Mental health care needs and preferences for mothers of children with a disability

Perceptions of motherhood in mothers of children with disabilities in Turkey: a qualitative study

OBJECTIVES

This study aimed to explore how mothers of children with disabilities perceive mothering through metaphor.

SUBJECTS AND METHODS

The study was conducted in March 2023 with 28 women who had experienced motherhood. The data were collected using the Descriptive Information Form and the Metaphorical Perceptions Form developed by the researchers who reviewed the literature. The women's metaphorical perceptions were obtained by filling in the following sentence: 'Being a mother of a child with disabilities is like/similar to … … … . because … … '.. The interviews were conducted individually using the in-depth interview method and analysed using the descriptive analysis technique.

RESULTS

The metaphors created by mothers of children with disabilities were grouped under two main themes: interpretation and challenges. Each major theme contains sub-themes. The main theme of interpretation includes cleansing from sins and divine reward, empowerment, being privileged, and acceptance/change in outlook on life, while the sub-theme of challenges includes constant struggle, stigmatisation, imprisonment/isolation, and uncertainty.

CONCLUSION

The women involved in the study produced the most metaphors for their perceptions of being a mother of a child with a disability for the sub-theme of imprisonment/isolation in the main theme of challenges. On the other hand, the least number of metaphors were produced in the sub-theme of acceptance/change in the outlook on life in the main theme of interpretation. According to the results, the perception of motherhood of women with children with disabilities will especially guide midwives who are responsible for the care of children with disabilities aged 0-6 years, and mental health workers.

Qualitative differences in perspective on children's quality of life between children with cerebral palsy and their parents

BACKGROUND

Cerebral palsy (CP) is one of the most common childhood disabilities, impacting many areas of a child's life. Increasingly, quality of life (QOL) measures are used to capture holistic wellbeing of children with CP. However most validated QOL measures for children are based on adult perspective only, with limited focus on child perspective. Conceptual differences between children's and adults' definitions of QOL may reflect different underlying QOL models which contribute to measurement score divergence. This qualitative study investigated the conceptual meaning of QOL for children with CP, comparing child and parent perspectives. Eighteen families completed 8 child interviews and 18 parent interviews. Children (11 boys, 7 girls) represented the spectrum of motor functioning, with comorbidities including epilepsy, intellectual disability, and communication impairments. Child and parent interviews were analysed separately using constructivist grounded theory methods and then findings were integrated to examine similarities and differences.

RESULTS

All participants sought child inclusion in social activities, education, and recreation, requiring negotiation, adaptations, and advocacy. Five conceptual categories emerged from child interviews: socialising, play, negotiating limitations, self-identity, and developing agency. This reflected an individual model of QOL supporting child development goals. Parent interview findings revealed concepts related to child-specific QOL (day-to-day functioning and enabling child goals), as well as parent and family functioning concepts aligned to models of "family QOL", embracing impacts of family relationships and the interdependence of QOL among family members.

CONCLUSIONS

This study identified similarities and differences in child and parent perceptions of QOL for the child with CP. Children provided insights into the importance of play and peer support, and their developing self-identity and sense of agency. Self-directed free play, especially, was identified by children but not parents as a central everyday activity promoting wellbeing and social inclusion. Parents discussed family functioning and aspects outside of child sight, such as managing time and financial resources. Relying on parents' perspective alone to model child QOL misses valuable information that children contribute. Equally, child report alone misses parent experiences that directly influence child QOL. There is value in incorporating family QOL into parent reports while developing a conceptually separate child self-report QOL instrument.

Parents of children with disability: Mental health outcomes and utilization of mental health services

BACKGROUND

Caring for a child with disability may result in stress and difficulties for parents, leading to mental health problems.

OBJECTIVE

This study aims to investigate the prevalence of mental health problems, mental health service utilization, and costs in parents of children with disabilities compared to parents of children without disabilities.

METHODS

We used data from the Longitudinal Study of Australian Children, a nationally representative sample of children recruited in 2004 with biennial follow-up and linkage to out-of-hospital health service use and billing data for the parents. Descriptive analyses were used to present parental mental health measured using the Kessler 6. Generalized linear models were conducted to examine whether being the parent of a child with disability was associated with higher mental health service utilization and costs compared to those without disability.

RESULTS

A total of 4935 children and their parents were included in this study. There was a higher prevalence of mental health problems for parents of children with disabilities compared to those without in all child ages. Regression analyses indicated that parents of children aged 12-17 years with disabilities had significantly higher mental health service utilization and costs compared to parents of children without disabilities (biennial cost difference = $86.37, 95%CI ($15.67-$157.07)). However, these differences were not observed among parents of children aged 4-11 years.

