Child's Care Team Research Articles

Attitudes and responses of Victorian paediatric intensive care doctors to the detection and reporting of child maltreatment.

To determine the attitudes and responses of Victorian paediatric intensive care doctors to the detection and reporting of child maltreatment. A prospective study conducted in a 30-bed paediatric intensive care unit of a university teaching hospital using data collected from a questionnaire completed by paediatric intensive care consultants and registrars. The questionnaire covered the following domains - doctors' knowledge of Victorian mandatory reporting legislation, doctors' history of reporting and doctors' current role in the detection and reporting of child maltreatment. The questionnaire was completed by 37 doctors. All but one doctor considered their role in the detection and reporting of all six forms of maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, exposure to domestic violence and grooming to facilitate later sexual activity with a child) very important or somewhat important. Thirty-two percent of doctors did not feel adequately trained to detect child maltreatment while 51% did not feel adequately trained to report maltreatment. If a doctor wanted to make a report to Child Protection about the physical or sexual abuse of a child, only one would likely make Child Protection their first point of contact. Paediatric intensive care doctors show a strong intent to detect and report child maltreatment across a broad range of maltreatment types. Doctors are likely to contact one or more members of a child's care team and/or one or more relevant hospital/community services before making a report to Child Protection about the physical or sexual abuse of a child. Opportunities exist for the further education of doctors in regards to the detection and reporting of child maltreatment.

Perceived Parent Needs for Improving Parent Participation in School-Based Therapies for Children with Disabilities Using the Parent-Therapist Partnership Survey.

Rehabilitative and habilitative therapies can help children with disabilities increase independence and overall wellbeing. However, children and their caregivers face many barriers to accessing these therapies and often rely on the school for therapy access. Given the limited resources available within the special education system, increasing parent involvement in special education therapies could improve service delivery. However, providers must first understand what parents need to participate in therapies before attempting to engage families. 217 parents completed an online survey consisting of the Parent-Therapist Partnership Survey and demographic questionnaires about theirfamiliesand their child[ren] with disabilities. The percentage of needs parents endorsed as important and thepercentageofimportantneedsendorsedasunmetwere calculated. Differences across demographic variables were assessed. Overall, parents reported an average of 75% of needs as important with significantly more needs endorsed as important regarding being an informed, engaged member of the child's care team (M = 83%) than needs related to support and guidance (M = 65%, p < 0.001). Furthermore, parentsreportedan average of 58% of important needs as unmet, with no significant differences in subscale averages. Significant associations were found for race/ethnicity, education, income, partner availability, number of children with disabilities in the household, transportation access, neighborhood opportunities, parent efficacy and social, emotional, and behavioral concerns. Parents reported a high percentage of needs as important, but a large percentage of these important needs were considered unmet. Significant disparities based on racial/ethnic identities and access to resources were found. In order to successfully engage parents in special education therapy activities, providers must work to understand and address parents' engagement needs, paying special attention to each family's unique circumstances to optimize engagement.

Perception of Physicians' Notes Among Parents of Different Health Literacy Levels.

To explore the benefits and challenges of accessing physicians' notes during pediatric hospitalization across parents of different health literacy levels. For this secondary analysis, we used semi-structured interviews conducted with 28 parents on their impressions of having access to their child's care team notes on a bedside table. Three researchers used thematic analysis to develop a codebook, coded interview data, and identified themes. Parent interviews and respective themes were then dichotomized into proficient or limited health literacy groups and compared. Nine themes were identified in this secondary analysis: 6 benefits and 3 challenges. All parents identified more benefits than challenges, including that the notes served as a recap of information and memory aid and increased autonomy, empowerment, and advocacy for their child. Both groups disliked receiving bad news in notes before face-to-face communication. Parents with proficient literacy reported that notes allowed them to check information accuracy, but that notes may not be as beneficial for parents with lower health literacy. Parents with limited literacy uniquely identified limited comprehension of medical terms but indicated that notes facilitated their understanding of their child's condition, increased their appreciation for their health care team, and decreased their anxiety, stress, and worry. Parents with limited health literacy uniquely reported that notes improved their understanding of their child's care and decreased (rather than increased) worry. Reducing medical terminology may be one equitable way to increase note accessibility for parents across the health literacy spectrum.

