Outcomes For Children In Care Research Articles

The influence of disparities on intensive care outcomes in children with respiratory diseases: A systematic review.

The negative effects of socioeconomic, environmental and ethnic inequalities on childhood respiratory diseases are known in the development of persistent asthma and can result in adverse outcomes. However, little is known about the effects of these disparities on pediatric intensive care unit (PICU) outcomes in respiratory diseases. The purpose of this systematic review is to evaluate the literature on disparities in socioeconomic, environmental and ethnic determinants and PICU outcomes. We hypothesize that these disparities negatively influence the outcomes of children's respiratory diseases at the PICU. A literature search (in PubMed, Embase.com and Web of Science Core Collection) was performed up to September 30, 2022. Two authors extracted the data and independently evaluated the risk of bias with appropriate assessment methods. Articles were included if the patients were below 18 years of age (excluding neonatal intensive care unit admissions), they concerned respiratory diseases and incorporated socioeconomic, ethnic or environmental disparities. Eight thousand seven hundred fourty-six references were reviewed, and 15 articles were included; seven articles on the effect of socioeconomic status, five articles on ethnicity, one on the effect of sex and lastly two on environmental factors. All articles but one showed an unfavorable outcome at the PICU. Disparities in socioeconomic (such as a low-income household, public health insurance), ethnic and environmental factors (such as exposure to tobacco smoke and diet) have been assessed as risk factors for the severity of children's respiratory diseases and can negatively influence the outcomes of these children admitted and treated at the PICU.

The effectiveness of book-gifting programmes to enhance the reading skills of children in care: A randomised controlled trial of ‘Reading Together’ in England

There now exists a considerable body of international evidence demonstrating the consistently poor educational outcomes faced by children in care. These effects emerge early and worsen as children grow older and last longer term into adulthood. One popular intervention aimed at addressing this has been the use of book-gifting. However, there is limited evidence that this, on its own, is effective in improving reading outcomes for children in care. Moreover, previous research suggests the need for book-gifting programmes to be enhanced through including a direct role for foster carers to support their children’s reading when receiving the books. This article reports the main findings of a three-armed randomised controlled trial conducted in the UK across 22 local authorities and involving 266 children, that sought to evaluate the effectiveness of an enhanced book-gifting intervention, supplemented by a paired-reading component for foster carers to undertake with their children, known as Reading Together. The effects of the Reading Together intervention were measured on one primary outcome, children’s levels of reading comprehension, and also included a number of secondary outcomes (reading accuracy, reading rate, receptive reading and attitudes towards reading). The trial found no evidence of the effectiveness of the programme, which is attributed to both the possible ineffectiveness of the programme itself and/or the confounding effects of Covid-19 national lockdowns and other restrictions that impacted on foster families during the period of the trial. However, the trial raises a number of important issues which are drawn out and discussed including: which children in foster care a programme like this should be targeted at; how to better ensure fidelity through an enhanced peer foster carer support role; the involvement of schools in interventions like this; and the need for more attention to be paid to the nature and quality of the carer/child relationship. Implications for future research are outlined.

Post-intensive care syndrome in pediatrics—enhancing understanding through a novel bioecological theory of human development lens

BackgroundThe post-intensive care syndrome in pediatrics (PICS-p) framework offers a new understanding of the long-term impact of critical illness on child’s and family’s health. However, a comprehensive theoretical guide to investigate potential factors influencing these outcomes and recoveries is needed.ObjectiveThe aim of the study is to conceptualize post-intensive care outcomes in children and their families after PICU discharge in the context of the child’s surrounding environment and systems.MethodWe used Theory Adaptation, a shift in the use and perspective of the Bioecological Theory of Human Development (BTHD), and Theory Synthesis, the integration of BTHD and the PICS-p, to provide a novel PICSS-PF perspective for understanding PICS-p within the broader context of the child and family. This integration helps to see higher-order perspectives to link post-PICU outcomes and child development within the context of child’s surroundings.ResultsWhile PICS-p is a model for understanding and studying post-PICU outcomes and recovery in four domains of physical, cognitive, emotional, and social health, the BTHD offers a new lens for a holistic view of the contextual systems and factors affecting the outcomes and recovery. The BTHD contextual systems include intrapersonal (demographics, clinical), interpersonal (adjacent people’s characteristics and interactions), institutional (family situations, PICU environment), community, social resources, and networks.ConclusionsKnowing the complex nature of post-PICU outcomes in children and their families, the PICSS-PF helps in the better understanding of the complex interplay of factors that contribute to PICS in children and their families, leading to the development of more effective interventions to address this condition.

