Family Centeredness Research Articles

Family centeredness of care: a cross-sectional study in intensive care units part of the European society of intensive care medicine

PurposeTo identify key components and variations in family-centered care practices.MethodsA cross-sectional study, conducted across ESICM members. Participating ICUs completed a questionnaire covering general ICU characteristics, visitation policies, team-family interactions, and end-of-life decision-making. The primary outcome, self-rated family-centeredness, was assessed using a visual analog scale. Additionally, respondents completed the Maslach Burnout Inventory and the Ethical Decision Making Climate Questionnaire to capture burnout dimensions and assess the ethical decision-making climate.ResultsThe response rate was 53% (respondents from 359/683 invited ICUs who actually open the email); participating healthcare professionals (HCPs) were from Europe (62%), Asia (9%), South America (6%), North America (5%), Middle East (4%), and Australia/New Zealand (4%). The importance of family-centeredness was ranked high, median 7 (IQR 6–8) of 10 on VAS. Significant differences were observed across quartiles of family centeredness, including in visitation policies availability of a waiting rooms, family rooms, family information leaflet, visiting hours, night visits, sleep in the ICU, and in team-family interactions, including daily information, routine day-3 conference, and willingness to empower nurses and relatives. Higher family centeredness correlated with family involvement in rounds, participation in patient care and end-of-life practices. Burnout symptoms (41% of respondents) were negatively associated with family-centeredness. Ethical climate and willingness to empower nurses were independent predictors of family centeredness.ConclusionsThis study emphasizes the need to prioritize healthcare providers’ mental health for enhanced family-centered care. Further research is warranted to assess the impact of improving the ethical climate on family-centeredness.

Gap Analysis of Providing Primary Health Care in Comprehensive Rural Health Centers of Iran

Background: The lack of primary health care (PHC) assessment will lead to the lack of knowledge of the final client's needs and to deviation from the mission of the health system. This study was conducted to compare the understanding and experience of PHC providers and recipients regarding the principles of PHC in Iran.
 Methods: This cross-sectional descriptive-analytical study was conducted on Comprehensive Rural Health Centers (CRHCs) in 2022. The research population consisted of health service providers and recipients in rural areas. A Primary Care Assessment Tool (PCAT) was used. 410 child/ adolescent and 402 adult PCAT were completed by stratified cluster sampling method and 413 service providers were randomly selected. This questionnaire had 6 core domains and 3 ancillary domains. After collection and entering the Excel; data were analyzed by inferential statistics tests including Independent T-test and one-way ANOVA, by SPSS26 and STATA16 at the significant level of P>0.05.
 Results: Except for the Cultural Competence and Services Available domains, in the rest of the domains, there was not the same understanding between the service provider and recipient regarding PHC services. Also. child/adolescent PHC recipients had the same understanding as adult PHC recipients in the domains of Cultural Competence, Family Centeredness, Information System, Ongoing Care, and Access. But a significant difference was between the two groups in other domains, Primary Care Score, and Primary Care Expanded scores (P >0.05).
 Conclusions: For the common understanding between all three compared groups, cultural competence was the strongest component, and coordination-referral system, services provided, and community orientation were the weakest components. To fill this gap, increasing the health literacy of service recipients, real needs assessment, and providing services based on the needs of the community, reforming the processes of the referral system, and the commitment of the government to implement the processes seem necessary.

Living Situation of Juveniles After Secure Residential Treatment: Exploring the Role of Family Centeredness, Child, and Family Factors.

To promote the return of juveniles to a home-like environment (e.g. living with (foster)parents) after secure residential treatment (SRT), it is important to know which factors are related to this outcome. The current study examined which characteristics of the juvenile, family, and SRT, including family centeredness and use of systemic interventions, are related to the living situation after discharge. For 259 juveniles (mean age 15.82 years, 127 girls) in SRT and their parents, questionnaires were administered at admission, discharge, and 6-months follow-up. Furthermore, information about the living situation before and after SRT was gathered. Higher likelihood of living in a home-like setting after SRT correlated with more furlough moments with parents, receiving a systemic intervention, and a shorter duration of the SRT. Systemic interventions during SRT and spending furlough moments with parents may have a positive impact on returning to a home-like situation after SRT for juveniles.

