asgn2 mod480

Assignment 2: Continuing Your Professional Journey

In this module, you have been exploring key issues, including goals for your pursuit of knowledge and how you ultimately want to have a positive impact on the field and those within it. It is now time to consider and refine the goals for your academic journey at Walden University. What are your dreams for your academic work, and in what ways do you most want to impact others?

To Prepare

Reflect on topics in the course that have piqued your interest, and consider topics from this course that you would like to learn more about. Choose a topic about which you feel passionate, and, from the Walden Library, select at least one peer-reviewed article from the last 5 years or a dissertation that complements your interest and fuels your passion. Then, complete the following:

Submit a 2- to 3-page paper that provides the following:

· A summary of your interests/passion and of the article/dissertation you selected (including citations)

· A description of how you will use this information to inform your future work in the field, conduct your research, and help to make your passion productive

· An overview of how your topic can positively impact social change

Cite appropriate references in APA format to substantiate your thinking.

Two articles that’s needed

Fostering Resilience among Couples Coparenting a Young Child with Autism: An Evaluation of Together We Are Stronger.

Images

Authors:

Raffaele Mendez, Linda M. 1 [email protected] Berkman, Karen 2 Lam, Gary Yu Hin 3 Dawkins, Charisse 4

Source:

American Journal of Family Therapy . May/Jun2019, Vol. 47 Issue 3, p165-182. 18p. 3 Charts.

he purpose of this study was to evaluate a 4-week caregiver training program designed to promote resilience among couples raising a child with Autism Spectrum Disorder (ASD). Seven couples with a child between the ages of 3 and 9 completed a group-based training focused on values, communication, coparenting, and managing stress. Pre-post assessment of parenting stress, dyadic satisfaction, coparenting, life satisfaction, and hope showed that although parenting stress did not decrease, significant increases were observed in dyadic cohesion, coparenting, and hope. Implications for the development of couple-focused interventions to promote resilience among parents raising a child with ASD are discussed.

Keywords: Marital satisfaction; multi-family training; parenting stress; parent training; special needs

As the number of children diagnosed with an Autism Spectrum Disorder (ASD) has continued to rise and research has begun to explore the impact of ASD on families, it has become increasingly clear that there is a strong need for interventions to support caregivers of children with ASD. Recent research suggests that caregivers experience exceptionally high levels of stress, frequently resulting in the development of mental health disorders such as depression and anxiety (Hayes & Watson, [19]). Broader issues for caregivers also may include strained marital relationships, estrangement from extended family and friends, and concern regarding the ramifications of family dynamics for the child's sibling(s) (Karst & Van Hecke, [22]; Myers, Mackintosh, & Goin-Kochel, [26]). Some caregivers successfully navigate these challenges by coming together and supporting each other, demonstrating resilience despite difficulty (Raffaele Mendez, Loker, Fefer, Wolgemuth, & Mann, [30]) while others struggle with adapting to the demands of raising a child with ASD and experience ongoing frustration and pain (Raffaele Mendez et al., [30]). In this study, we developed and tested an intervention for caregivers designed to promote resilience among couples raising a child with ASD. The goal of the intervention was to increase positive caregiver adaptation by improving relationships among couples who were coparenting a child with ASD together.

Well-Being among caregivers raising youth with ASD

Approximately 1 in 68 children in the United States has ASD (CDC; Christensen et al., [ 8]), up from 1 in 152 in 2002 (Rice et al., [32]). Increasing prevalence rates mean that not only are more individuals impacted by ASD, but more families are impacted as well. ASD is a complex, potentially lifelong disorder that typically requires high levels of family support to achieve successful outcomes (Karst & Van Hecke, [22]). Parents of youth with ASD who are emotionally healthy and available to their children are better able to support their children's complex needs compared to those who are experiencing significant emotional distress (Osborne, McHugh, Saunders, & Reed, [28]). As such, understanding the challenges and needs of caregivers raising youth with ASD and how to best support them is important not only to parent well-being but also to child well-being, including the well-being of youth with ASD and their siblings.

Challenges of raising a child with ASD

ASD has been described as one of the most challenging disorders of childhood in terms of its impact on families (Bonis, [ 5]; Karst & Van Hecke, [22]). Challenges for parents often begin relatively early in the child's life. Parents of young children who are not yet diagnosed often report confusion regarding the source of their child's atypical behaviors (e.g. head banging, delayed verbal skills) and concern regarding the "wait and see" messages sometimes given to them by healthcare providers (Raffaele Mendez & Hess, [31]). Once the child is diagnosed, many parents report experiencing tremendous shock and grief (Nissenbaum, Tollefson, & Reese, [27]), often accompanied by considerable relationship strain among coparenting partners (Hock, Timm, & Ramisch, [20]; Raffaele Mendez et al., [30]). Following diagnosis, parents report navigating the maze of treatment options and forward planning (Keenan, Dillenburger, Doherty, Byrne, & Gallagher, [24]), including finding the best services for their child, fitting services into their schedules, and coordinating and paying for services (Raffaele Mendez & Hess, [31]; Worcester, Nesman, Raffaele Mendez, & Keller, [39]).

