Quality Of Care For Children Research Articles

The complementary impacts of nurse home visiting and quality childcare for children experiencing adversity

AbstractAustralian Governments are increasingly understanding the impacts of early adversity, evidenced by ongoing policy and investment in two of the most widely implemented early interventions: nurse home visiting (NHV) and early childhood education and care (ECEC). Neither intervention fully redresses the developmental inequities engendered by early adversity, yet their synergistic impacts (“dynamic complementarity”) are unknown. In this research, we aimed to (1) inform evaluation of policy implementation by (2) experimentally testing the dynamic complementarity of NHV and ECEC. We capitalised on an opportunity afforded by the Australian “right@home” randomised trial, which involved 722 pregnant women experiencing adversity, randomised to receive NHV or usual care to child age 2 years. Detailed data describing family‐accessed ECEC were collected from parents at 3–4 years, and “quality ECEC” was categorised according to meeting quality recommendations defined by Australian policy and provision. Children's developmental outcomes (language, executive functioning, behaviour and well‐being) were parent‐reported or assessed directly at 4 years. At 4 years, 33 per cent of families had received neither intervention; 40 per cent NHV only; 14 per cent quality ECEC only; and 13 per cent had received both. We used linear regression to estimate differences in mean outcomes between exposure groups, including interaction between NHV and ECEC. Unadjusted analyses indicated modest effects of the combination of NHV and ECEC, which attenuated after adjustment for socioeconomic confounders. We present the design and preliminary findings as an approach that could be used to evaluate equitable implementation at scale and enable policymakers to determine the most effective evidence‐based policy.

Regional determinants of quality of care for sick children: A multilevel analysis in four countries.

The limited impact of increased access to care on improvements in health outcomes during the Millennium Development Goal era has been attributed, in part, to inadequate quality of care. We identified regional factors associated with health service quality for sick child care in low-income countries and examined whether provider factors interact with regional factors to affect the quality of care. We conducted cross-sectional random intercept four-level linear regression using the most recent Service Provision Assessment and Demographic Health Survey data from four countries (467 from the Democratic Republic of Congo 2018, 2425 from Afghanistan 2018, 2072 from Nepal 2015, and 813 from Senegal 2017). The outcome variable was the service quality score for sick child care, which was measured as the percentage of clinically recommended tasks completed in the integrated management of childhood illness (ranging from 0 to 100). Regional factors were selected based on the High-Quality Health System Framework. The service quality score was found to be positively associated with the proportion of large facilities (β = 8.61; P = 0.004) and the proportion of providers ranked in the top fifth for service quality score (β = 30.15; P < 0.001) in the region. We identified significant cross-level interactions between provider qualifications (β = -16.6; P < 0.001) or job descriptions (β = 12.01; P = 0.002) and the proportion of providers in the top fifth for service quality scores within the region. As the proportion of top-performing providers in a region increased, the increase in the service quality score was more pronounced among providers who were nonmedical doctors or did not have job descriptions than among their counterparts. Our findings indicate that the quality of care for sick children in a region improves with a greater proportion of high-performing providers or larger facilities. Providers who are not medical doctors, or those who have specific job descriptions, tend to benefit more from the presence of these top-performing providers.

The parental role in intergenerational educational persistence: an empirical investigation with cross-country panel data