SAT374 Indirect and Intangible Burden of PCOS: A Patient Advocacy Organization Study

Abstract Disclosure: L. Thai: Employee; Self; PCOS Challenge: The National Polycystic Ovary Syndrome. O. Delau: None. S. Yadav: None. R.P. Buyalos: Employee; Self; Fertility & Surgical Associates of California. S. Ottey: Employee; Self; Executive Director at PCOS Challenge: The National Polycystic Ovary Syndrome. Other; Self; Received honoraria from Institute for Family Centeredness, Travel support for attendance at Women's Health Innovation Summit. W. Patterson: Employee; Self; PCOS Challenge: The National Polycystic Ovary Syndrome. R. Azziz: Advisory Board Member; Self; Arora Forge. Consulting Fee; Self; Rani Therapeutics, Fortress Biotech, Spruce Biosciences, Core Access Surgical Technologies. Grant Recipient; Self; Foundation for Research and Education Excellence, Ferring Pharmaceuticals. Stock Owner; Self; Martin Imaging. Background: Polycystic Ovary Syndrome (PCOS) is a complex genetic trait, and the most common endocrine disorder of women, clinically evident in between 10% to 20% of all reproductive-aged women. PCOS is associated with reproductive, cardio-metabolic, dermatologic, maternal health and mental health morbidities, with an estimated healthcare-associated economic burden exceeding $15 billion yearly for the U.S. alone. However, the extent of indirect (lost wages due to disability or death related to the disease) and intangible (related to pain, suffering, and reduced QOL) costs of PCOS are unknown. Objective: To determine the extent of the indirect and intangible burden of PCOS. Materials and methods: We performed a prospective survey among members of an international patient advocacy organization using the Work Productivity and Activity Impairment Questionnaire: General Health v2.0 (WPAI:GH), the European QOL (EQ-5D), and the Willing-to-Pay (WTP) assessment instruments. Results: A total of 426 women responded to the study. The WPAI:GH indicated that 77.9% (332/426) were employed and had worked in the past 7 days, with 71.1% working ≥31 hrs. Of all respondents, 20.4% (70/344) reported missing ≥6 hrs for health problems. Health problems significantly (Likert score 8-10) affected the ability to do regular daily activities in 18.3% and productivity while working in 9.0%. Of the total hours worked, 9.97% (1162/11654) were reported as missed due to health problems. The EQ-5D survey indicated that 51.6% and 35.8% of respondents suffered moderate to extreme anxiety/depression and pain/discomfort, resp; and 11.5%, 6.0%, and 18.9% reported moderate to significant difficulty in walking, self-care (washing and dressing), and usual activities (e.g., housework, etc.), resp. When assessing how good or bad their health was on the day of the survey, 40.6%, 50.1%, and 9.2% described it as the ‘best/near best’, ‘moderate’, or ‘worse/near worse’ that they could imagine, resp. When queried regarding the maximum amount they were WTP as a one-time payment within their economic means for a hypothetical cure of PCOS, 61.0%, 24.9%, and 12.7% of respondents stated they were willing to spend $0-$5000, $5001-$25,000, and >$25,000, resp, although many noted they were willing to pay well beyond what they could afford. Conclusions: Regarding indirect burden, due to health problems, 10% of total hours worked were reported missed, and 20% of respondents reported missing ≥6 hrs.; in 9% of respondents, health problems significantly affected work productivity. Regarding intangible burden, >50% of respondents reported significant anxiety/depression and 20% moderate to significant difficulty in their usual activities; 10% reported their health as the worse/near worse they could imagine. Overall, the economic burden of PCOS far exceeds its direct medical costs, and indirect and intangible costs need to be considered. Presentation Date: Saturday, June 17, 2023

