• It is critical to increase engagement among at-risk families in parenting programs. • Assessing parent readiness for change is crucial to prevent dropout and low adherence. • We developed a brief, reliable measure of parental readiness for change for at-risk parents. • The results support the validity and reliability of the PFRCS-SV. • The scale is suitable for various settings, including research and clinical or social services. Low education and socioeconomic status are consistent predictors of low enrolment and dropout in parenting programs and family support services. Therefore, it is crucial to understand how to enhance the reach of these services, particularly for at-risk families. The Parent Readiness for Change Scale is a self-report measure developed to assess parents’ readiness for change in parenting programs, and it has been studied mostly with middle-class samples. The present study aimed to develop a short-form version of the PRFCS (PRFCS-SF) suitable for parents with low literacy and psychosocial risk. As specific aims, we examined the factorial structure, convergent validity, and reliability of the PRFCS-SF. The sample consisted of 94 Portuguese parents (76.6% mothers), with a mean age of 36.52 years ( SD = 10.61) and a low level of schooling. The participants were recruited from social welfare agencies, public child protection services, and prisons. The original factor structure was replicated. A three-factor solution emerged from the principal component analyses: Pre-contemplation, Contemplation, and Action. The subscales showed a good internal consistency and significant correlations among them. Convergent validity was also supported. Globally, the results support the suitability of the PRFCS-SF for parents with low literacy from at-risk contexts. The brief version of the PRFCS developed in the current study can be applicable in different contexts, including research, clinical settings, and social services.

Lead is a nonessential, toxic heavy metal that causes widespread environmental contamination, affecting humans, animals, plants, and ecosystems. Globally, an estimated 800 million children have blood lead levels (BLLs) above 5 µg/dL. Lead persists in the environment and accumulates in the body, particularly in bone, due to its chemical similarity to calcium. This review aimed to summarize the prevalence, environmental sources, molecular and cellular mechanisms, dose-dependent toxic effects, and mitigation strategies related to lead exposure. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar to identify relevant studies published between 2010 and 2025. Both peer-reviewed and gray literature were qualitatively synthesized. The findings indicated that lead exposure is pervasive, with detectable levels in 100% of participants in EU biomonitoring studies. In the United States, ~590,000 children under 5 years of age had BLLs above 3.5 µg/dL. Lead disrupts essential metal homeostasis, induces oxidative stress, causes mitochondrial dysfunction, disrupts calcium signaling, impairs heme synthesis, and triggers DNA damage, endoplasmic reticulum stress, cell membrane injury, and impaired signal transduction. Experimental studies in mice and chickens demonstrated dose-dependent accumulation in blood, tissues, and organs, accompanied by significant decreases in Zn, Fe, Mg, and Ca levels and elevated oxidative stress markers. Effective mitigation strategies include regulatory policies, environmental remediation, occupational safety measures, public health education, maternal and child health interventions, food and water safety measures, technological innovations, and continuous monitoring. This review showed that lead remains a significant public health threat and underscores the need for targeted and equity-focused interventions.

ABSTRACT This paper offers a comprehensive analysis of French Law No. 2023-451, 1 1 LOI n° 2023-451 du 9 juin 2023 visant à encadrer l'influence commerciale et à lutter contre les dérives des influenceurs sur les réseaux sociaux (1), JORF n°0133 du 10 juin 2023, Texte n° 1. <https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000047663185>. the first integrated European legislation to comprehensively regulate digital influencers. The law fundamentally redefines the influencer’s status, shifting from that of a ‘free-speech content creator’ to a ‘responsible economic actor’ subject to strict legal obligations in areas such as public health, financial services, advertising transparency, and child protection. The legislation mandates a written contract for all commercial collaborations, explicitly prohibits the promotion of certain high-risk activities, including cosmetic surgery and unlicensed digital assets, and establishes criminal liability for serious violations. It also addresses the legal status of non-resident influencers by requiring them to appoint an EU-based legal representative and to hold professional liability insurance covering activities targeting French audiences. More broadly, this law marks a decisive departure from voluntary self-regulation toward a robust legal framework that carefully balances freedom of expression with consumer protection, with particular attention to child influencers. The paper concludes that the French model offers an advanced and forward-looking reference for regulating the ‘influencer economy’ in the digital age.

