Child Advocate Research Articles

Building a statewide home visiting program from 2 to 42 sites: A state agency's perspective

In 1995, based on emerging research across the US and a tragic case in Connecticut (Gomby, Larson, Lewit, & Behrman, 993; Kauffman, 1996; Tuohy, 1992; Office of the Child Advocate, 2001) that highlighted the need to prevent child abuse, the onnecticut Children’s Trust Fund, now a division of the State’s Department of Social Services, launched amajor initiative to evelop a universal home visiting program throughout the state. Through the home visiting program the Trust Fund sought o identify at-risk parents and provide themwith effective services. The goal of these services was to address the risk factors hat made parents vulnerable to child abuse and neglect and, ultimately, to reduce the number of children substantiated by he child welfare system as abused or neglected. Although much has been written about home visiting programs (Donelan-McCall, Eckenrode, & Olds, 2009; Howard & rooks-Gunn, 2009; Leventhal, 2005;MacMillan et al., 2009), little has beenwritten about the perspectives of state agencies hat fund and direct such programs. The purpose of this commentary, therefore, is to describe the Trust Fund’s strategy to evelop the statewide program and describe how it was expanded from 2 to 42 sites. Chief among these strategies were fforts to gain the support of the state legislature, to develop a partnership with academic centers that would conduct arefully designed research to provide data and feedback to inform and refine practices as the program developed, and to ut in place an infrastructure to ensure an effective program model that could be adapted based on advances in the field nd findings from the Trust Fund’s research in Connecticut.

WGCA: Music for the Gifted Child Advocate

WGCA: Music for the Gifted Child Advocate

Standards for the reporting of sex/sexual activity of minors in a research context

While there are no specific protocols for dealing with reports of sexual abuse of children, the Criminal Law (Sexual Offences and Related Matters) Amendment Act of 2007 (Act No. 32 of 2007) clearly stipulates that, in the event of a report of sexual abuse by a child or any other person of the abuse of a child, the relevant person has the legal (statutory) obligation to report such abuse to the police; and that it replaces previous legislation where reporting could be done to a social worker or the police. According to the Child Advocate, a disclosure by a child (specific child, specific offender) is sufficient to require such reporting.

Child Health in America: Making a Difference through Advocacy

Reviewed by: Child Health in America: Making a Difference through Advocacy Fahmida Hussain, BDS, DMD, MBE, FAGD (bio) Child Health in America: Making a Difference through Advocacy by Judith S. Palfrey, MD. Baltimore, MD: Johns Hopkins University Press, 2006. 312 pp. Child Health in America: Making a Difference through Advocacy focuses on the issues that affect quality of care for U.S. children. Palfrey’s efforts revolve around the fact that despite a whopping $1.8 trillion health care budget, many U.S. children still receive inadequate care. “There are unconscionable disparities in child health status between white and nonwhite, rich and poor, educated and less educated families,”[p.xiii] she notes. Palfrey draws on her first-hand encounters with injustices faced by the children in the U.S. health care system and on the combined experience of many knowledgeable [End Page 1091] professionals. “Advocacy,” she quotes the 19th century French social commentator Honoré Daumier saying, is “speaking out, speaking up, speaking for.”[p.7] In that sense, Palfrey’s book is a perfect example of how writing can function as advocacy, reaching millions of people. Palfrey’s book will prove to be invaluable for the committed individuals who seek to change the current health care system in a positive way. Activists and advocates who are active participants can use it as an excellent tool to modify the dysfunctional landscape of child health care in America. The inclusion of the list of online resources increases the information that a reader can easily access. However, it is first crucial to understand Palfrey’s arguments in order to put the information to work. In an ideal setting, from birth till adulthood, the right to achieve quality of life is respected. Good health habits, on top of “satisfactory housing, good nutrition, a quality education, an adequate family income, a supportive social network, and access to community resources”[p.3] would improve the health of many children who suffer ill health today. Moreover, proper health can be ensured through “ready access to coordinated, comprehensive, health-promoting, therapeutic, and rehabilitative medical, mental health, and dental care.”[p.2] Palfrey contends that lack of accountability in every step of the way has led to the need for increased advocacy. Palfrey details the history of child health care advocacy and the role of leading individuals and organizations. Group advocacy can be an all-inclusive effort through structured grouping by age and social factors (such as national, ethnic, or cultural attributes) and by clinical conditions. Legislative advocacy, on the other hand, promotes policies to ensure social justice and reduce administrative burden. In a democratic society it allows for a “large-scale policy change that affects the lives of children now and for many years to come.”[p.181] Although this volume has been faulted in a previous review [Child Health in America: Making a Difference Through Advocacy: Book Review: JAMA 2007;297(24): 2768–9], this reader found it well-grounded in the literature and likely to remain relevant in years to come. Dr. Palfrey is a general pediatrician and child advocate. She is the president of the American Academy of Pediatrics (AAP) and the T. Berry Brazelton Professor of Pediatrics at Harvard Medical School. She also directs the Children’s International Pediatric Center, Children’s Hospital, Boston. “Child Health in America: Making a Difference through Advocacy” is one of the five books and more than 100 articles written by her on children heath system. [End Page 1092] Fahmida Hussain Dr. Hussain is the Director of the Dental Department at Quality Community Health Care, Inc., where she can be reached at 4508 Locust Street, Philadelphia, PA 19139; (215) 227-0300; fhussain@qchc.org. Copyright © 2010 Meharry Medical College