Evaluation of a Secure Messaging System in the Care of Children With Medical Complexity: Mixed Methods Study.

The Connecting2gether (C2) platform is a web and mobile-based information-sharing tool that aims to improve care for children with medical complexity and their families. A key feature of C2 is secure messaging, which enables parental caregivers (PCs) to communicate with their child's care team members (CTMs) in a timely manner. The objectives of this study were to (1) evaluate the use of a secure messaging system, (2) examine and compare the content of messages to email and phone calls, and (3) explore PCs' and CTMs' perceptions and experiences using secure messaging as a method of communication. This is a substudy of a larger feasibility evaluation of the C2 platform. PCs of children with medical complexity were recruited from a tertiary-level complex care program to use the C2 platform for 6 months. PCs could invite CTMs involved in their child's care to register on the platform. Messages were extracted from C2, and phone and email data were extracted from electronic medical records. Quantitative data from the use of C2 were analyzed using descriptive statistics. Messaging content codes were iteratively developed through a review of the C2 messages and phone and email communication. Semistructured interviews were completed with PCs and CTMs. Communication and interview data were analyzed using thematic analysis. A total of 36 PCs and 66 CTMs registered on the C2 platform. A total of 1861 messages were sent on C2, with PCs and nurse practitioners sending a median of 30 and 74 messages, respectively. Of all the C2 messages, 85.45% (1257/1471) were responded to within 24 hours. Email and phone calls focused primarily on clinical concerns and medications, whereas C2 messaging focused more on parent education, proactive check-ins, and nonmedical aspects of the child's life. Four themes emerged from the platform user interviews related to C2 messaging: (1) connection to the care team, (2) efficient communication, (3) clinical uses of secure messaging, and (4) barriers to use. Overall, our study provides valuable insight into the benefits of secure messaging in the care of children with medical complexity. Secure messaging provided the opportunity for continued family teaching, proactive check-ins from health care providers, and casual conversations about family and child life, which contributed to PCs feeling an improved sense of connection with their child's health care team. Secure messaging can be a beneficial additional communication method to improve communication between PCs and their care team, reducing the associated burden of care coordination and ultimately enhancing the experience of care delivery. Future directions include the evaluation of secure messaging when integrated into electronic medical records, as this has the potential to work well with CTM workflow, reduce redundancy, and allow for new features of secure messaging.

Medical experts and trusted confidants: parent perceptions of the clinician-parent relationship in childhood cancer

A childhood cancer diagnosis threatens the health, safety, and security of the child and whole family unit. A strong relationship between the healthcare team and family is integral to provision of holistic support during this time of crisis. Family-centered care necessitates a fluid, therapeutic relationship between parents and the child's healthcare team. This study investigated bereaved parents' perspectives on their relationship with their child's care team and the impact of these relationships on their coping across the cancer trajectory and into bereavement. Thirty-one parents whose child died from cancer between 1 and 6 years prior to study enrollment participated in semi-structured interviews about their relationships and interactions with their child's healthcare team across the illness course and into bereavement. We audio-recorded interviews, transcribed them verbatim, and utilized a codebook thematic analysis approach to analyze interview transcripts. Four themes emerged across interviews with parents describing their perceptions of the parent-clinician relationship: (1) a collaborative approach improves perceptions of care, (2) professional trust is core to the relationship, (3) parental personal preference and bias can limit relationship-building, and (4) meaningful connections form on an emotional, individualized level. These themes highlight relational patterns between parents and clinicians that can promote or erode alliance and collaboration. Bereaved parents recognize key attributes that influence the parent-clinician relationship. Educating clinicians about parent-identified positive modifiable behaviors (e.g., communication deficits) and awareness of non-modifiable care factors (e.g., individual personality preferences) may enable clinicians to strengthen relationships with parents and ultimately improve quality of care.

What do childcare professionals agree on when they propose non-kin foster care?