ABSTRACT In this study, we explore the relational dimensions of resilience among adolescents in Iceland during the COVID-19 pandemic. Using the frameworks of social-ecological resilience and the embodied, social, and public child, we examine how resilience manifests through interactions with family, peers, and community. Participants employed tactical trust and creative strategies to navigate restrictions, transforming digital and physical spaces into sources of social connection. Their critical engagement with public health policies highlighted vulnerability as integral to resilience. Our findings reveal resilience as an active, context-dependent process shaped by relational and systemic factors, offering insights for inclusive, child-centered public health strategies.

ABSTRACT Technical assistance (TA) seeks to influence organizational change and improve system outcomes while continuous quality improvement (CQI) aims to help organizations adopt data-driven improvements. This paper presents a case study of CQI strategies in a national TA center serving public child welfare agencies. Three themes about how CQI can influence TA types and quality emerged: 1) building a proactive and data-focused infrastructure, 2) prioritizing infusion of multiple stakeholder perspectives, and 3) embedding flexibility into services and prioritizing realistic, achievable outcomes. These strategies influenced TA that facilitated changes in agency policy and practice as well as outcomes for children and families.

ABSTRACT The National Child Welfare Workforce Institute supported four public child welfare agencies in developing worker well-being interventions through site action teams. Ripple effects mapping (REM), a storytelling method for capturing expected and unexpected outcomes, was used to assess the initiative’s impact. Using appreciative inquiry, team members shared stories that were mapped to visualize ripple effects. Thematic analysis of seven REM group sessions identified individual, unit, and organizational impacts, including increased knowledge, empowerment, peer support, and inclusion in decision-making. Findings demonstrate REM’s capacity to capture meaningful impact and highlight how action teams helped cultivate a healthy workplace culture and worker well-being.

Stunting is a major public health issue, particularly in developing countries, causing long-term physical and cognitive impairments in children that reduce their quality of life and future productivity. To address this challenge, this study aims to develop an IoT-based smart detection system for child growth monitoring, enabling quicker and more accurate detection of stunting risks. The proposed system combines both hardware and intelligent software components to measure key growth indicators—height, weight, and BMI—using digital sensors and microcontrollers, transmitting the collected data to a cloud platform for real-time analysis. Machine learning algorithms, such as Support Vector Machine (SVM) and Extreme Gradient Boosting (XGBoost), are employed to predict stunting risk. Experimental results show that the XGBoost model outperforms SVM, achieving an accuracy of 80%, precision of 82%, recall of 78%, and F1-score of 79.9%, compared to SVM’s accuracy of 70%, precision of 68%, recall of 65%, and F1-score of 66.4%. This research provides a scalable technological framework for real-time stunting monitoring and early intervention, with the potential for implementation in resource-limited settings. By supporting national stunting reduction initiatives, the system enhances public health innovation and child welfare.

Child welfare caseworkers have significant decision-making authority, ultimately determining if allegations are substantiated, if a case should be opened for ongoing services, and if removal from the parental home is required. This research considers the role of caseworker turnover on these decisions, considering decisions for 372,968 unique screened-in reports assessed by 2,128 unique child welfare caseworkers in Wisconsin. Specifically, this study uses logistic regressions to estimate the likelihood of maltreatment substantiation, case opening, child removal, and the timeliness of the assessment as a function of the caseworker's timeline to departure from the public child welfare field, net of case-related characteristics, caseworker demographics, and county/year fixed effects. Results indicate that the odds of substantiation, case opening, and timely assessment are lower as caseworkers near departure. Findings expand our understanding of the consequences of turnover, highlighting how it influences case decisions and providing insight into effects on child and family well-being.

ABSTRACT Formal partnership agreements (FPAs), such as contracts, Memorandums of Understanding, or service agreements, are tools for aligning human services across systems and sectors. Yet, specific elements of FPAs most critical for supporting service alignment remain unclear. This mixed methods study examines whether inclusion of FPA elements addressing shared purpose, data, and governance were associated with timely receipt of services. We conducted qualitative analysis on FPAs (n = 57) between public child welfare agencies and private behavioral health providers participating in a cross-sector systems intervention in 26 Ohio counties. These data were linked with quantitative analysis of county-level administrative data on a key process outcome: timeliness of substance use treatment receipt for families involved in the child welfare system. Findings suggest that treatment timeliness was higher in counties where FPAs emphasized shared purpose across partners. FPAs may support cross-sector and multi-system collaboration by clarifying service alignment goals.

