Child Health Populations Research Articles

Preventing Job Burnout: Could Workplace Support Protect Maternal and Child Health Professionals Who Are Doing Public Health Equity Work?

To assess the potential of workplace support to protect public health equity workers against job burnout and to identify key workplace support components. This mixed-methods, explanatory sequential study analyzed survey and interview data collected between August 2020 and June 2021. Participants included governmental and non-governmental public health employees whose programs largely focus on Maternal and Child Health populations and who reported that their jobs involved working to reduce health inequities ("equity work"). Regression analysis tested the effect of emotional labor on job burnout, and whether workplace support modified that effect. Qualitative analysis of interview transcripts explored possible components of needed workplace support. Emotional labor was positively associated with job burnout (p < .001), and there was a significant negative interaction between emotional labor and workplace support, meaning workplace support appeared to reduce the effect of emotional labor on burnout (p = .036). Qualitative analysis identified four support components: peer-to-peer mentoring connections, workplace accommodations, engaged and empathetic supervision, and mental health resources. Workplace support is associated with reduced job burnout for public health equity workers, especially those whose jobs involve high levels of emotional labor. Few public health employers are providing needed emotional supports for their equity workers, but certain supports appear to be helpful in reducing job burnout.

A Qualitative Study on Trainees' Perspective on the Benefits of Maternal and Child Health Pipeline Training Programs.

The purpose of this qualitative study was to determine the benefits of the Maternal and Child Health Pipeline Training Program (MCHPTP) to the program participants. The MCHPTP exposes undergraduate students to a series of activities designed to introduce them to career choices in health or health-related professions, which serve maternal and child health populations. A qualitative research interview design was utilized to conduct this study. Data were collected from 15 undergraduate trainees at six Maternal and Child Health Pipeline Training Programs from colleges and universities across the U.S. The results showed that all the trainees would recommend the MCHPTP to other students, they were satisfied with their career interests, and there were many benefits of the MCHPTP.

Measuring LEND Core Competencies Using Trainee Follow-Up Surveys.

Measuring the value-added impact of Leadership Education in Neurodevelopmental Disabilities and Related Disorders (LEND) training on trainees' leadership and career trajectories is necessary to understand program efficacy. In the current study, we leveraged an existing ex post facto design to develop and test a new measure of LEND competencies and compare outcomes of LEND trainees and comparison peers. We developed the LEND Outcomes Follow-Up Survey using a multi-step, mixed methods process. A series of focus groups and consultations with key stakeholders identified eight important LEND leadership outcomes: (1) interdisciplinary work; (2) advocacy; (3) intersectional approach; (4) systems perspective; (5) life course perspective; (6) leadership; (7) engagement with maternal and child health populations; and (8) research experience. We developed and piloted this novel survey to measure these LEND leadership outcomes. We used data collected from this novel measure and an existing survey that is used nationally by LEND, to compare the outcomes of 43 LEND trainees and 30 comparison peers at two years post completion of LEND training. We found that, compared to comparison peers, LEND trainees: (1) worked with a greater number of disciplines; (2) were more likely to be engaged in advocacy; (3) were more likely to utilize a systems perspective in their work; (4) were more likely to work with maternal and child health populations; and (5) were more likely to have experience conducting research. Our findings suggested that LEND training improves LEND leadership outcomes at two years post-completion of LEND training.

An Evaluation of Florida’s Zika Response Using the WHO Health Systems Framework: Can We Apply These Lessons to COVID-19?

ObjectivesFrom 2016 to 2018 Florida documented 1471 cases of Zika virus, 299 of which were pregnant women (Florida Department of Health, https://www.floridahealth.gov/diseases-and-conditions/mosquito-bornediseases/surveillance.html, 2019a). Florida’s response required unprecedented rapid and continuous cross-sector communication, adaptation, and coordination. Zika tested public health systems in new ways, particularly for maternal child health populations. The systems are now being challenged again, as the Coronavirus COVID-19 pandemic spreads throughout Florida. This qualitative journey mapping evaluation of Florida’s response focused on care for pregnant women and families with infants exposed to Zika virus.MethodsFifteen focus groups and interviews were conducted with 33 public health and healthcare workers who managed outbreak response, case investigations, and patient care in south Florida. Data were thematically analyzed, and the results were framed by the World Health Organization’s (WHO) Healthcare Systems Framework of six building blocks: health service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership and governance (World Health Organization, https://www.who.int/healthsystems/strategy/everybodys_business.pdf, 2007, https://www.who.int/healthinfo/systems/monitoring/en/, 2010).ResultsResults highlighted coordination of resources, essential services and treatment, data collection, communication among public health and healthcare systems, and dissemination of information. Community education, testing accuracy and turnaround time, financing, and continuity of health services were areas of need, and there was room for improvement in all indicator areas.ConclusionsThe WHO Framework encapsulated important infrastructure and process factors relevant to the Florida Zika response as well as future epidemics. In this context, similarities, differences, and implications for the Coronavirus COVID-19 pandemic response are discussed.

