Service Provision For Children Research Articles

Global burden and trends of acute viral hepatitis among children and adolescents from 1990 to 2019: a systematic analysis of the Global Burden of Disease Study 2019.

Children and adolescents are at high risk for acute viral hepatitis (AVH), but epidemiological research focusing on them has been overshadowed by adult chronic B and C. We provide global, regional, and national estimates of the AVH burden and their trends on people under 20years from 1990 to 2019. AVH data from Global Burden of Disease Study (GBD) 2019 was used. Incidence and disability-adjusted life years (DALYs) were calculated, analyzing trends with estimated annual percentage change (EAPC) and Joinpoint regression. In 2019, 156.39 (95% uncertainty interval 145.20-167.16) million new cases of AVH were reported among children and adolescents globally, resulting in 1.98 (1.50-2.55) million DALYs. Incidence rates for young children (< 5years), older children (5-9years), and adolescents (10-19years) were 12,799 (11,068-14,513), 5,108 (4829-5411), and 3020 (2724-3339) per 100,000 population, respectively. The global AVH incidence displayed a linear decline with an EAPC of - 0.66 (- 0.68 to - 0.65). High-incidence regions included sub-Saharan Africa, Oceania, South Asia, and Central Asia, with India, Pakistan, and Nigeria facing the greatest burden. Leading causes were hepatitis A, followed by hepatitis E, B, and C. All hepatitis types showed declining trends, especially hepatitis B. Furthermore, we confirmed the association between the AVH incidence and the socioeconomics, vaccine, and advanced liver diseases. Effective vaccines and treatments for hepatitis B and C offer eradication opportunities. Broadening diagnostic and therapeutic coverage is vital to address disparities in service provision for children and adolescents.

Exploring context for implementation of inclusive education for children with developmental disabilities in mainstream primary schools in Ethiopia.

A large gap in provision of services for children with developmental disabilities (DD) has been identified in Ethiopia, especially in the education system. Including children with disabilities in mainstream schools is encouraged by policies, but progress in this direction has been limited. This study aimed to explore stakeholders' perspectives on contextual factors relevant for inclusive education for children with DD in mainstream schools in Ethiopia, with a focus on Adis Ababa. Data were collected through semi-structured interviews with 39 local stakeholders, comprising caregivers of children with DD, school teachers and principals/managers, non-governmental organisation representatives, government officials, clinicians and academics/consultants. We used template analysis to code the data and map them onto domains of the Context and Setting dimensions of the Context and Implementation of Complex Interventions framework. Stakeholders discussed frameworks in the Legal and Ethical context endorsing the right of all children to education. However, they reported multiple reasons why children with DD in Ethiopia have limited access to education, either in special or mainstream schools. First, individual features, such as gender and support needs, discussed in the Epidemiological context, may affect the likelihood of a child with DD to be accepted in school. Transportation challenges are a key barrier in the Geographical context. Socio-economic and Socio-cultural contexts present barriers at the levels of the nation, school and family, mostly related to limited services and material and financial resources and limited awareness of DD. Stakeholders believe the currently limited but growing commitment in the Political context can support progress towards the removal of these barriers. Our findings can form the basis for development of an implementation plan that addresses such barriers and capitalises on existing facilitators.

Mapping and identifying service models for community-based services for children with intellectual disabilities and behaviours that challenge in England

