Commentary on “Implementing New York's Universal Pre-Kindergarten Program: An Exploratory Study of Systemic Impacts”

The Morrissey, Lekies, and Cochran (this issue) article is a welcome addition to the literature focusing on whether state-funded preschool education negatively impacts child care. Yet, although the study is a step in the right direction, it does not provide the data needed to answer the question at hand or inform state preschool and child care policy. Furthermore, while there is merit to research that begins with the premise that publicly funded preschool initiatives may contribute to instability in the child care market, the present commentary offers an alternative perspective on such an outcome. More specifically, the commentary argues that such initiatives may be the best thing that ever happened to children, their families, and those who work in the field. The commentary concludes with a recommendation for additional studies that combine concern for an adequate supply of child care with robust data and an overall focus on improving children's outcomes.     

Commentary on “Implementing New York's Universal Pre-Kindergarten Program: An Exploratory Study of Systemic Impacts”

The Morrissey, Lekies, and Cochran (this issue) article is a welcome addition to the literature focusing on whether state-funded preschool education negatively impacts child care. Yet, although the study is a step in the right direction, it does not provide the data needed to answer the question at hand or inform state preschool and child care policy. Furthermore, while there is merit to research that begins with the premise that publicly funded preschool initiatives may contribute to instability in the child care market, the present commentary offers an alternative perspective on such an outcome. More specifically, the commentary argues that such initiatives may be the best thing that ever happened to children, their families, and those who work in the field. The commentary concludes with a recommendation for additional studies that combine concern for an adequate supply of child care with robust data and an overall focus on improving children's outcomes.     

First,Do No Harm: How Routine Interventions,Common Restrictions,and the Organization of Our Health-Care System Affect the Health of Mothers and Newborns

In this column, the author reprises recent selections from the Lamaze International research blog, Science & Sensibility. Each selection discusses a new study that demonstrates the “First, do no harm” principle in a different way. New research on the potentially harmful effects of intravenous lines demonstrates that refraining from routine interventions in labor protects the safety of women and babies. A new systematic review of movement and position changes in labor shows that eliminating unfounded restrictions also protects maternal and infant health and well-being. Finally, a study of patterns of use of neonatal intensive care units reveals how the organization of the maternity care system itself can affect the health outcomes of its beneficiaries.     

Beyond an “Either–Or” approach to home- and center-based child care: Comparing children and families who combine care types with those who use just one

Most research focuses on preschoolers’ primary non-parental child care arrangement despite evidence that multiple arrangements are relatively common. Using the nationally-representative Early Childhood Longitudinal Study, Birth Cohort, we compare characteristics and outcomes of families whose 4-year olds attend both home- and center-based child care with those who attend either home- or center-based care exclusively or receive no non-parental care at all. We find that about one fifth of 4-year olds attend both home- and center-based child care. Mothers’ priorities for care (getting their child ready for school, matching their families’ cultural background) and perceptions of good local care options predict their combining home- and center-based care. Preschoolers score higher on reading and math assessments, on average, when they attend centers, alone or in combination with home-based child care, than when they are cared for only in homes, either by their parents or by others. Preschoolers’ average socioemotional outcomes generally do not differ between families who do and who do not combine care types. Implications for research and policy are discussed.     

Improving numeracy outcomes for children through community action research

Virtue, according to Aristotle, is doing the right things at the right time with the right people for the right end and in the right way. This concept is central to the work of the Early Learning Initiative, an Irish community-based educational initiative. This paper describes how a community of parents, early childhood care and education practitioners and a third-level institution used action research to develop a three-year numeracy programme for children aged zero to six years. The Early Numeracy Project was one of 11 national projects that aimed to influence early years practice, provision and policy in Ireland. Remaining true to our local values and virtuous practice while implementing a national project was challenging, particularly when robust evidence of the impact of the programme on the children and parents in our community was required at national level. Approximately 860 children (zero to six years old) and their families took part in the Early Numeracy Programme each year, with national and local evaluations indicating that the outcomes for children in the programme had improved. The programme is an example of how a local community can use action research and virtuous practices to implement a national programme and improve outcomes for children.     

