Parental Separation Research Articles

Influencing Factors on Left-Behind Children’s Mental Health

A polarization between urban and rural areas has urged a a growing number of people leave their hometown and go to bigger cities in search for better paying jobs. This has led to a goring number of left behind children in China. Left behind children tend to endure worse mental health. This study hopes to find the influencing factors that might impact the effect of parental separation on left behind children’s mental health. By studying this, people can better protect the mental well-being of the left behind children. This study used secondary analysis, which requires synthesizing previous findings. Previous findings lack in depth investigation into each influencing factor. This study discovered that female left behind children (LBC)have higher rates of mental illness than male LBC, younger LBC have higher rates of mental illness than older LBC, and LBC who communicate with their parents less frequently have higher rates of mental illness than those who maintain close contact with them.

Parent‐child contact problems: Family violence and parental alienating behaviors either/or, neither/nor, both/and, one in the same?

AbstractThis article argues that in order to intervene effectively and ethically with children who are manifesting Parent–child contact problems (PCCPs) after parental separation, we begin by being mindful of what is normal about divorce transitions and use developmentally appropriate and culturally sensitive analysis to rule out children's common transitory reactions. It is then important to concurrently assess for both family violence (FV) and severe parental alienating behavior (PAB) on the part of both parents, which can co‐occur in some cases. The article asserts that it is also important to consider common problematic parenting responses that may potentiate the PCCP but not necessarily rise to the level of abuse. FV is defined as a child's direct experience of physical, sexual, or psychological maltreatment and indirect exposure to sibling abuse and/or to intimate partner violence (IPV). PAB is defined as an ongoing pattern of unwarranted negative messages on the part of one parent that conveys that the child's other parent is disinterested, irrelevant, dangerous, and not to be trusted. Any one or all of these factors may contribute to a child's strident negativity and sustained rejection of one parent, these being defining features of a PCCP. This article proposes ethical principles and priorities for decision‐making in these cases, considering the growing social science controversy about assessment and intervention for PCCPs. It concludes with an analysis of recent, contrasting policy approaches to PCCPs (e.g., Kayden's Law and the Joint Statement of the AFCC and NCJFCJ) and their potential impact on family justice system professionals and the families they serve.

Perlindungan Terhadap Hak Anak Dalam Perceraian Menurut Hukum Keluarga Di Indonesia

The aim of this study is to clarify the legal certainty related to the protection of children who have been separated. The main issues that are central to this issue are: 1) What legal provisions apply to protect the well-being of children affected by the separation of parents? What rights are given to children? Studies using qualitative research methodology. Researchers, they do observational practice, conduct interviews with sources, and document relevant information. The aim of this study was to investigate the influence of religious courts in shaping laws relating to the protection of children affected by divorce. Can the decision of this religious court provide protection for the rights of the child? The current analysis has several implications: 1) Enhancing the role of judges in evaluating and determining custody forchildren victims of divorce. 2) It serves as a framework for judges to assess the rights of children to be recognized and fulfilled.

Adolescent Adjustment to Parental Marital Transitions: Experiences in Urban, Rural and Suburban Communities

ABSTRACT This study aimed to (1) identify the perceived helpfulness of relationships and resources adolescents relied on in their transition to their parents’ divorce or separation and (2) to ascertain any differences in experiences with these resources and relationships based on rurality. A retrospective design was implemented with 47 young adults who experienced parental divorce or separation between the ages of 10 and 18. Three themes were constructed through coding reliability thematic analysis. Participants indicated that helpful resources and relationships provided support in: (a) managing emotions following parental marital transitions, (b) reframing the experience of a parental marital transition, and (c) assistance with boundaries following a parental marital transition. Nearly half of the rural participants did not rely on formal resources (e.g., therapist/counselor), but across rurality levels the perceptions of what made these relationships and resources helpful in adapting to a parental marital transition were similar.

A call for early, effective, and scalable parent education programs for high-conflict separated/divorcing parents: A synthesized perspective from prevention science and family law.

