Service Provision For Children Research Articles

“It All Goes Back to the Services”: A Rural/Urban Comparison of Service Providers’ Perceptions of Challenges and Facilitators to Disability Services

Purpose: The purpose of this qualitative study was to explore rural/urban differences in service providers’ perceptions of challenges and facilitators to services for children with special health care needs (CSHN) and their families in southeast Georgia. Methodology: A total of 23 individual interviews were conducted with service providers in one rural county in southeast Georgia (N = 12) and in one urban county in north central Georgia (N = 11). Interviews were based on the National Survey of Children with Special Health Care Needs 2009-2010 survey. All interviews were audio recorded, transcribed and coded with the intent of identifying themes and illustrative quotes. Findings: Service providers discussed a variety of challenges to accessing services related to socioeconomic status and the transition out of the school system. Urban and rural service providers’ perceptions were similar overall, with the exception of lack of transportation and access to a variety of services in rural area. Service providers overcome challenges through identifying parents’ needs and limitations and adapting service provision. Some of the facilitators mentioned by both urban and rural service providers are availability of transportation and resources. Practical Implications: The results of this study provide public health practice and policy implications that could guide the pathways of targeted interventions to improve the access and availability of variety of services for CSHCN. Originality/value of paper: This paper represents an in-depth exploration of service provider’s perceptions of challenges and facilitators related to service provision for children with special healthcare needs.

Enhancing Family Support in Practice through Postgraduate Education

Family Support as a named orientation is a relatively new concept in service provision for children and their families in the Republic of Ireland. Notwithstanding this, there are a number of practitioners across a range of disciplines and agencies within this arena who apply a Family Support approach in their day-to-day work. Furthermore, it is increasingly expected that these practitioners and agencies work together in a collaborative manner with the intention of providing the best possible assistance and support. Practitioners are also required to develop their knowledge and skills on an ongoing basis while in practice. One model of postgraduate education which is responding to such developments is the Master’s Degree in Family Support Studies. This programme is delivered in one University in the Republic of Ireland. In 2011, the programme was reviewed to assess its influence on participants’ understanding and knowledge of Family Support and on their practice. A mixed methods approach was used in this review, the results of which provide the basis for this article. At an overall level the programme is found to have a very positive influence on participants with a growing pool of practitioners who are skilled and confident in their practice.

Counseling Self-Efficacy, Quality of Services and Knowledge of Evidence-Based Practices in School Mental Health

Counseling self-efficacy (CSE), defined as one's beliefs about his or her ability to effectively counsel a client, is an important precursor of effective clinical practice. While research has explored the association of CSE with variables such as counselor training, aptitude and level of experience, little attention has been paid to CSE among school mental health (SMH) practitioners. This study examined the influence of quality training (involving quality assessment and improvement, modular evidence-based practices, and family engagement/empowerment) versus peer support and supervision on CSE in SMH practitioners, and the relationship between CSE and practice-related variables. ANCOVA indicated similar mean CSE changes for counselors receiving the quality training versus peer support. Regression analyses indicated that regardless of condition, postintervention CSE scores significantly predicted quality of practice, knowledge of evidence-based practices (EBP) and use of EBP specific to treating depression. Results emphasize the importance of CSE in effective practice and the need to consider mechanisms to enhance CSE among SMH clinicians.Keywords: self-efficacy, school mental health, evidence-based practices, counselor training, depressionThere are major gaps between the mental health needs of children and adolescents and the availability of effective services to meet such needs (Bums et al., 1995; Kataoka, Zhang, & Wells, 2002). This recognition is fueling efforts to improve mental health services for youth in schools (Mellin, 2009; Stephan, Weist, Kataoka, Adelsheim, & Mills, 2007). At least 20% of all youth have significant mental health needs, with roughly 5% experiencing substantial functional impairment (Leaf, Schultz, Kiser, & Pruitt, 2003). Further, less than one third of children with such mental health needs receive any services at all.The President's New Freedom Commission on Mental Health (2003) documented the position of schools as a point of contact and universal natural setting for youth and families, recognizing schools as a key factor in the transformation of child and adolescent mental health services (Stephan et al, 2007). In the past 2 decades, there has been a significant push for full-service schools that expand beyond a sole focus on education, and employ community mental health practitioners to respond to the emotional and behavioral needs of students (Conwill, 2003; Dryfoos, 1993; Kronick, 2000). The education sector is the most common provider of mental health services for children and adolescents (Farmer, Bums, Phillips, Angold, & Costello, 2003), with 70%-80% of youth who receive any mental health services obtaining them at school (Bums et ah, 1995; Rones & Hoagwood, 2000). Therefore, attention must be paid to the quantity, quality and effectiveness of school mental health (SMH) services.School Mental HealthIn recent years, SMH programs, supported by both school staff (e.g., school psychologists, social workers, counselors) and school-based community mental health clinicians, have emerged as a promising approach to the provision of mental health services for students and families (Weist, Evans, & Lever, 2003). The growth of these programs has facilitated investigation of what constitutes high-quality SMH service provision (Nabors, Reynolds, & Weist, 2000; Weist et al., 2005). This work has been supported and furthered by the Center for School Mental Health, a federally funded technical assistance and training program to advance SMH programs within the United States. In collaboration with other SMH centers (e.g., UCLA Center for Mental Health in Schools) and interdisciplinary networks focused on school health, consensus was reached to develop a guiding framework defining best practices in SMH (Weist et al, 2005). These principles call for appropriate service provision for children and families, implementation of interventions to meet school and student needs, and coordination of mental health programs in the school with related community resources, among other things. …

