Improve Outcomes For Children Research Articles

Building School-Based Capacity to Support Parenting: Challenges and Lessons Learned.

Both schools and caregivers play an important role in supporting children's mental health, but there are few mechanisms for caregivers and school-based mental health providers to work collaboratively to address children's needs. Closures of schools during the first wave of the COVID-19 pandemic left gaps in mental health support services to children and increased the burden on caregivers to ensure their children's well-being. In this study, investigators explored the feasibility and acceptability of a motivational interviewing-based program in which school-based mental health providers were trained to connect directly to caregivers to assist them in supporting key aspects of their children's well-being, including sleep, coping, and academic behavior. Results indicated a high degree of satisfaction with the program and a perception that it was helpful to caregivers and children. However, major challenges in recruitment of providers, as well as qualitative interviews with those providers who participated, indicated that the feasibility of implementing such a program is limited without significant additional implementation infrastructure. Findings suggest that structured support of caregivers, accessed through their children's schools, has high potential for improving child outcomes and family well-being. Future research should explore what implementation infrastructure is needed for schools to effectively offer these types of supports.

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.

Nurturing families: One year pilot outcomes for a modified Parent Child Assistance Program in Australia.

Alcohol and Other Drug (AOD) exposure during pregnancy is linked to serious adverse child outcomes, including Fetal Alcohol Spectrum Disorder (FASD). The Parent-Child Assistance Program (PCAP) supports women with problematic AOD use, who are pregnant or have young children, and are not effectively engaging with services. PCAP has been shown to reduce alcohol exposed pregnancies, promote AOD abstinence, increase employment and family planning and improve child outcomes. This manuscript reports the first pilot evaluation of the PCAP program delivered in Australia. A pre-post-intervention repeated measures design was used. Eleven women receiving PCAP from a not-for-profit organisation were invited to take part in the study, with eight providing complete pre-post data. Home visitation case management was provided by trained and experienced case-managers. Clients were assisted to engage with existing services effectively to meet their own goals via a combination of relational theory, motivational interviewing and harm reduction concepts. The PCAP Modified Addiction Severity Index 5th Edition was adapted for use in Australia and was used to measure domains of addiction severity related problems as the primary outcome. Secondary outcomes included client satisfaction and program fidelity. There were significant changes in composite addiction severity scores from baseline to one year. 80% of participants had periods of abstinence of longer than four months. All clients had better connection to services, no subsequent AOD exposed pregnancies, and were highly satisfied with the program. Four had children returned to their care. Implementation was similar to the original PCAP program with major differences including case-managers relying on training manuals only without undertaking in-person training; being more experienced; providing more direct AOD counselling; and having less supervision. The findings will inform future program delivery and methodology for a larger longitudinal study assessing outcomes at program exit.

Omalizumab is associated with improved asthma outcomes in children and adolescents with serum immunoglobulin E above dosing guidelines

Asthma is an increasingly common chronic disease in children, accounting for more hospitalizations than many other chronic health conditions.1 Omalizumab is used to treat severe allergic asthma in children 6 years and older and improves asthma control and reduces asthma exacerbations and health care utilization as early as 16 weeks into treatment.2,3 Omalizumab dosing guidelines are dependent on serum immunoglobulin E (IgE) level and body weight and were designed to produce serum free IgE levels of 25 ng/mL or lower, which was associated with improved outcomes in clinical trials.

Technology to Facilitate Progress Monitoring of Infant–Toddler Growth and Development: Measuring Implementation in Community-Based Agencies

Despite evidence that frequent progress monitoring to identify children at-risk of delays and inform early intervention services improves child outcomes, this practice is rare in infant–toddler settings where children could benefit the most from early intervention. Using a descriptive research design within an Implementation Science framework, we evaluated how 10 community-based infant–toddler agencies implemented a standardized progress monitoring assessment using a web application to monitor children’s growth and identify children at-risk for delay. An Implementation Index was developed to quantify implementation progress for each agency, which included their percent of tasks completed, and rate of task implementation over time. Staff turnover and high staff:child ratios were associated with low implementation of progress monitoring. The Implementation Index differentiated between agencies that otherwise demonstrated similar implementation rates. Implications for supporting progress monitoring and other evidence-based practices in community-based infant–toddler childcare settings are discussed.

