Family-centered Intervention Research Articles

Current Status of Neonatal Music Therapy Services Within the US

Abstract Over the past 30 years, music therapy services in the neonatal intensive care units (NICUs) have expanded, yet there is still limited literature available that captures current practice trends in this setting. The purpose of this paper was to obtain descriptive data about current demographics, consultation, and clinical practice trends in NICU music therapy clinical practice in the US. A questionnaire was sent to 9,222 Board-Certified Music Therapists. Those providing music therapy services in the NICU and choosing to participate (N = 87) completed the questionnaire. Results showed that a majority of music therapists working in the NICU who responded to the questionnaire have completed additional training to provide specialized services. Most NICU music therapists reported spending less than 20 hr a week on the unit and providing a variety of family-centered interventions to infants starting at 28 weeks postmenstrual age (PMA). Common diagnoses for referral besides prematurity were Neonatal Opioid Withdrawal Syndrome and Chronic Lung Disease. Music therapists are well integrated within treatment teams with a majority reporting collaborating and/or co–treating with other therapies and/or clinical staff.

Family Resources and Parental Problem-Solving Skills Mediate Family Functioning and Family Adaptation in Families of Children With Cancer.

To explore the mediating roles of family resources (at the individual [parental self-efficacy], family [family resilience] and social level [social support]) and parental problem-solving skills in the association between family functioning and family adaptation in families of children with cancer. A cross-sectional study. This study recruited 318 parents of children with cancer from three tertiary hospitals in mainland China. Self-report questionnaires were used to collect data on key variables, including family functioning, parental self-efficacy, family resilience, social support, parental problem-solving skills and family adaptation. Data analyses were carried out using descriptive analysis, univariate analysis, Pearson correlation analysis, hierarchical linear regression and bootstrapping. Family functioning was significantly and positively correlated with family adaptation. Family resources (parental self-efficacy at the individual level, family resilience at the family level or social support at the social level) and parental problem-solving skills both independently mediated the relationship between family functioning and family adaptation. Additionally, family resources at all three levels mediated the relationship through their effects on cumulatively parental problem-solving skills, constructing a chain mediating model. The study underscores the significance of family functioning, family resources at the individual, family and social levels and parental problem-solving skills in promoting adaptation in families of children with cancer. It highlights the need for family-centred interventions targeted at these factors to improve family adaptation. This study extended related theories and previous studies to confirm the mediating role of family resources and parental problem-solving skills, both independently and sequentially. Moreover, parental problem-solving skills were confirmed as key elements that can be incorporated into future interventions, suggesting that problem-solving skills training may serve as a highly promising program for families of children with cancer. This study was reported according to the STROBE checklist. No Patient or Public Contribution.

Translation, Reliability and Development of a Calculator for the Brazilian Portuguese Version of the Family Empowerment Scale (FES) in Caregivers of Individuals With Cerebral Palsy.

Care for patients with cerebral palsy (CP) poses significant challenges, with emphasis on the crucial role of family involvement in patients' well-being. The Family Empowerment Scale (FES) assesses parents/caregivers' perception of their ability to promote and influence their children's development in three domains: family, service system and community. The objectives of this study were to translate the FES into Brazilian Portuguese, to develop a calculator for data transformation and analysis and to evaluate the psychometric properties of the scale with Brazilian caregivers of children and adolescents with CP. Translation occurred in four stages: translation, synthesis, back-translation and review of the translated version. A calculator was then developed in the Excel program, to present data in absolute values and graphically for each subscale. Statistical analysis included Bland-Altman, Intraclass Correlation Coefficient (ICC), Internal Consistency, and Floor and Ceiling Effect. In total, 50 parents and caregivers participated to the measurement properties investigation, and the scale demonstrated good reliability for the family (ICC = 0.80) and services (ICC = 0.81) subscales, as well as for the overall scale (ICC = 0.88). The community subscale showed moderate reliability (ICC = 0.68), with an adequate Cronbach's alpha (0.89). The FES showed no ceiling or floor effects and a small limit of agreement. The data of all participants were analysed using the calculator. The FES-Brazilian Portuguese presented good reliability for assessing family empowerment in caregivers of children and adolescents with CP in Brazil, offering insights into this construct and guiding family-centred interventions. In addition, the calculator could be viable for adequate management and dissemination of data.

