Family-centred care and health-related quality of life of patients in paediatric neurosciences.

BACKGROUND: Little is known about the influence of contextual factors such as health services characteristics on health-related quality of life (HRQL) for children with a neurological condition. To address this gap, we conducted an exploratory study of the relationship between family-centred care (FCC) and HRQL outcomes in children from neurosciences clinics in a large acute care hospital. METHODS: A total of 187 family caregivers completed questionnaires regarding their socio-demographic status, the severity of their children's condition (FIM), perceptions of their children's HRQL (PedsQL 4.0) and their experiences of FCC (MPOC-20). Hierarchical regression analyses explored the hypothesis that FCC is a significant predictor of children's HRQL, independent of illness severity. RESULTS: Illness severity and FCC jointly explained one-third of the variance in children's total HRQL. When FCC was controlled for illness severity, it remained a significant predictor of physical, psychosocial and total HRQL scores. CONCLUSIONS: This study provides evidence that the level of FCC is positively related to paediatric HRQL independent of neurological illness severity. The implication is that the uptake of FCC practices by service providers can positively impact the quality of life of children with neurological disorders.

Family-centred service coordination in childhood health and disability services: the search for meaningful service outcome measures.

BACKGROUND: Potential service outcome measures were tested for their utility in the assessment of the quality of 'family centred' service coordination in the provincial network of children's disability services in Manitoba, Canada. METHODS: This study is based on in-home survey data provided by 103 mothers at 6 and 18 months following assignment of a 'dedicated' service coordinator. Service outcome indicators included measures of parent self-esteem, parenting stress, family functioning and the need for family support resources. RESULTS: Hierarchical regression analyses showed no relationship between level of quality of family-centred service coordination and standardized psychosocial measures of parent and family functioning. However, family centredness of service coordination was found to predict significant reduction in level of family need for psychosocial support resources after 18 months of contact with a service coordinator. CONCLUSIONS: Outcome measures that are focused on specific and tangible results of service coordination appear to be of higher utility in service quality assessment than are more global, standardized measures of parent and family functioning.

Couples therapy for women survivors of child sexual abuse who are in addictions recovery: a comparative case study of treatment process and outcome.

Treatment for women who are survivors of child sexual abuse and who have a history of substance abuse has largely involved gender-specific interventions. This study examines the use of conjoint couple therapy with a cohort of women who were survivors of child sexual abuse and who are in addiction recovery and with their partners. A comparative case study analysis incorporated standardized clinical measures with client and therapist interviews. Brief conjoint therapy was found to assist couples in the specific relationship skill areas of communication and mutual problem solving. Further, substantive gains were found in the realm of affective relations. The women reported an increase in support from their male partners, and the men reported a decrease in negative emotional atmosphere in the relationship.

Gender differences in the psychological adjustment of parents of young, developmentally disabled children.

Psychological distress, as expressed through symptoms of depression, was studied in a cross-sectional sample of parents providing homecare to developmentally disabled children. Mothers and fathers were interviewed separately in 73 households. The intent of the study was to explore predictors of symptoms of depression to better understand what child, family and life circumstances might be differentially related to psychological stress in the cohorts of men and women. Hierarchical regression analyses showed similar levels of variance explained in depression of mothers (42%) and fathers (40%). Mothers with younger children, and fathers with male children, appeared to be at higher risk for depression. Personal or intra-psychic coping resources (self-esteem), and strong-tie social support resources (spousal relationship) were found to be significant predictors of depression in both mothers and fathers. Informal respite resources were related to mothers' well-being.

Professional attitudes regarding the sexual abuse of children: comparing police, child welfare and community mental health.

A survey was completed involving three of the key professional groups engaged in the investigation and treatment of child sexual abuse. Police, child welfare and community mental health in a large, rural geographic area in Canada completed attitudinal items relating to professional response to child sexual abuse. An empirical scale was created which was comprised of three orthogonal factors, each with acceptable levels of internal consistency: 1) Beliefs in regard to the extensiveness and seriousness of the issue; 2) treatment versus punishment priority; and 3) view regarding identity of those who perpetrate child sexual abuse. Important gender differences were found across professional groupings in attitude toward sexual abuse. Greatest difference in attitude between service sectors was tied to emphasis placed on treatment versus punishment as a primary aspect of professional intervention. Significant differences were found between child welfare and police, the two service sectors most needing a coordinated approach during the "investigative phase" of professional intervention.

Social rejection of the mentally ill: a replication study of public attitude.

A replication survey of public attitudes toward the mentally ill was completed after a decade had elapsed which employed similar measures across the same urban area. Prior research evidence was empirically corroborated which indicated that attitude toward the mentally ill is not a uni-dimensional phenomenon, but is tied to differing social contexts. It does appear that a distinction can be made between attitudes in regard to social relations (personal contact) and social responsibility (impersonal contact). It was found that rejection of the mentally ill in situations of social relations was linked to prior personal experience with mental illness, perceived dangerousness of the mentally ill, and age of the survey respondent. Rejection of the mentally ill in circumstances involving social responsibility contracts (employment, housing, community affairs) was found to be largely tied to education of respondent. No significant differences were found in levels of public rejection of the mentally ill over the comparison ten year period.