Enhancing Parental Coping with a Child's Heart Condition: A Co-production Pilot Study.

Families of children with congenital heart disease (CHD) can have difficulties coping with the stress of their child's condition and would benefit from assistance to cope better. To address the needs of these parents, the Australian Center for Heart Health/HeartKids Australia/Melbourne Graduate School of Education co-produced Family Coping Project was initiated. This project involved two systematic literature reviews, interviews with parents of children with CHD, and the development and piloting of a manualised parental coping program. The primary aims of the pilot study were to determine whether the program would: attract high needs families; enhance the coping self-efficacy of parents; and be acceptable to parents in terms of content and mode of delivery. The secondary aims were to investigate whether the program would impact on parental coping, parental stress and general stress. Parents completed pre-, post-program and 6-month follow up assessment measures, with parent stress scores being compared to stress scores reported for other chronic condition parent carer groups. Twenty-one parents participated and provided baseline data. They were found to be significantly more stressed than other parent carer groups. Eleven parents completed post-program data and 13 completed 6-month follow-up data. There was a significant increase in parents' coping self-efficacy from pre- to post-program, and from pre- to 6-months. Parents' use of productive coping styles increased significantly from pre- to post-program. The program was rated as highly acceptable in terms of content and delivery mode. The pilot provides strong evidence for upscaling the program in conjunction with individualized psychological support for parents to extend knowledge acquisition and attitude change into enhanced coping skills and demonstrated the benefits of a co-production process.

Parent's Perspectives on How They Cope With the Impact on Their Family of a Child With Heart Disease.

PURPOSE: Studies of familial coping with a child's chronic condition have highlighted psychological distress; family functioning; and quality of life; as issues that demand coping strategies. There are conflicting findings on impact and coping and a paucity of information about the specific coping challenges for parents of a child with heart disease, with few qualitative studies in this area. The purpose of the study was to explore the way parents coped with their child's heart condition as it impacted on different domains of family functioning. DESIGN AND METHOD: In this qualitative study, interviews were held with 17 parents attending a pediatric hospital-based family support program in 2015. Fifteen of the 17 children's conditions were classified as "major". Domains covered in the interviews included: coping challenges posed at different stages of the illness trajectory, parenting, condition management, transitions, psychological impact, social support and coping strategies. Interview transcripts were coded thematically. RESULTS: Multiple points of stress and challenges to coping were identified: coping with the diagnosis, including consideration of termination; dealing with the challenges facing their child; coping with parenting including co-parenting issues; the role of social support in coping; and identification of adaptive and maladaptive coping behaviours. CONCLUSION: A large range of positive coping strategies were identified, as was the need for coping-focused psychological support throughout the parents' and children's journey. PRACTICE IMPLICATIONS: The strategies identified have formed the basis of a manualised intervention for these parents.

The intergenerational transmission of at-risk/problem gambling: The moderating role of parenting practices.

BACKGROUND AND OBJECTIVES: Although parenting practices are articulated as underlying mechanisms or protective factors in several theoretical models, their role in the intergenerational transmission of gambling problems has received limited research attention. This study therefore examined the degree to which parenting practices (positive parenting, parental involvement, and inconsistent discipline) moderated the intergenerational transmission of paternal and maternal problem gambling. METHODS: Students aged 12-18 years (N = 612) recruited from 17 Australian secondary schools completed a survey measuring parental problem gambling, problem gambling severity, and parenting practices. RESULTS: Participants endorsing paternal problem gambling (23.3%) were 4.3 times more likely to be classified as at-risk/problem gamblers than their peers (5.4%). Participants endorsing maternal problem gambling (6.9%) were no more likely than their peers (4.0%) to be classified as at-risk/problem gamblers. Paternal problem gambling was a significant predictor of offspring at-risk/problem gambling after controlling for maternal problem gambling and participant demographic characteristics. The relationship between maternal problem gambling and offspring at-risk/problem gambling was buffered by parental involvement. DISCUSSION AND CONCLUSIONS: Paternal problem gambling may be important in the development of adolescent at-risk/problem gambling behaviours and higher levels of parental involvement buffers the influence of maternal problem gambling in the development of offspring gambling problems. Further research is therefore required to identify factors that attenuate the seemingly greater risk of transmission associated with paternal gambling problems. SCIENTIFIC SIGNIFICANCE: Parental involvement is a potential candidate for prevention and intervention efforts designed to reduce the intergenerational transmission of gambling problems. (Am J Addict 2017;26:707-712).

Parent education programmes for special health care needs children: a systematic review.

