State Child Research Articles

Russian National Electronic Children's Library

ABSTRACTThe Russian State Children's Library (RGDB) is the largest children's library in the world and has been serving as a cultural and educational center for more than 45 years. Important aspects of RGDB's activities are the development of electronic resources and setting up the library site for distant users. The National Electronic Children's Library in Russia is a specialized digital collection of publications about children and for children. This article focuses on these aspects and the future steps of the project.

The health capability paradigm and the right to health care in the United States.

Against a backdrop of non-ideal political and legal conditions, this article examines the health capability paradigm and how its principles can help determine what aspects of health care might legitimately constitute positive health care rights-and if indeed human rights are even the best approach to equitable health care provision. This article addresses the long American preoccupation with negative rights rather than positive rights in health care. Positive health care rights are an exception to the overall moral range and general thrust of U.S. legal doctrine. Some positive rights to health care have arisen from U.S. Constitutional Eighth Amendment cases and federal and state laws like Medicare, Medicaid, the State Children's Health Insurance Program, the Emergency Medical Treatment and Active Labor Act, and the Patient Protection and Affordable Care Act. Finally, this article discusses some of the difficulties inherent in implementing a positive right to health care in the U.S.

Using a Theory-Guided Learning Collaborative Model to Improve Implementation of EBPs in a State Children's Mental Health System: A Pilot Study.

Learning collaboratives (LCs) are used widely to promote implementation of evidence-based practices. However, there has been limited research on the effectiveness of LCs and models vary widely in their structure, focus and components. The goal of the present study was to develop and field test a theory-based LC model to augment a state-led, evidence-based training program for clinicians providing mental health services to children. Analysis of implementation outcomes contrasted LC sites to matched comparison sites that participated in the clinical training program alone. Results suggested that clinicians from sites participating in the LC were more highly engaged in the state-led clinical training program and were more likely to complete program requirements.

The Catholic Bishops in the U.S. Public Arena: Changing Prospects under Pope Francis

The public profile of the Roman Catholic bishops of the United States results not simply from their own interventions in political life, but from the broad array of actions and actors within “public Catholicism” broadly conceived. This article assesses the contemporary profile of the American bishops from this broad angle, particularly in light of new dynamics under the papacy of Francis I. It does so by documenting public Catholicism’s presence in ecclesial institutions, other public institutions, and lay-centered social movements (particularly faith-based community organizing) and via a case study of the healthcare reform debate around the State Children’s Health Insurance Program and the Affordable Care Act. Cultural and institutional factors shaping Catholic public presence are analyzed in three dimensions of social life: institutional leadership; authority dynamics within the Church; and the culture of prayer, spirituality, and worship in parishes. Finally, the conclusion discusses the key dynamics likely to shape the future of public Catholicism in America.

Improving Data, Enhancing Enrollment: Florida Covering Kids & Families CHIPRA Data System.

According to the Kaiser Family Foundation (2014), 502,866 (11.7 %) of Florida children under 19 years of age are uninsured, giving Florida the second largest number of uninsured children in the United States. Florida Covering Kids & Families (FL-CKF) is dedicated to developing innovative outreach methods for enrolling and retaining eligible children in Florida KidCare, the state's Children's Health Insurance Program. FL-CKF has developed a strong data system that allows it to evaluate the effectiveness and success of statewide enrollment and retention efforts. The data system was created using the Checkbox survey systems. Community and school outreach partners enter data each month on all completed Florida KidCare applications via a secure interface. The system requires data be entered in a uniform format and forces vital data points to be completed. These data are then transmitted to the state to obtain timely application determination information on enrollments. The data system helps FL-CKF to determine which outreach strategies are successful and where changes need to be made to increase effectiveness. The system also provides feedback to community outreach partners in order to enable follow up with families when needed. Organizations helping uninsured children apply for health insurance may benefit from creating data collection systems to monitor project efficacy and modify outreach and enrollment strategies for greater effectiveness.

