Positive Caregiving Experiences Research Articles

An Examination of Positive and Negative Dementia Caregiving Experiences

ABSTRACT Objectives We examined associations among three measures of caregiver experiences (i.e., positive aspects of caring [PAC], caregiver burden, and mutuality) in 228 dyads involving persons with dementia (PWD) and their informal caregivers. The associations between predisposing, enabling, and need factors and each of these three measures of caregiver experiences were also examined. Methods We used baseline data from a randomized controlled trial of a psychosocial intervention aimed at preventing aggression in PWD. Associations among PAC, caregiver burden, and mutuality were examined. The Behavioral Model of Health Services Utilization guided the selection of predisposing, enabling, and need components. Results Enabling characteristics (e.g., race/ethnicity, caregiver education and employment and PWD education) and most predisposing characteristics (e.g., caregiver age, PWD age, relationship type) were not associated with any caregiving experience measures. Need characteristics (e.g., levels of memory and functional impairment, behavioral problems, depression, pleasant events) were associated with the caregiving experience. Conclusions Bivariate correlations between PAC, caregiver burden, and mutuality were between −0.20 and −0.58. Predisposing, enabling, and need factors were differentially associated with outcomes, with need characteristics being most frequently associated with various aspects of caregiving. Clinical implications Assessment of both positive and negative aspects of caregiving is important. Particular attention to depression and interventions that improve depressive symptoms may increase PAC and mutuality and reduce caregiver burden.

Interventions to Enhance Resilience Among Family Caregivers: A Systematic Review

Long-term caregiving can negatively impact caregivers’ physical and psychological well-being and are associated with increased morbidity and mortality among caregivers. A more positive caregiving experience is associated with increased coping skills and resilience. Caregiver-targeted interventions designed to promote caregivers’ resilience may lead to improved caregivers’ well-being, the quality of caregiving, and care recipients’ outcome. However, a comprehensive evaluation of effective interventions that enhance resilience among caregivers is lacking. Therefore, the purpose of this study is to critically evaluate existing training programs to inform clinical practice and future program design. A literature review was conducted to search available articles published before June 2018 in databases including PubMed, CINAHL, PsycINFO, and Scopus. Search strategies used index and keyword methods. The inclusion criteria were peer-reviewed, research studies published in English that evaluated an intervention primarily aimed to improve family caregivers of adult patients’ resilience or had a primary outcome of resilience. Seven studies fit the criteria identified. Six studies used psychosocial therapy and one used pharmacological therapy to promote caregivers’ resilience. Several effective resources were identified, such as counseling, self-help manuals, psychoeducation, cognitive behavioral therapies, and the use of an antidepressant. All studies reported positive improvements in caregivers’ outcomes and six studies reported caregivers had improved resilience after receiving interventions. However, most interventions require health professionals to train patients and caregivers for multiple sessions. Future studies should develop feasible, effective, and less labor-intensive interventions, such as self-help manuals, telehealth interventions, or interventions delivered during routine visits.

Older Caregivers’ Positive and Negative Experiences With Caregiving

U.S. population growth is greatest amongst the oldest-old who are most likely to need temporary or permanent reliance on formal or informal care-giving. With co-survival of older spouses, and greater longevity, informal care-giving is increasingly provided by older adults for other older adults. Little is known about the positive and negative care-giving experiences of older informal caregivers. This observational study examines the relationship between the care-giving situation and the positive and negative perceptions of care-giving in caregivers age 65 and older. A survey of 108 older informal caregivers utilizes well-validated instruments to measure perceptions of two positive (positive self image, positive life) and two negative (stress, uncertainty) experiences due to care-giving. Regressions statistically assess the relationship between care-giving situations and these positive and negative perceptions. We find that while some care-giving situations, such as higher amounts of unpaid support, are related to positive care-giving experiences, others, such as care-giving a recipient with a greater number of ADL deficits, having more care-giving responsibilities, and having increased hours of work due to care-giving, are related to more negative experiences. Some situations, such as lower income and greater involvement in care-giving, are related to both positive and negative perceptions. Higher levels of emotional support were related to mixed positive and less negative perceptions of care-giving. Result indicate that healthcare system and community support is needed to provide opportunities for unpaid support and assistance with caregivers of recipients with a high number of ADL deficits and caregivers who have more care-giving responsibilities.