Conflict between parents is stressful and disruptive to children living in the midst of parental separation or divorce. Although some level of post-separation/divorce conflict is understandable in an emotionally-charged separation/divorce, it undermines the extent to which parents protect their children from short- and long-term problems. In this article, we weave together a synthesized perspective informed by our respective training and experience in prevention science and family law on the role of parent education programs for high-conflict separating/divorcing parents. To do so, we first describe the research on the effects of high interparental conflict on children's outcomes and then discuss current approaches and challenges to reducing these negative effects by offering parent education programs for high-conflict separating/divorcing parents. Then, we propose and describe a new model for early, effective, and scalable parent education programs with the ultimate goal of protecting children after separation/divorce.

Early growth, stress, and socioeconomic factors as predictors of the rate of multimorbidity accumulation across the life course: a longitudinal birth cohort study

Early growth, stress, and socioeconomic factors are associated with future risk of individual chronic diseases. It is uncertain whether they also affect the rate of multimorbidity accumulation later in life. This study aimed to explore whether early life factors are associated with the rate at which chronic diseases are accumulated across older age. In this national birth cohort study, we studied people born at Helsinki University Central Hospital, Helsinki, Finland between Jan 1, 1934, and Dec 31, 1944, who attended child welfare clinics in the city, and were living in Finland in 1971. Individuals who had died or emigrated from Finland before 1987 were excluded, alongside participants without any registry data and who died before the end of the registry follow-up on Dec 31, 2017. Early anthropometry, growth, wartime parental separation, and socioeconomic factors were recorded from birth, child welfare clinic, or school health-care records, and Finnish National Archives. International Classification of Diseases codes of diagnoses for chronic diseases were obtained from the Care Register for Health Care starting from 1987 (when participants were aged 42-53 years) until 2017. Linear mixed models were used to study the association between early-life factors and the rate of change in the number of chronic diseases over 10-year periods. From Jan 1, 1934, to Dec 31, 2017, 11 689 people (6064 [51·9%] men and 5625 [48·1%] women) were included in the study. Individuals born to mothers younger than 25 years (β 0·09; 95% CI 0·06-0·12), mothers with a BMI of 25-30 kg/m2 (0·08; 0·05-0·10), and mothers with a BMI more than 30 kg/m2 (0·26; 0·21-0·31) in late pregnancy accumulated chronic diseases faster than those born to older mothers (25-30 years) and those with a BMI of less than 25 kg/m2. Individuals with a birthweight less than 2·5 kg (0·17; 0·10-0·25) and those with a rapid growth in height and weight from birth until age 11 years accumulated chronic diseases faster during their life course. Additionally, paternal occupational class (manual workers vs upper-middle class 0·27; 0·23-0·30) and wartime parental separation (0·24; 0·19-0·29 for boys; 0·31; 0·25-0·36 for girls) were associated with a faster rate of chronic disease accumulation. Our findings suggest that the foundation for accumulating chronic diseases is established early in life. Early interventions might be needed for vulnerable populations, including war evacuee children and children with lower socioeconomic status. Finska Läkaresällskapet, Liv och Hälsa rf, the Finnish Pediatric Research Foundation, and Folkhälsan Research Center. For the Finnish and Swedish translations of the abstract see Supplementary Materials section.

Effect of video distraction on preoperative anxiety scores in pediatric patients undergoing general anesthesia in ophthalmic daycare procedures: A randomized controlled trial.