Knowledgeable but not specialist: Virtual School Heads’ experiences of supporting autistic children in care

ABSTRACT Autistic children comprise a large group of young people who are looked-after by their local authority and for whom educational outcomes are amongst the poorest of all children in care. Virtual School Heads (VSHs) in England have a statutory responsibility to improve the educational outcomes of children in care following the implementation of the Children and Families Act 2014. However, very little is known about the experiences of VSHs in supporting autistic children in care, including whether and how knowledge about autism diagnosis is shared within interprofessional teams. This qualitative study reports the findings from nine semi-structured interviews with eight VSHs and one occupational therapist from eight local authorities in England. VSHs worked within multiple and diverse teams locally and nationally to co-ordinate and manage effective provision but reported that knowledge about autism was often uncertain and conflated with attachment difficulties. They could not state with confidence that individuals around the child were sufficiently enabled to provide appropriate support and educational provision. The VSH, and the children they support, occupy liminal roles which create challenges for effective communication and support. Crucially, young people’s views need to be authentically gathered and holistically understood to inform and improve provision.

A 5-year multidisciplinary care outcomes in children with wilms' tumour managed at a tertiary centre: A retrospective observational study.

Background:Over the last two decades, there has been significant improvement in the outcomes of children with Wilms’ tumour (WT) in high income countries (HICs) with approximately 85% survival rate globally. This is partly attributable to a multi-disciplinary team approach to care and the evolution of more robust treatment measures. A previous review in our centre prior to multi-disciplinary team shows a survival rate of 31.48%, However, the survival rates from low- and middle-income countries are still low when compared to HICs due to delays in access to care at all levels, poor to non-existent health insurance coverage, limited workforce resources, weak health-care systems and infrastructure. The aim of this study is to determine the impact of a multi-disciplinary team approach on the treatment outcomes of children with WT.Methodology:This is a 5-year retrospective review of all patients managed with WT at the Lagos University Teaching Hospital, Lagos, Nigeria. Information was extracted from the patients’ case notes, operation notes and ward admission records. The data were analysed with SPSS 25, and P < 0.05 was considered to be statistically significant.Results:Forty patients were included in the study; male to female ratio was 1.6:1. The disease occurred in the right kidney in 23 patients (57.5%) and on the left in 17 patients (42.5%). The average duration of symptoms before presentation was 3.6 months (range 1–7 months), majority of patients presented with abdominal masses and were assessed as per unit protocol with abdominal Computerized tomography scan, chest X-ray and abdominal ultrasound scan to assign the patient International Society of Paediatric oncology regimen. The predominant stage at surgery was Stage III 26 (65%), while Stage IV was 9 (22.5%). Morbidity after chemotherapy was 10 (25%). Twenty-five patients (63%) completed chemotherapy while 15 patients (37%) started chemotherapy but defaulted midway. The 5-year survival rate was 75%. Increasing age and male sex were associated with reduced odds of mortality; however, this was not statistically significant. Increased duration of treatment, being treated with chemotherapy alone, as well as advanced tumour stage and histology were associated with increased odds of mortality, however, this was not statistically significant.Conclusion:The development of an institutional WT treatment pathway involving a multidisciplinary team has resulted in improved outcomes. There is need for increased community awareness to improve the time to presentation.

