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.     

State programs for medical diagnosis of child abuse and neglect: case studies of five established or fledgling programs

OBJECTIVE: To describe the programs for medical diagnosis of child abuse and neglect in three states and efforts to establish state-wide programs in two states. To describe common themes and issues that emerged related to the establishment and maintenance of these programs. METHODS: Five states were selected as case studies to represent a range of experience and type of function embodied in programs that address medical diagnosis of child abuse and neglect. Individuals knowledgeable about the programs or efforts to establish state-wide programs in their home states described these in detail. Inductive analysis was used to identify themes and issues that emerged across the states studied. FINDINGS: Themes emerged in three general areas: funding, services, and training. Findings related to funding were: 1) State funding was vital for initiation of statewide programs; 2) Alliances with other groups with parallel interests were successfully used to garner support for child abuse programs; 3) Services needed to be adequately reimbursed to be sustained; 4) Political climate often affected funding. With regard to services we found: 1) There was no optimal way to organize services, but rather many ways that worked well; 2) It was critical to address local service needs; 3) Provision of standardized quality services was essential. With regard to training: 1) Professional training was an integral part of all statewide programs; 2) New technologies, including televideo, have been explored and implemented to assist in training in statewide programs. CONCLUSIONS: Each state has taken a unique approach to programs for the medical diagnosis of child abuse and neglect. However, there are commonalities, particularly among the states that have been successful in establishing and maintaining comprehensive services and/or training.     

Depending on the kindness of strangers: current national data initiatives and developmental research

This article provides a brief review of current large-scale, longitudinal data collection initiatives focusing on children. These studies will be available for secondary data analyses in the twenty-first century. In addition to child outcome data, process-oriented information is being collected on child-parent interactions, quality of child care, elementary school teacher reports and classroom observations, accessibility and use of health, educational and social services, parental mental health, family violence, fathering, parental residence patterns, income and income sources, child support, employment patterns, and community characteristics. Several of these studies are randomized trials of the efficacy of early childhood intervention services and housing mobility programs. The usefulness of these efforts for exploring policy-relevant issues (child support enforcement, work requirements for welfare recipients, antipoverty strategies, housing subsidies and relocation, availability of child care, child-care subsidies) are discussed.     

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.     

American Indian law on child abuse and neglect

A wide variety of American Indian tribal codes on child abuse and neglect are currently in effect. They range from anachronistic codes that were promulgated about fifty years ago and have never been revised to recently enacted codes that are innovative and incorporate the best practices in the field of protective services. The efforts, now underway, to collect and analyze Indian tribal codes on child abuse and neglect is supportive of the national interest to improve Indian child welfare services. The knowledge gained will be helpful to Indian tribes as they assess their own codes and will provide a new body of information on the laws in the U.S. on child abuse and neglect. In the past few years, increased national support in the United States has been focused on the protection of the best interest of Indian children with specific resources provided for the support of local Indian children and family programs operated by Indian tribal governments. Many Indian tribes are using these resources to develop and revise their child welfare codes, including those elements pertaining to child abuse and neglect. The momentum under way in the United States to improve Indian child welfare services can be expected to continue to include developments in Indian tribal codes on child abuse and neglect.     

The use of telemedicine in child sexual abuse evaluations

OBJECTIVE: To describe the advantages, disadvantages and current status of child abuse consultations conducted through telemedicine networks. METHOD: The results of a telephone survey of seven statewide telemedicine networks are reported and discussed with respect to goals, funding, technical support and expertise, infrastructure, and extent of use. Quality assurance and liability issues concerning telemedicine child abuse consultations are also reviewed. RESULTS: The goals of telemedicine networks in child abuse are to provide (1) expertise to less experienced clinicians primarily in rural areas; (2) a method for peer review and quality assurance to build consensus of opinions particularly in sexual abuse cases; and (3) support for professionals involved in an emotionally burdensome area of pediatrics. Problems encountered by existing networks include: (1) funding for equipment and reimbursement for consultation; (2) consistent technical support: (3) clinician lack of technical expertise, knowledge, or motivation; and (4) lack of network infrastructure. Legal considerations include licensure exemptions for consulting across state lines, potential for malpractice, patient confidentiality and security of images forwarded over modem lines, and liability of the equipment, consulting site, and the consultant in criminal proceedings. CONCLUSIONS: Telemedicine consultations offer a unique opportunity to raise the standard of care in child abuse evaluations, but success depends on clinician motivation, appropriate infrastructure, and ongoing funding and technical support.     