Caring for America's Children: Military Youth in Time of War

1. Keith M. Lemmon, MAJ, MD* 2. Molinda M. Chartrand, LTC, MD† 1. *Director, Military Child & Adolescent Center of Excellence, Adolescent Medicine & Pediatric Faculty at Madigan Army Medical Center; Assistant Professor of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Md 2. †Developmental & Behavioral Pediatrician, Spangdahlem Air Base; Assistant Professor of Pediatrics, Uniformed Services Health Services University, Bethesda, Md After completing this article, readers should be able to: 1. Describe the differences between Active Duty and Reserve Component military forces and how these differences may affect the emotional and behavioral well-being of military children and adolescents. 2. Discuss the differences between the service and sacrifice offered by a military service member on behalf of his or her country and the service and sacrifice a military child or adolescent offers in support of the military family member. 3. Explain why civilian pediatricians and other youth-serving professionals may come into contact with military children and adolescents and how they could support the emotional and behavioral health needs of this population more proactively. 4. Recognize some of the emotional and behavioral changes that may occur to military service members as a result of their service in the military and how these changes may affect their children. 5. Characterize the spectrum of stress in military youth. 6. Name three support resources designed specifically to support the emotional and behavioral health needs of military children and adolescents. 7. List three steps pediatricians can take within their practices to provide culturally competent care to military children and adolescents. “If you want to honor a service member, the best way to accomplish this is to honor and support their legacy, their children.” COL Elisabeth Stafford, MD, FAAP, FSAM, Career-long Military Child Advocate, Pediatrician, and Adolescent Medicine Specialist The events of September 11, 2001, clearly altered the lives of most citizens of the United States. However, few have been affected more significantly than military service members and their families. As the United States and its allies near the beginning of the eighth year of the global war on terrorism, the effects of prolonged wartime deployments on military families and children are beginning to be recognized and characterized more fully. Many military children and adolescents …

A Review of Special Education Law

Children with disabilities require special education and related services that are as diverse as the individual children themselves. Special education is not necessarily a special classroom but a well thought-out program of collaborative interventions leading to educational goals set forth by a multidisciplinary team. Effective special education is guided by both state and federal laws that protect the rights of the child and encourage certain universal core principles. Special-needs children are entitled to a free and appropriate education with related services in the least restrictive environment. Pediatricians and pediatric subspecialists are in a unique position to develop a medical home for the disabled child, and in doing so must be well-versed in both case law and federal legislation as it applies to special education, in an effort to be a child's best advocate. A chronological review of case law and federal legislation, including the Individuals with Disabilities Education Act, No Child Left Behind Act, and recent amendments, are discussed, and their relevance to physician practice is detailed.