Developing personalised outcome measures (POMs) in a child health population

Introduction: The UK is developing new models of care1,2; delivering better outcomes while using resources more efficiently. New models of care require smarter commissioning that moves away from pathways and instead commissions for outcomes. There are insufficient meaningful outcome metrics to support effective healthcare commissioning for children and young people (CYP).3 Patient-reported experience measures (PREMs) are extensively used in the NHS but are designed by the system to elicit patient feedback. In contrast, personalised outcome measures (POMs) are co-developed with the population, reflecting patient priorities. Practice change implemented: We have developed a whole-population segmentation4 approach to commissioning for CYP and are developing robust outcome measures in partnership with children and their families for two segments: the healthy child and acutely mild/moderately unwell child. Aim and theory of change: We are developing POMs for CYP with a primary aim of creating a tool to inform commissioning and planning of new models of care and a secondary benefit of growing the culture of patient-centred care. Our process involves the following stages: 1. Create valid segments 2. Identify patients representative of those segments 3. Create the setting (workshops) for authentic dialogue 4. Design measure 5. Test measure 6. Implement measure in new model of care 7. Observe impact of new model on measure Targeted population and stakeholders: These POMs are for CYPs and families, the health professionals in child health and the commissioners and policy makers and budget holders. Timeline: - Preparatory phase March ‘16 – Feb ‘17 - POM development March – May ‘17 - Dissemination of findings June – August ‘17 Highlights: Innovation – POMs represent a significant shift from process and proxy measures of disease towards what matters to patients, against which care can be commissioned, evaluated and improved. However, they are not widely used within the health setting and have never been applied to child health populations. Impact – to put the patient at the centre of what we do Outcomes – valid, meaningful measures of CYP healthcare Sustainability: These POMs are designed to have long-term validity across the NHS and beyond. Transferability: The work will develop POMs that can be used anywhere in the UK and internationally. Importantly, the methodology will also be transferable to adult populations too. Conclusions: This work lays the foundations for effective CYP commissioning by developing population segments with meaningful metrics: clinical, activity and POMs. It supports the move to the capitated payment approaches seen within accountable care organisations. There is a pressing need for efficient utilisation of health care resource and POMs enable us to keep patients at the centre of care delivered. Discussions: How does CYP integrated care differ from adult integrated care? How can we adjust for bias of those who will engage with co-development? Lessons learned: Children can be engaged meaningfully in the development of integrated healthcare systems and delivery. Commissioning against outcomes must include POMs if it is to be meaningful. Our whole-population segmentation provides an important framework around which to develop patient-centred care.

Issues and Solutions for Collecting Biological Specimen in Longitudinal Studies: Experience from the Community Child Health Network Research Network.

The inclusion of biomarkers in studies of stress and health outcomes is of growing interest, including for community-based participatory research (CBPR) studies. Yet the perspectives of participants and communities have been infrequently consulted to inform the biomarker collection process. The objective of this paper is to describe the process and outcomes of using CBPR in framing biomarker collection in a study of allostatic load in a maternal and child health population. Through analysis of focus group data, we identify aspects of CBPR that facilitate increased community trust and endorsement related to collecting biological samples, and also provide a community perspective that is often overlooked in the literature. We found that a CBPR approach facilitated greater understanding among community members about the importance of biomarkers, while simultaneously informing the design of a biomarker data collection protocol that was responsive to the desired scope and data collection procedures that reflected community priorities.

Bridging the gaps: An early integrated support collaborative for at risk mothers in rural Maine.

The antecedents that contribute to health disparities in maternal child health populations begin before birth and extend into the early prenatal and gestational growth periods. Mothers and infants living in rural poverty in particular are at considerable risk for problems associated with reproductive health, including pregnancy complications and premature births. The aim of this manuscript is thus two-fold, to describe the epidemiologic makeup of the community and the intervention model of the Community Caring Collaborative. Innovative models of early-integrated care for high-risk mothers and children are showing promise for long-term outcomes. They foster environments that enable mothers to trust health systems while maintaining a workforce of high functioning health workers who understand the mechanisms that underpin maternal and child health disparities. The Community Caring Collaborative in Washington County, Maine developed one such model that has made inroads in bridging such gaps. This manuscript explicates a case study of how the Community Caring Collaborative came into being and why it established the Bridging model of comprehensive care. The focus of this manuscript is thus two-fold, the community and the intervention model. The "bridging model" develops trust-based relationships between high-risk mothers with the health system and its multiple resources. Community members with advanced training provide the support and care linkages that are critical for family success. Innovative models of collaborative care impact the health of vulnerable mothers and their children working toward a marked decrease in health related disparities.