Communication Intervention in South Africa: Advocating for the Listening and Spoken Language Approach.

Adhering to Early Hearing Detection and Intervention (EHDI) guidelines is critical for the timely identification and management of infants with hearing impairment. Early intervention specifically focusses on family-centred communication interventions, of which the Listening and Spoken Language-South Africa (LSL-SA) approach is available for children with hearing impairment in South Africa. Studies have evidenced significant benefits for children with hearing impairment enrolled in LSL-SA compared to those enrolled in Traditional Speech-Language Therapy (TSLT), that is, age-equivalent communication outcomes, shorter duration of therapy until discharge, meritorious academic performance and integration into a hearing society. Despite these positive outcomes related to the LSL-SA approach, significant contextual barriers hinder effective implementation nationwide.Contribution:The successful implementation of EHDI guidelines in South Africa hinges on overcoming barriers through tailored healthcare strategies and contextualised delivery. Adapting frameworks such as LSL-SA to fit the local context is crucial for advancing equitable access to EHDI services, positively impacting children with hearing impairment and their families. This article highlights the systemic challenges in South Africa in optimising resources by adopting linguistically appropriate and culturally responsive early intervention approaches to champion hearing healthcare initiatives. Effective collaboration among diverse stakeholders is essential for enhancing the uptake of EHDI guidelines and translating policy into impactful communication interventions. Implementing the core principles of the LSL-SA approach will not only ensure access to this specialised service for suitable candidates but may also alleviate specific barriers to EHDI implementation within TSLT approaches.

Adaptation of an evidence-based, preventive intervention to promote mental health in Hispanic adolescents: eHealth Familias Unidas Mental Health.

Youth internalizing symptoms (i.e., depression and anxiety), suicide ideation and attempts have been rising in recent years, including among Hispanics. Disparities in mental healthcare are concerning and require intervention, ideally prevention or early intervention. Familias Unidas is a culturally-syntonic, family-centered intervention effective in reducing youth drug use and sexual risk, with evidence of unanticipated effects on internalizing symptoms. This paper describes the systematic process used to adapt the eHealth version of the Familias Unidas intervention to more directly address internalizing symptoms and suicide risk in preparation for an effectiveness-implementation hybrid trial for youth with elevated internalizing symptoms, a history of suicide ideation/attempts, or poor parent-youth communication. The resulting eHealth Familias Unidas Mental Health intervention is described. Guided by a 4-phase framework, the steps in the adaptation process involved: assessment of the community and intervention delivery setting (pediatric primary care clinics); integration of previous intervention research, including intervention mechanisms of action; and expert and community consultation via focus groups. Focus group analyses showed that youth and parents perceived that the intervention was helpful. Their feedback was categorized into themes that were used to directly target mental health by addressing technology use, parent mental health, and social support. Effective and scalable preventive interventions are needed to address mental health disparities. The systematic adaptation process described in this paper is an efficient approach to expanding interventions while maintaining known, empirical and theoretical mechanisms of action. Findings from the ongoing effectiveness-implementation trial will be critical.

Feasibility of a complex psychosocial intervention for families with parental cancer: acceptability, suitability, implementability, and perceived support

PurposeThis study aimed to assess the feasibility of a comprehensive psychosocial intervention for families coping with parental cancer.MethodsA quasi-experimental trial with intervention and control group, employing a mixed-methods approach, was conducted. A total of 472 families affected by parental cancer participated. The feasibility of the intervention was evaluated based on study monitoring measures (on-site visits, team supervision meeting observations, case conference observations, best practice workshops, coordinating information exchange between intervention sites, and reviewing intervention documentation), process evaluation (semi-structured interviews, focus group discussion) and survey data. Data analysis involved thematic coding and descriptive statistics.ResultsThe intervention was well-received by the participating families, with a high degree of acceptance observed. The feasibility of the intervention was found to be associated with specific dynamics within each family system and the motivation of the family members. The success of the intervention was described as dependent on the family-centered arrangement of the encounters, including factors such as frequency, duration, and mode, which greatly influenced its overall acceptability.ConclusionThe family-scout intervention demonstrates its feasibility as an effective intervention to reduce the burden experienced by families coping with parental cancer. Psychosocial oncology services should continue to develop and implement family-centered interventions to offer support to families during their cancer journey.Trial registrationClinicalTrials.gov, NCT04186923. Retrospectively registered on 4 December 2019.

