Mental Health Intervention Reduces Burnout, Stress in Trauma Social Workers

A new study finds that a mental health intervention for social service workers called Caregivers Journey of Hope can help relieve the stress, trauma and burnout social workers may be experiencing while helping residents heal from a community disaster.

The findings are published in Traumatology: An International Journal.

There’s a significant need for mental health interventions for social service workers, who are at high risk of burnout, chronic stress and emotional distress in disaster recovery, said the study’s co-authors, University of Illinois social work professors Tara Powell and Kate M. Wegmann.

“Since many people in helping professions may be trying to rebuild their own lives while helping traumatized people in the community, providing these workers with the training and tools to practice physical, emotional and social self-care is critical to helping them reduce their own stress and avert burnout,” said Powell, who led the study.

For the study, the researchers looked at the impact that the Caregivers Journey of Hope workshop had on 722 professionals who assisted victims of Superstorm Sandy in New York and New Jersey.

Sandy ravaged the Eastern Seaboard of the U.S., Canada and the Caribbean during October 2012, killing more than 200 people and causing more than $70 billion in damage.

New York and New Jersey were among the hardest-hit places on the U.S. mainland: 87 people died and more than 650,000 homes were damaged or destroyed, according to the study.

Powell co-developed the Caregivers Journey of Hope curriculum while working for Save the Children. The program was designed to bolster the resilience of social workers, teachers and children in New Orleans and reduce emotional distress they experienced as a result of Hurricane Katrina in 2005.

Recovery from disasters often takes years, note the researchers. Working closely with traumatized people and vicariously experiencing their terror and pain can adversely affect the mental health of counselors and social workers.

In turn, this distress can trigger a host of emotional, behavioral, physical and interpersonal problems, negatively affecting caregivers’ job performance and personal lives, according to the study.

Receiving social support can be very important for counselors because the often-confidential nature of their work prevents them from discussing traumatizing or stressful experiences outside the workplace, the researchers wrote.

“The half-day Caregivers Journey of Hope workshop gives front-line care providers an opportunity to process disaster-related stress in a safe, confidential environment, build social support and develop strategies to cope with stressors in the workplace and at home,” Powell said.

“A wealth of research over the past couple of decades has illustrated that higher levels of stress are associated with lower levels of social support.”

Working in small groups, workshop participants share their experiences; explore the types, sources and effects of stress; and develop solutions, such as ways they can build their social support networks. They also talk about strategies for rebuilding their communities and for enhancing individual and community-level recovery.

The researchers tested the intervention with social workers and counselors from 37 agencies in New York and New Jersey after Sandy.

Participants reported significant reductions in their stress levels and showed major improvements on all of the other measures surveyed.

Social service workers who were newest on the job — those with one to four years’ experience — benefited the most, showing the greatest increases in their ability to recognize the signs and effects of stress and in their perceived ability to cope with mentally draining situations.

“This finding is of particular importance, as those with less experience in the social service field are at a higher risk for experiencing various forms of caregiver distress,” Wegmann said. “Research has shown that those who perceive that they can actively cope with stressors or who have higher coping self-efficacy tend to have better health and mental health outcomes.”

Source: University of Illinois at Urbana-Champaign, New Bureau

UK Study: More Support Needed for Young Caregivers of Mentally Ill Parents

In a new U.K. study, published in the journal Advances in Mental Health, researchers from the University of East Anglia (UEA) assert that young caregivers of parents with mental illness should be given more support as they move into adulthood.

The authors argue that services need to be flexible, combining both practical support — such as additional support to the parent as the child caregiver transitions out of the home — as well as emotional support for the young person and the parent to help renegotiate boundaries within their relationship.

The study explored the experiences of young caregivers who grew up with a parent with severe and long-term mental illness, and their understanding of their parent’s illness from childhood to the present day.

The findings reveal five key challenges for young adult carers: education and employment, relationships with partners, becoming a parent, making choices within their lives and maintaining boundaries with parents.

“The term young carer implies that the role stops once the child reaches maturity, but care for parents often continues into adulthood,” said study leader Dr. Kate Blake-Holmes, a lecturer in social work. “However, as young carers reach the age of 18 the acknowledgement and support for their needs falls away in many areas.”

“This study extends our knowledge of young carers’ experiences and support needs during the transition to adulthood and suggests the need for services to support parents so that young adult carers are able to make choices about their own lives.”