School leavers with learning disabilities moving from child to adult Speech and Language Therapy (SLT) teams: SLTs’ views of successful and less successful transition co‐working practices

School‐leaving for pupils with long‐term speech, language, swallowing or communication difficulties requires careful management. Speech and language therapists (SLTs) support communication, secure assistive technology and manage swallowing difficulties post‐school. UK SLTs are employed by health services, with child SLT teams based in schools. School‐leaving entails transition from child‐ to adult‐services. Little is known about the process, or how SLTs develop co‐working across managerial boundaries. A qualitative study within one health board employing separately managed child and adult SLT teams interviewed SLTs and analysed their views on successful and less successful school‐leaver transitions. A critical incident approach elicited views on transitions that ‘stuck in the mind’, rather than typical instances, identifying supportive and risky co‐working factors. Interviews were recorded, transcribed, checked and thematically analysed. Three linked overarching themes emerged: SLT team remits and properties; communication and information exchange across SLT teams, and outside influences on teams. These applied to successful and less successful transitions, suggesting robust constructs along which SLTs evaluated transitions. Risk factors included unclear provision, pupils’ earlier discharge by child SLTs affecting referral at school‐leaving, and practical issues in accessing notes. SLTs used existing social‐capital relationships to facilitate transitions. Implications for practice and ways of improving transitions are discussed.     

Patterns of interactions in multidisciplinary child protection teams in New Jersey

OBJECTIVE: The objective of this study was to gain an understanding of how multidisciplinary team members in child protection worked together within the team, meeting to provide assessments of, and services to, children and families. METHOD: Fifteen multidisciplinary child-protection teams in New Jersey were observed during one meeting of each team. The interaction among team members was recorded and analyzed using a structured observation method, Bales' Interaction Process Analysis. RESULTS: There was a wide variation in participation among team members, with some contributing nothing to the meeting and others contributing a great deal. In some teams, participation by members was more equal than others. Some professional groups and agencies contributed very little to any meeting while others contributed a great deal to many meetings. CONCLUSIONS: Professionals are members of multidisciplinary teams because they are expected to contribute to the investigation of child maltreatment cases and to the planning for further work with cases. However, the findings from this study suggest that there is a considerable degree of inequality in levels of participation in multidisciplinary meetings. It is particularly noticeable that staff from the prosecutor's offices participate in every meeting and either the agency as a whole or individual members of it dominate many of the meetings.     

Data surveillance in child protection systems development: an Indonesian case study

Objectives

Successful implementation of child protection program interventions and child and family welfare services is contingent upon the availability and use of good quality information, as emphasized by the recent Convention on the Rights of the Child's General Comment 13. Yet, the role of information within child protection is not well understood, and ongoing efforts to strengthen child protection systems have not systematically examined this critical function. Recognizing these shortcomings, the Government of Indonesia and UNICEF commissioned a study to identify a “road map” for a national child protection information system.

Methods

The used desk review, semi-structured interviews, focus groups and site visits to identify existing data collection practices, and analyze the appropriateness and efficiency of information management mechanisms from the national down to the community level.

Results

The results show that the prevailing situation in Indonesia is characterized by a lack of accurate information on all necessary aspects of child care and protection including magnitude of problems, causality analysis and impact of programmatic responses. There is no lead actor for child protection at the national level, and there are no agreed upon data collection priorities, procedures or methods for a shared data collection system.

Conclusion

The study suggests a need to reframe the dominant language from a “child protection information management system” to a “child protection surveillance system” to promote clearer data collection objectives and activities. Identifying a government ministry to lead child protection efforts and to forge closer partnerships among relevant actors will be required to support a national surveillance system. Additionally, addressing obstacles that limit child protection incident detection at the community level is critical. In addition to strengthening Indonesia's system, this study's approach and findings have the potential to help to inform ongoing child protection system development initiatives in other countries as well.     