Informatics tools to implement late cardiovascular risk prediction modeling for population health management of high-risk childhood cancer survivors.

10048 Background: Marked improvements in outcomes for children with cancer and robust cohort studies with longitudinal follow-up inform evidence-based guidelines for survivors at risk for late cardiomyopathy. Clinical informatics tools to integrate data from multiple sources have the potential to catalyze population health management. Methods: The Oklahoma Childhood Cancer Survivor cohort was constructed from an institutional cancer registry of survivors diagnosed between 2005 and 2014 (n=382). Data elements (cumulative anthracycline, cumulative chest-directed radiotherapy, alkylator, and platinum exposures) were extracted from Passport for Care (PFC) to implement previously validated late cardiovascular risk prediction modeling from the Childhood Cancer Survivor Study (CCSS) for cardiomyopathy. Risk groups were compared to the Children’s Oncology Group (COG) Long-Term Follow-up Guidelines. Standard query language facilitated extraction of echocardiogram data from the electronic health record to determine adherence, defined as an echocardiogram within 27 months and 63 months from the last day of therapy for high and moderate risk survivors, respectively. Results: Sixty-nine percent (n=264) of survivors from the cancer registry were documented in PFC, of whom 29%, 56%, and 15% were classified as low, moderate, high risk, respectively, based on the CCSS late cardiomyopathy risk calculator. Concordance was modest for high and moderate risk groups (Kappa = 0.42 and 0.46, respectively) and good for the low risk group (Kappa = 0.77) compared to COG risk groups. There was excellent adherence to echocardiogram guidelines with 93% and 81% of moderate and high-risk survivors, respectively. There were significant differences based on risk group (p=0.02) and age at diagnosis (p&lt;0.01). Conclusions: Clinical informatics tools represent a feasible approach to leverage discrete data elements regarding key treatment exposures from PFC to successfully implement previously validated late cardiovascular risk prediction models on a population health level. PFC promotes adherence to echocardiogram surveillance and serves as a platform for future interoperability to generate real-world data to improve survivorship-focused care. [Table: see text]

Early intervention for very young children with or at high likelihood for autism spectrum disorder: An overview of reviews.

To identify which interventions are supported by evidence and the quality of that evidence in very young children with or at high likelihood for autism spectrum disorder (ASD) to improve child outcomes. We conducted an overview of reviews to synthesize early intervention literature for very young children with or at high likelihood for ASD. Cochrane guidance on how to perform overviews of reviews was followed. Comprehensive searches of databases were conducted for systematic reviews and meta-analyses between January 2009 and December 2020. Review data were extracted and summarized and methodological quality was assessed. Primary randomized controlled trial evidence was summarized and risk of bias assessed. This overview of reviews was not registered. From 762 records, 78 full texts were reviewed and seven systematic reviews and meta-analyses with 63 unique studies were identified. Several interventional approaches (naturalistic developmental behavioral intervention, and developmental and behavioral interventions) improved child developmental outcomes. Heterogeneity in design, intervention and control group, dose, delivery agent, and measurement approach was noted. Inconsistent methodological quality and potential biases were identified. While many early interventional approaches have an impact on child outcomes, study heterogeneity and quality had an impact on our ability to draw firm conclusions regarding which treatments are most effective. Advances in trial methodology and design, and increasing attention to mitigating measurement bias, will advance the quality of the ASD early intervention evidence base. Naturalistic developmental behavioral interventions, as well as developmental and behavioral interventions, improve child outcomes in autism spectrum disorder (ASD). If only randomized controlled trials are considered, guidelines for early intensive behavioral intervention in younger children should be revisited. The greatest intervention impacts were on proximal, intervention-specific outcomes. Inadequacies in the quality of the early ASD intervention evidence base were observed.

Does the child support grant incentivise childbirth in South Africa?