BackgroundOne in five children with an intellectual disability in the UK display behaviours that challenge. Despite associated impacts on the children themselves, their families, and services, little research has been published about how best to design, organise, and deliver health and care services to these children. The purpose of this study was to describe how services are structured and organised (“service models”) in England for community-based health and care services for children with intellectual disability who display behaviours that challenge.MethodsSurvey data about services were collected from 161 eligible community-based services in England. Staff from 60 of these services were also interviewed. A combination of latent class and descriptive analysis, coupled with consultation with family carers and professionals was used to identify and describe groupings of similar services (i.e., “service models”).ResultsThe latent class analysis, completed as a first step in the process, supported a distinction between specialist services and non-specialist services for children who display behaviours that challenge. Planned descriptive analyses incorporating additional study variables were undertaken to further refine the service models.Five service models were identified: Child and Adolescent Mental Health Services (CAMHS) (n = 69 services), Intellectual Disability CAMHS (n = 28 services), Children and Young People Disability services (n = 25 services), Specialist services for children who display behaviours that challenge (n = 27 services), and broader age range services for children and/or adolescents and adults (n= 12 services).ConclusionsOur analysis led to a typology of five service models for community health and care services for children with intellectual disabilities and behaviours that challenge in England. Identification of a typology of service models is a first step in building evidence about the best provision of services for children with intellectual disabilities who display behaviours that challenge. The methods used in the current study may be useful in research developing service typologies in other specialist fields of health and care.Study registrationTrial Registration: Current Controlled Trials ISRCTN88920546, Date assigned 05/07/2022.

The role of the multiple Index of deprivation in predicting mental health outcomes after the COVID-19 pandemic in adolescents: a cross-sectional study

BackgroundThe number of children and young people (CYP) diagnosed with mental health problems has increased over the past decade. The COVID-19 pandemic also has accelerated this increase, raising significant concerns about adolescent emotional wellbeing. Research suggests that adolescents who live in more deprived areas are more likely to experience poor emotional wellbeing. Children in the northwest of England are among those with the poorest outcomes in the UK. We aimed to investigate the association between deprivation and mental health outcomes from 2019 to 2022. The aim was to support local authorities with targeted provision of public health services as well as predicting service need for 2022 onwards. MethodsIn this cross-sectional study, we analysed routinely collected Schools Health Needs Assessment (SHNA) data. The School Health Needs Assessment dataset contained 32 676 responses from Year 6 (ages 10–11 years) and Year 9 (ages 13–14 years) who completed the annual survey in 2019–22. The questionnaire was offered to all mainstream schools, delivered by the public health school nursing service. Index of multiple deprivation (IMD) data were provided for household postcodes. Data were analysed using IBM SPSS. Factor analysis created a composite emotional wellbeing scale (EWS) and estimates generated by school year (Years 6 and 9) and three academic years (2019–22). We calculated correlations between IMD and EWS overall and within school and academic year samples. FindingsThe final total sample across the three consecutive survey years and the two school years was 32 659. The sample consisted of 15 932 (49%) female students and 5066 (16%) students who registered at school as from an ethnic minority. Of the total sample, 9209 (28%) lived in a postcode in the most deprived IMD quintile in England. There was an overall decrease in EWS from Year 6 to Year 9 and from 2019 to 2022. The Year 6 students in 2022 reported mean levels of EWS equivalent to Year 9 students in 2019 indicating a shift toward poorer mental health in younger children. The correlational analyses showed no significant associations between IMD and EWS scores within the school or academic year cohorts. A follow-up analysis of children in receipt or not in receipt of free school meals also showed no significant association with EWS scores. InterpretationFindings showed that the emotional wellbeing of children and young people in the northwest of England has deteriorated since 2019, with greatest changes observed in the younger cohort of children in Year 6. This was not explained by postcode-based indices of multiple deprivation. Although it is recognised that deprivation is both a cause and a result of poor mental health, policy decisions on service provision for children and young people should not be based solely on IMD or receipt of free school meals. A rapid response is required to address the decline in emotional wellbeing currently observed in younger children of the northwest of England. FundingNone.