Parental stress

Research to date also has demonstrated that raising a child with ASD has significant implications for parents' mental and physical health (Bonis, [ 5]; Karst & Van Hecke, [22]). In particular, high levels of stress have been found among mothers raising children with ASD (e.g. Phetrasuwan & Miles, [29]) as well as among parents of children with ASD in general (e.g. Moes, Koegel, Schreibman, & Loos, [25]). Higher levels of stress and mental health concerns (i.e. depression, anxiety) have been found in families with a child with ASD compared to parents of typically developing children and children with other disabilities (e.g. Estes et al., [11]). Although several studies have found that mothers of children with ASD have more stress and other negative outcomes than fathers (e.g. Hastings, [17]), other studies have found no significant differences between maternal and paternal mental health (e.g. Hastings & Brown, [18]).

Family functioning

From a family systems perspective, it is important to consider the health of dyadic relationships within families as well as the functioning of the family as whole. One means for comparing the health of dyadic relationships within different subsets of the population is through examining rates of divorce. In one survey of 391 families raising a child with ASD in Wisconsin and Massachusetts, divorce was found to be more common among couples raising a child with ASD than in couples with typically developing children (23.5% vs. 13.8%; Hartley et al., [16]). Moreover, Hartley et al. ([16]) found that divorce rates among couples raising a child with ASD remained high throughout their children's adolescent and early adult years when divorce rates for families with typically developing children often decrease. A recent review of dyadic satisfaction found that parents of children with ASD generally have similar or lower marital satisfaction than parents of children with other disabilities (Saini et al., [33]). Notably, the quality of dyadic relationships and coparenting is likely to influence family coping and functioning more than parents' marital status per se (Saini et al., [33]).

Promoting resilience among families raising a child with ASD

Given the high stress levels among parents reported in the literature, research has begun to investigate how to promote resilience among this population of families. One line of research is focused on how child-centered interventions improve parent well-being. The premise behind this line of research is that if the parents learn skills to better manage their child's challenging behaviors, their own well-being will improve. A second line of research is focused on psychoeducation for families of youth with ASD. For example, Smith, Greenberg, and Mailick ([36]) piloted a program for families of youth with ASD transitioning out of high school (i.e. Transitioning Together) to provide psychoeducation about common challenges and supports for youth with ASD during this developmental period. A third line of research is focused on how interventions delivered directly to caregivers to address their own needs help to foster resilience. This is the focus of the current study. The premise underlying parent-focused interventions is that raising a child with ASD is challenging, and in addition to responding to the child's needs, caregivers need to be able to take care of themselves and their other children. Moreover, in situations where two caregivers are working together to raise a child with ASD, there is the potential for caregivers to support each other to benefit themselves and their families.

Parent-focused interventions for families raising a child with ASD

Despite well-documented mental health concerns among parents of children with ASD, there have been few parent-focused intervention efforts described in the literature. Below we describe a few notable exceptions.

In one of the earliest studies in this area, Shu and Lung ([35]) used a 10-week support group to strengthen the social support network of mothers of children with ASD. The treatment involved active discussion and interaction related to raising a child with ASD, including caring for children, interpersonal relationships, coping strategies, caring for oneself and family, social and community resources, and perspective-taking. Significant post-treatment differences were not found in psychological well-being or quality of life between the treatment and control groups, but they noted that their small sample size (N = 8 in the treatment group) may have limited their ability to detect significant differences.

Another study by Blackledge and Hayes ([ 3]) involved a parent-focused training using Acceptance and Commitment Therapy (ACT) techniques to alleviate distress in a non-symptomatic sample of parents of children with ASD. Twenty parents received a two-day workshop with a total of 14 hours of instruction, group activities, and experiential exercises. At the end of the intervention, participants showed significant improvements in general psychological distress and depressive symptoms. These gains remained at 3-month follow-up.

Keen, Couzens, Muspratt, and Rodger ([23]) examined whether a professionally supported parent-focused intervention or a self-directed intervention was more effective at reducing parental stress and increasing parental competence for families with children between the ages of two and four with a recent diagnosis of ASD. The professionally supported intervention was found to be more effective in reducing parenting stress and increasing parental self-efficacy than the self-directed intervention, highlighting the importance of providing individualized support to parents around the time of initial diagnosis.

