Better Outcomes For Children Research Articles

Parental poverty, physical neglect and child welfare intervention: Dilemma and constraints of child welfare workers in Ghana

Background and PurposeThere is ample evidence in the literature to suggest that poverty and deprivation are strong correlates of parent and caregiver neglect. With specific reference to physical child neglect, the impact of poverty complicates child welfare interventions, especially in developing economies where parent and caregiver poverty are commonplace. This study explores the dilemma and constraints of child welfare workers when intervening in physical neglect cases involving poor parents. The study draws attention to the unique situation of developing countries as far as the issue of parental poverty and child welfare practice is concerned and highlights informal measures that promote child welfare practice, thereby ensuring better outcomes for children and families. MethodIn-depth interviews were conducted with 13 child welfare workers (10 females, three males) from three social welfare agencies in the Ashanti region of Ghana, using a semi-structured interview guide. The interviews were coded and analysed thematically with the assistance of NVivo 12 data management software. ResultsNon-existence of targeted family support programs, inability to develop child maintenance plans and the lack of adequate alternative care homes were found to be common constraints that affect child welfare workers’ intervention in physical neglect cases involving poor parents. The study shows that the development of child maintenance plans, which constitutes the typical approach used to address child neglect in Ghana, becomes inconsequential when parents neglect children due to poverty and deprivation. However, the results showed that focusing on informal traditional community resources could be a useful alternative in the development of intervention plans for poor families and their neglected children. ConclusionThe findings indicate the need to critically evaluate how the informal traditional child protection practices can be revived, enhanced and incorporated into formal child welfare practice.

Dependence of pancreas resection volume on PET-tomography and express biopsy findings

Introduction. Recently, achievements in molecular genetics, imaging techniques (PET/CT), medicamentous therapy as well as in surgical treatment have promoted a better control of hypoglycemia and, consequently, better outcomes in children with congenital hyperinsulinism.Purpose. To specify indications, volume and outcomes of surgical treatment in patients with congenital hyperinsulinism depending on pathology form, differential diagnostics with PET / CT and intraoperative express biopsy.Material and methods. 41 children with congenital hyperinsulinism were operated in the department of pediatric surgery in Almazov National Medical Research Centre (Saint-Petersburg) during 2011 – September 2020. In Group 1, there were 6 children who had standard treatment with subtotal resection of the pancreas (95%). In Group 2, there were 35 patients who had PET tomography with 18-F-DOPA before surgery and intraoperative express biopsy of pancreas tissue. The analyzed patients were operated on in 2017-September 2020. PET tomography with 18-F-DOPA findings revealed that these children had 10 diffuse forms and 22 focal forms; the other 3 children had a disputable picture.Results. After surgery, diffuse form was confirmed in 10 (29%) children; focal form - in 21 (60%) children; 4 (11%) patients had the atypical form which was diagnosed intraoperatively. Of 35 children from Group 2, 33 (94%) had complete hyperinsulinism reversal, significant improvement in their psycho-motor function; however, 10 (29%) of them require insulin replacement therapy with minimal dosages - 8 children with the diffuse form of hyperinsulinism and 2 children with the atypical one. There were no intra- and postoperative complications. 20 (95%) out of 21 children with focal forms recovered completely. The authors also describe problems and peculiarities of urgent histological examination.Conclusion. Thus, partial pancreatectomy in focal forms, subtotal in atypical ones and almost total in diffuse forms allows to cope with hypoglycemia caused by congenital hyperinsulinism.

Risk indicators in families with abused children and young people: scoping review

The promotion of rights and the protection of children implies involvement between state agencies and families in the evaluation processes, having developed in the child Welfare systems Internation...

Opsoclonus-myoclonus-ataxia syndrome in children.