Effective service provision and partnerships in service providers for children and young people with special educational needs and disabilities: a mixed methods systematic review protocol

It is widely recognized that provision of services for children and young people (CYP) with Special Educational Needs and Disabilities (SEND) are enhanced when services such as healthcare, social care, and education collaborate and interact effectively, rather than separately. In the UK, while there have been significant changes to policy and provision which support and improve collaboration, professionals responsible for implementing these changes face multiple challenges, including a lack of specific implementation guidance and a logic model or framework to illustrate how effective multi-agency working could, or should, work. This systematic review aims to identify the ‘key ingredients’ for effective multi-agency working in services for CYP with SEND; and the most effective forms of partnership working in this setting. In addition, the review will highlight interventions that lead to improved service outcomes; and the conditions in the local area (organisational or geographical) that support and encourage success. This protocol has been written following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols guidelines. Searches will be conducted on several health, care, education and applied social science databases from the year 2012 onwards. Citation chaining will be undertaken, as will broader grey literature searching to enrich the findings. Qualitative, quantitative, and mixed methods studies will be included, assessed independently and critically appraised or assessed for risk of bias using appropriate tools based on study design. Data will be extracted using a standardized, pre-piloted data extraction form. A convergent segregated approach to synthesis and integration will be used in which the quantitative and qualitative data will be synthesized independently, and then integrated using a joint display integration matrix. Results will be of interest to educators and health and social care professionals that provide services to those with SEND. These will also be used to develop policy recommendations for how UK healthcare, social care, and education services for CYP with SEND aged 0–25 can most effectively collaborate and improve service outcomes. The review will also identify any gaps in the literature to recommend areas for future research. Funding for this review was provided by the Department for Education.PROSPERO registration: CRD42022352194.

Biopolitics, care and the transformations of a large institution for children with disabilities in Romania from 1956 to 2015

ABSTRACT This paper connects research on deinstitutionalization as a dominant paradigm in service provision for children and adults with disabilities to the research on transformations from state socialism to neoliberal capitalism in a long durée perspective. It focuses on the transformations of care practices and infrastructures in terms of biopolitical shifts. By building on ethnographic fieldwork surrounding a now closed neuropsychiatric hospital for children in Romania, interviews and informal conversations with formerly institutionalized children from the institution, carers, professionals and volunteers, it traces both the transformations of the institution and its follow-up services from the 1950s to 2015, as well as the practices prevalent in these institutions and the ways in which these reflected dominant moral and political orders and how they were enacted in everyday life. It concludes that although biopolitical infrastructures and practices have changed greatly during the period under study, continuities can be observed in the ways in which productivist logics still work to exclude as well as include people with disabilities – thus perpetuating practices of hierarchization in relation to social inclusion based on economic criteria. Moreover, biopolitical shifts were not linear, but involved contradictory movements and logics, and entanglements of multiple transformation processes.

Public policy in the sphere of children’s social protection in war conditions

Social protection of children in the conditions of a full-scale war on the Ukraine’s territory has become significantly more complicated and has given rise to a number of problems: to save the children’s lives, to ensure their rights, to protect the most vulnerable, to meet the children’s humanitarian needs, in particular access to food, water and sanitation, psychosocial assistance, education, mine risk education, as well as the provision of services for children with special needs, etc. Racists often hide behind Ukrainian children as human shields and use them for their propaganda.The article analyzes the current social protection’s state of children and the acute problems associated with the inability to provide an adequate level of protection for children who are injured, victims of violence, abduction and illegal export of children to the territory of the aggressor country, children left without parental care, including for reasons and as a result of war and in need of adoption, as well as children with developmental disabilities who need early intervention services. Proposals for improving public policy in the social’s protection sphere of children in war are proposed.

A Coproduced Traumatic Bereavement Therapeutic Group for Moroccan Adolescents Affected by the Grenfell Tower Fire