A more recent study by Chiang ([ 7]) involved a 10-week parent education program focused on parental stress, confidence, and quality of life among parents of children with ASD. Parents attended two-hour sessions consisting of lectures, group discussions, role plays, and sharing on topics such as understanding ASD, the education system, communication skills, behavior, functional skills, and opportunities for children with ASD. Significant pre-post improvements were found in parental stress, quality of life in the physical health and environment domains, and parental confidence.

Overall, the parent-focused interventions that have appeared in the literature demonstrate that individual and group interventions designed to improve parent mental health hold considerable promise for promoting resilience among parents raising children with ASD. Nonetheless, most have examined outcomes for parents as individuals. Our goal in the current study was to expand the literature by examining whether a couples-focused intervention could improve both individual well-being and the couple relationship.

Research questions

· Does participation in a 4-week group-based resiliency program improve the individual well-being and/or couple functioning of parents of young children with ASD?

· How satisfied are participants with the program? How do they perceive the content and delivery of the training?

Method

Setting

This study took place in a southeastern state at one of seven regional university centers serving individuals with ASD and related disabilities. The Center for Autism and Related Disorders (CARD), funded by the Department of Education, provides services to over 5,000 families, schools, and businesses, including individual home-based consultation, research and resource distribution, connecting families to community supports, and assistance with implementing ideas from trainings.

Intervention

Together We Are Stronger is a revision of a previously developed resiliency intervention for couples raising a child with ASD called  Family  Unification through Empowerment and Learning (FUEL). FUEL was developed by a team consisting of the Executive Director of CARD (the second author) and five CARD consultants. Working from the literature on family resiliency and their own extensive experiences providing services to families and children, the FUEL development team selected six topics on which to focus the curriculum: Family history and values, communication, unity, optimism, self-esteem and humor, and resiliency and commitment. The goal of FUEL was to promote supportive relationships among couples raising a young child with ASD.

Together We Are Stronger is a revised, shorter version of FUEL. At the time of the revision, a faculty member in School Psychology with a specific interest in coparenting (the first author) joined the team. To develop Together We Are Stronger, each module of the FUEL curriculum was systematically reviewed by the research team, and information was pared down to include only what the team perceived as most critical. Additionally, a new module on coparenting was added to help families understand this construct and its importance in raising a child with ASD. The team also created new activities for each session to promote active participation in the training.

The final Together We Are Stronger curriculum included four sessions (each 3 hours in length) that aimed to promote resilience in couples raising a child with ASD through clarifying each family's mission and goals; improving communication among parenting partners; increasing coparenting skills; and coping more effectively with stress through humor, optimism, and working together. Table 1 provides the title of each session, session goals, examples of content and activities, and the homework that was assigned each week.

Table 1. Together we are stronger curriculum session content.

Session	Title of Session	Session Goals	Examples of Content and Activities	Homework
1	Past, Present, and Future: Family History and Values	Help families get to know each other Clarify each family's values, how they are tied to their history, and which values they want to pass on to their children Discuss how families are working to pass on important values to their children (including adaptations made because of children's special needs) Redefining the dream	1. Opening icebreaker: Introduce your partner and tell us one positive thing about your partner and something unique about your partner that you respect. 2. Create a family time capsule: What top 3 values would you like to leave behind that would help future family members you will never meet stay connected to you?	1. Create a family mission statement
2	Talking it Out: Communication	To make communication more efficient and less painful by giving parents tools that will: Increase the chance that their message will be heard Decrease the chance that their message will be misunderstood Promote more effective teamwork	Confirmation and discomfirmation in couple relationships Using" I" statements to communicate personal needs The importance of parent "check in" time (10–20 mins per day with no distractions; set children up with an activity beforehand)	Engage in check-in time for parents daily
3	There for Each Other: Working Together	Teach parents about the construct of coparenting Help parents see how working together as a team can reduce their overall stress levels Get parents talking about what they need from each other	Feinberg's (2003) four dimensions of coparenting Common sources of stress among parents of children with ASD How partners can help to reduce each other's stress	Parents help each other manage stress by doing one thing requested by their partner (written on fridge magnet during session and placed on fridge at home)
4	Don't Let Stress Get the Best of You: Optimism and Humor	To give parents cognitive tools for increasing optimism. To help parents recognize the role of humor in managing stress.	How self-talk is related to feelings and behavior Optimistic vs. pessimistic thinking Using humor and perspective-taking to enhance mental health	Notice your thinking this week. Is it optimistic or pessimistic? During check-in time, talk to your partner about how you might improve your perspective and ask your partner for ways to do that.