Family-Centeredness in Secure Residential Treatment and Its Relationship With Parental Involvement and Adolescent Behavioural Outcomes

Various Dutch secure residential youth care (SRYC) institutions are implementing a family-centered approach aiming to increase parental involvement and improve treatment outcomes. However, it remains unclear if and how family-centeredness (FC) is related to increased parental involvement and to improved treatment outcomes of adolescents. In this study, we unravelled the relation between FC, parental involvement, and behaviour problems of adolescents in SRYC. Families of 404 adolescents admitted to one of seven participating Dutch SRYC institutions completed a survey (at the start, at the end, and at 6-months follow-up) on problem behaviour of adolescents. In addition, 411 group care workers filled out a questionnaire about their residential group’s level of FC every 6 months. Moreover, the mentor of each adolescent filled out a questionnaire about the level of parental involvement. We analysed the data using multiple mediator models. Associations were found between FC and parental involvement. However, no relation was found between FC and adolescent problem behaviour, and no mediation and no moderation effects of parental involvement were found. Overall, results showed that most parents were involved during the residential stay, and, independent of FC, adolescent problem behaviour decreased over time. Implementing FC in SRYC institutions seems to be helpful in involving parents during the residential stay, but was not found to be associated with adolescent behavioural outcomes. Our results indicate that institutions could improve their level of FC by offering more informal contact moments for parents and by addressing barriers to FC among residential staff.

The potential of COPCA's coaching for families with infants with special needs in low- and middle-income countries.

Infants at high biological risk of or with a neurodevelopmental disorder run a high risk of delayed school readiness. This is especially true for infants in low- and middle-income countries (LMICs). This perspective paper first summarizes evidence on intervention elements that are effective in promoting family well-being and child development in infants at high biological risk in high income countries. Crucial elements are family centeredness, goal orientation, a home setting, focus on activity and participation, and challenging the infant to explore the world and the own body by means of self-produced movements. The studies revealed that coaching as applied in COPCA (COPing and CAring for infants with special needs) is a pivotal element determining the success of intervention.The paper continues by describing COPCA and its coaching. Next, we report on two pilot studies addressing COPCA's implementation in Brazil. Finally, we discuss why COPCA is a promising early intervention program for infants at high biological risk of neurodisability in LMICs: COPCA is adapted to the families' strengths and needs, it empowers families and promotes child development therewith facilitating school readiness. Moreover, it may be delivered by tele-coaching therewith eliminating families' burden to travel to distant intervention clinics.

Lived Experiences of the Philippine Coast Guards Personnel in Performing their Functions

The Philippine Coast Guard Personnel played a vital role on both the land and water, with its main responsibilities being the protectors of marine resources, the environment, and the lives and property at sea, as well as aiding in the enforcement of maritime laws under Philippine Jurisdiction. Their experiences in carrying out their duties include a variety of activities and problems. Each time they face harsh weather and tough situations in order to save lives and respond to distress calls, they risk their personal safety, witness difficult circumstances, and reap the benefits of supporting others in need throughout their lives. Their training, expertise, and commitment enable them to overcome challenges and carry out their responsibilities as Philippine coast guardians. The study explored lived experiences of the Philippine Coast Guard Personnel in performing their functions. The study included ten (10) personnel of Philippines Coast Guards participants of the study. This study was conducted during face to face interviewed. Results showed that the four (4) main themes based on the responses of the respondents such as: Family Centeredness, Sense of Service, Performing Challenging Duties and Responsibilities and Dealing with the Challenges. The personnel of Philippine Coast guard were continuously performing their duties and responsibilities for the safety of community travelers and living species in sea. Thus, safeguarding the sea and keeping citizens safe in voyage is evident that the personnel of Philippine coast guard were diligent in doing their duties and responsibilities.

