Effects of respite care for children with developmental disabilities: evaluation of an intervention for at-risk families

Study Aim/Purpose: This study sought to examine the effects of respite care on parental stress and the relationships between levels of respite service use, parental stress, and other parental characteristics on their children’s foster care placement and maltreatment rates.

Summary of Methods: Eighty-seven (87) parents completed the Parenting Stress Index (PSI) questionnaire before and after respite care use. This questionnaire (which measures measure parental competence and stress) was used to identify parent-child systems that are under stress and at risk for the development of dysfunctional parenting behaviors or child behavior problems. The authors assessed the PSI’s Total Stress score and three subdomain scores: Parent, Child, and Life Stress. The authors also examined rates of foster care placement and child maltreatment rates by matching the respite child client list with the state child maltreatment and foster care registries. They also examined associations between multiple parent variables and child maltreatment during enrollment in the program.

Summary of Key Results: Parental stress was found to be “above the high range” before and after respite use. Comparison of matched pre-respite and post-respite PSI scores found significant decreases in Total Stress scores, Parent Domain scores and Child Domain scores, but not the Life Stress Domain scores, after provision of care. The researchers also found that 17% of the respite parents had young children who were placed in foster care and/or had substantiated cases of maltreatment during enrollment in the program. Multiple logistic regression analysis found significant correlation between Life Stress scores and social support and the occurrence of child maltreatment during enrolment. The odds of maltreatment occurring during enrollment were also found to be highest for families receiving a medium amount (not high or low amounts) of respite services.

Study Limitations Cited by Authors: “In order to truly examine the intervention effect of respite care on prevention of child maltreatment and foster care placement, a control group of nonserved children with developmental disabilities would be required.”

Authors’ Discussion/Conclusions: The authors conclude that “respite care can be an appropriate and effective intervention to decrease stress in the parent-child relationship” for families of children with developmental disabilities. Based on the study findings (including the association between parental Life Stress and receipt of moderate levels of respite care with child maltreatment), “The investigator suggests that public health nurses can enhance their case management strategies when working with the parents of children with developmental disabilities by monitoring for caregiver burnout in addition to ensuring that the child is receiving care appropriate for his or her level of need.”