“Providing care for a parent is not in itself detrimental to a child; indeed it can be a positive experience, an expression of love and a thing to be proud of. However, it can become damaging if the level of care provided and the role and responsibilities attributed to the child fall far beyond what could reasonably be expected. If the child takes on an adult role beyond their developmental years it can negatively impact their own needs, coping skills and resilience.”

“While some individuals drew strength from their adversity, this study suggests that emerging adulthood may be more complex for young adult carers and they may have ‘grown up fast’ in certain areas while their emotional and psychological growth could have been delayed in others.”

For the study, the researchers interviewed 20 individuals, ages 19 to 54, from across the U.K. who had cared for and/or continue to care for their parents. For all of the participants, the complexities of the parent-child relationship and a sense of responsibility to provide care continued into their adult lives.

One participant had to leave university to care for her mother. Others were not able to follow their desired career due to their caring commitments. Several participants had difficulties forming and maintaining relationships with partners.

For one participant, the fear of becoming ill like her mother was so great that she asked her fiancé to sign a document giving him instructions and permission to leave her and have custody of any children should she show any symptoms.

Some of the participants made an active decision not to have children based on their experiences of parental mental illness, others planned to or had gone on to have children, but worried about the difficulty of balancing their children’s needs with those of their parents.

There are procedures already in place that could help young caregivers, such as the transition assessment, which the Care Act 2014 requires local authorities to conduct for those approaching 18. However, Blake-Holmes said these are rarely carried out.

“We need to push for these assessments to be done and to be having conversations with young people,” said Blake-Holmes.

“Everything points towards the patient, which is understandable, but we also need to include young carers in decision-making and meetings about their parents. They are the ones living with them and responding to crises, yet there is a fear of discussing issues with young carers because services feel it is inappropriate.”

“A lot of these people had really traumatic childhoods, but they still love their parents and their parents love them. Not everyone will have these experiences and this isn’t about saying the children or their parents should have been looked after elsewhere, but things could have been easier for these young carers and as adults it’s still impacting them now.”

“It’s about supporting these children, who are doing an amazing job, giving them the confidence to talk about their needs and ask for help, but also to support them in achieving their own goals.”

While all of the participants in the study spoke of negative experiences, several also spoke of gaining specific skills and strengths as a result. One participant felt her childhood experiences had enabled her to develop a “swiss army knife” of extraordinary skills and abilities that she could use to help others within her career.

Caregivers who felt they were most able to manage their parent’s ill health were those who believed that their relationship with their parent could be fluid, suggesting a level of resilience. They were able to draw close to their parent in times of need without fearing that they would become enmeshed and unable to go back to their own emotional needs, external commitments and aspirations.

This gave them a particular mindset which allowed them to adapt, not only within their relationship with their parent but also when faced with other stresses in their adult life.

In contrast, those who described themselves as fixed in the role of either “rejecting” or “rescuing” appeared most consumed by their parent’s illness and unable to manage the relationships necessary for successful transitions into adulthood.

Source: University of East Anglia

Coping Intervention for Dementia Caregivers Shows Long-Term Benefits for Mental Health

A therapy program designed to teach coping strategies to people who care for family members with dementia has been shown to effectively improve caregivers’ mental health for at least a six-year follow-up, according to a new study at the University College London (UCL).

Caregivers who participated in the program were five times less likely to have clinically significant depression than those who did not have the therapy. The intervention was also shown to be cost-effective in a prior study.

“Taking care of a family member with dementia can be immensely difficult, particularly as their condition deteriorates and they may not appreciate their carer, so close to four in 10 family carers experience depression or anxiety,” said Professor Gill Livingston (UCL Psychiatry), the trial’s principal investigator.

“We now can offer an evidence-based approach to support their mental health in the short- and long-term, which benefits both the carer and the person they’re caring for.”

The START (STrAtegies for RelaTives) program is delivered by psychology graduates, trained and supervised by the research team, instead of qualified clinicians, making it easy to implement in many settings.

Those delivering the therapy worked with caregivers to develop coping strategies, helping them manage their own wellbeing in the long run without needing further therapy sessions. Caregivers received eight sessions, during which there was an emphasis on planning for the future and accessing further support if needed.

A total of 260 family caregivers participated in the trial, most of whom were caring for a family member who had only recently been diagnosed with dementia. Of these, 173 were enrolled in the START program for a two-year period and the other 87 were randomly assigned to a control group that did not receive the intervention.