Family-Centered Treatment Program for Problematic Gaming and Excessive Screen Use in a Clinical Child and Youth Population (FAME): Protocol for a Feasibility Pilot Mixed Method Study.

Screen time among children and adolescents has increased dramatically, raising concerns about its impact on development and mental health. While research highlights both potential benefits and risks, excessive use has been linked to issues like anxiety, depression, and gaming addiction. Despite growing concern, effective interventions are scarce. Recognizing the importance of family dynamics in child development, we propose a family-centered program to address problematic gaming and excessive screen use in a clinical population. By involving both children and parents, we aim to create a more comprehensive approach to prevention and treatment. This study aims to determine the possibility of distributing and evaluating a family-centered group program for problematic gaming and excessive screen use (FAME) in a clinical child and adolescent psychiatry (CAP) population. We will monitor the recruitment rate; track the retention and attendance rates of both parents and children; and assess whether each session's objectives are met, the content is delivered within the allotted time, and the necessary resources (eg, facilitators and materials) are available. Additionally, we will gather qualitative and quantitative feedback from participants through postprogram surveys and individual interviews with both children and parents. A total of 10 families with ongoing contact with CAP in Skåne, Sweden, will be recruited and offered participation in a family-centered group program targeting children aged 10-18 years with reported difficulties regarding screen gaming or screen use. The intervention to be tested is a newly developed, family-centered, psychoeducational, cognitive behavioral therapy-based intervention addressing both positive and negative aspects of screen use; setting boundaries; the connection between thoughts, feelings, and behaviors; conflict triggers; and sleep hygiene. The primary goal of the pilot study is to test the feasibility of the program, as well as recruitment and the analysis of participants' experiences with the program. A total of 11 children and their parents were enrolled during first quarter of 2024. A 4-session pilot was delivered in first quarter of 2024, and the first results are expected in the third quarter of 2024. The overarching goal of this pilot study is to determine the possibility of distributing and evaluating a family-centered group program for problematic gaming and excessive screen use (FAME) in a clinical CAP population. The insights gained from this study will guide our future research, which will focus on conducting a larger-scale evaluation of the intervention's impact on family screen time conflicts and inform future strategies for the implementation of family-centered interventions in child and youth clinics. ClinicalTrials.gov NCT06098807; https://clinicaltrials.gov/study/NCT06098807. DERR1-10.2196/56387.

Embedding the ‘CoolCuddle’ intervention for infants undergoing therapeutic hypothermia for hypoxic-ischaemic encephalopathy in NICU: an evaluation using normalisation process theory

ObjectivesNewborn infants exposed to lack of oxygen and blood flow to the brain around birth may develop brain dysfunction (hypoxic-ischaemic encephalopathy—HIE). These infants undergo 72 hours of cooling therapy and...

The effectiveness of therapist-led family-centered language intervention for children with language delay.

China's language therapist shortage and intergenerational caregiving trends underscore the need for family-based language training, yet such interventions are underutilized and family roles undervalued. This study aims to investigate the effect of a therapist-led family-centered intervention on children with language delay. The study comprised 134 children, comprising 59 girls and 75 boys, aged between 2 and 5 years (39.92±10.23 months) who presented with language delay. These participants were selected from the pediatric rehabilitation ward of the Second Affiliated Hospital of Army Medical University from July 2021 and July 2023. They were divided into a control group (n=70) receiving language therapy led by a language therapist, and an observation group (n=64) receiving therapist-led family-centered language intervention in conjunction with the treatment provided to the control group. Demographic characteristics were analyzed. The Gesell and Sign-significant (S-S) were used for assessments before and after the intervention. No significant demographic differences were found between the groups. Both groups demonstrated significant improvements in language development following a 3-month intervention as assessed by the Gesell assessment. The control group showed an increase from 52.97±4.79 to 65.97±3.48 (P<0.001), while the observation group improved from 53.53±4.06 to 71.98±4.51 (P<0.001). Additionally, prior to the intervention, differences were observed between the control group and the observation group in S-S assessments, particularly in symbolic form and instructional content (P=0.04 and P<0.001) as well as foundational research topics (P=0.04 and P<0.001). Following the intervention, the observation group demonstrated more significant advancements in language development compared to control group as evidenced by higher Gesell scores (18.45±5.72 vs. 13.00±6.16, P<0.001), S-S assessments in symbolic form and instructional content (1.11±1.55 vs. 0.53±1.57, P=0.03), and foundational research topics (1.42±1.88 vs. 0.64±2.14, P=0.02). Based on the Gesell assessment, there was a significant improvement in personal-social skills for both groups of children following intervention (all P<0.05), with the observation group demonstrating a more pronounced enhancement compared to the control group (4.73±4.07 vs. 2.20±3.68, P<0.001). Therapist-led family-centered interventions enhance language development, with parents playing a significant role in mitigating skip-generation caregiving and fostering greater parent-child interactions.

