Models Of Child Health Appraised Research Articles

Comparative analysis of pre-Covid19 child immunization rates across 30 European countries and identification of underlying positive societal and system influences.

This study provides a macro-level societal and health system focused analysis of child vaccination rates in 30 European countries, exploring the effect of context on coverage. The importance of demography and health system attributes on health care delivery are recognized in other fields, but generally overlooked in vaccination. The analysis is based on correlating systematic data built up by the Models of Child Health Appraised (MOCHA) Project with data from international sources, so as to exploit a one-off opportunity to set the analysis within an overall integrated study of primary care services for children, and the learning opportunities of the 'natural European laboratory'. The descriptive analysis shows an overall persistent variation of coverage across vaccines with no specific vaccination having a low rate in all the EU and EEA countries. However, contrasting with this, variation between total uptake per vaccine across Europe suggests that the challenge of low rates is related to country contexts of either policy, delivery, or public perceptions. Econometric analysis aiming to explore whether some population, policy and/or health system characteristics may influence vaccination uptake provides important results-GDP per capita and the level of the population's higher education engagement are positively linked with higher vaccination coverage, whereas mandatory vaccination policy is related to lower uptake rates. The health system characteristics that have a significant positive effect are a cohesive management structure; a high nurse/doctor ratio; and use of practical care delivery reinforcements such as the home-based record and the presence of child components of e-health strategies.

Time of onset and/or diagnosis of ADHD in European children: a systematic review

BackgroundAttention-Deficit/ Hyperactivity Disorder (ADHD) is one of the most common childhood neurobehavioral conditions. Symptoms related to this disorder cause a significant impairment in school tasks and in the activities of children’s daily lives; an early diagnosis and appropriate treatment could almost certainly help improve their outcomes.The current study, part of the Models Of Child Health Appraised (MOCHA) project, aims to explore the age at which children experience the onset or diagnosis of ADHD in European countries.MethodsA systematic review was done examining the studies reporting the age of onset/diagnosis (AO/AD) of ADHD in European countries (28 European Member States plus 2 European Economic Area countries), published between January 1, 2010 and December 31, 2019. Of the 2276 identified studies, 44 met all the predefined criteria and were included in the review.ResultsThe lowest mean AO in the children diagnosed with ADHD alone was 2.25 years and the highest was 7.5 years. It was 15.3 years in the children with ADHD and disruptive behaviour disorder. The mean AD ranges between 6.2 and 18.1 years.ConclusionsOur findings indicate that there is a wide variability in both the AO and AD of ADHD, and a too large distance between AO and AD. Since studies in the literature suggest that an early identification of ADHD symptoms may facilitate early referral and treatment, it would be important to understand the underlying reasons behind the wide variability found.Trial registrationPROSPERO registration: CRD42017070631.

Factors influencing the uptake of evidence in child health policy-making: results of a survey among 23 European countries

BackgroundThe ability to successfully transfer knowledge across international boundaries to improve health across the European Region is dependent on an in-depth understanding of the many factors involved in policy creation. Across countries we can observe various approaches to evidence usage in the policy-making process. This study, which was a part of the Models of Child Health Appraised (MOCHA) project assessing patterns of children’s primary care in Europe, focused on how and what kind of evidence is used in child health policy-making processes in European countries and how it is applied to inform policy and practice.MethodIn this study, a qualitative approach was used. The data were analysed in accordance with the thematic analysis protocol. The MOCHA project methodology relies on experienced country agents (CA) recruited for the project and paid to deliver child health data in each of 30 European countries. CAs are national experts in the child health field who defined the country-specific structured information and data. A questionnaire designed as a semi-structured survey instrument asked CAs to indicate the sources of evidence used in the policy-making process and what needed to be in place to support evidence uptake in policy and practice.ResultsIn our data we observed two approaches to evidence usage in child health policy formulation. The scientific approach in our understanding refers to the so-called bottom-up initiatives of academia which identify and respond to the population’s needs. Institutional approaches can be informed by scientific resources as well; however, the driving forces here are governmental institutions, whose decisions and choices are based not only on the population needs but also on political, economic and organizational factors. The evidence used in Europe can also be of an external or internal nature. Various factors can affect the use of evidence in child health policy-making. Facilitators are correlated with strong scientific culture development, whereas barriers are defined by a poor tradition of implementing changes based on reliable evidence.ConclusionsFocusing on the facilitators and actively working to reduce the barriers can perceivably lead to faster and more robust policy-making, including the development of a culture of scientific grounding in policy creation.

Organization and activities of school health services among EU countries.

