Improve Outcomes For Children Research Articles

State policy teams probe strategies to address crisis in children's care

This month's convening of child‐serving agency officials from nine states offered a rare opportunity for policy leaders in mental health, child welfare and Medicaid to strategize together toward system improvement. Attendees of the Children's Behavioral Health State Policy Lab reported that while the nine state teams identified some immediate steps that they can take to improve service coordination, the most impactful actions to improve child outcomes would likely take shape over a much longer period.

Parental Expressed Emotion and Behavioural Outcomes in Autistic Children and Adolescents: A Systematic Review.

Growing interest in the links between parent-child relationships and child behavioural presentations in families of autistic children has led to an increased use of the Five Minute Speech Sample (FMSS) measure of parental expressed emotion (EE) in autism research. This review focuses on studies exploring the relationships between parental EE and behavioural outcomes in autistic children. Electronic searches of six databases and grey literature wielded eight studies that met eligibility criteria. Study designs were a mixture of cross-sectional and longitudinal and quality of studies was variable. Parental criticism was largely positively related to, and showed some predictive value for, child behaviour problems. Warmth was mostly negatively related to, and showed some predictive value for, child behaviour problems. Preliminary evidence from one study showed paternal warmth to be significantly related to child behaviours, whilst child behaviours were also significantly related to paternal warmth, suggesting a bidirectional relationship. Analysis of additional EE components produced variable results, however parental stress and depressive symptoms were consistently related to child behaviour, and preliminary evidence suggests a possible role of maternal education level and family cohesion. Outcomes were variable across FMSS coding systems and greater consistency in their application is needed in future research. The current findings suggest that parental EE has an important relationship with child behaviour and future intervention efforts may benefit from aiming to reduced EE in order to improve child outcomes.

Neural correlates of altered emotional responsivity to infant stimuli in mothers who use substances

Mothers who use substances during pregnancy and postpartum may have altered maternal behavior towards their infants, which can have negative consequences on infant social-emotional development. Since maternal substance use has been associated with difficulties in recognizing and responding to infant emotional expressions, investigating mothers' subjective responses to emotional infant stimuli may provide insight into the neural and psychological processes underlying these differences in maternal behavior. In this study, 39 mothers who used substances during the perinatal period and 42 mothers who did not underwent functional magnetic resonance imaging while viewing infant faces and hearing infant cries. Afterwards, they rated the emotional intensity they thought each infant felt (‘think’-rating), and how intensely they felt in response to each infant stimulus (‘feel’-rating). Mothers who used substances had lower ‘feel’-ratings of infant stimuli compared to mothers who did not. Brain regions implicated in affective processing (e.g., insula, inferior frontal gyrus) were less active in response to infant stimuli, and activity in these brain regions statistically predicted maternal substance-use status. Interestingly, ‘think’-ratings and activation in brain regions related to cognitive processing (e.g., medial prefrontal cortex) were comparable between the two groups of mothers. Taken together, these results suggest specific neural and psychological processes related to emotional responsivity to infant stimuli may reflect differences in maternal affective processing and may contribute to differences in maternal behavior in mothers who use substances compared to mothers who do not. The findings suggest potential neural targets for increasing maternal emotional responsivity and improving child outcomes.

Mindfulness-enhanced parenting programmes for improving the psychosocial outcomes of children (0 to 18 years) and their parents.

Mindfulness-enhanced parenting programmes for improving the psychosocial outcomes of children (0 to 18 years) and their parents.

A Different Vision: Centering Love Not Punishment for Families Affected by Substance Use

Improving maternal and child outcomes requires us to understand and deconstruct our country’s historically punitive policies toward pregnant and parenting people who use drugs. We also must build a new system that centers wellness in partnership with individuals directly affected by these policies. From a maternal and child health (MCH) perspective, wellness is defined as parent-infant dyads living in supportive, preserved, and loving families with access to the resources needed for optimal health. To achieve wellness and positive outcomes, all individuals must have equitable access to a full continuum of culturally and linguistically effective, geographically available, evidence-informed, non-punitive, and welcoming health and social services that prioritize family preservation. In addition, to attain transformative and equitable outcomes, advocates for families affected by substance use must focus on implementing and evaluating services and continuously monitoring disaggregated data to ensure inequities are eliminated.

