A secondary analysis examining the influence of emotional support on the mental health of caregivers of children with autism spectrum disorder.

PURPOSE: The study purpose was to examine the effect of emotional support on the overall mental health and stress for caregivers of children with autism spectrum disorder (ASD). METHODS: A cross-sectional retrospective study using secondary data from the 2016-2019 National Survey of Children's Health was conducted using single variable and multivariable linear regression analyses. RESULTS: More informal emotional support sources were associated with better overall mental health (ß = 0.124, SE = 0.015, p < .001) and reduced stress (ß = -0.261, SE = 0.039, p < .001) for caregivers of children with ASD, controlling for covariates. The number of formal emotional support sources was not significantly associated with caregiver overall mental health or stress when controlling for covariates. Increased amounts of total emotional support sources were significantly associated with increased overall mental health (ß = 0.042, SE = 0.010, p < .001) and reduced stress (ß = -0.093, SE = 0.024, p < .001) for caregivers. Other factors significantly associated with caregiver outcomes included caregiver sex, caregiver marital status, caregiver education level, economic hardship, child sex, child race/ethnicity, ASD severity, and child receipt of ASD treatment. CONCLUSION: More emotional support sources, in particular informal support sources, may be a protective factor for well-being for caregivers of children with ASD. PRACTICE IMPLICATIONS: Health care providers should evaluate the impact of their formal support services on caregivers of children with ASD and advocate for increased informal and formal support resources for these caregivers.

Web-Based Parent Training in Parents with Adolescents Admitted to Psychiatric Residential Treatment: A Mixed-Methods Study.

Despite intensive treatment, adolescents discharged from residential treatment (RT) often do not maintain treatment gains in the community. Providing support and education to caregivers through parent training may ameliorate the loss of treatment gains. Successful parent training programs have been delivered to this population; however, these interventions were delivered in-person, posing significant barriers affecting reach, access, and engagement. A convergent mixed methods design was used to assess the acceptability, appropriateness, and feasibility of a web-based parent training in a sample of parents (N = 20) with adolescents admitted to RT. Parents completed two interviews and an end-of-program survey. Parents completed at least 80% of the assigned modules and felt that PW was easy to use and that the features facilitated learning. Parents reported practicing the skills in their daily lives and found it beneficial to have a partner to practice with. Consistent with previous studies, parents perceived the delivery method as a strength because the web-based delivery circumvented multiple known barriers to in-person interventions. A large subset of parents related to the scenarios, while a small subset of parents felt the modules were challenging to relate to because of the severity of their adolescent's mental health challenges. Overall, findings indicate that web-based parent training programs may be an acceptable, appropriate, and feasible adjuvant evidence-based support. However, tailoring the intervention content is necessary to create a more relatable intervention that captures the breadth and severity of mental health challenges adolescents in RT face.

Variation in Evidence-Based Practices Among Youth-Serving Residential Treatment Facilities.

BACKGROUND: Residential treatment is among the most intensive and expensive settings for children with behavioral health challenges; yet, the extent to which evidence-based practices are used in these settings is unknown. AIM: The purpose of this study was to describe the extent which family therapy, case management, telehealth, peer support, and family psychoeducation are provided in residential treatment using data from the National Mental Health Services Survey (N-MHSS). Organizational factors-region, ownership, payment, licensing/accreditation, and facility size-were examined in relation to evidence-based practices to understand disparities in care. METHODS: This was a secondary analysis of publicly available data from the 2018 N-MHSS. A subpopulation was created consisting of residential facilities that served children (N = 576). Descriptive statistics were used to describe the sample, and Cohen's h was calculated to determine patterns of evidence-based practice utilization. RESULTS: Evidence-based practices from most to least prevalent were family therapy (76%), family psychoeducation (74%), case management (71.1%), telehealth (17.2%), and peer support (8.7%). The provision of evidence-based practices was not evenly distributed. There were primarily small to moderate differences by organizational factors, including region (i.e., Northeast, Midwest), ownership status (i.e., for-profit), payment type (i.e., self-pay, private insurance), licensing/accreditation (Department of Family and Children Services), and facility capacity (>251 clients served per year). CONCLUSION: Findings demonstrate a need for research-practice partnerships to determine the barriers that prevent effective evidence-based practices from being implemented in the residential treatment setting.

Caregivers of Children with Autism Spectrum Disorder in Rural Areas: A Literature Review of Mental Health and Social Support.

PROBLEM: Caregivers of children with Autism Spectrum Disorder (ASD) report high levels of stress, social isolation, and poor mental health. Social and emotional support may buffer negative effects of stress for caregivers of children with ASD, however, those living in rural areas may be disadvantaged due to social isolation and increased distance from resources. This scoping review examined the literature regarding the mental health and impact of support for rural caregivers of children with ASD. ELIGIBILITY CRITERIA: Articles were limited to those available in the English language and conducted in a high income country. Articles had to include a population of rural caregivers of children with ASD and focus on caregiver mental health and/or the impact of support on caregiver mental health. SAMPLE: Searches were conducted with Embase, PubMed, CINAHL, ERIC, and PsycINFO and 22 articles were included. RESULTS: Study findings indicate overall poor mental health for rural caregivers of children with ASD. Formal and informal support appear to be beneficial in decreasing stress for rural caregivers of children with ASD. However, a few studies indicated that formal support may add stress to rural caregivers. CONCLUSION: There is limited information regarding support needs and the impact of support services on the mental health of rural caregivers of children with ASD. IMPLICATIONS: There is a need to increase access to support resources in rural areas for caregivers of children with ASD. Healthcare professionals, including nurses, can play a fundamental role in supporting, educating, and connecting caregivers to other support services.

Interventions to Improve Mental Health, Well-Being, Physical Health, and Lifestyle Behaviors in Physicians and Nurses: A Systematic Review.

OBJECTIVE: This systematic review focused on randomized controlled trials (RCTs) with physicians and nurses that tested interventions designed to improve their mental health, well-being, physical health, and lifestyle behaviors. DATA SOURCE: A systematic search of electronic databases from 2008 to May 2018 included PubMed, CINAHL, PsycINFO, SPORTDiscus, and the Cochrane Library. STUDY INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria included an RCT design, samples of physicians and/or nurses, and publication year 2008 or later with outcomes targeting mental health, well-being/resiliency, healthy lifestyle behaviors, and/or physical health. Exclusion criteria included studies with a focus on burnout without measures of mood, resiliency, mindfulness, or stress; primary focus on an area other than health promotion; and non-English papers. DATA EXTRACTION: Quantitative and qualitative data were extracted from each study by 2 independent researchers using a standardized template created in Covidence. DATA SYNTHESIS: Although meta-analytic pooling across all studies was desired, a wide array of outcome measures made quantitative pooling unsuitable. Therefore, effect sizes were calculated and a mini meta-analysis was completed. RESULTS: Twenty-nine studies (N = 2708 participants) met the inclusion criteria. Results indicated that mindfulness and cognitive-behavioral therapy-based interventions are effective in reducing stress, anxiety, and depression. Brief interventions that incorporate deep breathing and gratitude may be beneficial. Visual triggers, pedometers, and health coaching with texting increased physical activity. CONCLUSION: Healthcare systems must promote the health and well-being of physicians and nurses with evidence-based interventions to improve population health and enhance the quality and safety of the care that is delivered.