Stable Caregiver Research Articles

Intensity and changes in grandparental caregiving: Exploring the link to loneliness in Europe

This study investigates the impact of the overall intensity and changes in grandparental caregiving on loneliness in grandparents in European countries. Data from waves 5 to 8 of the Survey on Health, Ageing, and Retirement in Europe (SHARE) were used (Nindividuals = 30,896 and Nobservations = 48,562). We included grandparents (aged 50 years and over) with at least one grandchild at the beginning of the study. The analyses reveal that any intensity of grandparental care decreases the risk of loneliness. When looking at changes in grandparental care the results show that stable caregiving roles appeared to reduce loneliness, while starting to provide grandparental care makes grandparents more vulnerable to loneliness. In conclusion, our findings underscore that consistent grandparental care is important for grandparents in mitigating loneliness, highlighting the importance of sustained caregiving roles over fluctuations in caregiving intensity.

The CAREPAL-8: a short screening tool for multidimensional family caregiver burden in palliative care

BackgroundFamily caregivers of terminally ill and dying people do not only experience varying levels but also different dimensions of caregiver-related strain and burden. The aim of the study was to develop a short multidimensional screening tool for the detection of burden in family caregivers in palliative care.MethodsFamily caregivers of cancer patients newly admitted to specialist inpatient palliative care (N = 232) completed questionnaires on psychological burden, quality of life, social support and need fulfillment. A latent class mixture model was used to identify discrete classes of family caregivers related to their multidimensional caregiver burden. Multinomial logistic regression analyses were performed to identify the most predictive items from a set of established questionnaires.ResultsFour latent classes of family caregivers were identified: Currently stable caregivers (37%), Caregivers with unmet needs (20%), Psychologically burdened caregivers (30%), and High-risk caregivers (13%). Each of these classes describes a different risk profile of multidimensional family caregiver burden, although family caregivers exhibit high levels of distress across all classes. From a set of 48 items, we identified eight items that predicted the class membership best. These items represent the items of the novel multidimensional screening tool: The 8-item Screening Tool for Family Caregiver Burden in Palliative Care (CAREPAL-8). Except for social support, the items maintained fidelity to the conceptualization of multidimensional caregiver burden used in this study. A preliminary classification system was developed, which has yet to be validated.ConclusionsThis study represents the first step in the establishment of a practical, self-administered screening tool that might help healthcare providers to tailor caregiver care according to their burden in daily practice. Brevity of the 8-item tool might facilitate its use in routine clinical care.

Children born to women in opioid maintenance treatment: Alongitudinal study of child behavioral problems and parenting stress.

In the wake of the "opioid epidemic", there is considerable concern regarding potential harmful long-term effects of prenatal opioid exposure. Opioid misuse and addiction confer increased exposure to lifestyle stressors and health burdens. Accordingly, it is challenging to disentangle effects of prenatal opioid exposure per se from factors related to maternal stress. In this study, we followed 36 women enrolled in comprehensive opioid maintenance treatment (OMT) program and their children alongside 36 age-matched mother-child dyads from a community sample (COMP) from pregnancy until child-age 8 years. Across five sessions, we used a battery of well-established questionnaires to investigate trajectories of parenting stress and mental health symptoms as well as child behavior problems. The 8-year retention was relatively high (OMT: 72%, COMP: 67%), and the OMT sample remarkably stable and well-functioning, with minimal concomitant illicit drug use. Mixed effects regressions showed significantly different trajectories of child behavior problems (F = 3.8, p = 0.024) and parenting stress (F = 3.1, p = 0.016) in the two groups. Differences in experienced stress were largely explained by more distress specifically related to the parenting role in the OMT group (F = 9.7, p = 0.003). The OMT sample also reported higher psychological distress (F = 15.6, p < 0.001) than the comparison group, but notably few participants presented with problems that warranted clinical intervention. The results underscore the benefits of tailored follow-up of children prenatally exposed to opioids and their families beyond infancy and toddlerhood. Long-term direct effects of prenatal opioid exposure on behavior problems are likely modest, given an otherwise stable caregiving environment conducive to healthy development.

