Why Is Rehabilitation Assistance Policy for Children With Disabilities Deviated in Supply-Demand? A Case Study in Mainland China

Anxiety, Depression, Quality of Life, and Family Support Among Family Caregivers of Children with Disabilities

Purpose

To investigate the family support, anxiety, depression, health-related quality of life (HRQoL), and their associations among parents and grandparents of children with disabilities.

Methods

This is a cross-sectional study and a total of 327 family caregivers were included. Chi-square test, Mann-Whitney U-test, and two independent t-test were used to identify the intergenerational differences in sociodemographic characteristics, received family support, anxiety, depression, and HRQoL. Eight generalized linear models were developed to examine the associations in both generations.

Results

Parents and grandparents were most in need of rehabilitation and financial support, but both populations received the least amount of financial support. 33.6% and 36.1% of family caregivers had the risk of anxiety and depression and found no significant intergenerational differences. As for HRQoL, intergenerational differences were found in the physical component score, but not found in the mental component score. Among parents, childcare support of respite care and household tasks assistance was negatively associated with their depression (p<0.05), professional support of appropriate surgery for children (p<0.05) and psychological support from professional psychologists (p<0.01) were negatively associated with their anxiety and depression, psychological support from relatives and friends was negatively associated with their depression (p<0.05) whereas was positively associated with their mental HRQoL (p<0.01). As for grandparents, financial support for daily living expenses was negatively associated with depression (p<0.05), and psychological support from families was negatively associated with depression (p<0.05) whereas was positively associated with mental HRQoL (p<0.05). However, no relationship was found between family support and anxiety among grandparents. Notably, no association was found between family support and physical HRQoL among both populations.

Conclusion

Both parents and grandparents had high risks of anxiety, depression and low levels of mental HRQoL. To efficiently improve psychological health, care providers and policymakers may consider intergenerational differences and provide targeted family support.

Changing Directions and Expanding Horizons: Moving towards More Inclusive Healthcare for Parents of Children with Developmental Disabilities

Family-centred service (FCS) acknowledges the importance of family engagement in therapeutic processes and focuses on the needs of all family members. This way of thinking and practicing is becoming increasingly recognized as an optimal care delivery model for families of children with developmental disabilities (DDs). However, in most places, disability services are oftentimes 'child-centric', wherein family members are seen only as partners in therapy or care delivery, while their own needs are not addressed. This arises from the lack of awareness of complex and highly individual family needs by professionals with whom they interact, but also from a significant lack of service infrastructure oriented towards parent-specific needs in existing service delivery models. This concept paper highlights the known challenges associated with parenting a child with a DD and discusses the intersectionality of factors impacting parental health and well-being, with a goal of promoting more equitable, holistic, and inclusive healthcare for all family members of children with DDs.

Assessment of Chinese rehabilitation assistance system for disabled children

Using the social support theory for reference, a subject-object influencing mechanism model of China's rehabilitation assistance system for disabled children is built based on the survey data on 1,698 disabled children in 243 designated rehabilitation institutions in Hu'nan Province as well as the topic of the assessment and optimization of the rehabilitation assistance system for disabled children. The analysis using the structural equation modeling reveals that the inclusive welfare effect of the rehabilitation assistance system for disabled children has emerged, and disabled children receiving free rehabilitation in the designated institutions have achieved good rehabilitation results as a whole, however, disabled children of different age groups have generational differences in the rehabilitation effects, and the preferential aspect of the system needs to be strengthened. Government support, institutional support, and social support have positive non-equilibrium effects in enhancing the rehabilitation effects of disabled children. Institutional support plays a partial mediating role between government support, family support, and disabled children's rehabilitation effects, showing that the current social support system for the rehabilitation assistance of disabled children is experiencing structural, social and kernel changes, to evolve from the traditional closed and disconnected one-way resource support to open, coordinated, and interactive multi-support, and gradually become a comprehensive and efficient interactive support system with families as the foundation, institutions as the main body, and the government as the core.

The mediating role of perceived social support: alexithymia and parental burnout in parents of children with autism spectrum disorder

Background

Parental burnout is a concept that reflects the emotional exhaustion and emotional distance of parents from children due to their inability to cope with the pressure of parenting. It has been confirmed that parents of autistic children are at higher risk for parental burnout. Additional research has suggested a relationship between parental burnout and parents' personality traits. However, the relationship between alexithymia, an independent personality factor, with parental burnout is little to none.

Objective

To look into the connection between parental burnout and alexithymia among parents of autistic children.

Method

Three hundred and one parents were approached for recruitment and data were collected from 203 parents through a cross-sectional survey assessing parental burnout, alexithymia status, and perceived social support. Because the data is not normally distributed, Spearman's rank correlation coefficient rho(p) was used to assess the correlation between the variables; and then using AMOS to analyze the mediating effects of perceived social support and the moderating effect of gender.

Result

The result showed that (1) There is a negative association between alexithymia with parental burnout (β = 0.6, p < 0.01), while perceive social support was the negative predictor of alexithymia (β = -0.45, p < 0.01) and parental burnout (β = -0.26, p < 0.01); (2) perceive social support partially mediated the relationship between alexithymia and parental burnout of parents of autistic children, which can explain 16.3% of the total effect; (3) Gender plays a moderating role in the first half of the indirect effect of alexithymia on parental burnout, as evidenced by the significant difference in path coefficients between the male and female models (male: β = -0.10, p < 0.05; female: β = -0.60, p < 0.05).

Conclusion

Health professionals and policymakers should be aware of parental burnout among parents of autistic children in China and take early intervention steps. Furthermore, they should recognize the negative impact of alexithymia and the positive impact of social support when developing plans to alleviate parental burnout in children with autism, with a particular focus on mothers with alexithymia, who are more likely to experience low social support and burnout than fathers with alexithymia.

