Service Delivery For Children Research Articles

Enhancing Care Planning Training for Children’s Services Social Workers in a Health & Social Care Trust in Northern Ireland—a Mixed Methods Study

ABSTRACT Care planning for Looked After Children (LAC) is accepted as being critical in ensuring good outcomes for LAC, however, the available evidence base highlights that despite the introduction of key legislation across the UK, that care planning for LAC remains inconsistent. There is limited Northern Ireland (NI) specific research available that relates to care planning for LAC; with the care planning experience of LAC being referenced in the recent review of Children’s services in NI, (Jones, R. (2023). The report of the independent review of Northern Ireland’s children’s social care services. https://www.cscsreviewni.net/files/cscsreviewni/2023-06/The%20NI%20Review%20of%20Children%27s%20Social%20Care%20Services.pdf.) which highlighted the variance in policies and procedures across the five Health and Social Care Trusts in Northern Ireland (NI), resulting in continued disparity in service delivery for children and families. The current, restricted evidence base for social work decision making in care planning, highlights practitioner’s overreliance on practice wisdom rather than evidenced-based research, theory and/or service user knowledge. This mixed methods study focussed on increasing knowledge around decision making in care planning. A training package was developed and delivered to practitioners across children’s services in one Trust area. A pre and post survey was completed with 74 practitioners in addition to 20 post training semi-structured interviews. The significant response rates and sample size offer validity and strength to the findings which correlate with previous studies completed across the UK that also conclude that research, theory and service user knowledge is not prominent in social worker’s understanding of what informs their decision making in care planning for LAC. This information is valuable for practitioners and managers attached to social work in children’s services. Recommendations include further embedding of a culture of learning and reflection to support the development of practitioner knowledge, skills and confidence; and to assist in the development of governance processes to audit the impact of practitioner training.

Remote Delivery of Allied and Behavioral Healthcare During COVID-19 for Children With Developmental Disabilities

Many children with autism spectrum disorder (ASD) and other developmental disabilities (DD) transitioned to telehealth services due to the COVID-19 pandemic. Our objectives were to describe reductions in allied and behavioral healthcare services and receipt of caregiver training to deliver services at home because of COVID-19 for children with ASD and other DD, and factors associated with worse response to remote delivery of services for children with ASD. Prior to the pandemic, children 2 to 5 years of age were enrolled in a multi-site case-control study and completed a developmental assessment. Caregivers completed questionnaires on child behavior problems and ASD symptoms. Children were classified as having ASD vs another DD based on standardized diagnostic measures. Subsequently, caregivers completed a survey during January to June 2021 to assess how COVID-19 affected children and families. Caregivers reported that most children with ASD and other DD had a decrease in service hours (50.0%-76.9% by service type) during the COVID-19 pandemic. Children with ASD were significantly more likely to experience reduced speech/language therapy than children with other DD. Receipt of caregiver training to deliver services at home ranged from 38.1% to 57.4% by service type. Among children with ASD, pre-pandemic problems with internalizing behaviors and social communication/interaction were associated with worse response to behavioral telehealth but no other common therapies. Our study demonstrates the caregiver-reported impacts of COVID-19 on remote delivery of allied and behavioral healthcare services for children with ASD and other DD. Considerations for caregiver support and remote delivery of services are provided.

Evidence-based service delivery interventions for testing, linking, treating, and retaining children and adolescents living with HIV in primary health care settings: Protocol for a systematic review.