PurposeThe main aim of this study is to investigate the role of fathers and mothers in the intergenerational educational persistence for sons and daughters under two dimensions that characterize the clusters of countries: redistributive policy and governance.Design/methodology/approachData from the Global Database of Intergenerational Mobility (GDIM), hierarchical cluster analysis on principal components and panel regression are used in this study to estimate intergenerational educational correlation and to investigate its determinants related to the parents’ and descendants’ education variables in 93 countries grouped in four clusters. The empirical analysis is differentiated by gender combinations of parents and descendants.FindingsIn the clusters of countries characterized by high inequalities and poor governance, our findings show that the role of the fathers is stronger than that of the mothers in educational transmission; fathers and mothers are more influential for the daughters rather than for the sons; parental educational privilege is the main driver of intergenerational educational persistence; there is an inverse U-curve in the association between educational inequality of the parents and educational correlation for the sons. Differently, in the countries characterized by high income, low redistributive conflict and better governance, the role of the mothers is stronger and education mobility for the daughters is higher than that for the sons.Social implicationsThe authors’ results remark on the importance of social welfare policies aimed to expand a meritocratic public education system including schooling transfers for lower social class students and narrowing the gender gap in educational mobility between daughters and sons. Social welfare policies should also be oriented to spread high quality child care systems that help to foster greater women equality in the labor market, because the strength of educational persistence depends on the position of the mother in the economic hierarchy.Originality/valueThe distinctiveness of the paper can be found in the fact that this study investigates the parental role differentiating by gender and coupling hierarchical cluster analysis on principal components with panel regression models. This allows us to have a sample of 93 countries aggregated in four groups defined in two dimensions: redistributive policy and governance. Amongst the determinants of educational transmission, we consider not only education’s years of the parents but also other determinants, such as educational inequality and privilege of the parents. We also identify the effects of investment in human capital and educational inequalities for the descendants on education mobility.

Standardization of medical care provision to children: local clinical protocol of medical care for children with glomerulonephritis at the level of the hospital district

Glomerulonephritis is one of the most common kidney diseases in children, which leads to the development of chronic kidney disease, chronic kidney failure, and early disability. According to statistical data (2022), glomerulonephritis is the second most common among acquired kidney childhood diseases after urinary tract infections in Ukraine. The system of standardization of medical care is focused on the development and implementation of medical and technological documents that help a doctor to act effectively in specific clinical situations, avoiding ineffective actions and interventions. The article considers the approaches to improving the quality of medical care for children at the regional level — a local clinical protocol of medical care for children with glomerulonephritis (coordination of the patient’s clinical route and standardization of diagnostic, therapeutic and preventive measures in health care facilities at the level of the hospital district).

National Service Evaluation of the Quality of Care for Children and Young People with Congenital Adrenal Hyperplasia in the UK: Survey Responses from Patients and Clinicians

Plain Language SummaryCongenital adrenal hyperplasia (CAH) is a lifelong condition where the body does not produce enough steroids, and thus patients need to take daily steroid replacement. There are differences of opinion in how CAH is treated, and we aimed to find out about these differences in the UK. We surveyed children and young people living with CAH, their parents or carers, and doctors and nurses who look after them throughout the UK. We received 152 responses from carers, 43 from patients, and 34 from clinicians from a total of 33 different clinics. Overall satisfaction with services was high, although, while 94% of clinicians said they provided formal training to families with CAH, over 80% of both patients and carers said that they had not attended what they considered formal training. Most patients and carers said that they would like to engage with further training. Clinicians said they wanted better access to other support for patients, including psychologists. Treatment of CAH was generally in keeping with international guidelines. New methods of monitoring, such as dripping blood onto a card instead of attending hospital for a formal blood test, are increasing with two-thirds of clinicians reporting this method being used. In conclusion, there is good satisfaction with care provision among patients and carers with CAH in the UK. However, there are opportunities for increasing psychological support and family education about the condition to further improve the lives of those living with this disease.

The Index of Parental Activities, Context and Experiences (I-PACE): Psychometric Properties of a New Brief Early Parenting Questionnaire

Time pressures make brevity important for parent self-report measures, yet evidence highlights the multi-faceted nature of parenting and contextual influences. To straddle these competing goals, we developed a brief (23-item) yet broad Index of Parental Activities, Context, and Experiences (I-PACE) aimed at parents of toddlers and pre-schoolers. In two studies we assessed the validity and reliability of the I-PACE. Study 1 involved 870 caregivers (95% female, 75% with degrees, 90% White British) and examined I-PACE ratings alongside; (a) ratings of children’s social-emotional skills and behavior problems; and (b) child age and parental depressive symptoms, to assess its sensitivity to contrasts in child development and parental experience. Study 2 included 191 families with 14-month-olds, for whom 188 mothers and 178 fathers completed the I-PACE and an index of life satisfaction. Supporting the replicability of findings from the I-PACE, both studies showed the same differentiated 5-factor structure (i.e., parental experiences, parenting activities, home environment quality, neighborhood environment quality and childcare environment quality). Supporting the I-PACE’s validity, Study 1 showed that all 5 factors were independently related to both children’s social-emotional skills and behavior problems, with predicted associations with child age and parental depressive symptoms. Supporting the I-PACE’s inter-rater reliability, within-couple associations were significant for parenting activities, home environment, neighborhood quality and childcare quality. Together, these findings indicate that the I-PACE offers a broad yet brief index of early parenting with good psychometric properties and we discuss promising avenues for future research.

