Acute respiratory infection, diarrhoea and fever in young children at-risk of intellectual disability in 24 low- and middle-income countries.

OBJECTIVES: This study aims to (1) estimate the prevalence of acute respiratory infection (ARI) symptoms, diarrhoea and fever in the previous two weeks among 3-4 year old children who are/are not at-risk of intellectual disability in 24 low- and middle-income countries and (2) to investigate possible inequities in access to treatment among affected children. STUDY DESIGN: Cross-sectional survey. METHODS: Secondary analysis of Rounds 4 and 5 UNICEF Multiple Indicator Cluster Surveys (MICS) from 24 low- and middle-income countries (n = 99,934 children). RESULTS: Pooled estimates indicated that young children at-risk of intellectual disability in low-income countries were significantly more likely than their peers to have reported symptoms of ARI and diarrhoea in the previous 2 weeks, and significantly less likely to have received appropriate treatment. Pooled estimates indicated that in middle-income countries children at-risk of intellectual disability were significantly more likely than their peers to have reported symptoms of ARI, diarrhoea and fever during the previous 2 weeks. Symptomatic children at-risk of intellectual disability were significantly less likely than their peers to have received antibiotics/antimotility medication for diarrhoea or antibiotics for ARI symptoms, but significantly more likely to be prescribed anti-malarials for fever. CONCLUSIONS: These results indicate the existence of significant inequalities and possible inequities in the exposure to and the treatment of three major infectious diseases among children who are/are not considered at-risk of intellectual disabilities in low- and middle-income countries.

Suicidal Ideation Among Adults with Disability in Western Canada: A Brief Report.

This study investigated prevalence and risk factors for suicidal ideation among adults with self-reported disability in Western Canada. The method was secondary data analysis utilising the Canadian Community Health Survey. The odds of 12-month suicidal ideation are 3.5 times greater for adults with self-reported disability compared with non-disabled adults, controlling for age, sex, ethnicity, and psychiatric morbidity. The heightened risk of ideation among adults with self-reported disability is partially explained by social adversity, including food insecurity and low sense of community belonging. Reducing suicide risk among adults with disability requires a broad-spectrum approach, including mental health care, and strategies to ameliorate social and economic hardship.

Ameliorating Psychosocial Risk Among Mothers with Intellectual Impairment.

The purpose of this study was to pilot a flexible, group-based program designed to strengthen the social connections and enhance the psychological well-being of mothers with intellectual impairment. A multi-site, mixed-method, pretest-posttest design was employed. To obtain rich process and outcome data, the evaluation incorporated measures of psychosocial well-being, goal achievement scaling, and interviews with group facilitators and participants. A total of 18 mothers completed the program. Participation was associated with a meaningful reduction in psychological distress with effect sizes ranging from .57 for depression to .71 for anxiety. Participating in the group program gave the mothers something to look forward to each week, opportunities to learn from and support others, and the feeling of "being a part of society". Further research is needed to determine whether these promising results can be replicated, and to evaluate the long-term impact of the program on mothers and their children.

Cracks in the foundation: The experience of care aides in long-term care homes during the COVID-19 pandemic.

BACKGROUND: Care aides (certified nursing assistants, personal support workers) are the largest workforce in long-term care (LTC) homes (nursing homes). They provide as much as 90% of direct care to residents. Their health and well-being directly affect both quality of care and quality of life for residents. The aim of this study was to understand the impact of COVID-19 on care aides working in LTC homes during the first year of the pandemic. METHODS: We conducted semi-structured interviews with a convenience sample of 52 care aides from 8 LTC homes in Alberta and one in British Columbia, Canada, between January and April 2021. Nursing homes were purposively selected across: (1) ownership model and (2) COVID impact (the rate of COVID infections reported from March to December 2020). Interviews were recorded and analyzed using inductive content analysis. RESULTS: Care aides were mainly female (94%) and older (74% aged 40 years or older). Most spoke English as an additional language (76%), 54% worked full-time in LTC homes, and 37% worked multiple positions before "one worksite policies" were implemented. Two themes emerged from our analysis: (1) Care aides experienced mental and emotional distress from enforcing resident isolation, grief related to resident deaths, fear of contracting and spreading COVID-19, increased workload combined with staffing shortages, and rapidly changing policies. (2) Care aides' resilience was supported by their strong relationships, faith and community, and capacity to maintain positive attitudes. CONCLUSIONS: These findings suggest significant, ongoing adverse effects for care aides in LTC homes from working through the COVID-19 pandemic. Our data demonstrate the considerable strength of this occupational group. Our results emphasize the urgent need to appropriately and meaningfully support care aides' mental health and well-being and adequately resource this workforce. We recommend improved policy guidelines and interventions.