School health services (SHS) can be defined as health services provided to enrol pupils by health professionals and/or allied professions. The aim of this study was to explore the current state of the governance, organization and workforce of SHS and their provision of preventive activities in European countries. Observational study. Data were collected as part of the Horizon 2020-funded project 'Models of Child Health Appraised'. Only 1 expert from each of the 30 included European countries answered a closed-items questionnaire during the years 2017 and 2018. All countries (except Spain and the Czech Republic, which do not have formal SHS) provided school-based individual screening and health-enhancing measures. The majority performed height, weight, vision and hearing checks; some integrated other assessments of limited evidence-based effectiveness. Most countries also delivered health education and promotion activities in areas, such as sexual health, substance use and healthy nutrition. Almost all countries seemed to suffer from a shortage of school health professionals; moreover, many of these professionals had no specific training in the area of school health and prevention. Many EU countries need better administrative and legal support. They should promote evidence-based screening procedures and should hire and train more school health professionals. Overall, they need to adapt to the evolving health priorities of pupils, adopt a more holistic paradigm and extend their activities beyond traditional screening or vaccination procedures.

Availability and accessibility of primary mental health services for adolescents: an overview of national recommendations and services in EU.

Mental health problems in adolescence can profoundly jeopardize adolescent current and future health and functioning. We aimed to describe existing recommendations and services regarding the delivery of primary mental health care for adolescents in 31 European countries. Data on the availability and accessibility of primary mental health services were collected, as part of the Horizon 2020-funded project Models of Child Health Appraised. One expert from each country answered a closed items questionnaire during years 2017-18. All 31 participating countries had some policy or recommendations regarding the availability and accessibility of primary mental health services for adolescents, but their focus and implementation varied largely between and within countries. Only half of the participating countries had recommendations on screening adolescents for mental health issues and burdens. Merely a quarter of the countries had ambulatory facilities targeting specifically adolescents throughout the whole country. Just over half had some kind of suicide prevention programs. Same-day access to primary care in case of -health emergencies was possible in 21 countries, but often not throughout the whole country. Nineteen countries had strategies securing accessible mental health care for vulnerable adolescents. Overall, around half of European countries had strategies securing access to various primary mental health care for adolescents. They frequently did not guarantee care over the whole country and often tackled a limited number of situations. EU countries should widen the range of policies and recommendations governing the delivery of mental health care to adolescents and monitor their implementation.

Key constituents for integration of care for children assisted with long-term home ventilation: a European study

BackgroundThe number of children requiring long-term home ventilation has consistently increased over the last 25 years. Given the growing population of children with complex care needs (CCNs), this was an important area of focus within the Models of Child Health Appraised (MOCHA) project, funded by the European Union (EU) under the Horizon 2020 programme. We examined the structures and processes of care in place for children with CCNs and identified key constituents for effective integration of care for these children at the community and acute care interface across 30 EU/ European Economic Area (EEA) countries.MethodsThis was a non-experimental descriptive study with an embedded qualitative element. Data were collected by a Country Agent in each of the 30 countries, a local expert in child health services. Data were analysed using descriptive statistics and a thematic analysis was undertaken of the free text data provided.ResultsA total of 27 surveys were returned from a possible 30 countries (90.0%) countries. One respondent indicated that their country does not have children on long-term ventilation (LTV) in the home, therefore, responses of 26 countries (86.7%) were analysed. None of the responding countries reported that they had all of the core components in place in their country. Three themes emerged from the free text provided: ‘family preparedness for transitioning to home’, ‘coordinated pathway to specialist care’ and ‘legal and governance structures’.ConclusionsWhile the clinical care of children on LTV in the acute sector has received considerable attention, the results identify the need for an enhanced focus on the care required following discharge to the community setting. The results highlight the need for a commitment to supporting care delivery that acknowledges the complexity of contemporary child health issues and the context of the families that become their primary care givers.

Primary care in five European countries: A citizens' perspective on the quality of care for children.