Positive Aspects of Caregiving Among Family Caregivers of Individuals With Dementia

Traditionally, caregiving for individuals with dementia has been viewed as a negative experience. Understanding positive aspect of caregiving and related factors is important to improve health among family caregivers. We analyzed baseline data from an ongoing dyadic sleep education trial for individuals with dementia and their caregivers (N=21 dyads; mean age 70.8± 11.1 for caregivers, 80.5± 8.3 for care-recipients). The Positive Aspects of Caregiving (PAC 9-item) was used to assess subjective satisfaction with caregiving. Other measures included Zarit Burden Interview (ZBI), SF-12 Health Survey (SF-12v2), Revised Memory and Behavior Problems Checklist (RMBPC), and Pittsburgh Sleep Quality Index (PSQI). Pearson correlations and t-tests were calculated for analyses. Caregivers most frequently endorsed that caregiving enabled them to appreciate life more (n=16 agreed a lot). Caregivers who began providing care within the first few months of the care-recipient needing care (n=16) had greater positive aspects of caregiving than those who started providing care sometime later (n=5) (36.37±7.33 versus 25.8±8.29, p=0.01). Caregivers with higher PAC scores had lower ZBI score (r=-0.49, p=0.02), better mental health on the SF-12v2 (r=0.53, p=0.01), less distress related to care-recipient behaviors on the RMBPC (r=-0.50, p=0.02), and lower PSQI subscale (perceived sleep quality) score (r= -0.46, p=0.04). Findings suggest that higher positive caregiving experience was associated with better mental health and sleep quality, and less burden and distress from the care-recipients behaviors. More research is needed to better understand this relationship and to determine possible interventions to increase positive aspects of caregiving.

Caregiving for older adults with hip fractures: Exploring the perspectives of caregivers, providers and decision-makers in Ontario, Canada

IntroductionCaregivers play an important role in providing physical, emotional and social support to individuals with hip fracture. This study sought to explore perceptions of caregiving for older adults with hip fractures by comparing experiences of caregivers, providers and decision-makers. MethodsSemi-structured interviews were conducted both in-person and by telephone with caregivers, providers and decision-makers (n=32) from one rural and one urban hospital selected from two health regions in Ontario, Canada. Interviews were audio-recorded and transcribed verbatim. The data were coded descriptively and interpretively, and compared within and across participants types. ResultsThree main themes reflected tensions between caregivers and providers/decision-makers. Firstly, differing expectations of caregiver roles were identified. Several caregivers wanted more participation in the decision-making process but often felt excluded, while others expressed feeling stressed due to the expectations placed on them. Conversely, providers and decision-makers often described caregivers needing to strike a balance between providing supportive care while avoiding becoming too involved. Secondly, different expectations of what the healthcare system and providers could provide, with tensions particularly around timing of discharge were noted. Finally, there were differing perceptions of information needs. Providers spoke about the importance of providing education to caregivers and perceived themselves to be providing appropriate education. However, caregivers often described poor communication and not having a clear understanding of next steps and the care plan. ConclusionManaging and tailoring expectations, improving communication (e.g., content, timing) and the consistency of information shared with caregivers from different providers could facilitate more positive caregiving experiences and interactions.

Gaining Longitudinal Accounts of Carers' Experiences Using IPA and Photograph Elicitation.

