# data[].attributes.body
Video presentation from December 13th AAC Presentation

# data[].attributes.attachment_link.title
Introduction to Augmentative and Alternative Communication 

# data[].attributes.body
Feb. 26, 2024 - Welcoming Wellness - Using Positive Psychology to improve quality of life for all

# data[].attributes.headline
Feb 26, 2024 - “Welcoming Wellbeing - Using Positive Psychology to Improve Quality of Life for all!” 

# data[].attributes.subject
Feb 26, 2024 - “Welcoming Wellbeing - Using Positive Psychology to Improve Quality of Life for all!” 

# data[].attributes.attachment_link.title
3 Intro to AAC articles_Introducción al CAA

# data[].attributes.attachment_caption
RL Therapies presents: What is AT_AAC and How to Get Started-RL Therapies

# data[].attributes.headline
January 25th and June 15th 2023: What is AT/AAC & How to Get Started

# data[].attributes.subject
January 25th and June 15th 2023: What is AT/AAC & How to Get Started

# data[].attributes.body
Learn about Assistive Technology and Augmentative and Alternative Communication and the process for assessment and referral of clients with communication needs who might benefit from this technology

# data[].attributes.attachment_link.title
06152023-What is AT_AAC and How to Get Started-RL Therapies

# data[].attributes.headline
13 de febrero de 2023, Academia de proveedores de RCRC, parte 2¡-La intervención temprana cumple! Pasado y presente: lecciones aprendidas

# data[].attributes.subject
13 de febrero de 2023, Academia de proveedores de RCRC, parte 2¡-La intervención temprana cumple! Pasado y presente: lecciones aprendidas

# data[].attributes.attachment_link.title
02132023 RCRC Provider Academy Early Intervention Delivers! SPANISH

# data[].attributes.headline
13 de febrero de 2023, Academia de proveedores de RCRC: una visión para el futuro: construir sobre lo que funciona

# data[].attributes.subject
13 de febrero de 2023, Academia de proveedores de RCRC: una visión para el futuro: construir sobre lo que funciona

# data[].attributes.attachment_link.title
2-13-2023 RCRC ProviderAcademy-A Vision for the Future- Spanish

# data[].attributes.headline
MARCH 29, 2021-The Importance of Joint Attention in Early Social Development 

# data[].attributes.subject
MARCH 29, 2021-The Importance of Joint Attention in Early Social Development 

# data[].attributes.attachment_link.title
March 29 2021 The Importance of Joint Attention in SED 0-5

# data[].attributes.headline
April 3, 2023 RCRC Provider Academy: Overcoming Barriers-Opening Doors

# data[].attributes.subject
April 3, 2023 RCRC Provider Academy: Overcoming Barriers-Opening Doors

# data[].attributes.headline
February 13, 2023 RCRC Provider Academy- A Vision for the Future: Building on What Works

# data[].attributes.subject
February 13, 2023 RCRC Provider Academy- A Vision for the Future: Building on What Works

# data[].attributes.attachment_link.title
2-13-2022 RCRC ProviderAcademy-A Vision for the Future V1.3

# data[].attributes.headline
Early Start Neighborhood: Professional Development, Early Start Resources and Early Start Library  Information

# data[].attributes.subject
Early Start Neighborhood: Professional Development, Early Start Resources and Early Start Library  Information

# data[].attributes.attachment_link.readable_text
Registration closes December 30, 2022.
Courses open January 10, 2023.

Find materials for outreach, child find, and family orientation; the 'Take a Minute" materials; videos; and more.

Best practices when serving families with infants and toddlers who are medically fragile

Posted by staff
November 30, 2022

# data[].attributes.attachment_link.title
Early Start Neighborhood - Making a difference for children with disabilities and their families

# data[].attributes.attachment_link.description
Registration closes December 30, 2022. Courses open January 10, 2023. Find materials for outreach, child find, and family orientation; the 'Take a Minute" materials; videos; and more. Best practices when serving families with infants and toddlers who are medically fragile Posted by staff November 30, 2022

# data[].attributes.headline
Expanded Hearing Aide Coverage for Children

# data[].attributes.subject
Expanded Hearing Aide Coverage for Children

# data[].attributes.attachment_link.title
Advocates Commend Expansion of Hearing Aides

# data[].attributes.headline
November 4, 2022-Annual Lake County Innovation Health Summit

# data[].attributes.subject
November 4, 2022-Annual Lake County Innovation Health Summit

# data[].attributes.headline
Deaf Culture Facts that May Surprise YOu

# data[].attributes.subject
Deaf Culture Facts that May Surprise YOu

# data[].attributes.headline
Guidelines for Serving Deaf and Hard of Hearing Clients

# data[].attributes.subject
Guidelines for Serving Deaf and Hard of Hearing Clients

# data[].attributes.headline
February 13, 2022, RCRC Provider Academy-pt 2 Early Intervention Delivers!: Past and Present-Lessons Learned

# data[].attributes.subject
February 13, 2022, RCRC Provider Academy-pt 2 Early Intervention Delivers!: Past and Present-Lessons Learned

# data[].attributes.attachment_link.title
Early Intervention Delivers! Past and Present Lessons Learned-HO

# data[].attributes.headline
February 13, 2023 RCRC Provider Academy-A Vision for the Future: Building on What Works

# data[].attributes.subject
February 13, 2023 RCRC Provider Academy-A Vision for the Future: Building on What Works

# data[].attributes.attachment_link.title
2-13-2022 RCRC ProviderAcademy-A Vision for the Future V1.3

# data[].attributes.headline
Easterseals-Increaseing Social and Emotional Development & Self=Awareness for Young Children

# data[].attributes.subject
Easterseals-Increaseing Social and Emotional Development & Self=Awareness for Young Children

# data[].attributes.headline
Easterseals Early Intervention Program Overview

# data[].attributes.subject
Easterseals Early Intervention Program Overview

# data[].attributes.attachment_link.title
ESNorCal Early Intervention Program Presentation RCRC-10.25.22 (1)

# data[].attributes.headline
Infant Development Association of California Presents: Serving From the Heart: A Look Into Native Teachings Connected to Self-Care and Humility February 14, 2022

# data[].attributes.subject
Infant Development Association of California Presents: Serving From the Heart: A Look Into Native Teachings Connected to Self-Care and Humility February 14, 2022

# data[].attributes.headline
Humboldt  County 0-8 Mental Health Collaborative

# data[].attributes.subject
Humboldt  County 0-8 Mental Health Collaborative

# data[].attributes.attachment_link.description
In this Issue:
* Leadership Meeting Schedule
* Upcoming Trainings
* Family Events & Resources
* Important Links

# data[].attributes.headline
Infant and Early Childhood Mental Health (IECMH) Grant Program

# data[].attributes.subject
Infant and Early Childhood Mental Health (IECMH) Grant Program

# data[].attributes.attachment_link.readable_text
Infant and Early Childhood Mental grants are authorized under the 21st Century Cures Act, Section 10006 which added Section 399Z-2 to the Public Health Service Act (PDF | 966 KB).

The purpose of this program is to improve outcomes for children, from birth up to 12 years of age, by developing, maintaining, or enhancing infant and early childhood mental health promotion, intervention, and treatment services.

Project Goals

Develop sustainable programs serving children at significant risk of developing, showing early signs of, or having been diagnosed with a mental illness, including serious emotional disturbance (SED) and/or symptoms that may be indicative of developing SED in children

Provide multigenerational therapy and other services that strengthen positive caregiving relationships

Provide access to a full range of infant and early childhood services

Build workforce capacity for individuals serving children from birth to age 12 years

Fill service gaps in systems of early childhood mental health care by providing evidence-based mental health promotion, prevention, early intervention, and treatment interventions

Successes of IECMH 2019-2021

Trained 9,991 members of the mental health workforce

17,346 young children and caregivers screened for mental health or related interventions

7,399 young children and caregivers referred for mental health and related services

9,457 young children and caregivers provided evidence-based mental health and related services

Current and Prior Grantees
Program Staff
Brooke Sims, M.S., Public Health Advisor
Nancy Kelly, M.S. Ed., Branch Chief, Mental Health Promotion
Captain Maryann Robinson as Acting Division Director

# data[].attributes.attachment_link.title
Infant Early Childhood Mental Health (IECMH) Grant Program

# data[].attributes.attachment_link.description
Infant and Early Childhood Mental grants are authorized under the 21st Century Cures Act, Section 10006 which added Section 399Z-2 to the Public Health Service Act (PDF | 966 KB). The purpose of this program is to improve outcomes for children, from birth up to 12 years of age, by developing, maintaining, or enhancing infant and early childhood mental health promotion, intervention, and treatment services.

# data[].attributes.headline
February 13, 2023 RCRC Provider Academy-“A Vision for the Future – Building On What Works” with Dr. Lucille Esralew and guests

# data[].attributes.subject
February 13, 2023 RCRC Provider Academy-“A Vision for the Future – Building On What Works” with Dr. Lucille Esralew and guests

# data[].attributes.body
Please join us as Dr. Lucille Esralew, Senior Supervising Psychologist, DDS, shares a brief overview of the Office of Statewide Clinical Services (OSCS) and a description of the Department’s (DDS) commitment to providing children and their families with a strong foundation that aids lifespan social and
emotional wellbeing.

# data[].attributes.headline
January 24th, 2023: RL Therapy Group present: What is AAC/AT & How to Get Started

# data[].attributes.subject
January 24th, 2023: RL Therapy Group present: What is AAC/AT & How to Get Started

# data[].attributes.headline
December 6, 2022 RCRC Provider Academy-Working Through Grief and Loss

# data[].attributes.subject
December 6, 2022 RCRC Provider Academy-Working Through Grief and Loss

# data[].attributes.attachment_link.title
12062022 PROVIDER ACADEMY-WORKING THROUGH GRIEF and LOSS-V3.final

# data[].attributes.headline
December 6, 2022- Working Through Grief and Loss-Spanish

# data[].attributes.subject
December 6, 2022- Working Through Grief and Loss-Spanish

# data[].attributes.attachment_link.title
12062022 PROVIDER ACADEMY-WORKING THROUGH GRIEF and LOSS-V4.final SPANISH

# data[].attributes.headline
APOYANDO A LOS NIÑOS PREESCOLARES EN DUELO

# data[].attributes.subject
APOYANDO A LOS NIÑOS PREESCOLARES EN DUELO

# data[].attributes.headline
Talking with Children about Death and Grief

# data[].attributes.subject
Talking with Children about Death and Grief

# data[].attributes.headline
National Alliance for Grieving Children: Responding to Change and Loss

# data[].attributes.subject
National Alliance for Grieving Children: Responding to Change and Loss

# data[].attributes.headline
RESPONDIENDO ALCAMBIO Y PÉRDIDA PARA EL APOYO DE NIÑOS, ADOLESCENTES Y FAMILIAS

# data[].attributes.subject
RESPONDIENDO ALCAMBIO Y PÉRDIDA PARA EL APOYO DE NIÑOS, ADOLESCENTES Y FAMILIAS

# data[].attributes.headline
Early Start Neighborhood: California Early Start Resource page

# data[].attributes.subject
Early Start Neighborhood: California Early Start Resource page

# data[].attributes.attachment_link.readable_text
Registration closes December 30, 2022.
Courses open January 10, 2023.

Find materials for outreach, child find, and family orientation; the 'Take a Minute" materials; videos; and more.

Best practices when serving families with infants and toddlers who are medically fragile

Posted by staff
November 30, 2022

# data[].attributes.attachment_link.title
Early Start Neighborhood - Making a difference for children with disabilities and their families

# data[].attributes.attachment_link.description
Registration closes December 30, 2022. Courses open January 10, 2023. Find materials for outreach, child find, and family orientation; the 'Take a Minute" materials; videos; and more. Best practices when serving families with infants and toddlers who are medically fragile Posted by staff November 30, 2022

# data[].attributes.headline
The Stages in Grief in Learning you Child has Special Needs

# data[].attributes.subject
The Stages in Grief in Learning you Child has Special Needs

# data[].attributes.attachment_link.title
Initially Learning About Your Child Having Special Needs

# data[].attributes.headline
Understanding the Stages of Grief (For parents of a child diagnosed with a disability)

# data[].attributes.subject
Understanding the Stages of Grief (For parents of a child diagnosed with a disability)

# data[].attributes.body
Parents whose child receives a diagnosis go through a different kind of grieving process. Understanding it can help them cope.

# data[].attributes.attachment_link.title
Understanding the Stages of Grief _ Parent Companion _ For parents of children with disabilities in Texas

# data[].attributes.attachment_link.title
Grieving The Loss Of The Perfect Child - The Karg Academy

# data[].attributes.headline
Recurrent grief in mothering a child with an intellectual disability to adulthood: grieving is the healing

# data[].attributes.subject
Recurrent grief in mothering a child with an intellectual disability to adulthood: grieving is the healing

# data[].attributes.body
A resource for professionals, parents and caregivers working with children and adults with IDD who have experienced a significant loss. The materials can help provide education and support for persons with IDD that enables them to be included in the process of grief so that they may have improved outcomes, and experience growth.

# data[].attributes.headline
December 6, 2022 RCRC Provider Academy-WORKING THROUGH GRIEF AND LOSS: Strategies to Promote Healing and Growth for Individuals with IDD and the People Who Love Them

# data[].attributes.subject
December 6, 2022 RCRC Provider Academy-WORKING THROUGH GRIEF AND LOSS: Strategies to Promote Healing and Growth for Individuals with IDD and the People Who Love Them

# data[].attributes.attachment_link.title
12062022 Provider Academy-Working Through Grief and Loss

# data[].attributes.headline
September 19, 2022-Social and Emotional Development in Young Children: When to Be Concerned

# data[].attributes.subject
September 19, 2022-Social and Emotional Development in Young Children: When to Be Concerned

# data[].attributes.attachment_link.title
9.19.22 Dr. Ivins-Social and Emotional Development in Young Childen_When to Be Concerned

# data[].attributes.headline
June 13, 2022-Building up Families with a Child Diagnosed with ASD

# data[].attributes.subject
June 13, 2022-Building up Families with a Child Diagnosed with ASD

# data[].attributes.attachment_link.title
Building Up Families With a Child Diagnosed with Autism HO

# data[].attributes.headline
September 19, 2022 RCRC Provider Academy-Social and Emotional Development in Young Children-When to Be Concerned

# data[].attributes.subject
September 19, 2022 RCRC Provider Academy-Social and Emotional Development in Young Children-When to Be Concerned

# data[].attributes.attachment_link.title
09192022 Provider Academy-SED in Young Children-Dr. Ivins

# data[].attributes.headline
December 13, 2021-Building Healthy Families-Addressing Parental Needs to Help Young Children Thrive

# data[].attributes.subject
December 13, 2021-Building Healthy Families-Addressing Parental Needs to Help Young Children Thrive

# data[].attributes.attachment_link.title
12-13-21 RCRC Provider Academy-Building Healthy Families

# data[].attributes.headline
September 29, 2021- Relieving Long Term Stress in Children, Families, and Providers

# data[].attributes.subject
September 29, 2021- Relieving Long Term Stress in Children, Families, and Providers

# data[].attributes.headline
February 9, 2022 The Brains Developmental Window in Childhood for Learning Consent

# data[].attributes.subject
February 9, 2022 The Brains Developmental Window in Childhood for Learning Consent

# data[].attributes.body
Hosted by First 5 Lake County, in this webinar, Dr. Hambrick will discuss the ages during development that children can learn to respect others' boundaries and instill their own. She will discuss the key developmental components that must be present for children to understand consent and ways to teach consent.