2024 Watch List: Top 10 Technologies and Issues Related to Caring for Children and Youth With Medical Complexity

What Is the 2024 Watch List?&#x0D; &#x0D; The Watch List annual Horizon Scan report presents emerging technologies and issues that have the potential to shape the future of health care in Canada.&#x0D; CADTH’s 2024 Watch List focuses on care for children and youth with medical complexity. This top 10 has been divided in 2 parts — the top 5 technologies and top 5 issues related to children and youth with medical complexity that have the potential to make a significant and meaningful impact in transforming health systems in Canada over the next 5 years. These technologies and issues could shape the future of health care for not only children and youth with medical complexity, but also for others with chronic health conditions.&#x0D; &#x0D; Why Is This an Issue?&#x0D; &#x0D; Children and youth (people aged 24 years and younger) with medical complexity are a diverse group with a range of needs (e.g., single or multiple conditions, rare diseases). Although there is no single definition, common characteristics include significant functional limitations often causing the child or youth to be reliant on technology; high health care utilization, often requiring specialized care and services from different providers in multiple settings; and high health care service needs, such as care provision in the home and care coordination, which can have significant social and financial impacts on caregivers and the family.&#x0D; Children and youth with medical complexity account for less than 1% of all children and youth in Canada, but they account for 37% of hospital stays and 17% of emergency department visits. Due in part to the high number of health care interactions, this group experiences the effects of challenges within the health care system more acutely than their less medically complex peers.&#x0D; &#x0D; What Is the Potential Impact?&#x0D; &#x0D; The Watch List highlights areas for innovation, systems change, and investment.&#x0D; Advances in medical care have resulted in more children living with conditions that previously would not have been survivable in infancy and childhood. Now there are more children and youth with medical complexity, and they are living longer. Our current health systems were not designed to meet the complex needs of this group of people and their caregivers, including that many of them face challenges in accessing needed care. This year’s Watch List spotlights new and emerging technologies and key issues that could have a major impact on how patient care is provided to children and youth with medical complexity.&#x0D; &#x0D; What Else Do We Need to Know?&#x0D; &#x0D; In the 2024 Watch List, we identify and describe the top 5 new and emerging technologies that could shape the future of health care for children and youth with medical complexity in Canada, including new models of care and technologies and systems to improve communication. We also explore some considerations for health care decision-makers about the potential impact of these technologies on care pathways, health care human resources, health care infrastructure, and health equity.&#x0D; The 2024 Watch List also identifies the top 5 issues that limit health systems from providing optimal quality of care for children and youth with medical complexity. Key issues such as the need for increased interoperability between health systems and the need for strategies to improve sustainability warrant more attention and will influence the wider adoption, diffusion, and implementation of new and emerging technologies for children and youth with medical complexity.&#x0D; Monitoring ongoing developments and evidence related to the top technologies and issues highlighted in the 2024 Watch List can help guide health system planning in Canada and improve access to high-quality care.&#x0D;

PRECIOUS demonstrated satisfactory measurement properties for assessing the quality of care for children with serious illnesses

