Background. Children with autism spectrum disorders have complex needs requiring a broad range of supports. High demand for autism services has led to gaps in the provision of care, and there is little research examining whether families of school-aged children receive services reflective of their needs. Objectives. The objectives of this thesis were to describe unmet needs reported by parents of school-aged children with an autism spectrum disorder and to examine the association between the child’s level of functional independence and the parent’s reported level of unmet need. Methods. A review of the literature on needs assessments in autism was performed. A cross-sectional study was then conducted among parents of 101 children who (1) had an autism spectrum disorder, (2) were between the ages of 6 and 13 years, and (3) were living in Manitoba, South Eastern Ontario, Prince Edward Island, or Newfoundland and Labrador. Data were collected using a written questionnaire (Family Needs Questionnaire, Impact on Family Scale, demographic questions) and a telephone interview (Scales of Independent Behaviour-Revised, service use questions). Log binomial regression was used to examine the association between the child’s functional independence and the parent’s perceived unmet needs. Results. The most commonly reported unmet needs were related to social inclusion for the child, information about special programs and services, and continuity of support. Families of children with high functional independence had lower unmet need compared to families of children with moderate functional independence (RR = 0.81, 95% CI = 0.67-0.99). Families of children with high functional independence, and who perceived a high level of impact of the child’s disability on the family, had greater unmet need (RR = 1.22, 95% CI = 1.03-1.45). Conclusion. This thesis identifies family needs which have not been met by the service system. Assessments of child and family functioning may provide insight into unmet need that is not revealed simply by knowing a child’s diagnosis on the autism spectrum. Information about the unmet needs of families of children with autism spectrum disorders may help policy makers and service planners to develop resources and services that are responsive to their client group. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2010-07-26 11:11:27.456

Background: Intensive care unit (ICU) admission is often life threatening, and may cause severe anxiety within the family system. Anxiety can impair decision-making ability. A majority of ICU patients cannot direct their own treatment; therefore, family members are often required to make major decisions under stressful conditions. Patient and family-centered care (PCFF) has been shown to reduce anxiety, improve decision-making, and improve outcomes for patients and their families. However, no published study has examined outcomes of a comprehensive PFCC program in the ICU. Purpose: The study purposes were to evaluate a comprehensive program to improve PFCC within an adult ICU, and to determine the usefulness of specific PFCC interventions. Methods: An exploratory comparative design was used. Data from ICU patients' family members and ICU nurses, before and after implementation of a PFCC program, were compared using the 30-item combined Critical Care Family Needs Inventory/Needs Met Inventory (CCFNI/NMI). Convenience samples of 49 adult family members of patients admitted to the ICU for at least 36 hours and 85 nurses employed in the ICU full-time for at least six months were recruited from an adult ICU in a 337-bed tertiary care hospital in the southwestern region of the United States. The program was conducted in 3 stages: baseline assessment, program development and implementation, and evaluation. Results: After the PFCC implementation statistically significant differences between nurses' and family members' responses were reported for18 items on the CCFNI and 20 items on the NMI. Five of the10 items family members ranked highest at baseline remained in the top 10 after PFCC implementation, and 3 needs ranked lowest at baseline moved up to the top 10. Conclusions: The results show that the nurses' education was likely the most efficacious program intervention. There may be a hierarchy of needs specific to ICU patients' family members, similar to those described by Maslow. Further study is needed to determine the effectiveness of the CCFNI/NIM in measuring outcomes before and after a PFCC intervention.