The role of long-term mentoring in alternative child care settings

BackgroundUdayan Care, an NGO based in New Delhi, India, provides alternative care to ‘Children without Parental Care’, in small-group residential homes. The homes have a Living In Family Environment (L.I.F.E) Model, where ‘Group Care’ ensures that children are loved and cared for by a group of long-term volunteers, called mentor parents, along with other care staff. A novel parenting concept, the mentor parents are ordinary individuals with extraordinary sensitivity, voluntarily committing themselves for life. They instill in children a sense of trust and belonging to the community and are concurrently empowered and fulfilled by the endeavor. ObjectiveThis study attempted to explore the scope and impact of a distinct mentor model in alternative child care, its positive outcomes, and some challenges faced, from the perspective of mentor parents. Participants and settingWith a qualitative research design, interviews were conducted with the mentor parents (n = 21) from Udayan Care, to capture their experiences and perspectives. MethodsThe interviews were conducted using an indigenously developed semi-structured interview guide, and the responses were transcribed, organized, coded, and analyzed using applied thematic analysis. ResultsThe unique roles and responsibilities that mentor parents bring to the care system were identified, along with how they add value to the mentor-mentee relationship. Some challenges in the care practice were also discerned. ConclusionsThis paper gleans mentor perspectives that could be valuable for the design and implementation of mentorship programs, encouraging similar scalable models that could support the growth, development, and outcomes of children in care.

The “New Father” Between Ideals and Practices: New Masculinity Ideology, Gender Role Attitudes, and Fathers’ Involvement in Childcare

Abstract Current research demonstrates a gap between widely shared ideals of new fatherhood and men’s limited participation in childcare. Previous studies treat gender attitudes primarily in terms of work and family roles. In contrast, this study centers on perceptions of masculinity as a broader cultural-ideological construct. Specifically, it focuses on “new masculinity ideology,” a previously unexplored masculinity perspective associated with values such as authenticity, emotional expressivity, and holistic self-awareness. Using a sample of around 1,400 employed fathers in the United States drawn from the AmeriSpeak Panel conducted by the National Opinion Research Center, we examined how identification with new masculinity relates to gender role attitudes and three childcare involvement outcomes. Results from moderation analyses based on the computation of simple slopes show that new masculinity played an important role in emotional engagement and parental responsibility but not in routine care. New masculinity moderated the association between father involvement attitudes and childcare outcomes, suggesting that fathers who endorse this ideology are more likely to act in ways that are congruent with their inner beliefs. The breadwinning role appeared to remain important. This study highlights the ways in which the often confounded images of the “new man” and “new father” are conceptually distinct.

Transition from child and adolescent mental health services to adult mental health services: children in care and adopted children

AimsMental health transition-related disengagement is a major public health problem. This study aims to review children in care (CIC) and adopted children's transitions from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). This study aims to illustrate the often overlooked complexities that are associated with this population's transitions.It is hypothesised that this population is at an increased risk for disengagement post-transition. Such is hypothesised as a result of the population's increased prevalence of complex mental health problems, neuro-developmental needs and developmental trauma. This population would benefit from a transition (optimal), as opposed to a transfer of care (suboptimal).MethodThis retrospective case study included young people from Lewisham CAMHS's team for looked after and adopted children. Optimal transition was evaluated using four criteria: continuity of care, parallel care, a transition planning meeting and information transfer.ResultA total of 34 cases (male = 14, female = 20) were included, 88% of which were CIC (12% were adopted children). 85% of the cases included reports of at least one form of abuse and/or neglect. 59% of the cases were categorised as having more than one diagnostic group of mental health problems.30% (n = 11) of the cases were discharged and were not recorded to have re-engaged with Lewisham AMHS. 12% of the cases had an outcome as 'unknown' due to miscellaneous reasons.Only 18% (n = 6) of the cases had an ‘optimal’ transition. 18% (n = 6) had a suboptimal transfer and of those cases, 66% (n = 4) did not engage with AMHS beyond three months post-transfer. 21% (n = 7) were re-referred to Lewisham AMHS after being discharged from CAMHS. None of the re-referred cases engaged with AMHS post-referral.ConclusionIn conclusion, these findings demonstrate that this population is highly complex and can often experience suboptimal transitions from CAMHS to AMHS. Anything less than an 'optimal' transition yields a low ratel of therapeutic engagement. Recommendations for clinical practice includes an extended period of ‘overlap time’ between CAMHS to AMHS for CIC and adopted children. This overlap period will enable mental health practitioners to provide more informed and consistent support that incorporates the needs of CIC and adopted children. Such a provision will enhance therapeutic engagement and subsequently, promote better outcomes for CIC and adopted children. These findings have important resource implications for both CAMHS and AMHS teams.

Addressing Health Inequities for Limited English Proficiency Patients: Interpreter Use and Beyond.