Child educational progress in Born in Bradford pregnancies affected by gestational diabetes and also exposed to maternal common mental disorders

Gestational diabetes and the maternal mental disorders of anxiety and depression have been implicated in adverse offspring neuro-behavioural outcomes but these exposures have only been studied in isolation. 1051 children whose mothers were diagnosed with gestational diabetes in UK’s Born in Bradford cohort had linkage to maternal primary care records, providing diagnostic and treatment codes for depression and anxiety. Education record linkage provided results of the Early Years Foundation Stage Profile from the first year of school, aged five. Risk of not attaining a ‘Good level of development’ was analysed using multivariable Poisson regression within a generalised estimating equation framework. Multiple imputation was implemented for missing data. There was limited evidence of increased risk of failure to attain a ‘good level of development’ in those additionally exposed to maternal mental disorders (adjusted RR 1.21; 95% CI 0.94, 1.55). However, there was more evidence in children of Pakistani maternal ethnicity (adjusted RR 1.36; 95% CI 1.04, 1.77) than White British; this may have been driven by English not being the primary language spoken in the home. Therefore there may be groups with GDM in whom it is particularly important to optimise both maternal physical and mental health to improve child outcomes.

Mindful parenting and its association with the prosocial behaviors of children

This paper explores the concept of mindful parenting and its association with prosocial behaviors in children. Mindfulness, characterized by non-judgmental, present-centered awareness, has been linked to enhanced emotional regulation and stress reduction. The application of mindfulness to parenting, as outlined in the mindful parenting model, includes aspects such as attentive listening, nonjudgmental acceptance, parent self-regulation, emotional awareness, and compassion.While mindful parenting interventions have gained attention, the paper emphasizes the need for a more thorough exploration of mindful parenting in the context of the parent-child relationship. The study reviews existing literature, noting that mindful parenting can positively impact parent-child interactions, reduce stress, enhance parenting satisfaction, and foster children's prosocial behaviors.The paper also delves into the developmental aspects of prosocial behavior in children, defining it as self-motivated, voluntary actions intendedto benefit others. Prosocial behaviors, such as sharing and cooperation, have been observed in early childhood and are associated with positive outcomes like well-being and academic performance.The association between mindful parenting and children's prosocial behaviors is examined, with evidence suggesting that parents practicing mindful parenting contribute to greater prosocial behaviors in their children. Studies indicate that mindful parenting interventions can lead to improved child outcomes, reducedbehavioral difficulties, and increased social competence.Furthermore, the paper discusses the broader impact of mindful parenting on various age groups, including adolescents. Mindful parenting has been associated with lower internalizing and externalizing symptoms, emphasizing its positive influence on youth mental health and overall well-being.In conclusion, the paper highlights the importance of incorporating mindfulness into parenting interventions to enhance their effectiveness. The findings underscore the positive outcomes associated with mindful parenting, advocating for its integration into parenting programs for a more comprehensive and holistic approach to child development.

Inpatient Screening of Parental Adversity and Strengths.

Social adversities, including health-harming social risks and adverse childhood experiences, contribute to poor outcomes after hospital discharge. Screening for social adversities is increasingly pursued in outpatient settings. Identifying and addressing such adversities has been linked to improved child outcomes. Screening for social adversities and strengths in the inpatient setting may contribute to better transitions from hospital to home. Our goal was twofold: 1. to use qualitative methods to understand parent perspectives around screening tools for potential use in inpatient settings; and 2. to develop a family-friendly inpatient screening tool for social adversity. We used in-depth, cognitive qualitative interviews with parents to elicit their views on existing screening tools covering social adversities and strengths. We partnered with a local nonprofit to recruit parents who recently had a child hospitalized or visited the emergency department. There were 2 phases of the study. In the first phase, we used qualitative methods to develop a screening prototype. In the second phase, we obtained feedback on the prototype. We interviewed 18 parents who identified 3 major themes around screening: 1. factors that promote parents to respond openly and honestly during screening; 2. feedback about screening tools and the prototype; and 3. screening should include resources. Social adversity routinely affects children; hospitalization is an important time to screen families for adversity and potential coexisting strengths. Using qualitative parent feedback, we developed the family friendly Collaborate to Optimize Parent Experience screening tool.

