Child Health Services Research Articles

Children exposed to family and domestic violence perpetrated against their mother are at an increased risk of emergency department attendance in childhood.

To determine the association between family and domestic violence (FDV) exposure and ED attendance in Australian children. The present study comprised a population-based retrospective cohort study using deidentified linked administrative data of children born 1987-2010, in Western Australia (n = 58 352). Multivariate Cox proportional hazards modelling was used to estimate the association of FDV exposure with ED attendance. Estimates are presented as adjusted and unadjusted hazard ratios (HR) with Wald 95% confidence intervals (CI). Children exposed to FDV had a 35% (HR = 1.35, 95% CI: 1.32-1.38) increased risk of ED attendance than non-exposed children. Following model adjustment for sociodemographic and clinical characteristics a statistically significant increased risk of 21% (HR = 1.21, 95% CI: 1.18-1.23) was observed in FDV-exposed children compared to their non-exposed counterparts. When stratified by Aboriginal status, an increased risk for ED attendance was observed in both Aboriginal and non-Aboriginal children exposed to FDV, when compared to non-exposed counterparts (aHR = 1.13, 95% CI: 1.11-1.16; aHR = 1.42, 95% CI: 1.37-1.47, respectively). Exposure to FDV is associated with an increased risk of ED attendance in childhood. The findings add to the limited literature providing further support that FDV exposure impacts children's health service utilisation and further supports that children's exposure to FDV as an area of public health concern. Attendance at the ED presents an opportunity for intervention.

Exploring the Use of Sea Swimming as an Intervention With Young People With Mental Health Challenges: A Qualitative Descriptive Study.

There is emerging evidence that sea swimming can have a positive impact on the mental health of adults. Less is known about how this intervention can impact young people's mental health. The aim of this study was to explore young service users and staff's perspectives on sea swimming in the child and adolescent mental health services. Fourteen participants were interviewed (eight young people and six staff members). Data were analysed using reflexive thematic analysis and five themes were identified. A preference for sea swimming was demonstrated by young people in comparison to other therapies. Young people reported an enhanced (and sustained) sense of well-being after sea swimming. They were able to relate the act of entering cold water to their recovery journey, acknowledging the importance of leaving their comfort zone. A sense of social cohesion was also described. Staff members acknowledged the risks of open sea swimming but highlighted the importance of positive risk taking, given the benefits of this novel intervention. Owing to the positive impact sea swimming can have on the physical and psychological health of young people, there is potential for this novel intervention to be used more frequently within the services.

Examining the Feasibility and Acceptability of Identifying Signs of Social Anxiety, in University Students Aged 18-25, While Watching 360° Immersive Films.

Timely, accurate assessment and treatment for social anxiety disorder (SAD) in young people is crucial. There is potential for the adoption of tailored virtual reality interventions for a complementary diagnostic tool using heart rate monitoring as a response indicator. This study examined the feasibility and acceptability of this concept by exposing healthy individuals, aged 18-25, to developed 360° immersive films while collecting heart rate sensor data. Two immersive scenarios were designed with a participatory advisory youth group. A clinical consultant nurse mapped scenario events against validated routine assessment subscales in child and adolescent services. The films were shown to seven participants through a VR headset while monitoring heart rate. They provided qualitative feedback on their quality, acceptability and usability. The study indicated that this approach has the potential to enhance assessments in child and adolescent mental health services. The study has several limitations which are discussed with recommendations for consideration if this concept is taken further. The intervention could act as a potential portable, user-friendly complementary diagnostic tool for clinicians in practice. However, further research is needed to examine its validity.

