Provision Of Child Health Services Research Articles

Effective coverage of curative child health services in Ethiopia: analysis of the Demographic and Health Survey and Service Provision Assessment survey

ObjectivesDespite a remarkable decline, childhood morbidity and mortality in Ethiopia remain high and inequitable. Thus, we estimated the effective coverage of curative child health services in Ethiopia.DesignWe conducted a cross-sectional...

The impact of donor transition on continuity of maternal and newborn health service delivery in Rwenzori sub-region of Uganda: a qualitative country case study analysis

BackgroundThe transition of donor-supported health programmes to country ownership is gaining increasing attention due to reduced development assistance for health globally. It is further accelerated by the ineligibility of previously Low-Income Countries’ elevation into Middle-income status. Despite the increased attention, little is known about the long-term impact of this transition on the continuity of maternal and child health service provision. Hence, we conducted this study to explore the impact of donor transition on the continuity of maternal and newborn health service provision at the sub-national level in Uganda between 2012 and 2021.MethodsWe conducted a qualitative case study of the Rwenzori sub-region in mid-western Uganda which benefited from a USAID project to reduce maternal and newborn deaths between 2012 and 2016. We purposively sampled three districts. Data were collected between January and May 2022 among subnational key informants (n = 26), national level key informants at the Ministry of Health [3], national level donor representatives [3] and subnational level donor representatives [4] giving a total of 36 respondents. Thematic analysis was deductively conducted with findings structured along the WHO’s health systems building blocks (Governance, Human resources for health, Health financing, Health information systems, medical products, Vaccines and Technologies and service delivery) framework.ResultsOverall, continuity of maternal and newborn health service provision was to a greater extent maintained post-donor support. The process was characterised by a phased implementation approach. The embedded learning offered the opportunity to plough back lessons into intervention modification which reflected contextual adaptation. The availability of successor grants from other donors (such as Belgian ENABEL), counterpart funding from the government to bridge the gaps left behind, absorption of USAID-project salaried workforce (such as midwives) onto the public sector payroll, harmonisation of salary structures, the continued use of infrastructure (such as newborn intensive care units), and support for MCH services under PEPFAR support post-transition contributed to the maintenance of coverage. The demand creation for MCH services pre-transition ensured patient demand post-transition. Challenges to the maintenance of coverage were drug stockouts and sustainability of the private sector component among others.ConclusionA general perception of the continuity of maternal and newborn health service provision post-donor transition was observed with internal (government counterpart funding) and external enablers (successor donor funding) contributing to this performance. Opportunities for the continuity of maternal and newborn service delivery performance post-transition exist when harnessed well within the prevailing context. The ability to learn and adapt, the presence of government counterpart funding and commitment to carry on with implementation were major ingredients signalling a crucial role of government in the continuity of service provision post-transition.

Patterns of service provision in child and adolescent mental health care in Australia.

Standard description of local care provision is essential for evidence-informed planning. This study aimed to map and compare the availability and diversity of current mental health service provision for children and adolescents in Australia. We used a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE) tool, to describe service availability in eight urban and two rural health districts in Australia. The pattern of care was compared with that available for other age groups in Australia. Outpatient care was found to be the most common type of service provision, comprising 212 (81.2%) of all services identified. Hospital care (acute and non-acute) was more available in urban than in rural areas (20 services [9.7%] vs 1 [1.8%]). The level of diversity in the types of care available for children and adolescents was lower than that for the general adult population, but slightly higher than that for older people in the same areas. Standardised comparison of the pattern of care across regions reduces ambiguity in service description and classification, enables gap analysis and can inform policy and planning.

Role of community pharmacy professionals in child health service provision in Ethiopia: a cross-sectional survey in six cities of Amhara regional state

BackgroundCommunity pharmacy professionals have great potential to deliver various public health services aimed at improving service access, particularly in countries with a shortage of health professionals. However, little is known about their involvement in child health service provision in Ethiopia.ObjectiveThe purpose of this study was to evaluate the level of involvement of community pharmacy professionals in child health service provision within Ethiopia.MethodsA multi-center cross-sectional survey was conducted among 238 community pharmacy professionals from March to July 2020 in Amhara regional state of Ethiopia. Independent samples t-test and one way Analysis of Variance (ANOVA) was used to test the mean difference.ResultsMost community pharmacy professionals were ‘involved’ in providing child health services related to ‘advice about vitamins/supplements’ (46.6%), ‘advice about infant milk/formulas’ (47.1%) and ‘responding to minor symptoms’ (50.8%) for children. The survey revealed that, community pharmacy professionals were less frequently involved in providing childhood ‘vaccination’ services. Further, level of involvement of community pharmacy professionals differed according to participants’ licensure level, setting type, responsibility in the facility and previous training experience in child health services.ConclusionCommunity pharmacy professionals have been delivering various levels of child health services, demonstrating ability and capacity in improving access to child health services in Ethiopia. However, there is a need for training and government support to optimize pharmacist engagement and contribution to service delivery.