Using Data Tools and Systems to Drive Change in Early Childhood Education for Disadvantaged Children in South Africa.

In line with United Nations Sustainable Development Goal (SDG) 4.2, South Africa's National Development Plan commits to providing high-quality early childhood education to all children by 2030 to drive improved child outcomes. Prior to 2016, South Africa lacked reliable, locally standardised, valid, and cross-culturally fair assessment tools for measuring preschool quality and child outcomes, suitable for use at scale within a resource-constrained context. In this paper we detail the development and evolution of a suite of early learning measurement (ELOM) tools designed to address this measurement gap. The development process included reviews of literature and other relevant assessment tools; a review of local curriculum standards and expected child outcomes; extensive consultation with government officials, child development experts, and early learning practitioners, iterative user testing; and assessment of linguistic, cultural, functional, and metric equivalence across all 11 official South African languages. To support use of the ELOM tools at scale, and by users with varying levels of research expertise, administration is digitised and embedded within an end-to-end data value chain. ELOM data collected since 2016 quantify the striking socio-economic gradient in early childhood development in South Africa, demonstrate the relationship between physical stunting, socio-emotional functioning and learning outcomes, and provide evidence of the positive impact of high-quality early learning programmes on preschool child outcomes. To promote secondary analyses, data from multiple studies are regularly collated into a shared dataset, which is made open access via an online data portal. We describe the services and support that make up the ELOM data value chain, noting several key challenges and enablers of data-driven change within this context. These include deep technical expertise within a multidisciplinary and collaborative team, patient and flexible capital from mission-aligned investors, a fit-for-purpose institutional home, the appropriate use of technology, a user-centred approach to development and testing, sensitivity to children's diverse linguistic and socio-economic circumstances, careful consideration of requirements for scale, appropriate training and support for a non-professional assessor base, and a commitment to ongoing learning and continuous enhancement. Practical examples are provided of ways in which the ELOM tools and data are used for programme monitoring and enhancement purposes, to evaluate the relative effectiveness of early learning interventions, to motivate for greater budget and inform more effective resource allocation, to support the development of enabling Government systems, and to track progress towards the attainment of national and global development goals. We share lessons learnt during the development of the tools and discuss the factors that have driven their uptake in South Africa.

Family caregivers’ experiences of caring for children diagnosed with haematological malignancies receiving chemotherapy in Ethiopia: A qualitative study

PurposeStudies from different countries show that caregivers of children with haematological cancer receiving chemotherapy encounter substantial distress when witnessing their children's suffering from the illness and chemotherapy side effects, alongside experiencing psychosocial problems and financial difficulties. However, no studies for this are available from Ethiopia in its specific cultural background and health care system. Thus, this study aimed to explore and bring into light the experiences of Ethiopian family caregivers of children with haematological malignancies receiving chemotherapy. MethodsA qualitative descriptive study was conducted using a maximum variation purposive sampling method among 20 caregivers. Semi-structured in-depth face-to-face interviews were conducted until no new themes discovered. The data were analysed through qualitative thematic analysis. ResultsParticipants believed cancer comes from different reasons and chemotherapy is ineffective in curing cancer. They identified various chemotherapy-related side effects, and psychosocial problems. The lack of health insurance, loss of job or income, and high cost of treatments were the major financial challenges. Adhering to treatments, acceptance and reassurance, religious and spiritual therapies, traditional medicine, and a support system were the major coping strategies. They had needs for improved support in information and education, psychosocial support, and in the availability of medications. ConclusionsSystematic health assessment, provision of targeted information and education, psychosocial support, nursing care respecting the caregivers' positive coping strategies, improvement in chemotherapy medication availability, and facilitating connections with supporting organisations would help improve child outcomes and address caregiver needs.

Feasibility and acceptability of a low-resource-intensive, transdiagnostic intervention for children with social-communication challenges in early childhood education settings.