Development of a Maternal and Child mHealth Intervention With Aboriginal and Torres Strait Islander Mothers: Co-design Approach.

BackgroundDespite their growing popularity, there are very few mobile health (mHealth) interventions for Aboriginal and Torres Strait Islander people that are culturally safe and evidence based. A co-design approach is considered a suitable methodology for developing health interventions with Aboriginal and Torres Strait Islander people.ObjectiveThe aim of this study was to co-design an mHealth intervention to improve health knowledge, health behaviors, and access to health services for women caring for young Aboriginal and Torres Strait Islander children.MethodsAboriginal researchers led engagement and recruitment with health services and participants in 3 Aboriginal and Torres Strait Islander communities in New South Wales, Australia. Focus groups and interviews were facilitated by researchers and an app developer to gather information on 3 predetermined themes: design characteristics, content modules, and features and functions. Findings from the co-design led to the development of an intervention prototype. Theories of health behavior change were used to underpin intervention components. Existing publicly available evidence-based information was used to develop content. Governance was provided by an Aboriginal advisory group.ResultsIn total, 31 mothers and 11 health professionals participated in 8 co-design focus groups and 12 interviews from June 2019 to September 2019. The 6 design characteristics identified as important were credibility, Aboriginal and Torres Strait Islander designs and cultural safety, family centeredness, supportive, simple to use, and confidential. The content includes 6 modules for women’s health: Smoke-free families, Safe drinking, Feeling good, Women’s business, Eating, and Exercising. The content also includes 6 modules for children’s health: Breathing well; Sleeping; Milestones; Feeding and eating; Vaccinations and medicines; and Ears, eyes, and teeth. In addition, 6 technology features and functions were identified: content feed, social connection, reminders, rewards, communication with health professionals, and use of videos.ConclusionsAn mHealth intervention that included app, Facebook page, and SMS text messaging modalities was developed based on the co-design findings. The intervention incorporates health behavior change theory, evidence-based information, and the preferences of Aboriginal and Torres Strait Islander women and health professionals. A pilot study is now needed to assess the acceptability and feasibility of the intervention.

Disparity in Nurse Discharge Communication for Hospitalized Families Based on English Proficiency.

Effective communication is critical for safely discharging hospitalized children, including those with limited English proficiency (LEP), who are at high risk of reuse. Our objective was to describe and compare the safety and family centeredness of nurse communication at hospital discharge for English-proficient (EP) and LEP families. In this single-center, cross-sectional study, we used direct observation of hospital discharges for EP and LEP children. Observers recorded quantitative and qualitative details of nurse-family communication, focusing on 3 domains: safe discharge, family centeredness, and family engagement. Patient characteristics and percentages of encounters in which all components were discussed within each domain were compared between EP and LEP encounters by using Fisher's exact tests. We used field notes to supplement quantitative findings. We observed 140 discharge encounters; 49% were with LEP families. Nurses discussed all safe discharge components in 31% of all encounters, most frequently omitting emergency department return precautions. Nurses used all family-centered communication components in 11% and family-engagement components in 89% of all encounters. Nurses were more likely to discuss all components of safe discharge in EP encounters when compared with LEP encounters (53% vs 9%; P < .001; odds ratio: 11.5 [95% confidence interval 4.4-30.1]). There were no differences in family centeredness or family engagement between LEP and EP encounters. Discharge encounters of LEP patients were less likely to include all safe discharge communication components, compared with EP encounters. Opportunities to improve nurse-family discharge communication include providing written discharge instructions in families' primary language, ensuring discussion of return precautions, and using teach-back to optimize family engagement and understanding.