CONCLUSION

There are high levels of mental health concerns among parents of children with disabilities in Australia. Mental health interventions are needed to support parents of children aged 4-11 years where there appear to be unmet health needs.

An intervention to improve the self-efficacy of key workers to support parental wellbeing at an early childhood intervention service in Australia: a stepped wedged randomized cluster trial

PURPOSE

It is well documented parents of children who have a disability are at an increased risk of poor mental health and wellbeing. A capacity building program designed to build key worker self-efficacy to support the mental health of parents accessing early childhood intervention services (ECIS) for their child was trialled.

MATERIALS AND METHODS

A stepped-wedge cluster randomised trial design was utilised to deliver and evaluate a 12-month intervention program, comprising tailored professional development, resource development and sustainability measures. The repeated measurements on individuals in six clusters over three follow-up periods were analysed using linear mixed models. Comparison of the control and new program statistical means (adjusted for period effects) were assessed with an F test.

RESULTS

Key workers reported increased confidence to talk to parents about their own wellbeing (d = 0.51, F(1, 51.8) = 4.28, p = 0.044) and knowledge of parental mental wellbeing improved (p = 0.006). A reduction in staff sick leave partially offset the cost of the intervention.

CONCLUSIONS

A multi-pronged intervention targeted at key workers was found to be an effective way to ensure parental wellbeing is supported at an ECIS in Australia.

TRIAL REGISTRATION

ACTRN12617001530314Implications for RehabilitationThere are implications for the development of children whose parents are experiencing high stress and poor mental health, whereby parents of children with disability or developmental delays are at increased risk.Findings from this study support the recommendation that a key worker is provided to holistically support families who access Early Childhood Intervention Services to aid in reducing poor parental wellbeing and child outcomes.Improved confidence to support and initiate conversations regarding parental wellbeing by key workers, in combination with support from management and the organisation to undertake this as part of their role, is a positive finding from this intervention study.

Protocol for a mixed-methods randomised controlled trial evaluating the effectiveness of a dyadic expressive arts-based intervention in improving the psychosocial well-being of children with intellectual disability in special schools and their mothers

INTRODUCTION

Mothers of children with intellectual disability (ID) are often distressed because of intensive workloads and difficulties in communicating with their children. Given the interdependence between the psychosocial well-being of such dyads, interventions that promote parent-child relationships and mutual communication would be beneficial. Arts provide alternative avenues for expression and offer an imaginative and playful environment for discovering new communication strategies. Given the lack of studies on arts-based dyadic interventions, this study aims to examine the effectiveness of dyadic expressive arts-based intervention (EXAT) in improving the psychosocial outcomes of children with ID and their mothers and the mother-child relationships.

METHODS AND ANALYSIS

This study will adopt a mixed-methods randomised controlled trial design, wherein 154 dyads of children with ID and their mothers will be randomised into either the dyadic EXAT group or the treatment-as-usual waitlist control group. Quantitative data will be collected at four time points: baseline (T0), postintervention (T1), 3-month postintervention (T2) and 6-month postintervention (T3). Qualitative data will be collected from a subset of 30 mothers in the intervention group at T1 and T3 to document their experiences and perceived changes after the intervention. Mixed-effects models and path analysis will be adopted to analyse the quantitative data, whereas thematic analysis will be applied to the qualitative data. Both sets of data will be triangulated for an integrated view of the effectiveness and mechanism of the intervention.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Human Research Ethics Committee of the University of Hong Kong (Ref. no.: EA200329). Written consent forms will be obtained from all recruited participants (mothers, children with ID and teachers/social workers) before data collection. The study findings will be disseminated in international conferences and peer-reviewed academic journals.

TRIAL REGISTRATION NUMBER

NCT05214859.

Feasibility of Health Promoting Activity Coaching for Mothers of Children With Disabilities: Pilot Nonrandomized Controlled Trial

IMPORTANCE

Mothers of children with disabilities experience health disparity. Interventions targeting maternal mental health need to be developed.

OBJECTIVE

To determine the feasibility and preliminary effectiveness of the Healthy Mothers Healthy Families-Health Promoting Activities Coaching (HMHF-HPAC) intervention for mothers to improve participation in healthy activities and mental health and to evaluate outcome measures.

DESIGN

Nonrandomized controlled pilot feasibility study with one group who received HMHF-HPAC and a control group.

SETTING

Pediatric occupational therapy service; on site or telehealth.

PARTICIPANTS

Twenty-three mothers completed prequestionnaires; of those, 11 mothers participated in the intervention, and 5 did not (7 withdrew).

INTERVENTION

Eleven pediatric occupational therapists were trained to deliver six 10-min sessions of HMHF-HPAC to mothers, integrated into their child's therapy session or separately via telehealth.

