Services For Children Research Articles

493 Increased Utilization of Healthcare Services in Children with Craniosynostosis

INTRODUCTION: Craniosynostosis is a condition characterized by the premature fusion of at least one cranial suture. While evidence suggests that both syndromic and nonsyndromic patients may benefit from developmental, behavioral, and mental health support, data on utilization of healthcare services is lacking. METHODS: The Optum Clinformatics® DataMart database was queried to identify 1340 patients with craniosynostosis. Long-term utilization of mental health care, rehabilitation therapies, and other medical services up to age six was calculated. Rates of utilization were compared to healthy controls (n = 1577) and children with plagiocephaly (n = 1249). RESULTS: Mental health care was utilized more frequently in craniosynostosis patients (8.1%) compared to plagiocephaly (5.0%, p=0.0020) and healthy controls (2.9%, p<0.0001) . Physical, occupational and speech therapy were more frequently used by plagiocephaly than craniosynostosis patients (14.1% vs. 11.2%, p = 0.0283), which was significantly higher than use by controls (11.2% vs. 3.9%, p<0.0001). Other medical subspecialty services (developmental pediatrics, ophthalmology, optometry and audiology) were utilized by 37.0% of craniosynostosis patients, compared with 20.9% (p<0.0001) and 15.1% (p<0.0001) of plagiocephaly and healthy controls, respectively. Among craniosynostosis patients, utilization was not uniform by age; while ophthalmology utilization did not differ by age (p = 0.1003), mental health care was most commonly used among older children (p = 0.0107). CONCLUSION: In this study, we demonstrate that children with craniosynostosis utilize mental health care, rehabilitation therapies, and other medical subspecialty services at a higher rate than controls. While surgical correction may be considered an isolated event, these children should be monitored for developmental and mental health support longitudinally. Future work should explore risk factors driving utilization, including suture involvement, repair type, and comorbidities.

Availability and Uptake of Community-Based Rehabilitation and Inclusive Development Services for Children with Spina Bifida in Southwestern Uganda

Background: It is over a decade since services for children with Spina bifida were established in Uganda, which has increased the survival rate after Spina bifida repair through follow-ups. Such children have significant disability and other complications, which damage the central nervous system. The consequences of this are more profound in low-income countries if post-operative and long-term care interventions are not well adhered. This study explored the availability and uptake of community-based rehabilitation and inclusive development services to children with Spina bifida in Southwestern Uganda. Methods: A qualitative approach was adopted. The study considered a sample size of 110; 50 children (aged between 0 and 10 years) with Spina bifida were assessed on aspects QoL, while 50 parents and 10 professionals participated in the study. Interviews and children assessments were done at OURS and during home visits between January and April 2019. Results: Special services to children with Spina bifida were offered at one facility; OURS in the whole of Southwestern Uganda. Neuro surgeons and doctors from CURE hospital work with a team from MRRH and OURS. The findings indicated that improved health outcomes resulted from long-term rehabilitation services. These were friendly and free at OURS. Awareness about Spina bifida has been created in communities through Spina bifida associations. 82.3% of the assessed children of school-going age were not in school, some of them were had developed more health complications. Children with Spina bifida traveled long distances to access specialized services. Their peers socially excluded children. Specialized services were not offered at lower health units. Conclusion: This study concluded that such services could be extended to lower levels of healthcare delivery (at least Health Centre IV) in order to shorten the distance. The academic institutions could train more neuro surgeons and doctors and more funding should be availed through MoH.

Why young people stop taking their attention deficit hyperactivity disorder medication: A thematic analysis of interviews with young people.