There have been increasing calls to coproduce psychological initiatives and services for children and young people to improve access to mental health services and service user experience. This paper outlines the development of an innovative therapeutic group for young people affected by collective trauma and loss who were reluctant to engage with mainstream services following the Grenfell Tower fire. The June 2017 apartment building fire was one of the largest and deadliest to occur in the United Kingdom (UK) in decades, with 72 deaths. The project’s central principle was partnership and coproduction with potential users and offering a culturally appropriate service. Its aim was to meet the mental health and other needs of young people, support them through their bereavement and trauma, and to improve access to mental health services by addressing the barriers they reported. The group approach used community psychology and systemic principles, narrative therapy concepts, creative arts, and collective memorialization. Semi-structured focus groups were conducted with 14 Moroccan-origin adolescents, 13 whom identify as Muslim. A thematic analysis was conducted. Findings indicated the benefits of collective memorialization and therapeutic groups, such as improved emotional expression, recognition of shared Grenfell-related experiences, strengthened social support networks and subjugated narratives, and reduced social isolation and stigma. The evaluation findings indicated that the group’s coproduction and collaboration between statutory services, potential/service users, and community organizations improved community engagement, access to mental health services, and service provision for children and young people from Moroccan and Muslim backgrounds.&amp;nbsp;Note: Any views expressed in this service evaluation are of the authors and do not necessarily reflect the views of their employers.

Identifying Gaps for Service Provision in Children and Young People With Learning Disability and Challenging Behaviours And/or Mental Health Needs

AimsChildren and adolescents with learning disability need multi-disciplinary input when they present with challenging behaviours or mental health disorders. This patient group needs specialist skills from the clinicians and professionals to support and meet their needs. There is no commissioned Child and Adolescent Learning Disability Mental Health Service (CAMHS) in Waltham Forest and support comes from Specialist Tier 3 generic CAMHS which comprises of Emotional Difficulties Pathway, Neurodevelopmental Disorders Pathway and recently developed Behaviour Pathway which mostly comprises of specialist parenting training/interventions. To identify gaps in service provision for children and young people with learning disability presenting with challenging behaviours and/or mental health needs in Waltham Forest as there is no formally funded CAMHS learning disability service in the locality.MethodsAll children and young people under 18 with learning disability under Waltham Forest CAMHS with ASD/ADHD and other neurodevelopmental disorders who meet the project criteria are included. Project criteria include 1) Main diagnosis of Learning Disability (Including clients with Learning difficulty (global), likely to have low IQ with cognitive impairment.), with or without associated other Neurodevelopmental disorders (e.g., ASD, ADHD or tics) or other mental health disorders and 2) Engages in challenging behaviours. Challenging behaviours defined as behaviours significantly limiting engagement in daily &amp; family life, education and/or social activities, and have persisted for at least a period of 3 months. Data were collected from electronic recoding system of individual patients; using a data collection sheet on level of learning disability; comorbid neurodevelopmental or emotional and mental health disorders; profession of allocated clinician; joint working with discipline; involvement with social care; allied health professionals input; presenting difficulties and severity; CETR or hospital admissions; referral to National services; What interventions offered (Medications, Behaviour assessment and/or interventions); if medications offered, was it used as first line and how long for; parents’ view on medication management.ResultsAs we have expected, medication management were used as first line and there were limited offers of behaviour support. Joint working with social care, speech therapy and occupational therapy but with limited input especially occupational therapy in cases with high sensory needs. It was unclear with the cognitive assessment and diagnosing the learning disability in the population under 16s.ConclusionThere is a service gap for CAMHS learning disability population and more joint working needed among relevant health professionals.

Impact of new health care reform on enabling environment for children's health in China: An interrupted time-series study.

BackgroundCreating an enabling environment (EE) can help foster the development and health of children. The Chinese government implemented a new health care reform (NHR) in 2009 in a move to promote an EE for health. The purpose of this study was to evaluate the impact of the NHR on EE for children’s health.MethodsAn interrupted time-series analysis was used to evaluate the changes in the EE before and after 2009 in China. This study analysed the EE through five quantitative indicators, including policy element coverage rate (PECR), service meeting with children’s needs rate (SMCNR), multisector participation rate (MPR), and accountability mechanism clarity rate (AMCR), based on the content analysis of available public policy documents (updated as of 2019) from 31 provinces in mainland China, and the number of health care personnel of maternity and child care centres per 10 000 population (HP per 10 000 population), based on the 2002–2019 China Health Statistical Yearbook and China Statistical Yearbook.ResultsThe average values of PECR, SMCNR, and MPR increased rapidly to 90.96%, 82.46%, and 81.31%, respectively, in 2019, representing a higher value compared to the AMCR (7.38%). The NHR promoted the EE, in which HP per 10 000 population showed the fastest increase (β1 = 0.03, P < 0.01; β3 = 0.10, P < 0.01), followed by SMCNR (β1 = 0.94, P < 0.01; β3 = 1.83, P < 0.01), AMCR (β1 = 0.13, P < 0.01; β3 = 0.24, P = 0.14), MPR (β1 = 1.35, P < 0.01; β3 = 2.47, P < 0.01) and PECR (β1 = 1.43, P < 0.01; β3 = 1.47, P < 0.01).ConclusionsThe NHR has a positive impact on the EE, especially on the human resources and service provision for children. Efforts should be intensified to improve the clarity of the accountability mechanism of the health-related sectors.