Participants

Participants were seven married couples raising a child with ASD. Three identified as Caucasian; two as Hispanic; one as African American; and one as Hispanic (mother) and Caucasian (father). Participants ranged in age from 25 to 47 years, with the majority of participants in their 30's. All families had 2 to 4 children, including the child with ASD. One family had two children with ASD. All participants had completed at least some college, with four participants reporting a college degree and two reporting a postgraduate degree. All participants reported a relationship length of 5 years or more.

Measures

Demographics

A 12-item demographics questionnaire created for this study was administered to gather background information about participants. Items on the measure inquired about parental age, education level, marital status, length of relationship, number of other adults in the home, race/ethnicity, total household income, names and ages of children living in the home, occupation, and number of hours worked outside of the home each week.

Marital satisfaction

The Dyadic Adjustment Scale (DAS; Spanier, [38]) was used to assess dyadic adjustment. The DAS is a 32-item self-report measure with four subscales: (a) Dyadic Consensus (agreement with partner; 10 items; score range from 0 to 24), (b) Dyadic Satisfaction (satisfaction with partner; 13 items; score range from 0–50), (c) Dyadic Cohesion (participation in activities with partner; 5 items; score range of 0 to 65), and (d) Affectional Expression (agreement with partner regarding emotional expression; 4 items; score range of 0–12). A total score (score range of 0–150) consisting of the four subscales combined provides a measure of overall dyadic adjustment. Higher scores are indicative of better dyadic adjustment. Spanier ([38]) classified individuals with scores below 101 as relationally distressed and those with scores of 102 of higher as relationally nondistressed. Criterion-related validity was demonstrated by Spanier through analysis of mean scores of 218 married individuals and 94 divorced individuals. On each of the 32 items, married individuals' mean scores were significantly higher (p<.001) than those of divorced individuals. Similarly, the total score among married individuals (M = 114.8) was significantly higher than that of divorced individuals (M = 70.7; p<.001). A more recent study of couples in therapy showed that the mean score of individuals who stayed married (M = 96.5) was significantly higher than that of those who chose to divorce (M = 84.49; p=.0001). The DAS has been found to have strong internal consistency as well, with coefficient alphas ranging from.95 for the total score and.70 for Affectional Expression (Carey, Spector, Lantinga, & Krauss, [ 6]).

Coparenting quality

Coparenting quality was measured with the Coparenting Relationship Scale (CRS; Feinberg, Brown, & Kan, [14]), a self-report measure of coparenting quality. The CRS includes seven subscales (35 items total). We omitted one (Division of Labor; 2 items) because of low reliability. As such, our measure included 33 items across six subscales: (  1 ) Coparenting Agreement (4 items measuring the degree to which partners agree on parenting decisions), (  2 ) Coparenting Closeness (5 items measuring the degree to which coparenting has strengthened the couple's relationship), (  3 ) Exposure to Conflict (5 items measuring the degree to which parents expose their children to couple conflict), (  4 ) Coparenting Support (6 items measuring perceptions of the degree to a parent feels supported by his/her partner in parenting), (  5 ) Coparenting Undermining (6 items measuring perceptions of the degree to which a parent feels undermined or not supported by his/her partner in parenting) and (  6 ) Endorse Partner Parenting (7 items measuring perceptions of the degree to which a parent believes that his/her partner is a good parent). All items are rated on a Likert-type scale ranging from 0 (Not at all true of us) to 6 (Very true of us). Scores from all items are summed and then divided by the number of items to calculate a mean score (for the total as well as for each subscale). Higher scores indicate greater coparenting agreement. Feinberg, Brown, & Kan ([14]) reported strong internal consistency for the CRS, with coefficient alphas above.90 for the Coparenting Total Score and in the range of.66 to.90 for the six subscales used in this study. They also demonstrated concurrent and discriminant validity through moderate to high correlations with other measures of couple relationships and low correlations with a measure of social desirability. In their study of 169 couples of young children (mean age = 36.8 months), they reported total mean CRS scores of 4.83 (raw score of 169.05) for mothers and 4.77 (raw score of 166.95) for fathers.