A-189 Multicomponent-Multidomain Cognitive Intervention with Care-partners

Abstract Objective: The main objective of this presentation is to present a case study assessing the feasibility of a cognitive intervention for individuals with mild cognitive impairment or early stages of dementia due to Alzheimer’s disease. The secondary objective is to assess the efficacy of the intervention. Method: A multicomponent-multidomain intervention was conducted with patients diagnosed with mild cognitive impairment and their care-partners. Due to the pandemic the intervention was conducted in individual dyads, rather than in groups. The intervention consisted of three components - psychoeducation about brain health and cognition, compensatory strategies, and cognitive skills training in four domains – attention, processing speed, executive functioning, and memory. The training was completed in twenty to twenty five sessions. Pre and post cognition, self-reported mood and cognition measures, and measures of cognition, daily functioning and caregiver burden completed by care partners were utilized to assess the efficacy of the intervention. Results: Results suggested stable or improved cognition over a year, with improved daily functioning, mood, and reduced or stable caregiver burden. Conclusion(s): The multicomponent-multidomain intervention with care patterner is a feasible and efficacious treatment for mild cognitive impairment. In future, implementation in a group format will be assessed.

Cancer survivors' financial hardship and their caregivers' employment: results from a statewide survey.

Many caregivers take paid and/or unpaid time off work, change from full-time to part-time, or leave the workforce. We hypothesized that cancer survivor-reported material hardship (e.g., loans, bankruptcy), behavioral hardship (e.g., skipping care/medication due to cost), and job lock (i.e., staying at a job for fear of losing insurance) would be associated with caregiver employment changes. Adult cancer survivors (N = 627) were surveyed through the Utah Cancer Registry in 2018-2019, and reported whether their caregiver had changed employment because of their cancer (yes, no). Material hardship was measured by 9 items which we categorized by the number of instances reported (0, 1-2, and ≥ 3). Two items represented both behavioral hardship (not seeing doctor/did not take medication because of cost) and survivor/spouse job lock. Odds ratios (OR) were estimated using survey-weighted logistic regression to examine the association of caregiver employment changes with material and behavioral hardship and job lock, adjusting for cancer and sociodemographic factors. There were 183 (29.2%) survivors reporting their caregiver had an employment change. Survivors with ≥ 3 material hardships (OR = 3.13, 95%CI 1.68-5.83), who skipped doctor appointments (OR = 2.88, 95%CI 1.42-5.83), and reported job lock (OR = 2.05, 95%CI 1.24-3.39) and spousal job lock (OR = 2.19, 95%CI 1.17-4.11) had higher odds of caregiver employment changes than those without these hardships. Caregiver employment changes that occur because of a cancer diagnosis are indicative of financial hardship. Engaging community and hospital support for maintenance of stable caregiver employment and insurance coverage during cancer may lessen survivors' financial hardship.

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

Development and feasibility testing of a mobile phone application to track children's developmental progression.

Given that mobile phone usage has increased rapidly throughout the world, one possibility to increase parental involvement in monitoring their children’s progression is to train parents or primary caregivers on the use of mobile phone technology to track their children’s developmental milestones. The current paper aimed to describe the development of a mobile phone application for use among primary caregivers and establish the feasibility and preliminary impact of caregivers using a mobile phone application to track the progression of their children’s development in a context where there is a paucity of similar studies. This study is a substudy that focusses on the intervention group only of a recently completed two-armed quasi-experimental study in an informal settlement in Nairobi. The mobile phone application which consisted of questions on children’s developmental progression, as well as stimulation messages, was developed through a step-wise approach. The questions covered five child developmental domains: communication; fine motor; gross motor; personal-social; and, problem-solving. Depending on the response received, the child would be classified as having ‘achieved a milestone’ or ‘milestone not achieved.’ If a child had achieved the milestone for a specific age, a caregiver would receive an SMS on how to stimulate the child to achieve the next milestone. Where the milestone was not achieved, the caregiver would get a message to enhance development in the area of delay. Caregivers with children aged between six months and two years were recruited into the study and received questions and messages regarding their children’s development (age-specific) on a monthly basis for 12 months. Caregiver adherence to the intervention was above 90% in the first three months of implementation. Thereafter, the response rate fluctuated between 76% and 86% across the subsequent months of the intervention. The high level and fairly stable caregivers’ rate of response to the 12 rounds of messaging indicated feasibility of the mobile technology. Further, in the first three months of intervention implementation, the majority of caregivers were able to keep track of how their children attained their developmental milestones. The intervention seems to be scalable, practical and potentially low-cost because of the wide coverage of phones.