OUTCOMES AND MEASURES

Mixed-design analysis of variance explored changes in scores on the Depression Anxiety Stress Scale-21 Items and the Health Promoting Activities Scale.

RESULTS

The intervention group reported, on average, significant reductions in depressive symptoms and stress symptoms and significant increases in participation in health-promoting activity. No significant main effect of time was found for these variables in the control group.

CONCLUSIONS AND RELEVANCE

The HMHF-HPAC program is a viable occupational therapy coaching intervention that can be embedded in existing services for families of children with disabilities. Future trials that evaluate the effectiveness of the HMHF-HPAC intervention for mothers of children with disabilities are warranted. What This Article Adds: This article provides support for the feasibility of appropriate and sensitive outcome measures and program content and delivery to implement the novel HMHF-HPAC intervention in further research. Mothers of children with disabilities benefited from integrated HMHF-HPAC delivered by pediatric occupational therapists within the family's existing services.

How to measure barriers in accessing mental healthcare? Psychometric evaluation of a screening tool in parents of children with intellectual and developmental disabilities

Caring for children with intellectual and developmental disabilities (IDD) can cause an enormous physical and emotional burden, and therefore these parents have an elevated risk to experience mental health problems. The characteristics of current healthcare systems and parents' responsibilities to care for their children seem to impede their access to mental healthcare. There is so far a lack of instruments to screen for such obstacles. The aim of this study was to develop and validate a scale for measuring barriers to accessing mental healthcare. The Parental Healthcare Barriers Scale (PHBS) was developed on the basis of an extensive literature research, input and discussion from experts and parents with lived experience. A cross-sectional survey was used to collect data from 456 parents of children with IDD. Physical health, mental health, social support, and parenting were measured for concurrent and discriminant validity of the PHBS. The PHBS scale revealed acceptable to good reliability and validity. It consists of four subscales (i.e., support accessibility, personal belief, emotional readiness, and resource availability). The PHBS found parents prioritized their children's treatments over their own mental health challenges (93.4%), did not have enough time (90.4%), and had financial concerns (85.8%). Parents in rural and remote areas had more limited resources. Findings from our study suggest increasing financial support for the parents seeking mental health services, introducing evidence-based treatments, increasing the availability of healthcare services for parents, and adjusting current services to their needs.

Parental experiences of caring for children who have learning disabilities and procedural anxiety in hospital: An interpretive phenomenological study

BACKGROUND

Children with learning disabilities (LD) are more likely to have health conditions that require hospital attendance than children without LD. Like all children, they can experience fear and distress related to procedural anxiety. Parents play a key role in managing procedural anxiety in children with LD. No previous published qualitative studies have explored parental experiences of caring for a child with LD and procedural anxiety in hospital.

OBJECTIVES

To explore how parents experienced caring for their child with LD and procedural anxiety in hospital.

METHODS

A purposive sample of six participants were recruited through a Facebook group for parents of children with LD. Remote semi-structured interviews were conducted via telephone, Microsoft Teams or Whatsapp. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis.

RESULTS

Five key themes were generated: (1) Emotional toll: parents characterized their experiences as highly emotional; reporting feeling stressed, anxious and worried. (2) Restraint and holding: parents spoke of their experiences of restraint which was largely viewed as negative and sometimes inappropriate. (3) Advocacy: parents articulated their responsibility as advocates for their children. (4) Going it alone: parents were extremely proactive in managing their child's anxieties but some also felt highly-pressurized and isolated. (5) Inconsistency and uncertainty: parents experienced inconsistency and uncertainty in their children's care from healthcare professionals which led to anxiety and frustration.

CONCLUSION

Parents of children with both LD and procedural anxiety experienced many challenges. Parents' expertise must be utilized by clinicians when caring for children with LD and procedural anxiety whilst ensuring appropriate support for parents. Nurses require specific training in psychosocial interventions to enhance care for children with LD and procedural anxiety. Further research identifying effective nursing strategies to enhance parental experiences would be beneficial to improve care to this patient group.

Meeting the care needs of people with intellectual and developmental disabilities and their families through the Model of Nursing Based on Activities of Living

AIM

This study aimed to identify the problems families of people with intellectual and developmental disabilities face in meeting their family members' care needs, using the Model of Nursing Based on Activities of Living, and planned implemented and evaluated the nursing interventions to fulfill these care needs.

METHOD

A cross-sectional screening model was used in the study. One hundred families of people with intellectual and developmental disabilities, who accepted home visits between September 2008 and December 2008, were included in the study.

RESULTS

The study revealed a statistically significant difference (p < 0.05) between the Model of Nursing Based on Activities of Living total mean scores of care needs in the pre- (1.69 ± 0.21) and post-nursing intervention (1.50 ± 0.24) periods. Nurse-led interventions for daily life activities of people with intellectual and developmental disabilities and their families were found to be effective (p < 0.05).