School Performance: The Pediatrician's Role

When children begin having difficulties in school, the first stop for parents is often the pediatrician's office. Although school performance problems may seem outside the realm of routine primary health care, there are many important roles that the primary care provider may play. These include identifying medical issues that may impact performance, helping the family form an intervention team, and acting as the child's advocate when interacting with the school. In addition, it is important for pediatricians to be familiar with cognitive, emotional, and developmental problems that affect school performance and to assist parents in becoming active participants in their children's education.

Estimation of adaptive computed tomography dose index based on body weight in pediatric patients

The aim of this study was to create an adaptive computed tomography dose index (by volume) (CTDI vol) for pediatric patients that would be fitted to a patient's particular body weight and to compare the adaptive CTDI vol with the CTDI vol displayed on the screen of the CT console. CT images of 60 children whose body weights were known were available for calculating the total amount of modified CT numbers as an attenuation area. The attenuation area values of four differentsized acryl phantoms were also calculated. The dose measurements of all four phantoms were carried out. We combined the results of the abdominal CT and phantom experiments. The weight-based complementary ratio for adaptive CTDI vol was calculated, and the result was applied to an example of pediatric abdominal CT protocol. The adaptive CTDI vol was always larger than the displayed CTDI vol with both small and large fields of view (FOV). The adaptive CTDI vol was 2.2 times larger than the displayed CTDI vol in the maximum value with the large FOV and 1.2 times larger with the small FOV. We radiologists must be the child's advocate and protect children from the deleterious effects of any of our technologies, including a lower indication of CTDI vol on the screen of a CT console.

Role of the tertiary child protection paediatrician: Expert and advocate

The role of the child protection paediatrician is varied. This study examines perceptions of how tertiary child protection (tCP) paediatricians view their multifaceted roles, perceived adequacy of length of pre-FRACP training and how this relates to confidence and satisfaction in their roles. An anonymous self-report survey was distributed to child protection paediatricians working in tertiary hospitals across New Zealand and Australia. The survey addressed the adequacy of training and confidence within the diverse roles encountered within child protection work. It also identified perceptions of stress and satisfaction. Responses were received from 32 out of 45 of eligible tCP paediatricians (72%). The majority (71.8%) had entered directly into a tCP unit in their first consultant position. Two-thirds (65.7%) of tCP paediatricians received less than 4 months of pre-FRACP child protection training while a third received no training at all. Generally tCP paediatricians perceived their training in all domains of child protection to be inadequate although their current confidence levels in all roles are high. They expressed most concerns within their role as forensic expert. Despite receiving little or no training pre-FRACP in child protection, this group of tCP paediatricians function in their specialised roles in tCP and feel confident in fulfilling the dimensions of forensic expert and child advocate. As the field of medical child protection continues to evolve, it is important for training to keep pace with expectations of the varied roles of the paediatric specialist in child protection.

Pupil involvement in special educational needs disagreement resolution: a parental perspective

Recent international and Governmental policy has identified the need for all public services and professionals involved with children to take into account the children's views, needs and wishes, when making decisions about their care and educational provision. This is of particular importance in the context of special educational needs disagreement resolution. This article reports on a small scale preliminary study carried out in January 2004, focusing upon parental perspectives of pupil involvement in SEN disagreement resolution. Ten parents of children with SEN were interviewed using a semi-structured interview schedule, addressing their experience of the disagreement resolution process and the extent and nature to which their child was involved. Whilst it is acknowledged that the sample in this study was small, and thus may be regarded as tentative and preliminary, a thematic analysis of the content of the interviews indicated that children are not directly involved in informal disagreement resolution meetings. Most notably the parents report that they are unclear about the process and rules about directly involving children. Where children are involved, their views are given indirectly and in most cases their views are only presented by the parents. The authors make several recommendations for enhancing pupil participation in SEN mediation arrangements including, making the overall process more transparent and perhaps having a child advocate who could ensure that the child's views are represented in a way that is suitable to the particular needs of each child.

