Day care for the child with cancer

Laughing and shrieking in the afternoon sun, the children unleash their pent-up energy on the playground. After a morning indoors, they are happy to shout without being shushed. One child, however, does not join in. She stands motionless, a colorful cap not quite covering her bald head. The right sleeve of her winter coat hangs limp and empty. She has osteosarcoma, a bone cancer, and after an absence of several months, this is her first day back at school.Sheila M. Bonaiuto is Writer-Information Specialist at ALSAC-St. Jude Children's Research Hospital, 501 St. Jude Place, Memphis, Tennessee. ALSAC is the fund-raising arm of St. Jude Children's Research Hospital.     

The role of the health care provider with the gifted child

The health care provider functioning in an organized pre‐school setting can play a vital role in the early identification of the gifted child. Early recognition and intervention with the child and family is important in meeting the special needs as well as challenges the gifted child presents. The health professional can make a unique contribution in this area as well as being alert for the potential health problems the child may have.     

The development and evaluation of a training program for school-based professionals dealing with child abuse: The University of Toronto interfaculty child abuse prevention project 1978–1979

This paper reports on a child protection training program for teachers, social workers, and nurses. The training format consisted of two 5-day workshops, one for preprofessional students and the other for practicing professionals, and two one-day workshops for students. The evaluation employed a pre-test/post-test design. Data were obtained from a total of 254 workshop participants who were randomly selected from a group of 400 volunteers. The training program was designed to provide information and experience in the areas of identification, family dynamics, legislation, intervention, and team responses. Curriculum effects were the dependent variables; group characteristics were the independent variables. The general finding was that the program was an effective means of accomplishing its objectives. Some of the specific findings were that professionals wanted more content in contrast to students who were satisfied with experiences which simulated practice. Both social work professionals and students were more confident in their ability to deal with the problem of child abuse before and after the program than teachers and nurses. In contrast, teachers began and ended the program with relatively low confidence and information levels. Overall, nurses had the highest level of entry and exit knowledge at the beginning and the end of the program. While the results indicate that the three groups profited from shared training experiences they also suggest that certain areas of training may best be realized by specialized workshops.     

Public perception of child abuse and the need for intervention: Are professionals seen as abusers?

Professionals who make decisions in child abuse cases often deny that their decision-making has a moral basis, claiming that they have a “non-judgmental” attitude, and that they only make decisions in the “interests” of their clients, reaching their conclusions on an assessment of the circumstances. This paper considers the implications of this for practice, and particularly for the ways in which cases are reported to the authorities. The study suggests that the general public are reluctant to report cases to the authorities, or even to suggest that professionals should intervene in an authoritarian way. This may arise from suspicion, often in effect justified, that the child will be removed and placed in an institution. Normally the decision to remove a child from home is taken in two stages: first professionals decide whether a child has been abused or whether he is in acute danger of being so; only if this is so can the second decision be taken, namely whether to remove the child or offer some less drastic form of help. This paper is primarily concerned with the first issue and with forms of abuse which are not in themselves life-threatening. Five types of criteria are considered for determining whether child abuse has taken place and the implications for each for public perception of professionals and for practice. The types are: legal, social norms, professional expertise, client subjectivity and no criteria. All present difficulties and may sometimes be in conflict with one another. The paper argues for standards to be clearer, criteria more available and for a shift of resources from therapy to education.     

Fusing the boundaries between home and child care to support children's scientific learning

Parent involvement in early childhood education is highly valued by staff and families alike. However, limited research is available to guide professionals in how best to involve families in the early childhood programs developed for their children. This article reports on a study which investigated the impact of a science teaching and learning program on families of children attending an Australian Child Care Centre. Particular reference is made to the level of scientific support families gave to their children.     