Qualitative Study of Healthcare Seeking Behavior and Development of Behavioural Nudges for a Nutrition Program in Gombe State, Nigeria

Objective: This qualitative study aimed to identify and explain healthcare seeking behaviours among caregivers of young children and apply these findings to develop a mobile phone-based messaging intervention to encourage sustained attendance at a community-based management of acute malnutrition (CMAM) program in Gombe state, Nigeria. Design: Researchers conducted focus group discussions (n=6) and key informant interviews (n=3) with 33 subjects. Transcripts were independently coded and thematic analysis was conducted to gain an understanding of the facilitators, barriers, and motivators shaping caregivers’ decisions to attend health services for malnourished children, as well as access to and use of mobile phones. Participants: Focus groups and interviews were conducted with caregivers of children aged 6-59 months living within travelling distance of three CMAM sites in Gombe state, Nigeria. Results: Barriers to seeking health services included high costs; perceptions of poor quality of care, including poor treatment by health workers; and female caregivers’ limited autonomy. Despite barriers, participants recommended seeking hospital care for a malnourished child. Participants described widespread mobile phone use and recommended messages emphasising that CMAM services are free, conveying respect for caregivers, and reminding caregivers to continue making an effort to attend the CMAM program even as their child began to appear healthier. Conclusions: This study provides a framework for developing contextually salient behavioural nudges for child health and nutrition programs which, in combination with other community outreach strategies, could help motivate and sustain care seeking behaviour.

A qualitative study exploring the feasibility and acceptability of computerised adaptive testing to assess and monitor children and young people’s mental health in primary care settings in the UK

BackgroundThe increasing prevalence of mental health disorders among adolescents highlights the importance of early identification and intervention. Artemis-A is a web-based application of computerised adaptive testing (CAT), originally developed for...

A community-based father education intervention on breastfeeding practice in Ethiopia: a quasi-experimental study.

Breastfeeding is the cornerstone of a newborn's nutrition, containing crucial nutritional components. While a substantial body of research focuses on mothers, there is limited understanding regarding effective strategies to engage fathers in promoting breastfeeding practices. Therefore, this quasi-experimental study investigated a community-based intervention to improve breastfeeding exclusivity and initiation rates by targeting fathers in breastfeeding education. This research was conducted in Dessie City in the Amhara region of Northeast Ethiopia from 5th October 2020 to 30th August 2021. Fathers and their wives were assigned individually to the intervention and control groups. Baseline data were gathered from selected Kebeles (Kebele: the lowest administrative level in Ethiopia) to identify couples seeking care through routine maternal and child health services. Fathers in the intervention area received breastfeeding education services at health facilities or home visits during antenatal, delivery, and postpartum periods. Trained midwives participated in giving breastfeeding education. In the control arm, they received routine counseling activities. Factors associated with early initiation and exclusive breastfeeding were analyzed using multivariable analysis among the two groups. The intervention involved 327 participants, 155 in the intervention arm and 172 in the control group. The multivariable analysis indicated that the community-based father health education intervention significantly influenced the early initiation of breastfeeding. Mothers in the intervention group were found to be nearly five times more likely to initiate breastfeeding within the first hour of their infants' lives (AOR: 4.85, 95% CI: 1.36-17.32). A significant positive impact was also found for exclusive breastfeeding (EBF) of infants at the 1st, 4th, and 6th months (AOR: 3.95, 95% CI: 1.09-14.27), (AOR: 5.47, 95%CI: 2.18-13.70), and (AOR: 1.70, 95% CI: 1.02-2.85) respectively. This study confirmed the positive effects of a community-based father education intervention on the rates of exclusive breastfeeding during the first, fourth, and sixth months, as well as the early initiation of breastfeeding. The government and healthcare workers should implement policies supporting father-inclusive breastfeeding initiatives such as creating awareness and the critical role fathers' play.

A consensus statement on child and family health during the COVID-19 pandemic and recommendations for post-pandemic recovery and re-build

IntroductionAs health systems struggled to respond to the catastrophic effects of SARS-CoV-2, infection prevention and control measures significantly impacted on the delivery of non-COVID children's and family health services. The prioritisation of public health measures significantly impacted supportive relationships, revealed their importance for both mental and physical health and well-being. Drawing on findings from an expansive national collaboration, and with the well-being of children and young people in mind, we make recommendations here for post-pandemic recovery and re-build.MethodsThis consensus statement is derived from a cross-disciplinary collaboration of experts. Working together discursively, we have synthesised evidence from collaborative research in child and family health during the COVID-19 pandemic. We have identified and agreed priorities areas for both action and learning, which we present as recommendations for research, healthcare practice, and policy.ResultsThe synthesis led to immediate recommendations grouped around what to retain and what to remove from “pandemic” provision and what to reinstate from pre-pandemic, healthcare provision in these services. Longer-term recommendations for action were also made. Those relevant to children's well-being concern equity and relational healthcare.DiscussionThe documented evidence-base of the effects of the pandemic on children's and family services is growing, providing foundations for the post-pandemic recovery and re-setting of child and family health services and care provision. Recommendations contribute to services better aligning with the values of equity and relational healthcare, whilst providing wider consideration of care and support for children and families in usual vs. extra-ordinary health system shock circumstances.

