'The hard work starts now': a glimpse into the lives of carers of community-dwelling stroke survivors.

AIMS AND OBJECTIVES: To explore the personal experiences of carers of stroke survivors and to elicit their views and opinions of what constitute the major issues and concerns of people in their situation. BACKGROUND: The unexpected nature of stroke can propel people into the role of carer with little or no warning. Some carers of stroke survivors suffer from considerable stress and a range of psychological and physical disorders. DESIGN: A small-scale qualitative study of experienced carers of stroke survivors. METHOD: Ten carers with experience of caring for a stroke survivor were recruited to the study through community stroke staff. Data were collected using semi-structured interviews and a focus group. RESULTS: The women's main concerns were focused around the need for information and support, including the need for some preparation and training in the necessary skills of caring. CONCLUSIONS: To understand fully the lives that carers lead, it is necessary to explore what carers want to do, and expect to do, for the care-recipient. There is a need to develop an understanding of factors that appear to be protective against stress, to identify how they can be enhanced and to develop ways to minimise the impact of those factors that have a detrimental impact on the well-being of carers and on those for whom they care. RELEVANCE TO CLINICAL PRACTICE: Health professionals need to ensure that appropriate information is clearly provided for carers. Communication between health professionals to ensure the 'joined up' provision of therapeutic services is another area for continual development. Carers expressed the wish to be better prepared to take on the caring role in the home and would have welcomed some training in this area.

Mental health need and access to mental health services by youths involved with child welfare: a national survey.

OBJECTIVE: This study assessed the relationship between the need for and use of mental health services among a nationally representative sample of children who were investigated by child welfare agencies after reported maltreatment. METHOD: Data were collected at study entry into the National Survey of Child and Adolescent Well-Being and were weighted to provide population estimates. RESULTS: Nearly half (47.9%) of the youths aged 2 to 14 years (N = 3,803) with completed child welfare investigations had clinically significant emotional or behavioral problems. Youths with mental health need (defined by a clinical range score on the Child Behavior Checklist) were much more likely to receive mental health services than lower scoring youth; still, only one fourth of such youths received any specialty mental health care during the previous 12 months. Clinical need was related to receipt of mental health care across all age groups (odds ratio = 2.7-3.5). In addition, for young children (2-5 years), sexual abuse (versus neglect) increased access to mental health services. For latency-age youths, African-American race and living at home significantly reduced the likelihood of care. Adolescents living at home were also less likely to receive services, whereas having a parent with severe mental illness increased (odds ratio = 2.4) the likelihood of service use. CONCLUSIONS: Routine screening for mental health need and increasing access to mental health professionals for further evaluation and treatment should be a priority for children early in their contact with the child welfare system.