ABSTRACT Decision-making around foster care is a highly complex process, both because of the nature of the issues to be decided and because of the positive or negative implications it may have, mainly on the lives of the children, but also for foster carers and birth families. To focus research on decision-making is to go to the core of the child protection system. The aim of this article is to analyse the factors that intervene in decision-making by childcare professionals regarding non-kin foster care in the north-east of Spain, given that three services intervene throughout this process for the same child. Moreover, coincidences and discrepancies in the weight given to the factors involved in the decision-making process have been analysed. Firstly, we analysed 90 cases of children in foster care assessed by the three services involved, and secondly, we obtained the evaluation made by 57 professionals from 28 childcare teams on general aspects of decision-making. The results highlight how the child’s young age and the likelihood of the birth parents not recovering are factors that play an important role in the decision to propose foster care, thus opening the debate on the current role of foster care within the care system.

Parent-Provider Communication in Hospitalized Children with Advanced Heart Disease

Communication between parents and providers of children with cardiac disease is essential to parental decision-making. This study explored how parents of hospitalized children with advanced heart disease perceived communication with their child's providers. We performed a prospective survey study of parents and physicians of children with advanced heart disease age 30days to 19years admitted to the hospital for > 7days over a 1-year period at a single institution (n = 160 parent-provider pairs). Descriptive statistics were primarily used and Fisher exact tests and kappa statistics were used to assess agreement. All parents rated communication with their child's care team as excellent, very good, or good, but 56% of parents reported having received conflicting information. Parental perception of "too many" people giving them information was associated with overall poorer communication and less preparedness for decision-making. One-third (32%) of parents felt unprepared for decision-making, despite 88% feeling supported. Parents and physicians showed poor agreement with respect to overall adequacy of communication, receipt of conflicting information, and evaluation of the most effective way for parents to receive information. Interventions involving physician communication training and proactive assessment of parent communication preferences may be beneficial.

Parent perceptions of pediatric oncology care during the COVID-19 pandemic: An Australian study.

BackgroundWe examined parents’ perceptions of their child's oncology care during a period of significant COVID‐19 restrictions in Australia.MethodsParents of children, 0–18 years, receiving hospital‐based cancer treatment, completed a survey examining their COVID‐19 exposure and impact, information and knowledge, and perception of their child's medical care. Recruitment occurred between October and November 2020.ResultsEighty‐four parents (95% mothers) completed the survey. Sixty‐seven percent of patients were diagnosed pre‐COVID‐19. The majority of parents (76%) reported negative impacts of COVID‐19 on family life, including parenting and emotional well‐being despite exposure to COVID‐19 cases being very low (4%). Family functioning and parent birthplace were associated with COVID‐19 impact and distress. Parents perceived the hospital as a safe place during the pandemic. Very few parents reported delaying presentation to the emergency department (12%). The majority identified no change (69%) or delay (71%) in their child's treatment delivery. Over 90% of parents were confident that COVID‐19 did not impact medical decision‐making. They felt confident in their COVID‐19 knowledge and sought information from trusted sources. Parents reported a positive relationship with their child's care team (93%); however, access to some support services was reduced.ConclusionUnderstanding patient and family experiences of pediatric oncology care across international contexts during the pandemic is important to inform present and future health care responses. In the Australian context of low infection rates and strict community restrictions, parents perceived their child's oncology care to be relatively unaffected. However, findings indicate that family well‐being was impacted, which warrants further investigation.

Parent Perceptions of Team-Delivered Care for Children With Advanced Cancer: A Report From the PediQUEST Study

ContextChildhood cancer care is delivered by interprofessional health care teams; however, little is known about how parents perceive overall team-delivered care (TDC). ObjectivesWe sought to describe parent perceptions of TDC and associated factors, including care rendered by individual clinicians, teamwork, information consistency, and patient and parent characteristics. MethodsCross-sectional surveys were distributed to parents of 104 children with recurrent/refractory cancer enrolled in a multisite symptom management trial. The primary outcome, TDC, was parent report of care quality delivered by the child's care team during the preceding three months. Likert-scaled items (excellent/very good/good/fair/poor) queried care quality delivered by individual clinicians, perceived teamwork, and other factors. Factors associated with parent perceptions of excellent TDC were identified using Fisher's exact test. ResultsEighty-six parents (83%) responded. During the preceding three months, 63% (n = 54) of parents reported excellent TDC. However, only 47% (n = 40) described their care team's teamwork as excellent. Approximately one-quarter (24%) described care rendered by their child's oncologist as less-than-excellent. Among parents who reported psychosocial clinician involvement (71%; n = 60), only 43% described this care as excellent. Individually, excellent care from each clinician type (oncologist, psychosocial clinician, and primary nurse) was associated with excellent TDC (all P ≤ 0.001; no correction for multiple comparisons). ConclusionAmong parents of children with advanced cancer, more than one-third report less-than-excellent TDC. In addition, less than half report excellent teamwork, and ratings of care rendered by individual clinicians are highly variable. Findings suggest that interventions are needed to enhance interprofessional teamwork in the care of children with advanced cancer.