Opsoclonus-myoclonus-ataxia syndrome is a rare neuroimmunologic disorder typically presenting in previously healthy infants and toddlers. It is characterized by a clinical triad of (1) erratic saccadic intrusions; (2) myoclonus and/or ataxia; (3) behavioral features, typified by developmental plateauing, irritability and insomnia. About half of cases are associated with an underlying neuroblastoma and diagnostic imaging is essential once OMAS is suspected. A thorough workup, including serum, urine, and cerebrospinal fluid studies is critical to identify underlying biomarkers of OMAS itself or neuroblastoma. Historically, many children had relatively poor long-term outcomes, with residual neurologic and/or neuropsychiatry sequelae typical. More recent concepts have emphasized combined immunotherapy regimens that offer hope for better outcomes in children with this remarkable, challenging disease.

Disruption of Patient and Family Centered Care Through the COVID-19 Pandemic

Disruption of Patient and Family Centered Care Through the COVID-19 Pandemic

Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines.

Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines.

A Proof-of-Concept Pilot for an Intervention with Pregnant Mothers Who Have Had Children Removed by the State: The ‘Early Family Drug and Alcohol Court Model’

This paper describes a ‘proof-of-concept’ pilot of the ‘Early FDAC model’. The evaluated Family Drug and Alcohol Court (FDAC) model, on which Early FDAC is based, is summarised and the rationale for introducing the pilot variation is set out. This short paper describes the learning from the pilot that set out to work with 30 families across three FDAC teams between 2015 and 2019. At the time of the pilot, there were, and remain, few other interventions in England for pregnant mothers who have already had children removed. An adaptation of the evaluated FDAC model suggested itself because of the overlap with families in public law care proceedings and emerging evidence that FDAC delivers a better experience of justice for families and professionals, better outcomes for children and families and better use of public money. Pilot families were engaged as soon as possible in the pregnancy (hence ‘Early’), and continued to receive support for up to two years. The process started in pre-proceedings with the aim of avoiding court. Where proceedings were necessary, cases were heard in an FDAC court, with provision for a post-proceedings phase. There were problems with recruitment and engagement and families had fewer ‘solvable problems’. Nevertheless, outcomes were promising, with 18 families keeping their children. This represents one-third of the referred families and almost two-thirds of the families who undertook a ‘Trial for Change’.

Regulating the traditional kinship care practice in Ghana: Reflections from young people with kinship care experience.

Kinship care has become a favourable alternative care option for orphans and vulnerable children without adequate parental care in Ghana. However, kinship care practices in Ghana are considered informal cultural practices without formal regulations. The absence of formal regulations could have consequences on the health and development of children due to the lack of proper supervision and empirical assessment of children's needs. In line with recent policy discussions on mechanisms to regulate informal kinship care practices, this study aimed to identify how the State could be involved in improving kinship care experience for children. Qualitative in-depth interviews were conducted with 22 young persons (aged 18-23) who had been received into kinship care to share their experiences on how the State could be involved in improving kinship care experience for children. Narratives from the young people were analysed following the constructivist grounded theory approach. Introduction of a welfare scheme for kinship caregivers, policy on child care, provision of start-up capital and training for caregivers, were measures suggested by the young people to improve kinship care practice. Providing start-up capital to kinship caregivers was identified to mitigate caregivers' unemployment challenges, which could have ripple effects on the well-being of children by escalating caregiver stress. The study's findings suggest that the State has a significant role to ensure that caregivers are equipped with the needed resources to provide adequate care for children. Regulating kinship care practices should embrace a strength-based empowerment model that builds on the capacity of the caregivers to ensure better outcomes for children. Studies that explore the views of policy makers and caregivers in a larger sample may yield promising results to complement the current findings.

Establishing Identity: How Direct‐to‐Consumer Genetic Testing Challenges the Assumption of Donor Anonymity

The rise of direct‐to‐consumer genetic testing is challenging the rules and expectations of the fertility industry concerning donor anonymity. While ethicists debate whose rights should prevail, many donor conceived people, recipient parents and donors are currently sharing their genetic information, along with methods to identify genetic links, in vast online communities, invalidating donor anonymity and providing a platform for those who advocate globally for legislative change to support donor‐linking practices. This article looks at why it is important to access this information in relation to identity and kinship formation and how the Family Court Community can apply this knowledge in order to achieve better outcomes for children and families.