Life satisfaction

Life satisfaction was measured with the Satisfaction with Life Scale (Diener, Emmons, Larsen, & Griffin, [ 9]), a 5-item scale assessing self-perceptions of global quality of life. Items are rated on a 7-point Likert-type scale ranging from Strongly Disagree (  1 ) to Strongly Agree (  7 ). Higher scores are indicative of greater life satisfaction. A score of 20 is the neutral point where a person is equally satisfied and dissatisfied. Scores are classified as follows: 5–9 = Extremely Dissatisfied, 10–14 = Dissatisfied, 15–19 = Slightly Dissatisfied, 20–24 = Slightly Satisfied, 25–29 = Satisfied, and 30–35 = Extremely Satisfied. Diener, Sandvik, and Pavot ([10]) reported that across various samples of adults, average scores typically fall in the range from 23 (Slightly Satisfied) to 28 (Satisfied). Diener et al. ([ 9]) reported internal consistency of ɑ=.87 and test-retest reliability of ɑ=.82, although the measure also has been shown to be sensitive to changes in life satisfaction based on both positive and negative events in an individual's life. Convergent validity has been demonstrated by significant negative correlations with measures of distress, including the Beck Depression Inventory (r=–0.72, p<.0001: Blais, Vallerand, Pelletier, & Brière, [ 4]).

Parenting stress

Parenting stress was measured using the Parental Stress Scale (PSS; Berry & Jones, [ 2]). The PSS is a self-report measure of parenting stress that includes 18 items (10 items focused on negative aspects of parenting and 8 focused on positive aspects) on a Likert-type scale ranging from Strongly Disagree (  1 ) to Strongly Agree (  5 ). Scores range from 18 to 90 with higher scores being indicative of higher parenting stress. Berry and Jones reported mean scores of M = 43.2 (SD = 9.1) among mothers of children with emotional or behavioral problems receiving services in school or through an outpatient facility vs. M = 37.1 (SD = 8.1) among demographically matched mothers raising children with typical development. These authors also reported high internal consistency (ɑ=.83) and test-retest reliability (ɑ=.81) over a 6-week period. In terms of validity, Berry and Jones reported a correlation of r=.75 between the PSS and the Parenting Stress Index (Abidin, [ 1]). They also found that mothers of children with developmental disabilities had significantly higher PSS scores than those raising typically developing children [t (161) = 2.03, p<.05].

Hope

Hope was measured using the Adult Hope Scale (Snyder et al., [37]), a 12-item self-report measure of level of hope. The measure includes two subscales: Hope Agency (4 items measuring goal-directed energy) and Hope Pathways (4 items measuring the sense that different routes can be used to achieve a goal). The additional 4 items are fillers. Item responses are on an 8-point Likert-type scale ranging from Definitely False (  1 ) to Definitely True (  8 ). Scores range from 12 to 96, with higher scores indicating higher levels of hope. The AHS has been used in many studies, including a number of studies of parents of young with special needs. A recent study by Neff and Faso ([12]) found a mean AHS score of 52.92 among parents of children with ASD aged 4–12. Snyder et al. ([37]) reported the AHS to have good internal consistency (α =.74 to.84) and test- retest reliability (.73 to.85 over 3–10 weeks). Gibb ([15]) also demonstrated that the AHS has strong convergent validity through a correlation of.60 with the Life Orientation Scale (Scheier & Carver, [34]), a measure of dispositional optimism.

Final evaluation

A 16-item final evaluation of training measure was developed by the first author for the purposes of this study. Participants rated each item on a 5-point Likert-type scale ranging from Strongly Agree (  5 ) to Strongly Disagree (  1 ). All items on the final evaluation are shown in Table 3. The measure also included an open-ended question where parents could provide general feedback about the training.

Procedure

Participants were recruited through an e-mail blast that was sent to all families registered with CARD-USF who had a child with ASD between the ages of 3 and 9. Parents who were interested in the study contacted the first author, who explained the study to the parent and confirmed that inclusion criteria were met (i.e. child was between 3 and 9; parent was coparenting the child with another individual; the family lived within one hour of the training site). The intervention was delivered on four consecutive Saturday mornings from 9AM to 12PM in a classroom close to the CARD office. Childcare (including for siblings) was provided in an adjacent building by CARD staff and School Psychology students who were trained in working with youth with ASD. The intervention was delivered through PowerPoint slides with accompanying lecture (with video clips embedded to illustrate concepts); large group discussion; discussion among individual couples (with subsequent group sharing); and couple skills practice. The majority of the training was provided by the first author and one of the CARD consultants who developed the original FUEL intervention. Pre-intervention measures were completed during the first 45 minutes of the first session; post-intervention measures were completed during the final 45 minutes of the last session. Couples sat apart from each other to complete the measures at both time points.

Data analysis

Non-parametric analyses were used in this study due to the small sample size and non-normal distribution of the data. Pre-post treatment scores were compared using the Wilcoxon Signed Rank Test. We used.10 as our significance level because the low number of participants in our study provided us with lower than optimal power, and a slightly higher significance level increased our chances of detecting significant differences if they occurred.