Pediatric rehabilitation services during COVID-19 pandemic in the United Arab Emirates

Introduction/Objective. COVID-19 pandemic has changed the rehabilitation practice across the globe. A sudden transition from in-person therapy at the center to remote therapy challenged the managers and multi-disciplinary team members providing pediatric rehabilitation. The main objective of this research was to assess the provision of services for children with disabilities during COVID-19 in the United Arab Emirates. Methods. Two surveys were developed by the research team, one for the managers and the others for multidisciplinary team members. Both surveys were validated through experts followed by a pilot study. The final versions of the survey were sent to all the pediatric rehabilitation centers within the United Arab Emirates in September 2020. A total of 44 managers and 434 multidisciplinary team members completed the survey. Results. The accessibility of the pediatric rehabilitation services was reported to be very high with 77%. Regarding the cost for running the services, almost half (46%) of managers reported them to be costlier than normal. Telerehabilitation was the most common approach utilized with synchronized live video calls (86%), YouTube video clips (88%), and created own videos (65%). Conclusion. Telerehabilitation appeared to be the most efficient model used for pediatric rehabilitation during the pandemic. The future investments for the continued use of telerehabilitation require planning, budgeting, investing, and creating supportive environments for parents, children, and multidisciplinary team members. There is a need for sharing platforms for educational and therapeutic resources created during the pandemic, with ongoing research on telerehabilitation.

Referral patterns to outpatient child and adolescent mental health services and factors associated with referrals being rejected. A cross-sectional observational study

BackgroundOutpatient child and adolescent mental health services (CAMHS) are faced with the challenge of balancing increasing demands with limited resources. An additional challenge is high rejection rates of referrals which causes frustration for referring agents and families. In order to effectively plan and allocate available resources within CAMHS there is a need for up-to-date knowledge on referral patterns and factors associated with rejection of referrals.MethodsIn this cross-sectional observational study we did a retrospective review of all referrals (n = 1825) for children (0–18) referred for assessment at the outpatient CAMHS of the North Denmark Region in 2018.ResultsThe most common referral reasons to CAMHS were attention deficit disorder (ADHD/ADD) (27.9%), autism spectrum disorder (22.4%), affective disorders (14.0%) and anxiety disorders (11.6%). The majority of referrals came from general practitioners, but for neurodevelopmental disorders educational psychologists were the primary referral source. Re-referrals constituted more than a third of all referrals (35.9%). Children in care were overrepresented in this clinical sample and had an increased risk (Adj. OR 2.54) of having their referrals rejected by CAMHS. Referrals from general practitioners were also associated with an increased risk of rejection (Adj. OR 3.29).ConclusionsA high proportion of children with mental disorders have a repeated need for assessment by CAMHS. There is a need for future research on predictors of re-referral to outpatient services to identify potential targets for reducing re-referral rates as well as research on how to optimize service provision for children with a repeated need for assessment. General practitioners are the main gatekeepers to CAMHS and research on interventions to improve the referral process should be aimed towards general practitioners.

Improving Psychosocial Risk Assessment and Service Provision for Craniofacial Team Patients: A Quality Improvement Project.