Parental perceptions of information needs and service provision for children with developmental disabilities in rural Australia

Purpose: Rural Australians comprise a third of the population. However, there are relatively few research studies that have focused on issues for children with developmental disabilities in rural regions. In particular, there is very limited research that gives voice to parents regarding challenges faced by them due to their location in rural regions. Methods: This article is based on the qualitative component of a mixed-methods study undertaken in rural settings. In-depth, face-to-face interviews were conducted with 17 parents yielding 30 h of information rich taped data. Thematic analysis techniques were used to identify major issues. Results: Three core themes emerged from analysis of the qualitative data regarding information and support needs: an ongoing lack of timely and relevant information about disabilities and support services; inadequacies in interactions with service providers particularly doctors and allied health staff; and considerable challenges and barriers to access and use of health services. Conclusions: Within the constraints of limited rural service provision, there are still opportunities for considerable improvements, through focussed in-service training to narrow the information gap, improve provider-client interaction around attitudinal issues and uptake of tele-health to minimise the long waiting times and the need to regularly travel long distances to access services and setting up online support groups.Implications for RehabilitationThere is limited information on challenges faced by parents of children with developmental disabilities in rural Australia.The challenges around lack of information about support systems available add to parental stress as does limited experience, frequent staff turnover and poor attitude of many service providers.There is a need to improve rural service provision. Feasible options within resource constraints include focussed in-service training to narrow the information gap, improve provider-client interaction around attitudinal issues, and uptake of tele-health services.Setting up of parent-professional support groups as well peer support groups using digital technologies will help reduce the sense of isolation for rural carers and minimise impediments related to travelling long distances.

Making the best use of assistive technology for children in Romania: a case study

Using a case example, this article demonstrates the role of occupational therapy in the field of low assistive technology for children with disabilities in Romania. When making decisions about assistitive devices for a particular person in a particular situation, the occupational therapist needs to be aware of the family’s socioeconomic backgound as well as the sociopolitical and cultural climate for practice. The article describes a client-centred approach with an emphasis on function and wellbeing in the provision of long-term services for children and their families. Future research should be conducted on strategies to improve occupational therapy practice using assistive technologies in relation to the health and wellbeing of children with disabilities.

Frequency and Pattern of Documented Diagnostic Features and the Age of Autism Identification

The DSM-IV-TR specifies 12 behavioral features that can occur in hundreds of possible combinations to meet diagnostic criteria for autism spectrum disorder (ASD). This paper describes the frequency and variability with which the 12 behavioral features are documented in a population-based cohort of 8-year-old children under surveillance for ASD, and examines whether documentation of certain features, alone or in combination with other features, is associated with earlier age of community identification of ASD. Statistical analysis of behavioral features documented for a population-based sample of 2,757 children, 8 years old, with ASD in 11 geographically-defined areas in the US participating in the Autism and Developmental Disabilities Monitoring Network in 2006. The median age at ASD identification was inversely associated with the number of documented behavioral features, decreasing from 8.2 years for children with only seven behavioral features to 3.8 years for children with all 12. Documented impairments in nonverbal communication, pretend play, inflexible routines, and repetitive motor behaviors were associated with earlier identification, whereas impairments in peer relations, conversational ability, and idiosyncratic speech were associated with later identification. The age dependence of some of the behavioral features leading to an autism diagnosis, as well as the inverse association between age at identification and number of behavioral features documented, have implications for efforts to improve early identification. Progress in achieving early identification and provision of services for children with autism may be limited for those with fewer ASD behavioral features, as well as features likely to be detected at later ages.