Better Decisions for Children with “Big Data”: Can Algorithms Promote Fairness, Transparency and Parental Engagement?

Most countries operate procedures to safeguard children, including removal from parents in serious cases. In England, care applications and numbers have risen sharply, however, with wide variations not explained by levels of socio-economic deprivation alone. Drawing on extensive research, it is asserted that actuarial decision tools more accurately estimate risks to children and are needed to achieve consistency, transparency, and best outcomes for children. To date, however, child protection has not achieved gains made within comparable professions through statistical methods. The reasons are examined. To make progress requires understanding why statistical tools exert effect and how professionals use them in practice. Deep-rooted psychological factors operating within uncertainty can frustrate processes implemented to counter those forces. Crucially, tools constitute evidence; their use and interpretation should not fall to one practitioner or professional body and modifications must be open to scrutiny and adjudication. We explore the potential of novel big data technology to address the difficulties identified through tools that are accurate, simple, and universally applied within child protection. When embraced by all parties to proceedings, especially parents and their advisors, despite societal fears, big data may promote transparency of social work and judicial decisions.

Awareness about Autism Spectrum Disorder (ASD) among Parents of Typically Developing Children

Autism spectrum disorder (ASD) is a neurodevelopmental disorder common among children. Special attention is frequently given to the early detection of ASD for early treatment implementation, which improves these children’s outcomes. Enhanced public awareness is necessary to prevent delays in the provision of such services by aiding the early identification of cases. There is a lack of studies that determine ASD awareness among parents of typically developing children (TDC). Therefore, the aim of this study was to comprehend the extent of ASD awareness and knowledge among Saudi parents of TDC. A cross-sectional descriptive survey using a questionnaire was distributed to survey 232 Saudi parents’ (98 female, 134 male) ASD awareness and knowledge. Overall, this study’s results showed that ASD awareness among Saudi parents is good, as the study participants were knowledgeable about its aetiology, signs and symptoms. However, there are still misconceptions and lacking of knowledge that need to be addressed. Interestingly, the fathers were found to be more knowledgeable about general ASD information and aetiology than the mothers. The findings showed that around 49.1% of Saudi parents do not know if vaccinations cause ASD, which indicates lacking awareness in this regard. Despite the efforts of different sectors to raise ASD awareness in the KSA, more work needs to be done to address misconceptions among parents. This is necessary to aiding the early detection and identification of ASD, which will expedite services’ provision for better outcomes for children with ASD.

Child Welfare Financing: What Do We Fund, How, and What Could Be Improved?

Government efforts toward the prevention, detection, and investigation of child abuse and neglect are carried out through the United States’ child welfare system—a complex web of programs that provide family assistance and promote child safety. Most funding for these activities is split among federal, state, and local governments and comprises specific child welfare–related funding (such as Titles IV-E and IV-B of the Social Security Act) and non–child welfare funding that is spent on programs that support poor and disadvantaged families (Medicaid and TANF). I provide an overview of these funding streams that finance the child welfare system, review the federal legislation since 1970 that has led to the current funding structure, and end with a discussion of how the Family First Prevention Services Act of 2018 has the potential to create better outcomes for children and families by promoting prevention activities and program support with strong evidence of success.

Parental Knowledge of Children's Developmental Milestones in Riyadh, Saudi Arabia.

