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.     

Facilitating online reflective learning for health and social care professionals

Drawing upon survey data and relevant literature, this paper compares the Radio and Television University System (RTVUS) in China, Indira Gandhi National Open University (IGNOU), and the Open University of Hong Kong (OUHK) in respect of academic courses offered, course delivery mode, student characteristics, funding, and staffing. Similarities and differences are discussed, and the impact of socio-cultural factors in shaping distance education systems in different societies is examined.     

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.     

Attitudes of health professionals to child sexual abuse and incest

While there has been increasing interest in the topic of child sexual abuse, few studies have focused on attitudes or the determinants of such attitudes held by professionals. To what extent concern is based on stereotyping or factual knowledge is not clear. The present study uses a combination of experimental and survey methodologies to address these issues. Sample case histories were issued to subjects who were then asked to complete a questionnaire on topics relating to the case and to incest in general. Results showed that the type of sexual activity involved influenced responses: type of relationship between adult and child, less so. Estimates of incest were low, but incest was considered, especially by female respondents, to be harmful to the victim.     

Disentangling the effect of out-of-home care on child mental health

BackgroundChildren in out-of-home care are consistently found to have poor mental health compared to children in the general population. However, UK research has so far failed to disentangle the impact of the care system on children’s mental health outcomes from the effects of the adverse circumstances that led to their admission to care.ObjectiveThis research investigated the association between care placement and the presence of child mental health problems after controlling for children’s pre-care experiences. It also identified factors associated with mental health problems among children in care.Participants and SettingThe sample comprised three groups of children involved with child welfare services due to maltreatment, including children in out-of-home care (n = 122), reunified children (n = 82) and those who had never been in care (n = 159).MethodsThe mental health of the children in the three groups was compared, using information collected from their parents/foster carers and social workers.ResultsThe odds of a child in out-of-home care having a mental health problem were not significantly higher than those of a child who had never been in care (AOR = 1.24; p = 0.462). However, the odds of a child in out-of-home care having reactive attachment disorder (RAD) were significantly higher than those of a child who had never been in care (AOR=1.92; p = 0.032).ConclusionsThese findings make an important contribution to international debates about whether placing children in care is beneficial or detrimental to their wellbeing, and highlight a range of inter-linking factors associated with the mental health of children in out-of-home care.     

Providing medical evaluations for possible child maltreatment to children with special health care needs

OBJECTIVE: Children with special health care needs are known to be at increased risk of all forms of child maltreatment when compared to children without such needs. We describe a health care team's experience providing medical evaluations for suspected child maltreatment to children with special health care needs. METHOD: Consecutive cases seen as outpatients in the Abuse Referral Clinic for Children with Disabilities were abstracted and analyzed. Mail and telephone follow-up contact was attempted after the medical evaluation to determine adherence with treatment recommendations. A subsample of cases for which complete financial information was available was reviewed to determine a reimbursement rate. RESULTS: During the study, 49 children received complete outpatient evaluations. Ages ranged from 3 to 16 years old, and 54% were males. Special needs spanned a wide range of physical, developmental/cognitive and behavioral conditions. The largest number of referrals came from child protective services (42%) followed by referrals from physicians (27%). After the team's comprehensive evaluation, 18% of the children were found to have a history or physical examination that was diagnostic for child maltreatment, 13% were thought to be at high risk, 25% were thought to be at low risk and 44% were thought to have non-abusive etiologies. The collection rate was 14% for an average reimbursement of $38 per case. Only 29 caregivers could be found at follow-up and 22 remembered the recommendations made by the team. Of the 25 cases that were referred for outpatient mental health counseling, 12 (48%) complied. CONCLUSION: Children with a wide range of special health care needs were evaluated in an outpatient special health care needs clinic that offered comprehensive medical evaluations for possible child maltreatment. Medical evaluation services for this group of children were poorly reimbursed. Mental health services were frequently recommended but often not accessed. Child maltreatment teams seeking to serve children with special health care needs will need to plan for service delivery to a potentially diverse group of children and families who may experience difficulty in carrying through on the team's treatment recommendations.     

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.     

Comparisons of observed process quality in early child care and education programs in five countries

In this cross-national study, observed process quality in preschool classrooms was compared across five countries—Austria (n = 37), Germany (n=103), Portugal (n=88), Spain (n=80), and the U.S.A. (n=390). Process quality was assessed using the Early Childhood Environment Rating Scale (ECERS) and the Caregiver Interaction Scale (CIS). Both instruments had comparable properties when used in the different countries. A MANOVA found overall ECERS differences between countries, with Austria and Germany scoring higher than Spain, and Austria higher than the U.S.A. CIS Sensitivity scale differences showed Austria and Spain with higher scores than the U.S.A. Tests of homogeneity of variance showed U.S.A. with the highest standard deviations. A discriminant analysis, using countries as groups and ECERS items as criterion variables, revealed differences between countries on two discriminant functions: Personalized Care and Availability and Use of Space and Play Materials. Results are discussed in terms of the early childhood traditions and infrastructures found in the five countries.     

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。     

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.     

Variation in prevention of child maltreatment by Dutch child healthcare professionals

Child maltreatment (CM) is a common condition with a large impact on the victim and society. In the Netherlands, the preventive child healthcare (CHC) aims to protect children against such threats. However, several studies indicate that the efficacy in this area may be suboptimal for many CHC professionals. Therefore, this study aims to map the practice variation in the primary and secondary prevention of CM, by CHC physicians and nurses. This mixed-methods study used interviews to identify relevant topics and develop an online questionnaire. All CHC organizations in the Netherlands (n = 45) were asked to forward this questionnaire to their professionals. Practice variation was described with domain scores and item response distributions. Multi-level analysis was used to assess case mix-corrected variance between organizations. Interview participants (n = 11) expected suboptimal care in 35 topics which they considered important for prevention of CM, resulting in a 15 min questionnaire. Nearly two-thirds of the organizations (n = 29) agreed to forward the questionnaire to their employees. The response rate was 42% (n = 1104). Suboptimal care and practice variation was found in all domains (i.e. communication, medical expertise, collaboration, involvement in prevention of CM, and improvement opportunities), mostly caused by intra-organization variance. Significant inter-organization variance was found for collaboration (variance partition coefficient 6–7%) and involvement (2–3%). Furthermore, the majority of the respondents (96%) reported fear in acting upon suspicions of CM. Substantial suboptimal care and practice variation in prevention of CM warrant action from authorities, CHC training institutes, CHC organizations, and professionals.     

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.     

Depressive symptoms in young adults: the influences of the early home environment and early educational child care

The relationship between depressive symptoms in young adults, the quality of the early home environment, and early educational child care was investigated in young adults randomly assigned to receive early childhood intervention in the Abecedarian study. Of the original 111 infants enrolled (98% African American), 104 participated in an age-21 follow-up. Those who had early treatment reported fewer depressive symptoms. The protective effects of the early childhood program were further supported by a significant home environment by treatment interaction. Negative effects of lower quality home environments on young adult depressive symptoms were almost entirely offset by preschool treatment, whereas depressive symptoms increased as the quality of the early home environment decreased for those in the control group.     

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.