A Comparison on Inclusive Practices for Children with Special Needs in Faith-Based Kindergartens in Hong Kong

This qualitative study aimed to examine the inclusive practices implemented in three faith-based kindergartens in Hong Kong. A questionnaire was used to collect information about school backgrounds, students' special needs, teacher training, special education services, curriculum design, school policy, parental involvement, and challenges faced by these schools when implementing their inclusive practices. The primary focus of this study was the influence of faiths on the provision of inclusive services for children with special needs. The results indicated that faiths, along with other factors, have played a significant role in contributing to the inclusive education services provided to children in these schools.

Children’s Services - Working TogetherChildren’s Services - Working Together

Divided into four sections, this book’s 26 chapters offer an analytical overview of children’s development and the impact professional teamwork can have on the provision of services for children.

Health-promoting schools: evidence for a holistic approach to promoting health and improving health literacy.

Chronic diseases are now the major causes of death and disability worldwide, and non-communicable diseases (NCD) account for the majority of the global health burden. About half of premature deaths are related to health-risking behaviours that are often established during youth and extend to adulthood. While these diseases might not be curable, they are preventable. Prevention is possible when sustained actions are directed at individuals and families, as well as at the broader social, economic and cultural determinants of NCD. A 'life-course' approach to promoting healthy behaviour should begin early in life. The aim of this article is to discuss the impact of the 'health-promoting school' (HPS) on improvements in youth health. HPS can be described as a holistic, whole-school approach in which a broad health education curriculum is supported by the environment and ethos of the school. HPS moves beyond individual behavioural change to consider organizational and policy change such as improving the physical and social environment of the school, as well as its curricula and teaching and learning methods. A positive culture for health would facilitate higher levels of health literacy by helping individuals tackle the determinants of health better as they build the personal, cognitive and social skills for maintaining good health. There is reasonable evidence to demonstrate that the whole-school approach using the HPS framework is effective in improving health, ranging from physical activities and healthy eating to emotional health. Schools adopting the HPS framework have demonstrated changes in culture and organizational practice to become more conducive to health improvement. These schools were reported to have better school health policies, higher degrees of community participation, and a more hygienic environment than non-HPS schools, and students in these schools had a more positive health behaviour profile. Health promotion and disease prevention is essential to reduce the healthcare burden of children and adolescents. HPS would help to combat the global burden of childhood obesity by promoting healthy eating behaviours and encouraging higher levels of physical activity. There are gaps in service provision for children and adolescents from both the health and education perspective; the HPS framework has the potential to develop a mechanism of closer integration with the primary healthcare system, making youth health services more school based and student centred. A new model of interconnection between HPS and different components of primary healthcare can be evolved to make services for disease prevention and health promotion more student friendly.

Evaluation of services for children with complex needs: mapping service provision in one NHS Trust

The aim of this paper is to identify and descriptively map the key characteristics of the model of service delivery in operation, and to explore the user, carer and professional experience of service provision. This included an exploration of congruity and mismatch between the different stakeholder groups. In the United Kingdom (UK), 15% of the children under five years of age and 20% of the 5 to 15-year age group are reported to have a complex long-term condition, with the likelihood of having a condition increasing according to socio-economic circumstances. An increasing number of young people with complex needs are now surviving into late adolescence and early adulthood. However, service provision for children with complex needs is an area that, nationally, has been underdeveloped. An exploratory single-site case study was undertaken across one Primary Care Trust in the UK. Documentary and policy review were undertaken along with in-depth qualitative exploration. Eighteen in-depth interviews were undertaken with relevant stakeholders and professionals across the multidisciplinary teams. Families with children between 12 months and 16 years of age who have continuing complex care needs were invited to take part in an interview to give their views about the care they receive. Interviews focused on the family experience and understanding of the child's condition, transition between secondary and primary care, effectiveness of admission and discharge planning and the overall contribution of different professionals. Professionals were also asked about their experiences of delivering care. Findings This study highlighted issues of communication between professionals and with parents and children as a major factor in determining the quality of service provision. Key aspects relating to the model of service provision, namely, paucity of communication, interagency collaboration and the parent as health worker, are highlighted. Parents experienced both health and social service communication challenges when seeking care for their child. These challenges can be located within a general systems theory and hierarchy approaches to understand the complexity of service provision.