ObjectivesTo determine the measurement properties of PaRental Experience with care for Children with serIOUS illnesses (PRECIOUS), a parent-reported measure of Quality of Care for seriously ill children across care settings and illness trajectories. Study Design and SettingParents self-administered baseline and 2-week follow-up surveys online. Exploratory Factor Analysis was used to determine PRECIOUS’s factor structure and select items. Internal consistency was evaluated with Cronbach’s α, test-retest reliability with intraclass correlation coefficients, and convergent validity with Spearman’s correlations between PRECIOUS scales and subscales of Measure of Processes of Care and Quality of Children’s Palliative Care Instrument. ResultsOf 152 parents [108 (71%) mothers, 44 (29%) fathers] who completed the baseline survey, 123 (81%) completed follow-up. Exploratory Factor Analysis grouped PRECIOUS into five scales: collaborative and goal-concordant care (12 items), caregiver support and respectful care (15 items), access to financial and medical resources (five items), reducing caregiving stressors (nine items), and hospitalization-specific processes (four items). Root Mean Square Error of Approximation was 0.040 and Comparative Fit Index was 0.980. Cronbach’s α ranged from 0.85 to 0.96. Intraclass correlation coefficients ranged from 0.72 to 0.86. Significant correlations with Measure of Processes of Care and Quality of Children’s Palliative Care Instrument confirmed convergent validity. The original 56-item tool was reduced to 45 items. ConclusionPRECIOUS demonstrates satisfactory measurement properties for assessing Quality of Care for seriously ill children.

Continuous improvement of quality of care in pediatric diabetes: the ISPED CARD clinical registry

Abstract Aim In Italy, the ISPED CARD initiative was launched to measure and improve quality of care in children and adolescents with type 1 diabetes. Methods Process and outcome indicators and the related information derived from electronic medical records were identified. A network of pediatric diabetes centers was created on a voluntary basis. Results Overall, 20 centers provided data on 3284 patients aged &lt; = 18 years. HbA1c was monitored ≥ 2/year in 81.2% of the cases. BMI was monitored ≥ 1/year in 99.0%, lipid profile in 45.3%, and blood pressure in 91.7%. Pubertal status, albuminuria, eye examination, and screening of celiac disease and thyroiditis were underreported. From 2017 to 2021, average HbA1c levels decreased from 7.8 ± 1.2 to 7.6 ± 1.3%, while patients with LDL cholesterol &gt; 100 mg/dl increased from 18.9 to 36.7%. Prevalence of patients with elevated blood pressure and BMI/SDS values also increased. In 2021, 44.7% of patients were treated with the newest basal insulins, while use of regular human insulin had dropped to 7.7%. Use of insulin pump remained stable (37.9%). Conclusions This report documents the feasibility of the ISPED CARD initiative and shows lights and shadows in the care provided. Improving care, increasing number of centers, and ameliorating data recording represent future challenges.

The Perceived Informational Needs of Family Caregivers of Children Hospitalized in a Burn Department: A Cross-sectional Study.

Children are most vulnerable to burn injuries, and their families are their most important source of support. Therefore, it is necessary to identify the information needs of such parents and support them to help children adapt to the new situation, recover to pre-accident conditions, and reintegrate into school and society. This study aimed to investigate the perceived information needs of family caregivers of children admitted to the burn wards of hospitals. This cross-sectional study was conducted on 200 family caregivers of children admitted to the burn ward of a hospital in Tabriz, Iran. Participants were selected through convenience sampling, and the required data were collected by using questionnaires on socio-demographic information, information needs, information resources, and information acquisition methods. The obtained data were analyzed statistically using descriptive statistics (mean, standard deviation, frequency, and percentage) and inferential statistics (Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests). Results indicated that the greatest informational need among family caregivers was related to the child's condition. The treatment team was identified as the most important source of information for them. It was found that information should be provided in a comprehensive and understandable manner, while maintaining honesty and human dignity. The study findings contribute to our understanding of the specific information needs of family caregivers in managing the medical care of children with burns. These findings can serve as a basis for interventions and support services aimed at meeting the needs of these families and improving the quality of care for children with burns.