Department of Oncohematology of the State Children’s Clinical Hospital of Simferopol

This material submits information on Department of Oncologic Haematology of CRI “Children’s Clinical Hospital” as one of the Russian leading regional centers majoring in children’s haemotology and oncology. The history of the Department began in 1988, when a detached department was opened within Children’s Hospital of Simferopol, managed by V.P. Usachenko. The Department contributed to implementation of various chemotherapy protocols within the cooperation between the international research groups. The history of Department development is remarkable by the names of western scientists – D. Pinkel, G. Shellong, А. Righter and others. In 2014 the Department was visited by the Prime-Minister of the Russian Federation D. Medvedev and Ministry of Health V.I. Skvortsova. The article sets out data on number of beds and medical staff of the Department, adult and children population in the Republic of Crimea, incidence of haemotological diseases for the recent years. It sets out details of 5-year relapse free survival for: acute lymphoblastic leukemia – 78 %, acute myeloleukemia – 55 %, non-Hodgkins lymphoma – 78 %, Hodgkin's lymphoma – 95 % and gives an information on the charitable entities helping people.

Patient Protection and Affordable Care Act of 2010 and children and youth with special health care needs.

ABSTRACT:The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN.

Insuring the Uninsured: Reducing the Barriers to Public Insurance

Health insurance is one of the essential enabling resources to gain access to medical care and ultimately increase health status. Over 11 million or one quarter of the nation’s uninsured individuals are eligible for Medicaid or the State Children’s Health Insurance Program (SCHIP), but are not enrolled. Interviews with 368 individuals from 1999 through 2003 identify eight primary barriers to enrollment in public insurance. These include: economic aspects of qualifying, lack of knowledge, benefit design of public programs, poor experiences and stigma, complexity and literacy, immigration status, poor customer service, and fear of fraud. These results suggest policy options alone are unlikely to result in reaching eligible uninsured individuals unless knowledge and instrumental support are offered to them about insurance.

‘Changing the way we do child protection’: The implementation of Signs of Safety® within the Western Australia Department for Child Protection and Family Support

ObjectiveThis paper describes a six-year large scale implementation of the Signs of Safety practise framework in a complex statutory child protection context in Western Australia. The case study documents both the practitioner-led and organisational-led implementation journey as part of the State's child protection system reform drawing on Roger's diffusion of innovation theory and Fixsen's five stage implementation model as conceptual frameworks, and highlighting the key facilitators and barriers. MethodsThe study is a collaboration between researchers investigating the impact and use of Signs of Safety in Western Australia who contributed the theoretical perspectives and analysis; and key personnel from the Department responsible for implementation who contributed documents, manuals, records and personal accounts to form the narrative of the implementation. A naturalist, intrinsic and multiple case study design utilising semi-structured interviews was used to consult with 27 Departmental staff and practitioners. Thematic analysis was utilised to identify key themes and patterns of experiences with the Signs of Safety framework implementation. FindingsMuch can be learned from the journey of the Department and their long term commitment and systematic implementation strategy of Signs of Safety including the significance of leadership, learning and developing initiatives, effective communication, instituting continuous improvement processes and the provision of feedback for individual practitioners. Signs of Safety appealed to natural champions of systemic social work practise within the Department whose organisational culture adapted to align with the principles of the framework in building partnerships and understanding with families, being solution-focused, maintaining an open stance of inquiry and balancing strengths and safety around children whilst concurrently working to solve dangers and harm. As a learning organisation, the Department also utilised case practise implementation teams to be able to move through more successfully the different stages of implementation. In utilising Fixsen's implementation framework, the challenges and gaps to implementation strategies were also highlighted, including a problematic data system and an internal focus compromising the success of interagency collaboration. ConclusionThis discussion paper has provided an overview of the key concepts of the diffusion and implementation literature, and highlighted the importance of utilising theoretical frameworks in guiding implementation of practise models especially in complex statutory child protection contexts. Findings will be of particular interest to child welfare leaders and supporters of organisational change, providing concrete examples of implementation strategies and demonstrates the systemic benefits of a theoretical framework for guiding implementation efforts.