AIMS AND OBJECTIVES: The aim of this review was to examine parent education programmes for families with children with special health care needs, to better design interventions focusing on the psychosocial aspects of living with a child's chronic condition. BACKGROUND: Studies of familial coping with children with special health care needs indicate high levels of parenting stress, with families with children with special health care needs at risk of major psychological and social disturbances and financial strain. Despite increased knowledge of the factors affecting children with special health care needs themselves, evidence for the effectiveness of preventative and treatment interventions in the form of parent education programmes remains limited. DESIGN: Systematic review using PRISMA guidelines. METHOD: Multi database Boolean searches in EBSCO Discovery Services using the search terms 'complex/special health care needs children', 'child/pediatric/congenital heart disease', 'chronic illness (including diabetes, cancer and cystic fibrosis)', 'family coping', 'siblings' AND 'parenting/family support programs' were conducted. RESULTS: Analysis of 13 included studies showed evidence for the effectiveness of both mixed-health condition and condition-specific parenting programmes delivered in a variety of modes. Three common core intervention approaches were: use of narrative therapy enabling families to tell their own stories, thus facilitating emotional processing and (co-) construction of meaning; a focus on strengthening protective factors such as enhancing parents' skills in communication, and behavioural management and provision of psycho-education to deepen parents' understanding of their child's condition and associated developmental challenges. CONCLUSION: Irrespective of the type of outcome measures used in the studies, the review showed that there were positive gains and improvements across a range of areas of family functioning such as mental health, parenting, communication and problem-solving skills postprogramme. RELEVANCE TO CLINICAL PRACTICE: Identification of what programme characteristics enhance functioning for families with children with special health care needs should encourage the design of effective interventions.

A randomized controlled trial of cognitive behaviour therapy to improve glycaemic control and psychosocial wellbeing in adolescents with type 1 diabetes.

We evaluated a cognitive behaviour therapy-based programme to improve glycaemic control and psychosocial wellbeing in adolescents with type 1 diabetes. A total of 147 adolescents aged 13-16 years were randomized to the intervention (n = 73) or standard care (n = 74). The primary outcome was glycaemic control at 3 and 12 months post randomization, and secondary measures were stress, self-efficacy and quality of life. Mixed-effects regression models were used to assess differences in means between groups at each time point. There was little evidence of differences in glycaemic control between groups. However, psychosocial wellbeing improved in the intervention group compared to the control group. Recommendations for future programmes are discussed. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12608000368336).

Familial impact and coping with child heart disease: a systematic review.

Families of children with congenital heart disease (CHD) cope differently depending on individual and familial factors beyond the severity of the child's condition. Recent research has shifted from an emphasis on the psychopathology of family functioning to a focus on the resilience of families in coping with the challenges presented by a young child's condition. The increasing number of studies on the relationship between psychological adaptation, parental coping and parenting practices and quality of life in families of children with CHD necessitates an in-depth re-exploration. The present study reviews published literature in this area over the past 25 years to generate evidence to inform clinical practice, particularly to better target parent and family interventions designed to enhance family coping. Twenty-five studies were selected for inclusion, using the PRISMA guidelines. Thematic analysis identified a number of themes including psychological distress and well-being, gender differences in parental coping, and variable parenting practices and a number of subthemes. There is general agreement in the literature that families who have fewer psychosocial resources and lower levels of support may be at risk of higher psychological distress and lower well-being over time, for both parent and the child. Moreover, familial factors such as cohesiveness and adaptive parental coping strategies are necessary for successful parental adaptation to CHD in their child. The experiences, needs and ways of coping in families of children with CHD are diverse and multi-faceted. A holistic approach to early psychosocial intervention should target improved adaptive coping and enhanced productive parenting practices in this population. This should lay a strong foundation for these families to successfully cope with future uncertainties and challenges at various phases in the trajectory of the child's condition.

Coping successfully with dyslexia: an initial study of an inclusive school-based resilience programme.

A dyslexia coping programme entitled Success and Dyslexia was implemented in two primary schools within a whole-class coping programme and whole-school dyslexia professional development context. One hundred and two year 6 students, 23 of whom had dyslexia, undertook surveys pretest, post-test and at 1-year follow-up. Effectiveness of the coping programme and maintenance of effects for the students after transition to secondary school were investigated. Inclusion of contrast group data in the follow-up year suggested significant positive changes at first and second follow-ups in locus of control and nonproductive coping may also be associated with increase in age. Most trends were in the expected direction, especially for students with dyslexia. At follow-up, students with dyslexia reported similar perceived control and adaptive coping to students without dyslexia rather than a decrease in these areas as is usually the case. A larger sample and an ongoing control group are needed to confirm these results.

The relationship between positive development and psychopathology during the transition to adulthood: a person-centred approach.

The transition to adulthood is characterised by potential for both positive development and problem outcomes such as psychopathology, yet little is known about relationships between the two. Given the diversity of pathways observed during this transition period, there is likely to be significant heterogeneity in young people's experiences of these outcomes. Drawing on data from 1158 19-20 year olds in the Australian Temperament Project and using latent profile analysis, we identified six subgroups. For most, higher positive development was associated with lower psychopathology and vice versa. One group (33.6%) was high across all positive development measures and low on psychopathology, and another (47.7%) average in both areas. The remaining four groups were low on positive development but differentiated by average psychopathology (4.7%), high internalising (5.5%), and moderate (7.2%) and severe (1.3%) externalising problems. Tailored intervention strategies that address both the promotion of competence and prevention of problem outcomes are needed.