A systematic review of the childbearing needs of single-child couples

BackgroundNowadays, the challenge of having single child is spreading in many countries. Only- child family is prevalent in 26% of families in Canada, 21% in the United States, 47.5% in Europe and 20% in Iran, which can lead to fertility below replacement level. Therefore, the current review was conducted to identify the needs of single-child couples.MethodsThe PRISMA checklist was used to prepare this systematic review report. English and Persian articles published between 2000 and April 2023 were searched in the English databases of ISI, PubMed, Cochrane library and Google Scholar search engine as well as Persian databases of SID and Magiran using keywords of only child, needs assessment and Reproductive behavior. All cross-sectional and correlational studies that addressed the needs of single-child couples were included in the study. The quality assessment of the articles was done by the STROBE checklist. Data extraction was done by two independent researchers using a self-structured checklist. To analyze the data, following tabulating the extracted data, the process of qualitative synthesis was done for systematic review taking into account ethical considerations.ResultsOut of 1,581 articles found, 17 articles were included in the systematic review. The needs of single-child couples were divided into four general areas included 1) Financial needs, 2) Cultural needs, 3) Educational needs, and 4) Supportive needs. The support needs included two kinds of social and family support.ConclusionSolving financial needs, creating a culture of positive values of childbearing and men's participation in household affairs, considering women's preferences in order to increase education and employment, childbearing training and counseling and creating social and family support in line with work and family harmony and quality care of children, as the most important needs of single-child couples, should be incorporated in the formulation of childbearing incentive programs.

Enhancing Diagnostic Follow-up and Care Coordination for Children with Autism in a Busy Resident Continuity Clinic: Leveraging the Electronic Health Record.

A high-quality primary care clinic should provide clear action points and important care coordination for a child receiving a new diagnosis of autism spectrum disorder (ASD). Unfortunately, a substantial proportion of caregivers report little-to-no post-diagnosis support from their home clinics and primary care providers often report lack of training and resources in providing these supports. We implemented an intervention package to investigate the impact on the frequency and quality of follow-up care for children with ASD in a busy, high-volume resident continuity clinic. The package consisted of a care coordination scheduling pathway and a standardized clinical template-embedded in the electronic health record (EHR)-that guided providers through best-practice recommendations and patient resources. As a result of these interventions, 74% of patients had ASD-specific follow-up, a more than threefold increase from baseline with a majority of providers using the EHR-embedded template to guide their visit. Providers also indicated a high degree of usability for the system and that it aided them in following best-practice guidelines for ASD care. Through explicit scheduling pathways and a novel EHR template, we saw a significant increase in ASD-specific follow-up visits and implementation of best practices for ASD care, demonstrating a new process for training and engaging primary care providers in clear action steps for post-diagnostic care without having to rely on tertiary referrals.

Evaluating the challenges and needs of parents caring for children with Williams syndrome: A preliminary study from Poland

BackgroundAlthough physical, cognitive and behavioural manifestations of Williams syndrome (WS) affect every dimension of caregivers lives, no studies on the parental experiences of caring for a WS child have to date been carried out in Poland. MethodsIn order to identify the challenges and needs of Polish carers of WS children a survey was conducted with 32 family caregivers who were supported by the Polish Williams Syndrome Association. ResultsWhile caregivers were mostly challenged by their WS child’s behaviours, health problems and mood swings, many parents experienced fatigue, intimacy problems with the partner and deterioration of mental health. They were also burdened by the lack of time for themselves and work restrictions resulting from caregiving responsibilities. Even though parents positively assessed quality of medical care for WS children, still many expressed their dissatisfaction both with the way the healthcare system for WS children works in Poland and complained about the doctors’ lack of knowledge about WS, access to specialist care and lack of support from government and social institutions. Although many parents stressed positive impact of rising WS child, more than half experienced role captivity or role overload and felt not being understood by others. They also experienced variety of distressing emotions, including impatience, emotional lability, helplessness, anxiety and depression. ConclusionsAlthough many WS parents stressed the affirmative aspect of raising WS child this research shows that the burden of caring for such a child goes far beyond clinical aspects and seriously affects every aspect of parents’ lives, including their mental health, daily lives, family, their professional and social lives. Because apart from the daily challenges related to caring for a WS child, parents’ dealings with the healthcare system and support services represent major problems there is a the need for a bio-psychosocial approach to WS that should include not only WS children, but also their caregivers. What this paper adds?1. It analyses the challenges and needs of parents caring for children with Williams syndrome;2. It provides evidence that the impact of caring for WS children goes far beyond clinical aspects and seriously affects every aspect of parents’ lives, including their mental health, daily lives, family, their professional and social lives;3. It also shows that, apart from the daily challenges related to caring for a WS child, parents’ dealings with the healthcare system and support services represent major problems.4. Thereby, it highlights the importance of incorporating a bio-psychosocial approach to WS that should include not only WS children, but also their caregivers.

