Child Advocate Research Articles

Cultural Understanding and the Impact of Domestic Violence Against Children in Uganda Communities: A Case Study of Child Maltreatment in Busoga and Acholi Regions

Child maltreatment is a grave concern affecting societies worldwide, with its impact extending across generations. This study delves into the intricate interplay of cultural, socio-economic, and institutional factors contributing to child maltreatment in Uganda's Busoga and Acholi regions. Guided by the case study methodology, the research examines the prevalence of child maltreatment, the influence of cultural norms and practices, the roles of cultural and religious leaders, and the challenges within the child protection system.The findings reveal alarming statistics, highlighting the pervasiveness of child maltreatment, including corporal punishment in schools, child defilement, sexual violence, and child labor. The socio-economic context, particularly in northern Uganda, amplifies children's vulnerabilities due to poverty, disease, conflict, and the prevalence of orphans. Cultural norms and traditions significantly shape disciplinary practices, emphasizing community involvement in child upbringing. Local cultural and religious leaders influence child discipline structures and advocate for children's rights. However, despite theoretical approaches to child protection, practical implementation lags, and identifying perpetrators remains challenging. Poor documentation and resource constraints hinder effective responses to child maltreatment, leading to a resource allocation disparity between urban and rural areas.The implications of child maltreatment are profound, affecting children's physical, psychological, and emotional well-being, potentially leading to long-term consequences. The study recommends collaborative efforts involving government bodies, NGOs, cultural and religious leaders, and communities. Culturally sensitive interventions, practical implementation of child protection measures, and equitable resource allocation are vital components of a holistic approach.

An Intersectionality-Based Policy Analysis of Canadian Child Advocate Reviews of Infants, Children and Youth with Prenatal Substance Exposure and Fetal Alcohol Spectrum Disorder in Child Welfare Care

Background and Objective Care providers in the child welfare system often support children with Fetal Alcohol Spectrum Disorder (FASD). Women who give birth to children with FASD face many multi-dimensional socio-structural challenges, including prenatal substance use, that lead to their children being placed in care. Alcohol use disorders have strong associations to trauma histories, psychiatric problems, adverse experiences in life, and other substance use. Children with FASD experience abuse and neglect along with other forms of adversities in childhood and adolescence at higher rates than other children, and are often kept in the care of the child welfare system. Risks of harm for children and youth with FASD exist due to distinct vulnerabilities associated with the disability. Even with child welfare intervention, adverse outcomes remain for children and youth with FASD. Our objective was to examine reports generated from Child Advocate offices in Canada on deaths and serious injuries where FASD was identified to gain a deeper understanding of the experiences of this population in the child welfare system. Material and methods We employed an intersectionality-based policy analysis (IBPA) framework to analyze child welfare reports from 1989 to 2019 available online publicly from Child Advocate (or equivalent jurisdiction) Offices across Canada. An underpinning theoretical framework in this research was life course theory, as it is critical to recognize the connection that exists between early decisions made for infants and children with FASD and later outcomes in life. Reports were included when there was evidence of FASD or prenatal substance exposure in the report. Sequential Excel spreadsheets were employed for data extraction, and individual word documents were generated for each report specific to the IBPA framework. Thematic analysis was employed to identify themes related to serious injuries or deaths in child and youth, report summaries, and recommendations. Results A total of 61 reports were reviewed, and deaths of 17 children or adolescents with FASD were reported. Four categories of reports existed, including investigative death reports, investigative serious injury reports, special reports, and annual reports. Key themes from these reports for this population included: (1) challenges to stability and permanency, (2) challenges to FASD-informed service provision, (3) over-representation of Indigenous children and youth, and (4) presence of concurrent mental health challenges. Recommendations within reports addressed needs of individuals, families, care providers, systems, and policies. There were many consistencies across time and jurisdictions. One notable concern was that FASD, while possible, was often not diagnosed, and therefore supports and services specific to this disability were not provided. It is critical to note that these reports served to document both a child's history and make key policy and practice recommendations to inform a differential response in the child welfare system in the case of FASD. Conclusion This analysis illuminated the risks and vulnerabilities for this population in the child welfare system and has implications for assessment, diagnosis, and practice interventions in responding to the needs of this population. This analysis also identified that many opportunities exist to improve practice and service delivery for individuals with FASD and their families. It is critical to recognize that a connection exists between early decisions made for infants and children with FASD and later outcomes in life.