Family-centeredness of services for young children with Down syndrome: an observational study from Turkey

Background/aimPhysicians require information on the family centeredness of services for children with Down syndrome, one of the most frequently encountered disabilities in childhood. We aimed to determine the family-centeredness of services for young children with Down syndrome and using a bioecological theory framework we hypothesized that child, family and service-related factors would be associated with such services. Materials and methodsIn a crosssectional design, children with Down syndrome seen at Ankara University Developmental Pediatrics Division (AUDPD) between February 2020 and June 2020 were included if they had received services in the community for at least 12 months. Mothers responded to the measure of process of care-20 (MPOC-20) used to measure family centeredness. ResultsAll 65 eligible children were included; 57% were boys and median age was 25.0 (IQR: 18.5–38.0) months. The MPOC-20 subscale scores were highest for the “respectful and supportive care (RSC)” (median 6.0; IQR: 4.8–6.8) and lowest for the “providing specific information” (median 3.0; IQR: 4.4–6.5) subscales. On univariate analyses, maternal education <high school was associated with scores ≤4 on the RSC (OR = 6.75; 95%CI = 1.77–25.64) and “enabling and partnership” subscales (OR = 3.10; 95%CI = 1.06–9.05); income ≤ minimum wage (OR=3.94; 95%CI=1.10-14.02) was associated with scores ≤4 on the RSC. In the multivariate logistic regression model, maternal education ≤ high school was independently associated with RSC scores ≤4 (OR = 5.13; 95%CI = 1.26–20.84). ConclusionOur findings imply that limitations in family-centeredness of community service for young children with Down syndrome. Deficiencies of services particularly for children with less educated mothers need to be urgently resolved.

Social Work Paradigms and Their Effect on Decision Making About Out-of-Home Placement

Purpose: This research aimed to understand the views of social workers on factors influencing decision making toward child placement and any possible differences in perception of these factors among social workers with experience in placement decision making and those without it. Methods: The Q sort methodology was used to analyze the opinions of 64 social workers by presenting them 54 statements on single sheets and asked to rank them on a grid. Results: Analysis showed five distinct paradigms: family-centered; veiled shared concept; child-centered; paternalistic; and professional evidence-based, which influence the entire process and outcomes of the decision making process. Both groups (those with experience in decisions towards placement and those without such experience) believed in family centeredness. Workers without prior experience of deciding to place children, regarded highly the role of workers in the decision-making process. They highlighted the need for data to guide decisions and the responsibility of workers to protect the child's welfare. Workers with prior experience focused mostly on generalized concepts and highlighted a detachment of the social worker from the decisions made. They attributed responsibility for decisions to the wider environment. Conclusion: Reflecting on the paradigms within which decisions concerning child welfare are made is essential to improving on the decision-making processes and has implications for both research and practice.

Community Readiness for Increasing Older Adult Physical Activity Levels in Kazakhstan.

Introduction:Physical activity is proven to be a significant element of successful aging, but many seniors worldwide fail to achieve the recommended levels. This study aimed to assess the readiness of the community in Nur-Sultan, Kazakhstan, to act on the issue of physical inactivity among older adults.Methods:In order to achieve this purpose, we conducted qualitative interviews with key informants in the community and applied a validated community readiness tool.Results:The results suggest that the local community is at early stages of readiness to act on the issue of older adult physical inactivity. We identified a number of barriers that prevented seniors from leading active lifestyles, which included community misconceptions about older adult physical activity, family centeredness in older adulthood, scarcity of resources, passive support from the leadership, and lack of efforts in the community. Research findings also highlighted the importance of conducting in-depth analysis of key informant responses in addition to calculating readiness scores, when using the community readiness tool.Conclusions:Community-specific strategies for enhancing the level of physical activity among seniors are required to offset the disease burden associated with aging and to prolong life expectancy in Kazakhstan, and it is of paramount importance to tailor potential efforts as to address the current readiness of the community and its needs.