A survey of current care for children and adults with osteogenesis imperfecta in Glasgow

<h3>Introduction</h3> There are scarce reports of the clinical caseload and the provision of services for children and adults with osteogenesis imperfecta (OI). <h3>Aims</h3> To perform a survey of the clinical characteristics of patients with a diagnosis of OI that attend metabolic bone and genetic clinics in the city of Glasgow <h3>Methods</h3> Clinical details of 53 children (M:28) and 23 adults (M:9) were obtained by review of case records obtained from the Genetics and Occupational therapist lists. <h3>Results</h3> The median age at presentation in children was 4.5 years (range 0.2-13.5), with 14/53 (26%) diagnosed within the first year. Of the 53 children, 33 (62%) had fracture onset within the first year, 17 between 1-5 years and 1 after 5 years. 34 (64%) had peak fracture frequency of 1-4 fractures per year with 4 (8%) having &gt;5 fractures per year. Peak fracture occurrence was between 1-5 years (47%). Skeletal deformities were recorded in 23 children (43%) and 6 adults (26%). Pain was recorded as a problem in 31 (58%) children and 10 (43%) adults. Most patients were fully mobile; 6 children and 1 adult had very limited mobility. In children, input from occupational therapy, dentistry, orthopaedics, genetics, physiotherapy and pain team was recorded in 35 (66%), 34 (64%), 23 (43%), 14 (26%), 9 (17%) and 2 cases, respectively. DXA scan was performed in 48 (90%) children but the results were uninterpretable in 30%; 18 (78%) adults had DXA scans. Spinal XR were performed in 52/53 (98%) children with normal results in 13, compression fractures in 17 and spinal deformity 16. All 6 adults who had spinal XR had compression fractures. Serum Vitamin D was measured in 85% children and 74% adults with levels &lt;50 nmol/l in 25 (47%) children, and 10 (43%) adults. 21 children and 12 adults were prescribed Vitamin D. Bisphosphonates were prescribed in 36 (68%) children and 11 (48%) adults. 8 (15%) children and 3 (13%) adults were recorded to have had orthopaedic interventions. Positive family history was recorded in 31 (58%) children and 17 (74%) adults. In 25/31 children and 11/17 adults with positive family history affected family members were offered appointments. <h3>Conclusion</h3> OI is a rare, life-long, skeletal condition requiring multidisciplinary specialist input. There is a need to develop standards of care that can facilitate long-term care.

The value of an inter-agency pathway for Attention Deficit Hyperactivity Disorder (ADHD)

Introduction: This article, co-authored by experts in research, child and adolescent mental health, occupational therapy and education services, considers service provision in Attention Deficit Hyperactivity Disorder (ADHD). Contents: This article outlines the roles of those who are involved in service provision for children and young people with ADHD, and identifies the challenges faced by ADHD services. Care pathways are then described, with details of factors that need to be considered in the mapping of potential local pathways. Conclusions: The development of local care pathways for the diagnosis and management of ADHD is suggested as a method of meeting the challenges identified.

Expectations and experiences of accessing and participating in services for childhood speech impairment