# data[].attributes.headline
January 24, 2022-USING CHILDREN’S BOOKS TO SUPPORTIDENTITY, EQUITY, & INCLUSION

# data[].attributes.subject
January 24, 2022-USING CHILDREN’S BOOKS TO SUPPORTIDENTITY, EQUITY, & INCLUSION

# data[].attributes.body
Hosted by First5Lake County, speaker Camille Catlett, an early childhood professional, will share with you the many ways in which children’s books can play a significant role in supporting each and every child and family.

# data[].attributes.headline
January 11, 2022 Moving from Aces to Hope

# data[].attributes.subject
January 11, 2022 Moving from Aces to Hope

# data[].attributes.body
Hosted by First5 Lake County, Dr. Dr. Jeff Linkenbach of the Montana Institute, will provide an overview of HOPE (Healthy Outcomes from Positive Experiences) and present some of the data about how positive childhood experiences can mitigate the impact of childhood trauma.

# data[].attributes.headline
Understanding stress in parents of children with autism spectrum disorder: a focus on under-represented families. International Journal of Developmental Disabilities

# data[].attributes.subject
Understanding stress in parents of children with autism spectrum disorder: a focus on under-represented families. International Journal of Developmental Disabilities

# data[].attributes.attachment_link.readable_text
Objectives: Parents of children with autism spectrum disorder (ASD) report high levels of stress that can interfere with important child and family treatments. Limited past research considers how the caregiving experience and social determinants of health may contribute to treatment engagement and outcomes, particularly in underrepresented families, who already experience service and health disparities. We aimed to assess the experiences of caring for an individual with ASD, with specific emphasis on perceptions of stress.

Methods: Three key informant interviews were conducted with parents (n = 1) and providers (n = 2) of children with ASD to refine interview guide questions. Once questions were refined, four focus groups (n = 17) and one key informant interview were conducted with parents of children with ASD who were (a) non-white, (b) Spanish speakers, (c) of limited financial resources, and/or (d) living in rural counties. All participants lived in Western New York, with the majority residing in Rochester. Content analysis by two independent coders was used to identify and refine themes.

Results: Themes included: (a) caregiving for an individual with ASD can cause interference with family functioning, (b) misperceptions of ASD contribute to caregiver stress, (c) culture contributes to stressors for parents, and (d) service navigation difficulties are a significant source of stress. Suggestions for interventions to address parents stress included: modular and integrative treatments for multiple content areas, addressing cultural barriers to treatment engagement, and education on ASD to the community.

Conclusions: Parent-focused interventions for caregivers of children with ASD should specifically explore and address service and health disparities for parents, especially those predicated on race, ethnicity, rurality, and language of origin. Interventions should also be individualized to parent characteristics and experiences. In future research on parent training, the unique contributions of caregiver stress and other characteristics (e.g. race-related stress, geographic location) should be included as potential modifiers of treatment.

Acknowledgments

We thank the families who participated in this project. We are also grateful to the Children’s Institute and Gladys Pedraza-Burgos and her team at the IBERO-American Action League, for their support. Finally, we thank Amina Alio and Caryn Stark for their comments on earlier drafts of this manuscript.

# data[].attributes.attachment_link.title
Understanding stress in parents of children with autism spectrum disorder: a focus on under-represented families

# data[].attributes.attachment_link.description
Objectives: Parents of children with autism spectrum disorder (ASD) report high levels of stress that can interfere with important child and family treatments. Limited past research considers how t...

# data[].attributes.headline
Parenting Stress and Resilience-A Systematic Review. Frontiers in Psychology (2018)

# data[].attributes.subject
Parenting Stress and Resilience-A Systematic Review. Frontiers in Psychology (2018)

# data[].attributes.attachment_link.readable_text
Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia

Department of Basic Sciences, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus Selangor, Shah Alam, Malaysia

Faculty of Medicine, Nursing, and Health Sciences, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia

School of Social & Health Sciences, Leeds Trinity University, Leeds, United Kingdom

Background: This paper aimed to review the literature on the factors associated with parenting stress and resilience among parents of children with autism spectrum disorder (ASD) in the South East Asia (SEA) region.

Methods: An extensive search of articles in multiple online databases (PsycNET, ProQuest, PudMed, EMBASE, CINAHL, Web of Science, and Google Scholar) resulted in 28 papers that met the inclusion criteria (i.e., conducted in the SEA region, specific to ASD only, published in a peer-reviewed journal, full text in English). Studies found were conducted in the following countries: Brunei, n = 1; Indonesia, n = 2; Malaysia, n = 12; Philippines, n = 5; Singapore, n = 5, Thailand, n = 2; and Vietnam, n = 1, but none from Cambodia, East Timor, Laos, and Myanmar were identified.

Results: Across the studies, six main factors were found to be associated with parenting stress: social support, severity of autism symptoms, financial difficulty, parents' perception and understanding toward ASD, parents' anxiety and worries about their child's future, and religious beliefs. These six factors could also be categorized as either a source of parenting stress or a coping strategy/resilience mechanism that may attenuate parenting stress.

Conclusion: The findings suggest that greater support services in Western countries may underlie the cultural differences observed in the SEA region. Limitations in the current review were identified. The limited number of studies yielded from the search suggests a need for expanded research on ASD and parenting stress, coping, and resilience in the SEA region especially in Cambodia, East Timor, Laos, and Myanmar. The identified stress and resilience factors may serve as sociocultural markers for clinicians, psychologists, and other professionals to consider when supporting parents of children with ASD.

Introduction

There have also been mixed findings in regards to the differences in stress levels experienced by mothers and fathers. Whilst some studies have found increased stress levels to be experienced by mothers and fathers as a couple (e.g., Dabrowska and Pisula, 2010; Ingersoll and Hambrick, 2011; Harper et al., 2013), others have instead determined stress levels among mothers and fathers as separate individuals and have found parental differences in the levels of stress experienced. For example, a study found mothers' stress levels to be more greatly affected ( Herring et al., 2006), whereas the findings from another study found fathers to report higher levels of stress ( Rivard et al., 2014).

When examining families who have a child with ASD, cultural factors are also very important to consider (e.g., Daley et al., 2013; Freeth et al., 2014). In many cases, there is a lack of information about ASD in the society, which may lead to parents of children with ASD to face stigmas, and be influenced by cultural beliefs and/or experience self-blame for their child's diagnosis (e.g., Gray, 2002; Mak and Kwok, 2010; Neely-Barnes et al., 2011; Ravindran and Myers, 2012; Sarrett, 2015; Riany et al., 2016). With the lack of support and adequte knowledge available at the societal level, these families may also struggle to make sense of their child's behavior, which may in turn increase the level of stress experienced and delay diagnosis and treatment planning for the family ( Karst and Van Hecke, 2012).

To achieve this, the current paper aimed to review peer-reviewed published studies conducted in Asia (limited to the South East Asian [SEA] region) in regards to parenting stress among parents with children with ASD, and therefore provide a discussion on the sources of stress among this sample, and the variables/ factors that may attentuate the levels of stress experienced by them. It is believed that findings from this review paper will be able to provide insights on the factors related to parenting stress, specific to the SEA region, an under-researched area. Furthermore, it is hoped that the findings will be able to provide a culture-specific understanding of the stress experienced by parents of chidren with ASD in the SEA region and that, the identified stress and resilience factors may serve as sociocultural markers for clinicians, psychologists, and other professionals to consider when supporting and treating parents and families of children with ASD.

Methods

Selection of the Studies

Figure 1. PRISMA flowchart illustrating article selection process.

At the second and last screening process, those that did not meet the other inclusion criteria (i.e., not published in peer-reviewed journals; full text not in English; doctoral dissertation; Master's thesis) were excluded. Finally, a total of 28 studies were deemed eligible to be reviewed.

A conscious decision was made not to limit the range of years of published studies, in order not to further reduce an already narrow yield of results in this under-researched region. However, it was planned to exclude studies published before 1980, in accordance with the initial inclusion of autism in the Diagnostic and Statistical Manual, 3rd edition ( American Psychiatric Association, 1980). Only one study was identified as published in the 1980s or 1990s ( Liwag, 1989) and this study was retained; themes were consistent with findings in later writings. Articles published after July 2016 were not included in this review. An intentional decision was made to focus on peer-reviewed articles and the search was not inclusive for theses/dissertations. It was judged that including theses/dissertations would introduce bias through the identification of some theses/dissertations over others, depending on their language of writing and online availability.

Before the search commenced, study authors agreed on the search strategy in consultation with a senior librarian advisor. A senior librarian advisor was also consulted throughout the search process. Moreover, an external auditor reviewed the process involved in the selection of studies before and after the study.

A-Priori Features of Interest Among Reviewed Studies

Studies included in this review are presented in Supplementary Table 1. Features of the studies as summarized in the header of Supplementary Table 1 include: location, design/method, sample, outcome measure, aim, findings, and control variable. The descriptor, "location" was included to allow face-value comparisons of the studies amongst SEA countries. The "design/method" of the study enables a quick evaluation of the methodology in which the study was conducted (i.e., quantitative, qualitative, or mixed-method), and thus, how that would relate to its findings. The header, "sample" specifies the number of participants in the study, if a particular study used a comparison group (i.e., parents of children with typical development), and if both mothers and fathers, or only single parents were sampled. The "outcome measure" looks at the utilization of differential measures across the reviewed studies in measuring common variables such as parenting stress, coping strategies, depression and anxiety symptoms, severity of autism symptoms and so forth. The "aim" describes the purpose of a particular reviewed study, while "findings" outlines key results from that study.

Analysis Procedures

Studies yielded from the search were analyzed through a careful and strategic process. Synthesis of literature findings was conducted by reading full-text articles of included studies, identifying parenting stress factors. Each study was read multiple times by four of the study authors to prevent bias. Identified factor(s) affecting parenting stress were noted and recorded for each study. Characteristics of each study, as listed in Supplementary Tables 1, 2 and Table 1 (e.g., location, design, parents' characteristics, child characteristics) were also noted and recorded. The use of objective measures, such as questionnaires were also noted to determine how parenting stress was differentially measured across studies.

Table 1. Characteristics of children diagnosed with ASD of parents sampled in this article review.

Similarities and differences between studies were highlighted as well as pooling together similar reporting measures and outcomes across studies. All relevant influential factors were thematically categorized and presented in a descriptive approach. All authors agreed on the data analysis findings and factor categorization. To minimize bias and promote trustworthiness of the findings, three experienced researchers with knowledge in the topic area also reviewed the data analysis findings and agreed with our factor categorization and discussion of the results.

Results

Description of Studies Reviewed in This Article

A total of 28 studies were finally chosen for review in this paper (see Supplementary Table 1). Out of these 28 studies, 14 had quantitative designs, 11 were qualitative, and three were mixed-method. Out of the 14 quantitative studies however, only one ( Lai et al., 2015) used an active control group (i.e., parents of children with typical development) for mean comparison.

The resulting search found relevant studies to be investigated in only seven of the total, 12 SEA countries (Brunei, n = 1; Indonesia, n = 2; Malaysia, n = 12; Philippines, n = 5; Singapore, n = 5, Thailand, n = 2; Vietnam, n = 1). It would however be inaccurate to infer that SEA countries that were not yielded in this search have a lower awareness of ASD. This lack of identified articles in five SEA countries may be mainly due to the possibility that factors such as funding may have played a role in the lack of/absence of published research in those countries.

Across the studies, the total sample amounted to 1, 639 participants, whereby 1, 288 were mothers and 253 were fathers. Note that two studies ( Vetrayan et al., 2013; Roffeei et al., 2015) did not report the sampled number of fathers and mothers in their study. Parents in the reviewed studies had at least one child who was diagnosed with ASD. The cumulative age range of these children across all studies was 0-20 years, though it should be noted that several studies failed to report the age of the child who was diagnosed with ASD in their study. The majority of the studies specified the diagnosis of the children under the broader term, "ASD" (Diagnostic and Statistical Manual of Mental Disorders 5th ed.; DSM-5; American Psychiatric Association, 2013) whilst others followed the categorization listed under Pervasive Developmental Disorders (PDD) in the fourth edition, text revision of the DSM (DSM-IV-TR; American Psychiatric Association, 2000). Supplementary Table 2 and Table 1 display the characteristics/demographics of parents and children, respectively.

Although "autism" more accurately refers to autistic disorder as listed under PDD in the DSM-IV-TR ( American Psychiatric Association, 2000), it has been used interchangeably with ASD in several of the reviewed articles to inclusively refer to other autism-related disorders besides autistic disorder. Therefore, to ensure clarity in this paper, the term "autism" was replaced with "ASD" or "autistic disorder" when its intended meaning was obvious to the authors.

Parenting Stress and Other Related Variables

One of the related variables of parenting stress that was explored was level of psychological well-being/distress among parents of children with ASD (e.g., Nikmat et al., 2008; Yeo and Lu, 2012; Lai et al., 2015; Rejani and Ting, 2015). For this, measures such as the Depression, Anxiety and Stress Scale (DASS; Lovibond and Lovibond, 1995), and the General Health Questionnaire (GHQ-28; Goldberg, 1978) were utilized. The use of these scales have, therefore, highlighted the need to understand and study "stress" among parents of children with ASD, as a component of psychological distress that is compounded with other related factors such as depression and anxiety. Accordingly, other studies ( Charnsil and Bathia, 2010; Rejani and Ting, 2015) were included in this systematic review, as their findings on depressive and/or anxiety symptom levels among parents of children with ASD could highlight several factors that might also be associated with parenting stress.