This paper considers the perverse incentive that can be created for poor households that are benefitting from the South African Child Support Grant (CSG). We acknowledge the fact that the CSG has been successful in improving child outcomes. However, if caregivers see the CSG as a livelihood strategy and respond with multiple births, this will jeopardise the long-term fiscal sustainability of the grant. Such an incentive may also perpetuate poverty and inequality , which will defeat the very purpose the CSG is meant to achieve. To examine if the Child Support Grant incentivise childbirth in South Africa, we estimate the relationship between CSG receipt and birth attempts over the last decade in the National Income Dynamic Study (NIDS) sample. In our analysis we make use of a number of econometric approaches including the instrumental variable estimator with possession of the South African identity card as an instrumental variable to control for selection. We argue that while possession of the identity card is a necessary condition for CSG, this variable is not driven by the outcome of child births and cannot be influenced by individual mothers because possession of identity card depends on government administrative rules and bureaucracy. Our result shows that those who benefit from the CSG have made more birth attempts within the last decade compared to non-beneficiaries. We find that this result is robust to the choice of econometric technique. We argue that there is a need to consider structuring welfare grants in a way that will incentivise behaviour that will align with the developmental goals of the nation. An unconditional, but targeted basic income grant, for example, is likely to offer fewer perverse incentives.

Parents matter: Parent acceptance of school-based executive functions interventions relates to improved child outcomes.

School-based interventions with parent-training components might improve access among lower-income families to effective help for children with neurodevelopmental disorders. This potential might be realized, however, only if parents perceive the interventions as acceptable and therefore engage with treatment. Parents (N = 124) of 3rd-5th grade students diagnosed with Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder rated the acceptability of their child's treatment (one of two culturally responsive behavioral interventions). Parent engagement was measured through attendance at parent training sessions and the extent to which they read a corresponding workbook. Education and income correlated inversely with parent perceptions of treatment acceptability. Acceptability correlated positively with engagement, more strongly among lower-income families. Acceptability had an indirect effect on treatment outcome, mediated by parent engagement. Treatment providers should focus on strategies to increase parent acceptability, with particular attention to improving access for lower-income families.

Executive function in kindergarten and development of behavioral competence: The moderating role of positive parenting practices

The present study used data from the Early Childhood Longitudinal Study–Kindergarten Cohort of 2011 (N = 15,827; 51.1% male; 48.4% White, 13.5% Black/African-American, 24.3% Hispanic/Latinx, 7.5% Asian, and 6.3% other ethnicity) to examine the unique contribution of specific executive function processes (working memory and cognitive flexibility) at kindergarten entry on externalizing and internalizing behavior problems in spring of kindergarten, after controlling for fall behavior problems and demographic covariates. Due to the transition to elementary school being a critical identification and prevention period, we also focused on examining the moderating role of specific positive parenting practices (i.e., cognitive stimulation, warmth, and behavior management) on associations between child executive function processes and behavioral functioning. Results indicated working memory was negatively associated with parent-reported externalizing and teacher-rated internalizing behavior problems. Further, the association between working memory and parent-rated externalizing problems was moderated by cognitive stimulation, whereas the association between parent-rated internalizing problems was moderated by behavior management. Cognitive flexibility did not have any significant associations. We discuss implications for research and practice on how parenting practices may be leveraged to improve child outcomes.

Specifying Adult Interaction Practices as a Step Toward Enhancing Our Conceptualization of Process Quality

Current conceptualizations of process quality in early childhood education highlight a variety of global classroom indicators that directly link to improved child outcomes. This conceptualization may need to be extended, however, to facilitate more meaningful change in children's development and readiness for kindergarten. To enhance our current definitions of process quality, we propose a set of more specific, observable adult interaction practice elements as a complement to existing global indicators within structural process elements and the broader preschool classroom ecology. We describe and define three practice types, as well as the individual practice elements within them, to include: (a) adult-led interaction practices, (b) child-led interaction practices, and (c) differentiated scaffolding. In operationalizing each practice element, we also provide empirical evidence as grounding for its inclusion in our conceptualization. We discuss implications and future practice and policy directions.