Competences for working with older people: The development and verification of the European core competence framework for health and social care professionals working with older people

Universities of applied sciences in Europe face the challenge of preparing students in health and social care for working with older people and contributing to the innovations needed in light of the ageing of society, along with changes in the health and social care systems in many countries. Dealing with the special needs of older people and the increasing burden of chronic diseases requires specific competencies for health and social care professionals, as well as an integrated approach to health and social care. Research has found that many educational programs lack adequate preparation for students in health and social care when it comes to the correct competences. To identify the competences needed for all health and social care professionals in Europe, who work with older people, the European Later Life Active Network (ELLAN) has conducted research and developed a verified competence framework. This “European core competences framework for health and social care professionals working with older people” describes roles and competences that students in health and social care programs need to learn in order to provide good care and support for older people. Within the ELLAN consortium, 26 universities of applied sciences from 25 European countries collaborated in this research and development process. The framework has been verified by two Delphi rounds among a group of 21 experts and a group of 21 researchers from 19 countries. The framework includes awareness of diversity and different cultural backgrounds. This makes it a useful document for educational purposes all over Europe.     

Becoming connected,being caring

This paper highlights perspectives on action research in education, health and social care and was originally presented as a keynote at the International Practitioner Research Conference and Collaborative Action Research Conference in 2005. The paper links with the other conference keynote given by Stephen Kemmis, co‐author of Becoming Critical. It reflects on the importance of Being Caring in action research in the context of health and social care; particularly in relation to emotionally supporting practitioners to improve their practice in settings which do not always welcome more emancipatory or critical approaches often used in education. The paper begins by exploring the nature of practitioner research and action research in health and social care and its links with quality. It argues that health and social care professionals have often drawn their methodological understanding from the literature written by colleagues in education. This literature tends to support critical and emancipatory forms of action research, which health and social care professionals have tended to adopt in an uncritical manner. Reflecting on some of the contextual constraints in health and social care, it argues that many of these factors are beyond the control of individual practitioners and suggests a need to focus on the neglected area of emotions, in addition to, contextual issues. To illustrate the usefulness of this approach an example of psychodynamically informed action research is given. The paper concludes that in the quest to be critical, practitioner researchers/action researchers in education, health and social care may be ignoring the emotional contexts in which they work. It suggests that being caring may be the key to being critical.     

A systems perspective on research and treatment with abused and neglected children

OBJECTIVE: To discuss two systems-level changes in the organization and financing of mental health and child welfare services that will increasingly affect abused and neglected children: the implementation of managed care processes and the incorporation of accountability mechanisms in the management of mental health and child welfare services, particularly the use of systematic outcomes assessments. A central goal of the paper is to identify critical research questions which will help us to understand the impact of these changes on maltreated children. METHOD: These two systems-level changes are described, and ways they may affect maltreated children are addressed. RESULTS: Both managed care and the growing focus on managing services by monitoring outcomes may positively or negatively affect maltreated children. Both of these trends are affecting the mental health and child welfare systems. It is likely that they will affect maltreated children's access to and the quality, cost, and outcomes of mental health and child welfare services. CONCLUSIONS: Systematic research on the impact of these large-scale changes can increase the likelihood that these changes will benefit maltreated children. A number of critical areas are identified for future research.     

The impact of individual forms of childhood maltreatment on health behavior

OBJECTIVE: This study examines the unique contribution of five types of maltreatment (sexual abuse, physical abuse, emotional abuse, physical neglect, emotional neglect) to adult health behaviors as well as the additive impact of exposure to different types of childhood maltreatment. METHOD: Two hundred and twenty-one women recruited from a VA primary care clinic completed questionnaires assessing exposure to childhood trauma and adult health behaviors. Regression models were used to test the relationship between childhood maltreatment and adult health behaviors. RESULTS: Sexual and physical abuse appear to predict a number of adverse outcomes; when other types of maltreatment are controlled, however, sexual abuse and physical abuse do not predict as many poor outcomes. In addition, sexual, physical, and emotional abuse and emotional neglect in childhood were all related to different adult health behaviors. The more types of childhood maltreatment participants were exposed to the more likely they were to have problems with substance use and risky sexual behaviors in adulthood. IMPLICATIONS: The results indicate that it is important to assess a broad maltreatment history rather than trying to relate specific types of abuse to particular adverse health behaviors or health outcomes.     