Other variables that were also determined in relation to parenting stress included parental satisfaction ( Moh and Magiati, 2012), resilience ( Santoso et al., 2015), quality of life ( Sian and Tan, 2012; Wisessathorn et al., 2013; Siah and Tan, 2015, 2016), family functioning ( Tait and Mundia, 2012; Xue et al., 2014), and hopelessness ( Vetrayan et al., 2013). Although these variables were not identical to the concept of parenting stress, they were included in the current review to provide a holistic understanding of the stress experienced by parents of children with ASD.

Factors/Variables Affecting Parenting Stress

As a result of the review, several factors were found to have played a prominent role in the levels of parenting stress experienced by parents of children with ASD in the SEA region. Particularly, these factors included: (i) social support, (ii) severity of autism symptoms, (iii) financial difficulty, (iv) parents' understanding and perception toward ASD, (v) parents' anxiety and worries about their child's future, and (vi) religious belief.

Another noteworthy finding points to the critical role professionals were suggested to play in providing social support to these parents ( Liwag, 1989; Foronda, 2000; Moh and Magiati, 2012; Rahman et al., 2012; Resurreccion, 2013; Xue et al., 2014; Santoso et al., 2015; Chong and Kua, 2016). Particularly, in Singapore, a research study found that higher parental stress was associated with a higher number of professionals consulted, and a lower perceived collaboration between parent and professionals; though, only the number of professionals consulted was found to significantly predict parenting stress ( Moh and Magiati, 2012). They also found that collaboration with professionals, the perceived helpfulness of the information provided, and parental stress significantly predicted parental satisfaction ( Moh and Magiati, 2012).

(ii) Severity of autism symptoms. Besides social support, severity of autism symptoms was also found to affect parenting stress among parents of children with ASD ( Liwag, 1989; Foronda, 2000; Nikmat et al., 2008; Charnsil and Bathia, 2010; Yeo and Lu, 2012; Athari et al., 2013; Wisessathorn et al., 2013; Lai et al., 2015; Ilias et al., 2016). Using a comparison group (parents of children with typical development) in a Singaporean sample, a study was able to show that parents of children with ASD (who were found to have a greater experience of difficult child behavior) had higher levels of parenting stress ( Lai et al., 2015). Moreover, the perception of autism severity (specifically, mother's perception) was found to be a cross-cultural factor (in Malaysia and China) that significantly predicted parenting stress. However, another study did not find ASD symptom severity to be associated with a retrospective rating of parenting stress in relation to the diagnostic process ( Moh and Magiati, 2012).

Autism severity was found to be negatively associated with related variables of parenting stress, such as parental quality of life ( Wisessathorn et al., 2013) and parental satisfaction during the diagnostic process ( Moh and Magiati, 2012). Similarly, a study found that severity of autism symptoms in a Thai sample was higher among children with caregivers who were clinically depressed, although autism symptoms did not predict depressive disorders among the caregivers ( Charnsil and Bathia, 2010). The authors commented that the non-significant finding may be impacted by the small sample size (27 participants) ( Charnsil and Bathia, 2010).

Uniquely, in the study by Xue et al. (2014), parents reported that although they were occasionally challenged with aggressive and self-injurious behaviors that are typically stereotyped with children with ASD, they found these behaviors to have only little interference with their lives. In fact, this group of parents reported low levels of stress, contradictory to the typical findings on parenting stress among parents of children with ASD.

On another note, the reverse of this ASD severity-parenting stress relationship was also found to be true, whereby further analyses ( Athari et al., 2013) revealed that levels of stress (and depression) among mothers of children with ASD predicted the severity of autism in their child. These findings together, therefore, suggest the complexity of this relationship.

From a cross-cultural perspective examining maternal parenting stress and maternal psychological distress, Yeo and Lu (2012) found treatment costs/father's income to have some differing impacts in Malaysia and China. For example, father's income/treatment costs contributed 15% of the variance in psychological distress for Malaysian mothers compared to only 3% for Chinese mothers. Treatment cost was considered to be an important factor that contributed to the difficulties and distress especially among Malaysian mothers, as it was speculated that Malaysian families are further challenged by having to support schooling needs for multiple children, in comparison to the Chinese, single-child families. Furthermore, Yeo and Lu's (2012) findings also highlight the cross-cultural experience of stress as a component of psychological distress.

(v) Parents' anxiety and worries about their child's future. Several studies (via qualitative interviews or an open-ended sentence completion task), found parents' anxiety in regards to the future of their child (who is diagnosed with ASD) to be one of their sources of stress ( Liwag, 1989; Foronda, 2000; Tait and Mundia, 2012; Ha et al., 2014; Quilendrino et al., 2015; Ilias et al., 2016). The parents' anxieties included the child's schooling and future secondary and/or higher education ( Tait and Mundia, 2012; Ilias et al., 2016), job and career prospects ( Ilias et al., 2016), and worries over finding care for their children in their older age ( Quilendrino et al., 2015). Conversely, thoughts of their child's future motivated mothers to be resilient when they were optimistic about their child's future ( Santoso et al., 2015).

Discussion

The present article aimed to review studies conducted in the SEA region, identifying the factors that influence or are associated with parenting stress among parents of children with ASD. Across the 28 studies that were included in this systematic review, four factors associated with parenting stress, were frequently reported: social support, severity of autism symptoms, financial difficulty, and parents' perception and understanding toward ASD. Two other factors were also found to relate to parenting stress, though to a lesser extent; these included parents' anxiety and worries about their child's future, and religious belief. The finding of these six factors could also be categorized in this review as either a source of parenting stress (i.e., severity of autism symptoms, financial difficulty and parents' anxiety and worries about their child's future) or as a coping strategy/mechanism that may attenuate levels of parenting stress (i.e., social support, parents' perception and understanding toward ASD and religious belief).

In regards to the identified factors, this systematic review was able to highlight the beneficial role of social support among parents of children with ASD, and that this social support could be drawn from various sources (e.g., spouse, immediate family, external family, other families of children with ASD, schools, professionals, online). However, it was noteworthy to find contradictory results in regards to the support received by external family members ( Foronda, 2000; Yeo and Lu, 2012). This difference may be due to the quality of the already existing relationship between the parent and external family members, whereby a close relationship to a member of the family, regardless if he/she is an external or immediate part of the family, could result in greater social support from him/her. In turn, this observation highlights the equally important need for the social support received to be of high quality. For instance, the findings of the spousal relationship as an important source of social support (e.g., Foronda, 2000; Yeo and Lu, 2012) might have an opposite effect if the spousal relationship was unhealthy and/or violent.

It should also be noted that despite finding social support to be a coping strategy for parents in the majority of the reviewed studies, a study found a lack of positive association between social support and parenting stress ( Nikmat et al., 2008). This finding may be attributable to the difference in the measure of social support used in their study in comparison to other studies. Whilst the Provision Social Relation (PSR; Turner et al., 1983) measure as used in a study ( Nikmat et al., 2008) specifically looks at the overall perception of social support received, other quantitative studies determined the sources of social support and/or their relative importance ( Moh and Magiati, 2012; Yeo and Lu, 2012; Xue et al., 2014); as did qualitative studies ( Liwag, 1989; Foronda, 2000; Wahyuni, 2013; Foo et al., 2014; Santoso et al., 2015; Chong and Kua, 2016). Together, this evidence might suggest that while social support may play a role in attenuating parenting stress experienced by parents of children with ASD, this finding is specific to the sources it is drawn from, rather than acting as a general perception of feeling supported. This offered interpretation, is merely preliminary based on the findings of this systematic review and would require a thorough mixed-method study ( Ilias et al., 2015) to support its accuracy.

The importance of quality social support was also seen from an informational perspective ( Roffeei et al., 2015) and was seen to include support received by professionals. Particularly, lower perceived collaboration with a professional was associated with greater stress ( Moh and Magiati, 2012), whereas contact with professional help was found to subside the suicide ideation within a family who was isolated from their own family members and community whilst caring for their children with ASD ( Rahman et al., 2012). As a cross-cultural observation, it is worth noting that the importance of support from professionals and/or policy makers has also been reported in other regions (mainly in the Western/European context; Ooi et al., 2016) in either creating a positive or negative experience for parents of children with ASD. However, in the SEA region, where support services are only beginning to phase into conception and early-development, there may be a greater challenge as to how these support services are attained and experienced. As a result, this lack of quality support services, might increase the stress experienced by parents of children with ASD, which is likely to be more evident in developing countries that are limited in assessment, diagnosis, intervention services, and government provisions (e.g., Ting and Chuah, 2010; Tait and Mundia, 2012; Ha et al., 2014).

In regards to financial difficulty, there is a tacit assumption that this factor may be more specific to the stress experienced by fathers in comparison to mothers (e.g., Pisula, 2011). Accordingly, in this review, Liwag (1989) found financial difficulty to be a source of stress that was more relevant to fathers in comparison to mothers of children with ASD. This finding may presumably reflect the paternal dominance as the breadwinner of the family in an Asian context. However, given the lapse of time since this finding (30 years) and hence, the sociocultural changes and shifting gender roles since then, it is uncertain if such gender differences might still exist. Moreover, the variability in design across the studies in this review makes it difficult to determine if there are indeed gender differences in respect to this factor. For example, most studies that revealed financial difficulty to be a contributing factor of parenting stress, sampled only mothers and thus, made it impossible to determine gender differences between fathers and mothers ( Foronda, 2000; Yeo and Lu, 2012; Athari et al., 2013; Wahyuni, 2013). Similarly, other studies, which also found financial difficulty to positively associate with parenting stress, analyzed fathers and mothers as a dyad, and did not look for gender differences ( Tait and Mundia, 2012; Vetrayan et al., 2013).

In parallel to this, findings from quantitative studies ( Nikmat et al., 2008; Rejani and Ting, 2015) also provide support to the notion of possible gender differences in how parents of children with ASD experience stress. Particularly in the study, mothers' higher rates of psychological distress (i.e., stress, anxiety, and depression) were found despite an absence of gender differences in level of parenting stress ( Nikmat et al., 2008). Here, it is important to note that whilst "stress" is a sub-component of psychological distress, it is compounded with other variables such as depression and anxiety in the conceptualization of psychological distress. As such, this finding ( Nikmat et al., 2008) further corroborates the idea that whilst both mothers and fathers of children with ASD experience parenting stress, there may be an "emotion-focused" theme that underlies more strongly maternal than paternal stress. However, this observation is limited to the small number of studies that compared mothers and fathers and the comparatively fewer number of fathers who were recruited as participants. Therefore, further research in respect to these observations are needed to provide better insight and understanding of how parenting stress is differentially experienced by mothers and fathers in the SEA region, and thus, how intervention methods can be tailored to meet these differences.

Additionally, several studies ( Rahman et al., 2012; Ha et al., 2014; Ilias et al., 2016) have found cultural beliefs (e.g., karma, parental sins, curses) to influence how society perceives the diagnosis of ASD, which is less commonly found in studies conducted in a Western context. Parents who are persuaded by such beliefs may adopt an external locus of control, such that they feel helpless and adopt maladaptive methods (e.g., substance abuse) to cope with the stress experienced as found in the study by Rahman et al. (2012). However, as observed through the current systematic review, a greater number of studies ( Liwag, 1989; Foronda, 2000; Wahyuni, 2013; Xue et al., 2014; Quilendrino et al., 2015; Siah and Tan, 2015, 2016; Chong and Kua, 2016; Ilias et al., 2016) found parents to adopt a positive perception and understanding toward ASD (e.g., adaptability, emotional acceptance, positive belief, sense of coherence) and hence, effectively cope with the obstacles of raising a child with ASD. It is therefore plausible, that the South-East Asian society is beginning to move away from cultural beliefs of parental sins, karma and/or curses in the etiological understanding of the ASD diagnosis.

Two other factors (i.e., parents' anxiety and worries about child's future, and religious belief) were also found to be associated with parenting stress among parents of children with ASD. In regards to the parents' anxiety and worries about the child's future, this factor was related to the lack of resources and support services available in the region to manage the ASD symptomologies and associated comorbidities ( Neik et al., 2014). This finding suggested that parents in the SEA region face an imperative need for more resources and support services. Despite the inconsistency in the presence or absence of both these factors across the reviewed studies, these factors have also been found elsewhere (e.g., Ooi et al., 2016). However, in this paper, "religious belief" stood out as a culturally related factor as it was comparatively more salient among the reviewed studies (i.e., in the SEA region) than in studies conducted in a Western/European context (e.g., Hayes and Watson, 2013; Ooi et al., 2016). However, even in other contexts, there is evidence suggesting that the role of religion may serve as a positive source of support and aid in the initial acceptance and accommodating phase of adjustment (e.g., Tarakeshwar and Pargament, 2001; Gupta and Singhal, 2004; Benson, 2010; Willis et al., 2016).

On the whole, this systemic review is limited such that is it restricted to the findings of the studies reviewed in this article. Notwithstanding a thorough search of the literature review in multiple databases, only 28 studies related to parenting stress among parents of children with ASD in the SEA region was yielded. Whilst there is a possibility that selection bias occurred, this is less likely to be case as the authors were cautious to include studies that investigated other variables (e.g., hopelessness, parental satisfaction, quality of life) that might also provide a better understanding of the parenting stress experienced by parents of children with ASD. Hence, the limited number of studies that met the inclusion criteria despite this precautionary step might also point to the lack of research conducted in the SEA region in regards to parenting stress and resilience among parents of children with ASD.

At face value, it is noticeable that low-income countries and those with lower ratings in the Human Developmental Index ( United Nations Development Programme, 2013) in the SEA region were underrepresented in this systematic review; specifically, Cambodia, East Timor, Laos, and Myanmar. It is thus possible that the findings are biased toward countries in the region with higher ratings in the Human Developmental Index. Accordingly, this necessitates the advancement and expansion of the research area on ASD in this region, especially in regards to parenting stress and resilience. It should be pointed out, that in the SEA region, where native, traditional languages (e.g., Burmese, Chinese, Cambodian, Indonesian, Lao, Malay, Tagalog, Thai, and Vietnamese) are still spoken among the people, research articles published in these languages and in relation to parenting stress could illuminate on factors that may have been overlooked in the English-only, published articles included in this review. Nevertheless, very few articles were identified in native languages, although initial attempts were made to locate them as well. The English-only search strategy could have introduced bias leading articles published in local languages to be overlooked. Future reviews are recommended to include multi-languages in the search process.

