Family networks to improve outcomes in children with intellectual and developmental disorders: a qualitative study

Syed Usman Hamdani, Najia Atif, Mahjabeen Tariq, Fareed Aslam Minhas, Zafar Iqbal, Atif Rahman, Syed Usman Hamdani, Najia Atif, Mahjabeen Tariq, Fareed Aslam Minhas, Zafar Iqbal, Atif Rahman

Abstract

Background: There are at least 50 million children with an intellectual or developmental disorder in South Asia. The vast majority of these children have no access to any service and there are no resources to develop such services. We aimed to explore a model of care-delivery for such children, whereby volunteer family members of affected individuals could be organized and trained to form an active, empowered group within the community that, a) using a task-sharing approach, are trained by specialists to provide evidence-based interventions to their children; b) support each other, with the more experienced FaNs i.e. family networks, providing peer-supervision and training to new family members who join the group; and c) works to reduce the stigma associated with the condition.

Methods: We used qualitative methods to explore carers' perspectives about such a care-delivery model.

Results: The key findings of this research are that there is a huge gap between the needs of the carers and available services. Carers would welcome a volunteer-led service, and some community members would have time to volunteer. Raising community awareness in a culturally sensitive manner prior to launching such a service and linking it to the community health workers programme would increase the likelihood of success. Gender-matching would be important. It would be possible to form family networks around the more motivated volunteers, with support from local non-governmental organizations. The carers were receptive to the use of technology to assist the work of the volunteers as well as for networking.

Conclusions: We conclude that family volunteers delivering evidence-based packages of care after appropriate training is a feasible system that can help reduce the treatment gap for childhood intellectual and developmental disorders in under-served populations.

References

    1. Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar AS. et al.Grand challenges in global mental health. Nature. 2011;475(7354):27–30. doi: 10.1038/475027a.
    1. Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet. 2007;370(9590):878–89. doi: 10.1016/S0140-6736(07)61239-2.
    1. Yaqoob M, Bashir A, Tareen K, Gustavson KH, Nazir R, Jalil F. et al.Severe mental retardation in 2 to 24-month-old children in Lahore, Pakistan: a prospective cohort study. Acta Paediatr. 1995;84(3):267–72. doi: 10.1111/j.1651-2227.1995.tb13627.x.
    1. Durkin MS, Hasan ZM, Hasan KZ. Prevalence and correlates of mental retardation among children in Karachi Pakistan. Am J Epidemiol. 1998;147(3):281–8. doi: 10.1093/oxfordjournals.aje.a009448.
    1. Bashir A, Yaqoob M, Ferngren H, Gustavson KH, Rydelius PA, Ansari T. et al.Prevalence and associated impairments of mild mental retardation in six- to ten-year old children in Pakistan: a prospective study. Acta Paediatr. 2002;91(7):833–7. doi: 10.1111/j.1651-2227.2002.tb03336.x.
    1. Mirza I, Tareen A, Davidson LL, Rahman A. Community management of intellectual disabilities in Pakistan: a mixed methods study. J Intellect Disabil Res. 2009;53(6):559–70. doi: 10.1111/j.1365-2788.2009.01176.x.
    1. Government of Pakistan. Pakistan Economic Survey 2011–2012. Islamabad, Pakistan: Ministry of Finance; 2012.
    1. Robertson J, Emerson E, Hatton C, Yasamy MT. Efficacy of community-based rehabilitation for children with or at significant risk of intellectual disabilities in low- and middle-income countries: a review. J Appl Res Intellect Disabil. 2012;25:143–154. doi: 10.1111/j.1468-3148.2011.00679.x.
    1. Institute of Medicine. Neurological, psychiatric and developmental disorders meeting the challenge in the developing world. Washington, DC: National Academy Press; 2001.
    1. Hartley S, Ojwang P, Baguwemu A, Ddamulira M, Chavuta A. How do carers of disabled children cope? The Ugandan perspective. Care, Health & Development. 2004;31(2):167–180.
    1. Miles M. Children with hydrocephalus and spina bifida in East Africa: Can family and community resources improve the odds? Disabil Soc. 2002;17:6,643–658.
    1. Patel V, Thornicroft G. Packages of care for mental, neurological, and substance use disorders in low- and middle-income countries: PLoS Medicine Series. PLoS Med. 2009;6(10):e1000160. doi: 10.1371/journal.pmed.1000160.
    1. Dua T, Barbui C, Clark N, Fleischmann A, Poznyak V, van OM. et al.Evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries: summary of WHO recommendations. PLoS Med. 2011;8(11):e1001122. doi: 10.1371/journal.pmed.1001122.
    1. Tareen A, Ahmed M, Ahmed I, Sikander S, Tahir K, Hafeez A. et al.Feasibility study of a community-based intervention for mental retardation. Pak Pediatr J. 2008;32(4):200–7.
    1. Haq Z, Iqbal Z, Rahman A. Job stress among community health workers: a multi-method study from Pakistan. Int J Ment Health Syst. 2008;15(2):2–15.
    1. Jaskiewicz W, Tulenko K. Increasing community health worker productivity and effectiveness: a review of the influence of the work environment. Hum Resour Health. 2012;10(1):38. doi: 10.1186/1478-4491-10-38.
    1. Mirza I, Mehmood T, Tareen A, Davidson L, Rahman A. Feasibility study on the use of the ten question screen by lady health workers to detect developmental disabilities in Pakistan. J Pak Psychiatry Soc. 2008;5(2):97–100.
    1. Dennis CL. Peer support within a health care context:a concept analysis. Int J Nurs Stud. 2003;40:321–32.17. doi: 10.1016/S0020-7489(02)00092-5.
    1. Doull M, O’Connor AM, Welch V, Tugwell P, Wells GA. Peer support strategies for improving the health and well-being of individuals with chronic diseases (Protocol). 2005, Issue 3. Art. No.: CD005352. Cochrane Database Syst Rev. 2008.
    1. Davidson L, Chinman MKB, Weingarten R, Stayner D, Tebes JK. Peer support among individuals with severe mental illness: a review of the evidence. Clin Psychol Sci Pract. 1999;6:165–87. doi: 10.1093/clipsy.6.2.165.
    1. Solomon P. Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatr Rehabil J. 2004;4:392–401.
    1. Repper J, Carter T. A review of the literature on peer support in mental health services. J Ment Health. 2011;20:392–411. doi: 10.3109/09638237.2011.583947.
    1. Manandhar DS, Osrin D, Shrestha BP, Mesko N, Morrison J, Tumbahangphe KM. et al.Effect of a participatory intervention with women’s groups on birth outcomes in Nepal: cluster-randomised controlled trial. Lancet. 2004;364(9438):970–9. doi: 10.1016/S0140-6736(04)17021-9.
    1. Tripathy P, Nair N, Barnett S, Mahapatra R, Borghi J, Rath S. et al.Effect of a participatory intervention with women’s groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: a cluster-randomised controlled trial. Lancet. 2010;375(9721):1182–92. doi: 10.1016/S0140-6736(09)62042-0.
    1. Haider R, Ashworth A, Kabir I, Huttly SR. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet. 2000;2000(356):1643–7.
    1. Nankunda J, Tumwine JK, Soltvedt A, Semiyaga N, Ndeezi G, Tylleskar T. Community based peer counsellors for support of exclusive breastfeeding: experiences from rural Uganda. Int Breastfeed J. 2006;1:19. doi: 10.1186/1746-4358-1-19.
    1. Mohmand SK, Gazdar H. Social Structures in Rural Pakistan. Islamabad: Asian Development Bank; 2007.

Source: PubMed

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