Fluctuations in positive and negative caregiving experiences remain only partially explained as the significant variability over time of potential predictive factors themselves is understudied. The current study aims to gain considerable insight into caregiving experiences and perceptions over time by using photovoice methodology to support semi-structured interviews. A case study, longitudinal design is taken with three female caregivers who provide detailed insight into their caregivers' experiences over a 12 month period. The interview transcripts were analyzed using IPA- Interpretative Phenomenological Analysis. This innovative combination of methods resulted in the emergence of three related themes which included consuming the role, feeling consumed by the role, and letting go of the role. The idiographic approach taken allowed both within case differences to be examined over time, and also between carer differences to be highlighted. Implications of illness type and its characteristics, and of attachment and relationship quality with the care recipient were seen in terms of how and when the caregivers moved between the themes identified. The use of others' support or respite care is examined vis-a vis caregiver's own beliefs, emotions, relationship attachment and motivations to care. Caregivers self-efficacy beliefs also shifted over time and were influential in caregiver experience as the care recipient condition or needs changed. No previous studies have found that negative caregiving consequences are, in part, under volitional control and yet our data on the underlying reasons for consuming caregiving or allowing themselves to consume, would suggest this may in part be true. This is important because it suggests that interventions to support caregivers should address relational and motivational factors more fully.

Positive and negative experiences of caregiving in dementia: The role of sense of coherence.

Sense of coherence (SOC) is increasingly recognized as an important health determinant, particularly for mental health. Part of the evidence comes from informal caregivers in diverse clinical conditions. The extent to which SOC influences caregiving outcomes, however, is relatively under-researched in dementia, particularly regarding positive experiences. We analysed the association of SOC with dementia caregivers' subjective burden, psychological distress and positive aspects of care. This is a secondary analysis of cross-sectional data from the Lisbon study of Families of Persons with Dementia, involving a convenience sample of 99 primary caregivers of community-dwelling patients of neurology and psychiatry services. SOC was assessed with the Orientation for Life Scale. Measures of caregivers' outcomes were: the Zarit Burden Interview, the General Health Questionnaire for psychological distress and the Positive Aspects of Caregiving scale. Analyses controlled for demographics, caregiving arrangements, objective burden, social support, patients' neuropsychiatric symptoms and dementia stage. Lower SOC was associated with higher psychological distress (p = 0.001). No significant associations were found for subjective burden (p = 0.081) or positive aspects of caregiving (p = 0.688). Additional analyses showed that lower SOC was associated with less emotional support (p < 0.001) and past psychiatric illness (p = 0.044). These findings support previous research suggesting that SOC is protective for psychological distress, and extend evidence to the positive aspects of care in dementia. The cross-sectional design and small-scale convenience sampling preclude both causality presumptions and generalizability. SOC assessments may be useful to define subgroups of dementia caregivers at risk for anxiety and depression.

Positive Appraisal of Caregiving for Intensive Care Unit Survivors: A Qualitative Secondary Analysis.

More than half of intensive care unit survivors require assistance from family caregivers after discharge. Caregiving is associated with negative consequences including poor health-related quality of life, psychosocial distress, and burden. Little is known about how family caregivers find satisfaction and meaning in their experience. To explore positive descriptions of the experiences of family caregivers of critically ill patients and to describe factors that family caregivers view as important to a positive caregiving experience from hospitalization to 4 months after discharge. Qualitative secondary analysis was performed on data from semistructured interviews conducted as part of a longitudinal study that examined physical and psychological responses to stress in a convenience sample of family caregivers of adult intensive care unit patients who underwent prolonged mechanical ventilation (≥ 4 days). Interviews were conducted at 4 time points: during the hospitalization and within 2 weeks, 2 months, and 4 months after discharge. Participants (n = 41) reported factors that helped them positively appraise their caregiving experience in 113 interviews conducted face to face or via telephone. During patients' hospitalization, caregivers described changes in their role, with their primary responsibility being to advocate for the patient. They described how this experience fulfilled their identity and strengthened their relationship with the patient. Most family caregivers mentioned the importance of social support and prayer. Family caregivers of intensive care unit patients can identify positive aspects of caregiving during the experience. Interventions to reframe the caregiving experience in a positive light are warranted.