Specialized care services for children with congenital zika virus syndrome in Rio de Janeiro, Brazil: a social network analysis.

In 2015 the correlation between increasing numbers of cases of microcephaly and a zika virus outbreak led to recognition of an epidemic of congenital zika virus syndrome (CZVS), highlighting well-known weaknesses in health care measures. This article examines the network of virtual information available on health service provision for children suffering from CZVS in Rio de Janeiro. Using social media analysis, data on information about services and care institutions were collected from virtual sources using the Google search engine, so as to assess relations among these actors in 2018. The results revealed a fragmented network centred on virtual sources and secondary and tertiary public care services, with striking proximity of press sources to public services. Also salient was the isolation of private services and the lack of dialogue between philanthropic and public services. Moreover, the information offered was found to be insufficient and superficial, despite the gaps in the formal rehabilitation network. The evidence thus suggested the importance of a well-established health care service network and the necessity of fostering communication through virtual media.

Actions and Adaptations Implemented for Maternal, Newborn and Child Health Service Provision During the Early Phase of the COVID-19 Pandemic in Lagos, Nigeria: Qualitative Study of Health Facility Leaders.

Background:The early phase of the COVID-19 pandemic led to significant disruptions in provision of maternal, newborn, and child health (MNCH) services, especially in low- and middle-income countries (LMICs) with fragile health systems, such as Nigeria. Measures taken to ‘flatten the curve’ such as lockdowns, curfews, travel restrictions, and suspension of public services inadvertently led to significant disruptions in provision of essential health services. In these countries, health facility leaders are directly responsible for driving changes needed for service delivery.Objective:To explore perspectives of health facility leaders in Lagos, Nigeria, on solutions and adaptations implemented to support MNCH service provision during the early phase of the COVID-19 pandemic.Methods:Key informant interviews were remotely conducted with purposively sampled 33 health facility leaders across primary, secondary, and tertiary public health facilities in Lagos between July and November 2020. Following verbatim transcription of recordings, data familiarization, and coding, thematic analysis was used to synthesize data.Results:Health facility leaders scaled down or discontinued outpatient MNCH services and elective surgeries. However, deliveries, newborn, immunization, and emergency services continued. Service provision was reorganized with long and staggered patient appointments, collapsing of wards and modification of health worker duty rosters. Some secondary and tertiary facilities leveraged technology like WhatsApp, webinars, and telemedicine to support service provision. Continuous capacity-building for health workers through training, motivation, psychological support, and atypical sourcing of PPE was instituted to be able to safely maintain service delivery.Conclusion:Health facility leaders led the frontline of the COVID-19 response. While they took to implementing global and national guidelines within their facilities, they also pushed innovative facility-driven adaptations to address the indirect effects of COVID-19. Insights gathered provide lessons to foster resilient LMIC health systems for MNCH service provision in a post-COVID-19 world.

Adopting population-based interventions towards sustaining child health services in the midst of COVID-19 in sub-Saharan Africa: application of the socio-ecological model.

Child health services remain one of the most cost-effective strategies in reducing child mortality which is still disturbingly high in sub-Saharan Africa (SSA). Efforts by governments and other stakeholders in response to the COVID-19 pandemic have inadvertently disrupted the provision of other essential health services including those focusing on children. This comes at the backdrop of the World Health Organization´s guidelines for countries to sustain priority services while fighting the COVID-19 pandemic. Underpinned by the Socio-Ecological Model (SEM), we propose population-based interventions which could help in sustaining child health services in the midst of COVID-19 in SSA. At the intrapersonal and interpersonal levels, educating mothers during routine community outreach services, during child welfare clinics, and in church/mosques could be useful. Education and sensitization of male partners could also be an important intervention. At the institutional and community levels, we recommend the allocation of more funds to other essential health services including child health services. The training and deployment of more general nurses, community health nurses/officers, and public health officers is imperative. The provision and adherence to COVID-19 preventive protocols at health facilities are also recommended at these levels. At the public policy level, insurance and tax relief packages for frontline professionals providing child health services and micro-credit facilities at reduced interest rates for women could be implemented towards sustaining the utilisation of child health services.