The Land of Long Days

The Land of Long Days Frances De Pontes Peebles (bio) Everywhere, there are rainbows—on the stairs to Girls' Block, around the bulletin board announcing our meals for the week, on the playground equipment where we sit during Outdoor Time. (Sometimes Nayeli goes down the rainbow slide, and we follow her, laughing like it's a big joke—us, pretending to be kids.) There's a rainbow on the front of the building, too, over the glass doors. Those doors are for Monitors and Counselors and for visitors, who show up every week wearing sticker badges and standing too close together, staring at our bunk beds and our art projects but never at us. In the back of the building is our door: gray metal, with a buzzer and cameras and a fence too tall to climb. "Everybody wants happiness, nobody wants pain," Alicia raps. "But you can't have a rainbow without a little rain." "I like the colors," Julissa says. "They're nice for little kids." "We're not kids," I say. "What are we, magical princesses?" Alicia asks. Nayeli says nothing, like always. We sit in Town Square. There're little huts (FaceTime House, Craft Place, Game Room) painted in candy colors and metal picnic tables all around. A rainbow village dropped inside a "juvenile immigrant shelter." That's what our Head Counselor, Mr. Miguel, calls this place. Alicia calls it jail. The rest of us call it Sunset Harbor, because that's what's written on our paperwork and printed on our sweatshirts. It was meant for little kids—the ones the Monitors call "tender age." That's the reason for the rainbows, the playground, the rec room full of toys and baby books. Nayeli heard that, when Sunset Harbor first opened, there were protests; people didn't want a baby jail in their town. So now we're here instead—fifty of us. The youngest is twelve. The oldest, seventeen. We cover construction paper in glitter. Julissa prints "PROM 2020!" in big, bubble letters and cuts them out to stick on our centerpieces. We have to make fifteen—one for each table in Town Square. Then we'll paint a banner. [End Page 101] "Prrrrrrrom! Prrrrrrom! Prrrrrrrom!" Alicia purrs. She's an engine, revving. Julissa rolls her eyes. "They tell you the playlist yet?" Alicia asks. "Mr. Miguel's got to approve the requests," Julissa replies. "Then we're fucked," Alicia whispers, so the Monitor nearby doesn't hear. "It'll be Grease and Top 40 shit." "You have Tupac in your ears every day. We don't need to listen to him at prom too," Julissa says. When she first arrived at Sunset Harbor, Alicia told her Child Advocate how much she loved Tupac Shakur. A week later, her Advocate burned her an old-school CD with bleeped-out versions of his greatest hits. Mr. Miguel held the CD for a few days and made calls to make sure it was allowed. Finally, he gave it to Alicia, who checks out a Sony Discman from the library every day (we aren't allowed computers, cellphones, or internet) so she can listen to the CD on repeat. Alicia scoots to the edge of her seat and does a body roll. "Fingertips on the hips as I dip, gotta get a tight grip, don't slip." "And you wonder why Mr. Miguel won't approve it …" Julissa says. "Loose lips sink ships, it's a trip …" Julissa gives up on Alicia and turns to me. "What kind of dress will you pick, Lilian? I want a big skirt, like a bride." I glance at Alicia, who's always ready to laugh at whatever comes out of my mouth. I have to think before I say things in Spanish. It's not too different from my Portuguese, but different enough for me to make mistakes. What I want to say is: I need a dress that glimmers like a million little fish scales. "Depends what they bring us," I mumble. Julissa wanted this party called prom very badly, so she convinced the Counselors and Ms. Susan, the Lead Monitor, to let her plan it. Julissa collected craft...

Roles, Responsibilities, and Rights: An Organisational Analysis of Provincial and Territorial Child and Youth Advocate Offices in Canada

Abstract Limited academic literature has explored the responsibilities of Provincial and Territorial Child and Youth Advocates in Canada. This paper analyses the responsibilities that constitute the role of Canadian Provincial and Territorial Child and Youth Advocates, as well as the forces that impact and shape these responsibilities. A total of 17 participants, including current and former members of the Canadian Council of Child and Youth Advocates (cccya) as well as their staff members are included in the study. Findings reveal that individual advocacy, systemic advocacy, investigations into critical injuries and child deaths, as well as educational outreach, constitute the primary responsibilities of the cccya. Additionally, at the provincial and territorial level, it is important for advocates to navigate the historical, cultural and political factors that inform discourses surrounding childhood as these factors impact the way advocacy is understood and carried out within these organisations.

