Child-centred Intervention Research Articles

Acceptability, engagement and exploratory outcomes and costs of a co-designed intervention to support children of parents with a mental illness: Mixed-methods evaluation and descriptive analysis.

Children whose parents have a mental illness are much more likely to experience mental health problems and other adverse long-term impacts. Child-centred psychosocial interventions can be effective, but not much is known about how to design and implement them in different settings. A pre-post, mixed methods, single-arm evaluation of a co-designed social support intervention with parents and children (4-18 years) measured parents' mental health (PHQ-9), perceived social support (ENRICHD), parental self-efficacy (PSAM) and children's mental health (SDQ), quality of life (Kidscreen-27), and child service use (CAMHSRI-EU) at baseline and 6 months. Qualitative data were gathered at 6 months to explore parents' and children's experience with the intervention. Twenty-nine parents and 21 children completed baseline and follow-up questionnaires; 22 parents and 17 children participated in interviews. Parents' depression (MD -1.36, SD 8.08), perceived social support (MD 1, SD 5.91), and children's mental health potentially improved, and children's service use and costs potentially reduced (€224.6 vs. €122.2, MD 112.4). Parental self-efficacy was potentially reduced (MD -0.11, SD 3.33). The sample was too small to perform statistical analysis. Favourable themes emerged describing the high satisfaction with the intervention, parents' improved understanding of the impact of their mental health problems on children, and improvements in parent-child relationships. This study contributes to an emerging evidence base for co-designed child-centred interventions to prevent the transgenerational transmission of poor mental health.

Child’s Play or Sexual Abuse? The Efficacy of International Law in Dealing with Child-to-Child Sex: A Ugandan Perspective

International and regional laws on children’s rights are fairly well developed and cover aspects of social rights such as the protection of children from sexual abuse. A dilemma remains however on the issue of child-to-child sex leaving many grey areas on how to deal with this predicament at the domestic level. Social and cultural norms that perceive adolescent sexual conduct negatively complicate matters further. This article uses Uganda as a case study to examine the sufficiency of the United Nations Convention on the Rights of the Child (UN CRC) and the African Children’s Charter in protecting child victims involved in child-to-child sex. Further, it interrogates the extent to which the law of Uganda legislates sexual intercourse for persons below the age of eighteen. The focus and backdrop of this article is based on a Ugandan landmark court ruling, that struck down the offence of child-to-child sex. It advocates for the adoption of jurisprudence both through case law as well as General Comments to expound on this critical issue especially at the African regional level where the prevalence of sexual violence by children is increasing. It also calls for less focus on criminalisation, but rather, child-centred interventions that seek to empower children’s participation, information and protection in matters of their sexuality.

Hypnotherapy for procedural pain, itch, and state anxiety in children with acute burns: a feasibility and acceptability study protocol

BackgroundBurns and related procedures are painful and distressing for children, exposing them to acute and chronic sequelae that can negatively affect their physiological, psychological, and social functions. Non-pharmacological interventions such as distraction techniques are beneficial adjuncts to pharmacological agents for procedural pain, state anxiety, and itch in children with burns but have limitations (e.g. lack of research on burn-related itch, tailoring, and consensus on optimal treatment). Hypnotherapy is a non-pharmacological intervention that can be tailored for varied settings and populations with evidence of benefit for itch and superior effectiveness in comparison to other non-pharmacological interventions for children’s procedural pain and state anxiety. Thus, children with burns can benefit from hypnotherapy as an adjunct to pharmacological agents. Yet, in paediatric burns, rigorous studies of effectiveness are limited and no studies have been identified that screen for hypnotic suggestibility, an important predictor of hypnotherapy outcomes. Considering potential barriers to the delivery of hypnotherapy in paediatric burns, the proposed study will examine the feasibility and acceptability of hypnotic suggestibility screening followed by hypnotherapy for procedural pain, state anxiety, and itch in children with acute burns.MethodsAn observational mixed-methods feasibility and acceptability study will be conducted over 15 weeks. Eligible children (N = 30) aged 4 to 16 years presenting to a paediatric burns outpatient centre in a metropolitan children’s hospital in Australia with acute burns requiring dressing changes will be included. Eligible parents of children (N = up to 30) and clinicians who perform dressing changes (N = up to 20) will also be included. Child participants screened as having medium to high suggestibility as assessed by behavioural measures will receive hypnotherapy during dressing changes. A process evaluation will target feasibility and acceptability as primary outcomes and implementation (i.e. fidelity in delivery), reach, potential effectiveness, and adoption of evaluation procedures and intervention as secondary outcomes.DiscussionEthical approval was obtained from the Queensland Children’s Hospital and Health Service ethics committee. Results will be published in peer-reviewed publications and conference proceedings.The findings will guide the design of future trials on the effectiveness of hypnotherapy and inform the development of child-centred hypnotic interventions in children with burns.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12620000988954