BackgroundAt the end of 2019, there were about 2.8 million children and adolescents aged 0–19 living with HIV. In contrast to pregnant women and adults, service delivery for children and adolescents living with HIV continues to lag behind with regard to access to care, components of care delivery, treatment options, and clinical and immunologic outcomes.AimThe aim of this systematic review is to synthesize the evidence on the most effective interventions, models, programs, and strategies to optimize the delivery of services for the testing, linkage, treatment and retention of children and adolescents living with HIV globally.MethodsThis review protocol is registered at PROSPERO with Registration number: CRD42020209553. The systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P). We will use a comprehensive search strategy to search several bibliographic databases including MEDLINE, Embase, CINAHL, Cochrane Library, Global Health, and Psycinfo to identify relevant studies published in the last ten years (2010 to 2020). In addition, we will review cited and citing references of included studies. A pair of reviewers will independently screen titles, abstracts and full texts of articles, extract data from articles meeting inclusion criteria and perform quality assessments of the evidence collected. We will conduct a narrative synthesis of our findings, and if there are sufficient clinically similar studies available, we will conduct meta-analysis using a random-effects model.DiscussionThis review will provide evidence on service delivery models that have been evaluated in a range of settings to efficiently and effectively locate, link, treat and retain in care, children and adolescents living with HIV. The synthesized evidence will help guide national governments and health care providers in prioritizing and adopting evidence-based service delivery approaches for children and adolescents living with HIV.Systematic review registrationPROSPERO CRD42020209553.

Using clinical audits in complex Allied Health interventions: challenges, barriers, and application – our experience applied in service delivery for children with Autism Spectrum Disorder

This paper discusses the use of retrospective clinical audits in complex Allied Health interventions, specifically based on our experience of designing and trialling a clinical audit in one service delivery area of occupational therapy (i.e., occupational therapy for sensory needs of children with autism spectrum disorder). Covered in our discussion is the application considerations of conducting an audit as external auditors to service organisations, however, lessons learnt can be applied to other Allied Health service delivery contexts as well. We encourage Allied Health professionals and researchers to utilise clinical audits as foundation of decision-making and especially for further research in areas with limited efficacy- and effectiveness-based research.

An Assessment Approach for Use in Counselling to Promote Young People’s Quality of Life

Quality of life (QOL) has come to be considered a primary outcome of service delivery for children and youth. Still, after decades of debate, no consensus exists regarding what this concept means or how to measure it. There has been a multitude of instruments used to measure this outcome for young people. The majority of these tools have focused on health and functioning, with little attention paid to other aspects of life that may matter to the QOL of children and youth and, more generally, what QOL specifically means to them. This paper provides a brief overview of the current approaches to conceptualizing and measuring young people’s QOL and related issues. It then considers one potential assessment approach that could be used by various types of counsellors (e.g., education, mental health, rehabilitation, family). This approach is based on the available literature that has explored the perspectives of young people, both with and without chronic conditions and disabilities, regarding what QOL means to them. It will then be discussed how this approach may provide a valid, efficient, positively-oriented, relationship-centred way for counsellors to accurately identify needs and goals to target for intervention that are meaningful and interrelated within the overall context of a young client’s life and long-term development. Directions for future research are presented.

How Good Are Child Vulnerability Assessment Tools in China?

Accurately assessing children’s vulnerabilities and needs is important for child service delivery in social work. In China, different agencies (including international non-governmental organizations, government sectors and social organizations) utilize different tools for assessing children’s needs. However, the advantages and disadvantages of these tools have been rarely discussed, leaving their quality and effectiveness unknown. As a result, it is difficult to realize the goal of improving the well-being of Chinese children. This paper contributes to existing knowledge through the use of semi-structured interviews with key stakeholders of different types of agencies, along with an in-depth exploration, analysis and comparison of their practical assessment tools.

The Evolution of Access to Speech Therapy Services in American Schools

Aim: To trace the historic changes, track the progress, and examine the laws that have resulted in access to speech-language therapy for American school children.
 Rationale: Examination of the outcome of these changes will help future speech-language pathologists make optimal decisions for school children in the future. 
 Summary: Over the last hundred years, dramatic changes have taken place in service delivery for children with speech/language disorders and other disabilities. The evolution of laws, the shifting mindset toward children with handicaps, and the development of the profession of speech-language pathology have ensured that students with disabilities who are in need of speech and language services are eligible to receive them in the schools. There are still difficulties and differences of opinion as to what makes a child eligible for speech therapy services and how service should be delivered. However, the progression that has occurred thus far has resulted in remarkable changes in speech-language therapy in schools in the United States. Examination of the successes and failures during this one-hundred year journey should serve as a roadmap for the future direction of the profession of speech-language pathology as it is employed in the schools.