Investigating the association between professional development and educators’ beliefs in U.S. center- and home-based early childhood education

The child-centered beliefs held by educators in early childhood education (ECE) are important in high-quality interactions between children and adults and are central to the recent policy emphasis on childcare quality. Using a national ECE workforce sample of home- and center-based centers from the 2019 National Survey of Early Care and Education (N=7,505), this study examined the relationships between professional development experiences and ECE educators' child-centered beliefs measured by a revised Parental Modernity Scale. We focused on the three PD models of mentoring and coaching, workshops, and college courses, and found that attending college courses was related to greater child-centered beliefs in home-based educators. Mentoring and coaching were found to effectively promote center-based educators’ beliefs. In terms of the contexts that support PD participation in home- and center-based childcare programs, our findings suggest that providing more opportunities to participate in coaching and college courses can offer effective support and thus improve ECE quality. The policy and practical implications of the findings are discussed.

The quality of dental care in children with permanent teeth trauma according to analysis of medical records in an emergency unit of a municipal dental clinic

Was to assess the efficacy and timing of emergency dental care in children with permanent teeth trauma according to analysis of medical records in an emergency unit of a municipal dental clinic. The study involved 320 medical records of pediatric patients admitted to emergency dental care unit of a municipal dental clinic in 2021 because of maxillofacial trauma from which 221 records of children with acute dental trauma were extracted. The quality of documentation of the medical records, rationale for diagnosis and adequacy of emergency dental treatment were analyzed. No records included diagnosis code according to ICD-10. Trauma history was described in the majority of records by in 67% of them no trauma time was stated with proper precision. In 67.6% of permanent teeth trauma cases emergency aid was carried out inadequately. All patients with uncomplicated crown fractures were dismissed with no treatment. In complicated crown fractures needing pulp vitality preservation the pulp was devitalized or just anesthetized. Tooth replantation in avulsion cases was not performed. In 13.5% of records the treatment was not properly described. In 67.6% of records there were no recommendations for follow-ups. There is a strong need for the improvement of knowledge of traumatic dental injuries management among Russian pediatric dentists by elaboration and implementation of protocols for dental traumas treatment.

Comparison of healthcare quality for uninsured and underinsured children through community health centres in Canada and the USA: a scoping review protocol

IntroductionChildren and youth who are uninsured or underinsured in Canada and the USA have limited options where they can receive healthcare. In both countries, community health centres (CHCs) have been...

Work-life integration among nurse educators: a meta-synthesis.

Work-life integration has been extensively researched in various contexts. Women dominate the nursing profession, but work-life integration is essential for men and women since both are expected to focus equally on their families and careers. The nursing faculty perceives nurse educators' work environment as undervalued, lacking support, and limited time to grow and carry the heavy workload. A qualitative meta-synthesis of studies between 2013 and 2023 was conducted using ScienceDirect, EBSCO Host, Sage and Sabinet databases. Seven articles related to the research phenomenon were retrieved. The resulting themes revolved around two central aspects: nurse educators' work and life integration. Nurse educators face various challenges with work-life integration and often view their failure as a personal rather than a societal issue. However, as much as achieving work-life integration is personal, there is a call for employers in academic environments to improve workplace policies, like better-paid maternity leave, affordable quality childcare, and social support. Furthermore, nurse educators' line managers should display warmth and encouragement about personal challenges affecting nurse educators.

Childcare Voucher: A Qualitative/Pilot Study, Exploring the Experiences of Expectant and Parenting Teenage Mothers in Washington, District of Columbia (DC)

Objective: The aim of this study is to use human-centered design and journey mapping to explore the experience of Expectant and Parenting Teens in the District of Columbia (DC) in accessing childcare while attending school and/or seeking employment. Methods: In-depth interviews were conducted with 20 young mothers who had experienced teenage pregnancy and 10 providers assisting young parents in accessing support services, including childcare. Journey map interview guide (Table 1) was used for this interview. Interviews were audio recorded and transcribed verbatim to ensure that the participants’ statements were maintained in the transcripts. A thematic analysis was used to examine data and themes arising from the interviews. Open and axial coding was used to code the interview transcripts and organize them into categories and themes following an inductive and deductive approach. Results: The design team conducted 30 deep-dive interviews with 20 young parents (ages 18 - 25) and 10 providers assisting young parents in accessing support services, including childcare. The young parents interviewed were majority Black (66%) and Hispanic (19%), and largely live in wards 7 (33%) and 8 (28%). Their children’s average age was 4 years (range 2 months -8 years). Discussion: Three main themes and categories were identified as (1) Motivation to finish high school and find employment, (2) Challenges of accessing childcare voucher and quality childcare (3) Support staff (school councilors) experience.