An intervention to improve the quality of life in children of parents with serious mental illness: the Young SMILES feasibility RCT.

An intervention to improve the quality of life in children of parents with serious mental illness: the Young SMILES feasibility RCT.

User-provider experiences of the implementation of KidzAlive-driven child-friendly spaces in KwaZulu-Natal, South Africa

BackgroundKidzAlive is a child-centred intervention aimed at improving the quality of HIV care for children in South Africa. Through this intervention, 10 child-friendly spaces were created in 10 primary healthcare centres (PHCs) in KwaZulu-Natal to enhance child-centred HIV care. However, the user-provider experiences of these child-friendly spaces in these facilities have not been explored. This paper addresses this gap.MethodsWe conducted qualitative interviews with children (n = 30), their primary caregivers (PCGs) (n = 30), and KidzAlive trained healthcare workers (HCWs) (n = 20) using and providing child-friendly spaces, respectively. Data were generated, using a semi-structured interview guide printed in both English and IsiZulu. The interviews were audio-recorded transcribed and translated to English by a research team member competent in both languages. Data were imported to NVivo 10 for thematic analysis. The COREQ checklist was used to ensure that the study adheres to quality standards for reporting qualitative research.ResultsChild-friendly spaces contributed to the centredness of care for children in PHCs. This was evidenced by the increased involvement and participation of children, increased PCGs’ participation in the care of their children and a positive transformation of the PHC to a therapeutic environment for children. Several barriers impeding the success of child-friendly spaces were reported including space challenges; clashing health facility priorities; inadequate management support; inadequate training on how to maximise the child-friendly spaces and lastly the inappropriateness of existing child-friendly spaces for much older children.ConclusionChild-friendly spaces promote HIV positive children’s right to participation and agency in accessing care. However, more rigorous quantitative evaluation is required to determine their impact on children’s HIV-related health outcomes.

Promoting resilience in children and adolescents living with parental mental illness (CAPRI): children are key to identifying solutions.

None.

Self-reported needs after pediatric stroke.

Pediatric stroke has the potential for long term impact on the lives of children and their families. Child-centred intervention depends on understanding of needs from diagnosis onwards. However, little is known about the health and care support self-reported needs of this population. This study aimed to describe the nature and extent of needs (met and unmet) of pediatric stroke patients and their families and compare these with previously reported adult stroke needs. The questionnaire, adapted from a previously published adult stroke study, was conducted with parents of children who had an ischemic or haemorrhagic stroke between birth - 18 years, and young people with stroke now aged between 12 and 18 years. Participants were recruited from three tertiary pediatric stroke clinics in England. Levels and type of needs, and self-reported neurological impairment were captured. Comparisons of needs was reported descriptively and explored using Chi-square test. Of 44 participants (39 parents, 5 young people), over two thirds reported at least one unmet need. Over half had difficulties in school-related activities, and over one-third in leisure activities and social relationships. Participants reported similar nature and extent of need when compared to previously reported adult stroke needs. Higher severity of neurological impairment was associated with higher number of needs. Children and young people and their parents have high levels of unmet need across a range of health domains in the months and years after pediatric stroke. This information supports the importance of a needs-based approach to maximising health and well-being.

Interventions to improve fundamental motor skills in pre-school aged children: A systematic review and meta-analysis.