Clinician Perceptions of the Importance of Hospital Discharge Components for Children.

Discharging hospitalized children involves several different components, but their relative value is unknown. We assessed which discharge components are perceived as most and least important by clinicians. March and June of 2014, we conducted an online discrete choice experiment (DCE) among national societies representing 704 nursing, physician, case management, and social work professionals from 46 states. The DCE consisted of 14 discharge care components randomly presented two at a time for a total of 28 choice tasks. Best-worst scaling of participants' choices generated mean relative importance (RI) scores for each component, which allowed for ranking from least to most important. Participants, regardless of field or practice setting, perceived "Discharge Education/Teach-Back" (RI 11.1 [95% confidence interval, CI: 11.0-11.3]) and "Involve the Child's Care Team" (RI 10.6 [95% CI: 10.4-10.8]) as the most important discharge components, and "Information Reconciliation" (RI 4.1 [95% CI: 3.9-4.4]) and "Assigning Roles/Responsibilities of Discharge Care" (RI 2.8 [95% CI: 2.6-3.0]) as least important. A diverse group of pediatric clinicians value certain components of the pediatric discharge care process much more than others. Efforts to optimize the quality of hospital discharge for children should consider these findings.

Becoming a Team: The Nature of the Parent-Healthcare Provider Relationship when a Child is Dying in the Pediatric Intensive Care Unit

PurposeTo explore bereaved parents' perspectives of parent and staff roles in the pediatric intensive care unit when their child was dying, and their relationships with healthcare staff during this time. Design and MethodsConstructivist grounded theory was used to undertake this study. Semi-structured interviewers were conducted with 26 bereaved parents recruited from four Australian pediatric intensive care units. The constant comparative method, coupled with open, focused, and theoretical coding were used for data analysis. ResultsBecoming a team explores the changes that occurred to the parent-healthcare provider relationship when parents realized their child was dying and attempted to become part of their child's care team. When the focus of care changed from ‘life-saving’ to ‘end-of-life’, parents' perspectives and desires of their and the healthcare providers' roles changed. Parents' attempted to reconstruct their roles to match their changing perspectives, which may or may not have been successful, depending on their ability to successfully negotiate these roles with healthcare providers. ConclusionsFindings offer insights into parental understandings of both the parental and healthcare provider roles for parents of dying children in intensive care, and the ways in which the parent-healthcare provider relationships can influence and be influenced by changes to these roles. Practice ImplicationsSuccessful parent-healthcare provider relationships require an understanding of the parental and healthcare provider role from the parents' perspective. The meanings of the parental and healthcare provider roles should be explored with parents of dying children, and supported as much as possible to enable the development of a collaborative relationship.

Call for Papers - Innovative Professional Learning in Early Childhood Education and Care: Inspiring Hope and Action

Call for Papers - Innovative Professional Learning in Early Childhood Education and Care: Inspiring Hope and Action

Trauma-informed child welfare systems and children's well-being: A longitudinal evaluation of KVC's bridging the way home initiative

This study evaluated the effectiveness of a system-wide reform effort to implement trauma-informed care (Trauma Systems Therapy [TST]) across a large, private child welfare system. The longitudinal associations among implementation of TST and four measures of children's well-being (functioning, emotional regulation, and behavioral regulation) and placement stability were examined. A description of the implementation of TST can be found in a separate article in this issue. Latent growth curve models were estimated using child-level administrative data on children's well-being, placement stability, and exposure to TST dosage for 1499 children in out-of-home placements. Results indicate that, as children's care teams implement TST, children demonstrate greater improvements in functioning, emotional regulation, and behavioral regulation and they experience increased placement stability. Moreover, results demonstrate that positive effects of implementation of TST are produced by both those who work closely with the child (caregivers, case managers, and therapists) and those who work more distally with the child (case manager supervisors and family service coordinators), suggesting that no one staff member or caregiver is central to providing trauma-informed care; rather it may be the confluence of the TST skills of the child's entire care team that produces better outcomes.