There is a great deal of literature in civilian rehabilitation settings that documents the tremendous impact a brain injury has on both the injured person and the family as a whole. TBI is a leading cause of both death and disability world-wide and is often cited as the signature injury of the ongoing OEF/OIF conflict. In 2005, Congress recognized the severity of injuries that military personnel were encountering in the OEF/OIF conflicts and created the Polytrauma System of Care (PSC). While the PSC has made great efforts to provide innovative and effective treatment for active duty and veteran patients, little is known about the needs of their family members. Given the tremendous impact TBI has on families and the important caregiving role assumed by many, there is an urgent need to better understand their needs. The Family Needs Questionnaire (FNQ) was administered to 44 family members of patients at the Polytrauma Rehabilitation Center (PRC) at McGuire Veterans Affairs Medical Center (VAMC) over a 30 month period. Family members rated 40 needs indicating the importance and extent to which needs were met. Results were compared with findings from similar studies in civilian rehabilitation settings. A review of the rated needs indicated that PRC families rated the needs in the Health Information domain as most important and most frequently met. In addition, PRC family members rated Emotional Support and Instrumental Support as least important and most frequently unmet. Overall results were consistent with findings in civilian rehabilitation research, but subtle differences were examined. Exploratory analyses were conducted to examine a subset of family variables associated with needs indices. Needs were rated differently based on respondents', gender, income, relationship to patient, and time since injury. Results highlight similarities across family needs in rehabilitation settings. However, there remains a need for further research within VAMC PRC's that include a larger more diverse sample and participants utilizing both inpatient and outpatient services.

This cross-sectional study examined differences in family needs (informational, social, financial, health, and household support), caregiver mental health (depression, satisfaction with life, vitality, social functioning, and emotional role limitations), and caregiver burden (personal life, guilt, and psychological) among caregivers of individuals with traumatic brain injury, spinal cord injury, multiple sclerosis, and dementia from cities in Colombia and Mexico (N = 343). The study also examined the connections among family needs, caregiver mental health, and caregiver burden in the combined sample of caregivers of individuals with neurological conditions. Many significant differences were identified among groups, and implications are discussed. Family needs, caregiver mental health, and burden were all robustly associated with each other, with financial and social support needs, depression, and burden-personal life and guilt emerging as particularly important. Clinicians should focus on helping caregivers meet financial and social support needs in order to positively influence caregiver burden and mental health.

Health care professionals have begun to view family members as an integral part of the healing process and the well-being of patients in the intensive care unit. The needs of family members may be varied, and nurses must become attuned to the family members' needs and acquire skills to direct interventions toward identifying and meeting those needs. The aim of the research study was to explore and identify the perceptions of family members' needs and to ascertain if those needs were perceived as met or unmet by the family members of patients housed in the intensive care units. The hypothesis proposed that a gap exists between identified needs of family members visiting intensive care patients and their perceptions of needs as being met or unmet. Data analysis included quantitative and qualitative methods.

No description available.