Psychological distress in the neonatal intensive care unit: a meta-review.

Parental psychological distress (PD) (anxiety, depression, stress and post-traumatic stress syndrome) can adversely affect parents' own physical and mental health as well as their children's long-term health and development. Numerous studies have addressed PD in mothers of infants admitted to NICU, with interventions proposed, but few have addressed the impact on fathers or other family members. The present review examined systematic reviews that addressed PD in NICU and potential interventions. A meta-review was performed by searching various databases between 2000 and May 2024. Fifty-four studies were included. The incidence of maternal PD varied depending on the screening tool used (13-93%), as did paternal PD (0.08-46%). The incidence of PD in sexual, racial and gender minorities, siblings, grandparents and those in lower-middle income countries is not known. Numerous screening tools were used with a wide variety of cut-off values. Various intervention programmes were evaluated and showed contradictory evidence regarding their effect on PD. Routine screening should be implemented together with acombination of interventional programmes, specifically family-centred interventions. More research is required for PD in siblings, sexual and genderminority parents as well as parents living in low middle income countries. Psychological distress is high in NICU, affecting parents and siblings. Maternal psychological distress may have long lasting effects on infant health and differs from that of fathers, who require as much attention as mothers Little is known about emotional stress in siblings and sex and gender minority group peoples Few interventions showed conclusive effectiveness in reducing psychological distress with combination interventions showing more effectiveness than single interventions.

Development of a family-centred intervention for families and children with hearing loss transitioning into early intervention: application of the Behaviour Change Wheel

Objective To describe the application of the Behaviour Change Wheel (BCW) to the development of a family-centred intervention for families of children with hearing loss transitioning into early intervention. Design The BCW was used in a mixed methods design to understand the gaps in family-centred service provision and to identify appropriate intervention functions and implementation options to address these gaps. Study sample Families and health professionals participated in different steps of the BCW. Results The qualitative interviews revealed that families required individualised information and support. The quantitative and interview data suggested inconsistencies in the provision of information and support to some families. It was determined that administration of a needs assessment by the support professionals was the most appropriate target behaviour to address this issue. In the analysis of the professionals’ capabilities, opportunities, and motivations for administration of a needs assessment, a resource limitation was identified, and therefore, a Minimum Data Set for a Needs Assessment Tool was developed to facilitate the assessment of families’ needs during the transition period. Conclusions This study provided an example of how the BCW could be successfully applied to the design of a family-centred intervention for families of children with hearing loss.

THE INFLUENCE OF FAMILY DYSFUNCTION ON ADOLESCENT PSYCHOLOGICAL HEALTH: A LITERATURE REVIEW-BASED STUDY

The increasing prevalence of adolescent psychological health issues worldwide has become a significant public health concern affecting the future. Families, as the primary environment providing material and emotional support for adolescent development, play a crucial role in fostering growth and psychological well-being. This study employed a literature review methodology, using keywords such as family dysfunction, adolescents, and psychological health, to search for definitions of family dysfunction and relevant literature about its effects on adolescents' psychological health. The review study summarized the definitions of family dysfunction, related research, and its impact on adolescent psychological health. The findings suggest that addressing the impact of family dysfunction on adolescent psychological health effectively requires collaborative efforts from families, schools, and society. Establishing collaborative prevention and intervention mechanisms among family, schools and society, providing educational programs to improve family function, and adopting family-centered intervention strategies are essential steps toward solving this critical issue.&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/soc/0200/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Improving access to tuberculosis preventive treatment for children in Ethiopia: designing a home-based contact management intervention for the CHIP-TB trial through formative research