Parental separation, fear, and exposure to the operating room environment lead to stress and anxiety in pediatric patients. This study aims to identify the research gaps in the effect of video distraction on pediatric patients of Indian origin. We hypothesized that video distraction along with parental presence would reduce preoperative anxiety in pediatric patients undergoing ophthalmic procedures under general anesthesia compared with parental presence alone. In this prospective randomized trial, 145 patients aged 2-8 years, ASA I-II, with at least one functional eye undergoing elective ophthalmic daycare procedures were enrolled. They were randomly allocated to two Groups: Group V had distraction by watching a video/playing a video game together with parental presence, whereas control Group C had parental presence alone without any video distraction. The primary objective of the study was to compare preoperative anxiety using the Modified Yale Preoperative Anxiety score (mYPAS) and heart rate (HR), whereas the secondary objective was to compare child fear, emergence delirium, and parental satisfaction between the two groups. The three time points for intergroup comparisons were the preoperative holding area 10 min before induction (T0), transport of the child to the operating room (T1), and face mask introduction (T2). There was a statistically significant difference between mYPAS score in groups V and C at all time points (P = 0.036, P = 0.0001, P = 0.0000), parental satisfaction score at all three time points (P = 0.0049, P = 0.0000, P = 0.0000), and Child Fear Score at T1 and T2 (P = 0.0001, P = 0.0001, respectively). However, there was no statistically significant difference in the emergence of delirium between the two groups. Video distraction together with parental presence has a promising role for implementation in hospitals with heavy workload settings where pharmacological intervention would not be feasible, to alleviate preoperative anxiety in children. However, preoperative anxiety may not translate into increased postoperative emergence delirium as was earlier believed.

Parental Grandiose and Vulnerable Narcissism and Helicopter Parenting: Mediation Through Parent Separation Anxiety and Parental Contingent Self-Worth

Parental Grandiose and Vulnerable Narcissism and Helicopter Parenting: Mediation Through Parent Separation Anxiety and Parental Contingent Self-Worth

Executive control training for adolescents with ADHD: Study protocol for a randomised controlled trial

BackgroundAttention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental conditions diagnosed during childhood and adolescence. In addition to the commonly observed symptoms of inattention, hyperactivity, and impulsivity, individuals with ADHD often experience impairments in executive functions (EFs). Goal management training (GMT) is a cognitive remediation intervention targeting EFs, with empirical support from studies with adult populations, including ADHD. The objective of the upcoming trial is to assess the effectiveness of GMT for adolescents with ADHD. MethodsThis pre-registered protocol outlines a multi-centre randomised controlled trial (RCT) comparing GMT to treatment as usual (TAU) to improve EFs. We aim to recruit 120 participants, aged 12 to 18 years, recently diagnosed with ADHD. Participants will be randomly allocated to the group-based GMT intervention in addition to TAU, or the TAU condition, through block randomisation with site stratification. GMT will be delivered in groups of four to six participants, with weekly two-hour sessions for seven weeks, complemented by separate parent and teacher sessions. TAU is standard community mental health treatment. The primary outcome measure will be parent-reported EF assessed with the Behaviour Rating Inventory of Executive Function 2 (BRIEF-2). Secondary outcomes will include ADHD symptom measures, social functioning, quality of life, and neuropsychological tests (attention span, inhibition, working memory, and visuo-motor speed). The outcome assessments will be conducted at baseline, 12 weeks, 12 months, and 24 months post-treatment. ConclusionThe study findings will contribute to determine the effectiveness of a non-pharmacological ADHD treatment, including outcome trajectories up to 24 months post-treatment.

Economic Burden of Health Conditions Associated With Adverse Childhood Experiences Among US Adults

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events in childhood, such as experiencing abuse or neglect, witnessing violence, or living in a household with substance use disorder, mental health problems, or instability from parental separation or incarceration. Adults who had ACEs have more harmful risk behaviors and worse health outcomes; the economic burden associated with these issues is uncertain. To estimate the economic burden of ACE-associated health conditions among US adults. In this economic evaluation, regression models of cross-sectional survey data from the 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) and previous studies were used to estimate ACE population-attributable fractions (PAFs) (ie, the fraction of total cases associated with a specific exposure) for selected health outcomes (anxiety, arthritis, asthma, cancer, chronic obstructive pulmonary disease, depression, diabetes, heart disease, kidney disease, stroke, and violence) and risk factors (heavy drinking, illicit drug use, overweight and obesity, and smoking) among the 2019 US adult population. Adverse childhood experience PAFs were used to calculate the proportion of total condition-specific medical spending and lost healthy life-years related to ACEs using Global Burden of Disease Study data. Data analysis was performed from September 10, 2021, to November 29, 2022. Adverse childhood experiences (age <18 years). Monetary valuation of ACE-associated morbidity and mortality using standard US value of statistical life methods and presented in terms of annual and lifetime per affected person and total population estimates at the national and state levels. A total of 820 673 adults, representing 255 million individuals, participated in the BRFSS in 2019 and 2020. An estimated 160 million of the total 255 million US adult population (63%) had 1 or more ACE, associated with an annual economic burden of $14.1 trillion ($183 billion in direct medical spending and $13.9 trillion in lost healthy life-years). This was $88 000 per affected adult annually and $2.4 million over their lifetimes. The lifetime economic burden per affected adult was lowest in North Dakota ($1.3 million) and highest in Arkansas ($4.3 million). Twenty-two percent of adults had 4 or more ACEs and comprised 58% of the total economic burden-the estimated per person lifetime economic burden for those adults was $4.0 million. In this cross-sectional analysis of the US adult population, the economic burden of ACE-related health conditions was substantial. The findings suggest that measuring the economic burden of ACEs can support decision-making about investing in strategies to improve population health.