The limited English proficiency (LEP) status of parents is associated with poor health care outcomes in children.1–3 The use of professional interpretation has been associated with improvement in communication errors, patient comprehension, health care use, clinical outcomes, and patient satisfaction.4,5 Yet, professional interpretation continues to be underused.6,7In this issue of Pediatrics, Lion et al8 aim to understand interpreter underuse, with a deeper look into factors associated with interpreter use among health care providers in the pediatric emergency department. They found that physicians and nurse practitioners used interpreters more often than registered nurses and that interpreters were used more frequently for detailed history taking and discharge, in comparison with medication delivery and procedures.In the study, the researchers add to the growing literature questioning how we define and collect data related to medical interpretation. The study reveals how dichotomous terms, such as “interpreter used” and “interpreter not used,” do not accurately encapsulate interpreter use and frequently overestimate time spent with an interpreter. As a result, the benefits of professional interpretation may be even larger than reported because many events are measured as “interpreted,” when, in reality, they are not or not to the extent desirable to achieve the full benefit.Most notably, with the study’s results, the researchers highlight how, even when health care providers recognize the need for an interpreter, they do not always use one. In the majority of encounters with Spanish LEP parents, a professional interpreter was used at least once. By looking at the individual “communication event level,” the authors were able to show that interpreters were only used for only about one-third of the time for the entire encounter. Therefore, even when health care providers recognize the need for an interpreter, evidence bears that there continues to be gaps in their use.Previous work has revealed that these lapses in interpreter services occur because of actual and perceived time constraints by providers and provider perceptions on interpreter quality and role and because families often prefer that a family member conducts the interpretation.9 Although it is important to address these issues through adequate training for interpreters and education for providers on how to use interpreters appropriately and effectively, we must also look at the diversity of our own health care workforce to address these issues.Patient–physician concordance, in which the patient and physician are fluent in the same language, has been shown to improve patient outcomes, including medical adherence, pain management, medical understanding, patient satisfaction, and mental health.10 Yet, there is a discrepancy between the languages physicians and patients speak11 that, if left unaddressed, will continue to grow, as the percentage of LEP patients and families rises.12 Increasing outreach to underrepresented-in-medicine students, dismantling systemic bias in recruitment, valuing multilingual skills,13 and developing inclusive work environments can improve the diversity of our workforce. We must all work together to make sure health care providers can communicate directly with the patients they are caring for so that they are best able to provide high quality care to all, no matter what language they speak.

The educational outcomes of children in care – a scoping review

AbstractThis article presents a brief scoping review of the literature on the educational outcomes of care experienced children and young people in Australia published since 2010. The review also examines key educational issues and the impact of being in care on the educational experience of children and young people. Twenty-five papers were selected for review, key information extracted and recurrent themes noted. Themes include stigma and low expectations, school disruption and absenteeism, issues within the care and education systems and the importance of good relationships with supportive adults. The review found that young people in care often experience much worse educational outcomes than their peers. Conclusions and recommendations include reforming the care and education systems, focussing workers on building strong supportive relationships with young people, helping them to build resilience and prioritising education. Further targeted research is also recommended.

Educating Children in Our Care

In Canada, there is increasing recognition that poor educational outcomes of children and adolescents involved with the child welfare system represent an emerging crisis for youth, their families, and the broader society. Interprofessional education and collaboration between educators and social workers may facilitate better outcomes for children in care. Although interprofessional education (IPE) and interprofessional collaboration (IPC) are well established in the allied health fields, there is not an equivalent acceptance within the applied social sciences, specifically in education and child welfare contexts. This may partially be attributed to the “siloed” nature of these professions, which limits both capacity and opportunities for professionals to understand each other’s mandates, roles, and policies. The purpose of this paper is to describe the development, implementation, and evaluation of a graduate elective course for social workers and educators that was geared toward educational outcomes of children in care. Thirty-eight students from both disciplines participated in a summer institute. Although participants valued the content and process of the course, it is unclear whether these types of initiatives facilitate enhanced IPC. Findings do however suggest that IPE initiatives targeted toward a specific population may have more positive outcomes, compared to general IPC.

Children in care of grandparents and non-grandparents: Which have greater odds of high academic performance?