Secondly, the overrepresentation of mothers/ underrepresentation of fathers in this paper might lead to a gender bias in the reported findings. The large difference in the number of mothers and fathers sampled across studies in this review paper may reflect the easier nature to recruit mothers in comparison to fathers as they, in general, remain to be the primary caregiver in an Asian context ( Phetrasuwan and Shandor Miles, 2009; Rejani and Ting, 2015; Siah and Tan, 2015). On the other hand, this could also be attributed to the sampling methods that aim to recruit only one parent of a child with ASD (usually the mother) rather than both parents. As elaborated above, this makes it difficult to thoroughly determine how parenting stress is experienced differently for mothers and fathers. This overrepresentation of mothers has also been a commonly observed bias in Western samples (e.g., Bitsika et al., 2013; Braunstein et al., 2013; Hayes and Watson, 2013; Ooi et al., 2016).

Moreover, majority of the studies in this review did not also report the age at which the children were diagnosed with ASD. Whilst the children of some parents would have received an earlier diagnosis, other children might have only just been diagnosed relative to the time at which the respective study was conducted. This difference might lead to parents of children with an earlier diagnosis, to over time, be more equipped and resilient in caring for their child with ASD in comparison to parents who are only beginning to seek for clarity and support. As such, if this factor was instead maintained as a control variable, it would have allowed for a clearer and more accurate examination of parenting stress among parents of children with ASD.

Further limiting the conclusions made in this review, the common use of purposeful and convenience sampling may have led to a biased sample of more resilient parents who are more likely to volunteer and participate (e.g., Tait and Mundia, 2012; Wisessathorn et al., 2013; Xue et al., 2014; Chong and Kua, 2016; Ilias et al., 2016). Even, in one article ( Foronda, 2000), the author was transparent reporting she included herself as one of the 16 participants. No other conflicts of interest were specifically reported, although it is possible they may have been present in some studies. Other than that, the sampling could have also led to a biased sample of more parents from middle to higher socioeconomic backgrounds who have access to intervention services (e.g., Liwag, 1989; Sian and Tan, 2012; Ha et al., 2014; Xue et al., 2014; Santoso et al., 2015; Siah and Tan, 2016). Additionally, studies included in the review were cross-sectional and therefore inferred an association rather than a causal relationship. Longitudinal investigations are recommended for future research.

Besides that, variation in designs, factors analyzed, methods, and outcome measures, made direct comparison between the findings of the studies, problematic. As illustrated in Supplementary Table 1, significant variation was observed for the outcome measures of parenting stress, and conceptual ambiguity of the construct remains an area for future investigation to tackle. Furthermore, the use of an active control group in only one of the reviewed studies ( Lai et al., 2015) elucidates the need for more experimental/quasi-experimental design components in the research area of ASD in the SEA region. The 28 studies had a reasonable balance between quantitative and qualitative studies (14 quantitative, 11 qualitative, and three mixed-method) that were found to corroborate the findings among them. Therefore, as a seminal article (at least, to our knowledge) that has reviewed articles in the SEA region in regards to parenting stress among parents of children with ASD, this paper provides a helpful and informative starting point for future researchers, parents, as well as professionals in the field.

To conclude, this systematic review observed four main factors to be associated with parenting stress among parents of children with ASD in the SEA region: social support, severity of autism symptoms, financial difficulty and parents' perception and understanding toward autism. Other factors that were also found to be associated with parenting stress in this sample (though, to a lesser extent) included, parents' anxiety and worries about their child's future, and religious belief. Whilst several of these factors may have similarly been reported in a Western context, findings from the current systematic review lean to suggest that the greater advanced development and implementation of policy, economical and professional support services in Western countries than in South-East Asian countries might impart cultural differences in regards to how these factors are manifested. Therefore, further research is imperative to more clearly identify cultural specificities that differentiate how parenting stress and its associated factors are uniquely experienced across countries in the SEA region in comparison to Western countries. Additionally, as majority of the studies identified in this review were not published in high-impact journals with large readerships, funding and research bodies are recommended to increasingly support the methodological rigor in the design, conduct, and publication of studies in the SEA region, especially in the lower-income countries.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Funding

The authors would like to acknowledge that this work was supported by the Ministry of Higher Education Malaysia under a Fundamental Research Grant Scheme [FRGS/1/2013/SKK10/MUSM/02/1] and by the Faculty of Medicine, Nursing and Health Sciences, Monash University Australia, under a Faculty Strategic Grant Scheme [SPG066]. The authors would also like to thank Universiti Teknologi MARA for the support throughout this study.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We would like to thank the grant funders for their support. Also, we would like to thank the Monash University Malaysia library staff for their assistance with this project.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00280/full#supplementary-material

References

Athari, P., Ghaedi, L., and Kosnin, M. (2013). Mothers' depression and stress, severity of autism among children and family income. Int. J. Psychol. Res. 6, 98-106. doi: 10.21500/20112084.691

CrossRef Full Text | Google Scholar

Neik, T. T. X., Lee, L. W., Low, H. M., Chia, N. K. H., and Chua, A. C. K. (2014). Prevalence, diagnosis, treatment and research on autism spectrum disorders (ASD) in Singapore and Malaysia. Int. J. Spec. Educ. 29, 82-92. Retrieved from: http://files.eric.ed.gov/fulltext/EJ1045960.pdf
Google Scholar

# data[].attributes.attachment_link.title
Parenting Stress and Resilience in Parents of Children With Autism Spectrum Disorder (ASD) in Southeast Asia: A Systematic Review

# data[].attributes.attachment_link.description
Background: This paper aimed to review the literature on the factors associated with parenting stress and resilience among parents of children with autism spectrum disorder (ASD) in the South East Asia (SEA) region.Methods: An extensive search of articles in multiple online databases (PsycNET, ProQuest, PudMed, EMBASE, CINAHL, Web of Science, and Google Scholar) resulted in 28 papers that met the inclusion criteria (i.e., conducted in the SEA region, specific to ASD only, published in a peer-reviewed journal, full text in English).

# data[].attributes.headline
June 13, 2022 RCRC Provider Academy-Building Up Families with a Child Diagnosed with Autism

# data[].attributes.subject
June 13, 2022 RCRC Provider Academy-Building Up Families with a Child Diagnosed with Autism

# data[].attributes.attachment_link.title
Building Up Families With a Child Diagnosed with Autism

# data[].attributes.headline
June 13, 2022 RCRC Provider Academy: Building Up Families with a Child Diagnosed with Autism

# data[].attributes.subject
June 13, 2022 RCRC Provider Academy: Building Up Families with a Child Diagnosed with Autism

# data[].attributes.attachment_link.title
06132022 RCRC Parent Academy-Building Up Families

# data[].attributes.headline
March 28, 2022 RCRC Provider Academy:  Family Centered, Strength Based Pactices

# data[].attributes.subject
March 28, 2022 RCRC Provider Academy:  Family Centered, Strength Based Pactices

# data[].attributes.headline
3-28-2022 RCRC Provider Academy:  Family Centered, Strength Based Pactices

# data[].attributes.subject
3-28-2022 RCRC Provider Academy:  Family Centered, Strength Based Pactices

# data[].attributes.headline
September 29, 2022 RCRC Provider Academy with Dr. Lucille Esralew: Relieving Long-Term Stress

# data[].attributes.subject
September 29, 2022 RCRC Provider Academy with Dr. Lucille Esralew: Relieving Long-Term Stress

# data[].attributes.headline
California Child Development and Early Learning

# data[].attributes.subject
California Child Development and Early Learning

# data[].attributes.attachment_link.readable_text
Learn about state, territory and local resources and programs that support child development and school readiness.

This section identifies resources at the state and local level, and the links will take you to websites outside of ChildCare.gov.

# data[].attributes.attachment_link.title
California: Child Development & Early Learning

# data[].attributes.attachment_link.description
Learn about state, territory and local resources and programs that support child development and school readiness. This section identifies resources at the state and local level, and the links will take you to websites outside of ChildCare.gov.

# data[].attributes.headline
Administration for Children and Families

# data[].attributes.subject
Administration for Children and Families

# data[].attributes.attachment_link.title
Welcome To ACF | The Administration for Children and Families

# data[].attributes.attachment_link.description
Domestic Violence Awareness Month (DVAM) has been observed in October since 1987. It is a time for advocates, survivors, their loved ones, and the community to come together to mourn those whose lives have been lost to domestic violence, celebrate the accomplishments to end and prevent further viol…

# data[].attributes.headline
Center for Parent Information and Resources

# data[].attributes.subject
Center for Parent Information and Resources

# data[].attributes.attachment_link.readable_text
There are nearly 100 Parent Training and Information Centers (PTIs) and Community Parent Resource Centers (CPRCs) in the US and Territories.

These Centers perform a variety of direct services for children and youth with disabilities, families, professionals, and other organizations that support them.

Some of the activities include:

Working with families of infants, toddlers, children, and youth with disabilities, birth to 26

Helping parents participate effectively in their children's education and development

Partnering with professionals and policy makers to improve outcomes for all children with disabilities

# data[].attributes.attachment_link.title
About Parent Centers Serving Families of Children with Disabilities

# data[].attributes.attachment_link.description
There are nearly 100 Parent Training and Information Centers (PTIs) and Community Parent Resource Centers (CPRCs) in the US and Territories. These Centers perform a variety of direct services for children and youth with disabilities, families, professionals, and other organizations that support them.

# data[].attributes.headline
March 28, 2022 RCRC Provider Academy: Family Centered, Strength-Based Practices: Maintaining Boundaries While Instilling Hope

# data[].attributes.subject
March 28, 2022 RCRC Provider Academy: Family Centered, Strength-Based Practices: Maintaining Boundaries While Instilling Hope

# data[].attributes.attachment_link.title
3-28-2022 R Provider Academy-Family centered strength-based practices-maintaining boundaries while instilling hope

# data[].attributes.headline
Infographic From Parenting Matters on Elements of Effective Intervention

# data[].attributes.subject
Infographic From Parenting Matters on Elements of Effective Intervention

# data[].attributes.headline
Parenting Matters: Supporting Parents of Children Ages 0-8

# data[].attributes.subject
Parenting Matters: Supporting Parents of Children Ages 0-8

# data[].attributes.body
Link to a free download of the Parenting Matters book from The National Academies Press

# data[].attributes.attachment_link.readable_text
Contributors

Description

Decades of research have demonstrated that the parent-child dyad and the environment of the family-which includes all primary caregivers-are at the foundation of children's well- being and healthy development. From birth, children are learning and rely on parents and the other caregivers in their lives to protect and care for them. The impact of parents may never be greater than during the earliest years of life, when a child's brain is rapidly developing and when nearly all of her or his experiences are created and shaped by parents and the family environment. Parents help children build and refine their knowledge and skills, charting a trajectory for their health and well-being during childhood and beyond. The experience of parenting also impacts parents themselves. For instance, parenting can enrich and give focus to parents' lives; generate stress or calm; and create any number of emotions, including feelings of happiness, sadness, fulfillment, and anger.

Parenting of young children today takes place in the context of significant ongoing developments. These include: a rapidly growing body of science on early childhood, increases in funding for programs and services for families, changing demographics of the U.S. population, and greater diversity of family structure. Additionally, parenting is increasingly being shaped by technology and increased access to information about parenting.

Parenting Matters identifies parenting knowledge, attitudes, and practices associated with positive developmental outcomes in children ages 0-8; universal/preventive and targeted strategies used in a variety of settings that have been effective with parents of young children and that support the identified knowledge, attitudes, and practices; and barriers to and facilitators for parents' use of practices that lead to healthy child outcomes as well as their participation in effective programs and services. This report makes recommendations directed at an array of stakeholders, for promoting the wide-scale adoption of effective programs and services for parents and on areas that warrant further research to inform policy and practice. It is meant to serve as a roadmap for the future of parenting policy, research, and practice in the United States.

Topics

Suggested Citation

National Academies of Sciences, Engineering, and Medicine. 2016. Parenting Matters: Supporting Parents of Children Ages 0-8. Washington, DC: The National Academies Press.https://doi.org/10.17226/21868.

Import this citation to:

Publication Info

Copyright Clearance Center
22 Rosewood Drive
Danvers, MA 01923
Tel (toll free): 855/239-3415 (select option 1)
E-mail: info@copyright.com
Web: https://www.copyright.com

Loading stats for Parenting Matters: Supporting Parents of Children Ages 0-8...

# data[].attributes.attachment_link.authors[].name
Division of Behavioral and Social Sciences and Education

# data[].attributes.attachment_link.title
Parenting Matters: Supporting Parents of Children Ages 0-8

# data[].attributes.attachment_link.description
Decades of research have demonstrated that the parent-child dyad and the environment of the family-which includes all primary caregivers-are at the foundation of children's well- being and healthy development. From birth, children are learning and rely on parents and the other caregivers in their lives to protect and care for them.

# data[].attributes.headline
Parenting Matters: Supporting Parents of Children Ages 0-8

# data[].attributes.subject
Parenting Matters: Supporting Parents of Children Ages 0-8

# data[].attributes.attachment_link.title
Parenting Matters-Supporting Parents of Children Ages 0-8

# data[].attributes.headline
Article: Mental Health of Parents and Primary Caregivers by Sex and Associated Child Health Indicators. ADV RES SCI 2, 125-139 (2021).

# data[].attributes.subject
Article: Mental Health of Parents and Primary Caregivers by Sex and Associated Child Health Indicators. ADV RES SCI 2, 125-139 (2021).

# data[].attributes.body
Poor mental health among parents or primary caregivers is associated with poor mental and physical health in children; however, research often excludes the mental health of male caregivers including fathers. This analysis examines associations between caregiver mental health by caregiver sex and child health indicators (i.e., child’s general health; child’s history of diagnosed mental, behavioral, or developmental disorders (MBDDs))

# data[].attributes.attachment_link.title
Mental Health of Parents and Primary Caregivers by Sex and Associated Child Health Indicators - Adversity and Resilience Science

# data[].attributes.attachment_link.description
Poor mental health among parents or primary caregivers is associated with poor mental and physical health in children; however, research often excludes the mental health of male caregivers including fathers. This analysis examines associations between caregiver mental health by caregiver sex and chi…

# data[].attributes.headline
The ARC Parents With Intellectual and/or Developmental Disabilities. 

# data[].attributes.subject
The ARC Parents With Intellectual and/or Developmental Disabilities. 

# data[].attributes.attachment_link.readable_text
The presence of an intellectual and/or developmental disability ¹ does not in itself preclude effective parenting; therefore, the rights of parenthood must not be denied individuals solely on the basis of intellectual and/or developmental disabilities. Parents with intellectual and/or developmental disabilities should have access to support as needed to perform parental roles just as they are supported in other
valued social roles and activities.