From attachment to mental health and back

Over the past 70 years, attachment theory and associated research have documented the crucial role of continuity of care and stable caregivers to serve as attachment figures, and this has had a major effect on public mental health policy. Attachment theory has the potential to provide mental health clinicians with a rich model for understanding the development of early human relationships, but availability and applicability of diagnostic measures and treatments remain a concern. Attachment refers to the way in which children learn to use their parents as a so-called safe haven to cope with distress and as a secure base to explore their social and physical environments.

Infant Psychosocial Environment Predicts Adolescent Cardiometabolic Risk: A Prospective Study

To prospectively assess whether the infant psychosocial environment was associated with cardiometabolic risk as early as adolescence. Participants were recruited in Santiago, Chile, and have been followed from infancy. Inclusion criteria included healthy infants with birth weight ≥3kg and a stable caregiver. The psychosocial environment, including depressive symptoms, stressful life events, poor support for child development, father absence, and socioeconomic status, was reported by mothers at 6-12months. Body mass index (BMI) z score was assessed at 5 and 10years. BMI z score, waist-to-hip ratio, systolic and diastolic blood pressure, fat mass and body fat percentage, fasting glucose, total and high-density lipoprotein cholesterol, and homeostatic model of insulin resistance were tested in adolescence. Adolescents ranged from 16 to 18years of age (n=588; 48.1% female). A poorer infant psychosocial environment was associated with BMI z score at 10years (β=0.10, 95% CI=0.00-0.19) and in adolescence (β=0.15, 95% CI=0.06-0.24) but not at 5years. A poorer infant psychosocial environment was associated with higher blood pressure (β=0.15, 95% CI=0.05-0.24), greater anthropometric risk (β=0.13, 95% CI=0.03-0.22), greater biomarker (triglycerides, homeostatic model assessment of insulin resistance, total cholesterol) risk (β=0.12, 95% CI=0.02-0.22), and a higher likelihood of metabolic syndrome in adolescence (aOR=1.50; 95% CI=1.06-2.12). These findings demonstrate that a poorer infant psychosocial environment was associated with greater adolescent cardiometabolic risk. The results support screening for infants' psychosocial environments and further research into causality, mechanisms, prevention, and intervention.

Quality of life and care burden in primary caregivers of liver transplantation recipients in China.

So far, liver transplantation (LT) has become the most effective way to treat end-stage liver-related diseases. As we all know, a stable caregiver is crucial to LT recovery. However, compared with LT patients, few studies were focused on LT caregivers.This study aimed to describe the quality of life (QoL), care burden, and their related factors in caregivers of LT patients in Shanghai, China.We collected 225 liver transplanted patients and their corresponding caregivers’ social demographic and medical information; meanwhile, we assessed 225 LT recipients’ caregivers’ life quality; by using Caregiver Quality of Life Index-Liver Transplantation in Chinese version (CQOLC-LT), Zarit caregiver burden inventory in Chinese version (ZBI) was used to access the care burden. Self-Rating Anxiety Scale (SAS) and Center for Epidemiological Survey-Depression Scale (CES-D) were used to assess caregivers’ anxiety and depression status. For physical assessment, we used Fatigue Scale-14 (FS-14). Logistic regression analysis was performed to identify clinical factors influencing QOL of LT primary caregivers.The QoL of LT caregiver was not optimistic; the care burden on caregiver was still heavy. In particular, most caregivers experienced mild to moderate mental health disorders.In general, our findings emphasized the importance of assessment of physical and mental health in primary caregivers during overall process.