积极心理学理念下的大学生心理健康教育新思考

传统的高校心理健康教育模式,重点关注预防和矫正大学生的心理问题,忽视了学生积极的情绪体验、潜能的开发和积极心理品质的培养。积极心理学重点关注人的积极品质,是一种积极乐观、充满人文关怀的教育理念,它为高校做好新时期大学生心理健康教育工作提供了新的方向和思路。     

博客相关法律权利初探

又一种新的媒介一博客,在今天成为公民可以充分表达自己思想与情感的平台。但它的出现同样引发了诸多与权利相关的法律问题。本文试图从言论自由权、隐私权、名誉权在博客中发生的权利冲突,探讨权利规制在虚拟空间的重要性。     

高校医院社会化改革之我见

高校医院的社会化改革,既要坚持履行面向学校的卫生检查和监督、保健医疗等职能,又要面向社区和社会,提供多种多样的医疗卫生服务,在改革中发展自己.     

Exploring the Group Prenatal Care Model: A Critical Review of the Literature

Few studies have compared perinatal outcomes between individual prenatal care and group prenatal care. A critical review of research articles that were published between 1998 and 2009 and involved participants of individual and group prenatal care was conducted. Two middle range theories, Pender’s health promotion model and Swanson’s theory of caring, were blended to enhance conceptualization of the relationship between pregnant women and the group prenatal care model. Among the 17 research studies that met inclusion criteria for this critical review, five examined gestational age and birth weight with researchers reporting longer gestations and higher birth weights in infants born to mothers participating in group prenatal care, especially in the preterm birth population. Current evidence demonstrates that nurse educators and leaders should promote group prenatal care as a potential method of improving perinatal outcomes within the pregnant population.     

Screening for adverse childhood experiences (ACEs): Cautions and suggestions

This article argues that it is still premature to start widespread screening for adverse childhood experiences (ACE) in health care settings until we have answers to several important questions: 1) what are the effective interventions and responses we need to have in place to offer to those with positive ACE screening, 2) what are the potential negative outcomes and costs to screening that need to be buffered in any effective screening regime, and 3) what exactly should we be screening for? The article makes suggestions for needed research activities.     

Survivors of institutional abuse in long-term child care in Scotland

BackgroundThe Scottish Child Abuse Inquiry (SCAI) commissioned the research project to document the outcomes of institutional abuse in long-term child care in Scotland.ObjectiveTo profile the experiences of survivors abused in long-term child care in Scotland, and to develop a model which linked maltreatment, risk and protective factors, and outcomes.Participants and Setting225 survivors of historical institutional abuse in Scotland, who made witness statements to SCAI.MethodsData were extracted from witness statements using a coding frame developed through a thematic analysis of a subsample of 52 statements.ResultsSurvivors had been in care in predominantly Catholic and non-religious residential institutions in Scotland for an average of 8 years, having entered at an average age of 6.8 years. They had suffered multiple forms of maltreatment. Maltreatment rates were: physical abuse, 95.6%; emotional abuse, 85.3%; sexual abuse, 60.4%; emotional neglect, 51.1%; and physical neglect, 37.3%. Across the lifespan survivors had negative outcomes in psychosocial adjustment (96%), mental health (84%), and physical health (43%). The effect of maltreatment in care on psychosocial problems was mediated by both risk and protective factors; and on mental health was mediated by risk factors, but not protective factors. Maltreatment in care had a direct effect on physical health which was not mediated by risk or protective factors. The effects of the cumulative number of risk factors on adverse mental health and psychosocial outcomes was greater than that of maltreatment, and protective factors had a limited impact on adverse outcomes.ConclusionsEvidence-based child protection policies and practices should be implemented to prevent institutional abuse and treat child abuse survivors in Scotland.     

