Provision Of Child Health Services Research Articles

Children of substance‐using mothers: child health engagement and child protection outcomes

Maternal substance use has been associated with a range of child risk factors. The study investigated the relationship between engagement with child health services and child protection outcomes for children of substance-using mothers. The sample comprised 119 children of mothers who disclosed opiate, amphetamine or methadone use during a maternity admission between 2000 and 2003. Statutory child protection agency and child health engagement information for the first 2 years of life was obtained. The relationship between type of maternal substance use, child health engagement and child protection outcomes was examined. Of study group infants, 72% were engaged with child health services during the first 2 years of life. Chi-squared analysis showed no significant relationship between child health engagement and child protection reports. Child health engagement was associated with decreased substantiated child protection notifications for children of methadone using mothers, but not for children of illicit substance users. Almost a quarter of identified children of substance-using mothers are not accessing standard child health services in their first 2 years of life. This study provides support for increased attention to the provision of child health services for children of methadone using mothers. Further research into effective intervention strategies for children of illicit substance-using mothers is indicated.

An intervention to improve paediatric and newborn care in Kenyan district hospitals: Understanding the context

BackgroundIt is increasingly appreciated that the interpretation of health systems research studies is greatly facilitated by detailed descriptions of study context and the process of intervention. We have undertaken an 18-month hospital-based intervention study in Kenya aiming to improve care for admitted children and newborn infants. Here we describe the baseline characteristics of the eight hospitals as environments receiving the intervention, as well as the general and local health system context and its evolution over the 18 months.MethodsHospital characteristics were assessed using previously developed tools assessing the broad structure, process, and outcome of health service provision for children and newborns. Major health system or policy developments over the period of the intervention at a national level were documented prospectively by monitoring government policy announcements, the media, and through informal contacts with policy makers. At the hospital level, a structured, open questionnaire was used in face-to-face meetings with senior hospital staff every six months to identify major local developments that might influence implementation. These data provide an essential background for those seeking to understand the generalisability of reports describing the intervention's effects, and whether the intervention plausibly resulted in these effects.ResultsHospitals had only modest capacity, in terms of infrastructure, equipment, supplies, and human resources available to provide high-quality care at baseline. For example, hospitals were lacking between 30 to 56% of items considered necessary for the provision of care to the seriously ill child or newborn. An increase in spending on hospital renovations, attempts to introduce performance contracts for health workers, and post-election violence were recorded as examples of national level factors that might influence implementation success generally. Examples of factors that might influence success locally included frequent and sometimes numerous staff changes, movements of senior departmental or administrative staff, and the presence of local 'donor' partners with alternative priorities.ConclusionThe effectiveness of interventions delivered at hospital level over periods realistically required to achieve change may be influenced by a wide variety of factors at national and local levels. We have demonstrated how dynamic such contexts are, and therefore the need to consider context when interpreting an intervention's effectiveness.

Evaluation of cultural competence and antiracism training in child health services

This study reports on an evaluation of an initiative in Cardiff and Huddersfield to provide multi-disciplinary cultural competence and antiracism training to those providing child health services. A postal questionnaire was sent to participants who had completed the course between two and five years previously. The authors tried to explore changes in behaviour or practice of the 48 health professionals who responded. Three quarters (36) were able to identify explicit changes in practice. Over half reported changes in communication methods. Others reported conducting audits of services to clients from black and ethnic minority groups, addressing images of diverse cultures in health clinics and challenging misconceptions or discriminatory statements made by colleagues. The study offers an innovation that could be replicated in other areas to identify whether similar subsequent changes occur.

Evaluating Medicaid Managed Care Programs for Children

Nearly every state has implemented some form of managed care for Medicaid recipients, partly in response to rapid increases in Medicaid expenditures. The unique features of children's health and the differences among states in the implementation and scope of their Medicaid managed care programs provide child health services researchers many opportunities to identify program features that result in favorable health outcomes and those that are less successful. Key stakeholders with interest in this information include state governments and managed care organizations charged with developing and implementing efficient delivery systems, as well as providers interested in understanding the best mechanisms for delivering care to children. This paper outlines potential approaches to evaluating Medicaid managed care programs for children, focusing on identification of appropriate data sources and selection of quality measures encompassing the structure, processes, and outcomes of health care.

Deconstructing the role of the public health nurse in child protection.