LEVEL OF PARENTAL KNOWLEDGE ABOUT PROVIDING A HEALTHY MP-ASI MENU IN EFFORTS TO PREVENT STUNTING IN TODDLERS (6-24 MONTHS)

MP-ASI represents a critical transition period for toddlers (6-24 months) requiring precise nutritional fulfilment by parents to meet optimal growth and development needs. Children are at risk of experiencing growth and developmental disorders or stunting in the early stages of life when it is not well fulfilled. Thus, parental knowledge plays a crucial role in ensuring proper MP-ASI provision. The purpose of this study is to assess the parental knowledge level regarding providing healthy MP-ASI menus. This study is classified as a quantitative study with a descriptive design, employing a descriptive survey approach. The population consists of all mothers with toddlers (6-24 months) in the working area of Puskesmas Limboto, Gorontalo Regency, totalling 1,249 respondents selected using cluster sampling, with a sample of 302 respondents. The instrument used is the “Questionnaire to asses parents’ knowledge about infant complementary feeding.” Data analysis is conducted using univariate analysis. The findings indicate that the level of maternal knowledge regarding the provision of healthy MP-ASI menus is categorized as good for 176 respondents (58.3%), fair for 108 respondents (35.8%), and poor for 18 respondents(6.0%). In conclusion, some mothers with toddlers (6-24 months) possess good knowledge regarding providing healthy MP-ASI menus. Therefore, it is imperative for research institutions to continue prioritizing education efforts to raise public awareness regarding the importance of comprehensively providing appropriate MP-ASI through integrated maternal and child health services programs.

Launching a child and adolescent psychiatry training program in Mongolia inspired by Japanese models.

This manuscript details the development and implementation of Mongolia's first official training program for child and adolescent psychiatry (CAP) specialists. This initiative, inspired by and developed in collaboration with Japanese CAP training models, addresses the substantial gap in specialized mental health services for children and adolescents in Mongolia. Our discussion elaborates on the collaborative efforts between the Mongolian National University of Medical Sciences, Nagoya University, and other partnering institutions, reflecting on the initial outcomes and the strategic importance of this program.

Where is Batho Pele? The perspective of child and adolescent mental health service users in the Western Cape Province of South Africa

BackgroundMental health disorders of children and adolescents represent a key area of concern, yet child and adolescent mental health services (CAMHS) are neglected, especially in low- and middle-income countries. There is a clear need to provide services that are relevant to the needs of service users, but little research to date has explored their needs and experiences of services, or to identify their recommendations for service strengthening. In 1997 the South African Government introduced the “Batho Pele” (‘People First’) initiative in all public sector services, with the aim of putting the voices of service users at the centre of decision-making of policy development and implementation. This study sought to explore user perspectives about CAMHS in the Western Cape, one of the nine provinces of South Africa.MethodsUsing focus group discussions and semi-structured interviews, qualitative data were collected from purposively sampled CAMHS users (caregivers and adolescents) across the Western Cape Province. Data were entered into NVivo, and thematic analysis was performed by two independent raters.ResultsResults highlighted slow, inappropriate and unacceptable CAMHS at primary level of care, and lack of dedicated CAMH resources and staff rudeness at primary and secondary levels of care. Only one positive theme was identified about a new service initiative at primary care. Only specialist CAMHS (tertiary level) were regarded as well-organised. To improve CAMHS, users recommended that the processes and procedures should be restructured to become child- and family-friendly, separate CAMHS should be developed at primary and secondary levels, CAMHS should be prioritized to provide equitable services to young people with mental health disorders, and better communication and information, including formal psychoeducation should be provided to caregivers.ConclusionsThe data from this study provided very little support for the “Batho Pele” principles and highlighted a clear need for CAMHS strengthening in the Western Cape, and in South Africa as a whole. These findings may be similar in other low-resource settings and highlight the importance of putting “people first” by listening to their voices on an ongoing basis and at all levels of service and systems strengthening.