Why can't children with autism integrate into society in China? Study based on the perspective of NGO classification

Introduction

In the field of protecting children with autism, NGOs have become a major force that cannot be ignored. Although NGOs for children with autism have expanded the number and improved the quality of the services they provide, a large number of autistic children still cannot achieve the goal of social inclusion in China. The existing literature has mostly tried to explain the reason from the perspective of the common characteristics of NGOs and has paid insufficient attention to the huge differences between these NGOs, so it is impossible to identify the obstacles that children with autism encounter accurately.

Methods

From the perspective of NGO classification, this study conducted an in-depth investigation of 4 NGO cases in City N, China, to show the impact of the difference of NGOs on the obstacles to the social inclusion of autistic children.

Results

The research has found that under the authoritarian regime, NGOs for children with autism that rely heavily on external funds include three common groups: government-oriented NGOs, foundation-supported NGOs, and individual-financed NGOs. The structural characteristics of the funders and their interaction with the NGOs for children with autism shape their different action logics, as the result that the desire of children with autism to integrate into society cannot be achieved as expected.

Discussion

The results of this study give more accurate insights into the barriers in social service provision for children with autism that impede their social inclusion and provide a reference for those seeking a solution to this problem.

Hidden hurt: A qualitative study of the microaggressions experienced by disabled children in education in China

BACKGROUND

Microaggressions are brief, commonplace indignities expressed through verbal or behavioral means. In China, microaggressions have proliferated with the wide implementation of education protection policies for disabled children (including learning in regular classes (LRC), special school education (SSE), and home-delivery education (HDE)), resulting in severe consequences. However, related issues have not been discussed yet.

OBJECTIVE

This study explores concrete forms of microaggressions that disabled children have experienced under three educational policies.

METHODS

We took a qualitative phenomenological approach and used semi-structured interviews to collect data. 22 disabled children, their guardians, and eight educators from three compulsory education schools in Jinan, China, were included in this study.

RESULTS

Microaggressions are categorized into three types: microassaults, microinsults, and microinvalidations. In LRC, typical microaggressions include the microassaults of refusal, extra requirements, avoiding needs, and accusations; the microinsults of labeling, differential patronization, and over-protection; and the microinvalidation of suspicion. In SSE, typical microaggressions include the microassaults of refusal, belittling, hiding, and ignoring; the microinsults of assumptions of low intelligence, ignoring, and distancing; and the microinvalidation of suspicion. In HDE, typical microaggressions include the microassaults of denial of privacy and denial of expression; and the microinsults of infantilization and blame.

CONCLUSIONS

The microaggressions that disabled children experience under educational policies produce serious disciplinary effects. To eliminate microaggressions, it is necessary to publicize the new disability rights paradigm, engage disabled children and their families in participation in the political process, develop demand-oriented assessment criteria, and standardize educators' discretion.

Double Disadvantage of Carers with a Disability: A Cross-Sectional Study of Care Duration and Perceived Importance for Service Improvement in Hong Kong, China

OBJECTIVES

this study examined (i) the relationships between the care duration of carers and their perceptions of the importance of service improvement by types of service, and (ii) whether carers had a disability that moderated the impacts of care duration on these perceptions.

DESIGN

survey data for cross-sectional analyses.

METHOD

The sample consisted of carers without disability (n = 625) and carers with a disability (n = 77). Hierarchical multiple regression was applied to examine the unique contribution of care duration. The interaction effects of the disability status of the carer was also estimated.

RESULTS

Longer care duration was associated with a greater perception of the importance of service improvement for certain services by carers. The positive relationships between care duration and perception of the importance of caregiver assistances and financial subsidy improvement were stronger for carers with disabilities compared to carers without disability.

CONCLUSIONS

Long-term carers with disabilities face a potential double disadvantage of service improvement needs with more years of caregiving. Policy makers should consider prioritizing caregiver assistances or financial subsidy service improvements for long-term carers who themselves have a disability.

Regional maldistribution of human resources of rehabilitation institutions in China Mainland based on spatial analysis

Objective

With the demand for rehabilitation has been increasing faster for the aging of China's population, the equity of rehabilitation resource has aroused great concern. This study aimed to analyze the spatial distribution and evolution of the human resources of rehabilitation institutions and propose targeted countermeasures and suggestions to promote optimal allocation.

Methods

A total of 31 provinces in China Mainland were identified and geocoded. The spatial weight matrix was introduced to analyze the spatial correlation. Spatial autocorrelation analysis and tests were used to analyze the spatial distribution and evolution characteristics of rehabilitation institutions' human resources in China from 2016 to 2019.

Results

The average density of rehabilitation staff from 2016 to 2019 has been rising yearly (From 1.60 to 1.88). From 2018 to 2019, the proportion of rehabilitation professionals was higher than 75% in only 5 provinces, and no provinces met 75% from 2016 to 2017. Global Moran's I index from 2016 to 2019 showed no apparent aggregation phenomenon in the allocation of management personnel resources (P > 0.05). Three provinces in western China belonged to the Low-Low area and a province in northeastern China fitted to the Low-High area, with statistically significant differences. In addition, the changes in the spatial distribution and evolution trend of the human resources of rehabilitation institutions in different periods were affected by health policies.

Conclusions

Although the overall spatial distribution gap of human resource allocation of rehabilitation institutions is shrinking, there are still internal structural defects and a maldistribution at the provincial level. It is necessary to improve the overall number of staff in rehabilitation institutions and to ameliorate the proportion of different types of staffing.