Bridging gaps in care for children with acquired brain injury: Perceptions of medical and educational service providers.

Significant gaps in service delivery for children with acquired brain injury exist between healthcare and educational systems, such as the lack of coordinated efforts to transfer rehabilitation strategies to school settings. This paper attempts to address these issues and offer recommendations to bridge these gaps in care. The American Congress of Rehabilitation Medicine (ACRM), Brain Injury-Interdisciplinary Special Interest Group (BI-ISIG), Pediatric-Adolescent Task Force constructed and disseminated a survey to medical rehabilitation (N= 44) and education professionals (N= 40). Responses were analyzed quantitatively and qualitatively, achieving > 85% inter-coder reliability. Results highlighted differences between groups in methods for seeking new information, opinions on advocacy needs, and differing priorities given to various resources. These discrepancies have important implications for improved collaboration needed for assuring an appropriate continuum of service for this population. Recommendations include: 1) providing education and training regarding brain injury in the most cost-effective ways utilizing technology that crosses the barriers identified and reaches people in multiple settings; 2) direct and active communication between medical and educational professionals; and 3) developing an interdisciplinary Community of Practice to help bridge medical rehabilitation and school systems.

Use of Large Data Sets in Evaluating Program Outcome in Pediatric Hearing Loss

IntroductionPermanent hearing loss (PHL) in childhood can profoundly impact development, with high economic costs to children and society. Hearing technology and service delivery advances, including universal newborn hearing screening implemented in Ontario in 2002 as part of the Infant Hearing Program (IHP), aim to improve outcomes of children with PHL.
 Objectives and ApproachWe examined the impact of IHP screening on age of identification of PHL, and compared healthcare utilization in children with and without PHL, in the Census Metropolitan Area of Ottawa. Children with PHL, identified from a database at the Children’s Hospital of Eastern Ontario, were linked to health administrative data housed at the Institute for Clinical Evaluative Sciences. Five residents of Ottawa acted as non-PHL controls for each PHL case. A regression discontinuity design (RDD) was used to investigate differences in age of identification pre- and post-IHP implementation. Poisson regression will compare healthcare utilization among children with and without PHL.
 ResultsReceipt of the HBPB was associated with reductions in low birth weight births (adjusted Relative Risk (aRR): 0.77; 95% CI: 0.63, 0.93) and preterm births (aRR: 0.78 (0.68, 0.90)), and increases in breastfeeding initiation (aRR: 1.05 (1.00, 1.09)) and large-for-gestational age births (aRR: 1.11 (1.01, 1.23)). HBPB receipt during pregnancy was also associated with increases in 1- and 2-year immunizations for FN children (aRR: 1.14 (1.09, 1.19), and aRR: 1.28 (1.19, 1.36), respectively). Reductions in the risk of being developmentally vulnerable in the language and cognitive domain of the EDI were also found for FN children whose mothers had received the HBPB during pregnancy (aRR: 0.85 (0.74, 0.97).
 Conclusion/ImplicationsIHP implementation resulted in earlier identificationof PHL in children, allowing earlier access to audiologic and habilitative services. However, children with PHL used the health system more often and in different ways from those without PHL. These results can support improvements in service delivery for children with PHL.

Implementing a routine outcome assessment procedure to evaluate the quality of assistive technology service delivery for children with physical or multiple disabilities: Perceived effectiveness, social cost, and user satisfaction