BackgroundAttention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that can persist into adulthood. Young people often stop taking ADHD medication during adolescence despite evidence that continuation would be beneficial. Increasingly, young people are restarting medication in early adulthood suggesting that cessation was premature. In this paper we explore the reasons given by young people for discontinuing ADHD medication.MethodsQualitative data from the Children and Adolescents with ADHD in Transition between Children's and Adult Services (CATCh‐uS) project was analysed to look for reasons for stopping medication. Semi‐structured interviews with three groups of young people were analysed using thematic and framework analysis; this included young people prior to transition (n = 21); young people that had successfully transitioned to adult services (n = 22); and young people who left children's services prior to transition but re‐entered adult services later (n = 21).ResultsReasons given by young people for stopping ADHD medication included the following: the perceived balance between benefits and adverse effects of medication; perceptions of ADHD as a childhood or educational disorder; life circumstance of the young person and challenges young people faced in accessing services.ConclusionsA multidimensional approach is needed to address discontinuation of ADHD medication in order to improve the long‐term prospects and quality of life for these young people. Possible approaches include access to non‐pharmacological treatments and improved psychoeducation. As many reasons given by young people are not unique to ADHD, these findings are also of relevance to medication adherence in other chronic childhood conditions.

Peran Pendidikan Agama Kristen Terhadap Pembentukan Moral Anak Sekolah Minggu

This paper is a theological analysis of the current post-modern situation and conditions showing that there has been a degradation of moral quality in the Indonesian nation, especially in hildren. Many aspects affect the symptoms of moral degradation.The role of parents in motivating Sunday School Children to Worship is not paying enough attention, marked by the lack of children attending worship/child services at the church or happy cottage. The use of less creative learning methods using only one method makes children uninteresting to hear stories and come to the children's service. Then the funding for Sunday School development did not get the attention of the church council, causing Sunday school teachers to go up and down the house to sell groceries to finance Sunday school activities.Christian religious education in moral formation essentially brings a spiritual change for the better (cognitive), which educates, teaches, and achieves a business with a future goal of noble character and fear of God. The moral formation of Sunday school children can be given formally in schools, non-formally in the church environment, namely the assembly, Sunday school teachers and informally in the family as the spearhead in the moral formation of children. These educators are required to be more creative in formulating learning patterns, methods, learning curricula and provide more funding to advance and develop Sunday school. In the application that very important role is 'exemplary' in everyday life, both the example that has been given by God Jesus as a great teacher, an example that is formally displayed by PAK; informal, and informal as well as the application of the 'dining table theory' as exemplified by the Lord Jesus. Of course, all of this cannot be separated from adjusting to the needs and growth and development of children according to conditions and characteristics in a holistic, effective and creative way.This study uses a descriptive qualitative approach, where the data obtained are in the form of an explanation of the concept or text and not numbers. The results of the study concluded that the role of Christian religious education on the moral formation of Sunday school children in the GMIM Golgotha congregation was able to develop the potential of Sunday school teachers to create the method of "Active, Creative, Effective, and Fun Learning in organizing Sunday school worship, building holistic service partnerships"

Are we starting to ‘think family’? evidence from a case file audit of parents and children supported by mental health, addictions and children's services

Key Practitioner Messages Cases are complex and families can feel overwhelmed by the number of agencies and referrals involved. Systemic, family‐focused practice can lead to improved outcomes; this should be consistent across mental health, addictions and children's services. Efforts to promote interagency collaboration include: clear job descriptions; co‐locating services; home visits; interprofessional education; and joint training. Joint decision‐making can help acknowledge and value everyone's role and contribution. Better recording and sharing of data can support informed, complex decision‐making and optimise support services.

Incorporation of Telehealth Into Multidisciplinary Clinics: Visits Via Video Offer Advantages for Team and Families.

Shelter in place orders in the coronavirus disease 2019 (COVID-19) pandemic necessitate changes in how medical care is delivered. We describe our method for team telemedicine visits for California Children's Services, a state insurance for children requiring multidisciplinary care, to demonstrate how such visits can be efficiently conducted. Although the physical distance provides some obstacles, telemedicine visits can also improve some elements of the team visit.

A critical review of cost‐effectiveness research in children's social care: What have we learnt so far?