Mission Statement of a Modern German Public Health Child and Youth Service (PHCYS): Statement of the PHCYS Expert Committee of the Federal Association of the Public Health Service (PHS)

Based on the mission statement of the Public Health Service (91st Health Minister Conference 2018), a mission statement for a modern Public Health Child and Youth Service (PHCYS) was derived in a "Future Workshop" at the BVÖGD Congress 2019. The central question addressed was: Which previous and new core tasks have to be put in practice by the PHCYS in terms of its role, both as a child and youth advocate and as a caretaker of their health, especially in light of major socially-shaped health differences. Based on a pre-structured workflow comprising 5 topics with core questions, the future tasks of the PHCYS were discussed and summarized. Additionally, the participants elaborated which new requirements have to be addressed by the PHCYS and how they could be realized. Significant core tasks: a) Counselling of community structures on child and youth health needs, and how to respond based on first graders' health data (including social spherical assessment). b) Moderation of networking and introduction of health aspects as a cross-sectional task of the community sectors. c) Support of vulnerable groups with specific health and psychosocial needs. PHCYS's specific preventive fields are, for example, speech and development promotion and health protection. d) Medical assessment and counselling "free of commercial self-interest". e) Networking with science and research. Qualifications needed in the PHCYS: Medical specialists, a health planner (to support data analysis), social workers ( for counselling, but also for targeted projects), health professionals like family nurses/midwives, and also child and youth psychiatrists/psychologists (to meet the requirements of increased psychosomatic and psychological diseases). The previous and new core tasks are big challenges for the PHCYS, in terms of work and personnel that cannot be overcome just with a mission statement but need a broadly diversified reinforcement of PHCYS's work. This also includes anchoring of tasks in different laws at the federal and regional levels.

Access to Play for Children in Situations of Crisis: Synthesis of Research in Six Countries

 2018 Children, Youth and Environments Children, Youth and Environments 28(1), 2018 Book Reviews Access to Play for Children in Situations of Crisis: Synthesis of Research in Six Countries Sudeshna Chatterjee (2017) International Play Association, 51 pages Available from http://ipaworld.org/wp-content/uploads/2018/02/IPA-APC-ResearchSynthesis -Report-A4.pdf The powerful role of play as catharsis, as medicine and as salve for life is profoundly evident in this text. Similar to Eisen’s (1988) study that looked at Jewish children’s play in ghettos during the Holocaust, this text draws attention to the fact that even though “a graveyard is no place for entertainment,” children, across cultures and in all circumstances, will naturally engage in this activity as an authentic part of their existence. The author and the several contributors to this report must be commended for the deep, rich and rigorous research presented. It provides readers with robust evidence of the complexity of children’s play. This text demonstrates just how children do this as they maneuver and meander the rugged terrains of their daily lives. While there is no dearth of research focusing on children’s play, the author of this text has filled a vast gap in the literature germane to children living in situations of crisis. Not since Whiting’s (1963) Six Cultures study has a text so profoundly addressed cultural interpretations and representations of play. Through cross-cultural descriptions and comparisons, readers are provided with deep insight into the role of play in helping children from Japan, Nepal, Turkey, Lebanon, India, and Thailand deal with their existence. While crisis in its multiple forms have often made headlines, when interest fades, and cameras are turned off, what happens in these spaces? How do people move on? This piece seeks to illuminate what the media has often not focused on: how children, as resilient beings, use play to escape the harsh realities of their daily lives. The author of this text outlines her rationale for selecting the research settings. Deliberate attempt was made to conduct research in countries that experienced natural disasters, humanitarian crises and those that were considered to be in “everyday crisis.” This is particularly welcomed because the deliberate focus on research in these countries illuminates the vast richness of what “research in other spaces can do.” The six countries in this study lie outside of highly visible research contexts (Europe, North America and Australasia). If I may say so, as a researcher Book and Film Reviews 129 from a region with minimal visibility in research, it is refreshing and empowering to see representations of countries culturally, economically and socially similar to mine reflected in this book. The research is more connectable and more relatable. I have no doubt that other readers will also appreciate this. Finally, perhaps what is even more commendable is that this book is not only about presenting research but rather about providing readers with tools with which to apply the research. The accompanying toolkit for educators, administrators, and policy makers is like a helping hand, providing guidance to help them to not only develop play spaces, but also to enable them to understand the need to establish, secure environments in order to assist children from crisis situations (Casey, 2017). As a researcher and a child advocate, I appreciate the depth of coverage of Sudeshna Chatterjee, as she draws attention to the importance of children’s play. This book is timely. It will certainly be of tremendous interest to all stakeholders who provide care, coverage or treatment to children. References Casey, T. (Ed.) (2017). Access to play for children in situations of crisis—Play: Rights and practice—A toolkit for staff, managers and policy makers. International Play Association. Available from http://ipaworld.org/wpcontent /uploads/2018/02/IPA-APC-Research-Synthesis-Report-A4.pdf Eisen, G. (1988). Children and play in the holocaust: Games among the shadows. Amherst: The University of Massachusetts Press. Whiting, B. B. (Ed.) (1963). Six cultures: Studies of child rearing. New York: Wiley. Review by Zoyah Kinkead-Clark Dr. Zoyah Kinkead-Clark is a lecturer and researcher in early childhood education at the University of the West Indies, Mona. She received her teaching...