ABSTRACTThere is a lack of evidence on the effects and quality of assistive technology service delivery (ATSD). This study presents a quasi-experimental 3-months follow-up using a pre-test/post-test design aimed at evaluating outcomes of assistive technology (AT) interventions targeting children with physical and multiple disabilities. A secondary aim was to evaluate the feasibility of the follow-up assessment adopted in this study with a view to implement the procedure in routine clinical practice. Forty-five children aged 3–17 years were included. Parents were asked to complete the Individual Prioritised Problem Assessment (IPPA) for AT effectiveness; KWAZO (Kwaliteit van Zorg [Quality of Care]) and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0 for satisfaction with ATSD; Siva Cost Analysis Instrument (SCAI) for estimating the social cost of AT interventions. At follow-up, 25 children used the AT recommended. IPPA effect sizes ranged from 1.4 to 0.7, showing a large effect of AT interventions. Overall, parents were satisfied with ATSD, but Maintenance, Professional Services, and AT Delivery were rated not satisfactory. SCAI showed more resources spent for AT intervention compared to human assistance without technological supports. AT may be an effective intervention for children with disabilities. Issues concerning responsiveness and feasibility of the IPPA and the SCAI instruments are discussed with a view to inform routine clinical practice.

An Adapted Assessment Model for Emergent Literacy Conducted via Telepractice

Children with complex communication needs (CCN) exhibit multiple needs in a variety of domains, including language, literacy, and speech. Children with CCN often require augmentative/alternative communication (AAC), a mode of communication designed to compensate for the communication and related disability patterns of individuals with CCN (Light, Beukelman, & Reichle, 2003). Given the diverse needs of this population, service provision presents challenges to teachers and therapists alike. Telepractice service provision offers solutions to guide service delivery for children with CCN, who may be located in remote settings with limited access to AAC specialists. The tele-AAC working group of the International Society on Augmentative and Alternative Communication (ISAAC) 2012 Research Symposium highlighted a need for increased information on telepractice service delivery for children with CCN in the area of literacy. To date, evidence-based practices for assessment of literacy skills in children with CCN are limited. In addition, literacy assessment for children with CCN via telepractice presents challenges requiring adaptation for telepractice service delivery. This paper summarizes existing literature examining literacy assessment and intervention, and applies these principles to development and implementation of adapted literacy assessment methods conducted via telepractice for a child with CCN.

Bilingual School Psychology: Challenges and Opportunities

National demographics clearly demonstrate that children from culturally and linguistically diverse (CLD) backgrounds are on the rise. Many regions in the United States are experiencing unprecedented growth in English language learner (ELL) populations without adequately trained personnel to serve this unique population. Unfortunately, the demographic makeup of school psychologists has not kept up. There is a documented shortage of bilingual school psychologists. This shortage has created a gap in service delivery for children and families that are not native English speakers. With the increased demand in bilingual school psychology service delivery, challenges in training standards, recruitment, definitions in bilingualism, and certification/licensing have become evident. Although scholarship and research are limited, this article reviews the literature on bilingual school psychology, implications for practice, and highlights the challenges and opportunities in solidifying this unique specialty.

Speech-language pathologists’ practices regarding assessment, analysis, target selection, intervention, and service delivery for children with speech sound disorders

A survey of 231 Australian speech-language pathologists (SLPs) was undertaken to describe practices regarding assessment, analysis, target selection, intervention, and service delivery for children with speech sound disorders (SSD). The participants typically worked in private practice, education, or community health settings and 67.6% had a waiting list for services. For each child, most of the SLPs spent 10–40 min in pre-assessment activities, 30–60 min undertaking face-to-face assessments, and 30–60 min completing paperwork after assessments. During an assessment SLPs typically conducted a parent interview, single-word speech sampling, collected a connected speech sample, and used informal tests. They also determined children’s stimulability and estimated intelligibility. With multilingual children, informal assessment procedures and English-only tests were commonly used and SLPs relied on family members or interpreters to assist. Common analysis techniques included determination of phonological processes, substitutions–omissions–distortions–additions (SODA), and phonetic inventory. Participants placed high priority on selecting target sounds that were stimulable, early developing, and in error across all word positions and 60.3% felt very confident or confident selecting an appropriate intervention approach. Eight intervention approaches were frequently used: auditory discrimination, minimal pairs, cued articulation, phonological awareness, traditional articulation therapy, auditory bombardment, Nuffield Centre Dyspraxia Programme, and core vocabulary. Children typically received individual therapy with an SLP in a clinic setting. Parents often observed and participated in sessions and SLPs typically included siblings and grandparents in intervention sessions. Parent training and home programs were more frequently used than the group therapy. Two-thirds kept up-to-date by reading journal articles monthly or every 6 months. There were many similarities with previously reported practices for children with SSD in the US, UK, and the Netherlands, with some (but not all) practices aligning with current research evidence.