AbstractThis article presents the findings from a critical review of cost‐effectiveness research in children's social care. With a focus on the past 20 years (since 2000), the review aims to assess the use and consistency of definitions relevant to evaluating cost‐effectiveness such as financial input (costs) and outcomes, and to review and summarise learnings from cost‐effectiveness studies in the English children's social care system. We included both academic and grey literature and identified 61 relevant publications for inclusion. The results are organised according to three themes: costs, outcomes and cost‐effectiveness. We identified that a large proportion of studies contained a discussion on cost, spend or unit cost, and an equal proportion of articles concerned outcomes of service, benefit to children or quality of service provided. The number of studies discussing cost‐effectiveness, cost–benefit or economic evaluation was considerably smaller. The findings highlight substantial gaps in the literature, with a disproportionate focus on stating the problem in terms of cost pressures, and very little robust evidence about cost‐effectiveness. Furthermore, the article sets out methodological limitations and indicates a lack of transparency in many of the report studies. We conclude that as a result of the gaps and limitations it is difficult for policymakers and other stakeholders in children's services to make evidence‐informed decisions about the best use of their limited resources.

Blended learning: Maintaining clinical placements for child nursing students during the COVID-19 pandemic

Clinical placement is an essential part of nursing education. students undertake 2300 hours of clinical learning throughout the programme ( Nursing and Midwifery Council [NMC], 2018: 1 ). Societal and service changes mean creative transformation is needed to develop sustainable placement opportunities ( Carolan et al, 2020 ; NHS England, 2021a ). A blended placement was developed and piloted in community-based children's services. The blended placement gave child nursing students the possibility of experiencing services during the COVID-19 pandemic, by utilising digital and virtual opportunities. Students were placed in the 0–19 public health integrated nursing service, and the integrated children's additional needs service. Two cohorts comprising 25 students undertook the placement. Students and practice supervisors were surveyed on completion of the placement. Survey findings demonstrated three aspects of a good placement experience – information provision, perceived learning opportunities and student support. Recommendations for future blended placements include improved timetabling and information provision adaptions to meet student expectations.

All about … military nurseries

What is nursery life like for children, staff and families at military bases such as those on Cyprus? Helen Lakey, Defence Children Services early years advisor, explains

Telephone Triage Toolkit for Children's cancer services: A quality initiative.

Service development to improve patient safety and experience, and improve staff safety and confidence when managing telephone calls from parents or carers of children with cancer in the UK. A multi-layered mixed methods approach broadly based on sequential PDSA (plan, do, study, act) cycles, to a series of quality initiative projects spanning 14 years. Various project styles and methods are described. A Telephone Triage Toolkit for children's cancer services was piloted, reviewed and rolled out across the UK. Similarities were identified between adult and paediatric cancer services when identifying the case for need, enabling partnership working. A scheduled review completed in 2020 included new developments in cancer treatment, building on user experience, local audits and national feedback, leading to a 2nd edition being implemented. Ground up, quality initiatives and collaborative working across organisations can be complex but draws on a wider pool of expertise and can lead to improved parent and staff experience of services. This initiative has improved practice and has application outside the UK.

School Health Services for Children with Chronic Health Conditions in California Public Secondary Schools: Findings from the 2018 School Health Profiles Survey

Background: More than 20% of school districts in the United States do not have policies on identification and case management for students with chronic health conditions (CHCs), suggesting that these students’ health needs may not be met during the school day. Prior research reports a gap in policy implementation and the actual provision or operationalization of the policy into action. Significance: While there is limited research on school health policies, little is known about the actual provision of the services that such policies indicate should be provided. Notably, the actual provision of health services in U.S. schools, particularly regarding CHC management and its association with school nurse employment, is underreported. Methodology: Using data from the 2018 School Health Profiles (SHP) Survey, health services including administering daily medication, providing stock rescue medication, providing case management, facilitating community partnering, and providing disease-specific education were examined in California public secondary schools together with school nurse employment. Complex sampling analysis and chi-square statistics were used to examine the statistical associations. Results: A significantly greater proportion of schools with a full- or part-time nurse compared with schools with no nurse provided: (1) daily medication administration (82.1% vs. 68.1%; p = .014); (2) case management services (75.8% vs. 62.0%; p = .031); (3) disease-specific education for parents and families (44.9% vs. 25.7%; p = .016); and (4) parent and student connection to health services in the community (83.7% vs. 72.2%; p = .035). Conclusion: Findings suggest that nationally representative data, such as SHP, contain important information for states to review regarding school health policies and provision of services. Further research needs to expand these findings to better understand school health policy and practice and its alignment with state and federal laws to support all children, especially those with CHCs.