Canine Visitors: The Influence of Therapy Dogs on Young Children's Learning and Well-Being in Classrooms and Hospitals

Trained therapy dogs are becoming an increasingly common sight in many educational and health care settings. This article, coauthored by a college professor, a Therapy Dogs International, Inc., Evaluator and local program director, and a registered nurse reviews the research on using registered therapy dogs as adjuncts in school programs and health care treatment plans for children ages 5–8. It addresses to the most commonly raised objections to allowing dogs in classrooms and patient rooms and offers practical guidelines for maximizing the positive outcomes of animal-assisted activities and therapy (AAA/T).     

Community Colleges: Rethinking STD Prevention for the Nontraditional College Campus

ABSTRACT

As increased attention and proposed funding are being directed toward community colleges, it is important to consider the sexual and reproductive health care needs of this growing population. Existing data suggest there are significant sexual health needs among this population and often insufficient provision of services. Some community college students are more likely than students at 4-year colleges to test positive for sexually transmitted diseases (STDs). Given resource constraints, creative solutions are required. These may include campus-wide policies addressing STD/HIV (human immunodeficiency virus) prevention, referral systems to connect students to care in the community, and partnerships with local health departments, Federally Qualified Health Centers, or community-based organizations to assist with the provision of services. Colleges have the unique opportunity to provide students with valuable information about sexual health and services. Community colleges, in particular, are uniquely positioned to reach at-risk community members for STD testing and sexual health care who might otherwise be lost to care. More research is needed on the sexual health needs of community college students, especially on factors such as geographic location, how embedded the school is into the community, social norms around sexual health on college campuses, and health services offered. New and innovative ways to promote linkage to care for testing and counseling could offer potential health benefits to this growing at-risk population.     

The effects of adult depression on the recollection of adverse childhood experiences

Adverse childhood experiences (ACEs) have been linked to numerous negative physical and mental health outcomes across the lifespan. As such, self-report questionnaires that assess for ACEs are increasingly used in healthcare settings. However, previous research has generated some concern over the reliability of retrospective reports of childhood adversity, and it has been proposed that symptoms of depression may increase recall of negative memories. To investigate the stability of ACE scores over time and whether they are influenced by symptoms of depression, we recruited 284 participants (M age = 40.96, SD = 16.05) from primary care clinics. Participants completed self-report measures of depression and ACEs twice, three months apart. The test-retest reliability of ACEs was very high (r = .91, p < .001). A cross-lagged panel analysis indicated that PHQ-9 scores at Time 1 were not predictive of changes in ACE scores at Time 2 (β = 0.00, p = .96). Results of this study indicate that changes in symptoms of depression do not correspond with changes in ACE scores among adults. This study provides support for the stability and reliability of ACE scores over time, regardless of depression status, and suggests that ACE measures are appropriate for use in healthcare settings.     

新形势下高校医疗卫生机构生存发展的几点思考

实行社区卫生服务是国家城市医疗改革的方向,是各级政府和部门解决老百姓看病贵、看病难的重要举措。遵循这个原则,高校医疗卫生机构应加强内部改革,进一步做好学校的预防、保健、健康教育、计划生育技术指导、医疗、康复“六位一体”工作,更好地为师生员工的健康服务,为学校的教学科研服务。     

Quality assurance and school‐based mental health services

Clinicians affiliated with expanded school mental health (ESMH) programs provide a range of mental health services for youth in schools. ESMH services offer unique opportunities for collaboration between school psychologists and mental health clinicians from the community to increase the quality of care for youth receiving mental health services. The number of ESMH programs is increasing; therefore, developing quality assurance (QA) activities for these programs is important to document accountability and provide evidence for effectiveness. In this paper, suggestions for phases and objectives for QA programs in ESMH programs and examples of suggested activities are presented. Assessment of the program structure as well as treatment process and outcome are critical phases. Important QA activities include examining staff training activities, assessment of stakeholder perceptions of services, conducting satisfaction surveys, examining therapy process, and investigating treatment outcomes. Results of QA evaluations should inform policy.QA programs need to be developed and the impact of QA activities in enhancing the quality of care provided by clinicians in schools should be evaluated. © 1999 John Wiley & Sons, Inc.