Much literature exists on social, emotional, and behavioral outcomes for children in care of their grandparents (i.e., grandfamilies), however little is known about academic performance among children living in grandfamilies when compared to other types of nonparental care. We conducted a cross-sectional analysis using secondary data from the United States 2013 National Survey of Children in Nonparental Care. We compare the academic functioning in math and reading/writing of school-aged children (N = 809) cared for by grandparents with two other types of nongrandparental caregivers. Using logistic regression models, we found that compared to children in care of their grandparents, children in care of foster caregivers and nonrelatives in nonfoster settings were approximately 45% less likely to have high academic performance in math and reading/writing. With this research we add to the literature on academic performance of children in out of home placement, setting the stage to compare arrangement options.

RECURRENCE OF INTESTINAL INTUSSUSCEPTION IN CHILDREN

Purpose. To evaluate outcomes in care of children with intestinal intussusception and to analyze the cause of recurrences of the disease. Material and methods. 196 children with intestinal intussusception were taken into the study. In 2009-2019, they all had standard examination, including ultrasound, radiography, laparoscopy and histological examination of the removed tissues. Results and discussions. 32 patients out of 196 children had a disease relapse. It developed after conservative desinvagination. These relapses developed: in 8 children because of the sagging of ileum mucosa into the cecum; in 4 patients- Mechelen diverticulum; in 6 - tumors of the ileocecal angle; in 8 children - hyperplasia of the lymph nodes of the mesentery. In 6 children the cause of intussusception recurrence was not defined. Conservative and laparoscopic desinvagination was not successful in any of cases with returned intussusception. Conclusion. 1) In most cases, intussusception recurrence in children was caused by mechanical factors: sagging of the ileum mucous into the cecum, Mechelen diverticulum, tumors of the ileocecal angle. 2) In case of intussusception recurrence, diagnostic laparotomy and revision of the abdominal cavity are recommended.

Exploring Relational and Parental Factors for Permanency Outcomes of Children in Care

This research examined the impact of individual and relational characteristics of foster parents on permanency outcomes for children in care. Previous research has focused on child and case characteristics. The sample consisted of 233 foster parents from the public child welfare system surveyed at the end of a training. The results of the surveys showed that couple relationship quality and altruism were predictive of reunification of foster children with biological parent. The significant predictors of placement in a residential facility were age, education, and avoidant attachment style of the foster parent. Practice and policy implications are discussed.

Working towards better education for children in care: longitudinal analysis of the educational outcomes of a cohort of children in care in Australia

ABSTRACTInternationally, reviews of educational outcomes of children in care reveal consistent findings highlighting the need for considerable policy attention to be paid to their education to ensure they achieve optimal economic and psychosocial life outcomes. Important to enhancing the educational achievement of children in care are support, stability of environment, teaching resources and the recognition by all stakeholders – birth parents, foster carers, social workers and statutory authorities — that education is paramount to a child’s future well-being. This paper highlights the perspectives of carers, teachers and children on the fostering experience with particular focus on educational outcomes drawing on a prospective longitudinal study of children in long-term care. Using a multimethod, repeated measures multi-informant design, children were assessed by carers and teachers using the Achenbach Child Behaviour Checklist and its companion, the Teacher Report. The findings indicate demonstrated gains in terms of improved scores and adaptive functioning at subsequent assessments following two years of stable care. Discussion of the findings and implications for practice will focus on the need for a coordinated strategy to improve placement continuity and focused professional and organisational support with respect to the emotional and educational needs of children in care.

The role of the Virtual School in supporting improved educational outcomes for children in care

ABSTRACTIn England, ‘Virtual Schools’ oversee and support the educational progress of children in care. This paper reports on the analysis of 16 interviews with Virtual School headteachers that were part of two mixed methods research projects on the educational progress of children in care. These interviews explored their role; the types of support they offer young people in care; what they see as the key factors about a young person’s individual characteristics and care experiences that influence their educational outcomes; how schools support young people in care; and the influence of the foster carer/residential staff on the educational outcomes of these children. The interviews were analysed using NVivo and emerging themes were identified informed by the literature on the education of children in care. The paper draws out the main findings which explore the status and role of Virtual Schools in England, their functions, strategies, and what they see as their contribution to improving the educational outcomes of children in care.