Value of a community pediatrics rotation for residents

Value of a community pediatrics rotation for residents

2003 C. Anderson Aldrich award lecture: enhancing developmental services in child health supervision--an idea whose time has truly arrived.

In 1938, in his famous Babies Are Human Beings , C. Anderson Aldrich was cautious in describing the feasibility of enhancing children's developmental potential: “Every human being, as he grows into childhood, must inevitably be hampered and opposed by the restrictions of his environment, and the best we can hope for is to modify somewhat the urgency of this conflict. The degree to which we are considerate of our baby's early needs, however, may be the measure of his later ability to feel secure in a world of change and to adapt himself to the necessities of circumstance.”1(p xi) Aldrich's contributions occurred at a crucial transitional period for child health. In the early 20th century, child health services were almost exclusively focused on the treatment of the sick child, with the modest exception of cursory examinations to detect signs of contagion, milk stations for feeding and weighing, and urban child health conferences for examining and later immunizing children. Subsequent control of infection through improved sanitation, public health measures, the introduction of antibiotic agents, and effective immunization profoundly influenced the scope of child health care, with the founding of the American Academy of Pediatrics in 1930 heralding a shift of emphasis to include health promotion and disease prevention.2 In 1944, Aldrich helped to pioneer this shift through the founding of the Rochester (Minnesota) Child Health Institute, devoted to research on the development of normal infants and children and to a program of delivering child health care to an entire community. Contemporary efforts to enhance the effectiveness of developmental services similarly occur within the context of a profound transition in children's health services. In the mid-1970s, the recognition of developmental, behavioral, and psychosocial problems as the “new morbidity” of pediatric practice by Haggerty et al3 reinforced an emphasis … Reprint requests to (P.H.D.) Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106. E-mail: pdworki{at}ccmckids.org

Physical abuse of children.

1. Andrew P. Sirotnak, MD* 2. Tamara Grigsby, MD† 3. Richard D. Krugman, MD§ 1. *Associate Professor of Pediatrics, University of Colorado School of Medicine; Director, Kempe Child Protection Team, The Children’s Hospital and Kempe Children’s Center 2. †Armed Forces Center for Child Protection, National Naval Medical Center, Bethesda, MD 3. §Dean, and Professor of Pediatrics, University of Colorado School of Medicine, Denver, CO After completing this article, readers should be able to: 1. Recognize the 10 commonly identified history elements and risk factors in the presentation of child abuse. 2. Identify the soft-tissue and skeletal injuries that are indicative of physical abuse. 3. Understand the complexity of the presentation of abusive head trauma and the key diagnostic findings. 4. Review the mandated child abuse reporting requirements for medical professionals. 5. Discuss the physician’s role as child advocate in both the identification and the prevention of child abuse. Since the last Pediatrics in Review update of physical abuse of children in 1994, information in the field has exploded. Data regarding diagnosis and treatment of physical abuse, neglect, and sexual abuse of children is more readily available to health care clinicians than ever before through peer review articles, written texts, picture atlases, internet resources, and American Academy of Pediatrics (AAP) educational materials. It is, however, even more difficult for the busy practitioner to evaluate suspected child abuse. According to the federal publication Child Maltreatment 2002 , the rate of childhood victimization was 12.3 per 1,000 in 2002 compared with a rate of 12.4 per 1,000 in 2001. Of nearly 3 million referrals to child protection agencies in 2002, 67.1% were assigned to workers for investigation. Of these assigned investigations, fewer than one third (26.8%) were “substantiated” or “founded” as child maltreatment, reflecting an estimated 896,000 victims. During 2002, 58.5% of victims suffered neglect, 18.6% were physically abused, 9.9% were sexually abused, and 6.5% were emotionally or psychologically maltreated. Children who suffered more than one form of abuse were more likely to be recurrent victims. Children who had been victimized in a prior year also were more likely to experience a recurrence of founded abuse. Children from birth to age 3 years had the highest rates of childhood victimization, and more …