To improve psychosocial risk assessment and service provision for children with craniofacial conditions presenting for annual interdisciplinary team visits. Institute for Healthcare quality improvement model. U.S. pediatric academic medical center. Caregivers of children ages 0-17 years with craniofacial conditions presenting for 1692 team visits between August 2017 and July 2019. Key drivers included: (1) standardizing pre-visit triage processes; (2) administering the Psychosocial Assessment Tool-Craniofacial Version (PAT-CV); (3) utilizing PAT-CV scores in real time to add patients to psychosocial provider schedules; and (4) family education. Interventions included improving patient screening, increasing PAT-CV completion rate, altering clinic flow, providing patient and parent education about psychosocial services, and altering team member roles to fully integrate PAT-CV administration and scoring in the clinic. The primary outcome was the percentage of patients identified for psychosocial consultations via nurse triage, PAT-CV score, family or provider request who completed consultations. The secondary outcome was the percentage of patients completing needed psychosocial consultations based on elevated PAT-CV scores. Use of the PAT-CV resulted in an increase in the percentage of patients with elevated psychosocial risk who received a psychosocial consultation from 86.7% to 93.4%. The percentage of children receiving psychosocial consultation at their annual team visit due to elevated PAT-CV scores increased from 72% to 90%. Integrating a validated psychosocial risk screening instrument can improve risk identification and psychosocial consultation completion. A combination of risk screening approaches may be indicated to identify patients in need of psychosocial services.

A qualitative study exploring community pharmacists’ perspectives of child and adolescent mental healthcare

Community pharmacists are involved in the health delivery sector through the provision of services that result in improved patient outcomes and optimization of pharmaceutical care. With growing concern about increasing prevalence of mental disorders in children and adolescents, the expanded roles of pharmacists in providing mental health services may be essential. This study aimed to explore the perspective of community pharmacists in child and adolescent mental healthcare (CAMH) service provision. A qualitative study employing semi-structured face-to-face individual interviews was conducted among 25 community pharmacists in Accra to explore their perspectives and experiences in service provision for children and adolescents with mental illness. Interviews were audio recorded, transcribed, and thematically analyzed in line with the study objective. Emerging themes from the results are presented and supported by narratives from the community pharmacists. Most of the participants were female (n = 15, 60%), 32.32 ± 10 years old and have an average of 7.68 ± 9.4 years of professional practice. The m main themes identified from the findings were (1) Illness perception (2) Use of medicines (3) CAMH service provision practices and (4) Barriers to CAMH service provision. The participants' perception about child and adolescent mental illness was along the dimensions of causal beliefs. They also acknowledged the role of medications in symptom reduction and improved mental health outcomes while indicating their safety concerns about these medicines. Community pharmacists were involved in CAMH activities by providing medication-related support, triaging, and appropriate referrals. However, barriers such as inadequate training, lack of subsidies for psychotropic medications for community pharmacies and poor linkage with health providers and facilities, limit community pharmacists’ involvement in the provision of these services.CAMH service provision by community pharmacists could be facilitated by training, psychotropic medicines subsidy support and enhanced linkage with hospitals while highlighting greater recognition of these services at the community level to support the policy agenda of deinstitutionalizing mental healthcare.

Speech-Language Pathologists’ Knowledge of Spanish-Influenced English and Dialectical Differences: A Survey

The purpose of this study was to assess the competence of speech-language pathologists (SLPs) in serving bilingual or English-language learning children. Specifically, are SLPs able to identify acceptable English productions of a native Spanish speaker when described and/or given in context? Data were collected through an anonymous 28-question, web-based survey designed for practicing SLPs who worked with children. A total of 99 completed responses were received. The majority of SLPs demonstrated a basic understanding of aspects of Spanish-Influenced English (SIE) and dialectal features associated with native speakers of Spanish; however, SLPs were better able to identify errors in context than features of SIE. To ensure best practice in service provision for children who are English-language learners, SLPs need an understanding of the features of SIE and other English variants. Training programs should therefore provide education on the specific contrasts between languages/dialects while encouraging critical thinking and self-study.