Best practice principles for management of children with developmental coordination disorder (DCD): results of a scoping review

Developmental coordination disorder (DCD) is a prevalent health condition that is frequently unrecognized despite the substantial evidence that has accumulated regarding how it affects children's health, education and skills. Most literature focuses on measurement of impairment and description of intervention approaches for individual children; little is known about the principles that should guide best practice and service delivery for children with DCD as a population. The purpose of this study was to identify these principles. A scoping review was used to 'map' the information available to inform intervention and service delivery. Scholarly and grey literature written in English was identified in six databases, using a combination of keywords (e.g. guidelines, management, models and DCD); a 'snow-balling' technique was also used in Canada and the UK to access clinical protocols used in publicly funded health care systems. Over 500 documents were screened: 31 met inclusion criteria as they outlined practice principles for children with DCD as a population. Data regarding best practices were independently extracted by two reviewers and then compared with achieve consistency and consensus. Two over-arching themes emerged, with five principles: (1) Organizing services to efficiently meet the comprehensive needs of children (e.g. Increasing awareness of DCD and coordination; Implementing clearly defined pathways; Using a graduated/staged approach); (2) Working collaboratively to offer evidence-based services (e.g. Integration of child and family views; Evidence-based interventions fostering function, participation and prevention). Numerous documents support each of the principles, reflecting agreement across studies about recommended organization of services. While these principles may apply to many populations of children with disabilities, this review highlights how essential these principles are in DCD. Researchers, managers, clinicians, community partners and families are encouraged to work together in designing, implementing and evaluating interventions that reflect these principles.

What’s in a name: Dual sensory impairment or deafblindness?

Communications about deafblindness within the clinical and research literature are littered with several terms that have not yet been well established or defined, such as deafblindness, dual sensory loss, or combined vision and hearing impairment. Depending on the context (e.g. service delivery for children, adults, or seniors) or the user (e.g. educators, clinicians, researchers, or clients), these terms are sometimes used interchangeably; such practice, however, can be misleading and does not assist the scientific goal of precise communication. The goal of this study was to review the existing definitions of these terms and their use through a systematic review of the literature and by conducting a qualitative survey to solicit the opinions of clinicians and researchers in the field of deafblindness. A systematic review of five databases resulted in 809 references containing terms relevant to deafblindness, which were then searched using the terms, such as deafblind, deaf-blind, deaf AND blind, dual, vision AND hearing, and combined, as they appeared in the titles and/or abstracts. In addition, a survey of researchers and rehabilitation professionals in this domain was conducted. The large majority of articles using deafblind-related terminology were published in clinician-oriented journals, whereas authors of high-impact research journal articles (many outside the domain of sensory rehabilitation) were more likely to utilize terms such as dual sensory or combined impairment. This segregation was similar in the 68 responses obtained through the survey. There is a need to harmonize the interpretation of terminology, specifically across professionals and interest groups relevant to deafblindness. Through the development of comparable terminology and clarity in communication, rehabilitation professionals will find it easier to access (and translate) research findings in their respective fields. In addition, the exchange of ideas between practitioners and researchers will be easier, resulting in more practically relevant research projects.