ABSTRACT The use of artificial intelligence (AI) to analyse big data in child protection holds significant potential for enhancing early detection, risk prediction and intervention in child abuse cases. This qualitative study explores the use of AI‐driven big data in child welfare in South Korea by exploring the perspectives of 10 child protection experts from public child protective services, data science and academia, recruited through purposive and snowball sampling. Thematic analysis identified AI's potential to improve the identification of at‐risk children, enhance data‐driven decision‐making and detect patterns of re‐abuse, contributing to more proactive intervention. However, substantial challenges emerged, including low predictive accuracy, the absence of qualitative and contextual data, misalignment between predictive systems and service delivery, workforce and operational constraints and gaps in follow‐up support. Ethical concerns—particularly regarding privacy, surveillance and discriminatory impacts on economically disadvantaged families—were also highlighted. Although participants viewed AI as a valuable tool that provides foundational data and strengthens early intervention, they emphasized the need for human judgment clearer operational guidelines, improved data literacy and integrated service systems. To ensure human‐cantered and ethical implementation, robust governance frameworks and sustained investment in service infrastructure are essential.

The Australian Pharmaceutical Benefits Scheme was changed on 15 January 2021 to provide people aged <18 years access to government-subsidised pre-exposure prophylaxis (PrEP) for HIV. This study investigated healthcare and service providers' attitudes and practices in discussing PrEP and impacts on PrEP prescribing practices, and the differences in the provision of PrEP to young adults aged >18years compared with people aged <18years. An online cross-sectional survey, conducted February to November 2023, used purposive, convenience and snowball sampling to recruit healthcare providers eligible to prescribe PrEP (GPs, nurse practitioners) and non-prescribing healthcare/service providers (sexual health nurses, HIV community workers) in Australia. Young people were split into three age groups for comparison between young adults (aged 18-24 years) and adolescents, including those above (aged 16-17 years) and below (<16 years) the age of consent in Australia. Cross-tabulation with Pearson's chi-squared and Fisher's exact tests were performed to investigate sexual health and PrEP-related attitudes and practices. Of the 122 respondents, 40.2% (49/122) were nurses, 18.0% (22/122) GPs, 11.5% (14/122) HIV community workers, 11.5% (14/122) were another profession (including public health physician, LGBTIQA child and family practitioner, social worker, counsellor), 10.7% (13/122) were sexual health physicians, 6.6% (8/122) nurse practitioners and two were HIV specialists. Most (73.8%, 90/122) reported initiating PrEP conversations with 18-24-year-olds, compared with 13.1% (16/122) with those aged >16years. Of the 48 (39.3%) eligible PrEP prescribers, 47.9% (23/48) reported feeling 'extremely/somewhat' comfortable assessing PrEP eligibility, 41.7% (20/48) reported awareness of 2021 Pharmaceutical Benefits Scheme changes and 18.8% (9/48) reported changes to prescribing practices. Prescribers were significantly more likely than non-prescribers to consider PrEP suitable (54.2% vs 35.8%, P<0.05) for clients aged <16 years. Guidelines and prescribing criteria need to reflect current Pharmaceutical Benefits Scheme eligibility for young people to support healthcare prescriber decision-making in recommending and prescribing PrEP for HIV for young people where appropriate. Greater education, training and support is required for healthcare providers to improve provider confidence in discussing sexual health needs, and recommending and prescribing PrEP to young people to optimise the possible benefits of access to sexual health services and PrEP in this priority sub-group.

We explored the provision of single-session interventions (SSIs) in public child and adolescent mental health service (CAMHS) provision, using freedom of information (FOI) requests to gather data from National Health Service (NHS) trusts. FOI requests were sent to all NHS trusts in England with CAMHS in 2024, seeking information on SSI use, delivery, and implementation. Responses from participating trusts indicated that most trusts did not use SSIs, with varied deployment of SSIs in those that provided them. Some trusts reported plans to expand SSI provision. Although SSIs are used in some CAMHS, variability in practice and reporting suggests a need for further research into decision-making and strategies for the implementation of SSIs in different localities.