Positive and negative experiences and life satisfaction among spousal caregivers for frail older adults in urban China: a parallel process model

Previous literature has suggested that negative and positive aspects of spousal caregiving co-exist. However, positive and negative experiences were often examined independently. This study aimed to empirically test a parallel process model of spousal caregiving. This cross-sectional survey of family caregiving involved 269 frail older adults living in Shanghai, China, in 2016. Quota sampling was conducted to find community-dwelling frail older adults with a primary caregiver. Path analysis was used to identify the relationship between negative and positive caregiving experiences and life satisfaction. We found two independent paths towards life satisfaction: (i) activities of daily living were negatively associated with burden, and burden was associated with lower life satisfaction; and (ii) spousal caregivers' self-reported health and financial state were positively associated with positive appraisal, and positive appraisal was associated with higher life satisfaction. Caregiving time contributed to both aspects of caregiving experiences. The covariance between caregiving burden and positive appraisals was not statistically significant. Spousal caregiving involves a parallel process. Negative and positive experiences are separate constructs and their associations with life satisfaction vary. We advocate for policy and interventions that promote positive views of caregiving that encourage caregivers to develop a high level of overall life satisfaction despite the hardships of their caregiving tasks.

The positive and negative appraisals of caregiving (PANAC) scale: A new measure to examine the caregiving experience in Alzheimer's disease and related dementias.

IntroductionDementia caregiving is often examined as a monolithic experience describing the challenges caregivers face, exploring one construct at a time, with little research on the positive experiences of caregiving. To address this, we developed the Positive and Negative Appraisals of Caregiving (PANAC) scale.MethodsPANAC was validated in 253 patient‐caregiver dyads. Factor analyses revealed a two‐factor solution: Positive Appraisals (PAs) and Negative Appraisals (NAs). Psychometric properties were compared with patient and caregiver characteristics and outcomes, disease stage, and etiology.ResultsInternal consistency was good with Cronbach's alpha: 0.82 NA and 0.80 PA (P < 0.001). NA correlated with patient and caregiver characteristics, whereas PA correlated only with caregiver characteristics. The PA/NA ratio could be used to capture change due to an intervention.DiscussionThe PANAC scale is a useful measure of the overall caregiver experience accounting for negative and positive experiences and may be used to tailor support to individual caregivers.

Stress sensitization among severely neglected children and protection by social enrichment

Childhood adversity may sensitize certain individuals to later stress which triggers or amplifies psychopathology. The current study uses data from a longitudinal randomized controlled trial to examine whether severe early neglect among children reared in institutions increases vulnerability to the effects of later stressful life events on externalizing problems in adolescence, and whether social enrichment in the form of high-quality foster care buffers this risk. Children abandoned to Romanian institutions were randomly assigned to a foster care intervention or care-as-usual during early childhood. A sample of never-institutionalized children served as a comparison group. Here we report that, among those with prolonged institutional rearing, more stressful life events in preadolescence predicted higher externalizing problems in adolescence. This effect was not observed for never-institutionalized children or those in foster care, thus providing experimental evidence that positive caregiving experiences protect against the stress-sensitizing effects of childhood neglect on externalizing problems in adolescence.

Community Social Capital and Positive Caregiving Experiences Among Adult-Children Caregivers of Older Adults With Disabilities in Urban China.

The present study aimed to examine the association between community social capital and positive caregiving experiences among adult-children caregivers of disabled older adults in urban China. Data for this study were derived from the 2016 wave of the Longitudinal Study on Family Caregivers for Frail Older Adults Aged 75 or Above in Shanghai. The final analysis featured 440 disabled older adult and adult-children caregiver dyads. Multiple indicators and multiple causes modeling was used to test the proposed model from a structural equation modeling perspective. Provision of support to others was significantly associated with self-affirmation. Citizenship activity was significantly associated with life enrichment. Support of units (i.e., employers) was significantly associated with self-affirmation and life enrichment. The findings support the integration of the stress process model and social capital theory and highlight the important role of community social capital in enhancing the subdimensions of positive caregiving experiences. Policy and intervention implications are discussed.

The Paths to Negative and Positive Experiences of Informal Caregiving in Severe Mental Illness: A Study of Explanatory Models.