BackgroundTuberculosis (TB) preventive treatment (TPT) is a long-standing recommendation for children exposed to TB but remains poorly implemented. Home-based contact management may increase access and coverage of TPT among children exposed to TB in their households.MethodsSixty in-depth interviews were conducted with key informants including program managers, TB providers (known as TB focal persons), health extension workers and caregivers whose children had recently engaged with TB prevention services in Oromia, Ethiopia in 2021 to understand the barriers and facilitators to providing home-based TB prevention services for children aged < 15 years. Thematic content analysis was conducted including systematically coding each interview.ResultsHome-based services were considered a family-centered intervention, addressing the time and financial constraints of clients. Stakeholders proposed a task-shared intervention between health extension workers and facility-based TB focal persons. They recommended that TB services be integrated into other home-based services, including HIV, nutrition, and vaccination services to reduce workload on the already overstretched health extension workers. Community awareness was considered essential to improve acceptability of home-based services and TPT in general among community members.ConclusionsDecentralization of TPT should be supported by task-sharing initiation and follow up between health extension workers and facility-based TB focal persons and integration of home-based services. Active community engagement through several existing mechanisms can help improve acceptability for both home-based interventions and TPT promotion overall for children.Trial registrationThe results presented here were from formative research related to the CHIP-TB Trial (Identifier NCT04369326) registered on April 30, 2020. This qualitative study was separately registered at NCT04494516 on 27 July 2020.

Family-centred interventions for people with substance use disorders in low-income and middle-income country settings: a scoping review protocol

IntroductionSubstance use disorder (SUD) and problematic substance use are global public health concerns with significant multifaceted implications for physical health and psychosocial well-being. The impact of SUD extends beyond the...

AMEsobreRuedas Early Powered Mobility in Children with Spinal Muscular Atrophy Type I: Protocol of a Randomized Controlled Trial.

Background: Young children with spinal muscular atrophy type 1 (SMA1) have limited independent mobility and participation that may lead to cognitive development delays. Implementing early powered mobility in interventions may help them to learn self-initiated movement, play, and having fun to participate in natural settings. The aim of this study is to evaluate the effectiveness of an early power mobility intervention for increasing participation, functional ability, and quality of life in young children with SMA1. Methods: AMEsobreRuedas is a randomized waiting list controlled clinical trial. A sample of 24 children (10 months-5 years old, with SMA1) will be randomly allocated to two groups. The experimental group will perform a family-centered intervention with powered mobility for 16 weeks in their natural environment: a 12-week-structured program three times a week; and a 4-week follow-up with free use of the powered mobility device. The control group (waiting list) will keep their routine and will receive the same intervention after the experimental group. Five assessments will be carried out at baseline and weeks 4, 8, 12, and 16. Primary outcomes are participation (YC-PEM); functional ability (PEDI-CAT); and quality of life (PedsQL-Neuromuscular module). Results: It is expected that this study will provide further knowledge about the positive impact of powered mobility for the analyzed variables. Moreover, family engagement in the intervention and establishment of functional goals may help to add valuable information about real needs in future research. Conclusions: Early powered mobility could increase the opportunities for children with SMA1 to learn to move independently and participate in their natural environment.

Fitting parameters in children with cochlear implants and severe additional disabilities.

The aim of this study was to investigate whether the fitting data of children with Cochlear implants (CI) and severe additional disabilities (CAD) differ compared to children with CI but without additional disabilities (CnonAD). In this retrospective analysis, 76 CI cases (fitted ears) from CAD were included and matched with 76 cases from CnonAD. The subjective set values, such as pulse width (PW), threshold (T) and most comfortable (MC) levels were recorded. Additionally, the response threshold values by means of aided soundfield threshold (AST), the values of the intracochlear electrode impedances, the eCAP thresholds and the daily wearing time by using data logging were recorded and analysed. The T and MC levels for the Medel implants were significantly lower in the sample than in the control group. A similar trend was evident for Cochlear® implants. The sample showed a positive correlation between the eCAP thresholds and the T level and MC level in case of the Cochlear implants. The CAD group showed a significantly higher aided soundfield threshold. In contrast to the CnonAD (0%), there was a total of 18% in the CAD with a reduced daily wearing time. When these were excluded, eCAP thresholds were significantly higher in the CAD group. In addition, there was a trend for eCAP thresholds to be higher if the contralateral ear was not also fitted with a CI. The significantly higher eCAPs in CAD may be explained by different neural survival but also by different fittings and MC levels. The audiuologist's subjectivity must be considered as a potential bias but also as potentially valuable input variable contributing to the variance in the fitting parameters and outcomes. Better fitting of T and MC levels focusing on behavioural and developmental responses may lead to a longer wearing time. To support the audiologist and the fitting process, it is necessary to interpret the response thresholds in the aided soundfield threshold against the background of the medical diagnosis and observations from everyday life should be considered. To ensure optimal development of CAD children according to their individual abilities, a multi-professional, family-centred intervention programme including videoanalyses should be implemented at an early stage, ideally from the decision process for a cochlear implant.