Using digital psychometric tests in an Irish Child and Adolescent Mental Health Service (CAMHS): an examination of the acceptability of Q-interactive for service users and clinicians.

Using digital psychometric tests in an Irish Child and Adolescent Mental Health Service (CAMHS): an examination of the acceptability of Q-interactive for service users and clinicians.

Parent's Perspective on Continuity of Care in the Maternity Care and Child Health Services Continuum: A Qualitative Systematic Review.

While the World Health Organization (WHO) advocates organizing maternity care and preventive child healthcare (PCHC) as people-centred, integrated healthcare services, globally these services are often established separately, causing discontinuity of care. Our aim is to synthesize the evidence concerning what impacts parents' experience of continuity of care, and how to promote it. Qualitative systematic review. Embase, Medline, Web of Science, Cochrane, CINAHL and Google Scholar were searched for studies on parents' perspectives on integrated care. Helpful practices and issues regarding continuity of care were identified. We found that parents valued easily accessible, tailored, family-centred care that is a display of interprofessional collaboration and is geared towards supporting and empowering parents. Study strengths are its qualitative nature, allowing for in-depth patient views and experiences, and the multidisciplinary research team, which ensured a multidimensional view of the issue. Ideally, (a) parents enter the postnatal period well-prepared, and well-informed about self-care, PCHC and possible postnatal carepathways, (b) number of caretransfers is limited, (c) by overlapping maternity care and PCHC, parents are provided with an opportunity to maintain meaningful relationships with their care providers, and (d) information is consistent, family-centred, and tailored.

Eating disorders: clinical update.

Variation exists in our attitude and behaviour towards food and exercise, resulting in different degrees of health and ill health. Cultural and economic factors contribute to this, alongside personal choices, leading to a spectrum from normative eating, through disordered eating to the extremes of eating disorders (EDs). Understanding the intricate interplay between biological, psychological, and sociocultural factors to eating, exercise and body image is paramount to understand the current state regarding EDs and to deliver/develop multifaceted and individualised treatments. Significant service developments have occurred following the launch of the Irish Health Service Executive Model of Care for EDs in 2018. However, incomplete roll out and surge in EDs referrals post Covid-19 require generic child and adolescent mental health services (CAMHS) to be competent in assessment of EDs, and to keep abreast of clinical updates in order to offer effective treatment.This review provides an evidenced based update on eating related difficulties, outlines a useful assessment framework, offers information on appropriate clinical management, and highlights exciting clinically relevant research developments.

Encountering children with suspected neurodevelopmental disorders in Child Health Services: Swedish nurses' experiences.

To describe nurses' experiences encountering children with suspected neurodevelopmental disorders in Child Health Services. This qualitative inductive study was conducted in Sweden. Twenty nurses were interviewed individually on a virtual platform using a semi-structured interview guide with open-ended and explorative questions. Interviews were audio recorded and transcribed verbatim and analyzed using qualitative content analysis. Nurses expressed responsibility for finding deviations in children but described an equilibrium of giving children time to develop without delaying referrals. Nurses had profound competence and intuition, but subjective intuition of assessment evoked a feeling of uncertainty. Nurses were sensitive and open-minded to different and contradictory parental reactions. Reactions were difficult and frustrating to manage, and communication needed to be versatile and flexible to achieve a partnership. When uncertain in an assessment they obtained complementary additional information from the child's preschool teacher. Nurses had several collaborators inside and outside the Child Health Services team and felt successful when correctly referred but frustrated with extended waiting times and protracted interplay. The results suggest further education for nurses about neurodevelopmental disorders and communication tools like Motivational Interviewing. Furthermore, screening for assessing neurodevelopmental disorders, guidelines in referral management and a care coordinator for multiple referrals should be implemented. Improvements in Child Health Services nurses' competence, screening methods and referral management could lead to more efficient care interventions and support that can promote health and well-being in the short and long-term for children and families.