Suicidal ideation and adverse experiences among adolescents with their separated/divorced parents in Hue city

Background: Suicide continues to be a leading cause of death worldwide. Recently, more than 45,000 children in the age group of 10 to 19 years died by suicide, making it the second leading cause of death in the age group of 15 to 19, surpassed only by traffic accidents, tuberculosis, and fighting. Objective: To determine the prevalence of suicidal ideation among adolescents whose parents are separated/divorced; and to explore the factors associated with suicidal ideation and describe adverse experiences among adolescents. Methods: A cross-sectional descriptive study was conducted in 309 adolescents with separated/separated parents in Hue City. Data was collected through direct interviews using a structured questionnaire. Suicidal ideation was defined as the presence of thoughts or plans related to suicide within the last 12 months. Multivariate logistic regression was applied to identify factors associated with suicidal ideation in adolescents with separated/ separated parents. Results: The study found that 15.5% (95% CI:11.7 - 20.1) of adolescents with separated /separated parents reported experiencing suicidal thoughts, in which men accounted 8.4% (95% CI:5.6 – 11.2) and women accounted 7.1% (95% CI:4.5 - 10.6). Several factors were identified as increasing the risk of suicidal ideation, including alcohol use (OR = 3.24; 95% CI:1.42 - 7.42), hyperactivity/inattention (OR = 4.96; 95% CI:1.58 - 15.605), and a poor quality of family relationships (OR = 4.82; 95% CI:1.26 - 18.50). On the contrary, certain factors were found to reduce the risk, including being in the 14-15 age group of 14-15 (OR = 0.26; 95% CI:0.10 - 0.69) and participating in physical activity (OR = 0.44; 95% CI:0.21 – 0.94). Conclusions: The research highlights a significant percentage of adolescents with separated / divided parents who experience suicidal ideation. Therefore, it is imperative for families, schools, and society to develop comprehensive strategies to monitor and address various risky behaviours among students simultaneously. Key words: suicidal ideation, adolescents, separation/divorce.

Children of Separation: An International Profile

AbstractThis study offers a comprehensive international overview of children from separated families across 13 countries, with an emphasis on the European context. We investigate changes in the number of children experiencing parental separation over birth cohorts (1960–1989) and changes in their social composition using data from the Generations and Gender Survey and official statistics. Results on absolute numbers highlight the impact of demographic shifts and complement previous research that focused on the relative risk of experiencing parental separation. We show that declining fertility rates have, in most countries, mitigated the rise in the number of children affected by increasing separation rates. Moreover, a large majority of contemporary children of separation are born to higher‐educated mothers, demonstrating that the spread of education across parent cohorts outweighed educational risk gradients in shaping the socioeconomic background of children of separation. These findings improve our demographic understanding of children of separation and inform policy targeting family disruption as a social problem and allocating resources to address it.

Review of the Impacts of Parental Divorce on Outsprings

The divorce rate around the world has risen, though only a few investments can be found that have complete conclusion to the future effects on children of the separation of parents. Therefore, in the present study, the impacts of divorce on the next generations are examined by searching and collecting the previous research. The research found that parents’ separation could influence children’s recent psychological state. More significantly, the separation of parents can also have a critical influence on a children's long-term development, an impact that was proven in research to persist into adulthood. Mental illness, worse academic achievements, suicide thoughts, fragile marriage and higher probability of crime are all the impacts of parental divorce. In summary, the consequences of parental divorce are widespread and long-lasting. Based on this, the paper provides suggestions on how to prevent the impact of parental divorce on individuals in youth from the perspective of the family, the school, and the individual.