Mastery in -fundamental motor skills (FMS) is associated with increased physical activity (PA) in school-aged children; however, there is limited research on pre-schoolers (3-5 years). We aimed to evaluate interventions for improving FMS as well as PA. A search of electronic databases was conducted for controlled trials using PA interventions with FMS as outcomes in healthy pre-schoolers. Standardised mean difference (SMD), 95% confidence intervals and publication bias were calculated for each outcome using Revman 5.3. Twenty trials met inclusion criteria. In total, 4255 pre-schoolers were analysed with 854 completing a FMS intervention. Studies were categorised into three groups (i) Teacher-Led (TL)(n=13); (ii) Child-Centred (CC)(n=6) and (iii) Parent-Led (PL)(n=1). Mean age was 4.3±0.4 years, with equal gender distribution. Interventions ran for 21±17 weeks, 3±1 times per week for 35±17 minutes. TL interventions significantly improved overall FMS (SMD=0.14[0.06, 0.21]; p=0.0003), object control (SMD=0.47[0.15, 0.80]; p= 0.004), and locomotor skills (SMD=0.44[0.16, 0.73]; p=0.002), whereas CC interventions were not significant. There was a small, non-significant reduction in sedentary time (SMD=-0.35[-0.80, 0.10]; p= 0.12), and a large non-significant increase in PA (SMD=0.79[-0.83, 2.41]; p=0.34). PA interventions improve FMS in pre-schoolers; however, due to limited research, more study is needed on CC interventions. Targeting FMS development in pre-schoolers may promote higher PA levels and reduce sedentary time, however more study is needed.

Physical Activity Interventions to Improve Fundamental Motor Skills in Preschoolers

PURPOSE: To evaluate interventions for improving fundamental motor skills (FMS) and physical activity (PA) levels in preschoolers. Mastery in FMS is associated with greater participation in PA in school aged children. Early childhood has been identified as the critical time for engaging in FMS development, however, there is limited research investigating this relationship in preschoolers aged 3-5 years. METHOD: We conducted a systematic search of electronic databases up until 31st October 2014. Randomised control trials (RCTs) using PA interventions with FMS as outcome measures in preschoolers were eligible for inclusion. Studies including children with disabilities or developmental delays were excluded. Between group mean differences, relative effect sizes (ES) and 95% confidence intervals were calculated for each outcome. RESULTS: Search terms yielded 1411 articles of which 8 RCTs and 2747 participants met the inclusion criteria. Studies were dichotomised into two groups (i) Teacher-Led (TL) Interventions (n=7) and (ii) Child-Centred (CC) Interventions (n=1). Mean age of children studied was 4.0±0.8yrs, with an equal gender distribution. Mean body mass index (BMI) was 16.52±0.23. On average interventions ran for 24±10wks, 3±1 times per week for 27±6mins. Five of the 7 TL studies reported significant improvements in FMS (ES Range 0.21-0.85;p≤0.01). The CC intervention also reported significant improvements in FMS, p≤0.001. Five TL interventions reported changes in PA levels, with one reporting significant improvements (ES 0.47;p≤0.01). Four studies reported body composition, with one reporting a significant decrease in BMI (p=0.02) and waist circumference (p=0.002). CONCLUSION: There is emerging evidence that PA interventions can improve FMS in preschoolers; however, there is a dearth of evidence on CC interventions, where an intervention is delivered directly to children by a trained professional. Targeting FMS development in this age group may promote higher PA levels throughout childhood, however more study is needed. Long term follow up is required to determine if improving FMS at preschool age increases participation in sports and PA. In addition, will it lead to lifestyle patterns throughout adolescence and adulthood, that will reduce the risk of metabolic and cardiovascular diseases.

Developing and evaluating a child-centred intervention for diabetes medicine management using mixed methods and a multicentre randomised controlled trial