Mediation in Juvenile Dependency Court: Multiple Perspectives

ABSTRACTFor approximately 10 years, the Santa Clara County (Calif.),1 Juvenile Dependency Court has utilized confidential mediation as an integral part of the court process. After hundreds of mediation sessions, we believe it is time for the various participants in the dependency system to reflect on their perspectives on mediation, its strengths and weaknesses, and its future in our court system. Each author, representing a different party or interest in the child welfare system, has a unique perspective on the process. We hope this information will be useful for other jurisdictions utilizing or considering implementing mediation.Beginning with a description of dependency mediation and the mediation process utilized in Santa Clara County, representatives from each participant in the juvenile dependency process–including the mediators, the social worker, the attorney for the family and children's services agency, the child's attorney, the parents, the parents' attorney, a domestic violence advocate, the child advocate (CASA), and the juvenile court judicial officer–follow with their perspectives on mediation. The article concludes with some general thoughts about mediation, its value, its problems, and its future in Santa Clara County.

PEDIATRIC ADVOCACY

Advocacy is part of the job description of a pediatrician. There is a long history of pediatrician involvement in civil society. Like other skills in pediatrics, the skills required for advocacy activities are learnable. Anyone who can learn the Krebs cycle can learn how to be a child advocate. Being a child advocate is not always easy, but it is rewarding. The 1995 Nobel Prize in Chemistry was awarded to Rowland et al for their work in the description of the destruction of stratospheric ozone by chlorofluorocarbons. Having done the groundbreaking research, Rowland and Molina spent much time working to ban chlorofluorocarbons. When asked why they, as bench scientists, ventured out of the laboratory as advocates, Rowland stated, "If not me, who? If not now, when?" (personal communication, December 7, 2000).

Child Advocates

To the Editor. I would like to comment on Berman's excellent commentary, “Training Pediatricians to Become Child Advocates.”1The excellence of his approach to child advocacy has been proven by the record of the pediatricians of Colorado in influencing public policy regarding children's health in that state.Dr Berman makes the point that “the perfect can too often be the enemy of the good …” He appropriately uses that aphorism in noting that progress toward a goal is most likely to be made in small steps. I should also like to use the same aphorism to note that, lacking a society of perfect child advocates, trained as suggested by Dr Berman, we should not disdain the help that can be given by [very] good child advocates. Ideally, all of us would have had residency training in child advocacy, a number of years in community organizations establishing credibility, and several years of legislative internship. Unfortunately, many chapters of the American Academy of Pediatrics do not have a large cadre (or anyone) trained in this way. That should not deter us from acting on behalf of children.By following the “approach to child advocacy” specified in Dr Berman's commentary, sensitive (to incipient signs of success or failure) pediatricians can and will make a difference. In Colorado, I am sure, Dr Berman and other fully trained child advocate-pediatricians have led the way, but in the process they have trained and relied ongood pediatricians from Denver, Greeley, Grand Junction, Boulder, and every other part of the state to support their efforts, to work with state legislators, and to rally their patients' parents and their communities to their causes.All of us would be well advised to heed the approach outlined by Dr Berman. However, it is my belief that “one pediatriciancan make a difference,” whether perfect or merely good. Not only can we make a difference, but we should. We all should not hide behind a lack of full training and should offer our support to those who are leading the advocacy effort.In Reply. Thank you for the opportunity to comment on Dr Chilton's letter. Dr Chilton implies that I “disdain the help that can be given by a good child advocate” who may not be fully trained in the way I have promoted in my article. Nothing can be farther from the truth, and I am disappointed that a friend and colleague might misinterpret my message in this way. Child advocacy is not an exclusive club, a boarded subspecialty, or a zero-sum game. Pediatricians have a unique opportunity to contribute to their communities—one pediatrician who cares and is committed can make an enormous difference. We have seen this happen in communities throughout our country. My message is that community service and child advocacy are linked and should be integrated into a pediatrician's career from residency training through retirement. We should expose all residents to the principles of community service and advocacy in a curriculum just as we expose residents to principles of fluid and electrolyte management and the judicious use of antibiotics. We should create opportunities for residents and young pediatricians who want additional child advocacy experiences. Developing a cadre of experienced, effective, and knowledgeable child advocates who can work with committed but less experienced pediatric colleagues is appropriate and should not be viewed as an excuse to “deter any of us from acting on behalf of children.”