CONCLUSION

In line with the Model of Nursing Based on Activities of Living, nurse-led collaboration with families and relevant institutions positively contributed to meeting the care needs of people with intellectual and developmental disabilities and their families.

A Systematic Review to Identify Screening Tools and Practices that Can Be Used by Children's Rehabilitation Service Providers to Screen Parents' Mental Health

BACKGROUND

Parents of children with disabilities often report stress, depression, and anxiety. This review identified screening tools and practices that pediatric rehabilitation service providers can use to screen the mental health of parents of children with disabilities.

METHODS

An interdisciplinary team and patient partner completed the systematic review in which 16,015 articles were screened and 473 articles were included to i) identify mental health tools that were used with parents, ii) determine the clinical utility of frequently used tools, iii) examine the screening practices used in pediatric rehabilitation contexts.

RESULTS

115 screening tools were used to screen parents' mental health. The Parenting Stress Index was used most often. Seven studies reported screening in order to recommend further assessment or supports. Increased awareness, training, resources, and infrastructure are needed to support parents' mental health.

DISCUSSION

Evidence is needed to guide mental health screening practices in pediatric rehabilitation and determine their effectiveness.

Healthy Mothers Healthy Families, Health Promoting Activity Coaching for mothers of children with a disability: Exploring mothers' perspectives of programme feasibility

BACKGROUND

Health Promoting Activity Coaching, an intervention within the Healthy Mothers Healthy Families programme (HMHF-HPAC), was delivered by occupational therapists in a project that assessed feasibility of this new intervention. The HMHF-HPAC promotes the health and well-being of mothers of children with disabilities and is a six-session programme with website, workbook, and one-on-one coaching. Consumer experiences of this novel health-promoting intervention were sought to enable consumer-informed feedback for future modifications and improvements prior to further development.

METHODS

This qualitative study explored the experiences of mothers who participated in the HMHF-HPAC and their perspectives on the service delivery, content and impact. This study was embedded within an overarching feasibility study and was conducted parallel to a quantitative component. Seven mothers who completed the HMHF-HPAC participated in semi-structured interviews. Data were analysed thematically using a six-stage thematic approach.

FINDINGS

Four key themes emerged: Recognising Mothers; From Vulnerability to Empowerment; A Goal for Me; and Perspectives on Content and Delivery. Mothers reported increased participation in health-promoting activities over the duration of HMHF-HPAC, reflective of their individual needs. Mothers described improved mood and energy levels, reduced stress and anxiety, greater self-awareness, and increased engagement in leisure activities with their children. Health-promoting goals identified by mothers' pertained to improving physical activity levels, healthy dietary changes, sleep quality and duration, community engagement, and mindfulness activities. Mothers reported that their child's occupational therapists, the website, and workbook were acceptable and viable.

CONCLUSIONS

Mothers' experiences support the feasibility of embedding the HMHF-HPAC programme into occupational therapy services directed towards child and family-focused interventions. Mothers found occupational therapists to be acceptable facilitators of the HMHF-HPAC, given the frequent interactions and rapport with mothers and the occupational underpinnings of the programme. The HMHF-HPAC is an accessible intervention that promotes family-oriented practice.

Research on Family Health and Children and Youth With Special Health Care Needs

Families of children and youth with special health care needs (CYSHCN) can face challenges with regard to health and well-being. Health systems are designed to support CYSHCN but do not often consider the health and well-being of their family. Despite a growing body of literature, substantial gaps remain in our understanding of the impact of caregiving on family health and well-being and mechanisms of supporting families. In order to better understand and address these gaps, a national CYSHCN network developed a national research agenda to prioritize key areas of insufficient understanding of health and well-being for families of CYSHCN. Questions identified by the research agenda include: 1) How can family resiliency and adaptability be measured and improved? 2) How can we better assess family mental health needs and implement appropriate interventions? 3) What is the impact of family health on CYSHCN health outcomes? This paper describes a review of what is currently known regarding health for families of CYSHCN, gaps in the literature focused on the research agenda questions, and recommendations for future research. Based on the research agenda and current state of research for family health of CYSHCN, the authors recommend focusing on resiliency and adaptability as outcomes, using implementation science to address mental health concerns of family members and to further assess the impact of family health on health outcomes of CYSHCN. In addition, research should have a special focus on diverse populations of families and consider these questions in the context of different family structures.

