Professionals’ opinions on support for people with chronic illness in their roles as parents in mental or in general health care

Chronic illness affects a person’s wellbeing and affects the ability to perform the social roles of spouse or parent. When working with people with long-lasting mental or somatic illnesses, social workers and nurses are confronted with needs for support, especially for parents. Although programs are in place for the children of parents with chronic illnesses, specific services for the parents themselves are scarce, as are parenting support courses for professionals. In an explorative study we investigated the similarities and differences between mental health organizations and general hospitals in providing support to parents. Using a cross-sectional design, information on supported parenting was collected through an internet questionnaire. Twice as many professionals in general hospitals can provide support to parents than did those in mental health organizations that were not trained in supported parenting. Professionals in mental health institutions generally reported that the attention paid to the parental role is insufficient. However, professionals in mental health organizations who were trained in supported parenting considered paying attention to the parental role more as a part of their job than the participants from organizations without such training. Further research should expand this first pilot study on the attitude of professionals towards supported parenting

Strategies for parenting by mothers and fathers with a mental illness

WHAT IS KNOWN ON THE SUBJECT?: The combination of coping with their mental health problems and caring for children makes parents vulnerable. Family-centred practice can help to maintain and strengthen important family relationships, and to identify and enhance the strengths of a parent with a mental illness, all contributing to the recovery of the person with the mental illness. WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE?: Taking the strength and the opportunities formulated by parents themselves as a starting point is fairly new. Parents with severe mental illness find strength for parenting in several ways. They feel responsible, and this helps them to stay alert while parenting, whereas parenthood also offers a basis for social participation through school contacts and the child's friendships. Dedication to the parent role provides a focus; parents develop strengths and skills as they find a balance between attending to their own lives and caring for their children; and parenting prompts them to find adequate sources of social support. In this study these strategies were found to be the fundamentals of recovery related to parenting. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can support and coach patients who are identified as parents, and self-chosen parenting related goals are set and addressed. A family-focused approach by nurses can be used to prevent problems for children and their families, identify their strengths as well as vulnerabilities, and address the challenges to build resilience. ABSTRACT: Introduction Understanding of the problems of parents with mental illness is growing. Gaining insight into strategies for parenting, while taking the opportunities formulated by these parents themselves as a starting point is fairly new. Question What are the strategies of parents with a mental illness to be successful? Method Experiences of 19 mothers and eight fathers with a mental illness were explored with in-depth interviews. Data were content analysed, using qualitative methods. Results Next to feelings of inadequacy, interviewees also describe how children enrich and structure their lives and are not only a burden but serve as distraction from problems. Developing activities that interest both child and parent provides avenues for emerging strength. Mental illness constrains fathers, but also gives opportunities to develop a meaningful relation with their children. Discussion Strategies like being fully dedicated to the parental role, finding a balance between attention for one's own life and parenting and finding adequate sources of support are found to be fundamental for recovery in the parent role. Implications for practice Peer groups can be of valuable help and mental health workers can support parents to set self-chosen parenting related goals

Ouderschap en psychiatrische rehabilitatie:kunnen ouders profiteren van een nieuwe benadering?

Poster op Phrenos Rehabilitatiecongres 21 mei 2015. Eerste prijs

Identifying social participation subgroups of individuals with severe mental illnesses:a latent class analysis

Purpose To investigate factors that influence participation in and needs for work and other daytime activities among individuals with severe mental illnesses (SMI). Methods A latent class analysis using routine outcome monitoring data from 1069 patients was conducted to investigate whether subgroups of individuals with SMI can be distinguished based on participation in work or other daytime activities, needs for care in these areas, and the differences between these subgroups. Results Four subgroups could be distinguished: (1) an inactive group without daytime activities or paid employment and many needs for care in these areas; (2) a moderately active group with some daytime activities, no paid employment, and few needs for care; (3) an active group with more daytime activities, no paid employment, and mainly met needs for care; and (4) a group engaged in paid employment without needs for care in this area. Groups differed significantly from each other in age, duration in MHC, living situation, educational level, having a life partner or not, needs for care regarding social contacts, quality of life, psychosocial functioning, and psychiatric symptoms. Differences were not found for clinical diagnosis or gender. Conclusions Among individuals with SMI, different subgroups can be distinguished based on employment situation, daytime activities, and needs for care in these areas. Subgroups differ from each other on patient characteristics and each subgroup poses specific challenges, underlining the need for tailored rehabilitation interventions. Special attention is needed for individuals who are involuntarily inactive, with severe psychiatric symptoms and problems in psychosocial functioning

Parenting and psychiatric rehabilitation:can parents with severe mental illness benefit from a new approach?

Abstract: Objective: The aim of this pilot implementation study was to explore the initial experiences with and impact of Parenting with Success and Satisfaction (PARSS), a psychiatric rehabilitation and recoverybased, guided self-help intervention, for parents with severe mental illnesses. Methods: Changes in the PARSS intervention group were compared with changes in a control group in a nonequivalent controlgroup design. Outcome measures included: parenting satisfaction reported by parents; parenting success reported by mental health practitioners and family members; empowerment as reported by parents, practitioners and family members; and parents’ reported quality of life. Additional process data were obtained on relationship with practitioner, quality of contact, satisfaction with the intervention and fidelity. Results: Parenting satisfaction increased after 1 year for the PARSS group, but not for the control group. Parents’ reports of empowerment did not change for either group. The scores of parents’ empowerment reported by practitioners and family members increased in the control group, with no such change in the PARSS group. Quality of life improved significantly for the intervention group. Process measures showed that, although PARSS was not always implemented as intended, both parents and practitioners expressed satisfaction with the intervention. Conclusions and Implications for Practice: The first experiences with PARSS were mixed. This intervention, implemented by mental health practitioners, has the potential to function as a useful tool for supporting parents. Attention must be paid to enhancing intervention implementation and fidelity. doi: 10.1037/prj0000067 PMID: 2486683