AimTo develop and evaluate an individually tailored age-appropriate diabetes diary and information pack for children and young people aged 6–18 years with type 1 diabetes to support decision-making and self-care with a specific focus on insulin management and blood glucose monitoring, compared with available resources in routine clinical practice.DesignFour-stage study following the Medical Research Council framework for designing and evaluating complex interventions. Stage 1: context – brief review of reviews and mixed-method systematic review; updating of database of children’s diabetes information; children’s diabetes information quality assessment and diabetes guideline analysis; and critical discourse analysis. Stage 2: intervention development – working with expert clinical advisory group; contextual qualitative interviews and focus groups with children and young people to ascertain their information preferences and self-care practices; ongoing consultation with children; development of intervention programme theory. Stage 3: randomised controlled trial (RCT) to evaluate the diabetes diaries and information packs in routine practice. Stage 4: process evaluation.FindingsThe RCT achieved 100% recruitment, was adequately powered and showed that the Evidence into Practice Information Counts (EPIC) packs and diabetes diaries were no more effective than receiving diabetes information in an ad hoc way. The cost per unit of producing the EPIC packs and diabetes diaries was low. Compared with treatment as usual information, the EPIC packs fulfilled all NHS policy imperatives that children and young people should receive high-quality, accurate and age-appropriate information about their condition, self-management and wider lifestyle and well-being issues. Diabetes guidelines recommend the use of a daily diabetes diary and EPIC diaries fill a gap in current provision. Irrespective of allocation, children and young people had a range of recorded glycated haemoglobin (HbA1c) levels, which showed that as a group their diabetes self-management would generally need to improve to achieve the HbA1clevels recommended in National Institute for Health and Care Excellence guidance. The process evaluation showed that promotion of the EPIC packs and diaries by diabetes professionals at randomisation did not happen as intended; the dominant ‘normalisation’ theory underpinning children’s diabetes information may be counterproductive; risk and long-term complications did not feature highly in children’s diabetes information; and children and young people engaged in risky behaviour and appeared not to care, and most did not use a diabetes diary or did not use the information to titrate their insulin as intended.LimitationsRecruitment of ‘hard to reach’ children and young people living away from their families was not successful. The findings are therefore more relevant to diabetes management within a family context.ConclusionsThe findings indicate a need to rethink context and the hierarchical relationships between children, young people, parents and diabetes professionals with regard to ‘partnership and participation’ in diabetes decision-making, self-care and self-management. Additional research, implementation strategies and service redesign are needed to translate available information into optimal self-management knowledge and subsequent optimal diabetes self-management action, including to better understand the disconnection between children’s diabetes texts and context; develop age-appropriate Apps/e-records for recording blood glucose measurements and insulin management; develop interventions to reduce risk-taking behaviour by children and young people in relation to their diabetes management; reconsider what could work to optimise children’s self-management of diabetes; understand how best to reorganise current diabetes services for children to optimise child-centred delivery of children’s diabetes information.Study registrationCurrent Controlled Trials ISRCTN17551624.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

A systematic narrative review of the studies on structured child‐centred interventions for families with a parent with cancer

To perform a systematic narrative review of the current state of published articles on the structured interventions targeted at children with a parent suffering from cancer. The study was based on a narrative synthesis approach. Eleven structured child-centred intervention studies were systematically searched through PubMed, PsycINFO and MEDLINE. The interventions were grouped into two main categories: 'structured family interventions' and 'structured peer group interventions'. Special attention was focused on the preventive purpose of the interventions. The participants (children, parents and health professionals) reported several positive impacts of interventions on children's and parents' psychosocial well-being, although no improvement or changes were also observed. The effect of interventions on the children was evaluated by structured methods only in five studies. This review showed the lack of valid psychosocial preventive intervention methods focusing on children with parental cancer and highlighted the need of intervention research with controlled study designs and long follow-up periods. However, an intervention method should be easy to train and applicable to the clinical practice of healthcare professionals. By refining the practice-based experiences with scientific research evidence it is possible to move to the next level in providing psychosocial support and prevention for children living in families with parental cancer.

Cognitive Orientation to Daily Occupational Performance (CO-OP)

This paper is the first in a series of three papers that present the systematic development and evaluation of Cognitive Orientation to daily Occupational Performance (CO-OP). CO-OP is a cognitively based, child-centred intervention that enables children to achieve their functional goals. In Part I, the breadth of literature that provides the theoretical underpinnings for the approach is reviewed. Parts II and III provide a description of the approach and present the evidence to support its use with children with developmental coordination disorder.

Child psychiatric emergencies: a research note.

In a controlled study, emergency referrals to a child psychiatric clinic showed increased depressive and suicidal symptomatology and more perceptual abnormalities. There was also more commonly a recent deterioration in the presenting condition. Parents rated themselves as depressed more frequently and there were more problems in the father-child relationship. There were no significant associations between emergency referrals and ratings of family dysfunction, availability of an extended family or contact with social agencies, but there was a trend towards increased use of the latter by the emergency group. The results highlight the need for early child-centred psychiatric intervention in a minority of conditions of children and adolescents.