Introduction: Between 2020 and 2025, Cuba experienced a profound healthcare collapse, exposing structural weaknesses in a system long praised for universal coverage. Economic decline, political constraints, and institutional limitations hindered service delivery, leading to shortages of essential supplies and personnel.Objective: To examine the main factors driving the deterioration of Cuba’s healthcare workforce and assess the resulting public health consequences, including maternal and child health, resurgence of preventable diseases, and urban–rural disparities.Methods: A review of secondary sources, including official Cuban statistics, international health reports, and independent media, was conducted to analyze trends in physician migration, workforce shortages, resource limitations, and health outcomes.Results: Low salaries, restrictive policies, and supply shortages triggered a large-scale exodus of physicians and healthcare professionals. Consequences include rising maternal and infant mortality, outbreaks of preventable diseases such as measles and dengue, and widening urban–rural health disparities. Cuba’s diminished capacity has also weakened its role in global health diplomacy, threatening regional health security.Conclusions: Without urgent economic, institutional, and policy reforms, Cuba’s healthcare system risks irreversible deterioration. Immediate measures are needed to retain healthcare professionals, ensure adequate resources, and maintain domestic and international public health standards.

Public education spending, family background, and child education attainment

BackgroundCongenital anomalies, encompassing structural or functional defects present at birth, pose a significant global health challenge. Addressing congenital anomalies can contribute significantly to further reducing neonatal mortality and advancing overall child health in Ethiopia.ObjectiveThis study aimed to assess the magnitude, pattern, birth outcome, and determinants of congenital anomalies among newborns in Ethiopia.MethodsEmploying a facility-based cross-sectional design over one month, the study enrolled 813 deliveries attending two public and private maternal and child health centers. We used consecutive sampling of all eligible deliveries who fulfils the inclusion criteria during the study period and meticulously screened for congenital anomalies using a well-designed pictorialized data collection tool by training pediatricians and midwives. To determine the strength of the association and identify independent predictors of birth defects, the adjusted odds ratio (AOR) and 95% confidence interval were computed using binary logistic regression analysis.ResultsForty-six neonates (5.66%, 95% CI: 4.17%–7.47%) had one or more congenital anomalies detected on physical examination. Of these, 36 had a single anomaly, while 10 had multiple malformations. There were a combined 60 anomalies among the 46 newborn babies. The majority of the patients had central nervous system anomalies (31.7%), followed by genitourinary system (25.4%) and musculoskeletal system (22.2%) anomalies. The odds of birth defects increased by 3.73 for women attending a private hospital compared to those attending a public hospital (AOR 3.73, 95% CI 1.67, 8.32). The odds of birth defects were 1.97 times greater for males than for females (AOR 1.97, 95% CI 0.99, 3.91; p = 0.051), which is clinically or practically significant even if the p value is slightly above the cutoff point, 0.05. The odds of birth defects were found to be 9.3 times greater among neonates with very low birth weight and low birth weight than among neonates with appropriate birth weight (AOR 9.29, 95% CI 3.41, 25.31). Primipara women had 3.64 times greater odds of delivering babies with birth defects than did multipara women (AOR 3.64, 95% CI 1.45, 9.13). In this study, perinatal mortality was markedly higher among newborns with congenital anomalies (37%) compared to those without anomalies (1%), and this difference was statistically significant (p < 0.001).ConclusionIn conclusion, this study provides important insights into the prevalence, patterns, birth outcomes, and predictors of congenital anomalies. The high anomaly rates highlight the need for comprehensive prenatal care, including early diagnosis, risk factor monitoring, and targeted interventions for private MCH clinics, male neonates, low birth weight infants, and primipara women. Further longitudinal research and collaboration with the Ministry of Health to establish a congenital anomaly surveillance system can improve the understanding and management of these conditions.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12887-025-06403-z.

ABSTRACT More scholarship is needed to explore workplace and systems factors that may protect child welfare professionals from poor well‐being outcomes, including secondary traumatic stress (STS). This study explored whether tenets of a team‐based culture were associated with levels of STS symptoms. This project is a secondary analysis of data collected through a routine quality improvement survey on organizational culture and climate in a statewide public child welfare system ( n = 518). Child welfare professionals with low levels of STS had significantly higher psychological safety and workplace connectedness scores than respondents with moderate levels of STS. Both psychological safety and workplace connectedness predicted STS scores using a cross‐sectional regression analysis. However, mindful organising was not associated with lower STS scores. Child welfare work is often team‐based, and strategies aimed at strengthening teams may have a downstream impact of protecting against STS. Within team culture, psychological safety and workplace connectedness may be uniquely related to STS.