Extra-Institutional Factors Limiting Access to Rehabilitation Services for Children with Cerebral Palsy: Perspectives of Caregivers in Marsabit County, Kenya

Disability, CBR and Inclusive Development aims to enhance knowledge in the field of disability and inclusive development, addressing the needs of practitioners, policy makers, DPOs and the scientific community.

Linking Leeds: A Social Prescribing Service for Children and Young People.

The use of social prescribing interventions for common mental health issues is expanding as clinicians seek to diverge from the traditional medical model of treatment. This intervention allows for the referral of patients to a nonclinical social activity via a link worker. Evidence for the benefits of social prescribing is growing. Most evidence is based on adults; however, a smaller number of studies involving children and young people have produced encouraging results. This evaluation reports on data routinely collected by the Linking Leeds service between 9 January 2019–11 January 2020. Linking Leeds provides Social Prescribing for people aged 16 years and above; however, the current paper focuses on service users aged between 16 and 25. Their aim is to connect people to services and activities in their community in order to benefit overall health and mental wellbeing. This evaluation of the Linking Leeds program supports the growing body of evidence to support the benefits social prescribing can have on young people’s mental health. Two main mechanisms were identified which underpin social prescribing in young people: social connectedness and behavioural activation.

Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings.

In low tuberculosis-burden countries, children and adolescents with the highest incidence of tuberculosis (TB) infection or disease are usually those who have immigrated from high-burden countries. It is, therefore, essential that low-burden countries provide healthcare services to immigrant and refugee families, to assure that their children can receive proper testing, evaluation, and treatment for TB. Active case-finding through contact tracing is a critical element of TB prevention in children and in finding TB disease at an early, easily treated stage. Passive case-finding by evaluating an ill child is often delayed, as other, more common infections and conditions are suspected initially. While high-quality laboratory services to detect Mycobacterium tuberculosis are generally available, they are often underutilized in the diagnosis of childhood TB, further delaying diagnosis in some cases. Performing research on TB disease is difficult because of the low number of cases that are spread over many locales, but critical research on the evaluation and treatment of TB infection has been an important legacy of low-burden countries. The continued education of medical providers and the involvement of educational, professional, and non-governmental organizations is a key element of maintaining awareness of the presence of TB. This article provides the perspective from North America and Western Europe but is relevant to many low-endemic settings. TB in children and adolescents will persist in low-burden countries as long as it persists throughout the rest of the world, and these wealthy countries must increase their financial commitment to end TB everywhere.

Impacts of race on family reunification: A longitudinal study comparing exits from Quebec's child welfare system

BackgroundIn the United States, Black children spend more time in out-of-home placement than other children and are less likely to experience family reunification following involvement with child welfare services. Within Canada, very few studies have examined Black children's exits from the child welfare system and factors influencing their service trajectory. ObjectiveThis study, the first of its kind in Canada, uses longitudinal clinical administrative data to examine reunification outcomes for Black children following placement in out-of-home care. Participants and settingThe study population includes 1395 children receiving ongoing child welfare services in Quebec between April 1, 2002 and March 31, 2011. MethodsA longitudinal research design from anonymized clinical administrative data extracted from a single child welfare agency in Montreal. Survival analysis using a Kaplan Meier and Cox proportional hazard regression examined the trajectory and chances of family reunification from the point of each child's initial placement. ResultsBlack children spend longer lengths of time in out-of-home placement and are less likely to experience family reunification when compared to other children. Poorer reunification outcomes for Black children were associated with placement instability, the age of the child and reasons for child welfare involvement. ConclusionsWhile we tend to prioritize prevention services for vulnerable communities, this study indicates that attention must be given to services all throughout Black children's service trajectory to ensure that these children are able to exit the child welfare system in a timely manner.