Supporting foster carers to meet the needs of looked after children: A feasibility and pilot evaluation of the Reflective Fostering Programme

This study presents the feasibility and pilot evaluation of the Reflective Fostering Programme (RFP), a recently developed, group-based program to support foster carers, based on the concept of “reflective parenting.” This innovative development follows calls by the National Institute for Health and Clinical Excellence and other organizations to help improve outcomes for children in care by providing better support to their carers. This study aimed to establish whether it is possible to implement the RFP and to gather preliminary data on the acceptability and effectiveness of the program. Twenty-eight foster carers took part in the study. Results indicate that training and delivery of the RFP were feasible; the program was felt to be relevant and meaningful to both foster carers and social care professionals delivering it. Preliminary pre-post evaluation showed a statistically significant improvement in foster carers’ stress, their achievement of self-defined goals and child’s emotion lability and overall strengths and difficulties. There were no statistically significant changes in carers’ reflective functioning, although some foster carers reported on changes in reflective capacity during focus groups. Preliminary findings about the feasibility of training and delivery of the RFP, as well as the acceptability and effectiveness of the program, are encouraging, but further impact evaluation is needed.

How children in foster care engage with loyalty conflict: presenting a model of processes informing loyalty

The increasing emphasis on outcomes for children in care has prompted much research and drawn attention to the importance of harnessing users’ views on the services they receive. However, this awareness is still limited in some areas, one of which is the loyalty conflict experienced by children in foster care who have to negotiate living with a new family while also retaining their birth family membership. This study assesses the extent to which they experience such conflict and how they cope with the challenges it presents. A qualitative methodology, involving semi-structured interviews with 15 children was employed and grounded theory used to inform the data analysis and construction of a theoretical model. The model comprises five core categories: new realities; considering position; making sense; relating emotionally; and working out loyalties. A sixth category, considering others’ perspectives, emerged from respondent validation and an overarching perspective, self-determination, was found to permeate all other processes and contributed to highlighting complexity. New knowledge is gained through seeking the voices of the children and exploring the position they hold by being within and between two families. Implications for practice and future research are also discussed.

The Reflective Fostering Programme: background and development of a new approach

Looked after children represent a vulnerable group in society, many of whom are exposed to maltreatment, particularly in the form of relational trauma, prior to placement with a foster family. Challenging behaviours can place foster placements at risk and looked after children often confront the possibility of placement breakdown. A carer’s capacity to retain a robust understanding of the children in their care as autonomous individuals with needs, feelings and thoughts can be important in enabling them to respond more effectively to the worrying or disruptive behaviour they may encounter. The Reflective Fostering Programme (RFP) is a new group-based programme aiming to support foster carers of children aged 4–11. This innovative development follows calls by the National Institute for Health and Care Excellence (NICE) and other organisations to help improve outcomes for children in care by improving resources for their carers. The RFP is rooted in evidence drawn from the field of contemporary attachment and mentalizing research, which indicates that children who have a carer high in reflective functioning tend to have more favourable outcomes in terms of social-emotional well-being. It also draws on the evidence that looking after a child who has impaired capacity to mentalize as a result of early relational trauma affects the carer’s capacity to mentalize and respond sensitively to the child (Ensink, et al., 2015). This article sets out the rationale for the RFP, outlines its key elements and concludes by indicating future service implementation and a planned feasibility study examining this approach.

Is the Care System to Blame for the Poor Educational Outcomes of Children Looked After? Evidence from a Systematic Review and National Database Analysis

It is recognised internationally that children in out-of-home care (‘children in care’ or ‘children looked after’) generally have lower educational attainments than other pupils. This article provides two forms of evidence that challenge the view that care status in itself can explain this ‘attainment gap’. A systematic review of 28 studies was conducted to assess the evidence on whether being in care is detrimental to young people's educational outcomes. This is complemented by an analysis of administrative data from England, which compares the educational outcomes of children in care at age 16 to those of children in the general population and to other children supported by social services. Taken together, the findings suggest that while research demonstrates an important attainment gap between children in care and children in the general population, this difference is reduced and in many cases disappears when other important factors are taken into consideration to reduce selection bias. We find little evidence that being in care is detrimental to the educational outcomes of children looked after, but suggest that given the heterogeneity of the population, special attention should be paid to different groups of children and their particular needs while in care.