ObjectiveAs part of the Models of Child Health Appraised (MOCHA) project, this study aimed to answer the following research questions: 1) How do European citizens perceive the quality of primary health care provided for children? And 2) What are their priorities with respect to quality assessment of primary health care aimed at satisfying children’s needs?MethodsNine potential attributes of quality of primary care were operationalized in 40 quality aspects. An online survey was used to elicit opinions in a representative sample of citizens of Germany, the Netherlands, Poland, Spain, and the United Kingdom. Data collection comprised: background characteristics; perceived quality of primary health care for children; and priority setting of quality aspects. Descriptive analysis was performed and differences between groups were tested using Chi-Square test and ANOVA.ResultsValid results were obtained from 2403 respondents. Mean satisfaction with quality of primary care ranged from 5.5 (Poland) to 7.2 (Spain). On average, between 56% (Poland) and 70% (Netherlands) of respondents had a positive perception of the primary health care system for children in their country. The ability of a child to limit their parents’ access to the child’s medical records was judged most negatively in all countries (average agreement score 28%, range 12–36%). The right of a child to a confidential consultation was judged most differently between countries (average agreement score 61%, range 40–75%). Overall top-10 priorities in ensuring high quality primary care were: timeliness (accessibility); skills/competences, management, facilities (appropriateness); no costs (affordability); information, dignity/respect (continuity); and swift referrals, collaboration (coordination).DiscussionBetween countries, significant differences exist in the perceived quality of primary care and priorities with regard to quality assessment. Taking into account the citizens’ perspective in decision-making means that aspects with low perceived quality that are highly prioritized warrant further action.

Organization and content of primary care for adolescents – comparison of actual and desired situation

Abstract To successfully navigate increasing autonomy, independence and health behaviors in adolescence, accessible adolescent health care services (AHS) are essential. AHS comprise all services in primary care that are aimed at the specific needs of adolescents and can be provided in various settings such as public services, private services, schools and hospitals. In the MOCHA project (Models of Child Health Appraised) we assessed the structure and content of AHS in 30 European countries against the standards in the field of adolescent health services: accessibility, staff attitude, communication, staff competency and skills, confidential and continuous care, age appropriate environment, involvement in health care, equity and respect and a strong link with the community. The results revealed that although half of the 30 countries did adopt adolescent-specific policies, many countries did not meet the current standards of quality health care for adolescents. For example, the ability to provide emergency mental health care is limited. In addition, one third of the countries do not have a formal policy which guarantees the confidentiality of a consult and the possibility to consult a physician without parents knowing. Finally, around half of the countries do not have specialized centers in adolescent health care in order to tackle comprehensive health issues. Access to adolescent health care services needs to be improved for vulnerable adolescents such as migrant adolescents. Schools, ambulatory settings and hospitals should offer accessible, comprehensive health care and a culturally appropriate approach, particularly given the number of migrant adolescents living in EU and EEA countries. Finally, the health care systems should improve their communication strategies, to assist young people in understanding their rights and responsibility in the domain of health, and how and where to access to adequate care.

Contextual determinants of CHILDREN\u2019S health care and policy in Europe

BackgroundThe main objective of this study was to explore the contextual determinants of child health policies.MethodsThe Horizon 2020 Models of Child Health Appraised (MOCHA) project has one Country Agent (CA) in all 30 EU and EEA countries. A questionnaire designed by MOCHA researchers as a semi-structured survey instrument asked CAs to identify and report the predominating public and professional discussions related to child health services within the last 5 years in their country and the various factors which may have influenced these. The survey was issued to CAs following validation by an independent Expert Advisory Board. The data were collected between July and December 2016.The data was qualitatively analysed using software Nvivo11 for data coding and categorization and constructing the scheme for identified processes or elements.ResultsContextual determinants of children’s health care and policy were grouped into four categories. 1) Socio-cultural determinants: societal activation, awareness, communication, trust, freedom, contextual change, lifestyle, tolerance and religion, and history. 2) Structural determinants which were divided into: a) external determinants related to elements indirectly correlated with health care and b) internal determinants comprising interdependent health care and policy processes. 3) International determinants such as cross-nationality of child health policy issues. 4) The specific situational determinants: events which contributed to intensification of debates which were reflected by behavioural, procedural, institutional and global factors.ConclusionsThe influence of context across European countries, in the process of children’s health policy development is clearly evident from our research. A number of key categories of determinants which influence child health policy have been identified and can be used to describe this context. Child health policy is often initiated in reaction to public discontentment. The multiple voices of society resulted, amongst others, in the introduction of new procedures, action plans and guidelines; raising levels of awareness, intensifying public scrutiny, increasing access and availability of services and provoking introduction of structural changes or withdrawing unfavourable changes.

Human papillomavirus vaccination and respect for children's developing autonomy: Results from a European Union wide study.