Social support and elder mistreatment in Brazil: exploring relationships and moderating effects

ABSTRACT Prior literature has demonstrated a negative association between social support and elder mistreatment. Furthermore, social support may moderate the negative relationship between health-related indicators and elder mistreatment. This study is the first to investigate these assertions in Brazil using nationally representative data. We employ the 2019 National Health Survey and a series of binary logistic regressions. Overall, increased social support from stronger ties, like family and close friends, reduces the likelihood of elder mistreatment. However, increased participation in broader and more distant social networks and circles of sociability may increase the risk of mistreatment. Moreover, the negative relationship between health-related indicators and elder mistreatment is partially moderated by increased social support. While findings on other support dimensions vary, family support appears crucial in mitigating elder mistreatment. This study contributes by underscoring the intricate interplay of social support, health, and mistreatment, advocating for family-centered interventions to improve elder well-being in Brazil.

Inpatient Skin-to-skin Care Predicts 12-Month Neurodevelopmental Outcomes in Very Preterm Infants

To examine the relationship between inpatient skin-to-skin care rates and neurodevelopmental scores measured at 12months in very preterm (VPT) infants. From a retrospective review of medical records of 181 VPT infants (<32weeks gestational age [GA] at birth), we derived skin-to-skin care rate, ie, total minutes of skin-to-skin care each infant received over the number of days of hospital stay. We used scores on the Capute Scales from routine follow-up assessments at 12months to measure neurodevelopmental outcomes. Families averaged approximately 17minutes/day of skin-to-skin care (2days/week, 70minutes/session), although there was substantial variability. Variation in skin-to-skin rate was positively associated with outcomes at 12months corrected age (r=0.25, P<.001). Skin-to-skin rate significantly predicted 6.2% unique variance in 12-month neurodevelopmental outcomes, after adjusting for GA, socioeconomic status (SES), health acuity, and visitation frequency. A 20-minute increase in skin-to-skin care per day was associated with a 10-point increase (0.67 SDs) in neurodevelopmental outcomes at 12months. GA and infant health acuity did not moderate these relations. VPT infants who experienced more skin-to-skin care during hospitalization demonstrated higher scores on 12-month neurodevelopmental assessments. Results provide evidence that skin-to-skin care confers extended benefits to VPT infants through the first year of life. Skin-to-skin care offers promise as a family-centered intervention designed to promote positive developmental outcomes in at-risk infants.

The role of lexical and prosodic characteristics of mothers' child-directed speech for the early vocabulary development of Italian children with cochlear implants.