Results

Table 2 shows the means for all pre- and post-treatment scores on the quantitative measures used in the study. Results for each measure also are described in the paragraphs below, followed by parents' ratings on the final evaluation.

Table 2. Pre-post intervention scores on all dependent variables using the Wilcoxon signed-rank test (N = 14).

	Pre-Intervention	Post-Intervention
Measure/Scale	Median	Range	Median	Range	Z	p	r
Total Dyadic Adjustment	119	87 – 129	123	97 – 131	1.721	.085*	0.477
Dyadic Consensus	50	32 – 60	51	34 – 60	0.351	.726	0.097
Dyadic Satisfaction	39	28 – 47	40	35 – 45	1.132	.258	0.314
Dyadic Cohesion	18	13 – 20	19	15 – 22	2.022	.043**	0.561
Affectional Expression	11	6 – 14	12	5 – 14	1.724	.085*	0.478
Total Coparenting	155	89 – 190	164	109 – 186	1.712	.087*	0.475
Coparenting Agreement	20	11 – 24	22	10 – 24	0.994	.320	0.276
Coparenting Closeness	21	11 – 30	27	9 – 30	1.829	.067*	0.507
Coparenting Conflict	10	0 – 19	6	0 – 25	0.945	.345	0.262
Coparenting Support	30	6 – 36	32	14 – 36	1.364	.173	0.378
Coparenting Undermining	2	0 – 24	3	0 – 18	0.491	.624	0.136
Coparenting Endorsement	36	24 – 42	38	25 – 42	1.011	.312	0.280
Satisfaction With Life	23	15 – 35	25	11 – 32	1.124	.261	0.312
Parenting Stress	45	26 – 61	41	23 – 66	0.746	.455	0.207
Total Hope	54	40 – 59	56	45 – 62	1.611	.097*	0.447
Hope Agency	28	17 – 30	27	19 – 31	1.234	.217	0.342
Hope Pathways	27	21–30	28	19–32	1.671	.095*	0.463

1 *p <.10, **p <.05.

Dyadic satisfaction

Comparisons of the pre-post scores on the DAS showed a significant increase in Total Dyadic Adjustment from pre-intervention (median = 119) to post-intervention (median = 123) (Wilcoxon Z = 1.721, p =.085). Analyses of subscales within the DAS showed significant increases in Dyadic Cohesion from pre-intervention (median = 18) to post-intervention (median = 19) (Wilcoxon Z = 2.022, p =.043) and in Affectional Expression from pre-intervention (median = 11) to post-intervention (median = 12) (Wilcoxon Z = 1.724, p =.085). No statistically significant differences were found in pre-post measures on the Dyadic Consensus and Dyadic Satisfaction subscales.

Coparenting quality

On the CRS, the total score showed a significant increase from pre-intervention (median = 155) to post-intervention (median = 164) (Wilcoxon Z = 1.712, p =.087). Additionally, the subscale measuring coparenting closeness showed a significant increase from pre-intervention (median = 21) to post-intervention (median = 27) (Wilcoxon Z = 1.829, p =.067). No significant differences were found in pre-post measures on the Coparenting Agreement, Exposure to Conflict, Coparenting Support, Coparenting Undermining, and Coparenting Endorsement subscales.

Life satisfaction

On the Satisfaction with Life Scale, participants' life satisfaction did not show significant changes from pre-intervention (median = 23) to post-intervention (median = 25) (Wilcoxon Z = 1.124, p =.261).

Parenting stress

On the Parenting Stress Scale participants' scores did not show significant change from pre- (median = 45) to post-intervention (median = 41) (Wilcoxon Z = 0.746, p =.455).

Hope

On the Adult Hope Scale, the total score showed a significant increase from pre-intervention (median = 54) to post-intervention (median = 56) (Wilcoxon Z = 1.611, p =.097). Pre-intervention (median = 28) to post-intervention (median = 27) scores were not significantly different on the Hope Agency subscale (Wilcoxon Z = 1.234, p=.217). In contrast, the Hope Pathways subscale showed a significant increase from pre-intervention (median = 27) to post-intervention (median = 28) (Wilcoxon Z = 1.671, p =.095).

Parent satisfaction

Mean scores from the final evaluation are shown in Table 3. Consistent with the findings of the standardized measures, they indicated that the intervention had a greater positive impact on their coparenting and hope than on parenting stress. With regard to focus of training and logistics, responses showed that although couples indicated that they would have liked to have more time to talk with each other, they did not want to get to the training venue earlier to do so nor did they necessarily want to have less PPT slides in order to make more time for connection. In terms of the focus of the training, participants were neutral on integrating more information on how to help their children. Some indicated in qualitative comments that they understood the purpose of the training when they registered, and although they were always interested in new ways to help their child, they appreciated the opportunity to focus on themselves.