Facilitators and barriers of accessing community health services for children in the early years: An Australian qualitative study.

Foundations for health are set in the first years of life, however many children in Australia do not attain optimal development due to inequitable access to specialist care through impacting social determinants of health. There is a research gap in evidence for sustaining early years services that address these barriers. This study aimed to understand experiences and priorities of parents/carers and service providers around access to specialist early years health services in low socioeconomic areas of Armadale, Western Australia. Thematic analysis was used to interpret meanings across focus group discussion data and find priorities for access to care and service delivery using a multilevel socio-ecologic model. Facilitators and barriers to access were identified related to each theme. Two major themes were identified. Within theme 'Finding Help', facilitators to access included extended family, community, and childcare. Barriers included social isolation, and overwhelm. In theme 'Structural Factors', facilitators included safe places and practices, political action and universal care. Barriers included social determinants of health, institutional bias, and fiscal policy. Findings will inform policy, service delivery, and research priorities toward facilitating timely access to integrated care for vulnerable families with young children. Health equity will focus on co-design to remove structural barriers using a "one-stop-shop" model with soft entry, triage capacity, and a key worker to coordinate care for at risk families. To promote structural equity, a focus on access will include continuing engagement with families, facilitated by relational models of care to scaffold and support families toward autonomy.

Navigating perinatal mental health integration in maternal and child health services: progress and priorities for research and practices in Pakistan

Navigating perinatal mental health integration in maternal and child health services: progress and priorities for research and practices in Pakistan

Determinants of healthcare utilization under the Indonesian national health insurance system – a cross-sectional study

BackgroundIndonesia has implemented a series of healthcare reforms including its national health insurance scheme (Jaminan Kesehatan Nasional, JKN) to achieve universal health coverage. However, there is evidence of inequitable healthcare utilization in Indonesia, raising concerns that the poor might not be benefiting fully from government subsidies. This study aims to identify factors affecting healthcare utilization in Indonesia.MethodsThis study analysed cross-sectional survey data collected by the “Equity and Health Care Financing in Indonesia” (ENHANCE) Study. Andersen’s behavioural model of health services use was adopted as a framework for understanding healthcare utilization in Indonesia. Sociodemographic variables were categorized into predisposing, enabling and need factors. Outcome measures included the utilization of primary and secondary health services. Multi-level logistic regression models were run to examine factors associated with each type of health service utilization.ResultsOf the 31,864 individuals included in the ENHANCE survey, around 14% had used outpatient services in the past month. Fewer than 5% of the study population had visited hospitals for inpatient care and about 23% used maternal and child health services in the past 12 months. Age, gender and self-rated health were key determinants of health services utilization. No significant differences in primary care utilization were found among people with different insurance status, but people who received subsidised premiums under the JKN were more likely to receive primary care from public health facilities and less likely from private health facilities. Compared to people who pay JKN insurance premiums themselves, the uninsured and those whose premiums were subsidised by the government were less likely to visit public and private hospitals when other factors were controlled.ConclusionThis study demonstrates that the distribution of healthcare utilization in Indonesia is largely equitable as predisposing factors (age and gender) and health need were found to greatly influence the utilization of different types of health services. However, enabling factors such as health insurance status were also found to be associated with inequity in utilization of hospital services. Further policy actions regarding resource allocation and health service planning are warranted to achieve a more equitable pattern of health service use in Indonesia.

Adolescents with first-episode psychosis and clinical high risk in the Province of Ferrara: an audit on the implementation of a specialised early intervention program

Objective The first-episode psychosis (FEP) and clinical high-risk (CHR) team within the child and adolescent mental health (CAMH) service receives referrals by psychiatric units, CAMH service, schools, and general practitioners. This audit evaluated the implementation of the FEP-CHR team in Ferrara, Italy. Methods The FEP-CHR team provides standardised assessment and up to 2-year individualised treatment including pharmacological prescription, cognitive-behavioral psychotherapy, and vocational activities. Data regarding access and pathways to care, assessment, and outcome of all patients admitted to this service from January 2019 to June 2023 were analysed. Descriptive statistics were reported and discussed. Results The service admitted 29 patients (19 FEP, 10 CHR), mostly females. FEP referrals primarily came from families via general practitioners, while half of CHR patients were already receiving CAMH care. One in three in the total sample had psychiatric hospitalisation during treatment. At discharge, most transitioned to usual or specialised mental health care and five patients achieved full recovery. Conclusions The audit revealed a lower-than-expected incidence rate, a sub-optimal adherence to the standardised assessment, and a need for improved outcome monitoring. It promoted quality improvement initiatives including professional training to improve psychiatric differential diagnosis, drug prescribing, and transition to adult psychiatric services.

