with parents of typical children (odds ratio [OR]: 1.51 [95% confidence interval, CI: 1.08, 2.12]) and had the lowest likelihood among all subgroups of parents to children with developmental disabilities or special health care needs. Parents of children with Down syndrome also had a significantly greater likelihood of being physically inactive compared with parents of children with other special health care needs (OR: 1.56 [95% CI: 1.11, 2.19]), with developmental disabilities without high functional impact (OR: 1.58 [95% CI: 1.12, 2.24]) and with developmental disabilities with high functional impact (OR: 1.46 [95% CI: 1.03, 2.08]).

CONCLUSION

Parents of children with Down syndrome are more likely to be physically inactive compared with parents of typically developing children and parents of children with other developmental disabilities or special health care needs. These findings suggest that parents of children with Down syndrome are a population in urgent need for interventions/programmes that promote physical activity, particularly as child well-being is linked to caregiver health.

Mental health outcomes among parents of a child who has a developmental disability: Comparing different types of developmental disability

BACKGROUND

There is very little information on the effects of different types of developmental disability on the mental health of parents of children who have a DD.

OBJECTIVE

This paper compared the mental health of parents of children with Autism Spectrum Disorder (ASD), Down syndrome, Fetal Alcohol Syndrome (FAS) and other types of DD.

METHODS

A cross-sectional design was used to examine population-level administrative health data for mental health outcomes in cohorts of fathers and mothers of children with four different types of a DD. As well as type of DD, additional variables were examined, these included: sex of the parent, age of the parent at birth of the child with the DD, income, sex of the child with the DD, number of children in the family and place of residence.

RESULTS

For both fathers and mothers odds of a diagnosis of depression or another mental health problem were associated with type of DD. Parents of children with FAS experienced the greatest odds of a depression or other mental health diagnosis. Odds of a diagnosis for fathers were associated with low income. Odds of a diagnosis for mothers were associated with the sex of the child with the DD.

CONCLUSIONS

These findings are important for understanding families which include a child with a DD, as a guide for future research, and for developing effective programs and services for these parents.

Mental health of parents of children with a developmental disability in British Columbia, Canada

Background

There is evidence in the literature that parents of children who have a developmental disability experience an increased risk of mental health problems.

Methods

This study used population-level administrative data from the Ministry of Health, British Columbia, Canada, to assess the mental health of parents of children who have a developmental disability compared with the mental health of parents of children who do not have a developmental disability. Population-level and individual explanatory variables available in the data were included in the models.

Results

At a population level, the study found strong evidence that parents of children who have a developmental disability experience higher odds of depression or other mental health diagnoses compared with parents of children who do not have a developmental disability. Age of the parent at birth of the child, income and location of healthcare services were all associated with outcomes.

Conclusion

Parents of children who have a developmental disability may be in need of programmes and services that support their mental health.

Health Care Transition for Adolescent and Young Adults with Intellectual Disability: Views from the Parents

PURPOSE

This study explored the health care transition (HCT) experiences of parents of adolescents and young adults (AYAs) with intellectual disability (ID), 18-33 years of age, including barriers and facilitators to the AYA's transition to adulthood within and between the medical, educational, community, and vocational systems.

DESIGN AND METHODS

A qualitative descriptive design with semi-structured individual interviews with 16 parent participants was used. Purposive sampling of parents was utilized with variation on race/ethnicity and AYA age, stage in transition, and condition. This study was conducted through a major medical center in the southeast United States. Content analysis was utilized.

RESULTS

Three overarching themes represented the factors and essence of supporting AYAs with ID transition to adulthood. Inefficient and siloed systems illuminated barriers families are commonly experiencing within and between the medical, educational, community, and vocational systems. 'Left out here floundering' in adulthood, described the continued inadequacy of resources within each of these systems and parent's having to find available resources themselves. Hope despite uncertainty, included the perceived costs and benefits of their AYA's disability and the value of parent peer support in providing key knowledge of resources, strategies, and perspectives.

CONCLUSIONS

Our findings illuminate the need for improved infrastructure to provide effective HCT and partnerships to help integrate HCT support within other life course systems. Results support the rationale for non-categorical HCT-focused approach.

PRACTICE IMPLICATIONS

A parent peer coach-facilitated intervention offers promise for bridging the gap between systems and meeting family needs.

A population-level study of the mental health of siblings of children who have a developmental disability

This study used population level administrative data for health service utilization from the Ministry of Health, British Columbia, Canada to assess the mental health of siblings of children who have a developmental disability. At a population level, the study found strong evidence that siblings of children who have a developmental disability experience higher odds of a depression or other mental health diagnosis compared to siblings of children who do not have a developmental disability. In addition, there was evidence that in families with a child with a developmental disability, siblings who are diagnosed with depression or another mental health problem use physician and/or hospital services for these conditions to a greater extent than siblings who are diagnosed with depression or a mental health problem but do not have a family member with a developmental disability. Evidence of increased depression and mental health problems existed across all income levels, indicating that other stressors may have an impact. These findings suggest that siblings of children who have a developmental disability are a vulnerable group in need of programs and services that support their mental health.

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This study used population-level administrative health data to examine some of the variables affecting mental health in 45,578 siblings of children who have a developmental disability (DD) compared to two comparison groups of siblings of children who do not have a developmental disability.

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Siblings of children who have a DD experience increased odds of a depression or other mental health diagnosis compared to either of the two comparison groups.

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In addition there was evidence that siblings of children who have a DD and who have a diagnosis of depression or another mental health problem use the health care system to a greater extent than siblings of children who do not have a DD but have a diagnosis of depression or another mental health problem.

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Evidence of increased depression or another mental health problem existed across all income levels.

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This is the first study to use population-level administrative health data to compare e mental health outcomes of siblings of children with a DD to siblings of children without a DD.