Understanding Fathers’ Involvement Relative to the Other Parent After Parental Separation

ABSTRACTFollowing parental separation, fathers’ greater or lesser parental involvement relative to the other parent may be differently accounted for by father, child, and coparental factors. A representative sample of 671 separated fathers completed questionnaires two and four years after separation. For fathers less involved than the other parent, a better coparenting relationship accounts for greater T1 involvement, but predicts a decrease in involvement by T2. For fathers more involved than the other parent, a better coparenting relationship accounts for more balanced involvement of both parents at T1 and T2. For all fathers, more custody time accounts for greater T1 and T2 involvement and greater psychological well-being accounts for greater T1 involvement. Implications for intervention and research are discussed.

Comparison of the effects of ketamine via nebulization versus different pharmacological approaches in pediatric sedation: a systematic review and meta-analysis of randomized controlled trials

BackgroundNebulized drug delivery is commonly used in pediatric clinical practice. The growing number of literatures have reported the application of nebulized ketamine in pediatric sedation in recent years. This meta-analysis of randomized controlled trials comparing the efficacy and safety of nebulized ketamine versus different pharmacological approaches was conducted to estimate the effects of this technique in pediatric sedation.MethodsWe searched PubMed, Embase, and Cochrane Library from inception to Feb 2023. All randomized controlled trials used nebulized ketamine as presurgical and pre-procedural sedatives in children were included. Sedative effects and various adverse events were considered as the outcomes.ResultsTen studies with 727 pediatric patients were enrolled. Compared to nebulized dexmedetomidine, using of ketamine via nebulization showed similar sedation satisfaction (54.79% vs. 60.69%, RR = 0.88, with 95%CI [0.61, 1.27]), success rate of parental separation (57.27% vs. 73.64%, RR = 0.81, with 95%CI [0.61, 1.08]), and mask acceptability (37.27% vs. 52.73%, RR = 0.71, with 95%CI [0.45, 1.10]). However, the using of combination of two medications (nebulized ketamine plus nebulized dexmedetomidine) was associated with better sedative satisfaction (33.82% vs. 68.11%, RR = 0.50, with 95%CI [0.27, 0.92]) and more satisfactory mask acceptance (45.59% vs. 71.01%, RR = 0.69, with 95%CI [0.56, 0.86]). Compared with nebulized ketamine, using of nebulized dexmedetomidine was associated with less incidence of emergence agitation (18.18% vs. 3.33%, RR = 4.98, with 95%CI [1.88, 13.16]).ConclusionsBased on current evidences, compared to nebulized dexmedetomidine, nebulized ketamine provides inconspicuous advantages in pediatric sedation, and it has a relatively high incidence of emergence agitation. Combination of nebulized ketamine and dexmedetomidine might be considered as one preferred option in pediatric sedation as it can provide more satisfactory sedative effects. However, there is insufficient evidence regarding nebulized ketamine versus ketamine administered through other routes and nebulized ketamine versus other sedatives. The overall low or moderate quality of evidence evaluated by the GRADE system also calls for more high-quality studies with larger sample sizes in future.Research registrationThe protocol of present study was registered with PROSPERO (CRD42023403226).

Comparative effectiveness of intranasal dexmedetomidine dosing as premedication in paediatric surgery: Randomized controlled trial