Prevention and Intervention Programs Targeting Sexual Abuse in Individuals with Mild Intellectual Disability:A Systematic Review

Introduction: Compared to their non-disabled peers, individuals with mild intellectual disability (MID) are at higher risk of becoming a victim of sexual abuse and more vulnerable to its disruptive effects. This review provides an overview of content and effectiveness of prevention and intervention programs targeting sexual abuse in individuals with MID. Methods: PRISMA guidelines were followed and quality and effectiveness of the programs were evaluated taking into account the rating of the Quality Assessment Tool for Quantitative Studies (QATQS). Results: Twelve studies were included. In prevention programs role-play prevailed, whereas the content of intervention programs varied. All studies received a "weak" QATQS rating. By consequence, effectiveness of the program was downgraded to "unclear" in ten, and "ineffective" in two studies. Conclusion: Further development of programs and higher quality of research is needed to investigate whether they are effective in preventing sexual abuse or reducing its consequences in individuals with MID

The effectiveness of a training for patients with unexplained physical symptoms: protocol of a cognitive behavioral group training and randomized controlled trial

Abstract: BACKGROUND: In primary care, up to 74% of physical symptoms is classified as unexplained. These symptoms can cause high levels of distress and healthcare utilization. Cognitive behavioral therapy has shown to be effective, but does not seem to be attractive to patients. An exception herein is a therapy based on the consequences model, which distinguishes itself by its labeling of psychosocial distress in terms of consequences rather than as causes of physical symptoms. In secondary care, 81% of the patients accepts this therapy, but in primary care the outcome is poor. We assume that positive outcome can also be reached in primary care, when the consequences model is modified and used bottom-up in an easily accessible group training, in which patients are relieved of being blamed for their symptoms. Our aim is to investigate the (cost-)effectiveness of this training. METHODS AND DESIGN: A randomized controlled trial is designed. One hundred patients are randomized to either the group training or the waiting list. Physicians in general practices and outpatients clinics of general hospitals refer patients. Referral leads to inclusion if patients are between 18 and 65 years old, understand Dutch, have no handicaps impeding participation and the principal DSM-IV-TR classification is undifferentiated somatoform disorder or chronic pain disorder. In contrast to other treatment effect studies, the co-morbidity of a personality disorder does not lead to exclusion. By this, we optimize the comparability between the study population and patients in daily practice enlarging the generalization possibilities. Also in contrast to other effect studies, we chose quality of life (SF-36) instead of physical symptoms as the primary outcome measure. The SF-6D is used to estimate Quality Adjusted Life Years (QALYs). Costs are measured with the Trimbos/iMTA Questionnaire for Costs associated with Psychiatric Illness. Measurements are scheduled at baseline, after the training or waiting list, three and twelve months after the training. The differences between measurements are analyzed according to the intention-to-treat principle. The cost-effectiveness is expressed as costs per QALY, using multiple sensitivity analyses on the basis of a probabilistic model of the trial. DISCUSSION: If we show that our group training is (cost-)effective, more patients could be served, their quality of life could be improved while costs might be reduced. As the training is investigated in a heterogeneous patient group i

The Body Experience Questionnaire for adults with mild intellectual disability or borderline intellectual functioning (BEQ-mb):Development and initial evaluation

Background: Body experience is an important facet of psychosocial functioning and health. However, to date no test exists to measure body experience in adults with mild intellectual disability and borderline intellectual functioning (MID-BIF). We therefore adapted the Body Experience Questionnaire (BEQ) to this group, resulting in the BEQ-mb, and evaluated its usability, comprehensibility, and reliability. Method: The BEQ-mb was developed in five stages: concept development, focus group, verbal reports, pilot testing, and evaluation. Results: The BEQ-mb is applicable in, and comprehensible by, adults with MID-BIF. Internal consistency is good for the total scale and the body awareness and body satisfaction subscales, but low for the body attitude subscale. Test-retest reliability is excellent for the total scale and the subscales. Conclusion: The BEQ-mb unlocks new opportunities for clinical examination and research on body experience. Future research is needed to investigate its structural validity

Clinical characteristics of individuals with intellectual disability who have experienced sexual abuse. An overview of the literature

Background: Sexual abuse in individuals with average IQ or above is associated with a wide range of behavioural, psychological and body-related characteristics. It is unknown whether individuals with intellectual disability (ID) and a history of sexual abuse suffer from similar clinical characteristics. Objective: The aim of the review is to provide an overview of the literature on the clinical characteristics of individuals with ID who have experienced sexual abuse. Method: PubMed, Embase, PsycInfo, CINAHL, Cochrane Library and Web of Sciences were searched for relevant publications using terms related to concepts of “intellectual disability” and “sexual abuse”. Two independent reviewers screened and selected articles for inclusion in the study, resulting in seven studies. Results: The studies mostly reported behavioural and psychological characteristics such as aggression, self-injury, or posttraumatic stress, anxiety or depressive symptoms associated with sexual abuse in individuals with ID. None mentioned body-related characteristics. Conclusions: Similar to individuals with average IQ or above, sexual abuse in individuals with ID is associated with a broad range of behavioural and psychological characteristics. Conduct disorders, self-injury, inappropriate sexualised talk and poor feelings of personal safety seem to be more indicative for the ID population. Anxiety, depression and PTSD are prevalent in individuals with and without ID who both have experienced sexual abuse. Whether individuals with ID experience body-related characteristics is unclear