title: Children with medical complexity: a scoping review of interventions to support caregiver stress.
abstract: Caring for children with chronic and complex medical needs places extraordinary stress on parents and other family members. A scoping review was undertaken to identify and describe the full range of current interventions for reducing caregiver stress.
  
  
  
  Applying a broad definition of caregiver stress, a systematic search of three scientific databases (CINAHL, Embase and Ovid Medline), a general internet search and hand searching of key peer-reviewed articles were conducted. Inclusion criteria were as follows: (i) published in English between 2004-2016; (ii) focused on familial caregivers, defined as parents, siblings or extended family; (iii) targeted children/youth with medical complexity between the ages of 1-24 years; and (iv) described an intervention and impact on caregiver stress. Data on type of intervention, study design and methods, measures and overall findings were extracted.
  
  
  
  Forty-nine studies were included from a list of 22 339 unique titles. Six domains of interventions were found: care coordination models (n = 23); respite care (n = 8); telemedicine (n = 5); peer and emotional support (n = 6); insurance and employment benefits (n = 4); and health and related supports (n = 3). Across studies, there was a wide variety of designs, outcomes and measures used.
  
  
  
  Positive findings of reductions in caregiver stress were noted within an emerging body of evidence on effective interventions for families of children with medical complexity. A commonality across domains was a significant focus on streamlining services and reducing the burden of care related to varied pressures experienced, including time, finances, care needs and service access, among others. There was non-conclusive evidence however around which of the six identified intervention domains or combination thereof are most effective for reducing stress. These promising findings demonstrate that stress reduction is possible with the right support and that multiple interventions may be effective in reducing burdens of care experienced by families of children with medical complexity.
authors.affiliation: Evidence to Care, Teaching and Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Edelstein
authors.affiliation: Evidence to Care, Teaching and Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Schippke
authors.affiliation: Evidence to Care, Teaching and Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Sheffe
authors.affiliation: Evidence to Care, Teaching and Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.|Department of Occupational Science and Occupational Therapy, and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.|Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Kingsnorth
mesh_terms: D017028:Caregivers / Q000523:psychology*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy*; D019988:Children with Disabilities; D006801:Humans; D020407:Internet; D012944:Social Support; D013315:Stress, Psychological / Q000517:prevention & control*
keywords: child disability; chronic (health) condition; complex needs; parents; stress