Speech impairment (speech sound disorder) is a high prevalence condition that responds well to early intervention provided by speech-language pathologists (SLPs). However, not all children in Australia are able to access necessary speech-language pathology services. The aim of this research was to investigate Australian parents' experiences of accessing and engaging in speech-language pathology services for their children with speech impairment. Two studies were conducted to achieve this aim. In Study 1, questionnaires were completed by 109 parents of pre-school children who had been identified with concerns about their speech. Only a third (n = 34, 31.2%) of the parents had previously accessed speech-language pathology services for assessment of their children's speech and just 29 of these (26.6% of the entire sample) reported their children had received intervention. Two thirds (n = 68, 62.4%) of the parents had not sought speech-language pathology services and half of these (n = 35, 32.1% of the entire sample) reported that “services were not needed”. There was a small number of parents (n = 7, 6.4%) who had attempted to access services but had been unsuccessful. Parents identified teachers, family, friends, and doctors as important sources of information about their children's speech. In Study 2, interviews were conducted with 13 of the parents to discuss their experiences of speech impairment and service delivery in greater depth. Parents expected that others would make them aware of their child's speech impairment and that they should be able to access speech-language pathology services when required. Consequently, there is a need to raise awareness about speech impairment and speech-language pathology services to ensure appropriate identification, referral, and service provision for children at risk.

Lifelong Learning in Public Libraries in 12 European Union Countries: Policy and Considerations

Public libraries have traditionally provided key inputs to support lifelong learning. More recently, significant social and technological changes have challenged this sector to redefine their role in this field. For most public libraries in Europe this has meant continuing their role as providers of information and advice while increasing services to help learners with processing and evaluating knowledge. In some cases, new roles are undertaken with limited legislative changes and stagnant levels of funding. A consortium representing 12 European Union (EU) countries, ENTITLE, undertook a survey amongst its members in 2008–09 to scope policies and strategies linking learning and public libraries. This paper uses results from this survey to establish a typology of lifelong learning in public libraries in these countries. It explores how traditions, institutions, and policies influence learning provision at public libraries. The results show strong provision of learning services for children in almost all these countries, but inconsistent provision for adults. The paper argues that there is a divergence amongst these 12 countries in terms of innovation and resourcing. Those with a stronger provision benefit from local autonomy, the drive and skills to create partnerships, and formal legal and strategic recognition as partners in this agenda.

Preventing violence to women and children in the home: an overview

It has been estimated that 4 to 16% of children are physically abused and 1 in 10 are neglected or psychologically abused, the vast majority of the time by their...

General surgery of childhood: guidance to commissioners and service planners

The Children's Surgical Forum (CSF) has published new guidance for commissioners and service planners to ensure the continued availability of general surgery for children that is safe, sustainable and close to home. The guidance, Ensuring the Provision of General Paediatric Surgery in the District General Hospital, aims to provide a tool for establishing managed clinical networks across NHS boundaries that will support the provision of routine surgical services for children in local hospitals.

The development and provision of educational services for children with intellectual disabilities in Egypt

This paper aims to provide an overview of the development and provision of educational services for children with intellectual disabilities in Egypt. Intellectual disability is a significant sub-average general intellectual functioning existing concurrently with deficits in adaptive behaviour and manifested during the developmental period. The education of children with intellectual disabilities is a right endowed and authorised by the Egyptian government. The Ministry of Education in Egypt is keen to provide those children who have intellectual disabilities, along with other children with special needs, with an appropriate education that addresses their needs and allows them to live in society using their full potential, as typically developing children. Observations and interviews were carried out to collect further information about the educational services the children with intellectual disabilities receive in Egypt. The findings of this study indicated that, despite the efforts exerted by the Ministry of Education, to provide advanced and new services for children with intellectual disabilities, the provision may still need improvements. A series of recommendations was suggested to improve the services that children with intellectual disabilities receive in Egypt.

Adequação da demanda de crianças e adolescentes atendidos na Unidade de Emergência em Maceió, Alagoas, Brasil

OBJETIVOS: avaliar a adequação da demanda de crianças e adolescentes atendidos na Unidade de Emergência Doutor Armando Lages em Maceió - Alagoas, Brasil. MÉTODOS: estudo observacional-transversal de 2153 registros de crianças e adolescentes atendidos na Unidade de Emergência, em 1998, 2001 e 2004. Variáveis: sexo, idade, setor e horário do atendimento, procedência, internação, tipo de agravo e adequação da demanda, segundo critério de Furtado et al. Para testar associações entre variáveis de interesse foi utilizado teste do Qui-quadrado, adotandose nível de confiança de 95%. RESULTADOS: entre os 2153 registros analisados, 1792 (83,2%) foram classificados como não adequados. Predominaram usuários do sexo masculino (1252 - 58,2%), entre 10 e 18 anos (931 - 43,2%), residentes em Maceió (1742 - 81,1%), atendidos à tarde (800 - 37,2%), no setor de pediatria e com agravos do Capítulo XIX da Classificação Internacional de Doenças (1039 - 48,3%). A não adequação da demanda foi maior no sexo feminino, entre 10 e 18 anos, atendida no horário da manhã e residente próximo à Unidade de Emergência. CONCLUSÕES: verificou-se alto percentual de não adequação da demanda de crianças e adolescentes à Unidade de Emergência. Esse resultado sinaliza para o não atendimento às necessidades de saúde na rede básica do Sistema Único de Saúde em Alagoas.