Does policy matter? The effect of increasing child care subsidy policy generosity on program outcomes

A dramatic change in the generosity of one state's child care subsidy policy provides an opportunity to study the relationship between subsidy policy generosity and program outcomes. We find positive effects of policy generosity on child care usage and continuity in the program. We also find these outcomes affected by employment characteristics of participating parents. Unstable employment as evidenced by frequent employment losses, job changes, and periods of unemployment, challenge the ability of a parent to remain in a program tightly linked to being employed. Generosity of subsidy policy is positively related to achievement of Child Care and Development Fund program goals of continuity and parental access to care that meets the developmental needs of their child.

American federalism in practice: the formulation and implementation of contemporary health policy

American Federalism in Practice is an original and important contribution to our understanding of contemporary health policy. It also illustrates how contentious public policy is debated, formulated, and implemented in today's overheated political environment. care reform is perhaps the most divisive public policy issue facing the United States today. Michael Doonan provides a unique perspective on health policy in explaining how intergovernmental relations shape public policy. He tracks federal-state relations through the creation, formulation, and implementation of three of the most important health policy initiatives since the Great Society: the State Children's Insurance Program (CHIP) and the Insurance Portability and Accountability Act (HIPAA), both passed by the U.S. Congress, and the Massachusetts health care reform program as it was developed and implemented under federal government waiver authority. He applies lessons learned from these cases to implementation of the Affordable Care Act. Health policymaking is entangled in a complex web of shared, overlapping, and/or competing power relationships among different levels of government, the author notes. Understanding federal-state interactions, the ways in which they vary, and the reasons for such variation is essential to grasping the ultimate impact of federalism on programs and policy. Doonan reveals how federalism can shift as the sausage of public policy is made while providing a new framework for comprehending one of the most polarizing debates of our time.

Implementation of differential response: A racial equity analysis

Differential response is a growing approach in child welfare that allows for a more flexible response to keep children safe by better engaging families. This study examined the implementation of Minnesota's approach called Family Assessment response, and explored the impact on racial equity outcomes in the state's child welfare system. Using logistic regression to analyze administrative child welfare data for all screened-in cases between 2003 and 2010 (n=122,095), this study explored whether race was a predictor in the following decision points: (1) pathway assignment to either Family Assessment (FA) response or a traditional investigation (TI); and (2) switching pathway assignment from FA to TI. Findings of the analysis indicated that when controlling for poverty and other risk factors, African American, Native American and Multiracial children were less likely to be assigned to FA compared to Caucasian children for some, but not all years in the study timeframe; while Hispanic children were more likely to be assigned to FA compared to non-Hispanic children for several years in the study timeframe. Disparities around pathway switch from family assessment to traditional investigation completely diminished over time. The results of this study highlight the importance of applying a racial equity lens in examining new policies and practices to ensure equitable implementation for all children and families. The findings also emphasize the need for better understanding of the unique experiences of Native American and Multiracial children and families, who have been under-represented in the research on racial disparities in child welfare.

Transferring MSW Education to Practice: A Qualitative Study With Public Child Welfare Employees

This study used a qualitative analysis of survey data collected from public child welfare employees (n = 168) as they completed master's of social work courses in a weekend/hybrid program, to examine their perceptions of ability to apply classroom learning to practice. The program, which combined a focus on direct practice and management, was developed in partnership with the state's public child welfare agency, during a period of systemic change and case practice reform. Findings indicate that students readily transferred knowledge and skills to the workplace, albeit with some challenges. In particular, management courses appeared to provide an important framework in understanding the organizational context of practice.

Adolescent Views on Comprehensive Health Risk Assessment and Counseling: Assessing Gender Differences

Adolescence is an important time for the detection of health risk behaviors and factors with subsequent counseling and intervention. Limited research has examined adolescent perceptions of comprehensive health risk assessments (HRAs) and counseling with an assessment of gender differences. Participants were identified using Florida's Medicaid and State Children's Health Insurance Program databases. A total of 35 low-income, racially/ethnically diverse adolescents (ages 14-18 years) participated in eight focus groups stratified by gender. Adolescents completed an internet-based, tablet-administered, comprehensive HRA and then participated in a semi-structured interview. Discussions were recorded, transcribed, and analyzed using a multi-step, team-based approach applying grounded theory to determine major themes. Male adolescents desired less parental involvement, had less understanding of the protections of clinical confidentiality and the need for comprehensive HRA, and placed greater emphasis on the importance of professional appearance. In contrast, more females valued face-to-face interactions and stressed the importance of concern from the health risk assessor. Overall, adolescents placed importance on their relationship with the health risk assessor, and on valuing trust, confidentiality, and nonjudgmental care. Adolescents preferred to complete HRAs in clinical, private, and professional settings, and reported that tablet technology supported their confidentially in completing the HRA. Furthermore, they stressed the importance of autonomy and learning about the health risk outcomes for risk reduction. Gender differences exist in adolescent perceptions of comprehensive HRAs. Adolescent perceptions of HRAs support their use in confidential primary care settings using modalities that emphasize nonjudgmental, private care, and the use of communication techniques that respect adolescents' autonomy to change health risks.