Systematic review of integrated mental and physical health services for children and young people with eating and functional symptoms.

Evidence suggests that by recognising the psychosocial component of illness as equally important to the biological components, care becomes more holistic, and patients can benefit. Providing this type of care requires collaboration among health professionals, rather than working in isolation, to achieve better outcomes. However, there is a lack of evidence about the implementation of integrated health care. This review focuses on children and young people experiencing eating disorders (i.e. disorders related to feeding and eating) or functional symptom disorders (i.e. medically unexplained symptoms). The present review is part of a larger study that will inform the development of a new children's hospital in England. Both eating disorders and functional symptom disorders are conditions that may be particularly likely to benefit from an integrated approach to health care, and this review aims to investigate what service models have been used to integrate care, what factors influence their implementation, and what effects these integrated models have on access to and outcomes from care. We conducted a systematic review of studies based on children and young people with eating disorders or functional symptom disorders, investigating the effectiveness of integrated mental and physical health services versus any other type of services provided in these populations. We searched MEDLINE, EMBASE and PsycInfo® (American Psychological Association, Washington, DC, USA) electronic bibliographic databases in July 2024 without restriction on the date of publication or country of interest. We reviewed only studies written in English. We identified 2668 citations which resulted in 1939 papers eligible for title screening. Only one single-site Australian evaluation of an integrated care model from over 20 years ago was included in our review. The study reported significantly higher number of total admissions and total bed-days utilised in the integrated approach. However, the burden of care shifted from psychiatric wards to medical wards and as a result, the cost per admission and the cost per inpatient decreased. The lack of conceptual consistency about the definition of integrated care may have driven false screening and loss of some evidence. The same limitation applies in terms of the definition of functional symptom disorders. The review identified a gap in the evidence base relating to integrated secondary service provision for children and adolescents with eating disorders or functional symptom disorders in comparison with generic services. No similar studies were identified for children and young people with functional symptom disorders. Our findings align with previous evidence and show that despite the existence of studies describing aspects of integrated care, integration of physical and mental health services for children and young people with eating disorders or functional symptom disorders is underexplored and the limited available evidence is of weak quality. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133613.

Factors influencing women's and men's place of birth decisions in rural Western Highlands Province of Papua New Guinea: A qualitative descriptive study.

Evidence shows that birthing with a skilled birth provider improves maternal and neonatal health outcomes. However, whilst most women in the Western Highlands Province of Papua New Guinea seek skilled health care during pregnancy in a health facility, more than half give birth at home or in the village without a skilled birth provider. To explore the factors influencing women's and men's decisions about place of birth in rural Western Highlands Province of Papua New Guinea. A qualitative-descriptive study was conducted. Semi-structured, in-depth interviews were conducted with 20 participants (16 women who were pregnant or recently given birth and four men whose partners were pregnant or recently gave birth). Interviews were audio-recorded and transcribed verbatim. The data was thematically analysed. Three key themes associated with the place of birth decision factors were identified from the study findings: (1) health service accessibility and availability, (2) socio-cultural influences, and (3) previous maternity care experiences. Participant experiences influenced their choice of place of birth, resulting in many giving birth at home in their village without a skilled birth provider. Maternal and child health services need to be appropriately tailored to improve accessibility and meet the unmet needs of pregnant women in Papua New Guinea. Additionally, health education programs should address socio-cultural factors influencing the uptake of healthcare services, especially in rural areas where health disparities are more evident. Further research is required to explore health worker perspectives, patriarchal control, and respectful care regarding health service utilisation in this study context.