Current status of multi-disciplinary paediatric weight management services in Australia.

To identify multi-disciplinary paediatric weight management services currently available in Australia and determine gaps in service provision for children and adolescents with obesity. Surveys were distributed to 17 identified Australian multi-disciplinary paediatric weight management services. A representative from each service was asked to complete an online survey regarding service and patient characteristics, assessment and management practices, and professional development approaches. Representatives from 16 multi-disciplinary paediatric weight management services completed the survey. Fourteen services were based in major metropolitan cities and two in regional areas. Fourteen services provided care to pre-school aged children (0-4 years old), 15 to primary school aged children (5-12 years old) and 13 to high school aged children (13-18 years old). The number of patients seen per year per service ranged from 20 to 250 and duration of waiting lists ranged from 2months to more than 12 months. The current availability and accessibility of multi-disciplinary paediatric weight management services is inadequate to service Australian children and adolescents with obesity, particularly those with severe obesity and those in rural and remote communities. To better address the issue of paediatric obesity, establishment of additional multi-disciplinary services, training for health-care professionals and monitoring of the provision of evidence-based care is urgently needed.

Children and young people's experiences of living with developmental coordination disorder/dyspraxia: A systematic review and meta-ethnography of qualitative research.

BackgroundTo date services for children with Developmental Coordination Disorder (DCD) have not been informed by the perspective of children with DCD. This study aimed to synthesise the findings of discrete qualitative studies reporting the lived experiences views and preferences of children and young with DCD using a meta-ethnographic approach to develop new conceptual understandings.MethodsA systematic search of ten databases; Academic Search Complete, AMED, CINAHL, ERIC, MEDLINE, PsychArticles, PsychInfo, EMBASE, SPORTDiscus, and Web of Science, was conducted between March and April 2019, and updated in early June 2020. Meta-ethnography, following the method described by Noblit and Hare was used to synthesise included studies. The Joanna Briggs Institute Checklist was used to appraise all included papers. PROSPERO registration number CRD42019129178.ResultsFifteen studies met the inclusion criteria. Meta-ethnographic synthesis produced three themes; a) ‘It’s harder than it should be’: Navigating daily activities b) Fitting in, and c) ‘So what? I drop things’: Strategies and supports to mitigate challenges. Children with DCD describe a mismatch between their abilities and performance norms for daily activities that led to a cascade of negative consequences including negative self-appraisal, bullying and exclusion. In the face of these difficulties children described creative and successful strategies they enacted and supports they accessed including; assistance from others (parents, friends and teachers), focusing on their strengths and talents, accepting and embracing their difference, adopting a “just do it” attitude, setting personal goals, self-exclusion from some social activities, using humour or sarcasm, viewing performance expectations as a social construct, and enjoying friendships as a forum for fun, acceptance and protection against exclusion.ConclusionService provision for children and young people with DCD should address the social and attitudinal environments, focus on friendship and social inclusion and address stigma-based bullying particularly within the school environment. Furthermore, practitioners should identify and foster children’s own strategies for navigating daily life activities with DCD. The identified themes resonate with contemporary disability theory and the International Classification of Functioning. The social and attitudinal environmental context of children and young people with DCD profoundly influences their experiences. Future intervention development and service provision for children and young people with DCD should consider opportunities to address social and attitudinal environmental factors.

