Child Health Services Research Articles

Reflections on facilitating a ‘Tree of Life’ group for pupils transitioning from a specialist school for neurodivergent young people

Times of transition can be challenging for young people, particularly neurodivergent young people who have been diagnosed by professionals. The current reflective piece explores the facilitation of a ‘Tree of Life’ group in a specialist school for school leavers who were experiencing anxiety related to the transition. The group took place over three sessions and feedback from group members reflected an increase in confidence in dealing with the transition and positive reflections on engaging with the ‘Tree of Life’ intervention. However, no changes in levels of anxiety were observed from a custom-made questionnaire. The authors reflect on the strengths and challenges of facilitating the group, in addition to helpful adaptations to support the engagement of these young people with the intervention.Easy to read summary■We are two professionals working in a Child and Adolescent Mental Health Service.■We ran a ‘Tree of Life’ group in a specialist school, to help students who were feeling worried about leaving school.■In this article, we talk about what helped to run the group, particularly the changes we made to help the students engage with it, and what helpful changes we would make for future groups.■After the group, we did not find any changes in how worried, ready or prepared students felt to leave school, when we measured this through questionnaires. However, students did say they enjoyed telling their own stories and hearing other students’ stories. The group also shared that it helped them see their strengths and to feel more confident about moving on from school.

Strength-Based approaches to providing an Aboriginal Community Child Health Service

Strength-Based approaches to providing an Aboriginal Community Child Health Service

Experiences of help-seeking from professional services for a child or young person's mental health concerns during the pandemic: A qualitative study.

The immediate response to the Covid-19 pandemic saw school closures and a shift in provision to online health services for children and young people experiencing mental health concerns. This study provides mental health and referral services with an insight into difficulties experienced as well as recommendations on potential improvements. Semi-structured interviews with 11 parents and six young people. Reflexive thematic analysis was used to analyse the data. Parents and young people reported mixed experiences on accessing mental health support. Priorities and pressures on health services impacted the likelihood of choosing to seek and being able to obtain help. Parents and young people had varying expectations and experiences in help-seeking during the pandemic which were also impacted by others' experiences and views. For many, the relationship with the professional they were in contact with impacted their mental health treatment. Provision was sometimes accessed via private services due to long waiting lists or problems that did not "meet threshold". Understanding the experiences of seeking mental healthcare during the pandemic can inform improvements to access to services at a time when people are most vulnerable. Accessible provision other than private services needs to be made for those on waiting lists. For those who do not meet service threshold, intermediary support needs to be secured to prevent unnecessary exacerbation of symptoms and prolonged problems. If schools are to remain the hub for children and young people's mental health services, they should be considered essential services at all times.

Birth Plan Utilization and Associated Factors among Post Natal Women Attending Maternal Child Health Services in Moyale Sub County, Kenya