Family Centeredness in Mental Health: A Concept Analysis

Background: Mental illness affects the entire family structure. The family members are the main provider of care that results in caregiving burden. Thus, the care given should encompass the entire family system, termed as family centeredness.&#x0D; Purpose: This study clarifies the concept of "family centeredness" in mental health to enhance individual and family cares living amid mental illness.&#x0D; Methods: This research employed Walker and Avant's method of Concept Analysis. Literature was reviewed, and the characteristics that appeared repeatedly were noted and categorized. Data were mapped according to its definition, antecedents, attributes, and consequences.&#x0D; Results: Three key defining attributes were identified: (a) A mutual, collaborative partnership between the patient, family and health care providers based on knowledge exchange, open communication and cooperation; (b) A supportive, professional relationship/bond/engagement among health care providers, patient and family characterized by empathy, understanding, respect and empowerment; and (c) Individualized care wherein the process is defined by the family is supported, enabling the opportunity to choose, control over decisions and empowerment.&#x0D; Conclusion: The result of the study clearly defines family centeredness as a health care approach in mental health that acknowledges the patient and family as the experts on themselves, involves families as collaborative partners in all aspects of services and decisions about care through mutually beneficial supportive partnerships with health care providers; to help patients make progress towards recovery.

Towards personalized care: Factors associated with the quality of life of residents with dementia in Australian rural aged care homes.

Quality of dementia care improves with a personalized approach to aged care, and knowledge of the disease process and unique care needs of residents with dementia. A personalized model of care can have a significant impact on the overall organizational culture in aged care homes. However, the dimensions of personalized aged care relating to dementia often remain under-managed. We aim to explore the factors that shape the dimensions of personalized dementia care in rural nursing homes using qualitative data of a mixed-method 'Harmony in the Bush' dementia study. The study participants included clinical managers, registered nurses, enrolled nurses and care workers from five rural aged care homes in Queensland and South Australia. One hundred and four staff participated in 65 semi-structured interviews and 20 focus groups at three phases: post-intervention, one-month follow-up and three-months follow-up. A multidimensional model of nursing home care quality developed by Rantz et al. (1998) was used in data coding and analysis of the factors. Three key themes including seven dimensions emerged from the findings: resident and family [resident and family centeredness, and assessment and care planning]; staff [staff education and training, staff-resident interaction and work-life balance]; and organization [leadership and organizational culture, and physical environment and safety]. A lack of consideration of family members views by management and staff, together with poorly integrated, holistic care plan, limited resources and absence of ongoing education for staff, resulted in an ineffective implementation of personalized dementia care. Understanding the dimensions and associated factors may assist in interpreting the multidimensional aspects of personalized approach in dementia care. Staff training on person-centered approach, assessment and plan, and building relationships among and between staff and residents are essential to improve the quality of care residents receive.

Person and Family Centeredness in Ethiopian Cancer Care: Proposal for a Project for Improving Communication, Ethics, Decision Making, and Health.