ISSUE

The history of discrimination toward individuals with intellectual and/or developmental disabilities includes the denial of rights and opportunities to have and to raise their own children. This history has included segregation and involuntary sterilization of adolescents and adults. After birth, infants have been removed immediately from parental care, and through legal provisions, parents have been denied the opportunity to raise their children in their home.

Examples of social and social service biases and discriminatory practices include:

Presumption of incompetence, that is, a general belief that people with intellectual and/or developmental disabilities are unfit to be parents;

Limited supports to parents with intellectual and/or developmental disabilities;

Professional emphasis on limitations of parents with intellectual and/or developmental disabilities to the point of weakening parents' sense of competence and potential for success;

Public resources primarily focused on crisis-driven support;

Lack of trust of service providers or government officials by parents with intellectual and/or developmental disabilities based upon fears of losing their children and their vulnerability to arbitrary authority; and

Disproportionate representation of parents with intellectual and/or developmental disabilities in child custody proceedings, where, their competence as parents is held to higher, less flexible and more frequently applied standards than those applied to other parents.

Despite research which documents the ability of many parents with intellectual and/or developmental disabilities to raise a child successfully with appropriate and effective supports, access to these supports continues to be limited, fragmented and uncertain. Few specialized programs exist. Many family support and early intervention programs are not equipped to provide the intensive and ongoing supports that parents with intellectual and/or developmental disabilities and their children are likely to require.

POSITION

All adults, when provided access to appropriate and effective supports as needed to fulfill the basic responsibilities of child rearing, are more likely to be effective in their roles as parents.

Parents with intellectual and/or developmental disabilities and their children deserve social and health supports that:

Recognize the need of parents to be viewed as unique individuals able to learn and improve in their skills and to respond to the needs of their children;

Distinguish the effects of the family's living conditions and economic status independently from assessing ability to perform a parenting role;

Build a trusting relationship between the parents, child, and those who provide formal and informal supports to them;

Recognize, include, and engage the informal supports of family members, neighbors, and their community members to assist parents and the family as a whole;

Recognize that as the needs of children change, parenting skills must evolve and may require new forms of support for parents and children;

Respond to the unique learning needs of parents with intellectual and/or developmental disabilities;

Assist parents in becoming actively engaged in their children's school and community;

Reflect the full range and multiple components of effective support programs including, as needed:

in-home visits to teach parenting skills;

assistance with daily living skills;

access to nutritional resources such as "ready to feed" formula;

child care, early intervention services, and counseling;

basic academic education for parents;

assistance in accessing public benefits as appropriate;

crisis intervention services, availability of intensive supports as needed, and volunteer mentoring programs; and

Assure that access to parent supports and to the environments and programs in which parental participation is beneficial to the child and family are provided with proper consideration of Section 504 of the Rehabilitation Act, the Americans with Disabilities Act, and related accommodations.

The Arc of the United States and the American Association on Intellectual and Developmental Disabilities support adoption of the United Nation's Convention on the Rights of Persons with Disabilities. Article 23, "Respect for Home and the Family," Obligation 4 states that "Parties shall ensure that a child shall not be separated from his or her parent against their will, except when competent authorities subject to judicial review determine, in accordance with applicable laws and procedures, that such separation is necessary for the best interests of the child. In no case shall a child be separated from parents on the basis of a disability of either the child or one or
both of the parents."
Rev'd 2019
Joint statement with the American Association on Intellectual and Developmental Disabilities (AAIDD). Intellectual Disability (ID) is a lifelong condition where significant limitations in both intellectual functioning and adaptive behavior emerge during the developmental period (before adulthood). Developmental Disabilities (DD), first defined in 1975 federal legislation now known as "The DD Act", are a group of lifelong conditions that emerge during the developmental period and result in some level of functional limitation in learning, language, communication, cognition, behavior, socialization, or mobility. The most common DD conditions are intellectual disability, Down syndrome, autism, cerebral palsy, spina bifida, fetal alcohol syndrome, and fragile X syndrome. The acronym "IDD" is used to describe a group that includes either people with both ID and another DD or a group that includes people with ID or another DD. The supports that people with IDD need to meet their goals vary in intensity from intermittent to pervasive.

# data[].attributes.attachment_link.title
Parents With Disabilities Position Statement | The Arc

# data[].attributes.attachment_link.description
The presence of an intellectual and/or developmental disability 1 does not in itself preclude effective parenting; therefore, the rights of parenthood must not be denied individuals solely on the basis of intellectual and/or developmental disabilities. Parents with intellectual and/or developmental disabilities should have access to support as needed to perform parental roles just as they are supported in other valued social roles and activities.

# data[].attributes.attachment_link.title
Person-centred Thinking Tools | HSA | Consultancy | Training

# data[].attributes.attachment_link.description
Practical tools that help people to think and plan for their life, direct their own support and identify and achieve their goals.

# data[].attributes.headline
Parents and Parenting with Intellectual Disabilities 

# data[].attributes.subject
Parents and Parenting with Intellectual Disabilities 

# data[].attributes.attachment_link.readable_text
Marja W. Hodes ,

Corresponding Author

Marja W. Hodes

VU University Amsterdam, Faculty of Behavioural and Movement Sciences and EMGO+ Institute for Health Research, Amsterdam, the Netherlands

ASVZ, Sliedrecht, the Netherlands
Correspondence
Any correspondence should be directed to Marja W. Hodes, VU University Amsterdam, Faculty of Behavioural and Movements Sciences and the EMGO⁺ Institute for Health Research, Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands (e-mail: m.w.hodes@vu.nl ).
Search for more papers by this author

First published:

# data[].attributes.attachment_link.title
Alleviating Parenting Stress in Parents with Intellectual Disabilities: A Randomized Controlled Trial of a Video‐feedback Intervention to Promote Positive Parenting

# data[].attributes.attachment_link.description
Marja W. Hodes , Corresponding Author Marja W. Hodes VU University Amsterdam, Faculty of Behavioural and Movement Sciences and EMGO+ Institute for Health Research, Amsterdam, the Netherlands ASVZ, Sliedrecht, the Netherlands Correspondence Any correspondence should be directed to Marja W.

# data[].attributes.headline
12-13-2021 Provider Academy with Dr. Barbara Sprout: Building Healthy Families

# data[].attributes.subject
12-13-2021 Provider Academy with Dr. Barbara Sprout: Building Healthy Families

# data[].attributes.attachment_link.title
12-13-2021 Building Healthy Families--Addressing Parental Needs to Help Young Children Thrive_ A Person-Centered Approach.

# data[].attributes.headline
Building Healthy Families with Dr. Barbara Sprout

# data[].attributes.subject
Building Healthy Families with Dr. Barbara Sprout

# data[].attributes.attachment_link.title
12-13-2021 Building Healthy Families--Addressing Parental Needs to Help Young Children Thrive_ A Person-Centered Approach.

# data[].attributes.attachment_link.provider_name
Center on the Developing Child at Harvard University

# data[].attributes.attachment_link.readable_text
There is large amount of evidence from developmental psychology about the importance of contingent, reciprocal interaction ("serve and return") for many aspects of early childhood development (see Working Paper 1). But how do we know it actually "builds brains"? An increasing number of more recent studies, utilizing brain imaging and other new technologies, now document the impact of nurturing, supportive interaction and "sensitive caregiving" on both brain function and structure. A sampling of these studies are cited below.

"Neuroimaging revealed a neural mechanism by which language experience may influence brain development; namely, children who experienced more conversational turns exhibited greater activation in left inferior frontal regions (Broca's area) during language processing, which explained nearly half the relationship between children's language exposure and verbal abilities."

Romeo, R.R., Leonard, J.A., Robinson, S.T. et al. (2018). Beyond the 30-million-word gap: Children's conversational exposure is associated with language-related brain function. Psychological Science, 29(5), 700-710.

"Sensitive parental care, characterized by prompt and adequate response to the child's signals and needs, predicts a more secure attachment relationship, higher levels of cognitive competence, and fewer psychological problems."

"Parental sensitivity in early childhood was positively associated with markers of more optimal brain development at age 8 years, including a larger total brain volume, larger gray matter volume, and thicker cortices in the precentral, postcentral, caudal middle frontal, and rostral middle frontal gyrus."

Kok, R., Thijssen, S., Bakermans-Kranenburg, M. et al. (2015). Normal variation in early parental sensitivity predicts child structural brain development. Journal of the American Academy of Child and Adolescent Psychiatry, 54(10), 824-831.

"Variations in typical mother-infant interactions are associated with differences in infant brain volumes. Specifically, we found that lower maternal sensitivity was correlated with smaller subcortical grey matter volumes"

Sethna, V., Pote, I., Wang, S. et al. (2017). Mother-infant interactions and regional brain volumes in infancy: An MRI study, Brain Structure and Function, 222, 2379-2388.

"After considering age at imaging, household income and postnatal maternal anxiety, regression analyses demonstrated significant indirect associations between maternal sensitivity and bilateral hippocampal volume at six months. ... Moreover, functional analyses revealed direct associations between maternal sensitivity and connectivity between the hippocampus and areas important for emotional regulation and socio-emotional functioning."

Rifkin-Graboi, A., Kong, L., Sim, L.W. et al. (2015). Maternal sensitivity, infant limbic structure volume and functional connectivity: A preliminary study. Translational Psychiatry, 5, e668.

"Parent-child synchrony provides the first experience of nonverbal resonance where the mother adapts her gaze, affective expression, vocal quality, and movements to the infant's earliest signals to create a shared dialog. Synchrony supports the development of abilities that sustain social engagement, including symbol formation, moral understanding, emotion regulation, and frustration tolerance and provides a template for biological synchrony; during synchronous moments parent and child coordinate their heart rhythms, neural response, and oxytocin release, hence, synchrony is a mechanism by which the parent's mature physiological systems externally-regulate the child environment-dependent systems and tune them to social life. Here, we show that synchrony longitudinally shapes the neural basis of empathy in preadolescence and specifically targets brain areas that underpin the interface of cognitive and affective empathy."

Levy, J., Goldstein, A. & Feldman, R. (2019). The neural development of empathy is sensitive to caregiving and early trauma. Nature Communications, 10, 1905.

"7-mo-old infants activate auditory and motor brain areas similarly for native and nonnative sounds; by 11-12 mo, greater activation in auditory brain areas occurs for native sounds, whereas greater activation in motor brain areas occurs for nonnative sounds, matching the adult pattern. We posit that hearing speech invokes an Analysis by Synthesis process: auditory analysis of speech is coupled with synthesis that predicts the motor plans necessary to produce it. Both brain systems contribute to the developmental transition in infant speech perception."

Kuhl, P.K., Ramírez, R.R., Bosseler, A., Lin, J.L. & Imada, T. (2014). Infants' brain responses to speech suggest analysis by synthesis. Proceedings of the National Academy of Sciences. 111(31) 11238-11245.

"The quality of the interactions between parents and their children, measured with gesture and speech, is associated with advanced language development ... Infants' language learning is enhanced in one-on-one social contexts, perhaps because these contexts allow more contingent social interaction between adult and child. ... Evidence is accumulating to indicate a greater role for social interaction and social contingency in language learning. A large number of studies now suggest an important role for social behavior in language learning, among them: (1) the necessity of a social context for phonetic learning from exposure to a new language (Conboy & Kuhl, 2011; Kuhl et al., 2003); (2) the role of contingent response to infants' babbling... (Goldstein et al., 2003; Goldstein & Schwade, 2008), (3) the role of social behavior (eye gaze) as a tactic that provides vital information for language learning in infants (Brooks & Meltzoff, 2008). ... These findings contribute to our understanding of the social foundations of language, as observed in both typically developing and developmentally challenged young children, suggesting that language acquisition fundamentally requires social interaction to instigate learning (Kuhl, 2007; Kuhl, 2011; Kuhl, Coffey-Corina, Padden, Munson, Estes, & Dawson, 2013)."

Ramírez-Esparza, N., García-Sierra, A. & Kuhl, P.K. (2014). Look who's talking: Speech style and social context in language input to infants is linked to concurrent and future speech development. In press: Developmental Science, 17(6), 880-91.

"Our findings, derived from the moment-to-moment tracking of eye gaze of one-year-olds and their parents as they actively played with toys, provide evidence for an alternative pathway, through the coordination of hands and eyes in goal-directed action. In goal-directed actions, the hands and eyes of the actor are tightly coordinated both temporally and spatially, and thus, in contexts including manual engagement with objects, hand movements and eye movements provide redundant information about where the eyes are looking. Our findings show that one-year-olds rarely look to the parent's face and eyes in these contexts but rather infants and parents coordinate looking behavior without gaze following by attending to objects held by the self or the social partner. This pathway, through eye-hand coupling, leads to coordinated joint switches in visual attention and to an overall high rate of looking at the same object at the same time, and may be the dominant pathway through which physically active toddlers align their looking behavior with a social partner."

Yu, C. & Smith, L.B. (2013). Joint attention without gaze following: Human infants and their parents coordinate visual attention to objects through eye-hand coordination. PLoS One, 8(11), e79659.

# data[].attributes.attachment_link.title
5 Steps for Brain-Building Serve and Return - Center on the Developing Child at Harvard University

# data[].attributes.attachment_link.description
Child-adult relationships that are responsive and attentive-with lots of back and forth interactions-build a strong foundation in a child's brain for all future learning and development. This is called "serve and return," and it takes two to play! Follow these 5 steps to practice serve and return with your child.

# data[].attributes.attachment_link.title
6 Mindfulness Exercises You Can Try Today

# data[].attributes.attachment_link.description
If you feel stressed today, like you haven’t had a moment to yourself, try these 6 mindfulness exercises & find sanctuary for a few moments.

# data[].attributes.headline
Provider Academy with Dr. Lucille Esralew: Relieving Long-Term Stress

# data[].attributes.subject
Provider Academy with Dr. Lucille Esralew: Relieving Long-Term Stress

# data[].attributes.headline
Getting Started with Mindfulness Toolkit

# data[].attributes.subject
Getting Started with Mindfulness Toolkit

# data[].attributes.attachment_link.title
Getting Started with Mindfulness Toolkit

# data[].attributes.headline
For Providers: Why Self-Care Is Essential to Parenting (A child with special needs).

# data[].attributes.subject
For Providers: Why Self-Care Is Essential to Parenting (A child with special needs).

# data[].attributes.body
Caring for children with intense needs can take an emotional (and physical) toll on parents

# data[].attributes.attachment_link.readable_text
Parenting can be stressful under the best of circumstances, but moms and dads of children with developmental and mental health challenges often have to deal with strain of a different magnitude. Caring for a child with special needs can become a full-time job - and an overwhelming one at that, if you don't have adequate support. Without enough help, parents may be headed toward caregiver burnout, which negatively affects everyone.

