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Objective Evaluate the efficacy of a 12 month nursing case-management intervention over a period of 18 months, 6 months after the end of intervention, for families of children attention deficit hyperactivity disorder (ADHD). Methods Mother and child dyads were enrolled to participate in a randomized controlled clinical trial. Children were 4-18 years old. Data were collected at baseline, 6, 12, and 18 months or 6 months after the termination of direct intervention. Longitudinal analyses, using generalized estimating equations, were conducted to assess change in study outcomes relating to family function, maternal stress, and child behavior over the 18 month period. Results Compared to control families, some family function outcomes were moderately improved in the intervention group. In particular, intervention families demonstrated substantial improvement in implementing family behavior controls (p value = 0.038) and improvement in family satisfaction (not statistically significant p = 0.062). Although there was improvement in the overall family function measure there was not a statistically significant difference between groups. Maternal stress and child behavior outcomes were not significantly different between control and intervention groups by the end of the intervention. Conclusions for Practice Addressing ADHD is complex and requires the assessment of comorbidities that might exacerbate negative behavior. Our findings support the latest American Academy of Pediatrics guidelines to use behavioral therapy as the first line of treatment in young children. Nursing case-management interventions that provide direct family education and improve family function, especially with respect to providing structure and behavior control, may complement and facilitate behavioral therapy for treatment of ADHD and improving child behavior.
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Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Terapia Comportamental/métodos , Comportamento Infantil , Família , Mães/psicologia , Estresse Psicológico/psicologia , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oregon , Avaliação de Resultados em Cuidados de SaúdeRESUMO
This study utilized the conservation of resources theory to guide the examination of employment outcomes for caregivers of children with emotional and/or behavioral disorders. The sample included 2455 caregivers whose children received services through federally funded systems of care. Of special interest was whether receiving services and supports predicted change in employment status. We examined change in employment between baseline data collection and the six-month follow-up including: (1) gaining employment, and (2) retaining employment. Findings indicated that the relationship between service/supports and caregiver employment differed depending on initial employment status, and type of service received. Accessing any service was associated with gaining employment. For families who accessed any services, receiving behavioral aide services was associated with gaining employment. Caregivers of children who used residential services were less likely to lose employment. Several child, caregiver, and demographic variables also predicted employment status over time. Taken together, the findings suggest that caregivers of children with emotional and behavioral challenges are at risk for downward cycles of resource loss, and that services and supports have the potential to mitigate that risk.
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Employed parents raising children with disabilities manage exceptional care responsibilities along with their work careers. This study examines the effects of targeted diversity training on human resource (HR) professionals' knowledge of the work-family experiences of these parents, and on their self-efficacy in providing workplace supports. Using computer-based training in field settings, 64 U.S. human resource professionals in an international company participated in two diversity training sessions. Data related to knowledge and efficacy of dependent and disability care were collected before the first training and immediately after the second. HR participants demonstrated significant increases from pretest to posttest on the trained items: knowledge of dependent and disability care and self-efficacy regarding provision of workplace supports. There was no change in relevant but untrained variables over time. Training HR professionals on parents' exceptional care responsibilities, specific community resources, and heightened self-efficacy promoted their likelihood to grant flexible work arrangements. Results suggest HR self-efficacy is developmental, building on prior knowledge of dependent care and tenure in HR positions. This is one of the first studies that address the effects of HR diversity training regarding employees providing exceptional care. Theoretical developments and implications for inclusive practices are discussed.
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Participatory action research processes guided a national online survey of service providers working with transition age youth with mental health challenges. The survey investigated transition service providers' ratings of the importance of competencies and skills, self-assessed need for training in these competencies and skills, their preferred training modalities, and obstacles to engaging in training. The 254 participants identified trauma-informed care, understanding youth culture, promoting natural supports, and using culturally responsive practices as most important training needs. Age, years in current job, years in transition work, and race/ethnicity predicted training needs regarding some competencies and skills. Peer providers expressed preferences for young adult-led training. Qualitative responses highlighted training needs for supporting specific underserved populations: youth from communities of color, LGBTQ youth, and those with co-occurring disorders. Results may guide future training initiatives for peer support and non-peer support providers and workforce development initiatives designed to improve behavioral health services for young people.
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Competência Clínica , Aconselhamento/educação , Transtornos Mentais/psicologia , Saúde Mental , Avaliação das Necessidades , Adolescente , Adulto , Serviços Comunitários de Saúde Mental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupo Associado , Inquéritos e Questionários , Adulto JovemRESUMO
Emerging adults who receive services based on positive youth development models have shown an ability to shape their own life course to achieve positive goals. This paper reports secondary data analysis from the Longitudinal Child and Family Outcome Study including 248 culturally diverse youth ages 17 through 22 receiving mental health services in systems of care. After 12 months of services, school performance was positively related to youth ratings of school functioning and service participation and satisfaction. Regression analysis revealed ratings of young peoples' perceptions of school functioning, and their experience in services added to the significant prediction of satisfactory school performance, even controlling for sex and attendance. Finally, in addition to expected predictors, participation in planning their own services significantly predicted enrollment in higher education for those who finished high school. Findings suggest that programs and practices based on positive youth development approaches can improve educational outcomes for emerging adults.
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Logro , Transtornos Mentais/terapia , Serviços de Saúde Mental , Saúde Mental , Satisfação do Paciente , Instituições Acadêmicas , Adolescente , Escolaridade , Feminino , Humanos , Masculino , Adulto JovemAssuntos
Competência Clínica , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/normas , Autoeficácia , Adolescente , Adulto , Competência Clínica/normas , Feminino , Pessoal de Saúde/psicologia , Humanos , Relações Interprofissionais , Masculino , Psicometria , Inquéritos e Questionários , Adulto JovemRESUMO
Employed parents of children with emotional or behavioral disorders overcome significant challenges to fulfill their daily work-family responsibilities; however, their experiences in meeting these multiple demands have not been examined. The purpose of the present study was to describe the strategies these parents use and their perceptions about how caregiving and employment responsibilities can successfully fit together. Findings of five focus groups conducted with 41 employed parents whose children had been diagnosed with mental health problems are presented. Qualitative analysis was used to identify major themes across the areas of employment responsibilities and adaptations, child care arrangements, and achieving fit between job and home. Results revealed that parents experience a serious lack of community-based services and resources necessary to support work and family obligations in a meaningful way. The data suggest a need for more research and services development to support these families in their communities.