This thesis focuses on service utilisation among children with mild ID and their families, their needs for support and their experiences of support. Aims The overall aim of the thesis was to explore and describe service utilisation patterns among families of children with mild ID from a systems perspective. Methods A cross-sectional, descriptive and comparative quantitative design was used to describe the extent of service utilisation among 84 children with mild ID and their families (paper I and II). The types and number of services utilised were investigated in relation to the child’s age, gender and school setting. Data concerning the services utilised were collected from the organisational records of social services and paediatric habilitation units. In paper III, a descriptive questionnaire design was used to describe the support needs of families of 38 children with mild ID. A confirmatory design was used to examine the relation between family needs for support and (a) parental self-efficacy and (b) parents’ control over services. A confirmatory design was also used to examine the relation between parents’ experiences of the helpfulness of the support and (a) parental self-efficacy and (b) parents’ control over services. In paper IV a longitudinal, comparative and confirmatory design was used to investigate whether social service utilisation patterns differ over time when children with mild ID in self-contained classes are compared with those integrated into mainstream classes (n=405). Results In total, 60% of the families utilised paediatric habilitation services, and 40% of the families used disability-related services provided by social services. The most commonly utilised services were services concerned support outside of the home, such as respite care and services to improve children’s participation in society. Approximately 25% of the families utilised social problems-related services provided by social services. The most commonly utilised services concerned those to support parents in their parenting roles and financial assistance. In contrast to older children, younger children were more likely to utilise paediatric habilitation services. Older children utilised a higher number of disability-related service types provided by social services. Few differences were found between males and females. The majority of families did not utilise such services that are provided by social services. It was rare for families to use both disability-related services and those that address social problems during the same year. Commonly reported family needs concerned information about what services are available for their child, their child's impairment, how to respond to their child's behaviour and how to teach their child skills. Other common needs included access to parent support networks, to find suitable leisure activities for the child, and more alone time for parents. In contrast to families with mothers who did not participate in paid work, families with mothers who were employed expressed a lower requirement for support such as counselling, contact with other parents of children with impairments, more friends and more alone time for parents. Similar results werefound for families with mothers with higher levels of education. Parents with higher levels of perceived self-efficacy reported a lower need for information, as did also parents with higher levels of control over services. Parents with higher levels of control over services experienced the support as being more helpful. Children with mild ID who attended self-contained classes were more likely to utilise paediatric habilitation services than children integrated in mainstream classes. The same pattern was found for utilisation of disability-related services provided by social services. Integrated children who changed school setting to attend self-contained classes were more likely to begin to utilise disability-related services in comparison with those children who continued to be integrated. The former also had a higher likelihood of increasing the number of disability-related service types utilised. Conclusions In addition to disability-related problems, families of children with mild ID may also be at a higher risk of experiencing social problems when compared with the general population. Furthermore, very few families utilised both disability-related services and services addressing social problems. This implies that collaboration flaws exist between those professionals concerned with child welfare services and those concerned with disability-related services. A strong predictor of service utilisation was the type of school setting: children attending self-contained classes had a higher rate of service utilisation than those attending mainstream classes. This indicates that service systems outside of school are designed to collaborate with groups of pupils in special classes rather than individual children in mainstream classes. The strong need for information by families indicates that an ecological framework should be used to identify those factors that affect information availability and effectiveness. To increase parents’ perceived level of control over services, HSO professionals need to work in a capacity building manner with the explicit goal to enhance parental self-efficacy.

Magistro baigiamajame darbe yra nagrinėjamos galimybės sutuoktiniams vedybų sutartimi sureguliuoti, nustatyti ar pakeisti jų atsakomybės pagal turtines prievoles aspektus, atsižvelgiant į Lietuvos teisinio reguliavimo ir teismų praktikos šiuo klausimu specifiką. Darbe apžvelgiami bendrieji sutuoktinių prievolių prieš trečiuosius asmenis atsiradimo pagrindai, sutuoktinių prievolių rūšys taip pat sutuoktinių tarpusavio turtinės teisės ir pareigos, kurios gali būti vedybų sutarties reguliavimo objektu. Pagrindinė darbo linija siejama su teisinio reguliavimo ir teismų praktikos ištyrimu nagrinėjant tarp sutuoktinių ir jų kreditorių kilusius ginčus turtinių prievolių srityje. Magistro baigiamojo darbo temos aktualumą lėmė teisinio reguliavimo neapibrėžtumas, Lietuvos teismų praktikos ir mokslinės literatūros šiais klausimais trūkumas. Nors teismų praktika nagrinėjant sutuoktinių ir jų kreditorių turtinius ginčus paskutiniu metu yra išplėtota, tačiau ši praktika daugiausia remiasi įstatyminiu sutuoktinių atsakomybės reguliavimu, tačiau pavyzdžių, kaip įtakotų vedybų sutartis šių klausimų sprendimą, Lietuvos teisminėje praktikoje beveik nėra. Šio darbo pagrindinis diskusinis aspektas atsiskleidžia per sutarties laisvės principo, kuris yra pamatinė ir vedybų sutarties dalis, bei imperatyvių teisės normų, kurių sutuoktiniai negali pakeisti vedybų sutartimi, konkurenciją bei turinio aiškinimą. Teisminėje praktikoje daugiausiai ginčų kyla tarp sutuoktinių ir jų kreditorių... [toliau žr. visą tekstą] / The main purpose of this paper is to explore the possibilities for the spouses to settle, fix or change some aspects of their liability in marriage contract, considering the mandatory Lithuanian law rules and case law on the subject specifics. The paper gives an overview of the general backgrounds of obligations of spouses in accordance with their creditors, types of obligations of the spouses, as well as liability and obligations between the spouses, which may be the subject of regulation of the marriage contract. The general line of the work is associated with the legal regulation and judicial practice in the context of disputes between the spouses and their creditors in matters relating to liability under the obligations, rising during the marriage. Relevance of this study was determined by uncertain law regulation and lack of Lithuanian case law and literature on these issues. While the case law relating the liability of the spouses in respect of their creditors lately is developed, but there are almost no examples, how marriage contract could influence their liability and obligations in respect of third parties. The main debatable aspect of this paper is revealed through the competition and content interpretation of the principle of freedom of contract, which is also a fundamental part of the marriage contract, and the mandatory rules of law, which the spouses cannot overcome by the marriage contract. In case law most disputes arises between the spouses and their... [to full text]