The consequences of chronic stress related to raising kids who have intense needs are real. Studies show that parents of children with developmental, psychiatric or learning disorders are far more likely than others to experience:

According to one British study, chronic stress puts these parents at risk for medical issues as well. This study found that parents of children with either autism or ADHD had significantly higher levels of both cortisol, the stress hormone, and CRP, a biomarker linked to everything from colorectal cancer to diabetes to heart disease.

The risks, both emotional and physical, to caregivers of challenging children are important to address, for the children's sake as well as the parents'. Below, we look at common contributors to caregiver stress and offer some suggestions to help parents stay healthy, balanced and committed to their kids.

Accepting limits to what you can do

Experts agree that part of avoiding or lessening burnout is to challenge the idea that you are the only one who can help and there is no limit to what you need to do.

Dr. Wendy Blumenthal, an Atlanta-based psychologist, says she sees mothers who reach a breaking point because they are driven to shoulder all the responsibility for their high-needs child. "These supermoms - they're not sleeping, they're constantly anxious, calling every doctor they can think of."

"These parents feel like they should be able to do it all and the first thing to go is basic self-care," says Elaine Taylor Klaus, the cofounder of Impact ADHD, which offers training for parents of kids with ADHD and other disorders. "There are long-term risks of caring for these kids," she says. "And one of them is that parents burn out." Taylor Klaus urges parents to take seriously their own basic self-care including:

Getting enough sleep every night

Staying hydrated

Getting regular exercise

Spending time away from children

Isolation and exhaustion

When you have a child whose behavior is difficult or whose needs are challenging, feeling cut off from support and empathy can contribute to the stress. Colleagues, neighbors, friends, family - even your spouse can seem to be on another planet. "People cannot understand what you're going through," says Patricia Kandel, who has raised two children with serious mental illness. "There's so much alienation."

By the time her family decided their youngest daughter needed to go into a group home, Kandel says, "I was barely functioning." She, her husband and her 20-year-old daughter were all diagnosed with PTSD "from all the years of living the way we did," and her marriage had become unrecognizable. "It's not a typical marriage. It's survival."

Outside assistance was nowhere to be found. "You can't get a babysitter," Kandel continues. "Our own family wouldn't even help us. We never had any money. I had to be here 24 hours a day."

High-stress and time-intensive situations like this one are also where respite care could play a role, says Jill Kagan, director of Access to Respite Care and Help (ARCH). "Respite care is temporary relief for the parent or the primary caregiver of the child so they can take a break from the responsibilities of their continuous caregiving," she explains.

Many parents aren't aware of the existence of respite care, she says. "They're so focused on getting services for their child that they may not even stop to think that there are services out there for them as well. It seems out of the realm of possibility." But it isn't. ARCH's website includes an introduction to respite care and ways for parents to locate respite care by state as well as a list of funding sources. (ABCs of Respite: A Consumer's Guide for Family Caregivers)

It takes a village, but you need to ask

Another obstacle to getting help is that you may be afraid to ask. But in truth, people who genuinely want to help may not know how.

Parents need to be fairly direct. "Could you watch the kids on Wednesday so that I can get a haircut?" "If I give you a list, could you pick up the groceries?" These specific requests make it easier for family and friends to pitch in while not feeling out of their depth.

"People are often willing to help you in small ways," says Dr. Blumenthal. "Like watching your non-challenged child so you can take your special-needs child to therapy." Proposing babysitting exchanges with another parent (or even network of parents) of another special needs child is another way to get some time away, and some needed perspective.

Getting out and about

Many parents of kids with psychiatric and developmental challenges find that they lose touch with friends and activities outside the home. "Fifty percent of my sessions are just parent sessions" to help navigate that reality, says Dr. Matthew Rouse, a clinical psychologist at the Child Mind Institute.

Taking care of your emotional and social health is just as important as practicing more routine self-care. Several experts, including Dr. Rouse, emphasized the importance of reclaiming an adult-only social life. Dr. Rouse asks questions like:

What are you doing for yourselves?

What are you as a couple doing to support each other?

When's the last time you had a date night?

When did you last spend time with friends?

To mitigate feelings of isolation, Dr. Rouse recommends:

Finding a support network outside the immediate family. There are online and in-person support groups for just about every diagnosis out there.

Spending time with friends who have no connection to your child. "Support groups are great," Rouse says "but that's still doing something for your child."

Planning social activities that put you among people who care about you.

Time for activities that are purely pleasurable - reading, running, painting.

"The way I've framed it with parents who are resistant to this," Dr. Rouse says, "is to tell them, 'It's like you're depositing money into a bank and building up cash reserves. To have more to give your child, you have to build up those reserves.'"

Related: How Parent Support Groups Can Help

Nurturing the marriage

Throughout, parents need to pay close attention to perhaps the most vulnerable relationship of all - the one between spouses. Experts suggest that parents make it a point of maintaining their relationship with small steps they can continue, and that they make it a point of letting the marriage exist outside of roles as caregivers.

"I encourage parents to take little breaks such as when their child is in a therapy session or in school," says Dr. Cindy Ariel, a Philadelphia-based psychologist who specializes in working with families of special-needs children. Other small steps you can take might include an in-home break or "date." Even if you don't have help, there are still ways of finding time to devote to your relationship so that you and your partner don't end up feeling like you're merely tag teaming as caregivers.

Maintaining a healthy marriage and effective caregiving team is made much harder when parents disagree about treatment strategies and approaches. Andrea Weissman's son Ethan, now 12, has learning, attention and social challenges. She and her husband often disagree on what is considered "normal" behavior.

"He thinks a lot of stuff is more normative than I do and tells me I'm 'catastrophizing,' " she says. "We certainly don't parent in a consistent manner - which is not good for Ethan." Or for her-she feels she drinks too much as a result.

This is a common situation, according to Dr. Blumenthal. "There are information seekers and information deniers," she says, "people who want to dismiss the diagnosis or write off their child's symptoms as normal." When one parent is a "seeker" and the other a "denier"- which she says is often, especially when a child is first being diagnosed - the conflict can put an enormous strain on the relationship.

"If you have differences around the child's treatment, try to see things from the other person's perspective," Dr. Rouse suggests. "That will help you to reconnect." And that's easier if you've laid the groundwork with even something as simple as a "nightly check-in" that can help you and your partner stay close.

"Just making time before bed to tell each other about the highlight and lowlight of the day" is beneficial, he says. "So it's focused more on the person's emotional experience during these events, and less like a planning or logistics meeting. It can build intimacy and empathy just through sharing and listening."

# data[].attributes.attachment_link.description
Parenting can be stressful under the best of circumstances, but moms and dads of children with developmental and mental health challenges often have to deal with strain of a different magnitude. Caring for a child with special needs can become a full-time job - and an overwhelming one at that, if you don't have adequate support.

# data[].attributes.headline
Disaster Distress Information and Resources from SAMHSA

# data[].attributes.subject
Disaster Distress Information and Resources from SAMHSA

# data[].attributes.attachment_link.readable_text
Learn about who is most at risk for emotional distress from wildfires and where to find disaster-related resources.

Wildfires are usually triggered by lightning or accidents and often go unnoticed at first. They can spread quickly and are especially destructive if they occur near forests, rural areas, remote mountain sites, and other woodland settings where people live. While not reported as often as floods or tornadoes and severe storms, they, too, can cause emotional distress in people living in affected areas.

In 2013, more than 47,500 wildfires were reported in the United States. They destroyed thousands of structures, including about 1,100 homes, and burned more than 4 million acres of land.

Feelings such as overwhelming anxiety, constant worrying, trouble sleeping, and other depression-like symptoms are common responses before, during, and after wildfires. Other signs of emotional distress related to wildfires include:

Having thoughts, memories, or nightmares related to the wildfire that you can't seem to get out of your head

Worrying a lot of the time; feeling guilty but not sure why

Excessive absences from work or school

These are just a few warning signs of disaster-related distress. Learn more about warning signs and risk factors for emotional distress related to wildfires and other disasters.

Where Can I Get Help?

If you or someone you know shows any of these symptoms for two weeks or more, whether you know they are in relation to a wildfire or if it is unclear how they started ... Talk with us. You are not alone! Call or text the Disaster Distress Helpline at 1-800-985-5990 for support and counseling. The Disaster Distress Helpline is a national hotline that provides 24/7, year-round crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster.

This toll-free, multilingual, and confidential crisis support service is available to all residents in the United States and its territories. Calls and texts are answered by trained, caring counselors from crisis call centers located throughout the United States.

Standard text and data message rates will apply when texting from mobile phones. International text and data rates may apply from within U.S. territories and free association nations.

Who is at Risk for Emotional Distress?

People living in areas where wildfires often occur, particularly in communities in Arizona, California, Colorado, Utah, and other states, may be vulnerable to emotional distress. People who have struggled to recover from experiences with past wildfires also may experience distress. Other people at risk for emotional distress due to wildfires include:

Children and teens. After a wildfire, young people may worry that another one will happen again, especially if they witnessed the fire and the loss of their home. Some children may become withdrawn, while others may become agitated and irritable and display outbursts of anger.

Older adults. Older adults are more likely to need social support to reduce the effects of stress and move forward on the path of recovery. They also may have limited physical mobility and lack independence.

First responders and recovery workers. These individuals may experience prolonged separation from loved ones (depending on the severity of the wildfire) and show signs of mental fatigue.

Once warnings and evacuation orders are issued, the risk for emotional distress becomes greater:

You or your loved ones may feel unprepared, isolated, overwhelmed, or confused. Uncertainty about where to go during a wildfire, how to keep you and your loved ones safe, how to care for your pets, or whether you will be able to continue taking any medications can cause emotional distress.

You may lose contact with a loved one in an impacted area.

If you are relocated or lost your house to a wildfire, being in an unfamiliar environment can be difficult, especially for people with limited physical mobility, economic means, or knowledge of the English language.

Returning to a home, business, school, or place of worship impacted by a wildfire may cause additional distress, especially if there is structural damage. A temporary or permanent loss of employment may also occur.

Remember, too, that the anniversary of a disaster or tragic event can renew feelings of fear, anxiety, and sadness in disaster survivors. Certain sounds such as sirens can also trigger emotional distress. These and other environmental sensations can take people right back to the event, or cause them to fear that it's about to happen again. These " trigger events " can happen at any time.

People can experience a wide range of emotions before and after a disaster or traumatic event. There's no right or wrong way to feel. However, it's important to find healthy ways to cope when these events happen. Learn about coping tips for dealing with wildfires and other types of disasters.

Additional Resources for Wildfires

The SAMHSA Disaster Technical Assistance Center (DTAC) also helps states, territories, tribes, and local entities deliver an effective mental health and substance abuse (behavioral health) response to wildfires and other natural disasters. Learn more about these issues and find more disaster-related resources at Disaster Preparedness, Response, and Recovery.

# data[].attributes.attachment_link.description
Learn about who is most at risk for emotional distress from wildfires and where to find disaster-related resources. Wildfires are usually triggered by lightning or accidents and often go unnoticed at first. They can spread quickly and are especially destructive if they occur near forests, rural areas, remote mountain sites, and other woodland settings where people live.

# data[].attributes.attachment_link.readable_text
You might not be familiar with the term "compassion fatigue," but you probably recognize the idea behind it: it's the feeling that you have no more empathy left to give.

Compassion fatigue used to be something that mostly struck health care workers, first responders, law enforcement officers and at-home caregivers. But as the pandemic continues and the 24-hour news cycle brings nonstop news of suffering from around the world, we're all at risk of compassion fatigue.

Compassion fatigue is similar to burnout. But burnout usually stems from having too much work or too many responsibilities. Compassion fatigue comes from helping others-you want to keep helping, but you're overwhelmed from being exposed to the trauma of others.

Like burnout, compassion fatigue is a process. "It takes time to develop. It keeps building slowly, to a point where you start to not care about yourself or others in your life. You end up overusing your compassion skills and reserves, so you no longer have much to provide," said Yazhini Srivathsal, MD, a psychiatrist with Banner Behavioral Health Hospital in Scottsdale, AZ.

Watch for these symptoms of compassion fatigue

The sooner you notice signs of compassion fatigue, the sooner you can care for yourself and replenish your stores of empathy. Be on the lookout for:

Feeling exhausted physically and psychologically

Feeling helpless, hopeless or powerless

Feeling irritable, angry, sad or numb

A sense of being detached or having decreased pleasure in activities

Ruminating about the suffering of others and feeling anger towards the events or people causing the suffering

Blaming yourself and having thoughts of not having done enough to help the people who are suffering

A decreased sense of personal and professional accomplishment

A change in your worldview or spirituality

Physical symptoms, including sleep and appetite disturbances, nausea and dizziness

Here's how you can prevent and treat compassion fatigue

It's important to take steps to reduce compassion fatigue. Untreated, the symptoms of compassion fatigue can lead to mental health conditions like depression, anxiety, obsessive compulsive disorders and substance use disorders.

"It might sound cliché, but you need to put your own oxygen mask on before you help others with theirs," Dr. Srivathsal said. "We need to make sure we are tending to our own emotional and physical well-being and needs while we are involved in providing care for others."

Dr. Srivathsal recommends:

Finding a balance between your professional and personal life and taking time off if you can

Following self-care routines-get enough sleep, choose healthy food, exercise regularly and nurture social relationships

Avoiding information overload and paying attention to how stressful or traumatic information affects you

Identifying your priorities and engaging in activities that replenish and rejuvenate you

Practicing gratitude and being in the present moment

Understanding that suffering and pain are a part of the collective human experience, and that you do not always have control over them

Focusing on areas that you have control over, including your thoughts and feelings, rather than having unrealistic expectations about changing things that might be beyond your control

Seeking professional help if you need it

The bottom line

Helping others without replenishing yourself can be overwhelming and can lead to compassion fatigue. As soon as you recognize some of the warning signs, take steps to care for yourself and stay a step ahead of compassion fatigue.

If you need professional help to cope with compassion fatigue, reach out to connect with an expert at BannerHealth.com.

For more information about coping when you're overwhelmed, check out:

# data[].attributes.attachment_link.title
Compassion Fatigue: Watch for These Warning Signs | Banner

# data[].attributes.attachment_link.description
You might not be familiar with the term "compassion fatigue," but you probably recognize the idea behind it: it's the feeling that you have no more empathy left to give. Compassion fatigue used to be something that mostly struck health care workers, first responders, law enforcement officers and at-home caregivers.