Table 3. Mean scores for final evaluation of training (N = 14).

Item	M
Satisfaction with/Perception of Training
This training met my expectations.	4.30
This training has had a positive impact on my coparenting relationship.	4.38
This training has reduced my stress levels.	3.84
This training has helped me feel more optimistic about the future.	4.38
I would recommend this training to a friend.	4.57
Purpose and Format of Training
I would have preferred less PPT slides and more opportunities for group discussion.	3.38
I enjoyed bringing food to share with the group.	3.91
I would have liked to have had more time to talk with the other couples.	4.41
I would have liked to have a half hour breakfast before the training began each week to network with the other couples.	3.00
I wish the training had been offered for more weeks (e.g. 6–8 rather than 4).	3.69
I wish we had covered more information on new and/or alternative treatments for autism.	3.84
I wish we had started later in the morning because it was difficult to get here on time.	2.00
I felt comfortable talking and sharing with the group.	4.38
I wish we had talked more about ways to manage my child's behavior.	3.61
I wish we had talked more about ways to help my child with communication.	3.61
I would not have been able to participate in this training without the child care offered.	3.38

2 Note: 1 = Strongly Disagree; 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly Agree.

Discussion

We began this work with a desire to promote resilience among couples raising young children with ASD. Toward this end, we delivered a training curriculum titled Together We Are Stronger across four Saturdays within one month. Pre-post comparisons of standardized measures showed that participants reported significantly greater dyadic satisfaction, coparenting quality, and hope following the intervention. In contrast, life satisfaction and parenting stress did not show significant changes. A final evaluation completed by all parents at the last session showed that the intervention had high treatment acceptability.

Promoting resilience through improving couple relationships

Overall, our results suggest that Together We Are Stronger holds promise for promoting resilience in families raising young children with ASD. The finding of improved couple relationships is particularly important given that previous studies have focused almost exclusively on individual well-being. The focus of our training was on how couples can work together to support each other. As such, during the 4-week training, couples created a shared family mission statement, practiced effective couple communication strategies, became familiar with research on coparenting, and learned how to use humor and optimism to combat stress. At post-test, both measures of relationship included in our study (i.e. dyadic satisfaction and coparenting quality) showed significant increases, suggesting that participants perceived that their marital relationships and skills in working together as parents had improved. In particular, examination of subscales on the measures of dyadic adjustment and coparenting quality showed that coparenting closeness, dyadic cohesion, and affectional expression (all of which showed medium effect sizes) seemed to account for the significant changes in total scores. This suggests that participants increased their connection to their partners during the training.

We found it interesting that although positive indicators of the couple relationship increased, parenting stress did not show a significant decrease. This pattern is similar to the findings of Smith, Greenberg, and Mailick ([36]) who found that while parents receiving their intervention (i.e. Transitioning Together) did not show a significant decrease in parenting stress, they did report an increase in their support systems and greater parental warmth toward their child. As noted by Johnson, Frenn, Feetham, & Simpson, ([21]), increasing protective factors (e.g. a supportive social network) may help to mitigate negative outcomes even if risk factors like parenting stress remain high.

Format of training

To date, most of the parent-focused interventions for families raising a child with ASD have been offered in group settings, which is how our intervention was delivered. A notable exception is the Keen et al. ([23]) study in which the intervention was provided individually to families in their homes. The positive outcomes observed in that study suggest that in-home intervention for families of young children with ASD is desirable. Nonetheless, one of the lessons learned in our study is that our couples really seemed to enjoy meeting each other, which is only possible in a group-based intervention. In our study, we noted that the opportunities to share information, ideas, and resources with other families seemed to be very important to our participants. At the end of the training, parents asked for contact information for everyone in the group and talked about inviting each other to their children's birthday parties. Our impression was that the opportunity to interact with others who understood what they were experiencing was very meaningful. It may even be the case that this opportunity for connection was part of the "active ingredient" that resulted some of the positive changes we observed (e.g. an increase in hope).

Implications for family therapy/practice

Our findings have three primary implications for family therapy/practice. First, training focused on improving couple relationships among couples raising young children with ASD appears promising in promoting positive outcomes both individually and in the relationship even if the couple's overall parenting stress is not reduced. This suggests that creating opportunities for couples to work together on activities such as conceptualizing family goals and enhancing communication may help to buffer negative outcomes for couples even when stress cannot be substantially reduced. Second, our findings suggest the positive impact of multi-family groups for couples raising young children with ASD. Our observations and feedback from families indicated that the opportunity to get to know other families experiencing similar situations was helpful both in gathering first-hand information about various schools, treatments, and local services as well as offering connection to others who could empathize and offer family opportunities for socialization. Finally, at a broader level, our findings suggest that rather than focusing solely on intervention for youth with ASD, family therapists should keep in mind the need to promote well-being among parents and caregivers, too. The families in our study were grateful for the opportunity to spend time with each other focusing on how to work together to improve family life for themselves and their children. Promoting the well-being of the families who have children with ASD should include consideration of all members of the family rather than focusing solely on the child.