Children’s rights to autonomy of choice are differently expressed throughout Europe. We explored differences regarding expressions of respect for children’s autonomy throughout Europe, using the procedure of human papillomavirus (HPV) vaccination offer as indicator. We used a mixed methods approach, utilizing an expert survey within the frame of “Models of Child Health Appraised” (MOCHA), among all 30 European Union (EU) and European Economic Area states. A questionnaire was designed using vignettes regarding the vaccine provision. Thirty MOCHA country agents were invited to respond from June 2017 to April 2018. In total, 28 country agents responded. We studied the following themes: (i) provision of informed consent, (ii) parental and medical paternalism, (iii) relevance of the child’s chronological age or maturity, and (iv) vaccination programs targeting boys. These are being handled differently across the region. We explored associations of these implemented practices with the national vaccine coverage rate across Europe. We used the processes of HPV vaccination to study child’s autonomy, the paradigm change toward libertarian paternalism and issues of sex-equity. Interestingly, greater respect for children’s autonomy tends to be associated with medium or high vaccination coverage rates and lower respect with lower rates. Respect and empowerment seem to have practical as well as moral benefits. Identifying and transferring the most suitable ethical approaches is crucial and should be strengthened.

How does societal reaction to children's health issues contribute to health policy in Europe? Results of a survey.

BackgroundIn the European context the awareness of societal responsibility for children's health has increased with greater attention to children's rights and child empowerment processes. Child health issues are considered particularly sensitive; thus, they often provoke strong societal reactions, which, as a consequence, influence national health policies across Europe. Effectiveness of societal influences increases with the involvement of various actors in the context.MethodsA qualitative approach was used to identify the level of societal involvement in health decision‐making. A questionnaire was sent to the Country Agents (CAs) of the Models of Child Health Appraised (MOCHA) project. CAs are contact points in each of the 30 participating in the project countries and were asked to identify strong public and professional discussions related to child health services in their countries. Data collection was undertaken between July and December 2016.ResultsBased on 71 case studies, we identified eight thematic patterns, which characterize societal reactions to the currently worrisome child health issues across Europe. We devoted our attention to the three most controversial: child vaccination, child poverty and child abuse. The cases described by the CAs show the broad perspective in the perception of child health problems. Child health issues involve the public and raise nationwide debates. Public concerns were directly or indirectly related to child health and depicted the national overtone.ConclusionsConcerns in Europe about child health care are twofold: they are devoted to systemic issues (indirect patient orientation) and to child health and well‐being (direct patient orientation). The phenomenon of societal responsibility for children's health is important for the support of public acceptance of child health policy.

Integrated school health services in Europe: an overview

Introduction: The extent to which School Health Services SHS professionals in Europe integrate their care with care of non-SHS professionals at school or with other primary health care providers, range from no integration at all to full integration. SHS in this study are defined as health services provided to enrolled pupils by healthcare professionals and/or allied professionals, irrespective of site of service provision and mandated by a formal arrangement between the educational institution and the provider healthcare organization. In this study, we focus on integrated SHS throughout 30 European countries. This study is part of the MOCHA study Models of Child Health Appraised, a Horizon 2020 study identifying the optimal models of children’s primary health care, including SHS. Methods: Data on cooperation policies and practices of SHS in 30 European countries is collected via Country Agents CA’s, a local expert in child health services. CA’s answered – for their country – questions on 1 types of SHS-professionals available; 2 informing and advising of non-SHS professionals teachers and other school staff members about children with life-affecting health issues and how to manage the child in school; 3 access to record keeping on pupils’ general health issues by non-SHS professionals; 4 reporting of non-SHS professionals of general health concerns about individual pupils; 5 any formal national recommendations relating to the cooperation between SHS-professionals and other forms of primary care services; 6 any formal national recommendations that supports inter-professional working within SHS 7 national policy or guidelines that encourages inter-professional meetings to discuss the issue of absenteeism, violence and disruptive behaviour or school drop-out, e.g. meetings between SHS-professionals, teacher, and other health care professionals? 8 means of provision of key health data if a child needs emergency treatment during the school day. Results: Preliminary results show that there is a great variation between European countries to what extent SHS-professionals cooperate and involve other professionals. Most countries have formal national recommendations relating to the cooperation between SHS and the other forms of primary care services and in most countries, but in many countries formal policies on sharing health concerns with non SHS-professionals are lacking. As the data collection is ongoing more data will be presented at the conference. Discussions: Thoughts of integrated care usually focus on older citizens, or those with chronic conditions. However, children of school age are at a formative stage regarding their health, health behavior, and health resilience. They spend most of their day in a school setting, which intentionally seeks to influence their future. Ensuring integrated support by health systems is very important. Conclusions: There is wide disparity across Europe on what constitutes good integrated health support to school children. Work is ongoing assessing best structures and outcomes. Lessons learned: SHS are an under-researched area, yet the principles of integrated care are crucial for the ongoing mental and physical well-being of this key generation. Limitations: This work is ongoing, and final conclusions have not yet been reached. Suggestions for future research: Deeper study of acceptability and outcomes of different models.