Analysis of Emergency Department Visits for Palpitations (from the National Hospital Ambulatory Medical Care Survey)

Palpitations is a common complaint in patients who visit the emergency department (ED), with causes ranging from benign to life threatening. We analyzed the ED component of the National Hospital Ambulatory Medical Care Survey for 2001 through 2010 for visits with a chief complaint of palpitations and calculated nationally representative weighted estimates for prevalence, demographic characteristics, and admission rates. ED and hospital discharge diagnoses were tabulated and categorized, and recursive partitioning was used to identify factors associated with admission. An estimated 684,000 visits had a primary reason for visit of "palpitations" representing a national prevalence of 5.8 per 1,000 ED visits (0.58%, 95% confidence interval 0.52 to 0.64). Women and non-Hispanic whites were responsible for most visits. A cardiac diagnosis made up 34% of all ED diagnoses. The overall admission rate was 24.6% (95% confidence interval 21.2 to 28.1), with higher rates seen in the Midwest and Northeast compared with the West. Survey-weighted recursive partitioning revealed several factors associated with admission including age >50 years, male gender, cardiac ED diagnosis, tachycardia, hypertension, and Medicare insurance. In conclusion, palpitations are responsible for a significant minority of ED visits and are associated with a cardiac diagnosis roughly 1/3 of the time. This was associated with a relatively high admission rate, although significant regional variation in these rates exists.

Response to a Mobile Health Decision-Support System for Screening and Management of Tobacco Use

To describe the predictors of nurse actions in response to a mobile health decision-support system (mHealth DSS) for guideline-based screening and management of tobacco use. Observational design focused on an experimental arm of a randomized, controlled trial. Acute and ambulatory care settings in the New York City metropolitan area. 14,115 patient encounters in which 185 RNs enrolled in advanced practice nurse (APN) training were prompted by an mHealth DSS to screen for tobacco use and select guideline-based treatment recommendations. Data were entered and stored during nurse documentation in the mHealth DSS and subsequently stored in the study database where they were retrieved for analysis using descriptive statistics and logistic regressions. Predictor variables included patient gender, patient race or ethnicity, patient payer source, APN specialty, and predominant payer source in clinical site. Dependent variables included the number of patient encounters in which the nurse screened for tobacco use, provided smoking cessation teaching and counseling, or referred patients for smoking cessation for patients who indicated a willingness to quit. Screening was more likely to occur in encounters where patients were female, African American, and received care from a nurse in the adult nurse practitioner specialty or in a clinical site in which the predominant payer source was Medicare, Medicaid, or State Children's Health Insurance Program. In encounters where the patient payer source was other, nurses were less likely to provide tobacco cessation teaching and counseling. mHealth DSS has the potential to affect nurse provision of guideline-based care. However, patient, nurse, and setting factors influence nurse actions in response to an mHealth DSS for tobacco cessation. The combination of a reminder to screen and integration of guideline-based recommendations into the mHealth DSS may reduce racial or ethnic disparities to screening, as well as clinician barriers related to time, training, and familiarity with resources.