Readiness to provide child health services in rural Uttar Pradesh, India: mapping, monitoring and ongoing supportive supervision

BackgroundIn 2018, 875 000 under-five children died in India with children from poor families and rural communities disproportionately affected. Community health centres are positioned to improve access to quality child health services but capacity is often low and the systems for improvements are weak.MethodsSecondary analysis of child health program data from the Uttar Pradesh Technical Support Unit was used to delineate how program activities were temporally related to public facility readiness to provide child health services including inpatient admissions. Fifteen community health centres were mapped regarding capacity to provide child health services in July 2015. Mapped domains included human resources and training, infrastructure, equipment, drugs/supplies and child health services. Results were disseminated to district health managers. Six months following dissemination, Clinical Support Officers began regular supportive supervision and gaps were discussed monthly with health managers. Senior pediatric residents mentored medical officers over a three-month period. Improvements were assessed using a composite score of facility readiness for child health services in July 2016. Usage of outpatient and inpatient services by under-five children was also assessed.ResultsThe median essential composition score increased from 0.59 to 0.78 between July 2015 and July 2016 (maximum score of 1) and the median desirable composite increased from 0.44 to 0.58. The components contributing most to the change were equipment, drugs and supplies and service provision. Scores for trained human resources and infrastructure did not change between assessments. The number of facilities providing some admission services for sick children increased from 1 in July 2015 to 9 in October 2016.ConclusionsFacility readiness for the provision of child health services in Uttar Pradesh was improved with relatively low inputs and targeted assessment. However, these improvements were only translated into admissions for sick children when clinical mentoring was included in the support provided to facilities.

Reviewing Mental Health Services and Support for Children and Young People in Northern Ireland: A Rights-Based Approach

ABSTRACT Objective: In Northern Ireland, it is widely agreed that mental health service provision for children and young people is inadequate and that there is a need for much greater prioritisation and strategic planning in this area. Successive Governments have made commitments to improve services, and although progress has been made, considerable reform is still required. Using a child rights framework, this paper provides an overview of children and young people's direct experiences of accessing mental health services or support. Methods: An online survey was used to gather respondents experience of six statutory and non-statutory health services. Respondents were asked to rate services against nine rights-based service quality statements. A likert agreement rating scale was used to gather quantitative data and qualitative information was captured using open-ended questions. Excel and NVivo were used to analyse the data. Results: Overall, 607 children and young people aged 11–21 years old shared their experiences of mental health services. The survey results show that young people are reaching out to a wide range of services to access support. However, there was considerable variation in young people’s satisfaction levels with different services. Conclusions: This paper brings a child rights focus to the research that exists on the child and adolescent mental health system by assessing it against a range of rights-based statements. This study found that although many services are improving, more is required to ensure that Northern Ireland has a rights compliant system.

Factors associated with child health service delivery by female community health volunteers in Nepal: findings from a national survey

BackgroundNepal has made a significant improvement in child survival in the last few decades and the involvement of female community health volunteers (FCHVs) has been crucial in such achievement. While there have been many studies on child health in Nepal however, rarely explored the status and factors associated with the child health service provided by these volunteers. This study aimed to identify the factors associated with the child health service delivery by FCHVs.MethodsA national survey was conducted in 2014 in Nepal that included 4302 FCHVs using the structured questionnaire across the 13 geopolitical domains of the country. Factors associated with the use of child health services was examined using Chi-square test (χ2) followed by logistic regression.ResultsOverall, 62.6% of FCHVs provided at least one child health service. Those FCHVs who utilized money from the FCHV fund, conducted health mothers’ group meeting, involved in local committees and those who supported antenatal care and outreach clinics related activities had higher odds of providing child health services. Similarly, FCHVs equipped with the stock of Cotrimoxazole tablet, Zinc tablet, Oral Rehydration Salt packets were more likely to provide child health services. The province-wise analysis showed that FCHVs from Province 5 and Sudur Paschim Province were more likely to provide child health services compared to their counterparts from province 1. Technology-wise, FCHVs who were using mobile were more likely to provide child health services.ConclusionsFCHVs are important human resource in providing child health services in Nepal. To improve child health service delivery by FCHVs; availability of key commodities, involvement of FCHVs in regular health mothers’ group meeting, use of mobile phone, involvement in other public health programs and social networks, and utilization of the FCHV fund need to be taken into consideration.

Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?

Recent years have seen increasing momentum towards task shifting of basic health services, including using community health workers (CHW) to diagnose and treat common childhood illnesses. Yet few studies have...

Work of the NHS England Youth Forum and its effect on health services.

To examine the role of members of the NHS England Youth Forum (NHSEYF) and the strategies used to influence health service provision for children and young people. An evaluative mixed-methods study was commissioned by NHS England and undertaken by the University of Hertfordshire between July 2015 and September 2016. Data collection comprised activity logs, a form of questionnaire, and semi-structured interviews. The analysis of the activity logs revealed that the young people were undertaking a wide range of activities across England. Seven themes emerged from the interviews: the young people; motivation; commitment; community (the local area as well as a community spirit); knowledge experts; youth workers; and funding. In summary, the members of the NHSEYF were committed to their role and their work was having a positive effect on health service provision. The NHSEYF has developed rapidly and successfully. It is enabling the voice of young people to be heard.

A cross sectional study to assess the utilisation of integrated child devel-opment services among children aged 6 months to 6 years in Tamil Na-du – 2017.

Background: Integrated Child Development Services (ICDS) scheme lays foundation for the devel-opment of nation’s human resource by providing an integrated package of early childhood services. Services are provided through public health facilities to improve the nutrition and health status of children 0-6 years. Objectives: To assess the utilisation of ICDS among Children aged 6 months to 6 years in Tamil Nadu. Mate-rials And Methods: A cross sectional study conducted among 84 mothers of child aged 6 months to 6 years in randomly selected districts of Tamil Nadu from September to November 2017, using a semi-structured pre-tested questionnaire. Data was entered in MS excel and analysis done using SPSS 16. Appropriate de-scriptive and inferential statistics were used. Results: The study results revealed that 16.7% of the children were registered and utilising any of the services provided under the scheme, among them 92.8% children were taking supplementary nutrition, 78.5% children were availing health check-up services and 78.5% children were taking non formal preschool education. Among those not utilising the ICDS services, 48.5% were not aware of ICDS, 51.5% were aware but not utilising ICDS services. Conclusion: This study indicated that the utilisation of ICDS providing child health services needs to be improved in the study area. Also, indi-cates that there is a gap in awareness regarding the services and beneficiaries under the scheme. So, we need to strengthen the IEC and BCC activities regarding the services provided under ICDS scheme. Keywords: ICDS, Supplementary nutrition, Utilisation, Non-formal education.

"LEARN"ing what is important to children and young people with intellectual disabilities when they are in hospital.

The need to review health service provision for children and young people (CYP) with disabilities and their families in the United Kingdom has been expressed in multiple reports: the most consistent message being that services need to be tailored to meet their individual needs. Our aim was to understand the hospital-related needs and experiences of CYP with intellectual disabilities. An ethnographic study of a neurosciences ward and outpatient department was conducted within a paediatric tertiary hospital setting. Five themes, developed using the acronym LEARN, explained what is important to CYP with intellectual disabilities in hospital: (i) little things make the biggest difference, (ii) eliminate unnecessary waiting, (iii) avoid boredom, (iv) routine and home comforts are key and (v) never assume. It is imperative that the present authors continue to challenge the idea that it is acceptable to exclude CYP with intellectual disabilities from research because of their inability to participate.

Promoting the uptake of preventative Aboriginal child health policy in Western Australia

Australian Aboriginal children are over-represented on all negative health indicators compared with non-Aboriginal children.Contributing factors to the disparity include the impact of historical events, racism and social determinants of health. Despite the benefits of child health checks, offered through the Medicare Benefit Schedule and community health services, uptake of these is low. In 2012, Western Australia Health implemented the Enhanced Aboriginal Child Health Schedule (EACHS) policy to address specific health needs of Aboriginal children. The Aboriginal Child Heath Project (the Project), was a five-year initiative funded through the Council of Australian Governments. Project staff promoted the profile of preventative child health and the uptake of the EACHS policy across the state by agencies operating in the sector. Western Australia. Reach of the implementation workshop was measured by the number of staff attending policy implementation and the total number for agencies represented. One measure of impact was the number of agencies requesting the EACHS policy who adapted or adopted it to deliver evidence based comprehensive child health programs. The Project offered policy implementation workshops to health staff delivering services to young Aboriginal children. In addition to the evidence-based policy, a suite of resources were made available to support service delivery. The EACHS is a framework used by agencies to deliver consistent care and support governance when providing child health services to Aboriginal families across Western Australia. Providing a policy that was consistent with identified service strengths allowed agencies to individually build their capacity to deliver child health checks, using existing resources, at their own pace.