Six years after receiving START therapy, caregivers had significantly fewer symptoms of depression and anxiety, and the researchers say the therapy program appeared to be both preventative and improve existing mental health.

In addition, patient-related costs were close to three times lower among the families in the START program, which the researchers say is likely due to the caregivers being more able to cope and provide care for their loved one.

The difference of patient-related costs did not reach statistical significance, but the researchers say this is due to the fact that medical costs can be very large and variable. However, their results do strongly suggest the program is not only cost-effective, but could save money for healthcare services.

“We’ve designed our programme to keep costs low, and our results suggest it could actually result in cost savings in the longer term as dementia patients will have fewer costly medical problems if their family carer is healthy and supported,” said Livingston.

The START team has developed manuals to make it easier for any healthcare provider to deliver the intervention, and plans to provide accredited training at UCL in the near future. Alzheimer’s Society are supporting the team to explore different options for getting the intervention further implemented into practice, and provided funding to make cultural adaptations to widen access to minority ethnic groups. The training manuals are also available in Japanese and Spanish, and are currently being translated into Urdu.

“Being a carer can be a grueling job; physically and emotionally demanding, 24 hours a day and often done purely out of love,” said James Pickett, Head of Research at Alzheimer’s Society.

“Unfortunately, depression and anxiety can be an inevitable side effect — with 90% of carers telling us they experience stress and anxiety several times a week. Yet, for the 700,000 carers across the UK, many receive little or no support, despite NICE guidelines recommending that they do.

“This is a major breakthrough. We are absolutely thrilled to see this monumental evidence that START is clinically effective at reducing depression and anxiety in carers, and that the effects can still be seen six years later. This could turn the tide for carers and we would love for it to be available to all people who care for someone with dementia. Alzheimer’s Society is delighted to be supporting the further development and implementation of the START programme so as many people can benefit as possible.”

The findings are published in the British Journal of Psychiatry.

Source: University College London


CBT May Benefit Mental Health of Kids with Long-Term Conditions

A new U.K. analysis finds that cognitive behavioral therapy (CBT) can help improve the mental health of children and young people with long-term physical conditions, including inflammatory bowel disease, chronic pain and epilepsy.

“Children and young people with long-term health conditions face enormous challenges. As well as their physical illness, many of these young people suffer from mental health problems as a consequence of their condition,” said Fiona Lockhart, co-investigator from the Biomedical Research Centre Patient & Public Involvement Group at University College London.

CBT is a type of psychotherapy in which negative thought patterns are challenged in order to treat mood disorders or alter unwanted behavior patterns.

Research has shown that children who struggle with long term health conditions are four times more likely to experience feelings of depression, anxiety and other mental health issues than those who are physically healthy.

“The two things that are needed alongside managing a medical condition like this are something to help the family manage and something to help with the children’s emotional problems that so often go alongside these medical conditions,” said consultant pediatrician Professor Stuart Logan.

The team also found that parenting programs offered some benefit in reducing behavioral problems in children with acquired brain injury and/or cerebral palsy.

Some studies in the review showed that the children valued treatments that addressed a range of needs rather than just their mental health. The opportunity to meet and build a supportive relationship with people who are managing their long term condition was also seen to help some young people by providing them with a sense of hope for the future and skills to manage their physical and mental health.

“As well as looking at whether treatments worked for these children, we also included studies that explored the experiences of people giving and receiving the treatments,” said study author Dr. Liz Shaw from the University of Exeter Medical School in England.

“These studies highlighted the benefits of building good relationships and providing treatments in what feels like a ‘safe space’.”

Throughout the study, the team worked with a group of children and young people who provided a real-world perspective on the issues they face. They were particularly disappointed in the lack of available research and urge researchers to do something about it.

“The mental health of children and young people is important and offering the best response is vital,” said study author Dr. Michael Nunns from the University of Exeter Medical School.

“When we set out to do this research we were hoping to make recommendations about what works to support children and young people with long term conditions who are also having difficulties with their mental health. However, we were disappointed in the lack of good quality evidence available to guide treatment decisions for these children.”

The systematic review is published in the journal Health Technology Assessment.

“The exciting thing about this project is that it provides researchers with a roadmap for what to do next — we need to work sensibly with parents and children to carefully design treatments and test them in a way that helps us understand whether they actually work,” said Logan.

Source: University of Exeter