Call for Papers - Innovative Professional Learning in Early Childhood Education and Care: Inspiring Hope and Action

Call for Papers - Innovative Professional Learning in Early Childhood Education and Care: Inspiring Hope and Action

PC-FACS

PC-FACS

Rethinking Filicide

Rethinking Filicide

Supporting Children’s Participation in Finnish Child Care Centers

Children’s participation in the early childhood education context is a multidimensional issue and educators have a significant role in enhancing participation. In this paper, we focus on the existing challenges to children’s participation and the ways that child care educators can work as teams to meet those challenges. The data were collected with a questionnaire from 1,114 child care teams working in the Helsinki metropolitan area. These teams consisted of almost 4,000 educators who took care of almost 20,000 children. Through ESEM factor analysis, the variables were organized into five factors: Adult–Child Ratios, Professional Skills; Managing Work; Work Practices and Special Needs. The team members felt they had a varying impact on the different challenges: highest on professional skills and managing work and lowest on Adult-Child Ratios. The results offer material for reflecting on practices in early childhood education especially when children’s participation must be developed.

Learning &amp; Development: Two-Year-Olds - Are you ready for me?

Help is at hand for settings preparing to offer funded places for two-year-olds in ‘Are you ready for me -now I'm 2?’. Its authors, the Cheshire East Early Years and Childcare Team, explain how it supports best practice.

Social defences and organisational culture in a local authority child protection setting: challenges for the Munro Review?

The study of social defences against anxiety used within institutions has a long history, beginning with the seminal work of Isobel Menzies Lyth, who examined the reasons for the high rate of nursing students dropping out of their professional training within a large London teaching hospital. She identified a range of social defences used by nursing staff to manage the anxieties inherent within their work, including ritual task performance, reducing the weight of responsibility by checks and counterchecks and reduction of the impact of responsibility by upward delegation. British social work is haunted by the memories of children known to social services who have died. The anxieties experienced by child protection social workers derive from a variety of sources, ranging from daily exposure to powerful emotions within the families and other professionals that they work with to an awareness of a history of public inquiries and media coverage that has influenced public perceptions of their profession. Menzies Lyth's study is over 50 years old and this article will provide a critical analysis of whether this theoretical framework is useful for understanding contemporary child protection social work. Preliminary data from an on-going ethnographic study of local authority childcare teams are used to illustrate the discussion, indicating that similar defences are used within current child protection practice. The implications for the organisational culture in child protection social work and for changes proposed by the Munro Review will be explored, particularly the emotional aspects of organisational change.

Championing the interface between mental health and child protection: evaluation of a service initiative to improve joint working in northern Ireland

The importance of establishing effective inter‐agency working between adult mental health services and child care services in order to safeguard children has been repeatedly identified by research, policy, inquiries and inspection reports. This article reports on the evaluation of an initiative in one health and social care trust in Northern Ireland that aimed to facilitate joint working and so improve service provision and protection for children and families. The Champions Initiative involved identifying a Champion in each multidisciplinary community mental health team and in each family and child care team that would have responsibility for providing information, promoting joint working and identifying any obstacles to better cooperation. The evaluation of this Initiative assessed levels of experience, training, confidence, understanding and awareness in the Champions and their team members at baseline. The Champions and their Team Leaders were then followed up after six months to obtain their qualitative views of the impact of the initiative. The results include comparisons between mental health and child care staff, and crucially, views about whether the initiative has had any impact on working together. This study also generated recommendations for further service development in this complex and important area of practice. Copyright © 2010 John Wiley &amp; Sons, Ltd.‘Identifying a Champion in each multidisciplinary community mental health team and in each family and child care team’