# data[].attributes.attachment_link.readable_text
Compassion fatigue used to be a problem that was most commonly seen among health care professionals. Because their work puts them in situations where they commonly see or hear about ongoing and sometimes unspeakable suffering, it is not unusual to see some of our most skilled, caring, and compassionate "helpers" fall victim to compassion fatigue. However, in today's world, where every tragedy is instantly broadcast directly into our living rooms (TV), laps (laptop), and/or hands (smartphone), compassion fatigue is no longer unique to certain professions. As Dr. Amit Sood points out in his book, The Mayo Clinic Guide to Stress-Free Living, "... we are inundated with graphic images of the unimaginable suffering of millions. We can fathom the suffering of a few, but a million becomes a statistic that numbs us."

Signs of compassion fatigue include:

Feeling burdened by the suffering of others

Blaming others for their suffering

Isolating yourself

Loss of pleasure in life

Difficulty concentrating

Physical and mental fatigue

Bottling up your emotions

Increased nightmares

Feelings of hopelessness or powerlessness

Frequent complaining about your work or your life

Overeating

Excessive use of drugs or alcohol

Poor self-care

Beginning to receive a lot of complaints about your work or attitude

In fact, according to the Compassion Fatigue Awareness Project, "denial is one of the most detrimental symptoms" because it prevents those who are experiencing compassion fatigue from accurately assessing how fatigued and stressed they actually are, which prevents them from seeking help.

To see where you fall on the compassion satisfaction/fatigue continuum, take the Professional Quality of Life (PROQOL) questionnaire, which was developed by Dr. Beth Hundall Stamm, one of the world's leading experts on compassion fatigue. In addition to English, the PROQOL has been translated into 17 different languages, all of which can be found here. Although the measure was originally developed for professional "helpers," it can provide important feedback about compassion fatigue, burnout, and life stress for anyone who spends a good deal of time helping others.

If it turns out that you scored high on the compassion fatigue scale (or any of the others), there is hope. Like burnout or any other stress-related condition, compassion fatigue is not terminal, but it certainly can impact the quality of your life, and awareness is the first step to recovery. Dr. Stamm explains that through awareness and healthy self-care, those who experience compassion fatigue can start to understand the complexity of the emotions they've been "juggling and, most likely, suppressing." For those who find themselves in the throes of compassion fatigue, she recommends the following:

Enhance your awareness with education

Accept where you are on your path at all times

Exchange information and feelings with people who can validate you

Clarify your personal boundaries-what works for you and what doesn't

Be kind to yourself

Express what you need verbally, and

Take positive action to change your environment.

If your compassion fatigue score is low or average, that's good news, but it's important to take measures to protect yourself. To help prevent compassion fatigue, Dr. Sood recommends:

Limit the amount of daily news you watch or read about

Try to comes to terms with the fact that pain and suffering are realities of life over which we have little or no control

Be grateful for what is good in your life and in the world

Try to find some meaning in the suffering you see

If you must blame something, blame the situation, not the person

Show compassion to yourself by being kind, soothing, and comforting to yourself

Citing research from the University of Michigan and the University of Rochester Medical Center that found that empathy among students has declined by more than 40 percent compared to the late 1970s, Dr. Sood says that we live in a world that desperately needs more compassion. So, the last thing we need is for those who are most adept at giving and showing compassion to lose that gift to something completely avoidable. By being aware of the warning signs of compassion fatigue, you can prevent it and continue to do what you do best-change lives for the better with one act of kindness at a time.

© 2014 Sherrie Bourg Carter, All Rights Reserved

Follow Dr. Bourg Carter on Facebook and Twitter.

# data[].attributes.attachment_link.title
Are You Suffering from Compassion Fatigue?

# data[].attributes.attachment_link.description
Compassion fatigue used to be a problem that was most commonly seen among health care professionals. Because their work puts them in situations where they commonly see or hear about ongoing and sometimes unspeakable suffering, it is not unusual to see some of our most skilled, caring, and compassionate "helpers" fall victim to compassion fatigue.

# data[].attributes.headline
Surviving Tough Time by Building Resilience

# data[].attributes.subject
Surviving Tough Time by Building Resilience

# data[].attributes.attachment_link.readable_text
stress management
Whether you're facing a global or personal crisis-or a mix of both-building resilience can help you cope with stress, overcome adversity, and enjoy the better days to come.

Experiencing hardship and adversity

Lately, the world seems to be lurching from one crisis to another. We've experienced a global pandemic, dramatic changes to how we conduct our daily lives, economic uncertainty, and political and social turmoil, as well as an array of natural disasters. Then there are personal traumas that people are also dealing with, such as the loss of a loved one, declining health, unemployment, divorce, violent crime, or tragic accidents. For many us, this is a time of unprecedented struggle and upheaval.

Whether the source of disruption in your life is a global emergency or a personal tragedy-or both-living through difficult times can take a heavy toll on your mood, health, and outlook. It can leave you feeling helpless and overwhelmed by stress and anxiety. You may be painfully grieving all that you've lost, flooded by a slew of difficult, conflicting emotions, or uncertain about how to move on with your life. You may even feel that your life is totally out of control and you're powerless to affect whatever may happen next.

While there's no way to avoid sorrow, adversity, or distress in life, there are ways to help smooth the rough waters and regain a sense of control. Resilience is the ability to cope with the loss, change, and trauma that have been inevitable parts of life even before these extraordinary times. Building resilience can help you better adapt to life-changing events, cope with turbulent times, and bounce back from hardship and tragedy.

The role of resilience in times of crisis

Why do some people seem to be better able to cope in these troubling times than others? While everyone's situation is different, it is true that people with resilience tend to have a higher tolerance for the emotional distress generated by hard times. The more resilient you are, the better you're able to tolerate the feelings of stress, anxiety, and sadness that accompany trauma and adversity-and find a way to rebound from setbacks.
[Read: How to Cope with Traumatic Events]
We all go through bad times, we all experience disappointment, loss, and change, and we all feel sad, anxious, and stressed at various times in our lives. But building resilience can help you to maintain a positive outlook, face an uncertain future with less fear, and get through even the darkest days.

Building resilience

If you're more sensitive to emotional distress and are finding it difficult to cope with hardship or adversity, it's important not to think of it as some kind of character flaw. Resilience isn't a macho quality and it isn't fixed; it's an ongoing process that requires effort to build and maintain over time.

Unless you've faced adversity in your life before, it's unlikely you've had the need or opportunity to develop resilience. Drawing on past experiences can help you cope with the challenges you're facing today. Even if you've struggled to cope with adversity in the past, you may at least be able to recognize some of the ways of coping that DON'T help, such as trying to numb your feelings with drugs or alcohol.

While it's often difficult to imagine anything good coming out of traumatic experiences, building resilience can help you find any positives in the difficulties you've faced. Surviving hardships can teach you important things about yourself and the world around you, strengthen your resolve, deepen your empathy, and in time enable you to evolve and grow as a human being.

Building resilience can also help you to:

Stay focused, flexible, and productive, in both good and bad times.

Feel less afraid of new experiences or an uncertain future.

Manage and tolerate strong emotions outside your comfort zone, even those you'd rather avoid like anger or despair.

Strengthen your relationships and improve your communication skills, especially under pressure.

Bolster your self-esteem.

Be confident you'll eventually find a solution to a problem, even when one isn't immediately apparent.

You can develop and improve these qualities of resilience at any time, regardless of your age, background, or circumstances. The following tips can help you face hardships with more confidence, better cope with these tumultuous times, and make it through to the brighter, more hopeful days ahead.

Building resilience tip 1: Practice acceptance

While we all react to stressful events in different ways, many of us try to protect ourselves by refusing to accept the truth of what's happening. After all, by denying that you're even experiencing a crisis, you can kid yourself that you still have some sense of control over what are usually uncontrollable events.

While denial can have some positive functions-it can give you an opportunity to come to terms with the shock of a traumatic event, for example-over time, it will just prolong your pain. Staying in denial will prevent you from adapting to your new circumstances, stop you from seeking solutions or taking action, and stifle the healing process.

Accept the situation

Change is an inevitable part of life and many aspects of the changing world are outside your individual control. You can't control the spread of a virus, for example, the pace of social change, or how the economy behaves. While it can be tough to acknowledge, railing against events or circumstances outside your control will only drain you of energy and leave you feeling anxious and hopeless. Accepting your situation, on the other hand, can free you up to devote your energy to the things that you do have control over.

Focus on things within your control. Make a list of all the things you can't control and give yourself permission to stop worrying about them. Instead, focus on the action that you can take. If you're unemployed, you can't control whether the ideal job appears in the wants ads or whether an employer will grant you an interview. But you can control how much time and effort you put into searching for work or brushing up on your skills. Similarly, if a loved one is facing a life-threatening illness, you may have to relinquish control to the medical experts, but you can still focus on providing your loved one with as much emotional support as possible.

Accept change by looking to your past. Looking back at examples where you've coped with uncertainty and change before can help you accept your current situation. Perhaps you suffered a painful breakup in the past and were eventually able to move on with your life, or you lost a job and ended up finding a better one? Examining your past successes can also help you see past the current crisis and derive some confidence that you'll be able to pull through again.

Accept your feelings

It's tempting to believe that the best way to get through hard times is by ignoring painful emotions and "putting on a brave face". But unpleasant emotions exist whether you choose to acknowledge them or not. Trying to prevent your emotions from surfacing will only fuel your stress, delay acceptance of your new situation, and prevent you from moving on.

By allowing yourself to feel your emotions, you'll find that even the most intense, upsetting feelings will pass, the trauma of these tough times will start to fade, and you'll be able to find a path forward. Talk to someone you trust about what you're experiencing or use HelpGuide's Emotional Intelligence Toolkit to reconnect with your emotions.

Grieve your losses

Undergoing tough times usually involves some kind of loss. Whether it's the loss of a loved one, the loss of a job, or the loss of your old life, it's important you allow yourself the opportunity to grieve. Only by facing your grief -acknowledging and mourning your losses-will you be able to heal and eventually move on with your life.

Tip 2: Reach out to others

Connecting with friends and family when you're going through tough times can help ease stress, boost your mood, and make sense of all the change and disruption. Instead of feeling like you're facing your problems alone, you can draw strength and build resilience from having others to lean on.

The people you reach out to don't need to have answers to the problems you're facing; they just need to be willing to listen to you without judging. In fact, what you talk about or the words used are often unimportant. It's the human connection-eye contact, a smile, or a hug-that can make all the difference to how you're feeling.

Prioritize relationships. Nothing carries the same health benefits as connecting face-to-face with someone who is caring and empathetic. These days, however, it's not always possible to see friends and loved ones in person. If you're kept apart by geography, lockdown, or travel restrictions, for example, reach out to others via phone, video chat, or social media.

Don't withdraw in tough times. You may be inclined to retreat into your shell when you're facing challenges in your life. You may fear being a burden to friends and loved ones or feel too exhausted to reach out. But try to keep up with social activities even when you don't feel like it. Good friends won't consider you a burden-they're more likely to feel flattered that you trust them enough to confide in them.

Try to avoid negative people. Some friends are good listeners, kind and empathetic. Others seem to only fuel negative emotions, leaving you feeling even more stressed, anxious, or panicky. Try to avoid anyone who magnifies your problems, criticizes, or makes you feel judged.

Expand your social network. Even though relationships are vital for good mental health, building resilience, and getting through tough times, many of us feel that we don't have anyone to turn to in times of need. But there are plenty of ways to build new friendships and improve your support network. If you know others who are lonely or isolated, be the one to take the initiative and reach out.

Tip 3: Invest in self-care

Living through tough times can be both mentally and physically draining. Constantly being in a heightened state of stress can lead to serious health problems, impact your immune and digestive systems, increase your risk of heart attack and stroke, and lead to burnout, a state of emotional, physical, and mental exhaustion.

Since the body and mind are so closely linked, investing in self-care is an important part of building resilience and getting through times of great stress. When your body feels strong and healthy so, too, will your mind.

Get enough exercise. When you're dealing with chronic stress, you likely carry it somewhere in your body. Maybe your muscles are tense, you have back or neck pain, frequent headaches, insomnia, heartburn, or an upset stomach? Getting regular exercise not only releases powerful endorphins in the brain to improve your mood, but it can also help to ease tension in the body and counteract the physical symptoms of stress.

Practice a "mind and body" relaxation technique. Practices such as yoga, tai chi, and meditation blend deep breathing and body awareness to help you relieve stress and bring your nervous system back into balance. Try one of HelpGuide's audio meditations to boost your physical and emotional well-being.
[Listen: Inner Strength Meditation]
Improve your sleep. When you're facing adversity, nothing wears down your resilience like missing out on a good night's sleep. Often, improving your daytime habits and taking the time to relax and unwind before bed can help you sleep better at night.

Eat well. There are no specific foods that can help build resilience and weather tough times. Rather, it's your overall dietary pattern that's important. Eating lots of processed and takeout food can take a toll on your brain and mood, sapping your energy, and weakening your immune system. A healthy diet, on the other hand-one that's low in sugar and rich in healthy fats-can give you the energy and focus to tackle the challenges you're facing.

Manage your overall stress levels

Taking steps to manage your overall stress can break the hold it has over your life, improve your mood, and help you build the resilience you need to hold up under pressure at this time.

Tip 4: Look for meaning and purpose

It's easy to get overwhelmed by frightening headlines or consumed by the crisis you're facing. But whatever your circumstances, it doesn't have to define you as a person. You are not your crisis. By pursuing activities that bring purpose and meaning to your life, you can keep your problems in perspective, prevent them from overwhelming you, and maintain your identity.

Everyone is different so we all have different ways of experiencing purpose and meaning. Don't limit yourself by others' expectations; pursue activities that are important to you and add satisfaction to your life.

Give help to others. When you're in the midst of a crisis, it's common to feel powerless and helpless. By proactively helping others, you can regain a sense of control as well as find purpose in your life. In fact, giving support can be just as beneficial as receiving support. Try volunteering, helping others in your neighborhood, giving blood, donating to a charity, or marching for a cause that's important to you.

Pursue your hobbies and interests. In turbulent times, it's important not to cast aside interests that nourish your spirit. For many of us, it's these things that define us as individuals and bring meaning to our lives. Whether it's playing a sport, caring for a pet, an artistic or musical endeavor, home improvement projects, or spending time in nature, continuing to draw pleasure from your pastimes adds to your ability to cope with the stress of difficult times.

Tip 5: Stay motivated

An important part of coping with adversity and making it through tough times is to foster qualities of persistence and endurance. Tough times don't last forever, but by their very nature they're rarely over quickly. As you plot a road through the darkness, you need to find ways to stay motivated and persevere.