Differentiating three conceptualisations of the relationship between positive development and psychopathology during the transition to adulthood.

The transition to adulthood is characterised by both great potential for positive change and a relatively high incidence of problem outcomes. A multidimensional model of positive development during the transition to adulthood (at 19-20 years) has recently been proposed. However, an unresolved question regarding the nature of positive development during this time is how best to conceptualise its relationship to psychopathology. We drew on data from 1158 participants in the Australian Temperament Project, a large longitudinal community-based study that has followed young people's psychosocial adjustment from infancy to early adulthood. Using structural equation modelling, we compared three models reflecting different conceptualisations of the relationship between positive development and psychopathology. The results suggest that positive development and psychopathology are best modelled as separate but correlated constructs. Hence, development in one domain is likely to influence the other, although separate and specific developmental pathways are also likely to be operating.

Coping styles and strategies: a comparison of adolescent students with and without learning disabilities.

In this study, the authors compared the results of a coping measure completed by 98 seventh through ninth grade students who were assessed as having learning disabilities with published means from the general Australian student population. The Adolescent Coping Scale was the measure used. The results suggested higher use by students aged 12 to 13 years who had learning disabilities of an overall nonproductive coping style and in particular of the nonproductive strategies of ignoring the problem and not coping. Although there was no difference in overall productive or nonproductive coping style for 14- to 15-year-olds, the students in this age group who had learning disabilities reported higher use of the strategies of not coping and ignoring the problem. These findings are discussed in relation to a need for interventions that give students who have learning disabilities strategies that address the risk of a passive coping style.

Promoting positive coping skills for rural youth: benefits for at-risk young people.

OBJECTIVE: To explore the effects of a coping skills program long term and to assess the utility of providing booster intervention. Young people at high risk for depression were of particular interest. DESIGN: Mixed method. SETTING: Rural Victoria (approximately 200 km from Melbourne). PARTICIPANTS: A total of 159 year 10 students (76 male and 83 female) from a Catholic Secondary school. MAIN OUTCOME MEASURES: Adolescent Coping Scale and the Kessler Psychological Distress Scale. RESULTS: Following initial coping skills training (with the Best of Coping program) students at risk for depression had significantly reduced their reliance on non-productive coping (P < 0.05). This decrease was not maintained at 12-month follow up but was improved through exposure to a booster program. Results suggest the high-risk group are likely to benefit from further intervention. At the 12-month follow up all students were involved in booster coping skills training (with the Coping for Success program) that significantly increased their likelihood of referring to others to assist in solving problems (P < 0.05). These findings were supported by qualitative interview data. CONCLUSIONS: Positive program effects for young people at risk of depression and beneficial outcomes of booster intervention for the general student population were achieved in a rural setting.

Relations among well-being, avoidant coping, and active coping in a large sample of Australian adolescents.

Coping by young people relates to both current and future well-being and is integral to the educational, clinical, and counselling arenas. This paper examined the relations between frequency of use and perceived efficacy of two coping styles (active and negative avoidant), and their relationship to well-being and distress in a sample of 870 adolescents. Students completed the short form of the Adolescent Coping Scale and the Reynolds' Scale of Wellbeing. Factor analysis of the former identified two coping styles. Greater use of negative avoidant coping correlated with less well-being and greater distress, and active coping correlated positively with greater well-being and positively with distress for girls only. However, relations with active coping became nonsignificant once coping efficacy was statistically controlled. Adolescents' wellbeing can be improved if adolescents are helped to minimize their use of negative avoidant coping strategies and to increase their use of active coping.

Concomitants of failure to cope: what we should teach adolescents about coping.

BACKGROUND: How young people cope with stress is an important component of health and well-being since failure to deal with stress is very costly in social and emotional terms. AIM: In this study we examine the relationship between young people's declared failure to cope and the many coping styles that are reported concomitantly. The research questions addressed the extent to which positive and negative coping strategies co-exist in adolescent populations and whether the co-existence of these strategies confounds interpretation of the impact of coping on outcomes. SAMPLE: A sample of 1219 adolescent school students was drawn from a wide range of 11 government and private coeducational schools situated in the three regions of metropolitan Melbourne, Australia. METHODS: All participants completed the General form of the Adolescent Coping Scale in class groupings. Administration was conducted by a teacher who was also a registered psychologist. RESULTS: It was found that young people who were coping less successfully were those utilising more emotion-focused strategies. Further, students' use of emotion and problem-focused strategies was intercorrelated. CONCLUSION: This suggests that failure to cope triggers off increased coping activities of all kinds and that over-use of non-productive strategies interferes with the capacity to use productive coping.