The critical illness/injury of a family member warranting an admission to an A&E unit can predispose a family to psychological and physiological needs. The patient-centred-care approach rendered in an A&E unit focuses on the patient as a priority, resulting in the family’s needs being neglected during a crisis situation. Based on the Family Resilience Framework, the aim of this study was to assess the needs of the families of the critically ill/injured patients in an A&E unit. Based on the identified needs, recommendations were made with regard to a family-centred-care approach as a relevant resilience-based strategy suitable to these families. The research adopted a quantitative, non-experimental, exploratory and descriptive design. A purposive convenience sample of 100 participants was recruited over a period of four months. The data were collected by means of a structured interview schedule. The study revealed that the five main domains of family needs identified by the respondents as very important was, in order of priority, the need for communication, support, meaning, comfort and proximity. The findings supported the need to initiate and foster a family-centred-care approach in the A&E unit, which could guide the nurse practitioners in supporting the affected families, which in turn could enable these families to become resilient. Copyright / Dissertation (MCur)--University of Pretoria, 2010. / Nursing Science / unrestricted

Text in Afrikaans / Die samelewing heleef tans groot veranderinge. Die kerk en gesinslewe word heide daardeur geraak. Al meer druk word op gesinslewe geplaas en daardeur verander gesinne se hehoeftes. Een van die grootste hehoeftes van gesinne is 'n hehoefte aan diepteverhoudings, medemenslike erkenning, emosionele sekuriteit en interpersoonlike intimiteit. Die kerk moet hierdie hehoeftes kan raaksien en aanspreek. Vir 'n hediening aan gesinne en deur gesinne, is dit noodsaaklik dat die gemeente opnuut weer God se plan met die gesin herontdek; die gemeente moet die gesin as 'n ekosistemiese eenheid verstaan en die ontwikkelingsfases en emosionele prosesse binne 'n gesinsisteem moet in ag geneem word. In hierdie studie word die selgemeente gehruik om moontlike antwoorde te hied vir die hehoeftes van gesinne. Die hevinding van hierdie studie is dat die selgemeente oor die potensiaal heskik om vir die gesin 'n ware tuiste te hied waar gelowige gesinne toegerus en opgehou kan word vir hulle roeping in die gemeente, die samelewing en die wereld. Die selgemeente kan 'n moontlike model vir 'n gesinshediening wees. / The church and family are both affected by the immense changes in society. Family needs change under the pressure of these changes. Among the greatest family needs are a relationship with depth, acknowledgement from fellow-man, emotional security and interpersonal intimacy. The church must recognise these needs and address them. A ministry to families must firstly rediscover God's plan for the family; secondly the family must be seen as an ecosystemic unity; thirdly development and emotional phases in the family must be understood and managed. I used the cell church model as a basis to develop a structure for family ministry. I found the cell church model to be essentially a relationship model. I came to the conclusion that the cell church model has the potential to be a genuine home for family; to be a basis from which the family can be built up and from which the family can be equipped for their calling. Thus, I found the cell church model to be a possible model for family ministry. / Philosophy, Practical & Systematic Theology / M. Th. (Practical Theology)