Association of child's disability status with father's health outcomes in Japan

Fathers' involvement in childcare has been increasing in recent years. However, very little is known about the health impact on fathers when they are caring for or living with a disabled child. This study aims to understand the psychological distress and subjective health outcomes among fathers living with a disabled child compared to fathers living without a disabled child. Data for this study were obtained from the Comprehensive Survey of the Living Conditions conducted by the Ministry of Health, Labour and Welfare in 2016. Multivariable logistic regression was used among 438 disabled-child and father dyads and 27,682 non-disabled-child and father dyads to analyse the association between a child's disability status with father's health outcomes. Fathers of disabled children had a higher prevalence of psychological distress (17% vs. 12%) and poor subjective health status (13% vs. 8%) than fathers of non-disabled children. A large proportion of disabled children were boys (70%) and had disability level 1 (47%). After adjusting for covariates, the odds ratio (OR) of having psychological distress (OR, 1.53; 95% CI, 1.19–1.97) and poor subjective health status (OR, 1.78; 95% CI, 1.34–2.36) among fathers of disabled children is significantly higher compared to fathers of non-disabled children. Unemployed fathers had a higher odds ratio of psychological distress (OR, 3.07; 95% CI, 2.49–3.79) and poor subjective health status (OR, 4.90; 95% CI, 3.95–6.09) compared to regular working fathers. Fathers of children with disabilities need greater physical and mental health and wellbeing support. They should be provided with additional support not just for their mental but also their subjective wellbeing.

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Fathers of disabled children have higher odds ratio of psychological distress.

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Fathers of disabled children have higher odds ratio of poor subjective health status.

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70% of disabled children were boys and 47% had mildest severity of disability.

Understanding key worker experiences at an Australian Early Childhood Intervention Service

The delivery of family-centred practice (FCP) within Early Childhood Intervention Services (ECISs) for young children with a disability or development delay conceptualises that children's learning environments, parenting, family and community supports intersect to have the greatest impact on the developing child. The transdisciplinary key worker model is considered a best-practice approach within ECISs whereby staff work collaboratively across disciplinary boundaries to plan and implement services for children and their families. Research suggests families who have a key worker have better relationships with services, fewer unmet needs, better morale, more information about services, higher parental satisfaction and more parental involvement than those not receiving this service. Using a phenomenological qualitative design this study sought to understand transdisciplinary key workers' perspectives regarding the strengths and challenges to undertaking their role in providing services to children and families accessing an ECIS at a major disability service organisation, in light of the changing policy reform during the roll out of the National Disability Insurance Scheme in Australia. Purposive sampling was used to recruit key workers (n = 13) to participate in semi-structured interviews during 2015. Data were analysed using an inductive, thematic approach. Results revealed four main themes that impact on the effectiveness of key workers' service provision. These are broadly categorised as (a) Engagement with the workplace, (b) Engagement with clients, (c) Professional capacity and (d) Staff Wellbeing. The findings aligned with previous studies identifying sources of support and stress for disability services staff. They also provided new insights into key workers' lack of confidence in addressing parental mental health issues, despite operating under a family-centred approach. These findings informed the development of an intervention trial and evaluation to improve support for parent and staff wellbeing within a Victorian Disability Service with the aim of building their capacity to support children with a disability.

Self-Rated Health and Pain Problems in Mothers of Healthy Children or Children Requiring Outpatient Observation or Hospitalisation: A Pilot Cross-Sectional Study

A child's illness or disability is a considerable stressor for the mother and a risk factor for many psychological problems and somatic diseases. The purpose of the study was to (1) assess the prevalence of poor SRH and pain, (2) compare self-rated health and pain, (3) and identify the determinants of SRH and pain in mothers of healthy children and children requiring ambulatory observation or hospitalization. The study covered 234 mothers of both healthy and unhealthy children who required outpatient observation or treatment at an intensive care unit, neonatal intensive care unit, or oncology department. To analyse the variables obtained, the following tools were used: Self-Rated Health, Numerical Rating, Interpersonal Support Evaluation List, Peritraumatic Distress Inventory, Modified Hospital Anxiety and Depression Scale, and Impact of Effects Scale-Revised. The self-assessment of health in mothers of healthy children and those in need of outpatient observation or hospitalization at units with various specialities differed in a statistically significant way. The severity of the average and maximum pain among mothers of healthy children and those with a history of disease differed statistically significantly. Poor SRH co-occurred with severe maximum pain in all of the examined groups. Both in the control group and the group of mothers of children requiring outpatient observation, poor SRH co-occurred with a high level of anxiety. Only in the control group was a correlation found between the severity of the average and maximum pain and the severity of anxiety and depression symptoms.