Infant Iron Deficiency and Iron Supplementation Predict Adolescent Internalizing, Externalizing, and Social Problems

To evaluate associations between iron supplementation and iron deficiency in infancy and internalizing, externalizing, and social problems in adolescence. The study is a follow-up of infants as adolescents from working-class communities around Santiago, Chile who participated in a preventive trial of iron supplementation at 6 months of age. Inclusionary criteria included birth weight ≥3.0 kg, healthy singleton term birth, vaginal delivery, and a stable caregiver. Iron status was assessed at 12 and 18 months of age. At 11-17 years of age, internalizing, externalizing, and social problems were reported by 1018 adolescents with the Youth Self Report and by parents with the Child Behavior Checklist. Adolescents who received iron supplementation in infancy had greater self-reported attention-deficit/hyperactivity disorder but lower parent-reported conduct disorder symptoms than those who did not (Ps < .05). Iron deficiency with or without anemia at 12 or 18 months of age predicted greater adolescent behavior problems compared with iron sufficiency: more adolescent-reported anxiety and social problems, and parent-reported social, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, oppositional defiant, conduct, aggression, and rule breaking problems (Ps < .05). The threshold was iron deficiency with or without anemia for each of these outcomes. Iron deficiency with or without anemia in infancy was associated with increased internalizing, externalizing, and social problems in adolescence.

The Fundamental Role of Early Environments to Developing an Emotionally Healthy Brain

The quality of early socioemotional environments has a clear link to emotional health. Findings from neuroscientific and behavioral studies explain this enduring link, and findings focus on the plasticity of emotional brain development. Implications include (a) prioritizing individuals as early as possible and throughout development, (b) remaining mindful that stable caregiving is a basic need for children, and (c) supporting children’s emotional development which means supporting their families. Addressing these needs is a large task, but not addressing these needs confers an even larger mental health cost to the individual as well as to society more broadly.

Impacts of media on sexual behaviour and relationships among youth in foster care

AbstractYouth in foster care (YFC) are at high risk of negative reproductive and other health outcomes and may be especially vulnerable to negative impacts of media due to early adversity and a lack of stable caregiver relationships. The aim of this project was to explore how access and exposure to media impacts YFC in order to inform future research in this realm and promote resilience in this understudied population. We conducted semistructured interviews with YFC ages 15–21 (n = 22) and focus groups with foster caregivers (n = 86). We used thematic analysis to analyse data for themes related to media. Youth and caregivers described four main themes: (a) impacts of media on youth norms and attitudes, (b) impacts of media on youth behaviour, (c) impacts of youth exposure to pornography, and (d) caregiver monitoring and mediation of media. Data from this study indicate that media has unique, important effects on YFC norms and behaviours, including sexual behaviours. Foster caregivers encounter multiple barriers to monitoring and mediating media use for YFC. Further research is needed to explore differential effects of media on YFC versus non‐YFC in order to develop effective interventions and mitigate potential negative effects of media.

Interpreting children’s best interests: Needs, attachment and decision-making

Summary Many decisions in the child welfare arena revolve around the concept of ‘children’s best interests’, but determining what they actually consist of is contestable and subject to conflicting criteria. This article describes the content of ‘children’s best interests’ discourses used by social workers and parents as part of decision-making rationales. Findings This study found that the construction of children’s ‘best interests’ was underpinned by concepts related to children’s needs. Needs were framed as emotional needs best met by family relationships, and theorised primarily using attachment theory. This resulted in decisions that tended to favour stability over change, as children’s distress on separation, indiscriminate affection, and difficult behaviours were interpreted as evidence of attachment problems that should lead to decisions to retain stable caregiving arrangements. The use of attachment theory was not straightforward, and illustrates the uneasy juxtapositions of conflicting discourses impacting on child welfare decision-making, particularly the influence of policy orientation. Applications These conflicts highlight the contested child welfare domain, and the contextualised interpretations required of attachment theories in decision-making contexts in order to make sound decisions for specific children. Implications for practice and education are discussed.