The integration of care at the acute/ community/ primary care interface for children with complex health needs in 30 European Countries: A MOCHA study

Introduction: Internationally, there are wide variations across the systems in place to care for children with complex care needs. The aim of this study is to provide an up-to-date account of the current approaches to the integration of care at the acute/community interface for these children across 30 European countries. This work is part of a large ongoing European Commission Horizon 2020 funded project – Models of Child Health Appraised (MOCHA). Methods: In this non-experimental descriptive study, utilising a sequential explanatory mixed-methods design, we surveyed in each country, using a local agent, a paediatric health expert. The survey consisted of a vignette and open and closed ended questions adapted from the Standards for Systems of Care for Children and Youth with Special Health Care Needs, and the Eurobarometer Survey. Vignettes were developed based on three clinical exemplars: Long-term Ventilation (LTV), Intractable Epilepsy, and Traumatic Brain Injury (TBI). Data were analysed to-date using descriptive statistics; thematic analysis of the qualitative data is ongoing. The final results for this study are expected July 2017. This presentation focuses on the early results of the LTV data. Results: There was a response rate of 76% (n=23), of which 22 (73.3%) could be analysed as one of the countries did not offer community care for children on LTV. There are significant gaps in the integration of care for children on LTV across Europe. Forty-five percent (n=10) of the countries surveyed have no policies/ procedures in place to support care coordination for children on LTV, while just over one third (36.4%, n=8) have a discharge planning coordinator in place to oversee the transfer of a child on LTV to home. However, the majority of respondents (63.6%, n= 14) indicated that their country had a process in place to facilitate direct access to and/or from a paediatric intensive care unit. Conclusions: The preliminary results suggest that there are limited structures and processes in place to support integrated care delivery to the child on LTV and their family across 22 European countries. Discussion: It is anticipated that the ongoing analysis of the qualitative data will help to contextualise the results to-date, within the socio-political landscape of each country. Further analysis will explore optimum facilitators of integration of care for these children and their families. Lessons learned: The development of a glossary of terms, with wide consultation across Europe, afforded clarity for data collection. The inclusion of this glossary with each survey facilitated comprehension of the concepts and the questions being asked. Limitations: There was a designated person assigned to respond to the surveys in each participating country. To-date the response rate is below 80%. This may be due to the fact that this was a lengthy survey, reflecting the level of detail required to build a comprehensive picture of the integration of care for this group of children and their families. Suggestions for future research: Further research is important to explore regional variations and equity of provision of integrated care for children with complex care needs.

Integration of health and social care for children with complex health conditions: an assessment of the policy and organisational context in Europe

Introduction : Across Europe, little is known about the policy, organisational and practical aspects of integrated health and social care for children with complex care needs (CCN) in Europe. This growing population of children typically have varying and extensive needs, that often require a coordinated and integrated response from multiple care providers. Aim : This study is part of a large EU funded project on children’s primary health care, Models of Child Health Appraised (MOCHA). This study seeks to examine the legal, policy and organisational structures for social care services for CCN in 30 European countries and to explore how they interface with primary care. Method : Using a network of child health and social care experts (Country Agents) across 30 EU countries, a standard set of questions were asked on the legal, policy and organisational structure for the delivery of social care services to these children and their families. The questions included a case vignette which sought to explore how both their health and social care needs were met in each country. Quantitative responses were analysed using descriptive statistics and qualitative responses were analysed using a thematic framework approach. Results : While some countries deliver social care through government agencies, many outsource services to non-profit and commercial organisations. Just over one-third of the countries surveyed have an established policy framework with specific recommendations on the integration of social care services with health care for children. Ongoing work will explore if this improved practice. Just under one third of the countries surveyed have a care coordinator in place for children with CCN; this role is identified as a positive facilitator of optimum care delivery. Discussion : The diversity of social care structures across the EU illustrates the challenge in trying to develop a model that can be applied across multiple countries. Further work in this project will explore optimum pathways for care delivery at the social healthcare interface. Conclusions : The results of this study suggest that meeting the wider needs (social care needs) of CCN requires a care coordination/management approach based on the wider needs of children so that they can lead an “ordinary life”. Lessons learned : Social care delivery is not uniform across the countries, however, the case vignette approach ensured some uniformity in response which was helpful in validating results. Limitations : The absence of national outcome data on social care needs for children with CCN in the participating countries adds to the complexity of comparing the effectiveness of country wide approaches to supporting this group of children and their families. Suggestions for future work : While most children with CCN require additional health and social care interventions, others may have complex social care needs without a complex health condition, for example, children who have child welfare and child protection requirements. The role of primary care in identifying and/or meeting these needs requires further exploration.