Profile of Mothers of Children with a Disability Who Seek Support for Mental Health and Wellbeing

This paper investigated the characteristics of mothers of children with a disability who registered for a mental health and wellbeing workshop. The questionnaire measured mental health, health-related behaviours, empowerment, family cohesion, wellbeing and child-related variables. Regression analysis identified factors associated with depressive symptoms and positive wellbeing. Fifty-seven percent of participants (N = 171) had depressive symptoms within the clinical range. Higher symptoms were associated with reduced: empowerment (r = - .39, p < .01); positive-wellbeing (r = - .66, p < .05); and healthy activity (r = - .41, p < .001). Low positive wellbeing (β = .55, p < .001) was the strongest predictor of depressive symptoms. Family cohesion (β = .25, p < .001), was the strongest predictor of positive-wellbeing. Future health and wellbeing interventions that support mothers with high care responsibilities should include psycho-education and strategies to address healthy maternal and family-related behaviour changes.

Experiences and barriers to accessing mental health support in mothers of children with a disability

BACKGROUND

Despite evidence for high levels of mental health problems in mothers of children with a disability and the potential impact on caring for their child, very little is known about mothers' experience in accessing professional mental health support. This study aimed to explore mothers' views and experience on seeking help for their mental health.

METHODS

Semi-structured interviews were conducted with 25 mothers of children with a disability. Thematic analysis was completed.

RESULTS

Mothers experienced significant barriers when accesing support at the personal, professional and system level. Personal barriers included the need for competency and stigma about mental illness: professional barriers included the lack of discussions about mental health and interpersonal factors that hindered disclosure. System barriers included feeling invisible to the health services, paediatric care focusing on the child rather than the family and limitations to the type of mental health support available.

CONCLUSION

Mothers perceive substantial barriers in accessing support for their mental health. It is important that strategies are designed so the importance of mentally healthy mothers is understood and to normalize a need for assistance when you are the mother of a child with additional support needs. Strategies are also needed to encourage mothers to seek help and to assist professionals having discussions about maternal wellbeing. Improvements are also required in the accessibility of service supports.

Effects of parent-child painting and creative crafting therapy on preschool children with autism spectrum disorder and their mothers: a prospective randomized controlled trial

OBJECTIVES

To study the effects of parent-child painting and creative crafting therapy on the core symptoms of preschool children with mild-to-moderate autism spectrum disorder (ASD) and the parenting stress and hope level of their mothers.

METHODS

A total of 56 preschool children with mild-to-moderate ASD and their mothers were divided into an experimental group and a control group using the block randomization method, with 28 pairs in each group. The subjects in the control group received an applied behavior analytic intervention and those in the experimental group received parent-child painting and creative crafting therapy in addition to the intervention in the control group. The intervention time was 20 weeks for both groups. Autism Behavior Checklist (ABC), Social Responsiveness Scale (SRS), Parenting Stress Index-Short Form (PSI-SF), and Herth Hope Index (HHI) were used to evaluate the core symptoms of children and the parenting stress and hope level of their mothers before and after 20 weeks of intervention.

RESULTS

Forty-nine child-mother pairs completed the study (25 pairs in the intervention group and 24 pairs in the control group). The children in the experimental group had significantly lower scores of social interaction, language, social communication, and social motivation and total scores of ABC and SRS compared with those in the control group (P<0.05). The mothers in the experimental group had significantly lower scores of parental distress and parent-child dysfunctional interaction and total score of PSI-SF (P<0.05) and significantly higher total score of HHI and scores of each dimension compared with those in the control group (P<0.05).

CONCLUSIONS

The combination of applied behavior analytic intervention with parent-child painting and creative crafting therapy can more effectively improve the core symptoms and social interaction of preschool children with mild-to-moderate ASD, reduce the parenting stress of mothers and improve their hope level.

Mental Health and Health Behaviour Changes for Mothers of Children with a Disability: Effectiveness of a Health and Wellbeing Workshop

Healthy Mothers Healthy Families (HMHF) is a program that educates and empowers mothers of children with disabilities to improve health behaviours. Outcomes were investigated in this study. A pre, post-test design was implemented using online questionnaires including the Health promoting activities scale (HPAS) and the Depressional anxiety stress scales (DASS). Mothers (N = 71) experienced improvements in HPAS scores, p < .001. Mental health symptomatology reduced: depressive symptoms (p = .005), Anxiety symptoms (p = .005) and stress (p = .002). Wellbeing improved (p < .001). Mothers also reported that their child with a disability experienced an increase in quality of life (p = .042). Mothers’ lifestyles goals improved: managing stress; dietary changes; leisure; self-perception and others. HMHF is an effective intervention with improved health status and outcomes for mothers.

The Efficacy of WeChat-Based Parenting Training on the Psychological Well-being of Mothers With Children With Autism During the COVID-19 Pandemic: Quasi-Experimental Study

BACKGROUND

During the COVID-19 pandemic, special education schools for children in most areas of China were closed between the end of January and the beginning of June in 2020. The sudden interruption in schooling and the pandemic itself caused parents to be anxious and even to panic. Mobile-based parenting skills education has been demonstrated to be an effective method for improving the psychological well-being of mothers with children with autism. However, whether it can improve the psychological states of mothers in the context of the COVID-19 pandemic is a subject that should be urgently investigated.