Are school-based mental health interventions for war-affected children effective and harmless?

In recent years, different approaches to large-scale mental health service provision for children in war-affected, mainly low- and middle-income, countries have been developed. Some school-based programs aiming at both strengthening resilience and reducing symptoms of trauma-related distress have been evaluated. In an article published in BMC Medicine, Tol and colleagues integrate their findings of the efficacy of universal school-based intervention across four countries and do not recommend classroom-based intervention as a treatment of trauma-related symptoms, since no consistent positive effects were found. On the contrary, for some children this type of universal intervention may impair recovery. Since universal school-based programs similar to the one evaluated here are widely implemented, Tol et al.’s results are highly relevant to inform the field of mental health service provision in war-affected countries.Please see related article http://www.biomedcentral.com/1741-7015/12/56.

Access to Child Health Care, Medical Treatment of Sick Children and Childhood Mortality Relationships in Kenya

Child health care factors such as medical treatment of sick children have direct and indirect effect on childhood mortality. Through international cooperation, a number of countries including Kenya have gathered information on provision of child health services at facility level from periodic Service Provision Assessment (SPA) surveys. Kenya has also gathered information on medical treatment of sick children at household level from periodic Demographic and Health Surveys (DHS). However, establishing how health care information in the SPA surveys relates to childhood mortality and also how these factors relate to medical treatment of sick children in the DHS has been constrained by differences in sample designs of the surveys. This study deployed a fstrategy of constructing community level variables derived from the SPA survey data and incorporated them into DHS data which served as the main data source. The SPA and DHS sampling designs for Kenya allow computation of stable estimates of regional demographic and health service indicators at provincial level. This study analyzed information gathered from 690 health facilities in 2010 SPA and 6079 births born less than 60 months from 2008/09 DHS. The study found that access to child health services, waiting time before service in facility and time to the nearest referral facility were significant facilitating factors for medical treatment of sick children. The study also established that waiting time before service in facility was the only access to health care factor which had a significant effect on childhood mortality when HIV prevalence was excluded in the analysis. However, the significance of waiting time before service diminished with inclusion of HIV prevalence. Further research is required to refine definition and measurement for child health care variable on female autonomy.

Strategies for Private Sector Participation in Child Healthcare: A Meta Analysis of Empirical Findings

A large number of households in developing countries seeks child health care services from the private sector. Despite this, policy makers have largely ignored it while developing health policies. Without an effective stewardship of government, the technical quality of child healthcare services provided by the private sector has generally remained poor. In this context, there is a growing consensus that a better match between the role of public and private sectors and their respective capabilities needs to be established. In such a redefined role, the public sector would largely perform a stewardship function and create an environment in which the private sector can help the state achieve its goals in the health sector. This raises a number of policy issues: how governments can fulfill their stewardship function in the context of child health, how they can work with the existing private sector to improve the effectiveness of child health services, and how they can encourage further private sector participation in the delivery of child health care services. Policy makers and analysts usually possess little knowledge or understanding of the private sector. In addition, the strategies and instruments to harness and grow the private sector for the achievement of child health objectives are not widely studied, or understood. This paper provides an overview of reform strategies and instruments being utilized in developing countries to enhance the contribution of the private sector to child health care. 1.1 Objectives The paper uses an analytical framework to gather and analyze information about public-private partnership programs, the effectiveness of these programs, and to identify the areas for future work on public-private issues in child health care. The paper is based on a review of 130 relevant studies, both published and unpublished. 1.2 Analytical Framework The paper uses an analytical framework to help health policy makers and planners identify policies to: Work with the private sector to ensure that the services it provides meet health sector goals (harnessing the private sector); Create an environment that supports private sector growth consistent with child health goals (growing the private sector). Certain principles of public finance and institutional economics guide the public-private division of labor. These principles also set out the stewardship role of the public sector in guiding (the often much larger) private sector in financing and provision of child health services. These principles help clarify the rationale for effective mix of public and private sectors in health care goods and services and marking out their specific domains. According to these principles, a desirable division of labor between public and private sectors in health depends on whether markets can work properly (contestability), so that the private sector will produce positive results, and whether information is sufficiently available (measurability) to permit assessment of the effectiveness of services. When markets and information fail, governments must play a corrective role. When markets and information succeed, government can open space for private response to consumer demand. As these conditions differ from time to time and place to place, the relative roles and relations of private and public sectors must evolve as well (For detailed description of the framework and the associated principles see, Chakraborty and Harding, 2001 pp.5-8).

