Spiritual Need Five: Providing Quality Pastoral Care as a Congregation

SUMMARY

Critical to the needs of older adults is the care and nurturing of the feelings and emotions that often offer context for the human spirit. Grounded in the history of pastoral care, this chapter explores an approach to pastoral care that is reflective of the author's study and experience in the parish.     

Enrichment and Stress in Families Caring for a Child with a Serious Emotional Disorder

We examined enrichment and stress in 214 families who had children with severe emotional disorders. Caregivers' ratings of enrichment and stress were obtained through a newly developed instrument, the Effects of the Situation Questionnaire, which used parallel items covering 17 life areas. While ratings of stress were generally higher than enrichment, caregivers reported some enrichment in areas encompassing self concept and family relationships, Bivariate and multivariate analyses using various child, family, and service-system variables revealed that stress was notably associated with severity of the child's disorder, low empowerment, and a lack of coordination among service providers. Enrichment was unrelated to severity but associated with high empowerment and spiritual support. Our findings suggest that families' experiences of caregiving can have both positive and negative aspects and that a comprehensive approach to serving and studying families should take both into account.     

Using Cognitive Mapping to Understand Problems Experienced by Family Caregivers of Persons with Severe Physical Disabilities

Individuals who provide ongoing care for family members who have a chronic disease or disability are likely to encounter a wide array of problems that can compromise their own health and their ability to function effectively in a caregiving role. Structured focus group meetings were conducted to elicit a comprehensive list of the problems that caregivers experienced during their first year of providing care to a person with a severe physical disability. A separate group of caregivers (N = 60) individually sorted problems into piles based on their similarity and assigned relative importance to each problem. The aggregated data were analyzed with multidimensional scaling and hierarchical cluster analysis. Results indicated that caregivers cognitively organize problems along three dimensions: I. Centeredness–caregiver versus patient-oriented; II. Relationship Demands–physical versus emotional; and III. Caregiver Burden–time versus emotional. Additionally, 6 clusters of substantively similar problems were identified and prioritized in terms of personal relevance: Basic Needs (lowest); Perceived Constraints; Caregiver Challenges; Patient Resentment; Patient Withdrawal; and Patient Intrapsychic Adjustment (highest). Further examination of the organization of problems identified by caregivers should provide important insights about the experience of caregivers and how more targeted interventions can be developed to address their specific needs.     

The role of negative reinforcement in infant caregiving: an experimental simulation

We observed 11 undergraduates in an experiment designed to simulate infant caregiving. In negative reinforcement conditions experienced by all participants, a targeted caregiving response (e.g., rocking a baby doll) produced escape from, and avoidance of, a recorded infant cry. Nine participants' caregiving was shown to be controlled by this negative reinforcement contingency. Nine participants experienced an extinction condition that consisted of an inescapable cry, and the previously reinforced caregiving responses of 2 of these participants were resistant to extinction. For both of these participants, the previously reinforced response was eliminated when an alternative form of caregiving was reinforced. These results highlight the role of negative reinforcement in infant caregiving and suggest the need for additional research on the effects of crying on caregivers as well as the development of effective strategies for minimizing infant crying.     

Unheard Voices: Experiences of Families Living with HIV/AIDS in India*

This study was aimed at understanding the impact of HIV on the family system in the Indian context. A sample of 20 families caring for a relative living with HIV/AIDS (PLWHAs) was recruited from a HIV counseling clinic at the National Institute for Mental Health and Neuro Sciences and a respite home for PLWHAs in Bangalore City in southern India. Qualitative data were collected from these families using a semi-structured interview guide and recorded in the form of narratives. Analysis of these data revealed the following themes: Stigma and discrimination; disclosure; changes in family functioning; financial difficulties; fears of the family; and helplessness. Each theme was presented in detail and implications for intervention to help these families and their PLWHAs discussed. V.A.S. Krishna, PhD, MPE, Fogarty Funded Post Doctoral Fellow, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63108 (krishnavas@epi.wustl.edu). Ranbir S. Bhatti, PhD, Professor of Family Therapy, Montfort College, Bangalore, Former Professor and Head, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (ranbirbhatti@yahoo.com). Prabha S. Chandra, MD, Additional Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (prabhachandra@rediffmail.com). Srilatha Juvva, PhD, Reader, Department of Family and Child Welfare, Tata Institute of Social Sciences (TISS), Mumbai, India 400088 (juvvas@tiss.edu). *The authors would like to thank all the PLWHAs and their family members for volunteering to be part of this study. Post-doctoral Fellowship support for Dr. V.A.S. Krishna from Fogarty Grant—TW05811 (LB Cottler, PI).     