011-Disclosures of Disorders of Sex Development to Children: When and How Do We Tell Kids About Their Diagnosis?

Background: Children can be diagnosed with a disorder of sex development (DSD) at birth with ambiguous genitalia, or later in childhood after investigations of other symptoms. In all cases, the diagnosis comes as a surprise, and there is initial parental distress and uncertainty about their child's future. The diagnosis of DSD can have a significant impact on the psychosocial development and wellbeing of the child, with challenges around diagnosis complexity, sex of rearing, uncertain outcomes, treatment options and psychological stressors. Purpose: Whilst disclosure in practice often occurs in a gradual manner when working within a multidisciplinary team, we propose to formalise a guidance system describing a developmentally staged approach. The process involves sequential information about body parts, differences between male and female, the wide potential for gender roles and later the potential for different individual development of sex, gender, sexuality and fertility. Description of Topic: The development of gender identity begins after the first year of life, with children generally identifying with one sex by age three. Self-awareness regarding identity and gender role evolves during childhood, with sexuality developing through adolescents, along with physical secondary sex characteristics. Critical psychological development also starts to occur, including the capacity to understand concepts such as future fertility potential. Therapeutic events such as genital surgery or requirement for sex hormone therapy can affect this process. Information provided to a child about their diagnosis therefore needs to be age appropriate, and tailored to the individual's developmental needs. Criticism of past DSD management has been poor or late disclosure of diagnosis to the young person, and although advice now supports earlier disclosure, there is limited literature guiding a method for this. Clinical Implications: The goal of treatment is to ensure that the child's psychological, physical and sexual well-being are supported in a respectful and appropriate manner. This can be achieved via a multidisciplinary team working with the parents to support the child, communicating honestly and respectfully to maintain trust, and providing guided appropriate information through defined developmental stages from infancy to adolescence and adulthood. The paediatric endocrine nurse plays a critical role in this process as both child's advocate and family educator.

Historic Leadership.

School nursing practice establishes itself in the midst of both education and nursing philosophies, ethics, standards, laws, and regulations. Treading these two worlds is difficult at times and requires that a school nurse possess a strong foundational knowledge base, seek professional collaboration, and navigate conflicting professional demands in order to promote student and public safety. This article is Part 1 of a four-part series that recounts the inspiring story of a school nurse, Ellen Johnsen, who did just that back in the 1980s in Broken Arrow, Oklahoma. Part 1 describes the upbringing and early career experiences that molded Ellen into a courageous and tenacious child advocate who rose to the challenge when she found herself in a school setting where tradition and policy were at odds with the nurse practice act and professional standards regarding medication administration. The purpose of this series is to enhance understanding of the legal parameters governing school nurse practice, provide examples of ethical decision making, and review the challenges associated with serving as a leader.