This paper argues that children who have been deemed to be 'at-risk' need specialist intervention and that the Irish public health nurse (PHN) cannot provide this intervention. It is further argued that a failure to acknowledge and act on this is placing children at further risk and it is suggested that the mismatch between actual and perceived (or expected) roles leads to practices which undermine rather than support child protection. The PHN's remit in protecting children is situated within the following contexts: the variety of client groups with whom the PHN works, overall provision of child health services in the community, her education and training, and primary, secondary and tertiary protection of children. Two recent reports on enquiries into the failure of the services to protect children living with their families are used to explore the discontinuity. Existing evidence on how personnel involved (directly and indirectly) in community care services perceive or understand the PHN's role in child protection is described in the context of what the PHN's role actually is. The evidence suggests that the PHN fulfils a range of prescribed roles but that there is a perception or expectation among other service providers that she is also fulfilling additional roles. The paper concludes by suggesting some possible solutions to this discontinuity with a view to improving child protection services.

Assessing community values in health care: is the 'willingness to pay' method feasible?

In this paper an economics approach to assessing community values in health care priority setting is examined. The approach is based on the concept of 'willingness to pay' (WTP). Eighty two parents were interviewed with regard to three aspects of provision of child health services. For each aspect a choice of two courses of action was presented. Parents were asked which course of action they preferred and what was the maximum amount of money they would be prepared to pay for this rather than their less preferred option. WTP responses are acceptable to the majority of respondents and appear to 'behave' in accordance with a priori expectations. A method of assessing the influence of ability to pay on preferences and WTP is outlined. Preferences and WTP do not appear to have been unduly distorted by ability to pay. Use of WTP data does have the potential to provide health care purchasers and providers with information on intensity as well as direction of the preferences of members of the community.

Family involvement and empowerment in mental health service provision for children with emotional and behavioral disorders

Involvement of families is a critical component in effective systems of care for children with disabilities and their families. We investigated the sociodemographic correlates of family involvement in mental health services for children who have emotional and behavioral disorders. Further, we investigated the relationship between family involvement and family empowerment. The Family Involvement Scale-Family Version was used to measure involvement of families in the provision of mental services for their children and the Family Empowerment Scale was used to measure pempowerment in families with children who have emotional and behavioral disorders. In additions, demographic data concerming family composition, race, education, incone, membership in a parent support group, and the mental health status of the children were also collected. The results showed that mothers, as well as respondents with less formal education, reported greater involvement in services for their children than fathers and those who were more educated. Further, the knowledge subscale of empowerment was significantly correlated with all, subscales of family involvement and personal empowerment was significantly correlated with the treatment subscale of family involvement.

Child health promotion, screening and surveillance.

After the Second World War, as the incidence of infectious and nutritional disorders declined, professionals and parents began to seek more precise diagnosis and more effective therapy for children with cerebral palsy, mental handicap and related disorders. Although a handful of exceptional men and women had shown what could be accomplished (Shonkoff & Meisels, 1990), the prevailing view was that little could be done and indeed parents of these children were not infrequently advised to "put them in an institution". In the 1950s and 60s, new ideas began to create a more optimistic climate of opinion. It was thought that much, perhaps most, disability was caused by perinatal complications and was therefore potentially preventable; and that early intervention (e.g. physiotherapy for cerebral palsy) might lead to cure or at least substantial improvement. Research in child psychology offered a more scientific basis for the assessment and management of developmental disorders. A sense of urgency was created by the prevalent belief that the child's developing nervous system and psychological functioning were far more amenable to intervention in the first few months or years of life than subsequently (Anastasiow, 1990), and that if suitable therapy was not provided then, the opportunity would be lost for ever. This notion of a "critical period" in development, together with optimism regarding the possibility of intervention, led to a sense of urgency which was responsible for a gradual change in the provision of child health services. Previously, the paediatric health professional had simply waited for the parent to seek advice--the "passive" or "reactive" approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Cystic fibrosis: current survival and population estimates to the year 2000.

Survival from cystic fibrosis is increasing rapidly. Estimates of the extent of this improvement should allow health care facilities to be planned to deal with the expanding population of patients with cystic fibrosis. Estimates of life expectancy are also essential if accurate information on current prognosis is to be given to parents of an affected child, or to prospective parents deciding whether to proceed with a pregnancy where the fetus may be affected. Survival trends in the national data on cystic fibrosis have been analysed to produce estimates of the likely size of the cystic fibrosis population over the next decade and to predict the life expectancy of children born with cystic fibrosis in the years up to 1990. In England and Wales the estimated number of patients with cystic fibrosis is at present about 5200, of whom 3300 (63%) are aged under 16 years. By the year 2000 the total population will increase to 6000, with 3400 (57%) aged under 16. Thus the number of children with cystic fibrosis will remain fairly constant over the next 10 years, whereas adult numbers will increase by about 36% (from 1901 to 2577). The median life expectancy of children with cystic fibrosis born in 1990 is estimated to be 40 years, double that of 20 years ago. This study suggests that health service provision for children will not need to change substantially over the next 10 years whereas services for adults will need to increase by about a third. Parents can be counselled that the median life expectancy of a newborn child with cystic fibrosis is currently likely to be of the order of 40 years.