Variability in the vocabulary outcomes of children with cochlear implants (CIs) is partially explained by child-directed speech (CDS) characteristics. Yet, relatively little is known about whether and how mothers adapt their lexical and prosodic characteristics to the child's hearing status (before and after implantation, and compared with groups with normal hearing (NH)) and how important they are in affecting vocabulary development in the first 12 months of hearing experience. To investigate whether mothers of children with CIs produce CDS with similar lexical and prosodic characteristics compared with mothers of age-matched children with NH, and whether they modify these characteristics after implantation. In addition, to investigate whether mothers' CDS characteristics predict children's early vocabulary skills before and after implantation. A total of 34 dyads (17 with NH, 17 with children with CIs; ages = 9-32 months), all acquiring Italian, were involved in the study. Mothers' and children's lexical quantity (tokens) and variety (types), mothers' prosodic characteristics (pitch range and variability), and children's vocabulary skills were assessed at two time points, corresponding to before and 1 year post-CI activation for children with CIs. Children's vocabulary skills were assessed using parent reports; lexical and prosodic characteristics were observed in semi-structured mother-child interactions. Results showed that mothers of children with CIs produced speech with similar lexical quantity but lower lexical variety, and with increased pitch range and variability, than mothers of children with NH. Mothers generally increased their lexical quantity and variety and their pitch range between sessions. Children with CIs showed reduced expressive vocabulary and lower lexical quantity and variety than their peers 12 months post-CI activation. Mothers' prosodic characteristics did not explain variance in children's vocabulary skills; their lexical characteristics predicted children's early vocabulary and lexical outcomes, especially in the NH group, but were not related to later language development. Our findings confirm previous studies on other languages and support the idea that the lexical characteristics of mothers' CDS have a positive effect on children's early measures of vocabulary development across hearing groups, whereas prosodic cues play a minor role. Greater input quantity and quality may assist children in the building of basic language model representations, whereas pitch cues may mainly serve attentional and emotional processes. Results emphasize the need for additional longitudinal studies investigating the input received from other figures surrounding the child and its role for children's language development. What is already known on the subject Mothers' CDS is thought to facilitate and support language acquisition in children with various language developmental trajectories, including children with CIs. Because children with CIs are at risk for language delays and have acoustic processing limitations, their mothers may have to produce a lexically simpler but prosodically richer input, compared to mothers of children with NH. Yet, the literature reports mixed findings and no study to our knowledge has concurrently addressed the role of mothers' lexical and prosodic characteristics for children's vocabulary development before implantation and in the first 12 months of hearing experience. What this study adds to the existing knowledge The study shows that mothers of children with CIs produce input of similar quantity but reduced variety, and with heightened pitch characteristics, compared to mothers of children with NH. There was also a general increase in mothers' lexical quantity and variety, and in their pitch range, between sessions. Only their lexical characteristics predicted children's early vocabulary skills. Their lexical variety predicted children's expressive vocabulary and lexical variety only in the NH group. What are the practical and clinical implications of this work? These findings expand our knowledge about the effects of maternal input and may contribute to the improvement of early family-centred intervention programmes for supporting language development in children with CIs.

Understanding how children and young people with chronic non-cancer pain and their families experience living with pain, pain management and services: a meta-ethnography.

Childhood chronic pain is a widespread public health issue. We need to understand how children with chronic pain and their families experience chronic pain and its management. To conduct a meta-ethnography on the experiences and perceptions of children with chronic pain and their families of chronic pain, treatments and services. We investigated how children and their families conceptualise and live with chronic pain; what they think of and want from health and social care services; and what they conceptualise as 'good' pain management. Meta-ethnography with stakeholder and patient and public involvement in the design, search and sampling strategies, analysis and dissemination. Review strategy: comprehensive searches of 12 bibliographic databases and supplementary searches in September 2022, to identify qualitative studies with children aged 3 months to 18 years with chronic non-cancer pain and their families. We included studies with rich explanatory data; appraised methodological limitations using the Critical Appraisal Skills Programme tool; and extracted, analysed and synthesised studies' findings. We used Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research to assess confidence in review findings. We integrated findings with 14 Cochrane treatment effectiveness reviews on children's chronic non-cancer pain. We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Studies had minor (n = 24) or moderate (n = 19) methodological limitations. Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research assessments of review findings were high (n = 22), moderate (n = 13) or very low confidence (n = 1). Moderate and severe chronic pain had profound adverse impacts on family members' well-being, autonomy and self-identity; family dynamics; parenting approaches; friendships and socialising; children's education and parental paid employment. Most children and families sought a biomedical cure for pain. They experienced difficulties seeking and receiving support from health services to manage pain and its impacts. Consequently, some families repeatedly visited health services. Cochrane reviews of intervention effects and trials did not measure some outcomes important to children and families, for example effects of pain on the family and resolution of pain. Reviews have mainly neglected a biopsychosocial approach when considering how interventions work. There were limited data on common pain conditions like migraine/headache, abdominal pain; some rarer conditions; children with learning disabilities and under-fives; siblings; fathers and experiences of treatments/services. We excluded studies on cancer, end-of-life pain and experiences of healthcare professionals. We developed the family-centred theory of children's chronic pain management, integrating health and social care with community support. Future research should explore families' experiences of services and treatments, including opioids, and social care services; experiences of children with autism and learning disabilities, under 5 years old and with certain common pain conditions. We need development and testing of family-centred interventions and services. This study is registered as PROSPERO (CRD42019161455) and Cochrane Pain, Palliative and Supportive Care (623). This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128671) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 17. See the NIHR Funding and Awards website for further award information.