Comparative parenting stress measures between segmental and community-based rehabilitation services in parents of children and adolescents with intellectual and developmental disabilities (IDD): A cross-sectional survey

1.Introduction

Parenting stress is a paramount issue for developmental health and social wellness in children with disability across their life span. Parenting stress includes financial stress, psychological stress, social stress, physical stress, and educational stress. A recent survey investigated parenting stress in parents of 818 children aged 8 to 12 years and demonstrated that parents of children with limited communication abilities, cognitive impairment, or pain, were at great risk of stress [1]. Goudie and colleagues examined the parenting stress in children with intellectual and developmental disabilities (IDD) was double when their caregivers had high levels of financial stress, and almost three and half times higher in caregivers with high levels of financial stress. The children’s stress was further compounded by very high levels of psychological stress, higher than in typical developing children [2, 3, 4, 5]. To mitigate such parenting stress associated with financial stress, psychological stress, social stress, physical stress, and educational stress, a segmental rehabilitation service (SRS) has been conventionally accepted as a mainstream health-care model in South Korea. The conventional SRS model tends to emphasize functional and structural impairments and activity limitation domains in individuals with IDD, rather than addressing the entire international classification of function (ICF) spectrum including the participation domain. Hence, based on the ICF conceptual framework, we have developed a community-based rehabilitation service (CRS) model that embraces functional and structural impairments and activity limitations, as well as the participation domain to effectively manage the special needs of individuals with IDD. However, the therapeutic benefits of such a model have never been ascertained. Hence, the aim of the present study was to compare the differential effects of SRS and CRS on financial stress, psychological stress, social stress, physical stress, and educational stress in the parents of children and adolescents with IDD. We hypothesized that CRS would produce a greater reduction in parenting stress and a greater increase in family quality of life than SRS because CRS might provide community-based rehabilitation care for body function and structure impairments and activity limitation as well as social participation for children and adolescents with multiple disabilities.

2.Methods

3.Results

4.Discussion

The present prospective investigation was the first community-based rehabilitation service survey to compare the segmental rehabilitation service model and community-based rehabilitation service model on parenting stress and quality of life. As anticipated, the survey demonstrated that the CRS model produced a greater reduction in social stress than the SRS model, and improved the quality of life in family interaction, child rearing, emotional well-being, and in areas of physical and material well-being.

The CRS model showed a greater reduction (5%) only in the social stress element when compared with the SRS model. This finding was consistent with previous evidence of increased social stress in parents of children with CP [8]. Social stress was primarily derived from the fact that the parents were unable to participate in social interaction due to their children’s physical and cognitive disability. Similarly, Wang et al. investigated the associations between parenting stress, social support, and family quality of life in parents of children with CP as well as the moderating effect of social support on the relationship between parenting stress and family quality of life. As a result, parenting stress was negatively correlated with total social support and quality of life in parents of children with CP due to their multiple disabilities [9]. The social stress of these parents may be associated with a lack of community-based care and assistance in the “conventional” segmental rehabilitation service model. Interestingly, other physical, psychological, financial, and educational stress factors were not different between the CRS model and SRS model. Family quality of life analyses demonstrated superior qualities in child rearing, emotional well-being, and physical and material well-being elements in the CRS model when compared with the SRS model. Certainly, this result supports previous research that the quality of life associated with child rearing, emotional well-being, and physical and material well-being elements, was better in the CRS model than SRS model. This finding was consistent with previous evidence that reported that the higher the parenting stress levels, the lower the family’s quality of life associated with child rearing in parents of disabled children [10]. Rolle and colleagues suggest that emotional well-being is an important element that mediates the relationship between parenting stress and adjustment in a family’s quality of life [11]. In conclusion, the present survey’s findings demonstrated that the CRS model was more conducive for parents of children and adolescents with IDD to mitigate their stress and to improve family quality of life than the SRS model.