Purpose: Maternal and neonatal mortalities continue to pose big public health concern in Kenya despite several interventions. These deaths are partly attributed to three delays; delay by the mother in deciding to seek timely care, delay in arriving at the point of health service delivery and delay in receiving adequate health care once at the health facility. Birth planning is important in addressing these delays. A birth plan serves to promote positive pregnancy outcome. There is however, a paucity of data showing level of birth plan utilization and factors associated to the utilization in many areas of Kenya. This hampers efforts in promoting its utilization in reducing maternal mortality ratio. This study sought to find out extent of utilization of individual birth plan and factors that are associated with it among post-natal women attending Maternal Child Health Services in Moyale Sub County, Kenya.
 Methodology: The study was a health care facility based cross sectional study that employed multi stage sampling methods. A total of 548 post-natal women attending Maternal Child health services within Moyale Sub County were interviewed. Data was collected through a structured quantitative questionnaire and FGD guide between May 2021 and July 2021 and analyzed using binomial logistic regression in SPSS version 22. To address confounding, significant variables were put through multinomial regression analysis.
 Findings: Overall, 42.3% of interviewed women had used a birth plan. Socio-demographic factors associated with utilization of a birth plan was secondary level of education (OR=1.214(1.1-2.4), p=0.000), Diploma and above level of education (OR=5.7(0.5-62.1), p=0.042). Maternal factors influencing utilization of birth plan included previous complications (OR=2.6(1.3-3.0), p=0.039), four or more ANC visits (OR=2.4(1.28-3.69, p=0.000), trimester of first ANC (OR=1.4(1.3-3.7), p=0.000), PNC visits (OR=2.3(1.4-3.8), p=0.001). Health system related factors influencing utilization included time of more than one hour in reaching health care (OR=0.999(0.9-1.0), p=0.048), availability of staff at health facility (OR=3.6(1.9-3.9), p=0.024). Treating women with respect at health facility (OR=1.049(1.16-6.5), p=0.034) and availability of drugs/supplies at health facility (OR=3.3(2.2-4.5), p=0.000).
 Unique Contribution to Theory, Policy and Practice: The study showed that there is need to improve quality of ANC services given in health care facilities. Health care workers in health facilities offering ANC need to initiate timely IBP counselling for pregnant mothers. There is also a need for Community health volunteers under the community health strategy to offer counselling on IBP during routine household visitations. Health care providers and patient interactions also need to improve, health workers need to be trained/sensitized on good customer relations to build patient trust. Further research is also recommended to assess quality of ANC services offered in health facilities in the region. Quality of health education and counselling offered by CHV’s during home visits to pregnant mothers also needs to be examined.

User satisfaction with child and adolescent mental health services: the association between user satisfaction and clinical outcomes

BackgroundThis study aimed to examine the association between user satisfaction and clinical outcomes with child and adolescent mental health services (CAMHS) from the perspective of young people and their parents. The evidence bases for CAMHS user satisfaction measures are limited, with few studies investigating the link between user satisfaction and clinical outcomes. In particular, the perspectives of young people are missing.MethodsThe parent and youth versions of the Experience of Service Questionnaire (ESQ), which evaluates the factors of general satisfaction (GS), satisfaction with care (SWC) and satisfaction with environment (SWE), were used to measure user satisfaction. The outcome measures were scores on the Strengths and Difficulties Questionnaire (SDQ), Children’s Global Assessment Scale (CGAS), and Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). Hierarchical regression analysis was conducted on data collected from 233 young people and 495 parents who utilized CAMHS services.ResultsGS and SWC predicted outcomes for both young people (ΔR2 = 0.08, p <.05) and parents (ΔR2 = 0.01, p <.05), indicating that user satisfaction had a significant impact on clinical outcomes for CAMHS users. In addition, GS and SWC significantly predicted young people-reported outcomes in the interaction model (ΔR2 = 0.10, p <.05), while no significant association was found with parent-reported outcomes (ΔR2 = 0.02, p =.09).ConclusionUser satisfaction, particularly for young people, has a significant impact on clinical outcomes. The causal relationship between user satisfaction and mental health outcomes requires further study.

Dismissive attitudes and affirmative journeys: Parental perspectives on the mental health support of gender diverse children

Transgender/gender diverse (TGD) children experience poorer mental health and social outcomes than those who do not identify as TGD (Smith et al., 2014; Geist et al., 2019), including increased risk for depression and suicidal ideation (Haas et al., 2011; VanBergen &amp; Love, 2022). Research has linked these poor outcomes to the micro-aggressions and dismissive attitudes of their families, communities and wider society (Brooks, 2000; Ryan et al., 2010). This service evaluation used Interpretive Phenomenological Analysis (IPA) with a small number of purposively sampled parents (n = 5) to explore experiences of their children’s involvement with CAMHS (Child and Adolescent Mental Health Services). The aim was to add to the understanding we have of the needs of TGD client groups and to inform service provision. This study supports the wider research base linking affirmative attitudes to more positive mental health outcomes, and adds additional nuance to our understandings of parental attitudes. Parents are not typically polarised in ‘affirmative’ or ‘dismissive’ positions, but rather engaged in journeys of personal growth and development, generally becoming more affirmative over time. These parents also described significant additional support needs with social deprivation, family breakdown and the impact of developmental difference highlighted. Recommendations for intervention are made.