Child Representation in Alberta: Role and Responsibilities of Counsel for the Child in Family Proceedings

There has been an increase in the number of family law cases in Alberta where counsel is appointed to represent a child, but there is a lack of guidance and there is controversy about the role and responsibilities of counsel for the child. In other jurisdictions government agencies, the courts, the legislature or the law society have provided clear direction, though taking different approaches to resolving the controversies about counselfor the child. This article reviews the different roles adopted by counsel appointed to represent a child in afamily proceeding: the child advocate, the best interests guardian and the friend ofthe court. It is argued that in Alberta there is no single role that is appropriatefor alt cases. While the child's wishes should always be placed before the court, counsel should only advocate based on those wishes if the child has capacity to instruct counsel. This article offers detailed suggestions for the professional responsibilities of counsel for the child, and concludes by making recommendationsfor action by the Law Society ofAlberta and Government of the Province if these bodies are to meet their responsibilities to children.

Forgotten Children of Immigration and Family Law: How The Absence of Legal Aid Affects Children in the United States

The absence of government‐appointed legal counsel in immigration proceedings adversely affects large numbers of children in the United States. Children born in the United States to parents without citizenship status (U.S.‐born children of noncitizen parents or UCNP) are harmed by a parent's detention and removal. Unaccompanied alien children (UAC) who have entered the country without legal status are adversely affected by their own detention and removal. The possibility of obtaining relief from removal is drastically diminished by the lack of legal representation. Currently UAC and immigrant parents are not entitled to court‐appointed attorneys. Any meaningful change in immigration law, such as a federal statutory amendment to provide UAC and immigrant parents with government‐appointed counsel is unlikely due to the present political dissension in Congress regarding this issue. Because UAC and immigrant parents are not entitled to government‐funded legal representation, a pro bono legal service system has developed, but is unable to meet the present need adequately. For immigrant parents, this Note proposes the adoption of a statute to allow the appointment of court liaisons in family court proceedings. The court liaison is a nonattorney who is familiar with the processes of the family court and ensures that immigrant parents are fully informed regarding all pertinent family court proceedings. For UAC, this Note proposes an amendment to the William Wilberforce Trafficking Victims Protection Reauthorization Act to mandate the appointment of a child advocate to all UAC. The child advocate is not a lawyer, but works with the UAC's attorney to provide the child with legal representation and advocacy. Key Points for the Family Court Community: UCNP confront the loss of parents to detention and removal. Children are condemned to limbo, torn between absent biological parents and placement in foster care. The recent surge in the number of UAC who enter the United States by crossing the border from Mexico has been described as a humanitarian crisis. These children often remain alone without legal protection, vulnerable to detention and removal. Ideally, UAC and the immigrant parents would be provided with government‐funded legal representation in immigration proceedings. In the absence of the federal statutory reform necessary to make that a reality, state statutory reform to allow for the provision of court liaison programs for immigrant parents and federal statutory reform to allow the appointment of child advocates for UAC can begin to offer children and families needed legal support and advocacy.

Ambiguous belonging and the challenge of inclusion: parent perspectives on school membership

Boundary ambiguity occurs when members of a family are confused or uncertain regarding roles, responsibilities and subsystem configurations within the family. Research suggests that perception of boundary ambiguity is associated with family stress despite internal and external resource availability. It has been suggested that research on family boundary ambiguity be broadened beyond the family unit to the interface between family and community. This study utilised boundary ambiguity, and paradoxical dilemma as sensitising concepts to guide a secondary analysis of narrative data from interviews conducted with 28 parents of children with a range of disabilities pertaining to the interface between home and school. Findings confirmed evidence of boundary ambiguity and boundary intrusion in parents’ perception of whether the child and family were considered valued members of the school community, and in ambiguous parental role assignments, such as information gatherer, child advocate and teacher. In addition, ambiguous situations often triggered paradoxical dilemmas that affected home–school relationships.

Competency 4: Advocate for quality patient care and optimal patient care systems

The traditions of pediatrics dictate that a pediatrician move from concern for the quality of care of each individual patient to the concern for the welfare of a group of children who might share a common illness, condition or life circumstance.1,2 This broader concern and translating the concern into action are what we define as advocacy. Pediatricians should move through a progression of attitude and skill attainment in order to become effective child advocates. Fundamental to becoming an effective child advocate is the understanding of systems and how they work, because ultimately, the advocate must be able to understand systems and how to change them.