Considering Identification and Service Provision for Students with Autism Spectrum Disorders within the Context of Response to Intervention

The Response to Intervention (RTI) framework, a preventive model of universal screening, tiered interventions, and ongoing progress monitoring, poses an interesting consideration for identification and service delivery for children with autism spectrum disorders (ASD). Upon examination of the existing literature, paucity exists regarding how RTI might guide identification and service delivery for students with ASD; however, the authors consider core tenets of RTI and how they are relevant for students with ASD given what is known about this unique population. Due to the importance of early identification and interventions for individuals with ASD, the RTI framework could be problematic if used to delay education eligibility. Thus, two routes of identification are outlined by the authors, one of which expedites evaluation based on pervasive symptomatology, while the other route uses a form of universal screening to assist in moving toward evaluation for those suspected of ASD. The use of tiered interventions for prevention or service delivery could cause potential complications given the need for early identification and individualized intensive programming. However, there is a clear match for several instructional RTI components and ASD, specifically for evidence-based interventions that are implemented with fidelity and monitored frequently, and other aspects such as family involvement, which could improve programming for students with ASD.

Implications of Changes for the Field

This article provides a thorough discussion of the proposed DSM-5 changes and their implications for current and future approaches to assessment, identification, and service delivery for children and adolescents with ADHD. Educational and clinical implications are discussed with special attention to the individual impact of the changes, diagnostic prevalence rates, and associated societal costs. Developmental period is considered as an important factor in the potential impact of the DSM-5 changes. The authors conclude that the DSM-5 proposed revisions may improve diagnostic sensitivity and specificity; yet the overall impact of these changes remains largely unknown as many were not empirically validated. The authors suggest that the cumulative impact of the set of changes be considered when finalizing the DSM-5 revisions.

Partnership working in services for children: Use of the common assessment framework

Transformation in the structure and delivery of services for children and young people in the UK Children Act (Department for Education & Skills, 2004. The Children Act. London: HMSO) initiated new alliances between statutory, public and voluntary agencies. Traditional relationships and notions of partnership have been extended, necessitating an innovative approach to dialogue and multiple perspectives. Hudson's assertion that although the “rhetoric on partnering remains strong, the real policy thrust is now about choice and contestability” (2006, Journal of Integrated Care, 14(1), 13–21) exemplifies the dynamic policy context around notions of partnership and the rationale for collaborative advantage. This paper explores the experiences of practitioners working in a relatively new multi-agency context – the common assessment framework (CAF). Envisaged as a standardized approach to the assessment of need and as a tool to facilitate integrated working, the CAF is utilized by practitioners in the UK to improve outcomes for children and young people. We present data from a study that employed an interpretative phenomenological analysis approach and gathered semi-structured interviews with 20 practitioners. Interviews drew upon their experiences of interprofessional working in which diversity, partnership working, and competing aims and objectives emerged as significant themes. The insights that were gained are discussed in terms of their potential impact on service delivery in the UK and their contribution toward responsive practice across dynamic professional boundaries.

The Legal Rights of Students with Disabilities in Christian Schools

The adoption of Section 504 of the Rehabilitation Act of 1973 (Section 504) and the Education for All Handicapped Children's Act, now the Individuals with Disabilities Education Act (IDEA), have had a major impact on the delivery of services for children with special needs. In light of the legal issues surrounding the delivery of special education to children who attend Christian schools, the remainder of this article is divided into two parts. The first section opens with an overview of relevant litigation pertinent to special education before reviewing Sections 504 and the IDEA, along with its regulations, as they apply to religious schools. The second part offers practical suggestions for educators in Christian elementary and secondary schools as they work to serve children with special needs.

Culturally Competent Case Study: Perspective from the Commonwealth of the Northern Mariana Islands

This case study is intended to help occupational therapists gain an appreciation for how collaboration can support effective service delivery in other cultures through cross-cultural awareness of Asian and Pacific Islanders' practices in the Commonwealth of the Northern Mariana Islands. Therapists use clinical reasoning to identify hierarchical skill acquisition for the child and consider the family's cultural values when developing an individualized family service plan and an individualized education plan. Early intervention and early childhood special education programs collaborate to provide smooth transitions and carryover of outcomes. Developing cultural competency may enhance occupational therapy services for families and children at ages birth to 5. Furthermore, the purpose is to understand different cultural contexts and encourage professionals to blend the family's priorities with the clinician's expertise to implement optimal service delivery for children in special education.