Risk of food insecurity in undocumented migrant households in Birmingham, UK.

This study aimed to understand the extent of household food insecurity amongst undocumented migrant families in Birmingham,UK. Cross-sectional survey of households (n=74) with dependent children using the USDA 18-item household food security (HFS) module. All households had an irregular immigration status and were accessing an immigration advice drop-in service (n=98 adults; n=138 children) in Birmingham. About 95.9% of households were food insecure, and 94.6% of children lived in households with low or very low food security. Food insecurity varied within households. Around 91.8% of adults were food insecure, compared to 75.6% of children. Spearman's rank-order correlation indicated a statistically significant positive correlation between household food insecurity level and number of children (rho=0.253, P=0.031). A Kruskal-Wallis H Test indicated no statistically significant difference (P=0.730) in HFS score between households supported by asylum support, children's social services or paid employment in the informal economy and those that had no regular income. Prevalence of HFS was higher in this sample of undocumented migrant households with dependent children in Birmingham, UK, than in the wider population, and larger households were more food insecure. Households without a regular income were no more likely to be food insecure than households with financial support.

Providers’ Perspectives on Implementing Mobile Crisis Services for Children and Youth in Connecticut

Providers’ Perspectives on Implementing Mobile Crisis Services for Children and Youth in Connecticut

The Effect of Parental Social Integration on the Physical Examination Utilization for Young Migrant Children: A National Cross-Sectional Study in China.

Purpose: Physical examination is a key component of child health management. Migrant children are a vulnerable group with lower healthcare service utilization, and this study aims to explore the effect of parental social integration on the physical examination service utilization for young migrant children under 6 years old in China.Method: This study conducted a secondary data analysis of the 2014 National Internal Migrant Dynamic Monitoring Survey in China. A total of 2,620 participants were included in this study. A total of 22 indicators were selected to measure social integration. Multivariate logistic regression was used to explore the association between parental social integration and physical examination use of young migrant children.Results: More than half (66.4%) of the migrant children aged 0–6 years had used free physical examination. Parental social integration, especially structural integration, was associated with the physical examination utilization of migrant children. Specifically, those migrant children's parents who had medical insurance (P < 0.05; OR = 1.29), who had participated in local activities (P < 0.001; OR = 1.98), who had registered local residents as neighbors (P < 0.05; OR = 1.34), and who had a deep sense of self-identity (P < 0.05; OR = 1.09) were more likely to take children to use physical examination.Conclusions: This study provided evidence that parental social integration was associated with migrant children's physical examination utilization, and this association was multifaceted, lying in the dimensions of economic, structural, and psychological integration. Improving the social integration of migrant parents would be effective to enhance the migrant children's healthcare service utilization.

The role of foster carers in England and Portugal: Is it solely a parenting role?

AbstractThe role of foster carers can be described as similar to the role of parents, but with some additional tasks. Through focus groups, children in care, young adults who are care‐experienced, foster carers, and social workers in England and Portugal shared their views on this role. Key themes included the need to promote children's sense of belonging and relationships with foster carers and their birth family, to support children's individual needs, and to recognise the influence of children's social care services, social workers and foster carers’ family and social network. Foster carers and social workers in the English sample talked about the complementarity between the parenting side of the role and these additional tasks. On the other hand, children and young adults in both samples, and foster carers and social workers in the Portuguese sample, focused mostly on the parenting side of the role, but also stated the importance of some additional tasks, such as collaboration with children's birth families. These findings reflect policies and alternative care context differences between England and Portugal.

Building Inpatient Pediatric Readiness for the Clinically Deteriorating Child.

Building Inpatient Pediatric Readiness for the Clinically Deteriorating Child.