Assessing Needs and Resources for the Home Visiting System in Alabama: A Mixed Methods Approach

The purpose of this article is to describe the initial assessment for the development of a home visiting (HV) system in a state with no existing system. We outline a mixed methods process where the quantitative component was used to identify the communities that possess "at-risk" profiles, and the qualitative component explored the resources and gaps in existing HV services. We employed a mixed methods approach, using six categories of indicators from quantitative secondary data sources to identify "at-risk" profiles for Alabama's 67 counties. A weighted score for each indicator was calculated and counties were ranked. Surveys and focus groups were conducted to further define resources and gaps of existing HV programs. The composite indicator scores identified 13 counties as having the highest level of risk. Five of these 13 communities had no HV home visitation services. Areas of focus for future HV system development include trust, communication, availability, cost, and timeliness. In this assessment related to the Alabama HV system, we used quantitative data to apply criteria to the indicators being measured and qualitative data to supplement the quantitative findings. We examined resources, gaps, program quality, and capacity of the existing HV programs in order to assist in the future development of the HV system and early childhood system. The methods presented in this paper have potential applications beyond HV programs and systems, including broader examinations of complex systems for service provision to the maternal and child health populations.

No increased risk of relapse after meningococcal C conjugate vaccine in nephrotic syndrome

Objectives:To investigate whether meningococcal C conjugate vaccine (MCCV) caused relapse in children with steroid-responsive nephrotic syndrome.Design:A population-based study was conducted using an active surveillance system, developed to assess adverse events...

Maternal and child health graduate and continuing education needs: a national assessment.

The purpose of this report is to describe the methodology and results of a recent national assessment of long-term graduate and short-term continuing education needs of public health and health care professionals who serve or are administratively responsible for the U.S. maternal and child health population and also to offer recommendations for future training initiatives. The target of this needs assessment was all directors of state MCH, CSHCN and Medicaid agencies, as well as a 20% random sample of local public health departments. A 7-page needs assessment form was used to assess the importance of and need for supporting graduate and continuing education training in specific skill and content areas. The needs assessment also addressed barriers to pursuing graduate and continuing education. Respondents (n = 274) were asked to indicate the capacity of their agency for providing continuing education as well as their preferred modalities for training. Regardless of agency type, i.e., state MCH, CSHCN, Medicaid or local health department, having employees with a graduate education in MCH was perceived to be of benefit by more than 70% of the respondents. Leadership, systems development, management, administration, analytic, policy and advocacy skills, as well as genetics, dentistry, nutrition and nursing, were all identified as critical unmet needs areas for professionals with graduate training. Education costs, loss of income, and time constraints were the identified barriers to graduate education. More than 90% of respondents from each agency viewed continuing education as a benefit for their staff, although the respondents indicated that their agencies have limited capacity to either provide such training or to assess their staffs need for continuing education. Program managers and staff were perceived in greatest need of continuing education and core public health skills, leadership, and administration were among the most frequently listed topics to receive continuing education training support dollars. Time away from work, lack of staff to cover functions, and cost were the top barriers to receiving continuing education. While attending on-site, in-state, small conferences was the continuing education modality of first preference, there was also considerable interest expressed in web-based training. Six recommendations were developed on the basis of the findings and address the following areas: the ongoing need for continued support of both graduate and continuing education efforts; the development of a national MCH training policy analysis center; the incorporation of routine assessments of training needs by states as part of their annual needs assessments; the promotion of alternative modalities for training, i.e., web-based; and, the sponsorship of academic/practice partnerships for cross-training.

Maternal and Child Oral Health Issues: Research

There is currently little oral research directed toward the maternal and child health population, especially outside of the National Institute of Dental Research funded programs. Although many agencies are involved with research in this area, there is no central national coordination, policy, or research agenda. Not all segments of the population are benefiting from existing knowledge. To improve oral health for all segments of the population, leadership in the establishment of research priorities is needed to direct activities that will benefit the population groups most affected by oral disease. New directions and perspectives are needed in the type of research conducted. The populations and conditions studied and the depth of the analyses performed must be extended. Additional emphasis should be placed on behavioral, evaluation, and health services research and collaborative research with other health fields. The population groups studied need to be expanded from the historical focus on relatively healthy elementary schoolchildren. As discussed by Waldman, information is particularly needed pertaining to children under age five, all women, and special population groups. As Frazier and Horowitz indicated, research on health promotion and health education within these target populations, as well as among other family members and care givers is needed. Data collected from surveys need to be analyzed more thoroughly. As new diagnostic systems and oral health care technologies are developed, they need to be evaluated adequately for safety, effectiveness, and efficiency. To accomplish all these activities, financial and human resources are needed--funding from appropriate sources in the public and private sector and qualified dental researchers interested in public health and clinical issues of concern to the maternal and child population.