An Exploration of Reflective Conversations in Early Intervention Caregiver Coaching Sessions

This descriptive study included a systematic examination of provider and caregiver reflective conversations during caregiver coaching sessions focused on embedded intervention. Transcribed videos from 31 provider–caregiver dyads in two groups (Embedded Practices and Interventions with Caregivers [EPIC] vs. business-as-usual [BAU]) were used for data collection, resulting in a total of 93 transcripts across three different time points. Using methods of directed content analysis, a coding scheme describing various components of shared reflection was developed and used to code transcripts. Coding data were used to explore the rate per minute and relative frequency of types, topics, and spontaneity of reflection. Although there were no statistically significant differences in the frequency and rate of reflective versus nonreflective conversational turns, there were group differences in the reflective topics and specific types of reflective comments and questions posed by participants. Results from this study and others can help the field further define reflection as a coaching strategy and consider the potential utility of different reflective comment and question types to increase caregiver capacity to embed interventions in home routines. Further research is recommended to explicate further definitions and processes for reflection specific to caregiver coaching, including methods used to code reflective conversations and evaluate how reflection impacts caregivers’ intervention implementation.

98 10 year prospective healthcare data on child maltreatment cases assessed at a tertiary care pediatric centre in Canada

Background Child maltreatment is common with a reported prevalence of 32.1%. Physical abuse (PA), sexual abuse (SA), and exposure to intimate partner violence (IPV) are reported by 26%, 10%, and 7.9% of Canadian adults, respectively. While many child maltreatment cases require health evaluation, there is little data on the medical assessment of these cases. The Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2008) reviewed child welfare cases but not data on their medical aspects, despite 5% of substantiated PA cases being sufficiently severe to require need for medical assessment. There is no published data describing the type, breadth, or outcomes of cases seen in the Canadian healthcare system. Objectives 1 - To describe 10 years of institutional data of children and youth seen for concerns of maltreatment. 2- To use this information to provide recommendations for resource allocation and highlight need for services. Design/Methods Secondary data was analyzed using descriptive statistics from a preexisting quality improvement database where information was collected from the CHEO Child and Youth Protection Review Committee (CYP RC) over 10 years (April 2009-April 2019). The project was approved by the CHEO REB. Results There were a total of 2651 cases reviewed at the CYP RC. Fifty-seven percent (n=1658) of child maltreatment cases were substantiated. The most common types of substantiated child maltreatment were caregiver capacity 29% (n=481), emotional abuse 19% (n=321), PA 18% (n=304), neglect 16% (n=259), SA 14% (n=227), sexual assault with CYP concerns 2% (n=36), and abandonment 2% (n=30). For PA, soft tissue injuries (e.g., bruising) and fractures were the most common injuries seen in medical evaluations for maltreatment. The most frequently ordered tests are skeletal survey, coagulation screening blood work, and CT head. In SA, most cases of substantiated sexual abuse cases were intra-familial (75%). Most physical examinations in SA cases were normal (83%). Forty one percent (1100/2651) of cases were alerted in the medical record for child protection purposes. Conclusion Our findings expand our knowledge of the different types of child maltreatment by linking child welfare and medical assessment information. In cases identified and/or assessed by hospital staff for child maltreatment, 54% were substantiated by child welfare and 41% were “alerted” in the electronic medical record (EMR). The most common type of child maltreatment was “concern for caregiver capacity” which highlights the need for parental education and supports.

INCLUDING FAMILY CAREGIVERS IN SERIOUSLY ILL VETERANS' CARE: A MIXED-METHODS STUDY

Family caregivers often serve as unpaid members of the home- and community-based care workforce for individuals with serious illness; as key partners in the home-clinic continuum, they should be included in healthcare teams. Without formal recognition, inconsistent identification of caregivers will remain, engendering communication gaps between caregivers and providers and difficulty connecting with supportive services. The Campaign for Inclusive Care is an initiative within the Veterans Administration Health Care System to improve practices for including caregivers in treatment planning and decisions. We define inclusive care using literature review, provider interviews, and a caregiver survey. We found that inclusive care involves clear definition of caregiver role, system policies for inclusion, assessment of caregiver capacity, explicit involvement of caregivers, and mutuality in caregiver/provider communication. We recommend solutions based on the definition, informative for development of a national caregiver strategy, required by the 2018 Recognize, Assist, Include, Support, and Engage Family Caregivers Act.

Caregivers—Who Copes How?

Within gerontological caregiving research, there is a major emphasis on stresses and burdens of this role. Yet there has been little attention directed toward the coping strategies that caregivers engage in to cope with this role and the factors that influence their adoption of different coping strategies. This article examines coping strategies and change in coping strategy over a 1-year period. In particular the differential importance of caregiver capacity (such as social support, health, and personality) compared with careload (such as hours of caregiving and need of the care recipient) is examined within a path model. Data came from a purposive sample of caregivers experiencing heavy demands. Overall, problem-focused coping is used more often than emotion-focused coping (either positive or negative) or seeking social support, but caregivers use all types simultaneously. Caregiver capacity, specifically neuroticism, is the strongest predictor of problem-focused coping with those high in neuroticism less likely to use this strategy. High neuroticism also predicts less use overall and negative emotion-focused coping strategies. Few significant predictors emerge of change; those that did were caregiver capacity, not careload variables. The use of all coping strategies, except seeking social support which remained stable, decreased over a 1-year period.