An intervention to improve the self-efficacy of key workers to support parental wellbeing at an early childhood intervention service in Australia: a stepped wedged randomized cluster trial

Abstract

Purpose

It is well documented parents of children who have a disability are at an increased risk of poor mental health and wellbeing. A capacity building program designed to build key worker self-efficacy to support the mental health of parents accessing early childhood intervention services (ECIS) for their child was trialled.

Materials and Methods

A stepped-wedge cluster randomised trial design was utilised to deliver and evaluate a 12-month intervention program, comprising tailored professional development, resource development and sustainability measures. The repeated measurements on individuals in six clusters over three follow-up periods were analysed using linear mixed models. Comparison of the control and new program statistical means (adjusted for period effects) were assessed with an F test.

Results

Key workers reported increased confidence to talk to parents about their own wellbeing (d = 0.51, F(1, 51.8) = 4.28, p = 0.044) and knowledge of parental mental wellbeing improved (p = 0.006). A reduction in staff sick leave partially offset the cost of the intervention.

Conclusions

A multi-pronged intervention targeted at key workers was found to be an effective way to ensure parental wellbeing is supported at an ECIS in Australia.

Trial Registration

ACTRN12617001530314

Implications for Rehabilitation

• There are implications for the development of children whose parents are experiencing high stress and poor mental health, whereby parents of children with disability or developmental delays are at increased risk.

• Findings from this study support the recommendation that a key worker is provided to holistically support families who access Early Childhood Intervention Services to aid in reducing poor parental wellbeing and child outcomes.

• Improved confidence to support and initiate conversations regarding parental wellbeing by key workers, in combination with support from management and the organisation to undertake this as part of their role, is a positive finding from this intervention study.

Keywords:

• Family centred practice
• mental health
• health services for persons with disabilities
• disabled children
• family caregivers
• cost consequences analysis

Acknowledgements

We acknowledge the contribution of our colleague and friend, the late Professor Elizabeth Waters, who founded this study in partnership with Yooralla to enhance the health and well-being of children with a disability and their families through improved support services. We acknowledge Dr Elise Davis and Dr Kim-Michelle Gilson during their employment at The University of Melbourne; Jennifer Morgan, Adjunct Professor Jeffrey Chan, Jenifer Morris-Cosgriff and Elaine Krassas from Yooralla for their key contributions to the study, particularly the design and delivery of the intervention. We thank the Melbourne Clinical and Translational Sciences research platform for the administrative and technical support that facilitated data collection via REDCap. The authors would lastly like to acknowledge the generous contribution by parents and staff members from Yooralla who willingly participated in this study.

Disclosure statement

Authors R Carr, PK, CK were employees of the partnering organisation and JT is a Board Member of the partnering organisation.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This study was supported by an Australian National Health and Medical Research Council (NHMRC) Partnership Project grant [#1076861]. Cash and in-kind contribution from Yooralla as the associated partner organization were provided. Salary support for investigators is acknowledged from the Jack Brockhoff Foundation, the APEX Foundation for Research into Intellectual Disability, the Royal Children’s Hospital Foundation, Deakin Health Economics, Deakin University and Monash University.