Objective Parental recognition of children's developmental milestones has been correlated with more effective childcare strategies and overall better outcomes for children. However, the knowledge that parents have about children's development remains uncertain which reflects serious concerns about children's health in Saudi Arabia. Therefore, this study was undertaken to identify parents' knowledge levels about children's developmental milestones and the information sources they rely on for this knowledge. Study Design. We recruited 1471 parents aged ≥18 with at least one child under 14 and living in Riyadh to participate in an online survey between July of 2019 and January of 2020. Results Most respondents showed a poor level of knowledge (80.0%) in all of four domains. However, mothers had more acceptable levels of knowledge (21.0%) than fathers (10.0%) (p ≤ 0.01). There was a significant association between knowledge and age at first child's birth; respondents who had their first child between 39 and 50 had the highest levels of knowledge (37.5%; p ≤ 0.01). In the four domains of development, parents were found to have the most knowledge about physical development (52.3%), followed by cognitive development (21.6%), social development (21.5%), and emotional development (21.2%). Only a few parents (5%) claimed to always rely on their healthcare professionals for information. Conclusion There is a lack of appropriate knowledge about developmental milestones among parents, which reflects serious concerns about children's health in Saudi Arabia. Healthcare institutions and pediatricians currently play a minimal role in health education. Effective health education programs and strategies should be implemented to improve child development outcomes in the community.

Child Maltreatment and Domestic Violence: Opportunities for Reform

Despite decades of effort, it remains difficult to create sustainable best practices and policies at the intersection of child welfare and domestic violence. As the courts, federal and state governments, and child welfare agencies seek better outcomes for children and families caught at the intersection, there is an urgent need for creative data collection, more and consistent data assessment, consistent assessments of children and families to identify and address domestic violence in child welfare cases, and a consistent legal response to improving outcomes for children and families in these cases while ensuring safety, permanency and well‐being for all family members.

Educating Children in Our Care

In Canada, there is increasing recognition that poor educational outcomes of children and adolescents involved with the child welfare system represent an emerging crisis for youth, their families, and the broader society. Interprofessional education and collaboration between educators and social workers may facilitate better outcomes for children in care. Although interprofessional education (IPE) and interprofessional collaboration (IPC) are well established in the allied health fields, there is not an equivalent acceptance within the applied social sciences, specifically in education and child welfare contexts. This may partially be attributed to the “siloed” nature of these professions, which limits both capacity and opportunities for professionals to understand each other’s mandates, roles, and policies. The purpose of this paper is to describe the development, implementation, and evaluation of a graduate elective course for social workers and educators that was geared toward educational outcomes of children in care. Thirty-eight students from both disciplines participated in a summer institute. Although participants valued the content and process of the course, it is unclear whether these types of initiatives facilitate enhanced IPC. Findings do however suggest that IPE initiatives targeted toward a specific population may have more positive outcomes, compared to general IPC.

Kinship navigator program development: Listening to family, youth, and advocate voice

ABSTRACT Kinship caregivers are relatives or close friends who assume caregiving responsibilities due to a variety of unexpected (and sometimes traumatic) circumstances. While many kinship care arrangements happen outside the child welfare system, kinship care also forms an increasing percentage of all child welfare placements and is distinct from traditional non-relative foster parenting. Kinship placements can promote family and cultural continuity and better outcomes for children. However, they also present unique dynamics and stressors, and could significantly benefit from a specific array of social supports and economic resources. This study describes how a partnership-based research project by the state child welfare agency and university partners informed the development of a model for Oregon's Kinship Navigator Program. Researchers gathered statewide input from a diverse array of caregivers, youth in care, and kinship caregiver advocates. Focus groups and key informant interviews were conducted to identify the gaps and needs of Oregon's kinship caregivers. Eleven emergent themes were identified. Recommendations are provided for integrating themes into kinship navigator programs.

Family group decision-making for children at risk of abuse or neglect: A systematic review.

Family group decision-making for children at risk of abuse or neglect: A systematic review.

Family resources moderate the relationship between seizure control and health-related quality of life in children with drug-resistant epilepsy.