: The use of alpha 2 agonists are now becoming the standard of care pre-medication drug in paediatric patients to induce induction and reduce separation anxiety. A prospective, randomized, double-blind, controlled study was designed to assess and compare the effectiveness and safety of two different strengths of intranasal dexmedetomidine in children between the ages of 2 and 8.: Sixty children between ages 2-8 years and of ASA physical status I or II scheduled for elective surgery were randomly assigned to one of two groups. Group A received 1 µg/kg of intranasal dexmedetomidine while Group B received 2 µg/kg as pre-medication. Patients sedation status, behaviour (mask acceptance) and parental separation scores were assessed over 30 min as primary endpoints along with its effect on haemodynamic and respiratory parameters over the same duration as secondary endpoints.: 7.4% of children in group A while 96.5% of children in group B achieved a satisfactory sedation score, 11.1% of children in group A while 100% of children in group B achieved a satisfactory mask acceptance score and 7.4% of children in group A while 100% of children in group B achieved a satisfactory parent child separation score (p&amp;#60;0.001). We did not observe any clinically significant effects of dexmedetomidine on RR, SpO2, HR or MAP and no child required atropine or supplemental oxygen.: We conclude that 2µg/kg dose as compared to 1µg/kg offers multiple advantages of being good sedative, analgesic and anxiolytic in this age group when used as pre-medication.

Retrospective audit of a school-based integrated health-care model in a specialised school for children with externalising behaviour.

Problematic externalising behaviours in adolescents are associated with high individual and societal burden. A school-based multidisciplinary health clinic, Ngaramadhi Space (NS), was developed at Yudi Gunyi School, a specialised behavioural school in Sydney, Australia, to improve access to holistic health-care and behavioural support. This evaluation aimed to describe the demographics, clinic attendance, health screening, recommendations made, and changes in Strengths and Difficulties Questionnaire (SDQ) scores of students attending the clinic. Retrospective evaluation of students including changes in SDQ scores using descriptive statistics (26 July 2016 to 14 May 2019; n = 79). Prior to the assessment, few students engaged with a paediatrician or mental health professional (22.8%; 27.8%, respectively). Child protection services were involved with 76%. NS attendance was high (failure-to-attend = 7.6%; cancellations = 8.9%). New issues found at the assessment included: parental separation (31.6%); trauma history (27.8%); substance use (19%); emotional wellbeing concerns (16.5%), learning difficulties (12.7%), domestic violence (12.7%) and medical conditions (10.1%). SDQ teacher reports showed a significant decrease in total difficulties scores (M = 6.2, SD = 6.165, P < 0.05, eta squared = 1.013 (large effect)) and all subsets. No significant differences in parent and self-reported SDQ. Students with problematic externalising behaviour have unmet health and social needs. The NS school-based integrated health-care model offers a novel, convenient and innovative way to engage these students. This approach has high initial attendance rates with teacher-reported SDQ results showing some behavioural improvement. Further qualitative studies are required.

Specific domains of positive childhood experiences (PCEs) associated with improved adult health: A nationally representative study

BackgroundPositive childhood experiences (PCEs) are supportive relationships and environments associated with improved health when aggregated into composite scores. Adverse childhood experiences (ACEs), a reciprocal measure to PCEs, are associated with worse health in aggregate scores and when disaggregated into measures of specific ACE types (hereafter domains). Understanding the associations between specific PCE domains and health, while accounting for ACEs, may direct investigations and intervention planning to foster PCE exposure. MethodsWe analyzed data from the nationally representative United States longitudinal Panel Study of Income Dynamics. Five PCE domains were examined: (i) peer support and healthy school climate, (ii) neighborhood safety, (iii) neighborhood support, and nurturing relationships with (iv) maternal and (v) paternal figures. Survey weighted logistic regression models tested associations between each PCE domain measure and adult general health rating, controlling for demographic covariates and nine ACE exposures: physical, emotional, or sexual abuse/assault; emotional neglect; witnessing intimate partner violence or household substance use; having a parent with mental illness; any parental separation or divorce; and/or having a deceased or estranged parent. Secondary outcomes included adult functional status and mental and physical health diagnoses. We also tested for statistical interactions between PCE domain and ACE score measures. ResultsThe sample included 7105 adults. Higher scores for the “peer support and healthy school climate” and “neighborhood safety” domain measures showed the most protective relationships with the adverse health conditions tested, most notably for mental illness. The relationship between PCE domain measures and health outcomes was attenuated, but not statistically moderated by ACE exposure. ConclusionExperiencing childhood peer support, a healthy school climate, and neighborhood safety were especially protective against multiple adult health conditions, including for ACE exposed individuals. Interventions that promote PCEs may yield population health gains.