Medicaid ACOs on MH care outcomes for Massachusetts children to be examined

A University of Massachusetts Amherst public health researcher has been awarded a five‐year, $2.2 million grant from the National Institutes of Health (NIH) to examine the impact of Medicaid accountable care organizations (ACOs) on the quality and outcomes of behavioral/mental health care for children in Massachusetts, a news release stated. ACOs are the value‐based health care delivery model designed to reduce Medicare and Medicaid costs while improving coordination and quality of care. “Fundamental changes in health care are needed to address socioeconomic and racial/ethnic disparities in behavioral health care quality and outcomes for children in vulnerable populations,” the grant summary states. In the past decade, the prevalence of mental health disorders among children has climbed in Massachusetts, said lead investigator Sarah Goff, M.D., Ph.D., a practicing pediatrician and internist and associate professor/chair of health promotion and policy in the UMass Amherst School of Public Health and Health Sciences. The researchers will use an innovative mixed methods approach to investigate how the launching of 17 new Medicaid ACOs in Massachusetts in 2018 may have impacted mental health care for children. Findings from the study are expected to inform providers, payers and policymakers responsible for the care of vulnerable populations of children with mental health disorders.

Driving improvements in the quality, safety, consistency and coordination of care and support for children using health and social care services, through the collaborative development of national standards.&amp;nbsp;

Background: Ireland has national strategies and policies setting out the importance of integrated care and coordination of care and support between health and social care services, to enable children to get timely and appropriate care and support. Despite Government commitment to a coordinated approach, delivery of care and support to children continues to be inconsistent and fragmented. While children with complex needs are more likely to experience significant gaps and delays in the care and support they need, evidence shows that any child in need of care and support from a health or social care service is at risk of gaps and delays.&#x0D; The Health Information and Quality Authority (HIQA) and the Mental Health Commission (MHC) are the regulatory bodies for health and social care services, and mental health services, in Ireland. To promote and support greater integration and collaboration between health and social care services, HIQA and the MHC worked together to develop national standards for all health and social care services working with children. Throughout the standards development process, we collaborated with children and families with lived experience, and advocates and staff working in health and social care services.&#x0D; Methods: These evidence-based standards cover all health and social care services working with children, including healthcare, disability, mental health and children’s social services. They provide a shared framework for all services and aim to support them to work together in a coordinated and collaborative way to improve the experience and outcomes of children and families.&#x0D; The standards were informed by a literature review, and extensive stakeholder involvement including focus groups with 217 children, young people and families with lived experience, advocates, staff, inspectors, and policy-makers; and 130 responses to two public consultations. An Advisory Group representing key stakeholders and a Children’s Reference Group informed the standards. The Children’s Reference Group comprised of young people and family members with experience of health and social care to ensure active people involvement and engagement in design and implementation of the standards. Their input helped ensure the standards authentically reflected what children should expect from a health and social care service committed to child-centred care. &#x0D; &#x0D; Initiative: This is the first time a set of Irish national standards has been developed focused on the needs of all children across health and social care services. The standards are underpinned by the principles of a children’s rights-based approach, safety and wellbeing, responsiveness, and accountability. Presented in the child’s voice, they articulate what outcomes a child should expect and what a service needs to do to achieve these outcomes.&#x0D; Impact: These standards will help to drive quality, safety, consistency and coordination across health and social care services working with children, as all organisations and services will be operating to one set of consistent national standards. Although an important lever for change, we recognise that services will need tools to support implementation of the standards and we will work with the sector to identify and collaboratively develop relevant tools to support implementation of the standards in day-to-day practice.&#x0D;