This Was My Crimean War: COVID-19 Experiences of Nursing Home Leaders.

OBJECTIVE: To describe professional and personal experiences of nursing home care leaders during early waves of the COVID-19 pandemic. DESIGN: Qualitative interpretive description. SETTING AND PARTICIPANTS: Eight sites across 2 Canadian provinces. Sites varied by COVID-19 status (low or high), size (<120 or ≥120 beds), and ownership model (for-profit or not-for-profit). We recruited 21 leaders as participants: 14 managers and 7 directors of care. METHODS: Remote Zoom-assisted semi-structured interviews conducted from January to April 2021. Concurrent data generation and inductive content analysis occurred throughout. Sampling ceased once we reached sufficient analytic variation and richness to answer research questions. RESULTS: Most participants were female, ≥50 years of age, and born in Canada. We found 4 major themes. (1) Responsibility to protect: Extreme precautions were employed to protect residents, staff, and leaders' families. Leaders experienced profound distress when COVID-19 infiltrated their care homes. (2) Overwhelming workloads: Changing public health orders and redeployment to pandemic-related activities caused administrative chaos. Leaders worked double shifts to cope with pandemic demands and maintain their usual work. (3) Mental and emotional toll: All participants reported symptoms of anxiety, depression, and insomnia, leading to ongoing exhaustion. Shifting staff focus from caring to custodial enforcement of isolation caused considerable distress, guilt, and grief. (4) Moving forward: The pandemic spotlighted deficiencies in the nursing home context that lead to inadequate quality of resident care and staff burnout. Some leaders indicated their pandemic experience signaled an unanticipated end to their careers. CONCLUSIONS AND IMPLICATIONS: Nursing home leaders faced mental distress and inordinate workloads during the pandemic. This is an urgent call for systemic change to improve working conditions for leaders and quality of care and quality of life for residents. Nursing home leaders are at increased risk of burnout, which must be addressed to mitigate attrition in the sector.

Integrating Triple P into existing family support services: a case study on program implementation.

The purpose of this paper is to present a case study of "evidence-based" program uptake and implementation. The process of integrating Triple P (levels 2 and 3) into existing family support centers in Alberta, Canada, was examined. We conducted ten individual interviews with directors, and ten group interviews, involving a total of 62 practitioners across ten Triple P pilot sites. Key findings show that there was variability in the approach and extent to which Triple P was integrated into family support centers. Five key factors impacting the integration process emerged from the interviews. These were: (1) the level of development of pre-existing support services; (2) the degree of "fit" between the Triple P program approach and existing agency practice, including the perceived suitability/unsuitability for some client groups; (3) practitioner perceptions of the adaptability of the program; (4) rules about who can and who cannot use Triple P resources; and (5) training and sustainability issues. In addition to identifying specific factors, this study was able to provide some insight as to why and how these factors were significant, thereby adding to the literature on knowledge/program dissemination processes.

Significant cognitive delay among 3- to 4-year old children in low- and middle-income countries: prevalence estimates and potential impact of preventative interventions.