BackgroundCancer is a major burden in Ethiopia. The Oncology Department of Tikur Anbessa (Black Lion) Specialized Hospital in Addis Ababa is the sole specialist unit for cancer care in the country. With only a handful of oncologists, a lack of resources, and a huge patient load, the work is challenging, especially in terms of achieving effective and ethical patient consultations. Patients, usually accompanied by family members, often wait for a long time to receive medical attention and frequently depart without treatment. Handling consultations effectively is essential to help patients as much as possible within such limitations.ObjectiveThe project has the following three main aims: (1) to enhance and expand the understanding of communicative and associated ethical challenges in Ethiopian cancer care; (2) to enhance and expand the understanding of the implications and use of person- and family-centered solutions to address such communicative challenges in practice; and (3) to plan and evaluate interventions in this area.MethodsThis project develops and consolidates a research collaboration to better understand and mitigate the communicative challenges in Ethiopian cancer care, with a focus on the handling and sharing of decision making and ethical tension among patients, staff, and family. Using theoretical models from linguistics, health communication, and health care ethics, multiple sources of data will be analyzed. Data sources currently include semistructured interviews with Ethiopian staff (n= 16), patients (n= 54), and family caregivers (n= 22); survey data on cancer awareness (n=150) and attitudes toward breaking bad news (n=450); and video recordings of medical consultations (n=45). In addition, we will develop clinical and methodological solutions to formulate educational interventions.ResultsThe project was awarded funding by the Swedish Research Council in December 2017 for the period 2018 to 2021. The research ethics boards in Sweden and Ethiopia approved the project in May 2018. The results of the studies will be published in 2020 and 2021.ConclusionsThe project is the first step toward providing unique and seminal knowledge for the specific context of Ethiopia in the areas of physician-patient communication research and ethics. It contributes to the understanding of the complexity of the role of family and ethical challenges in relation to patient involvement and decision making in Ethiopia. Improved knowledge in this area can provide a fundamental model for ways to improve cancer care in many other low-resource settings in Africa and the Middle East, which share central cultural prerequisites, such as a strong patriarchal family structure, along with strong and devout religiosity. The project will also serve to develop greater understanding about the current challenges in Western health systems associated with greater family and patient participation in decision making. In addition, the project will contribute to improving the education of Ethiopian health professionals working in cancer care by developing a training program to help them better understand and respond to identified challenges associated with communication.International Registered Report Identifier (IRRID)DERR1-10.2196/16493

Health System Research Priorities for Children and Youth With Special Health Care Needs.

In this study, we sought to establish priorities for a national research agenda for children and youth with special health care needs (CYSHCN) through a structured, multistakeholder, mixed-methods approach. Using surveys, we solicited responses from >800 members of expert-nominated stakeholder organizations, including CYSHCN families, health care providers, researchers, and policymakers, to identify what research with or about CYSHCN they would like to see in a national research agenda. From 2835 individual free-text responses, 96 research topics were synthesized and combined. Using an adapted RAND/UCLA Appropriateness Method (a modified Delphi approach), an expert panel rated research topics across 3 domains: need and urgency, research impact, and family centeredness. Domains were rated on 9-point Likert scales. Panelist ratings were used to sort research topics into 4 relative-priority ranks. Rank 1 (highest priority) research topics had a median of ≥7 in all domains. The RAND/UCLA Appropriateness Method was used to prioritize CYSHCN research topics and depict their varying levels of stakeholder-perceived need and urgency, research impact, and family centeredness. In the 15 topics that achieved rank 1, social determinants of health (disparities and rurality), caregiving (family resilience and care at home), clinical-model refinement (effective model elements, labor divisions, telemedicine, and system integration), value (stakeholder-centered value outcomes, return on investment, and alternative payment models), and youth-adult transitions (planning, insurance, and community supports) were emphasized. High-priority research topics identified by CYSHCN experts and family leaders underscore CYSHCN research trends and guide important directions. This study is the first step toward an efficient and cohesive research blueprint to achieve highly-effective CYSHCN health systems.

Unveiling the indigenous art and craft of bakat and its economic significations

PurposeThe purpose of this paper is to unveil the intricacies of bakat art of weaving; its origin; processes; uses; primary materials and principles used; the profile of the weavers; and its economic significations in the system of production and trade.Design/methodology/approachThe study used a descriptive–qualitative design with 35 key informants using narrative analysis. The unstructured questions listed in the interview guide were used during the interview. Responses were recorded using an audio–video recorder. Coding sheets were used in the actual transcription of data.FindingsThe results showed dependency on the bakat art of weaving with the available resources found in the environment. Its economic significations showed a sustainable impact on the weavers’ life. The bakat art of weaving represented the values of resiliency to hardships, adaptability to changes, passion to craftsmanship, sense of community and family centeredness. Aspiring craftsmen and artists may enhance continuously their craftsmanship for sustainable development with government support through the creation of the School of Living Traditions.Research limitations/implicationsThe study was limited to bakat art of weaving based on the responses of the key informants that were subjected to a point of saturation without sacrificing robustness, brevity, credibility and dependability.Practical implicationsThough the economic side of bakat art of weaving is sustainable within the village, it can create a powerful branding for cultural recognition that would transform the town of Barili into a creative weaving hub in Cebu. This creates the balance of the historical significance of bakat art of weaving and the tourism sector in promoting sustainable development.Social implicationsBakat art rekindled the spirit of consciousness among the majority of the Cebuano public for preservation and promotion.Originality/valueThe study is original because this has not been published.