The experience of caregiving in severe mental illness is a valuable concept for research and clinical practice as it can provide access to the idiosyncratic assessment of negative and positive dimensions of informal caregiving, thus allowing the design of interventions focused on reducing risk factors and promoting protective factors. This study was aimed at testing explanatory models of negative and positive experiences of caregiving considering the role of the caregiver’s perceptions of difficulties, satisfaction, and coping. A convenience sample of 159 informal caregivers of patients with schizophrenia was used in this study. Different variables were considered: (1) perception of difficulties (Caregiver’s Assessment of Difficulties Index); (2) perception of satisfaction (Caregiver’s Assessment of Satisfaction Index); (3) perception of coping (Caregiver’s Assessment of Managing Index); and (4) the experience of caregiving (Experience of Caregiving Inventory). Using structural equation modeling, the results revealed the following: (1) the perception of difficulties and of satisfaction coexist; (2) the negative experiences of caregiving are predominantly explained by the perception of difficulties and of coping with stress; and (3) the positive experiences of caregiving are mainly explained by the perception of sources of intrapersonal satisfaction, while the perception of coping does not have robust predictive value.

How Is End-of-Life Care With and Without Dementia Associated With Informal Caregivers' Outcomes?

Background:Palliative care for older people with life-limiting diseases often involves informal caregivers, but the palliative care literature seldom focuses on the negative and positive aspects of informal caregiving.Objective:To assess the association of proximity to end of life (EOL) and dementia caregiving with informal caregivers’ burden of care and positive experiences and explain differences in outcomes.Design:Data on 1267 informal caregivers of community-dwelling older people were selected from a nationally representative cross-sectional survey and analyzed using analysis of variance and multivariable regression analyses.Measurements:The Self-Perceived Pressure from Informal Care Scale and the Positive Experiences Scale were administered to assess caregiver burden and positive experiences with providing care.Results:Dementia care, both at EOL and not at EOL, was associated with the most caregiver burden relative to regular care. Dementia care not at EOL was associated with the fewest positive experiences, and EOL care not in dementia with the most positive experiences. Only the differences in burden of care could be explained by variables related to stressors based on Pearlin stress-coping model.Conclusions:Informal caregivers of people with dementia are at risk not only of high caregiver burden but also of missing out on positive experiences associated with caregiving at EOL. Future research should examine how dementia-related factors reduce positive caregiving experiences, in order to make palliative care a positive reality for those providing informal care to community-dwelling persons with dementia.

A qualitative examination of policy and structural factors driving care workers\u2019 adverse experiences in long-term residential care facilities for older adults in Cape Town

BackgroundThere is lack of adequate training and policy support for employed care workers (CWs) employed in the South African (SA) older persons’ sector. Existing literature neglects the influence of training and policy support on CWs’ experiences in long-term care (LTC) for older adults in residential care facilities (RCFs). We investigated the ways in which CWs’ experiences are rooted in the lack of adequate training and policy support.MethodsQualitative data was collected through focus group (FG) interviews with 32 CWs employed in RCFs in the City of Cape Town. Data was also collected using semi-structured interviews with representatives of five RCFs for older adults and four training organisations providing CW training in the City of Cape Town, South Africa.ResultsDespite some positive caregiving experiences, CWs face role ambiguity and experience care work as a ‘career-less job’. They also face poor employment conditions, negative interpersonal relations at work, and role overload. They are not coping with the demands of LTC due to role overload, and lack of basic caregiving skills, coping skills and socio-emotional support. Their motivation to cope and provide quality care is hamstrung by their experiences of role ambiguity, poor employment conditions, negative interpersonal relations at work, and lack of career growth opportunities.ConclusionsFindings suggest that CWs’ experiences derive from the policy and structural context of caregiving. Policy inadequacies and lack of structural support create conditions for adverse conditions which negatively impact on CWs motivation and ability to cope with the demands of LTC. Lack of policy implementation presents structural barriers to quality LTC in the older persons’ sector. Implementation of policies and systems for professionalising care work is long overdue.

