Mental health services and resources for children with developmental disabilities and their families: scan of local practices, gaps, and opportunities created

Mental health in children with disabilities and their families: red flags, services' impact, facilitators, barriers, and proposed solutions

Background

Children and youth with neurodevelopmental disabilities (NDDs) and their caregivers are at a high risk of experiencing mental health challenges, that in turn can significantly affect their functioning, productivity, and quality of life. In this already vulnerable population, mental health difficulties are now more frequently reported and pronounced secondary to the isolation and uncertainties experienced during the pandemic. Our previous work has shown important mental health services' gaps for children/youth with NDDs and their families, highlighting the need to optimize and tailor existing practices.

Objective

To explore mental health services' barriers, facilitators, impact, and solutions from the perspectives of HCPs and CGs, and to describe common precursors to mental health challenges in children with NDDs from the perspectives of these two groups.

Methods

In a triangulation mixed-method study design embedding quantitative and qualitative approaches, participants completed a survey and a semi-structured interview. Descriptive statistics and a hybrid inductive/deductive thematic approach were used for data analysis.

Results

Over 700 utterances were analyzed (247 from caregivers [n = 10], 531 from clinicians [n = 16]) and included 143 and 173 statements related to the precursors and barriers/facilitators, respectively. Common precursors to mental health challenges (n = 7 categories) were identified and included reported feelings/perception of self, behavioral and physical manifestations, emotional dysregulation, and school-related factors, among others. Clinicians reported a widespread need for pediatric, family-centered mental health services and conveyed lacking mental health resources/training to meet the demand. Caregivers indicated being only moderately satisfied when care was received. Salient facilitators identified by clinicians were having an interdisciplinary team and caregiver's engagement in the therapeutic processes. Participants recommended improvements to increase accessibility to mediate the existing discrepancy between the emergence of precursors and care received; that services must target a broader population and be more comprehensive (e.g., family-centered care, addressing high-risk transition periods); and training/toolkits to support clinicians' evidence-based practice.

Conclusion

Our findings emphasize the necessity of a systematic and standardized approach to mental health services for children with NDDs and their families. Enhancing caregiver support, addressing barriers, and adopting a proactive, family-centered approach are crucial for improving accessibility and quality. These proposed solutions provide valuable insights for shaping policies and practices in pediatric mental health services.

Impact of Child and Family Factors on Caregivers' Mental Health and Psychological Distress during the COVID-19 Pandemic in Greece

Although primary caregivers of children with developmental disabilities (DDs) experience higher levels of distress than primary caregivers of typically developing children do, this problem has received limited attention in Greece. Therefore, this study examined mental health and associated factors among primary caregivers of children with and without DDs in Greece during the COVID-19 pandemic. This cross-sectional study included 156 participants. Primary caregivers completed a self-report survey on sociodemographic characteristics, the Depression, Anxiety, and Stress Scale-21 items, and the 12-item General Health Questionnaire. Primary caregivers of children with DDs, particularly mothers, reported more mental health problems and higher levels of psychological distress than the control group. Among families parenting a child with disabilities, caregivers' psychological distress was significantly related to having a child with autism spectrum disorder and the severity of the child's behavioral difficulties. Significant predictors of caregivers' distress were the parent being female, the child being male, a single-parent family, a lower income, and higher depressive symptoms. Caregivers raising children with DDs face unique challenges in terms of care, necessitating the development of family-based interventions to improve the social-emotional well-being and overall quality of life for both parents and children.