Limitations and directions for future research

Although our findings are promising, the small sample size in this study meant that we had limited power to detect changes from pretest to post-test even if they were present. We attempted to recruit a larger sample by casting a wide net to recruit parents to participate, but the challenges faced by parents raising a child with ASD often put limitations on energy and time, making it difficult to recruit large samples without funding. Replication of this study with a larger sample is needed to further test the efficacy and effectiveness of the curriculum. Another methodological issue that will need to be addressed in future research is the lack of a control or comparison group. Because we only studied parents receiving the intervention, we cannot be sure that the pre-post changes were necessarily due to the intervention. A more rigorous design would permit greater decisiveness about the source of the changes observed. Finally, it is important to know if the changes observed endured over time. A replication that allows for post-test follow-up (at 6 months, for example) would help to determine if Together We Are Stronger produces lasting changes among participants.

References

1  Abidin, R. R. (1986). Parenting stress index manual, 2nd ed. Charlottesville, VA : Pediatric Psychology Press.

2  Berry, J. O., & Jones, W. H. (1995). The parental stress scale: Initial psychometric evidence. Journal of Social and Personal Relationships, 12, 463 – 472.

3  Blackledge, J. T., & Hayes, S. C. (2006). Using acceptance and commitment training in the support of parents of children diagnosed with autism. Child & Family Behavior Therapy, 28, 1 – 18.

4  Blais, M. R., Vallerand, R. J., Pelletier, L. G., & Brière, N. M. (1989). L'échelle de satisfaction de vie: Validation canadienne-française du" Satisfaction with Life Scale". Canadian Journal of Behavioural Science/Revue Canadienne Des Sciences du Comportement, 21 (2), 210 – 223.

5  Bonis, S. (2016). Stress and parents of children with autism: A review of literature. Issues in Mental Health Nursing, 37 (3), 153 – 163.

6  Carey, M. P., Spector, I. P., Lantinga, L. J., & Krauss, D. J. (1993). Reliability of the dyadic adjustment scale. Psychological Assessment, 5 (2), 238 – 240.

7  Chiang, H. M. (2014). A parent education program for parents of Chinese American children with autism spectrum disorders (ASDs): A pilot study. Focus on Autism and Other Developmental Disabilities, 29 (2), 88 – 94.

8  Christensen, D. L., Baio, J., Braun, K. V. N., Bilder, D., Charles, J., Constantino, J. N., ... Yeargin-Allsopp, M. (2016). Prevalence and characteristics of autism spectrum disorder among children aged 8 years – Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. Mmwr. Surveillance Summaries, 65 (30), 1-23.

Emergent literacy and childhood literacy-promoting activities for children in the Ontario Child Welfare System.

Images

Authors:

Moffat, Shaye Vincent, Cynthia

Source:

Vulnerable Children & Youth Studies; Jun2009, Vol. 4 Issue 2, p135-141, 7p, 1 Chart

Publication Year:

2009

611710  Educational Support Services 923110  Administration of Education Programs 611699  All Other Miscellaneous Schools and Instruction

Abstract:

Research has demonstrated that early exposure to literacy is one of the essential foundations for promoting positive outcomes and successful life transitions for children and young people. Academic and social successes within the domain of education are recognized factors in fostering resilience in at-risk populations. Unfortunately, in Canada the potential for differing outcomes exists between children within the general population and those children within the child welfare system, due to the latter's lack of educational and social supports. The purpose of this study was to investigate the frequency of engagements in literacy-promoting activities by children in the child welfare system. Participants were approximately 114 children living in out-of-home care in the province of Ontario, Canada, who were participating in the Ontario Looking After Children project. They were aged between 1 and 4 years, and virtually all the participants had experienced severe adversity while living with their birth families and, as a consequence, were under the custody and care of their local Children's Aid Society. The study incorporated the literacy-promoting activities scales from the National Longitudinal Study of Children and Youth, and explored the relationship between national literacy strategies and childhood development. Findings demonstrated that the in-care population was provided with ample opportunities to engage in literacy-promoting activities, and in fact generally did so more often than children in the general population. Implications for government policy and interventions to promote positive educational outcomes will be discussed. [ABSTRACT FROM AUTHOR]

 

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