Perceptions of Pediatric Primary Care Among Mothers in Treatment for Opioid Use Disorder.

To assess receipt of anticipatory guidance and family-centered care during well-child care (WCC) for children of mothers with opioid use disorder (OUD). Cross-sectional survey of 157 mothers receiving treatment for OUD who had a child < 3years old and received primary care. Survey items evaluated (1) receipt of anticipatory guidance on 15 topics during WCC for the participant's child and (2) whether WCC was family-centered. The percentage of participants who reported guidance for each topic and the distribution of responses on family-centered items were calculated. A Pearson correlation was conducted to evaluate the association between the total number of topics for which anticipatory guidance was received and the family centeredness summary score. Receipt of anticipatory guidance varied by topic, ranging from 59% for guidance on childcare to 98% for guidance on safe sleep. Less than two-thirds of mothers reported that their child's provider "always" knew their child's medical history (56%), listened carefully (58%), clearly explained things (61%), and respected the mother (62%). Less than half reported that the provider spent enough time with them, and less than one-third reported that they were asked for their viewpoints. Anticipatory guidance and family-centeredness scores were positively correlated (r = 0.22, P = 0.006). Mothers with OUD report gaps in anticipatory guidance on important WCC topics, and limited family-centered care for their children. Further research may focus on refinements to the delivery of care for this population.

TENDENCIES IN DEVELOPMENT OF MEDICAL REHABILITATION, FROM PAST TO FUTURE

A definition as stated by the American Academy of Physical Medicine and Rehabilitation in 1975 is: "Medical rehabilitation services can be defined as a coordinated multi - disciplinary approach to disability under a qualified physician who directs a plan of management for one or more of the categories of chronic disabling diseases or injuries, specifying realistic goals for maximal recovery". The Main rehabilitation principles include patient and family centeredness, a multidisciplinary approach and holistic attitude towards physical and mental health. From early in its development and until today, rehabilitation is represented as the third phase of medical care - after diagnosis and treatment. Physical and Rehabilitation Medicine (PRM) is a growing and a developing discipline. Gutenbrunner et al wrote: "Various societal and medical trends, including the ageing of populations, the increasing number of people with functional limitations due to improving survival rates in different disease entities (e.g. stroke, spinal cord injury, multiple trauma) and the need of elderly workers to remain integrated in the workforce despite the presence of chronic illnesses, call for an increasing importance of rehabilitation in the future".

TENDENCIES IN DEVELOPMENT OF MEDICAL REHABILITATION, FROM PAST TO FUTURE

A definition as stated by the American Academy of Physical Medicine and Rehabilitation in 1975 is: "Medical rehabilitation services can be defined as a coordinated multi - disciplinary approach to disability under a qualified physician who directs a plan of management for one or more of the categories of chronic disabling diseases or injuries, specifying realistic goals for maximal recovery". The Main rehabilitation principles include patient and family centeredness, a multidisciplinary approach and holistic attitude towards physical and mental health. From early in its development and until today, rehabilitation is represented as the third phase of medical care - after diagnosis and treatment. Physical and Rehabilitation Medicine (PRM) is a growing and a developing discipline. Gutenbrunner et al wrote: "Various societal and medical trends, including the ageing of populations, the increasing number of people with functional limitations due to improving survival rates in different disease entities (e.g. stroke, spinal cord injury, multiple trauma) and the need of elderly workers to remain integrated in the workforce despite the presence of chronic illnesses, call for an increasing importance of rehabilitation in the future".