Effect of Moderate to Vigorous Physical Activity Intervention on Improving Dementia Family Caregiver Physical Function: A Randomized Controlled Trial.

ObjectiveAlzheimer’s disease and related dementias (ADRD) affect more than five million Americans and their family caregivers. Caregiving creates challenges, may contribute to decreased caregiver health and is associated with $9.7 billion of caregiver health care costs. The purpose of this 12 month randomized clinical trial (RCT) was to examine if the Enhancing Physical Activity Intervention (EPAI), a moderate to vigorous physical activity (MVPA) treatment group, versus the Caregiver Skill Building Intervention (CSBI) control, would have greater: (1) MVPA adherence; and (2) physical function.MethodsCaregivers were randomly assigned to EPAI or CSBI (N=211). MVPA was assessed using a self-report measure; and physical function was objectively assessed using two measures. Intention-to-treat analyses used descriptive, categorical and generalized estimating equations (GEE), with an exchangeable working correlation matrix and a log link, to examine main effects and interactions in change of MVPA and physical function over time.ResultsAt 12 months, EPAI significantly increased MVPA (p=<0.001) and number of steps (p=< .01); maintained stable caregiving hours and use of formal services; while CSBI increased hours of caregiving (p=<0.001) and used more formal services (p=<0.02). Qualitative physical function data indicated that approximately 50% of caregivers had difficulties completing physical function tests.ConclusionThe EPAI had a stronger 12 month effect on caregiver MVPA and physical function, as well as maintaining stability of caregiving hours and formal service use; while CSBI increased caregiving hours and use of formal services. A study limitation included greater EPAI versus CSBI attrition. Future directions are proposed for dementia family caregiver physical activity research.

Pushing Forward: Examining Client Motivation in a Family Treatment Drug Court

In response to the growing drug epidemic in the 1980s, Family Treatment Drug Courts were established in the United States. Justice professionals noticed that the same parents would reappear in court for both substance dependence and child custody cases and decided there had to be a way to decrease recidivism and to increase the number of sober, stable caregivers once child custody cases closed (“History” 2014). Family Treatment Drug Courts (FTDC) are treatment programs that serve to establish permanent welfare for the child by providing comprehensive, intensive, individualized substance abuse services to the addicted parents after a child protection order has been filed by the Department of Health and Human Services (DHHS) (State of Maine 2011). FTDCs collaborate with the court, child welfare system, local health providers, the family, and close friends to help clients achieve sobriety and implement a permanent plan for the children. While the program does not guarantee reunification following graduation, FTDCs are more likely to result in family reunification or in a child permanency plan at a faster pace (Green et al. 2007). The first Miami-Dade Drug Court was established in 1989, and 492 more drug courts opened within the following ten years (“History” 2014). Three hundred family drug courts, in particular, are operating in the U.S. as of 2012 (Marlowe and Carey 2012).

What promotes secure attachment in early adoption? The protective roles of infants’ temperament and adoptive parents’ attachment

Life before adoption is characterized by the lack of sensitive and stable caregiving, putting infants at risk for non-secure attachment patterns. What leads to adoptees’ attachment security in their adoptive families has not been conclusively determined. We investigated the roles of children’s temperament and adoptive parents’ attachment on adoptees’ attachment security. The variables were studied in a sample of 30 early-placed adoptees (age at adoption placement M = 5.37 months, SD = 4.43) and their adoptive mothers and fathers. Attachment patterns were investigated by means of the Strange Situation Procedure and the Adult Attachment Interview, and temperament via the Infant Behavior Questionnaire. Results showed that mothers’ secure attachment, but not fathers’ attachment or adoptees’ temperament, increased the chance of secure attachment in adoptees. Temperament moderated the mother–child attachment match.