OBJECTIVE

The aim of this study is to evaluate the efficacy of WeChat-based parenting training on anxiety, depression, parenting stress, and hope in mothers with children with autism, as well as the feasibility of the program during the COVID-19 pandemic.

METHODS

This was a quasi-experimental trial. A total of 125 mothers with preschool children with autism were recruited in January 2020. The participants were assigned to the control group (n=60), in which they received routine care, or the intervention group (n=65), in which they received the 12-week WeChat-based parenting training plus routine care, according to their preferences. Anxiety, depression, parenting stress, hope, satisfaction, and adherence to the intervention were measured at three timepoints: baseline (T0), postintervention (T1), and a 20-week follow-up (T2).

RESULTS

In total, 109 mothers completed the T1 assessment and 104 mothers completed the T2 assessment. The results of the linear mixed model analysis showed statistically significant group × time interaction effects for the intervention on anxiety (F=14.219, P<.001), depression (F=26.563, P<.001), parenting stress (F=68.572, P<.001), and hope (F=197.608, P<.001). Of all mothers in the intervention group, 90.4% (48.8/54) reported that they were extremely satisfied with the WeChat-based parenting training. In total, 40.0% (26/65) logged their progress in home training each week and 61.5% (40/65) logged their progress more than 80% of the time for all 20 weeks.

CONCLUSIONS

The WeChat-based parenting training is acceptable and appears to be an effective approach for reducing anxiety, depression, and parenting stress, as well as increasing hope in mothers with children with autism during the global COVID-19 pandemic. Future studies with rigorous designs and longer follow-up periods are needed to further detect the effectiveness of the WeChat-based parenting training.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000031772; http://www.chictr.org.cn/showproj.aspx?proj=52165.

Associations Between Child Sleep Problem Severity and Maternal Well-Being in Children with Autism Spectrum Disorder

This study investigated whether sleep problem severity in children with autism spectrum disorder was associated with maternal well-being. Mothers of 234 children reported on their mental health (Kessler Psychological Distress Scale), parenting stress (Parenting Stress Index-4-SF), health-related quality of life (HRQoL; Assessment of Quality of Life-4D) and their child's sleep (Children's Sleep Habits Questionnaire-ASD). Analyses revealed sleep initiation and duration problem severity scores were associated with increased mental health difficulties. Specific child sleep problems were not associated with parenting stress or HRQoL. This study revealed the importance of considering sleep and the family system when assessing maternal well-being. Future research considering parent, child and family factors will be important to informing a family focused approach to mental health.

Increased maternal new-onset psychiatric disorders after delivering a child with a major anomaly: a cohort study

BACKGROUND

The birth of a child with a major congenital anomaly may create chronic caregiving stress for mothers, yet little is known about their psychiatric outcomes.

AIMS

To evaluate the association of the birth of a child with a major congenital anomaly with subsequent maternal psychiatric risk.

METHODS

This Danish nationwide cohort study included mothers who gave birth to an infant with a major congenital anomaly (n = 19 220) between 1997 and 2015. Comparators were randomly selected mothers, matched on maternal age, year of delivery and parity (n = 195 399). The primary outcome was any new-onset psychiatric diagnosis. Secondary outcomes included specific psychiatric diagnoses, psychiatric in-patient admissions and redeemed psychoactive medicines. Cox models were used to estimate hazard ratios (HRs), adjusted for socioeconomic and medical variables.

RESULTS

Mothers of affected infants had an elevated risk for a new-onset psychiatric disorder vs. the comparison group (adjusted HR, 1.16, 95% CI 1.11-1.22). The adjusted HR was particularly elevated during the first postpartum year (1.65, 95% CI 1.42-1.90), but remained high for years, especially among mothers of children with multiorgan anomalies (1.37, 95% CI 1.18-1.57). The risk was also elevated for most specific psychiatric diagnoses, admissions and medicines.

CONCLUSIONS

Mothers who give birth to a child with a major congenital anomaly are at increased risk of new-onset psychiatric disorders, especially shortly after birth and for mothers of children with more severe anomalies. Our study highlights the need to screen for mental illness in this high-risk population, as well as to integrate adult mental health services and paediatric care.

To screen or not to screen? Exploring the value of parent mental health screening in children's rehabilitation services

PURPOSE

Parents of children with disabilities are at increased risk of mental health challenges, yet it is unclear whether parent mental health screening should be considered in the context of children's rehabilitation.