Nurses’ perspectives on supporting children during needle-related medical procedures

Children state that among their worst fears during hospitalization are those related to various nursing procedures and to injections and needles. Nurses thus have a responsibility to help children cope with needle-related medical procedures (NRMP) and the potentially negative effects of these. The aim of the study is to describe the lived experience of supporting children during NRMP, from the perspective of nurses. Fourteen nurses took part in the study, six of whom participated on two occasions thus resulting in 20 interviews. A reflective lifeworld research approach was used, and phenomenological analysis was applied. The result shows that supporting children during NRMP is characterized by a desire to meet the child in his/her own world and by an effort to reach the child's horizon of understanding regarding these actions, based on the given conditions. The essential meaning of the phenomenon is founded on the following constituents: developing relationships through conversation, being sensitive to embodied responses, balancing between tact and use of restraint, being the child's advocate, adjusting time, and maintaining belief. The discussion focuses on how nurses can support children through various types of conversation and by receiving help from the parents’ ability to be supportive, and on whether restraint can be supportive or not for children during NRMP. Our conclusion is that nurses have to see each individual child, meet him/her in their own world, and decide on supportive actions while at the same time balancing their responsibility for the completion of the NRMP. This work can be described as “balancing on a tightrope” in an unpredictable situation.

Representation of children's views in court hearings about custody and parental visitations — A comparison between what children wanted and what the courts ruled

Following the UN convention on the rights of children, a shift in policy towards greater emphasis on child participation in child protection case processing has occurred. A growing body of research has emerged concerning participation processes in child protection cases and the experiences of children in child protection cases. Very few studies have looked into if and when children get what they want, however. The aim of this study is to assess children's views about living arrangements and visitations in dependency court hearings and to compare these views with the rulings of courts. The study uses a retrospective cohort design. Cases where child welfare board rulings are in line with the wishes of children are compared to cases where rulings differ from the wishes of children. Data were collected from regional social welfare board archives. The study included 151 cases that were randomly drawn from a total population of 2481 cases. Simple and multivariate logistic regression was used to identify factors associated with the rulings being in accord with the child's wishes in each sample case. A child advocate was appointed in almost 95% of the cases (n = 142). Fifty-nine percent of the children did not want a change in care. Rulings about care were in line with the wishes of the child in 39% of the cases. Rulings about care were most likely to be what the child wanted, if the child was presently living in public care and did not want to move. Children wanted more visitations with their mothers in 60.5% of the cases and with their fathers in 39.8% of the cases. Whether children wanted more visitations with their mothers was associated with more visitations being granted. What a child wanted was not associated with the ruling on visitations with the child's father. The impact of children's views on visitations on dependency court rulings depends on what a child wants and how these desires coincide with what is proposed by child protection services. Children's views can be quite effective in blocking certain decisions but are less effective if the child requested a specific change. If a child does not want to stay with his or her birth parents, then the odds that the birth parents will be granted custody is minimal.

Review on Neonatal End-of-Life Decision-Making: Medical Authority or Parental Autonomy?

As advances in medical technology are constantly re-defining the lower limit of newborn viability, the practice of withholding/withdrawing treatment in neonatal care is increasingly prevalent. Now more than ever, physicians working in neonatal intensive care units have to constantly face the ethical dilemma of terminating the neonates' life support, sometimes against the parents' desire. Traditionally and legally, parents have the duty to make decisions on behalf of their infants because they are the ones to whom the consequences matter the most. Physicians, on the other hand, often claim for themselves the role of the child's advocate, with the growing acceptance of the patient's “best interest” standard as the guiding principle. In this mini literature review, the authors examined the issue of medical authority versus parental autonomy in neonatal end-of-life (EoL) decision-making and found that consultations with parents were made in the majority (79–100%) of cases. Furthermore, conflicts between doctors and family were shown to occur quite frequently due to barriers to effective communication such as strong religious convictions and disagreements within medical team members. Only by encouraging active parental participation and overcoming some of these barriers, physicians and the patient's family could arrive at an ethically sound EoL decision.