Preschool classrooms provide a unique context for supporting the development of children with social-communication challenges. This study is an uncontrolled clinical trial of an adapted professional development intervention for preschool teachers (Social Emotional Engagement-Knowledge & Skills-Early Childhood). Social Emotional Engagement-Knowledge & Skills-Early Childhood is a low-resource-intensive, transdiagnostic intervention to address the learning needs of children with social-communication challenges and consists of four asynchronous online modules and three synchronous coaching sessions. The current research evaluated the feasibility and acceptability of intervention and research procedures, implemented in authentic early childhood education settings. Participants included one teacher and one target child with social-communication challenges from 25 preschool classrooms, sampled to maximize variability. Overall, the current research revealed high levels of feasibility, with 9 out of 10 benchmarks met: (a) procedures for participant recruitment reliably identified a neurodiverse sample of children with teacher-reported social-communication challenges; (b) teachers showed high levels of program engagement and Social Emotional Engagement-Knowledge & Skills-Early Childhood completion (76%); and (c) results revealed a robust pattern of gains in Social Emotional Engagement-Knowledge & Skills-Early Childhood classrooms and associations among key outcome measures (including active engagement, student teacher relationship, social-communication competencies). Implications for the design of a subsequent, larger effectiveness-implementation hybrid trial (Type 1) are discussed.

Supporting Depressed Mothers of Young Children with Intellectual Disability: Feasibility of an Integrated Parenting Intervention in a Low-Income Setting.

As a lifelong condition, intellectual disability (ID) remains a public health priority. Parents caring for children with ID experience serious challenges to their wellbeing, including depression, anxiety, stress and health-related quality of life. Integrated parenting interventions, which have been well evidenced for depressed mothers, may also effectively support depressed parents with a child with ID in low-resource settings such as Pakistan, and in turn optimise child outcomes. We conducted a mixed-method rater-blind feasibility randomised controlled trial, which assessed the feasibility and acceptability of the Learning Through Play in My Own Way Plus (LTP-IMOW Plus) intervention. Mothers who screened positive for depression (n = 26) with a young child (age 3-6 years) with ID were recruited from two low-resource community settings. Participants in the intervention arm (n = 13) received 12 group sessions of LTP-IMOW Plus and others (n = 13) received routine care. The intervention was feasible and acceptable with 100% retention and 100% session attendance. The intervention improved depression, anxiety, parenting stress and child socialisation score outcomes relative to the routine care arm. The framework utilised to analyse the qualitative interviews with seven participants at pre-intervention identified a range of struggles experienced by the mothers, and at post-intervention, found improved knowledge of child development and practices, improved mother-child relationships, recommendations for the intervention and perceived practical barriers and facilitators. The findings highlight the prospects for a clinical and cost-effective trial of an integrated parenting intervention to manage long-term parental mental health needs and improve child outcomes.

Predictive Analysis of Parent Activation and Autism.

We examined parent activation in families with autistic children over time. Activation is one's belief, knowledge, and persistence in obtaining and managing one's care (e.g., patient activation) and others (e.g., parent activation) and is associated with better outcomes. Four aims were examined: the associations between baseline parent activation and follow up treatment/outcome, between changes in activation and changes in treatment/outcome, differences in activation and treatment/outcome across demographic groups (e.g., gender, race, ethnicity, and income) and comparison of results using three different assessment approaches of parent activation, the Guttman scale (standard approach) and two factor subscales (Yu et al., in J Autism Dev Disord 53:110-120, 2023). The first factor tapped into behaviors aligned with highly active, assertive parental actions (Factor 1: Activated). The second tapped into behaviors representative of uncertainty, passivity, being overwhelmed, with growing awareness of the need for activation (Factor 2: Passive). Findings varied with assessment methods applied. The two subscales assessment approach produced the strongest effect sizes. Baseline activation was related to improved child outcomes at follow-up for Factor 1: Activated and to poorer child outcomes at follow-up for Factor 2: Passive. Changes in activation were unrelated to changes in treatment/outcomes. Outcomes differed based on the activation assessment approach used. Against expectations, activation remained the same over time. Further, no differences in outcomes were observed based on race, ethnicity, or family income. The results suggest that parent activation may behave differently than patient activation based on prior studies. More research is warranted on activation of parents of autistic children.