Prevalence of High-Risk Human Papillomavirus Infection, Associated Risk Factors, and Relationship With Cervical Precancerous Lesions in Perimenopausal and Older Women in an Area With High Cervical Cancer Incidence in China.

Purpose This study delves into the epidemiology of high-risk human papillomavirus (HR-HPV) infection and its link to precancerous lesions among perimenopausal (40-59 years) and elderly (60-65 years) women in a Chinese county with a notably high incidence of cervical cancer. By uniquely focusing on these age groups in underdeveloped regions, the research aims to offer novel strategies for the management and prevention of cervical cancer. It seeks to inform targeted interventions and public health policies that could significantly benefit women at heightened risk for HPV, addressing a critical gap in current prevention efforts in economically disadvantaged communities. Methods This observational study was conducted at the Maternal and Child Health and Family Planning Service Centre in Lueyang County, from September 2021 to January 2022. It assessed 2008 women aged 40-65 for HPV screening, with 342 undergoing further cytological examination. The study evaluated the prevalence of HPV infection across different age groups and risk categories. It utilized a questionnaire to collect participants' basic information, health behaviors, and other relevant data to analyze factors influencing HR-HPV infection. Statistical analyses comprised chi-square tests, trend analysis, logistic regression, and multiple imputation techniques to address missing data. Results The prevalence of HR-HPV infection among women aged 40-65 years in Lueyang County was 18.43%. Older women exhibited a higher incidence of HPV infection, abnormal ThinPrep Cytology Test (TCT) results (Shaanxi Fu'an Biotechnology Co.Ltd., Baoji City, China), and low/high-grade squamous intraepithelial lesions (LSIL/HSIL) (P<0.05). The most prevalent HR-HPV genotypes in the overall, perimenopausal, and elderly groups were HPV-52, -53, and -58; HPV-52, -53, and -16; and HPV-58, -52, and -53, respectively. The prevalent HR-HPV genotypes in the abnormal The Bethesda System (TBS) results were HPV-16, -52, -33, -58; -16, -52, -58; and-16, -33, and -52. HPV-16, -18, -33 prevalence increased with increasing lesion severity (P<0.05). In this study, factors affecting HR-HPV in the three age groups were found to be mainly related to sexual behavior and education level, including history of lower genital tract diseases, multiple pregnancies, contraceptive methods without tubal ligation, age at first marriage greater than 18 years, never washing the vulva after sex, abstinence from sex, education level of junior high school or above, and spouse's education level of high school or above. Conclusions These findings suggest that the elevated rate of abnormal TBS in the older age group may be attributed to the higher prevalence of persistent infection-prone HR-HPV genotypes (HPV-58, -52, and-53), multiple infections, and potent oncogenic HR-HPV genotypes (HPV-16 and -33). Additionally, the higher HR-HPV prevalence in older patients may be related to lower education attainment, reduced screening rate, and limited condom usage. Therefore, strategies targeting perimenopausal and older women should prioritize enhancing health awareness, increasing screening rates, and encouraging condom utilization.

Time spent outdoors in childhood related to myopia among young adults in the Swedish ABIS cohort.

Elucidate the prevalence of myopia among young adults from a birth cohort of Swedish children and its relationship to possible risk factors during their childhood. Five thousand two hundred young adults, mean 23.4 years and 58% females, participating in the prospective birth cohort All Babies in Southeast Sweden (ABIS) answered a questionnaire including questions regarding health and physical activity, spectacle use, myopia and age at first optical correction. Questionnaires at previous follow-ups at ages 2-3, 5-6 and 8 years included information on type of housing, time outdoors, screen time and hours of reading. Myopia prevalence and associations with potential risk factors were analysed in univariate and multivariate regression models with Bonferroni's correction of p-values. In the ABIS Swedish birth cohort of young adults, the prevalence of myopia was 29%. A univariate logistic regression showed a higher odds ratio for myopia with female gender (OR 1.59; p < 0.05) and a completed and started university education (OR 1.52; p < 0.05). Significantly lower odds ratios were found for hours spent outdoors at 8 years of age (OR 0.82; p < 0.05). Multivariate logistic regression showed a higher odds ratio for myopia in females (OR 1.52-1.57; p < 0.05) and completed and started university education (OR 1.34-1.49; p < 0.05) in all models. In a model including accommodative effort, measured in diopter hours at 8 years of age, hours spent outdoors were associated with a lower odds ratio for myopia (OR 0.86; p < 0.05). No association could be detected between myopia and the type of housing or near work. The prevalence of myopia among young adults in a Swedish birth cohort was lower or unchanged compared to previous data. Female gender, higher education and less time spent outdoors in childhood were associated with an increased risk of developing myopia. Recommendations from child health services and schools should be given to stimulate children to spend enough time outdoors.