Infants and Toddlers in Foster Care

Young children involved in the child welfare system are susceptible to behavioral and physiological dysregulation. These children need nurturing care to develop organized attachments to caregivers; they need synchronous care to support their physiological and behavioral regulation; and they need stable caregivers who can commit to them, supporting their sense of self and behavioral regulation. Without intervention at the level of the parent and the system, most children involved with the child welfare system are unlikely to have these needs met. We present two models of intervention designed to enhance parents' synchrony and nurturance, and highlight aspects of the system that can enhance the stability and commitment of caregivers.

Besoins ressentis des patients et des soignants quant à la prise en charge des troubles de personnalité limite

ObjectivesBorderline personality disorder (BPD) is characterized by a pervasive pattern of instability and impulsivity. International guidelines suggest long-term psychotherapy as the first line treatment. However, follow-up studies indicate that BPD patients partially accept the current provision of care (limited access and high drop-out). In view to explain the gap between recommendations and clinical practice, we aim to assess the felt needs of BPD patients and professionals working with them. Materials and methodsWe conducted a qualitative study. First, we screened BPD with the McLean Screening Instrument for BPD among 74 consecutives patients admitted for a psychiatric consultation in the Emergency Department of a General Hospital. We propose a self questionnaire to these 46 selected patients in line to assess their need. We also send a self questionnaire to professionals of the same area (social workers, psychiatrist [n=19], and general practitioners [n=248]). Based on this first line of results, we secondly interviewed ten BPD patients with a semi-structured questionnaire. At last, we conducted focus group with professionals: one group of psychologist, one of nurses, one of social workers and one with people of different profession. ResultsThe needs expressed by patients in self-administered questionnaires focused on improving interpersonal relationships (n=16), listening and support (n=8), the desire for change (n=7), the desire to understand themselves (n=6) and the need to improve their social skills (n=3). Along interviews, patients stressed the need for high availability of professionals to discuss with and their ability to provide counseling. A hotline has been valued. The drugs were presented negatively, while the hospital would be considered as a solution to protect them. Eight percent of General Practitioners send back the questionnaire. They consider BPD affect a small proportion of their patients. Fifteen percent of psychiatrists filled the questionnaire. They stressed the need for specific psychotherapies, available and stable caregivers, with flexible attitudes. At their focus group, the nurses stressed the need of care framework to promote availability and adaptation to the patients. The place of nurses was considered as central. Psychologists have considered the needs and the psychotherapy of these patients as non-specific. The group of social workers highlighted their lack of knowledge on the subject and supported the need for a stable support without constraint. ConclusionIn this article, based on a qualitative assessment of BPD patients and professionals concerned by them, we have highlighted that patients seek more a good therapeutic relationship (validation and collaboration) than a mental or behavioral change. The health care organization provided by professionals could appear as a defensive response to the chaotic presentation of these patients.

Attachment and Emotional Development in Institutional Care: Characteristics and Catch-Up.

Attachment has been assessed in the extreme environment of orphanages, but an important issue to be addressed in this chapter is whether in addition to standard assessment procedures, such as the Strange Situation, the lack of a specific attachment in some institutionalized children should be taken into account given the limits to the development of stable relationships in institutionalized care. In addition, this chapter discusses disinhibited or indiscriminately friendly behavior that is often seen in institutionalized children. Enhanced caregiving quality alone appears to be insufficient to diminish indiscriminate behavior, at least in some children, as evidenced by the persistence of indiscriminate behavior in children adopted out of institutions into adoptive families. We suggest that the etiology and function of indiscriminate friendly behavior may be different for institutionalized versus not-institutionalized children. In the first case it may reflect a distortion or disruption of early attachment relationships, in the latter case it is likely to result from the lack of expected input in the form of contingent interactions with a stable caregiver in early life. We try to delineate infant and caregiver characteristics that are associated with secure attachment in institutional settings, given the inevitable fact that large numbers of infants worldwide are being raised, and will be raised, in contexts of institutional care. We conclude that much further study is needed of the development of children's attachments following adoption out of an institutional setting.