The Development of Socially Inclusive Libraries in Šiauliai Region Providing Services for Children and Youth with Special Needs

&#x0D; &#x0D; One of socially vulnerable groups in society, which often faces social exclusion problems, is children and youth with special needs. In Lithuania, children with special needs comprise about 12.5 percent from the total number of children and youth up to 18 years (Statistics Department of Lithuania, 2020). It is a significant part of society and a group of library stakeholders, which needs to have access to library services since the earliest possible participation in educational, social and cultural activities can promote the development of these children. For this reason, it is important to study how library services meet the needs of and to assess how they are prepared to provide services for this group. In order to do this, the aim of this paper was to analyze the possibilities of Šiauliai region libraries social inclusion in the area of services for children and youth with special needs. To achieve this goal scientific literature was analyzed and a structured interview with 25 respondents was carried out by e-mail in empirical research, Research data was analyzed using a categorization method. Scientific literature analysis allowed the author to identify the main areas of library activities and services for children and youth with special needs. Empirical research provided an opportunity to assess how Šiauliai region libraries services meet the needs of children and youth with special needs and to examine their possibilities to maximise libraries social inclusion. Empirical research showed that Šiauliai region libraries social inclusion regarding their services for children and youth with special needs is insufficient in the context of library management, environment adaptation, cooperation development, information on cultural events, on library service dissemination. Regarding library management, there is a need for more detailed research into the needs of this target group, which could help to assess the needs of children and their representatives. Regarding environment and service adaptation, Šiauliai region libraries social inclusion can be raised by improving their infrastructure, technological equipment, expanding the variety of information sources and access to cultural services. It is also important to intensify libraries cooperation with organizations that represent children and youth with special needs and to more actively disseminate information that focuses on this target group.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Reviewing Mental Health Services and Support for Children and Young People in Northern Ireland: A Rights-Based Approach

ABSTRACT Objective: In Northern Ireland, it is widely agreed that mental health service provision for children and young people is inadequate and that there is a need for much greater prioritisation and strategic planning in this area. Successive Governments have made commitments to improve services, and although progress has been made, considerable reform is still required. Using a child rights framework, this paper provides an overview of children and young people's direct experiences of accessing mental health services or support. Methods: An online survey was used to gather respondents experience of six statutory and non-statutory health services. Respondents were asked to rate services against nine rights-based service quality statements. A likert agreement rating scale was used to gather quantitative data and qualitative information was captured using open-ended questions. Excel and NVivo were used to analyse the data. Results: Overall, 607 children and young people aged 11–21 years old shared their experiences of mental health services. The survey results show that young people are reaching out to a wide range of services to access support. However, there was considerable variation in young people’s satisfaction levels with different services. Conclusions: This paper brings a child rights focus to the research that exists on the child and adolescent mental health system by assessing it against a range of rights-based statements. This study found that although many services are improving, more is required to ensure that Northern Ireland has a rights compliant system.

State Insurance Mandates and the Workforce for Children With Autism.

State mandates have required insurance companies to provide coverage for autism-related child health care services; however, it has not been determined if insurance mandates have improved the supply of child health care providers. We investigate the effect of state insurance mandates on the supply of child psychiatrists, pediatricians, and board-certified behavioral analysts (BCBAs). We used data from the National Conference of State Legislatures and Health Resources and Services Administration's Area Health Resource Files to examine child psychiatrists, pediatricians, and BCBAs in all 50 states from 2003 to 2017. Fixed-effects regression models compared change in workforce density before versus one year after mandate implementation and the effect of mandate generosity across 44 US states implementing mandates between 2003 and 2017. From 2003 to 2017, child psychiatrists increased from 7.40 to 10.03 per 100 000 children, pediatricians from 62.35 to 68.86, and BCBAs from 1.34 to 29.88. Mandate introduction was associated with an additional increase of 0.77 BCBAs per 100 000 children (95% confidence interval [CI]: 0.18 to 1.42) one year after mandate enactment. Mandate introduction was also associated with a more modest increase among child psychiatrists (95% CI: 0.10 to 0.91) and was not associated with the prevalence of pediatricians (95% CI: -0.76 to 1.13). We also found evidence that more generous mandate benefits were associated with larger effects on workforce supply. State insurance mandates were associated with an ∼16% increase in BCBAs from 2003 to 2017, but the association with child psychiatrists was smaller and nonsignificant among pediatricians. In these findings, it is suggested that policies are needed that specifically address workforce constraints in the provision of services for children with autism spectrum disorder.