Background: We sought to: (i) estimate the prevalence of significant cognitive delay (a marked delay in the development of general cognitive functioning) among nationally representative samples of young children in middle- and low-income countries; (ii) estimate the total number of children under 5 years of age with significant cognitive delay living in low- and middle-income countries; and (iii) estimate the potential impact of five preventative interventions. Methods: Secondary analysis of data collected in Rounds 4 and 5 of UNICEF's Multiple Cluster Indicators Surveys in 51 countries involving 163 293 3- to 4-year-old children. Adjusted population-attributable fractions were used to estimate the potential impact of five interventions based on Sustainable Development Goals (SDGs). Results: The prevalence of significant cognitive delay in 3- to 4-year-old children in middle- and low-income countries was 10.1% (95% confidence interval 9.7-10.4%). Prevalence was strongly inversely related to country economic wealth. The estimated total number of children under 5 with significant cognitive delay living in low- and middle-income countries was just under 55 million. This number could be reduced by over 60% if three separate SDGs were achieved; every mother had secondary-level education, every household had access to improved water and sanitation, and every child had an acceptable level of home stimulation. Conclusions: Our results provide additional evidence in support of a range of specific preventative interventions in early childhood to reduce the loss of developmental potential among children in low- and middle-income countries.

Parent-mediated intervention: adherence and adverse effects.

PURPOSE: The purpose of this study was to investigate parent implementation of home-based therapy regimens, and the relationship between implementation and family-level outcomes. METHOD: A stratified (by child age group) random sample of 538 families raising children with disabilities in Alberta, Canada took part. Participants completed the Family Life Survey, which incorporated child and family measures, and items measuring parent implementation of home-based therapy regimens. RESULTS: Parents are more likely to implement therapeutic regimens when these are "enfolded" into other daily activities and routines. If parents have to "find a slot" in the daily routine to implement therapy, they will sacrifice personal leisure, participation in paid work, and time spent with other family members. Greater parent sacrifices/trade-offs was negatively associated with family well-being. CONCLUSION: As a general rule, children do well when their families do well, and families do well when they have the resources they need to juggle work and family and care demands. Recruiting parents as interventionists can tax family resources. Rehabilitation professionals must weigh up the pros and cons of parent-mediated intervention, and look to enfolding therapy into the everyday family routine.

Resilience in families raising children with disabilities and behavior problems.

The purpose of this study was to investigate the resilience displayed by families raising children with disabilities and behavior problems. The question is why do some families do well when others, exposed to similar stressors, struggle to keep their family life running? A stratified (by child age group) random sample of 538 families raising children with disabilities in Alberta, Canada took part. Participants completed the Family Life Survey, which incorporated measures of child behavior problems, social-ecological resources and family-level 'outcomes'. Families raising children with disabilities and behavior problems 'do well' under conditions of high social support and low financial hardship. In contrast, families with low levels of social support and high levels of financial hardship typically struggle, even when the number or intensity of child behavior problems is low. The study findings are consistent with the view that 'resilience' has more to do with the availability and accessibility of culturally relevant resources than with intrinsic, individual or family factors. With respect to family-level outcomes, strengthening social relationships and ameliorating financial hardship may be more important than behavior modification.

Experience and outcomes of stepping stones triple P for families of children with autism.

This study investigated the experience and perceived outcomes of a behavioural family intervention, standard stepping stones triple P (SSTP), for parents of children with autism. An indepth, prospective, mixed-methods, multiple case-study design was employed. Parent participants and SSTP practitioners took part. Participation in SSTP was consistently associated with improved parental self-efficacy, and was also associated with improved parental psychological well-being and decreased perceived need for behavioural services for some families. Three key themes emerged from the qualitative interview data, reflecting changes attributed to participation in SSTP: (1) changes in the "attribution of cause" of misbehaviour, (2) "Who's the boss?" reflecting a change to parents feeling more in charge of their child's behaviour, daily routines and choices, and (3) "Rewarding is rewarding!" reflecting appreciation of a positive approach to behaviour management. Practitioners discussed their impressions of appropriate participants, timing, structure, and session preferences for SSTP, and implications related to the professional qualifications of practitioners delivering SSTP. Clinical implications for the use of SSTP with families of children with autism are discussed.