Connecting technical assistance to implementation progress in child welfare capacity building efforts

ABSTRACT Child welfare jurisdictions implement practices designed to improve child outcomes. Three federally funded Child Welfare Capacity Building Centers provide technical assistance (TA) to jurisdictions to support implementation of practice improvements. The aim of this study was to understand implementation progress among jurisdictions served by the Centers. Analyses indicate (1) amount of TA was positively associated with achievement of implementation milestones; (2) jurisdictions with higher levels of foundational capacity were more likely to achieve milestones; and (3) coaching was associated with faster milestone achievement. Methodological limitations and implications for future evaluations of TA in child welfare are discussed.

Money Matters: Time for Prevention and Early Intervention to Address Family Economic Circumstances

Child poverty is associated with poorer physical and mental health, negative educational outcomes and adverse long-term social and psychological consequences, all of which impact on service demand and expenditure. Until now, however, prevention and early intervention practice has tended to focus on enhancing inter-parental relationships and parenting skills (e.g., via relationship skills education, home visiting, parenting programs, family therapy) or child language, social-emotional and life skills (e.g., early childhood education, school-based programs, youth mentoring). Programs often target low-income neighborhoods or families but rarely address poverty directly. While there is substantial evidence for the effectiveness of such interventions in improving child outcomes, null results are not uncommon and even positive effects are often small, short-term, and difficult to replicate. One avenue to enhance intervention effectiveness is to improve families’ economic circumstances. There are several arguments for this refocusing. It is arguably unethical to focus on individual risk without acknowledging or seeking to address (where relevant) families’ social and economic contexts, while the stigma and material constraints associated with poverty can make it harder for families to engage with psychosocial support. There is also evidence that increasing household income improves child outcomes. Although national policies to alleviate poverty are important, it is increasingly recognized that practice-based initiatives have a role to play (e.g., income maximization, devolved budgets, money management support). However, knowledge about their implementation and effectiveness is relatively thin. For instance, there is some evidence that co-located welfare rights advice in healthcare settings can improve recipients’ financial circumstances and health, but it is mixed and of limited quality. Moreover, there is little rigorous research on whether and how such services affect mediators (parent-child interactions, parenting capacity) and/or child physical and psychosocial outcomes directly. We call for prevention and early intervention programs to attend more to families’ economic circumstances, and for experimental studies to test their implementation, reach and effectiveness.

Patient and family-centered care for children: A concept analysis.

Family-centered care has evolved into patient and family-centered care. Although this is not a new concept; however, its application to nursing practice is very challenging among nurses due to its ambiguity. This study aimed to clarify the concept of patient and family-centered care for children. Walker and Avant's concept analysis method was used. A literature search was also done using the following databases: Google Scholar, ProQuest, ScienceDirect, and Scopus, for articles published from 2011 to 2021. The defining attributes of patient and family-centered care are partnership, communication, respect, and compassion. Antecedents include patient and family involvement, readiness to collaborate and participate, competency and desire of the care professional team, supportive environment, and policies. Consequences of the patient and family-centered care include improved child outcomes and quality of life, promotion of patient safety, increased patient and family satisfaction, enhancement of humanistic values, reduction of hospitalization cost and length of stay, and decreased stress, anxiety, and depression in family members. Four attributes of patient and family-centered care, its antecedents, and consequences may aid researchers in better understanding the concept and its application in nursing practice. This concept can also be used to establish quality care delivery strategies and promote professional relationships between nurses, patients, and families in clinical settings.