Community Experiences for Residents: Building a Better Rotation

The latest iteration of the Residency Review Committee Program Requirements mandates the preparation of residents for the role of child advocate in the community.1 The Ambulatory Pediatric Association Educational Guidelines for Residency Training in General Pediatrics provides a blueprint for a community-based rotation, with goals, objectives, and suggested sites.2 In the current issue, Shope and associates share their experience with the construction of a community-based rotation for residents.3The structure of the rotation appears to reflect the design described in the Ambulatory Pediatric Association guidelines, thereby contributing real-world experience to confirm the value of the recommendations. The report also illustrates that a blueprint is only a blueprint; construction also requires bricks, mortar, knowledgeable individuals to direct the work, and a considerable amount of effort by workers. The bricks, the components that make up …

Psychiatric Treatment of Children and Adolescents in Rural Communities: Myths and Realities

Rural child and adolescent psychiatry offers many challenges, a varied and interesting practice, and the satisfaction of performing needed and important work in an environment in which one's presence is valued. The successful psychiatrist can expect to be an integrated and appreciated member of the community. The fit is not a good one for every practitioner, however. Not only are incomes lower, although the cost of living is low as well, but practitioners may find they have only exchanged urban stresses for rural pressures. The characteristics important for the child and adolescent psychiatrist are the same for rural and urban settings: flexibility, creativity and innovation, competence, self confidence, a good sense of boundaries, a good balance between personal and private life, supportive personal relationships, and a sense of humor. One must be a child advocate, have a willingness to give of one's self and one's time, and be down to earth, comfortable with oneself, and capable of self entertainment. Training programs with access to rural populations can introduce residents to rural child and adolescent psychiatry while supporting those who are already in practice. The authors hope that this article will promote a dialogue with psychiatrists considering relocation to a rural area and encourage training programs to prepare residents for rural practice.

The Legacy of Domestic Violence

SUMMARY Children are often “invisible” victims of domestic violence involving their parents. This article will discuss some cases of child witnesses revealed to Tracey Treinen, child advocate of a small, rural Minnesota battered women's program. The children share experiences of their family violence and talk about how that violence affects them. Tracey also describes how children's disclosure changes when their parent(s) express outrage at what, under most circumstances, would be considered a positive change of behavior. Through the vignettes and research cited, it is hoped that the reader will identify the unique role played by an advocacy program to provide education and resources that empower participants to make more productive life choices. In all cases it must be recognized, however, that if violence against women were ended, its impact on children would also end.

The Paediatric Nurse, the Child and the Illness Network

Modem advances in health-care knowledge and technology have resulted in complex modalities of treatment. As a consequence children suffering conditions, once incompatible with survival, are now experiencing a lifetime of chronic health care and treatment. Acute paediatric health care can be simultaneously life-saving and terrifying for the child. Children's expression of emotional and psychological distress through somatoform symptoms can be confusing and perplexing for clinicians. If unrecognized, particularly in the acute care setting, somatoform symptoms may lead to abnormal illness behaviour and abnormal treatment behaviour with the child being subjected to unnecessary `abusive' investigations and treatment. The complexity for paediatric nurses lies in recognizing the child's distress and interpreting the symptoms for the child, the parents and other health-care professionals. This is different from the intervention that a psychologist or social worker might provide because of the experienced nurse's understanding of the child's illness environment. Nursing demands that the biological, the psychological and the psychosocial are woven into the structure of daily care. Quality nursing care is dependent on expert nursing knowledge and understanding of this illness environment. The expert nurse, by connecting with and understanding the child, fulfils a twofold role: the child's advocate, facilitating the coordination and integration of management plans, and the child's interpreter. Increasingly developed nursing expertise enables an appreciation of the particular needs of the child from the child's point of view.