Deal with your problems one step at a time. If a problem is too big to deal with all at once, try breaking it down into smaller, more manageable steps. If your problem seems to have no possible solution, you can still take action by drawing up a list, researching more about the subject, or seeking the advice of a trusted friend or loved one.

Celebrate small wins. To stay motivated and positive as you navigate stormy seas in life, take a moment to savor your small successes. If you're looking for work, for example, getting an interview isn't as meaningful as landing a job, but it's a sign of progress, a step in the right direction. Noting these small wins can give you a welcome break from all the stress and negativity you're facing and encourage you to keep going.
[Read: Finding Joy During Difficult Times]
Try to maintain a hopeful outlook. While it's difficult to stay positive and hopeful in the midst of a crisis, many of us tend to blow our problems out of proportion and make them seem even more negative than they really are. Try taking a step back and examining your situation as an outsider. Are their rays of hope that you can focus on? Instead of worrying about what you fear may happen, try visualizing what you'd like to happen instead.

Express gratitude. It may sound trite, but even when you're experience terrible times, it's usually possible to find one thing you can be grateful about-the love of a pet, for example, a beautiful sunset, or a caring friend. Taking a moment to acknowledge your gratitude for such small things can provide respite from the stress and really boost your mood.

Be kind to yourself. Everyone adjusts to change and upheaval differently. Don't criticize your coping skills or beat yourself up for every mistake you make. Self-compassion is an important part of building resilience, so go easy on yourself.

# data[].attributes.attachment_link.title
Surviving Tough Times by Building Resilience - HelpGuide.org

# data[].attributes.attachment_link.description
stress management Lately, the world seems to be lurching from one crisis to another. We've experienced a global pandemic, dramatic changes to how we conduct our daily lives, economic uncertainty, and political and social turmoil, as well as an array of natural disasters.

# data[].attributes.headline
How to Help Families and Staff Build Resilience During the COVID-19 Outbreak

# data[].attributes.subject
How to Help Families and Staff Build Resilience During the COVID-19 Outbreak

# data[].attributes.body
Welcome to the RCRC Parent Resource padlet, made possible by our Mental Health Services Act F.A.S.T. (Families and Supports Together) Grant.  The overarching goal of our grant is to increase the social/emotional competencies of children (ages 0-5) and their families within the Redwood Coast Regional Center (RCRC) catchment area through direct service, training opportunities for parents and providers, and community collaboration. Please follow the above link to learn more about the MHSA F.A.S.T. grant.

# data[].attributes.attachment_link.readable_text
MENTAL HEALTH SERVICES ACT

Department of Development Services

Fiscal Years 2020/2021 through 2022/23
WHAT IS IT?
The Department of Developmental Services distributes Mental Health Services Act (MHSA) funds to Regional Centers in three-year cycles utilizing a competitive application process. The Mental Health Services Act (2004 Proposition 63) focuses on "wellness; recovery; and resilience". Projects are evaluated and awarded based on how (in collaboration with key stakeholders) they address prevention, early intervention, and treatment for children, families, and adult consumers with mental health diagnosis. GOAL: To promote inter-agency collaboration; improved clinical capacity; and enhanced effectiveness of direct services. This is the first MHSA Grant for which RCRC applied. Our F.A.S.T. Grant was written to address the DDS priorities of (1) early mental health/social and emotional development in infants and toddlers in coordination with Family Resource Centers and/or other Community Partners and (2) projects that develop and/or use technological applications to increase access to services for underserved populations. Former RCRC Clinical Director, Dr. Lucille Esralew, submitted our Grant application on 2/12/20 (pre-Covid) with broad-based letters of community support and the F.A.S.T. Grant for Early Intervention was one of only 3 grants awarded by the State of California on 8/13/20 in this Grant Cycle.
A "FAST TRIP" THROUGH THE F.A.S.T. GRANT
PURPOSE - To increase social/emotional competencies of children (ages 0-5) and their families for Status 1 and Status 2 eligible children within the Redwood Coast Regional Center catchment area. Building upon the existing SSIP (State Systemic Improvement Plan), RCRC has identified the need to extend intervention services focused on social/emotional health for children 3-5, so that we are targeting services for children 0-5 across all four counties for the period of the grant. We anticipate service providers to be equipped to provide these services according to evidence-based practices; that families' knowledge base and resiliency will be increased and strengthened; and that the children involved in this grant project will demonstrate measurable progress in social/emotional competencies.
GOALS AND OBJECTIVES -

1. To host events and training's to build workforce capacity in supporting social/emotional development

2. To promote evidence-based initiative-programs to increase the social/emotional skills of young children 0-5

3. To increase our network of parents and collaborative partners with shared goals and strategies for building the social/emotional skills of young children.

APPROACH -
Following the Person-Centered approach of "What's working and what's not?" identify existing specific strengths within our catchment area and seek to expand them - while also identifying existing barriers and plan ways to overcome them.

To build upon existing structures in current counties of service in Year One of Grant, begin to expand to additional counties in Year Two, and expand catchment wide by Year Three (contemporaneous flow from North to South and South to North).
STRENGTHS TO EXPAND AND SHARE CATCHMENT WIDE BY END OF GRANT CYCLE:

1. Dr. Robin Kissinger's work at the North Coast Nurture Center in Humboldt County - grant will provide $ for Dr. Kissinger to purchase, provide training, and implement "The Incredible Years" evidence-based mental health curriculum for children 0-5 making it available to more children and families.

2. Easter Seals of Northern California's work in Early Intervention in Lake County - grant will provide $ to establish Early Intervention Services and Social Learning Groups ages 0-3 utilizing Family Guided Routines-Based Intervention (FGRBI) evidence-based approach and expanding those services to children 0-5.

3. RL Therapies - providing OT, PT, and Speech in Lake and Mendocino counties by POS according to to FGRBI evidence-based practices through teletherapy - grant will provide $ for RL Therapies to purchase apps, wi-fi-, and hot spots for families who cannot access Early Start Services due to barrier of low-income rural communities.

4. Autism Intervention Professionals - 10 clients per year Northern Counties and 10 clients per year Southern Counties

funded by POS - grant will provide $ for behavioral consultation in implementing FGRBI strategies with behavioral services clients utilizing technological applications through curriculum/program development, parent consultation, and data review and analysis
PROGRESS REPORTING REQUIREMENTS -

1. All assessors in the catchment area will be trained in best practice administration of the Developmental Assessment of Young Children (DAYC2) to insure consistency of administration catchment wide.

2. Baseline data will be gathered at Entry Assessment (DAYC2); goals and measurable criteria to be included on IFSP/IPP; progress monitored routinely through Intervention; Review Assessments at regular IFSP/IPP Meetings; and Exit Assessment (DAYC2) performed when child turns 3 and 5 (or termination of Grant). IY progress to be measured according to Dr. Kissinger and Clinical Staff designated tool.

MAKING A DIFFERENCE TOGETHER - FIND OUT MORE!!!
Please "check-out" our Padlets of Resources for Parents and Providers including information on past and upcoming Parent and Provider Academies offered by top experts in their fields - strengthening and encouraging families and building up the skill-sets of our providers according to evidence-based practices (proven effective child-centered, family-friendly strategies and techniques).

# data[].attributes.attachment_link.title
Mental Health Services Act Grant Project

# data[].attributes.attachment_link.description
MENTAL HEALTH SERVICES ACT Department of Development Services Fiscal Years 2020/2021 through 2022/23 WHAT IS IT? The Department of Developmental Services distributes Mental Health Services Act (MHSA) funds to Regional Centers in three-year cycles utilizing a competitive application process. The Mental Health Services Act (2004 Proposition 63) focuses on "wellness; recovery; and resilience".

# data[].attributes.headline
Red Flags for Social-Emotional Development 0-5

# data[].attributes.subject
Red Flags for Social-Emotional Development 0-5

# data[].attributes.attachment_link.title
Red Flags for Social Emotional Development 0-5 (Across Domains) R

# data[].attributes.headline
ESNORCAL Family Guided Routines Based Intervention (FGRBI ) training 5-30-2021

# data[].attributes.subject
ESNORCAL Family Guided Routines Based Intervention (FGRBI ) training 5-30-2021

# data[].attributes.headline
Infant and Early Childhood Mental Health: Relationship-Centered Principles and Practices for Early Intervention

# data[].attributes.subject
Infant and Early Childhood Mental Health: Relationship-Centered Principles and Practices for Early Intervention

# data[].attributes.headline
The Learning Curve-Knowledge of Early Child Development

# data[].attributes.subject
The Learning Curve-Knowledge of Early Child Development

# data[].attributes.body
The Learning Curve is a self-assessment tool for early childhood practitioners that helps to explore their knowledge of early child development and helps one figure out areas for self improvement.

# data[].attributes.attachment_link.title
Knowledge of Early Child Development - The Learning Curve

# data[].attributes.attachment_link.description
The Learning Curve is a self-assessment and self improvement tool that helps you explore your knowledge of early child development.

# data[].attributes.headline
Normative Fears of Early Childhood: Featuring Dr. Alicia Lieberman

# data[].attributes.subject
Normative Fears of Early Childhood: Featuring Dr. Alicia Lieberman

# data[].attributes.body
Dr. Alicia Lieberman describes normative fears of early childhood, and helps us understand foundational knowledge for working with young children.

# data[].attributes.attachment_link.title
Normative Fears of Early Childhood: Featuring Dr. Alicia Lieberman

# data[].attributes.body
In this 3 minute video, Dr. Brené Brown reminds us that we can only create a genuine empathic connection if we can get in touch with our own fragilities

# data[].attributes.headline
Alicia Lieberman: Key Relationships in the First Three Years of Life

# data[].attributes.subject
Alicia Lieberman: Key Relationships in the First Three Years of Life

# data[].attributes.attachment_link.title
Alicia Lieberman: Key Relationships in the First Three Years of Life

# data[].attributes.headline
California Association for Infant Mental Health website

# data[].attributes.subject
California Association for Infant Mental Health website

# data[].attributes.attachment_link.readable_text
Developmentally sensitive care stands on a foundation of safety. Yet we find ourselves in a moment where many of us feel our safety is lost. The deaths of African-Americans at the hands of police shake us to our core. California's stay-at-home policies have fractured many of the natural support networks that families rely on-the social connections that are their points of resilience.

Everyone is experiencing a stressful time. And for some families, past experiences with trauma make the current stress even harder to bear. For families who have faced historical racism, there is fear that nothing will change the system of oppression and violence.

Infants and young children depend on attuned relationships with their caregivers to feel safe . . . to connect with others . . . to grow up to be compassionate, tolerant members of society. Parents and caregivers who are facing toxic stress find their ability to stay attuned to their children becomes compromised.
As we reflect on the pain, the despair, the injustice that we see around us . . .

We also see that a gift of California is the richness of our diversity. We can bring together the wisdom, values, and passions of multiple perspectives to strengthen our communities.

And a gift of CalAIMH members is their commitment to lifting up young children and their families, through the dedication of our daily work. CalAIMH members mend trauma through nurturing, healing relationships. We hold reflective space for our colleagues and trainees, supporting and lifting up one another, so that we can all take another step forward. We advocate for fair and equitable funding and resources for the most vulnerable.

There are many paths to change . . . infant mental health offers a path of relational health. Knowing that our work with families is critical, now is the time to recommit ourselves to our service. Knowing that our work with families is not enough to change the systems that put them at risk, now is the time to advocate for change.

CalAIMH Executive Committee

Our purpose is clear

We want to bring together organizations and individuals who promote caregiver-child relational approaches; we want to prevent, and heal, adversity in young children. Learn more...

Interview with Mona Delahooke, Ph.D on children's behavior

CalAIMH inaugural member, licensed clinical psychologist, and author, shares her insights on the neurological functions that often drive children's behavior.

Dr. Nadine Burke Harris

Surgeon General of California, discusses the importance of infant mental health and the honor of being the recipient of the 2019 Alicia Lieberman Infant Mental Health Leadership Award.

Donate to CalAIMH

You can make a difference right now.

# data[].attributes.attachment_link.description
We want to bring together organizations and individuals who promote caregiver-child relational approaches; we want to prevent, and heal, adversity in young children. Learn more... Interview with Mona Delahooke, Ph.D on children's behavior CalAIMH inaugural member, licensed clinical psychologist, and author, shares her insights on the neurological functions that often drive children's behavior.

# data[].attributes.headline
Attachment Vitamins ©Addressing Attachment, Stress, and Trauma in Early Childhood

# data[].attributes.subject
Attachment Vitamins ©Addressing Attachment, Stress, and Trauma in Early Childhood

# data[].attributes.headline
California Compendium of Training Guidelines, Personnel Competencies, and Professional Endorsement Criteriafor Infant-Family and Early Childhood Mental Health

# data[].attributes.subject
California Compendium of Training Guidelines, Personnel Competencies, and Professional Endorsement Criteriafor Infant-Family and Early Childhood Mental Health

# data[].attributes.headline
DIVERSITY-INFORMED TENETS FOR WORK WITH INFANTS, CHILDREN AND FAMILIES

# data[].attributes.subject
DIVERSITY-INFORMED TENETS FOR WORK WITH INFANTS, CHILDREN AND FAMILIES

# data[].attributes.headline
Facilitating Attuned Interactions (FAN) Training Description

# data[].attributes.subject
Facilitating Attuned Interactions (FAN) Training Description

# data[].attributes.attachment_link.title
FAN Training Description and Learning Objectives - Level 1, 2, Day3 (2)

# data[].attributes.headline
The Basics of Infant and Early Childhood Mental Health

# data[].attributes.subject
The Basics of Infant and Early Childhood Mental Health

# data[].attributes.attachment_link.title
The Basics of Infant and Early Childhood Mental Health_ A Briefing Paper

# data[].attributes.headline
Infant and Early Childhood Mental Health

# data[].attributes.subject
Infant and Early Childhood Mental Health

# data[].attributes.body
Understanding infant mental health is the key to preventing and treating the mental health problems of very young children and their families. It also helps guide the development of healthy social and emotional behaviors. Learn more about infant mental health and how important trusted relationships are for infants and children.

# data[].attributes.attachment_link.keywords[]
infant and early childhood mental health

# data[].attributes.attachment_link.title
Infant and Early Childhood Mental Health - ZERO TO THREE

# data[].attributes.attachment_link.description
This session addresses a wide range of areas from the importance of attachment, building relationships, responsive caregiving as well as disorders that can disrupt these processes. Staff will gain a better understanding of the mental health needs of infants, toddlers, and young children and their families and strategies for supporting them.