Sustainability through Service Marketing- Below the Line Bangladesh

Social Marketing is a zero-sum game as it begets a dilemma to the marketer in terms of risk, benefit and cost. The descriptive paper covers the social Marketing concept from the facet of a Bangladeshi Company SMC, and its possible contribution to the below the line consumers. Attempt has been made to highlight various marketing programs and communication tools to cover the unidentified segments and ways to isolate them to better focus the strategic goals. Keywords - Sustainability, Social marketing, Promotion, Positioning I. INTRODUCTION Bangladesh has embarked on major strategies to advance its social marketing approaches. Their main focus is to facilitate sustainable consumption through social marketing. Notably, social marketing involves the use of various techniques and concepts with the aim of changing a specified behavioral change for the benefit of the society. In addition, it aims at promoting the society's well being. Therefore, only products and services that are of benefit to the society are promoted while at the same helping the public to avoid harmful products. Social Marketing Company (SMC) is a marketing organization in Bangladesh that plays a great role in maintaining a productive social marketing. It has greatly contributed in reproduction and provision of child health services in the country (Weinreich, 2010). SMC has started various social marketing programs. Some of these programs include the following: family planning, prevention of diseases, and child health among others. Their main aim is to promote quality of life of the less privileged population in the country. The company which is privately managed works closely with the national and international governments as well as donors. Its sustainable efforts on social marketing have benefited its population significantly. In this case, various commercial management techniques are usually applied in order to market, popularize, buy and sell product and services that are of benefit to the people. They also advocate for fair prices of goods and services which people can afford. Indeed, social marketing in Bangladesh focus on high availability and affordability of the product and services to the common public. Social marketing in Bangladesh uses two major strategies in order to achieve their objects. They include: multi-strategy communication as well as sustainability to enhance changed behavior among the members of the society (Weinreich, 2010). The communication is aimed at facilitating adoption and initiation of a positive behavior change. Virtually, commercial marketing technique is mainly used to support the change of behaviors on the use of products. The model of social marketing used in Bangladesh has achieved remarkable success. For this reason, it has become a best practice not only in Bangladesh but also in the international scenes. This has made United States together with other Asian countries to include the social marketing program in their curriculum. SMC has made major contributions in the national program. In the health sector, some of the major contribution has been seen in the social marketing of family planning through the use of contraceptives. This has played a great role in meeting the objective of the Bangladesh government on population control. Social marketing has greatly been achieved through the use of an innovative communication that facilitates behavior change. The company is able to offer large scale dissemination of information regarding the use of contraceptives. Moreover, it takes a major role in advertising these products to the larger population. Some of the barriers that have faced SMC in its endeavor of social marketing included: the larger illiterate members of the Bangladesh society, majority of the population was poor therefore access to media or buying the contraceptives was received with skepticism. In order to deal with this situation, SMC has to embark on strong and innovative sense of communication to facilitate behavior change. The major approach was on family planning and the use of contraceptives. The innovative modes of communication led to the success of these programs. This has made this company to gain a worldwide recognition. Its success is also based on its effort to promote health messages as well as enhance the sale and buying of the branded products only. Their advertisement and promotion is carried out not only through media but also through any means that will make the target audience receive the intended message. Thus, messages are found on billboards, buildings, shops, banners, water tanks among others.

Cross-system barriers to educational success for children in foster care: The front line perspective

Children in out-of-home placements are at increased risk for a multitude of poor educational outcomes. The federal Fostering Connections to Success and Increasing Adoptions Act of 2008 requires child welfare and education systems to collaborate towards improved educational outcomes for children in foster care. This study performed focus groups with ground-level stakeholders from child welfare and education systems to solicit information on the barriers, strategies, and daily experiences of working across systems towards educational success for children in child welfare in a large, urban area. Ten focus groups were completed with a total of 90 study participants. Knowledge and implementation of policies related to the educational needs of children in foster care was highly variable among participants. Across all groups, ineffective and limited cross-system communication, role uncertainty among stakeholders, and prevalence and complexity of behavioral health needs among children were identified as barriers to achieving educational success for children in foster care. Innovative approaches to cross-system collaboration between education and child welfare systems are needed to affect these positive outcomes. The complexity of mental health service provision for children in foster care with behavioral problems will require improved cross-system collaboration.