A PHENOMENOLOGICAL STUDY ON THE EXPERIENCES OF CARERS OF THE MENTALLY ILL ON A MENTAL HEALTH FACILITY IN THE PHILIPPINES

In the Philippines, mental illness remains a stigmatized, under-researched topic. Few studies on mental health are available, and at present, there is scant literature concerning the experiences of people living with and giving care to mentally ill peoples. This qualitative study aims to help families, mental health professionals, and the general community, gain an understanding of the experiences of caregivers and the challenges they face in sustaining their roles. Phenomenological method was employed for this research to explore the experiences of caregivers of the mentally ill patients in a Mental Health Facility in Leyte, Philippines. The primary data were collected through in-depth interviews with carers/caregivers/relatives of five (5) mentally ill persons. Library and internet desk research in its related literature were also employed. General findings of the study showed that caring for a mentally ill is burdensome. Data analysis revealed four superordinate themes under the experiences of caregivers, these consists of 1) caregiving difficulties, 2) various emotional reactions, 3) attitude towards the situation, and 4) positive caregiving experiences. Several support programs and services such as provision of mental health education and counseling regarding facts about the illness, its treatment and management, and leniency on watcher requirements during hospital admission are recommended to facilitate better caregiving experience of carers of the mentally ill.

Influence of Positive and Negative Dimensions of Dementia Caregiving on Caregiver Well-Being and Satisfaction With Life: Findings From the IDEAL Study

ObjectiveThe aim of this study was to identify the potential impact of positive and negative dimensions of caregiving on caregiver well-being and satisfaction with life (SwL). MethodsThis study used time-point one data from the Improving the experience of Dementia and Enhancing Active Life (also known as IDEAL)cohort study that involved 1,283 informal caregivers of people in the mild-to-moderate stages of dementia recruited from 29 sites within Great Britain. Multivariate linear regression modeling was used to investigate the associations between positive dimensions of caregiving (measured by caregiving competence and perceptions of positive aspects of caregiving), negative dimensions of caregiving (measured by caregiving stress and role captivity), and caregiver well-being and SwL. ResultsLower well-being was associated with low caregiving competence (–13.77; 95% confidence interval [CI]:–16.67, –10.87), perceiving fewer positive aspects of caregiving (–7.67; 95% CI:–10.26, –5.07), high caregiving stress (–24.45; 95% CI:–26.94, –21.96), and high role captivity (–15.61; 95% CI:–18.33, –12.89). Lower SwL was associated with low caregiving competence (–4.61; 95% CI:–5.57, –3.66), perceiving fewer positive aspects of caregiving (–3.09; 95% CI:–3.94, –2.25), high caregiving stress (–7.88; 95% CI:–8.71, –7.06), and high role captivity (–6.41; 95% CI:–7.27, –5.54). When these four measures were combined within the same model, only positive aspects of caregiving and caregiving stress retained independent associations with well-being and SwL. ConclusionBoth positive and negative dimensions of caregiving were associated with caregiver well-being and SwL. Psychological therapies and interventions need to consider not only the negative aspects of caregiving but also positive caregiving experiences and their implications for caregiver well-being and SwL.

Caregiving for a Companion Animal Compared to a Family Member: Burden and Positive Experiences in Caregivers.