METHODS

A nonsystematic narrative review was conducted guided by a framework for assessing the effectiveness of proposed health screening programs. Screening for the purpose of recommending further assessments and/or psychosocial supports and services was considered. The potential harms and benefits of mental health screening for parents of children with disability were examined considering relevant contextual factors.

RESULTS AND CONCLUSIONS

While best evidence in the form of a randomized controlled trial in this population does not yet exist, there was evidence to suggest that parent mental health is an important factor in promoting child and family health and well-being and deserves consideration in the practice of family-centered care. If appropriate referral pathways and resources are developed, children's rehabilitation service providers may be in an advantageous position to provide parent mental health screening.IMPLICATIONS FOR REHABILITATIONParents of children with disabilities are at increased risk for depression, stress, and anxiety.Service providers may be well placed to identify mental health concerns through screening.Contextual factors to consider before initiating screening include level of evidence for screening, whether screening would reach target clients, and whether additional supports are available.Children's rehabilitation service providers can be family-centered by attending to parent mental health needs, with the potential to improve the health, development, and well-being of the whole family.

A Capacity Building Program to Improve the Self-Efficacy of Key Workers to Support the Well-Being of Parents of a Child With a Disability Accessing an Early Childhood Intervention Service: Protocol for a Stepped-Wedge Design Trial

Background

Early childhood intervention services support children with disabilities or developmental delays from birth to school entry with the aim to achieve optimal outcomes for children and their families. A transdisciplinary approach to delivering early childhood intervention, particularly the key worker model, is considered the best practice, where allied health professionals (eg, speech pathologists, physiotherapists, occupational therapists, psychologists, and special educators) and the family work together as a collaborative team to share information, knowledge, and skills across disciplinary boundaries, with a key worker coordinating and delivering most of the intervention to achieve the goals for the child and their family. Initial qualitative research demonstrated parents want their key worker to also support their mental well-being. Poor mental well-being of parents of a child with a disability is of relevance to key workers because of its association with poor child-related outcomes. One of the major challenges key workers report in supporting families is managing parent distress and, because of lack of confidence, is a secondary negative impact on their own well-being.

Objective

This trial has been developed in response to the negative cycle of low professional confidence to support parents’ mental health, increased key worker stress, and high turnover of employees working within a disability service setting.

Methods

A stepped-wedge design is used to deliver and evaluate a capacity building intervention program, over a 9-month period, for key workers to improve both parent and staff mental well-being. The primary outcome is key workers’ self-efficacy in supporting parental mental well-being. Secondary outcomes include manager self-efficacy in supporting key workers and staff perceptions of supervisory support, staff job-related mental well-being, parental satisfaction with their key worker, parental mental well-being, and cost-consequence of the program.

Results

This study was funded in October 2014, supported by an Australian National Health and Medical Research Council Partnership Project grant (Grant number 1076861). Focus groups and individual face-to-face interviews were conducted from February to November 2015 with 40 parents who have a child with a disability and 13 key workers to gain insight into how the disability service could better promote child and family health and well-being and to inform about the development of the trial.

Conclusions

The stepped-wedge study design is practical and ethical for research with a vulnerable population group of parents of a child with a disability, providing high quality data with all participants exposed to the intervention by the end of the trial.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12617001530314; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372578 (Archived by WebCite at http://www.webcitation.org/76XjDavnG)

International Registered Report Identifier (IRRID)

DERR1-10.2196/12531

Supporting the mental health of mothers of children with a disability: Health professional perceptions of need, role, and challenges

BACKGROUND

Mothers of children with a disability have a higher risk of mental health difficulties than mothers of typically developing children. Very little is known about how health professionals perceive their role in supporting mothers' mental health. We aimed to explore the perspectives of health professionals working with families of children with a disability about how they provide support for maternal mental health in their roles. Specifically, whether professionals consider it their role and responsibility to provide support, the types of actions that they engage in to do this, and the challenges that they experience.

METHODS

This qualitative semi-structured interview study included 13 health professionals (allied health professionals, general practitioners, and paediatricians) working with families of a child with a disability. Thematic analysis was conducted on transcribed interview data.

RESULTS

Four overlapping themes were identified from the data indicating that professionals knew that mothers needed mental health support but were not always clear about their roles and responsibilities to support maternal mental health. Professionals also found it difficult to address maternal mental health difficulties, were not always aware of the best strategies to support maternal mental health, and faced difficulties that could be overcome with training and system improvements.

CONCLUSIONS

Although all health professionals were aware of the frequent occurrence of maternal mental health difficulties and the importance of addressing them, several challenges were identified to managing them successfully. Providing health professionals with training in discussing mental health and clearer referral pathways would contribute to mothers being better supported, in addition to policy change that allows parental support in child health services.