Building Equitable Mental Health Care for Latino Children: Perspectives from Providers and Communities.

The current pediatric mental health crisis has disproportionately impacted Latino youth in the United States (US), as demonstrated by their elevated risks of depression, substance use disorder, and anxiety. Despite this, research suggests Latino youth receive inequitable mental health services. To understand best practices, challenges, and priorities in providing accessible and equitable mental health care for Latino youth from the perspectives of front-line mental health providers and Latino community members. A bicultural, bilingual researcher conducted semi-structured interviews with 20 participants with expertise in Latino mental health. Topics included barriers and facilitators to mental health care access and cultural tailoring of treatment for Latino youth. Rapid qualitative analysis was used to identify themes. Four themes were identified: (1) Navigating immigration concerns and acculturation, practitioners should consider immigration-related concerns and be trained to address acculturation-related stressors respectfully; (2) Adapting to the cultural needs and strengths of the communities, cultural humility education can allow providers to engage with both the strengths and needs of Latino families; (3) Engaging Latino caregivers as partners, it is critical to engage with Latino caregivers' cultural perspectives on parenting and mental health collaboratively; and (4) Addressing systemic barriers to promote access, providers must recognize and attempt to alleviate the systemic barriers that limit families from seeking care. Participants identified several practical strategies to improve the provision of mental health services for Latino children. Future directions, policy and practice implications, and limitations are discussed.

Sociodemographic Correlates of Integrated Maternal, Newborn, and Child Health Services Utilization Among Childbearing Mothers in Nigeria.

Background Some social and demographic factors might limit the ability of childbearing mothers (CBMs) to use healthcare services for themselves and their children, thereby exposing them to maternal, infant, and child morbidity and mortality. This study aimed to investigate the sociodemographic correlates of the utilization of integrated maternal, newborn, and child health (IMNCH) services by CBMs in Benue State, Nigeria. Methodology A community-based, correlational survey study was conducted among a random sample of 1,200 CBMs. Face-to-face interviews were conducted using a pretested, structured questionnaire, the Integrated Maternal, Newborn, and Child Health Services Utilization Questionnaire (IMNCHSUQ), and study participants were chosen using a multistage sampling procedure. Of the IMNCHSUQ issued, only 896 copies had complete data, which were used for the analysis. The data collected were analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). The data were evaluated using the mean, standard deviation, and point-biserial correlation, and the null hypotheses were tested using linear regression at the 0.05 level of significance. Results The majority of the CBMs were married (79.7%) and unemployed (66.0%) while the predominant age group was between 15 and 24 years (42.7%). CBMs had a high level of utilization of IMNCH services (x= 3.30, SD = 0.94). The sociodemographic factors studied had little or no influence on the utilization of IMNCH services among CBMs. The most significant demographic predictor was the place of residence. Marital status, educational level, parity, and age were also found to be significant predictors in a few services. Conclusions Uneven distribution of IMNCH centers may be a major cause of the failure of CBM's lack of utilization of IMNCH services, especially in rural settlements with sparse distribution of facilities.

Changes to sleep patterns and insomnia symptoms following cognitive behavioural therapy for anxiety disorders in adolescents.