Child protective services contact and youth outcomes

BackgroundFew studies have investigated whether Child Protective Services (CPS) contact influences child wellbeing, independent of underlying maltreatment and not considered as a proxy for such maltreatment. ObjectiveThe present study estimates the association between CPS contact and child delinquency, education, substance use, and mental health and development. Participants and settingThe study used data from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study of children born in 20 US cities. Study outcomes were based on age-15 interviews with the focal children and their caregivers with sample sizes ranging from 2088 to 2327 across outcomes. MethodsThe relationship between CPS contact and child wellbeing was estimated using the propensity score method of inverse probability of treatment weighting. ResultsCPS contact was associated with an 88% increase in the probability of smoking (p = .010), a 29 % increase in externalizing behavior (p < .001), a 27% increase in internalizing behavior (p = .001), a 18 % increase in the probability of being expelled (p = .32), a 7.5 % increase in a depression (p = .002), a 6.9 % increase in anxiety (p = .002), a 6.2 % reduction in happiness (p = .008), a 6.0 % increase in impulsivity (p < .001), and a 5.5 % increase in school troubles (p < .001). ConclusionsDespite a federal mandate to improve child wellbeing, we found no evidence that contact with the child welfare system improves child outcomes. Rather, CPS contact was associated with worse mental health and developmental outcomes.

Mothers' Social Status and Children's Health: Evidence From Joint Households in Rural India.

The premise that a woman's social status has intergenerational effects on her children's health has featured prominently in population science research and in development policy. This study focuses on an important case in which social hierarchy has such an effect. In joint patrilocal households in rural India, women married to the younger brother are assigned lower social rank than women married to the older brother in the same household. Almost 8% of rural Indian children under 5 years old-more than 6 million children-live in such households. We show that children of lower-ranking mothers are less likely to survive and have worse health outcomes, reflected in higher neonatal mortality and shorter height, compared with children of higher-ranking mothers in the same household. That the variation in mothers' social status that we study is not subject to reporting bias is an advantage relative to studies using self-reported measures. We present evidence that one mechanism for this effect is maternal nutrition: although they are not shorter, lower-ranking mothers weigh less than higher-ranking mothers. These results suggest that programs that merely make transfers to households without attention to intrahousehold distribution may not improve child outcomes.

Intergenerational effects of maternal PTSD: Roles of parenting stress and child sex.

Parental posttraumatic stress disorder (PTSD) increases children's risk for emotional and behavioral problems. We examined parenting stress and parenting behavior quality as mediators of the relation between maternal PTSD and problematic child behaviors in a sample at high risk for trauma exposure. We also examined whether child sex moderated this association. Participants were 141 African American mother-child dyads (children aged 8-12). Mothers reported PTSD severity, parenting stress, and child behavior (externalizing, internalizing, and emotional self-control). Parenting behavior quality (accounting for factors including parental warmth and engagement) was assessed from an observational parent-child interaction task. Parenting stress, but not observed parenting behavior quality, mediated the relation between maternal PTSD severity and child behaviors. Child sex moderated this association, such that the effect was stronger for girls. Maternal PTSD may be associated with negative child behavior outcomes, and this relation appears to be mediated by increased parenting stress. Stress-reducing interventions for parents with PTSD could improve child outcomes, especially for girls. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Early Childhood Education Teacher Well-Being: Performativity as a Means of Coping.

Detrimental circumstances (e.g., poverty, homelessness) may affect parents, parenting, and children. These circumstances may lead to children being labeled “at risk” for school failure. To ameliorate this risk, more school and school earlier (e.g., Head Start) is offered. To improve child outcomes, Head Start teachers are expected to bolster children?s academic readiness in a manner that is beneficially warm, circulating warmth in their classrooms to sustain positive teacher-child relationships and the positive climate of the classroom. The Classroom Assessment Scoring System (CLASS; Pianta et al., 2008) is one tool by which these domains of warmth are assessed. There are, however, significant personal and professional stressors with which Head Start teachers contend which the CLASS (Pianta et al., 2008) does not consider in its scoring methods. Uplifting the voices of six Head Start teachers, the present study implemented individual and focus group interviews during the summer and fall months of 2020 during the COVID-19 pandemic, asking (a) What were the stories, histories, and lived experiences of these Head Start teachers with regard to stress and warmth in a time of crisis? and (b) How did these teachers understand and approach the CLASS (Pianta et al., 2008) and its measures of their warmth? Data demonstrated Head Start teachers engaged in a type of performativity to 1) mask their stress, potentially worsening their levels of stress in order to maintain warmth for their students’ sake, and 2) outwit the prescribed CLASS (Pianta et al., 2008) observations. Implications and insights are discussed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10643-022-01387-2.