Employee Eldercare Responsibilities: Should Organizations Care?

The question "Should organizations be concerned with the eldercare responsibilities of their employees?" was addressed from several perspectives: (1) prevalence of need, (2) the relationships among eldercare responsibilities, satisfaction with eldercare arrangements, and workplace attitudes and outcomes, and (3) support for organizational eldercare programs. Our sample was predominately female and we defined eldercare responsibilities broadly; however, only 5 of 885 employees reported eldercare responsibilities. The majority relied on family arrangements and reported dissatisfaction with these arrangements. Dissatisfaction was related to interruptions at work, leaving early, and intent to quit. Eldercare-givers did not differ from other groups on job satisfaction and organizational commitment, but were absent from work significantly more often. There was strong employee support for employer-sponsored eldercare programs.     

Effects of foster care intervention and caregiving quality on the bidirectional development of executive functions and social skills following institutional rearing

Institutional rearing negatively impacts the development of children's social skills and executive functions (EF). However, little is known about whether childhood social skills mediate the effects of the foster care intervention (FCG) and foster caregiving quality following early institutional rearing on EF and social skills in adolescence. We examined (a) whether children's social skills at 8 years mediate the impact of the FCG on the development of EF at ages 12 and 16 years, and (b) whether social skills and EF at ages 8 and 12 mediate the relation between caregiving quality in foster care at 42 months and subsequent social skills and EF at age 16. Participants included abandoned children from Romanian institutions, who were randomly assigned to a FCG (n = 68) or care as usual (n = 68), and a never-institutionalized group (n = 135). At ages 8, 12, and 16, social skills were assessed via caregiver and teacher reports and EF were assessed via the Cambridge Neuropsychological Test Automated Battery. Caregiving quality of foster caregivers was observed at 42 months. FCG predicted better social skills at 8 years, which in turn predicted better EF in adolescence. Higher caregiver quality in foster care at 42 months predicted better social skills at 8 and 12 years, and better EF at 12 years, which in turn predicted 16-year EF and social skills. These findings suggest that interventions targeting caregiving quality within foster care home environments may have long-lasting positive effects on children's social skills and EF.     

Links Between Reactive Attachment Disorder,Caregiving and Temperament: A Differential Susceptibility Perspective

Abstract

The links between Reactive Attachment Disorder (RAD) and temperament received relatively little research attention, in spite of their clinical and social relevance. Children with RAD sustain disproportionate burdens of early adversity related to their caregiving environment. However, there seem to be important individual differences in susceptibility to adversity, since only a small number of children show signs of RAD. Based on the work of Zeanah and Fox, this review aims to bring new insights to this relevant clinical issue in light of recent research. A differential susceptibility hypothesis will be considered as a promising and innovative approach toward a further understanding of the links between temperament and RAD.     

Fathers' caregiving in low-income African–American and Hispanic–American families

The present study assessed fathers' and mothers' relative involvement in infant caregiving tasks in 34 low-income African–American and Hispanic–American families. Analysis showed that involvement in childcare differed as a function of the gender of the parent. Fathers spent one half the time mothers did in caregiving. However, fathers' and mothers' participation in caregiving did not vary as a function of ethnic group. African–American parents reported to have received more family support than Hispanic–American parents. Although relationships were noted between age, income, education, length of marriage, social support, and involvement in infant caregiving, these sociodemographic variables did not predict parents' participation in childcare. The results are discussed in relation to the preconceived notion that low-income, minority fathers are ‘uninvolved’. ©1997 John Wiley & Sons, Ltd.