It is unclear whether treatment for an anxiety disorder improves sleep. This study examined baseline sleep characteristics of adolescents with an anxiety disorder, comparing weekdays and weekends, and whether there were significant improvements in sleep following cognitive behaviour therapy (CBT). To improve our understanding of sleep problems in adolescents with an anxiety disorder and examine whether CBT for the treatment of the anxiety disorder improves sleep. Data was gathered from 179 participants with an anxiety disorder (11-17 years old) who had previously engaged with the out-patient child and adolescent mental health service. Baseline self-report measures of anxiety and depression symptoms, sleep patterns and experiences of insomnia were examined. Of this group, 135 participants had baseline data. A subset (n=73) had outcome data, which was used to examine changes in sleep following CBT. At baseline, adolescents reported significantly less total sleep and more night-time waking on weekdays than weekends. Following treatment for their anxiety disorder, adolescents' weekday sleep patterns significantly improved for sleep onset latency and total sleep time, whereas weekend sleep patterns only showed improvements for sleep onset latency. No significant improvements were reported for symptoms of insomnia. The study relied upon subjective measurement of sleep and there was no control group; however, the findings provide promising results that CBT for adolescent anxiety disorders can improve some sleep problems. Further research is needed to understand discrepancies between subjective and objective sleep, and to explore avenues for the delivery of support for sleep problems.

Tobacco smoking primary survey of pregnant women in the maternity and child health service

Tobacco smoking primary survey of pregnant women in the maternity and child health service

Effectiveness of internet-delivered cognitive behavioural therapy for anxiety and obsessive-compulsive disorders within routine clinical care in rural Sweden

Few studies have evaluated the implementation of ICBT in regular child and adolescent mental health services (CAMHS). This study aimed to explore the acceptability, feasibility, and effectiveness of ICBT for children and adolescents with anxiety disorders and obsessive-compulsive disorder (OCD) within a rural CAMHS. The study also explored outcome predictors and long-term outcomes.Eighty-three participants were consecutively recruited from a non-specialized CAMHS in Region Jämtland Härjedalen in northern Sweden. Therapist-guided ICBT was offered during 12 weeks to children aged 8–17 with an anxiety disorder or OCD. Acceptability and feasibility measures included treatment adherence, treatment satisfaction, and adverse events. The primary outcome measure was the Clinical Global Impression–Severity. Secondary measures of effectiveness included clinician-, self-, and parent-ratings of symptom severity and functional impairment. Assessments were completed at baseline, post-treatment, and three-month follow-up (primary endpoint). A two-year follow up was conducted using medical records. Potential predictors included both patient characteristics and treatment variables.Results indicated that ICBT was both acceptable and feasible according to study measures. Statistically significant improvements were found from baseline to the three-month follow-up on clinician rated severity (B [SE] = −0.92 [0.09]; p < .001), as well as on all secondary measures. Forty-three percent of participants no longer fulfilled criteria for their principal disorder at the three-month follow-up. No serious adverse events were reported. Clinical improvement was highest among children with higher functioning at baseline (B [SE] = −0.05 [0.02]; p < .05). Forty-six percent of participants had been in contact with CAMHS during the two-year follow-up period, mainly for reasons other than their initial diagnosis. Findings suggest that ICBT could be an acceptable and feasible treatment option for young people with anxiety disorders and OCD in rural non-specialized CAMHS settings. Further studies are needed to confirm treatment effectiveness in this setting. Trial registration: NCT02926365.

Operationalising effective coverage measurement in Ethiopia: a qualitative study

Background Efforts to improve the quality of maternal, neonatal and child health services have intensified in Ethiopia. Consistent with global recommendations, measuring only coverage of these health services is no longer sufficient to assess their impact on population health. As a result, interest has grown in effective coverage measures that combine service access and service quality into one metric. However, operationalising effective coverage measurement in settings like Ethiopia requires understanding the context and feasibility with available data and resources. Thus, this study aimed to explore the demand for effective coverage measurement among Ethiopian key stakeholders and identify the actions needed to enhance its implementation in Ethiopia’s healthcare system. Methods An explorative, qualitative study design was employed, and data was collected through semi-structured interviews. Nineteen key informants from national level, three regions (Amhara, Oromia and Gambela), and one administrative city (Addis Ababa) in Ethiopia, participated in the study from March to April 2023. Key informants were identified using a snowballing approach. This study received ethical approval from the London School of Hygiene and Tropical Medicine and the Ethiopian Public Health Institute ethical review boards. Results There is a strong demand for effective coverage measurement for decision making on health care quality in the Ethiopian health sector. The demand is characterised either for individual patient care or for tracking health system performance; currently, there is limited clarity on the distinction between these two needs. A strong sentiment exists for the use of routine health information system data for this purpose, although stakeholders acknowledge the limitations of this data source. To advance the effective coverage measurement agenda in Ethiopia, respondents recommend building confidence in the quality of data sources, the need for more guidance on how to generate effective coverage measures, and the need for government leadership to coordinate these efforts. Conclusions The strong demand for effective coverage measures and the positive policy environment encourages further testing of effective coverage measurement in Ethiopia.