ADHD service provision by paediatricians: UK survey

PurposeVarious guidelines are available to help effectively manage attention deficit hyperactivity disorder (ADHD) in children. This paper aims to determine the current service provision for children with ADHD in the UK.Design/methodology/approachA cross‐sectional survey of the UK paediatricians was conducted online.FindingsA total of 93 completed survey forms were received. Of the clinicians, 71 per cent assessed one to five new cases every month; 51.6 per cent clinicians followed up six to 20 children, whereas 29 per cent followed up 31 to 50 cases per month. A total of 77.4 per cent worked jointly with CAMHS. There was no support by a nurse to 83.9 per cent and a junior doctor to 71 per cent clinicians. Share care was in place in 74.2 per cent; 19.3 per cent did not have a local guideline. Audit of the ADHD clinic was done by 71 per cent responders.Originality/valueThe paper reveals that service for children with ADHD offered by paediatricians showed wide variation. There is a need for more provision of resources to enable comprehensive assessment and multimodal treatment for ADHD.

Developmental disabilities: challenges for research practices and policies in the 21st century

Some of the issues include: how can modern research be translated into everyday practices and policies? How can we make use of new biomedical, psychosocial, and public health technologies? And, particularly in Central and Eastern Europe, how can we eradicate the deep-rooted myths about developmental disabilities that have shaped practices in the past? In the past 20 years many innovative services have been introduced in the area of childhood disability. It is sad however, that the huge amount of research in the field of developmental disabilities 1 has not resulted in full implementation of basic rights for children with disabilities. A similar gap between the results of good research and translating such research into everyday practice has also been identified in the area of mental health services 2,3 For many decades children with developmental disabilities in countries in Central and Eastern Europe were held hostage to state policies of institutionalization and medicalization, according to what was then perceived as the science of ‘defectology’ (i.e. children with developmental disabilities were ineducable and should be institutionalized) and child psychoneurology (i.e. providing highy medicalized care for children with emotional and behavioural problems). In many countries of this region more resources are still allocated to institutional care for these children than to providing community-based and family-focused services. Apart from institutionalization, other practices aimed at solving the problems of children with disabilities, although well intentioned, have sometimes led to tragic mistakes. These include treating autism and mental retardation* as ‘diseases’ and employing ‘therapies’ that are mostly ineffective or even harmful, often based on manipulating the hope of parents for a ‘miraculous’ cure for their child with disabilities. As a member of the committee for the implementation of the United Nations Convention on the Rights of the Child, I have had a unique opportunity to observe that the rights of children with developmental disabilities ‐ the right to education or the right to live with their parents rather than in institutions ‐ are seriously challenged all over the world. Although the second half of the 20th century has been marked by obvious progress in this field, children with disabilities in many countries of the world are suffering from grave violations of their basic rights. There are many safeguards that can be put in place to prevent mistakes in the provision of services for children with disabilities and in investing in research. One of the strongest protective factors is a rights-based approach. Dialogue between politicians, professionals, researchers, and parents of children with disabilities is a prerequisite for effective implementation of modern, evidence-based services based on a human rights approach. Modern research on genetic and biomedical determinants of disabilities needs today to be better integrated with social research and the social model of disability that is currently dominating disability policies and practices. The social model of disability acknowledges that obstacles to full participation and inclusion for children with disabilities reside in the social environment rather than in the individual and that such barriers can and must be prevented. Most of these obstacles and barriers are of an attitudinal nature, and this fact needs to be addressed more convincingly in research as well as in provision of services. We must avoid the mistakes of the past and implement the principles of participation, inclusion, and autonomy for children with developmental disabilities through better interaction between biomedical and social research and practices and policies.