Alcohol and tobacco use among maltreated and non‐maltreated adolescents in a birth cohort

This study examines whether child maltreatment experience predicts adolescent tobacco and alcohol use. The subjects were participants in the Mater-University Study of Pregnancy (MUSP), a birth cohort of 7223, of whom 5158 (71.4%) were available for analysis at the 14-year follow-up. Child protection history was obtained from the state's child protection agency and confidentially linked. Exposure to reported child maltreatment was the primary predictor variable. The outcome variables were self-reported smoking and alcohol use. Associations were adjusted for potential confounders. Reported child maltreatment was associated with early adolescent smoking [odds ratio (OR) 1.76, 95% confidence interval (CI) = 1.32-2.34] after adjustment for socio-demographic variables and coexisting alcohol use. Both neglect/emotional abuse (OR 2.03, 95% CI = 1.20-3.42) and neglect/emotional abuse that included physical abuse (OR 1.85, 95% CI = 1.19-2.88) were associated with smoking after full adjustment, including for coexisting alcohol use. After full adjustment, including coexisting smoking, only child neglect/emotional abuse predicted early adolescent alcohol use (OR 1.78, 95% CI = 1.06-2.97), but not the other types of maltreatment. Reported child maltreatment predicts early adolescent smoking after adjusting for alcohol use, but does not predict alcohol use after adjustment for smoking. Both smoking and alcohol use are predicted by reported child neglect. Early adolescent smoking is also predicted by multi-type maltreatment that includes physical abuse.

Children’s public health insurance and scholastic success

There are currently two public health insurance options available to United States children, Medicaid and the State Children’s Health Insurance Program (SCHIP). The programmes are similar in that they both target improvements in children’s health through increased access to medical care. A well-developed body of literature has examined the effect these programmes have on a child’s health and to a large extent has found that the programmes perform as desired. This article uses data from the Early Childhood Longitudinal Study–Kindergarten Cohort to determine whether access to public health insurance translates to an improvement in a child’s academic performance.

Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

While recent studies have demonstrated an overall increase in psychiatric visits in the emergency department (ED), none have focused on a nationally representative pediatric population. Understanding trends in pediatric psychiatric ED visits is important because of limited outpatient availability of pediatric specialists, as well as long wait times for psychiatric appointments. The study aim was to evaluate the trends in ED psychiatric visits for children between 2001 and 2010 with comparison by sociodemographic characteristics. This was a retrospective, cross-sectional analysis of ED psychiatric visits for children<18years of age using the National Hospital Ambulatory Medical Care Survey (NHAMCS). Visits were identified by International Classification of Diseases, Ninth Revision (ICD-9), codes. Outcome measures included frequency of visits for children with psychiatric diagnosis codes and odds and adjusted odds of psychiatric visits controlling for temporal, demographic, and geographic factors. From 2001 to 2010, an average of 28.3 million pediatric visits to EDs occurred annually. Among those, an approximately 560,000 (2% of ED visits) were psychiatric visits each year. Pediatric psychiatric ED visits increased from an estimated 491,000 in 2001 to 619,000 in 2010 (p=0.01). Teenagers (adjusted odds ratio [AOR]= 3.92, 95% confidence interval [CI]=3.37 to 4.57) and publicly insured patient visits (AOR= 1.47, 95% CI=1.25 to 1.74) had increased odds of psychiatric ED visits. Pediatric ED psychiatric visits are increasing. Teenagers and children with public insurance appear to be at increased risk. Further investigation is needed to determine what the causative factors are.

The Effects of Sequestration on Indian Health

AbstractThe budget battles have hit the Indian Health Service hard: sequestration forced a 5 percent reduction in funds, followed by an additional 0.2 percent rescission in the recently passed Consolidated and Further Continuing Appropriations Act. Exempted from sequestration (and rightly so) were other very important health care programs such as the Veterans Administration Health Programs, the State Children's Health Insurance Programs, and Medicaid. Medicare has been reduced by only 2 percent, with that cut targeted to provider reimbursement so as to avoid a reduction in service to beneficiaries. In March 2013, Representatives Betty McCollum, Tom Cole, and Michelle Lujan Grisham introduced a bill to reduce the impact of sequestration on the IHS to 2 percent (H.R. 1371). This bill was referred to the Committee on the Budget, but to date, there has been no movement on it.Why was the IHS susceptible to sequestration? Why is it considered a “discretionary” line item in the federal budget? Why is there not parity for Indians, whose health status remains far below that of mainstream America? As a matter of legal requirement, social contract, and moral obligation, the United States should fundamentally change how Indian Health is funded.