Social Justice, Anti-Racism, and Disproportionality in Social Work: A Capabilities Approach

ABSTRACT Despite social justice as an ethical imperative, racism is an ongoing problem in social work. Using critical race theory, this paper outlines the capabilities approach (CA) as one conceptual orientation toward social justice, promoting it as a useful anti-racist tool in social work. Employing CA to analyze the disproportionality in social services for racialized individuals in child welfare and health services in the United States and Canada, the article underscores the value of CA to investigate what should constitute social justice in social work. Indigenous Peoples/Native Americans and those of African descent will be the focus of attention. The article delineates how social work might utilize the commitments of CA for themselves as individuals, as well as in social work theory, education, practice, and policy.

Art therapy is associated with a reduction in restrictive practices on an inpatient child and adolescent mental health unit

Background The elimination of restrictive practices, such as seclusion and restraint, is a major aim of mental health services globally. The role of art therapy, a predominantly non-verbal mode of creative expression, is under-explored in this context. This research aimed to determine whether art therapy service provision was associated with a reduction in restrictive practices on an acute inpatient child and adolescent mental health services (CAMHS) unit. Methods The rate (events per 1,000 occupied bed days), frequency (percent of admitted care episodes with incident), duration, and number of incidents of restrictive practices occurring between July 2015 and December 2021 were analysed relative to art therapy service provision. The rate, frequency and number of incidents of intramuscular injected (IM) sedation, oral PRN (as-needed medication) use, and absconding incidents occurring in conjunction with an episode of seclusion or restraint were also analysed. Results The rate, frequency, duration, and total number of incidents of seclusion, the frequency and total number of incidents of physical restraint, and the rate, frequency and total number of incidents of IM sedation showed a statistically significant reduction during phases of art therapy service provision. Conclusions Art therapy service provision is associated with a reduction in restrictive practices in inpatient CAMHS.

Watch Me Play!: protocol for a feasibility study of a remotely delivered intervention to promote mental health resilience for children (ages 0–8) across UK early years and children’s services

BackgroundHalf of mental health problems are established by the age of 14 years and 75% by 24 years. Early intervention and prevention of mental ill health are therefore vitally important. However, increased demand over recent years has meant that access to child mental health services is often restricted to those in severest need. Watch Me Play! (WMP) is an early intervention designed to support caregiver attunement and attention to the child to promote social-emotional well-being and thereby mental health resilience. Originally developed in the context of a local authority mental health service for children in care, it is now also delivered online as a low intensity, scalable, preventative intervention. Although WMP shows promise and is already used in some services, we do not yet know whether it is effective.MethodsA non-randomised single group feasibility study with embedded process evaluation. We propose to recruit up to 40 parents/carers of children aged 0–8 years who have been referred to early years and children’s services in the UK. WMP involves a parent watching the child play and talking to their child about their play (or for babies, observing and following signals) for up to 20 min per session. Some sessions are facilitated by a trained practitioner who provides prompts where necessary, gives feedback, and discusses the child’s play with the caregiver. Services will offer five facilitated sessions, and parents will be asked to do at least 10 additional sessions on their own with their child in a 5-week period. Feasibility outcomes examined are as follows: (i) recruitment, (ii) retention, (iii) adherence, (iv) fidelity of delivery, (v) barriers and facilitators of participation, (vi) intervention acceptability, (vii) description of usual care, and (viii) data collection procedures. Intervention mechanisms will be examined through qualitative interview data. Economic evaluation will be conducted estimating cost of the intervention and cost of service use for child and parents/carers quality-adjusted life years.DiscussionThis study will address feasibility questions associated with progression to a future randomised trial of WMP.Trial registrationISRCTN13644899. Registered on 14th April 2023.