多功能坐便器的开发及其在家庭医疗监测中的应用

利用日常生活中所使用的家具、用具等进行生理信息检测,既能实现生理信息的长时期、无创性、无意识监测,又能实现对身体健康状况的日常管理,是家庭医疗监测监护发展的方向。提出了一种以PIC18F452单片机为核心,由4个高精度ZEMICL6D称重传感器、4个内部集成放大器的24位A/D转换器件HX711、按键、SIM900A通讯模块以及PB375A存储模块构成的新型多功能坐便器。实验结果表明,该坐便器在技术上实现了大范围高精度测量及多传感器数据融合;功能上,在不改变人们原有生活习惯的基础上实现了体重、排泄量、排泄速度的同时测量以及测量结果的存储与分析,在异常情况下能发出相应的提示。该坐便器对肥胖症、男性泌尿疾病等多种高发病率的疾病起到了早发现、早预防、早治疗的作用,并为后续健康管理提供可靠的数据。     

Social functioning in first grade: associations with earlier home and child care predictors and with current classroom experiences

Family and child care factors from birth to 54 months, achievement and social outcomes at entry to school, and qualities of first-grade classrooms were used to predict first-grade social functioning for 864 children from the NICHD Study of Early Child Care. Child gender, mothers' partner status, maternal education and depressive symptoms, sensitivity of mothering, and amount of time spent in nonmaternal child care were significant predictors. Home and child care variables predicted social functioning through associations with prior social functioning rather than directly. More teacher-led structured activities in first-grade classrooms predicted mother's reports of more internalizing behavior. Classrooms rated as more emotionally supportive predicted lower levels of mother-reported internalizing behavior and concurrently observed indicators of competence.     

Funding realities: child abuse diagnostic evaluations in the health care setting.

OBJECTIVE: This study examines staffing, funding sources, reimbursement, and financing of medically-oriented child protection teams. METHOD: A 16-item questionnaire on the composition, size, and services of the team, program costs, revenue sources, reimbursement rates, and perceptions of funding stability was mailed to a sample of 118 medically-oriented child protection teams. RESULTS: After excluding 10 programs, an overall response rate of 68% was obtained. Teams varied in configuration, services, charges, and funding. Over 50% identified funding as being important, yet, demonstrated varying levels of awareness of budget and reimbursement issues. Many generally relied on patient care reimbursement from health care and government payers. Some programs seemed to be doing well financially while others were struggling. Approximately one-third of the respondents indicated that funding was unstable. CONCLUSIONS: Many programs are innovatively knitting together patch-works of funding and support to serve children and families in need. Team leaders should increase their knowledge of fiscal issues in order to be effective advocates at the institutional level for continued team support. A potential way of accomplishing this would be to utilize the existing structure of a national professional association and its national meeting to provide a forum for relatively successful programs to showcase their "ideal models" of team financing.     

At the heart of child care: Predictors of teacher sensitivity in center-based child care

This study examined the extent to which characteristics of early childhood teachers and settings predicted observed teacher sensitivity. Participants included 41 head teachers at child care centers located in Northern California. Accreditation status, center size, and program quality were uniquely associated with teacher sensitivity. Accreditation was also associated with a number of other teacher (training, ethnic minority status, and depression) and setting characteristics (program quality, subsidies, and child ethnic minority enrollment). Other unique predictors included more teacher training, smaller center size, and perceived organizational health. Having a greater number of depressive symptoms or working in a larger center were identified as risks to teacher sensitivity, and were moderated by higher levels of teacher training and observed program quality The current study provides preliminary support for the importance of examining the ways that teacher and setting characteristics are related to teacher interactions with young children.     

Impact of a statewide home visiting program on parenting and on child health and development

OBJECTIVES: To assess the impact of a voluntary, paraprofessional home visiting program on promoting child health and development and maternal parenting knowledge, attitudes, and behaviors. METHODS: This collaborative, experimental study of 6 Healthy Families Alaska (HFAK) programs enrolled 325 families from 1/00 to 7/01, randomly assigned them to HFAK and control groups, interviewed mothers at baseline, and followed families until children were 2 years old (85% follow-up). Child outcomes included health care use, development and behavior. Parent outcomes included knowledge of infant development, parenting attitudes, quality of the home environment, and parent-child interaction. HFAK records were reviewed to measure home visiting services. Home visitors were surveyed to measure knowledge, perceived effectiveness and perceived training adequacy. RESULTS: There was no overall impact on child health, but HFAK group children had more favorable developmental and behavioral outcomes. HFAK and control mothers had similar parenting outcomes except that HFAK mothers had greater parenting self-efficacy (35.1 vs. 34.6 based on the Teti Self-Efficacy Scale, p<.05). Fewer HFAK families had a poor home environment for learning (20% vs. 31%, p<.001). HFAK families were more likely to use center-based parenting services (48% vs. 39%, p<.05). The impact was greater for families with lower baseline risk (Family Stress Checklist scores<45). There was little evidence of efficacy for families with a higher dose of service. CONCLUSIONS: The program promoted child development and reduced problem behaviors at 2 years. Impact could be strengthened by improving home visitor effectiveness in promoting effective parenting. Future research is needed to determine whether short-term benefits are sustained.     