Towards an Implicit Measure of Patient Engagement in Sickle Cell Disease: Relationships between Implicit Measures of Engagement and Previous Childhood Trauma Among Adolescents and Young Adults

Background: Historically, patient engagement among adolescents and young adults (AYAs, age 18-25) decreases, parallel with the shift from parental to patient responsibility for engagement, and the transition from pediatric to adult care. Simultaneously, among AYAs with sickle cell disease (SCD), increases in organ failure, visits for VOCs, and mortality occur during this period. One previously shown predictor of excess hospital and ED utilization is prior childhood trauma, including medical trauma from treatment, parental abuse, or neglect. We found no implicit and few explicit measures of SCD AYA engagement in self-care or cooperation with professional care. We did find that Adverse Childhood Experiences (ACEs) are linked to increased morbidity. Particularly Emergency Department (ED) visits for pain, among children and adolescents with SCD. So, as part of validating an empirically derived implicit measure of SCD AYA engagement, we tested the relationship of the new measure to a validated measure of previous childhood trauma. Method: We studied selected AYA patients (N=20) enrolled in an Adult Sickle Cell Medical Home. Childhood trauma was assessed using the Center for Disease Control's 13-item, Behavioral Risk Factor Surveillance System Adverse Childhood Experience (ACE) module, measuring self-reported exposure to 9 types of childhood adversities: emotional abuse, physical abuse, sexual abuse, household member mental illness, household member substance abuse, witnessing domestic violence, parental separation or divorce, and incarcerated family members. The implicit measure of patient engagement was the draft 4-item Tiers of Engagement (TOE) tool. The original TOE was developed for pediatric patients and assessed parental as well as patient engagement. The adult TOE assesses only AYA engagement. The TOE tool asks professionals of all disciplines caring for SCD patients to confer as a group during interprofessional meetings to subjectively assign ratings of one (ideal engagement) to three (poor engagement) to four different domains: medical, educational, mental, and social. The analysis of variance (ANOVA) test was used to analyze the relationship between the ACE score and each of the engagement sectors (medical, educational, mental, and social). Results: The graphs below show ANOVA results for the relationship of the ACE score to each TOE domain score. We found no significant relationships between ACE scores and TOE domain scores. Conclusion: We observed no significant relationships between childhood trauma and implicitly measured patient engagement among AYAs with SCD. Future research should measure the TOE in larger samples and identify whether the TOE score is related to explicit measures of SCD AYA engagement, or hypothesized predictors of SCD AYA engagement and healthcare utilization. Future research should also utilize the ACE measures to implement trauma-informed care in AYAs with SCD.

Violence, responsibility and best interests: children rights in Elizabeth Harrower’s A Few Days in the Country and Other Stories

Abstract In her short story collection of A Few Days in the Country and Other Stories (2015), contemporary Australian novelist Elizabeth Harrower skillfully portrays a cohort of children who have come of age in diverse fractured family settings since the 1960s. This article delves into the realm of child welfare and best interests in Australia, elucidating the intricate web of family laws that govern these principles. It casts a revealing light on the myriad challenges children confront in contexts marked by family violence, parental separation, and child custody and adoption. This analysis exposes the unfortunate reality where children’s rights are frequently subverted by guardians, effectively preventing their meaningful involvement in familial decision-making. In instances of family violence, children are relegated to the role of silent victims, rendered voiceless by their inability to resist. During divorce proceedings, children are relegated to the sidelines, unable to actively participate in the decision-making process, resulting in the neglect or outright harm of their best interests. Children who find themselves in foster care or adoption situations often respond with unprecedented rebellion, asserting their independence and self-determination beneath the facade of silent victimhood. Tragically, their fundamental rights consistently remain inadequately protected. By undertaking a critical examination of the dynamic between adults and children within the framework of family law and by juxtaposing it with the contemporary portrayal of marginalized children in Australia, as exemplified in Harrower’s works, this article offers multifaceted insights that can guide efforts to safeguard children’s rights and enhance the development and implementation of legislation pertaining to children.