Pediatric drug-resistant epilepsy (DRE) is associated with poor health-related quality of life (HRQOL). Achieving seizure control, however, does not improve HRQOL in all children. This study sought to evaluate whether (1) baseline caregiver and family factors are associated with child HRQOL at 1-year follow-up over and above epilepsy characteristics, treatment, and seizure outcome; and (2) baseline family factors moderate the association between seizure outcome and child HRQOL at 1-year follow-up. This multicenter longitudinal cohort study recruited 152 children with DRE who were being evaluated for surgical candidacy. Child HRQOL was rated by caregivers using the Quality of Life in Childhood Epilepsy Questionnaire at baseline and 1-year follow-up. Additional data collected at baseline included child epilepsy characteristics, caregiver demographics, caregiver mood, and family environment. Seizure freedom was achieved in 68% and 28% of patients 1 year after surgery and medical treatment, respectively. Caregiver and family factors were not associated with higher child HRQOL at follow-up after accounting for epilepsy characteristics, treatment, seizure outcome, and baseline child HRQOL, F11, 131 =1.34, P=.21, ΔR2 =.04. Family resources moderated the association between seizure outcome and child HRQOL at follow-up (b=.41, 95% confidence interval [CI] = 0.09-0.74, P=.03); seizure freedom was strongly associated with higher HRQOL when family resources were high (b=13.50, 95% CI = 8.35-18.54, P<.001), relative to when family resources were low (b=5.17, 95% CI = -0.18 to 10.52, P=.06). Family relationships and demands did not moderate the relationship between seizure outcome and HRQOL. Achieving seizure freedom was associated with better HRQOL in children with DRE, but this association was reduced for those children who presented with limited family resources. These results highlight the importance of assessing the family environment during presurgical evaluation and implementing early family-based intervention and supports to promote better outcomes for children in the long term.

Parental Age in Relation to Offspring’s Neurodevelopment

ABSTRACT Objective: Advanced parenthood increases the risk of severe neurodevelopmental disorders like autism, Down syndrome and schizophrenia. Does advanced parenthood also negatively impact offspring’s general neurodevelopment? Method: We analyzed child-, father-, mother- and teacher-rated attention-problems (N = 38,024), and standardized measures of intelligence (N = 10,273) and educational achievement (N = 17,522) of children from four Dutch population-based cohorts. The mean age over cohorts varied from 9.73–13.03. Most participants were of Dutch origin, ranging from 58.7%-96.7% over cohorts. We analyzed 50% of the data to generate hypotheses and the other 50% to evaluate support for these hypotheses. We aggregated the results over cohorts with Bayesian research synthesis. Results: We mostly found negative linear relations between parental age and attention-problems, meaning that offspring of younger parents tended to have more attention problems. Maternal age was positively and linearly related to offspring’s IQ and educational achievement. Paternal age showed an attenuating positive relation with educational achievement and an inverted U-shape relation with IQ, with offspring of younger and older fathers at a disadvantage. Only the associations with maternal age remained after including SES. The inclusion of child gender in the model did not affect the relation between parental age and the study outcomes. Conclusions: Effects were small but significant, with better outcomes for children born to older parents. Older parents tended to be of higher SES. Indeed, the positive relation between parental age and offspring neurodevelopmental outcomes was partly confounded by SES.

Early childhood social determinants and family relationships predict parental separation and living arrangements thereafter.

Parental separation has been associated with poor mental health in children with better outcomes in children living in joint physical custody compared with those living with one parent after the separation. In this study, we investigated socioeconomic and relational predictors in early childhood of later parental separation and family arrangements thereafter. This study included 34768 children from the Danish National Birth Cohort, who were living with both parents at the 6months' data collection and followed up in 2010-2014 at age 11years. Questionnaire data from the two data collections were linked with population registers in Statistics Denmark about parental income, education and psychiatric care and analysed in logistic regression models. Socioeconomic indicators of the family and parental psychiatric disorders before birth of the child and family relationships in infancy predicted parental separation at age 11year. For children with separated parents, a high family income and a high parental educational level were the main predictors of living in joint physical custody at the 11-year follow-up. Socioeconomic living conditions predict parental separation as well as living arrangements thereafter. Studies of consequences of living arrangements after parental separation should account for family factors preceding the separation.