A comparative study of attitudes toward child sexual abuse among social work and judicial system professionals

To meet the needs of mutual clients, perpetrators and victims, social service and judicial system professionals share an obligation to collaborate in cases of child sexual abuse. Unknown is the extent to which individuals in counter professions share common beliefs about perpetrators and victims of child sexual abuse. This paper reports an inquiry into the attitudes of five professional groups within an urban criminal justice system specific to victim credibility, victim culpability, offender culpability, and the crime and punishment of child sexual abuse. As predicted, statistically significant differences in attitudes were found among child welfare social workers, police officers, district attorneys, public defenders, and judges. In particular, groups differed in their beliefs about victim credibility and punishment of offenders, suggesting conflict in addressing two fundamental questions in these cases: (1) Can a child be believed when he or she reports sexual abuse? and (2) How should the system deal with offenders? Both questions beg the continuing attention of all professionals invested in these cases, ultimately benefiting victims and offenders. Both quantitative and qualitative findings are provided in this report.     

Financing medically-oriented child protection teams in the age of managed health care: a national survey

OBJECTIVE: The direct and indirect costs to society from child maltreatment are estimated to be quite high. The costs related to medical care are of interest to professionals serving on medically-oriented child protection teams that conduct medical evaluations of alleged abuse. This study was designed to explore a number of financially related issues on medically-oriented child protection teams specifically examining the team's staffing, funding sources, reimbursement, budgeting, perceived impact of managed health care and their perception of funding stability. METHOD: Mailed survey of medically-oriented child protection teams throughout the United States using a questionnaire that contained 28 items focused on a variety of financial issues; 14 items were drawn from a similar study done 6 years earlier, which allowed for comparison over time. RESULTS: Responses were received from 320 out of 472 organizations, yielding a response rate of 68%. Inclusion criteria were met by 153 responses and were included in the analysis; 22 of these had also responded to the earlier survey. Median total budget was $300,000 and state and local government funding was the largest revenue source (Mdn = 30%, range: 0-100%), followed by patient care generated revenue (Mdn = 20%, range: 0-100%). The mean charge for an evaluation was $283 (SD = 196.11, range: $0-$800). Forty percent of teams indicated that managed care had no impact where as 49% saw a negative impact. Comparisons between the responses to this survey and the one done 1993 demonstrated that teams were seeing about the same number of patients and showed trends towards increased budget amounts and broader inclusion of various health care and non-health care disciplines on the teams. CONCLUSIONS: No single source of funds for such teams has emerged as the uniform solution for all teams. Creative patchworks composed of various funding sources remain the typical solution to the funding needs of medically-oriented child protection teams.     

Determinants of foster care placement for the maltreated child

This study examined the records of the North Carolina Central Registry of Child Abuse and Neglect to determine which social, family, and child characteristics were most influential in the decision to place a child in foster care. These records contained all theoretically relevant factors as well as demographic data. Analysis included the computation of odds ratios for foster care for each of 250 variables. A maximum likelihood logistic regression model was constructed to obtain the independent and cumulative contribution of each factor. Some expected variables such as parental stress factors (substance abuse) and types of abuse (burns and scalds) placed a child at a significant risk for placement in foster care (p < 0.01). However, less obvious factors such as referral source (law enforcement agencies) or geographic area also placed children at risk. Overall, the model explained little of the variance of these decisions (R² = 0.168) and poorly predicted placement (sensitivity 66.3 per cent, specificity 74.6 per cent). Using existing data. we were unable to adequately describe the decision process in selecting foster care.