Introduction: Research in human caregiving shows burden is often present in the caregiver and can be reduced by interventions that increase positive perceptions of caregiving. Recent work suggests burden is also present in owners of a seriously ill companion animal. To help determine if findings from the human caregiving literature are likely to generalize to companion animal caregiving, we undertook a comparison of burden and positive aspects of caregiving in these groups.Material and Methods: Caregivers recruited through social media disease support and information groups completed self-report questionnaires of burden and positive aspects of caregiving in an online research protocol. Owners of a seriously ill companion animal (n = 117) and caregivers of a family member with dementia (n = 252) were cross-sectionally compared. Analyses in the full sample were repeated in a subset (n = 75 per group) of caregivers with blindly matched demographic profiles.Results: Burden was elevated in both dementia and companion animal caregiver groups, though higher overall for dementia caregivers (p < 0.001 for full and matched samples). In contrast, greater positive aspects of caregiving were reported by companion animal caregivers (p < 0.001 for full and matched samples). In both groups, positive aspects of caregiving were negatively associated with burden (full sample p < 0.001; matched sample p < 0.05). Exploratory item analyses suggested the two groups show comparable experiences of fearing the future, guilt, and financial strain (p = ns for full and matched sample).Discussion: Although both groups showed elevated burden, companion animal caregivers reported less burden and a more positive appraisal of caregiving. Elements of burden showing similarities across groups provide a foundation for understanding caregiver burden in the companion animal owner. The inverse correlation between positive aspects of caregiving and burden suggests the impact of positive caregiving experiences should be considered in burden interventions, but because companion animal owners already positively appraise caregiving, enhancing positive aspects of caregiving may not offset burden as it does in human caregiving samples.

A Pilot Study of Universal Teacher–Child Interaction Training at a Therapeutic Preschool for Young Maltreated Children

Young children are disproportionately exposed to maltreatment but are underrepresented in research on effective treatments. Universal Teacher-Child Interaction Training (TCIT-U), developed from Parent-Child Interaction Therapy, may be especially appropriate for maltreated children as they often experience caregiver disruptions which pose challenges to traditional parent-child treatment. Furthermore, research suggests that teachers can play an important role for children who lack positive caregiving experiences. The current study examined the effectiveness of TCIT-U versus treatment-as-usual (TAU) at a therapeutic preschool for youth exposed to maltreatment. Thirty-eight children (2–5 years old) and eight teachers from four classrooms participated in the study. Teacher behaviors were observed and coded at baseline, mid-treatment, post-treatment, and 3-month follow-up. Teachers reported on children’s behavior and social-emotional skills at baseline, post-treatment, and 3-month follow-up. TCIT-U teachers demonstrated substantial increases in positive attending skills (PRIDE [Praise, Reflection, Imitation, Description, and Enjoyment] skills) and decreases in negative talk and questions during intervention phases, and these skills were maintained at follow-up. In addition, children in the TCIT-U classrooms demonstrated a significantly greater increase in overall social-emotional skills by post-treatment than children in the TAU classrooms, and effect sizes were moderate for all child outcomes. Findings provide preliminary support for TCIT-U’s effectiveness in a therapeutic setting for children exposed to maltreatment.

A psychoeducational group intervention for family and friends of youth with borderline personality disorder features: protocol for a randomised controlled trial

BackgroundCaring for a person with borderline personality disorder is associated with poor outcomes including elevated psychological distress and burden. This study will compare the effectiveness of two brief psychoeducational programs for carers of youth presenting for early intervention for borderline personality disorder features. The protocol for this study is presented here.MethodsThe study is a single-centre parallel group, randomised controlled trial. As a family unit, relatives, partners and friends (‘carers’) are randomly allocated to one of two treatment arms to receive either an online borderline personality disorder psychoeducation program, or both the online psychoeducation group and a face-to-face group program, Making Sense of Borderline Personality Disorder. Carers are assessed at baseline and follow-up (4 weeks after the intervention). It is expected that participants who received the combined group and online programs will have better outcomes than those who received the online program alone. The primary outcome is carer burden, assessed using the negative appraisal subscales of the Experience of Caregiving Inventory. Secondary outcomes include positive experiences of caregiving, coping, self-rated personality disorder knowledge, psychological distress, expressed emotion and quality of life.DiscussionThis will be the first published evaluation of a psychoeducational intervention for carers of youth with borderline personality disorder features using a randomised controlled trial design. The results have the potential to inform clinicians and carers about the effectiveness of brief interventions designed to support families and friends of young people with borderline personality disorder, and what medium those interventions should utilise.Trial registrationProspectively registered with the Australian New Zealand Clinical Trial Registry ACTRN12616000304437 on 08 March 2016.