ABSTRACT Background Foster care agency communications and interactions in the process of becoming foster parents are examined as these variables can affect the retention and recruitment of foster parents. Materials and Methods A statewide survey was conducted of foster parents associated with the public child welfare agency. Binary logistic regression analyzed predictor variables such as satisfaction with their recruitment workers, ongoing workers, with their training experience, and with agency communications as well as personal variables. Results Multivariate analysis revealed that foster parents who have adopted from foster care, were satisfied with their R & C worker, and the child’s ongoing worker impacted the foster parent’s desire to continue. Having adopted from foster care, and having greater satisfaction with the child’s worker, ongoing training, and overall communication with the agency positively impacted foster caregivers’ desire to recommend fostering to others. Discussion The strongest predictor for both dependent variables, adopting a child, indicated those individuals who adopted were three times more likely to recommend fostering to others, but two times more likely to discontinue fostering – for reasons discussed. Conclusion Agencies may need to stress the importance of staff improving communications during training, supporting foster parents during recruitment, and working with the child.

Abstract We investigate how female representation impacts policymaking using the example of child care and new hand-collected data on local council elections in Bavaria. RDD estimations (mixed-gender races for last party-specific council seats) show that an additional female councilor accelerates the expansion of public child care by 40%. We also document an important nonlinearity: an additional woman accelerates the expansion of child care only in councils with few women. Council meeting minutes reveal that women can be effective in councils despite being a nonpivotal minority because they change “the conversation.”

The purpose of statutory oral health care services based on the Health Care Act (implemented 01 May 2011) and Decree (implemented 06 April 2011) is to provide equal services nationwide for all children. The aim of this register-based study was to explore the implementation and content (multiprofessional co-operation, absenteeism and the need for family's special support) of statutory oral health examinations and screenings among a group of Finnish preschool children. The study group consisted of the medical records of Finnish children in the City of Oulu from three different age groups (born in 2014-2018, n = 2,023-2,456). In this pilot study, data on dental examinations/screenings and missed appointments and their reasons of 206 randomly selected preschool-aged were collected from patient records in oral and public child health clinics during March 2022 to July 2022. Referrals within oral health care, along with the occupations of those referred to, were registered. Chi-squared or Fisher's Exact Test was used to evaluate differences between three age groups. Results: Across different age groups, 8.7% - 21.4% of children dropped out of statutory oral health care services. Dentists performed only a small proportion of oral health examinations for preschool-aged children (3.1%). Co-operation between oral health professionals was scarce. They rarely solved the reasons for missed appointments of dental care visits (5.1%). No referrals to Child Protection Services were made from oral health care. Conclusion: In this group of preschool children, implementation of Health Care Act and Decree was only partially completed. Absenteeism from statutory oral health care, addressing the need for Child Protection Services, and lack of multiprofessional co-operation seem to be causes for concern. Further research and attention to this topic is necessary.

This paper focuses on the topic of marital conflict and how it can be conceptualized and processed in the child’s mind through a psychoanalytic intervention carried out in public services, that is, child and family mental health and social welfare services operating within the Italian public healthcare system. As is often the case in the Italian context, in public mental health services for children and their families, interventions are typically reserved for patients with multiple diagnoses, leaving at-risk cases—those requiring clinical attention—on long waiting lists. Such situations of family conflict and emotional distress observed in public child and family services, however, could benefit from psychoanalytically-informed interventions capable of preventing future maladjustment. After providing a theoretical and clinical framework of the concept of co-parenting—understood as a psychic space offered to the child to accompany them through the phases of mental growth—I will highlight the most meaningful elements from a year-long weekly psychoanalytic psychotherapy with a seven-year-old boy. I believe this child allowed his mind to begin thinking again (Bion, 1962) and to emotionally reinvest in the surrounding world, reintroducing a virtuous cycle into family life that enabled more adequate care for each member’s emotional experiences.