Accessibility andutilization of maternal and child health services among mothers in rural and urban communities of Oyo State

Background: Utilization of maternal and child health services has been linked to the characteristics of the health delivery system like the geographical and economic accessibility (cost) of these services. Low utilization of these services has been implicated in the explanation of high maternal and child mortality worldwide. Early and prompt utilization of maternal and child health care services would have averted most of these deaths. This study assessed the accessibility and utilization of maternal and child health services among mothers in rural and urban communities of Oyo state.Methods: This is a comparative cross-sectional study using a mixed method (quantitative and qualitative) of data collection. A pre-tested interviewer-administered questionnaire was used to collect data from 300 respondents that were recruited using a multistage sampling technique. The qualitative data was obtained through focus group discussions (FGD) with four groups selected using purposive sampling. Data was analyzed using IBM SPSS version 22 at 95% significance level with a p&lt;0.05.Results: This study showed that significant differences existed between the respondents' utilization of maternal and child health services among women of child bearing age in the rural and urban communities (p= 0.013). Few respondents in rural communities (72, 48.0%) have good utilization of maternal and child health services compared to the urban communities where more respondents (119,79.3%) have good utilization of maternal and child health services. Proximity of health facility and affordability of maternal and child health service were found to be statistically significant for respondents in the rural community. This finding is also similar to the FGD findings from the rural discussants.Conclusion: Overall good accessibility and good utilization of maternal and child health services were found to be more for respondents in the urban areas compared their counterparts in the rural communities. It is important for the government to initiate policies on health insurance to favour maternal and child health services especially in the rural communities.

Risk-Benefit of Connected Health-Led Digital Transformation: A Case Study in Child and Adolescent Mental Health Service Clinical Decision-Making Support

ABSTRACT Digital transformation within healthcare services presents unique risks and benefits when compared to other organisations. This case study aims to identify key risks and benefits of connected health-led digital transformation within Irish community Child and Adolescent Mental Health Services (CAMHS), utilising qualitative analysis, consisting of interviews with CAMHS clinical personnel, to identify the key risks and benefits in this sensitive area. Our risk/benefit matrix is presented in this paper. Key areas of concern include electronic health records (EHR), telemedicine, and mHealth adoption within CAMHS. Twenty-one benefit factors were supported by 98 mentions (average = 4.7 mentions per factor). Twenty-nine risk factors were supported by 76 mentions (average = 2.62). While the information presented may align with existing literature on digital transformation in healthcare, the risks /benefits analysis is critical to the area of study as they arise directly from interviews with experts in CAMHS and are therefore validated by practitioners.

Turning 18 in mental health services: a multicountryqualitative study of service user experiences and views.

Worldwide, the division between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) has frequently resulted in fragmented care with an unprepared, non-gradual transition. To improve continuity of care and other service transition experiences, service user input is essential. However, such previous qualitative studies are from a decade ago or focused on one mental disorder or country. The aim of the present study was to learn from service users' transition experiences and suggested improvements. Semi-structured interviews were held with young people aged 18-24 and/or parents/caregivers in the United Kingdom, Ireland, the Netherlands and Croatia. Inclusion was based on the experience of specialist mental health care before and after turning 18. Thematic analysis of transcribed and translated interview transcripts was performed using ATLAS.ti 9. Main themes of service user experiences included abrupt changes in responsibilities, various barriers and a lack of preparation, communication and ongoing care. Young people expressed a great need for continuity of care. Their suggestions to improve transitional care included early and adequate preparation, joint working, improved communication from and between services, overlapping services, staying at CAMHS for longer and designated youth mental health teams. Young people who experienced care before and after turning 18 suggested either altering the age limits of services or ensuring early preparation and communication regarding the transition and finding AHMS. This communication should include general changes when turning 18. Further considerations include increasing collaboration and overlap between CAMHS and AMHS.