G02 ‘Stary Doktor’ -The Old Doctor- Janusz Korczak

Too few paediatricians have heard of Janusz Korczak (Dr Henryk Goldszmit) (1878–1942) even though he was a pioneer on children’s rights and child health care. Korczak devoted his life to...

Decision Making in Child Protective Services: A Risky Business?

Child Protective Services (CPS) in the United States has received a torrent of criticism from politicians, the media, child advocate groups, and the general public for a perceived propensity to make decisions that are detrimental to children and families. This perception has resulted in numerous lawsuits and court takeovers of CPS in 35 states, and calls for profound restructuring in other states. A widely prescribed remedy for decision errors and faulty judgments is an improvement of risk assessment strategies that enhance hazard evaluation through an improved understanding of threat potentials and exposure likelihoods. We examine the reliability and validity problems that continue to plague current CPS risk assessment and discuss actions that can be taken in the field, including the use of receiver operating characteristic (ROC) curve technology to improve the predictive validity of risk assessment strategies.

Childhood drowning in Georgia: A geographic information system analysis

Drowning is one of the major causes of childhood mortality from unintentional injury in the United States. This study aims to delineate the drowning hot spots by aquatic environment and to examine the socioeconomic characteristics of neighborhoods with high densities. Drowning death records (2002–2008) among children aged 0–17 were obtained from the Office of the Child Advocate in Georgia. Drowning victims are initially analyzed by race, gender, age, aquatic environment, use of a personal floatation device, and the security of a pool. Using kernel density estimation and LISA statistics, this paper delineates drowning clusters by density and rate respectively. High-density neighborhoods are then investigated using a variety of socioeconomic factors by multiple-comparison test, Ordinary Least Squares (OLS) regression, and Geographically Weighted Regression (GWR). The result shows that the majority of victims were white, male, and children aged 0–4. Private swimming pools and open water were two leading drowning places. Blacks were more likely to drown in public swimming pools and in children aged 5–14 than white counterparts. Private swimming pools and children aged 0–4 have seen more white victims than blacks. Substantial spatial variation in drowning density and rate is present in Georgia. High-density drowning neighborhoods had a significantly lower rank of median income (p < 0.01) and lower rank of educational attainment in their counties than the low-density group. The GWR results suggest such associations vary in space. This study highlights the role of different socioeconomic factors in the interconnections of drowning risk factors. Findings suggest that health policies and prevention campaigns may be customized based on specific aquatic types and risk factors in different local communities.

A Call to “Image Gently”

In August 2011, The Joint Commission (2011) issued a sentinel event alert discussing how high-radiation dosages delivered at any one timemay cause a risk and long-term injury to patients. This has been a particular concern for pediatric patients for many years. In a study by Brenner, Elliston, Hall, and Berdon (2001) in the American Journal of Roentgenology, concern was raised about the possible induction of added cancers because of the ionizing radiation of children undergoing computed tomography (CT). More recently, Brenner and Hall (2007) published that up to 2% of all cancers in theUnited States could be because ofCT radiation exposure. Although many experts disagree on the extent of cancers that may occur from diagnostic imaging, we, as pediatric nurses, should be aware of the possible risk to our patients and the need to provide education to their caregivers. Radiation is found all around us, and we have been exposed to radiation since we were born. Radiation occurs naturally; we are laid bare to these background sources daily as we breathe air (radon gas), ingest food that has absorbed trace radioisotopes, such as potassium, and absorb particles through means of cosmic bombardment. Artificial sources of radiation can either be from nonionizing radiation, such as the type that is used in cell phones or microwaves, or from ionizing radiation used in medical imaging (International Atomic Energy Agency, 2011). Since the creation of CT scans in the early 1970s, the number of ionizing studies have risen from 2 million studies per year to more than 72 million completed in the United States during 2007 (National Council on Radiation Protection, 2009). CT scans are essential for the diagnosis of certain conditions in children such as appendicitis, head injuries, multiple trauma, and congenital heart defects (Frosh, 2011). However, it is the call of the medical community to determine whether a CT scan is necessary. If the medical

‘Stary doktor’ — the old doctor — Janusz Korczak

Few paediatricians have heard of Janusz Korczak (Dr Henryk Goldszmit) (1878–1942) even though he was a pioneer on children's rights and child healthcare. Korczak devoted his life to children and...