淄博市社区居家养老服务面临的问题及对策

在政策体系初步形成、关爱服务力度不断加大、服务普惠面不断扩大的情况下,本文分析了淄博市开展社区居家养老服务的基本情况,从社区居家养老资金来源渠道单一、社区居家养老服务设施供不应求、社会组织难以参与社区居家养老服务、社区居家养老服务队伍建设亟须加强等方面阐述了淄博市社区居家养老服务面临的困难和问题,提出了通过建立社区居家养老多元化投资机制、加快社区居家养老服务设施建设、促进服务类社会组织发展、及加快社区居家养老服务队伍建设等措施,以达到积极推进淄博市社区居家养老服务的目的。     

Stopping abuse before it occurs: Different solutions for different population groups

This paper reports on a conference at which participants reviewed indepth the literature on child abuse prevention and child development, as it pertains to different cultural and ethnic population groups, and identifies alternative prevention strategies for these different groups. The efficacy of the following interventions are analyzed: perinatal support programs, education for parents, treatment for abused children, early and periodic childhood screening and treatment programs: social skills training for children and young adults; mutual aid programs and neighborhood support groups; family support services such as crisis care; public information about child abuse and community development activities such as employment assistance. The paper concludes that although treatment services for different groups may be quite similar, prevention strategies must take account of the individual and unique values, norms and socialization patterns of different groups.     

Defining and Assessing Quality in Early Intervention Programs for Infants and Toddlers with Disabilities and their Families: Challenges and Unresolved Issues

Historically, child care quality research has focused primarily on typically developing children cared for in center-based programs. Findings from this research suggests that variations in quality of care have an effect on children's well-being and developmental outcomes. In this paper, we draw on child care quality research to inform our understanding of quality in early intervention services for infants and toddlers with disabilities and their families. Conceptual issues in defining quality and methodological challenges for assessing quality of early intervention services are presented. In the final sections of this paper, we discuss our efforts to design a measure of quality for early intervention programs and present some of the unresolved issues related to the assessment of quality in early intervention programs.     

Characteristics of Early Care and Education Collaboration Associated with Success

ABSTRACT

Research Findings: In this non-experimental study, the research team analyzed data from a randomly selected sample of child care programs in Maryland and Vermont to understand what characteristics contribute to collaboration success. The team also examined the relationship between collaboration success and measures of child care program quality. We found positive correlations between collaboration success – defined as programs’ use of collaborative strategies, structural indicators of quality, and QRIS ratings – and programs’ collaboration administration and collaboration relationships. In addition, programs that used more collaboration strategies had higher ratings on the state’s Quality Rating and Improvement System (QRIS). Policy or Practice: Policies designed to encourage early childhood collaborations should support strong administrative processes among collaborators and provide specific guidance on building strong relationships among child care and early education administrators. Future research is needed to determine the causes of the associations. Research should focus on how policies can broaden the reach of federal and state programs that promote collaboration to include programs that have lower QRIS ratings or programs that opt out of these state systems.     

世界幼教事业发展趋势:国家财政支持幼儿教育

国家财政支持幼儿教育已成为一个世界性的发展趋势。这一趋势的出现基于对幼儿教育重要性的认识、有关幼儿教育的正外部效益的发现和对幼教市场缺陷的揭示。幼儿教育经费整体投入不足、有限资源分配不公、效益不高是我国幼儿教育财政投入体制的主要问题,必须从制度和政策层面加以改进。     

Addressing the needs of Latino children: A national survey of state administrators of early childhood programs

This study consisted of a national survey of 117 state administrators of early childhood programs to examine specific challenges, strategies, and beliefs around serving Latino children and families. Four types of early childhood programs were represented: child care, Head Start, Part B-Section 619 preschool special education programs, and Part C infant-toddler programs for children with developmental disabilities. The survey consisted of 48 Likert scale items across six subscales to gather information about challenges and strategies for serving young Latino children and their families, as well as administrators’ beliefs about issues related to language development and early literacy learning, child assessment, approaches to support equity and diversity, and parental involvement. Administrators generally agreed on the importance of preserving a child's home language and the need to assess young children in either their home language or their home language and English. All four groups held similar views about strategies. The study found less agreement among groups on issues related to challenges, approaches to promoting diversity, and strategies for promoting parental involvement.     

DEVELOPING AND EVALUATING AN INTERDISCIPLINARY CLINICAL TEAM TRAINING PROGRAM: LESSONS TAUGHT AND LESSONS LEARNED

The training of clinicians in working together as an interdisciplinary team has received growing support in geriatrics. Most teamwork training programs have focused on group process and development as the core competencies of team practice necessary to improve levels of team functioning. The experience of the Rhode Island Geriatric Education Center (RIGEC) in developing and implementing an ongoing teamwork training program, including the training of several geriatric teams from a variety of health care settings, suggests that additional objectives should include the empowerment of teams for advocacy in rapidly changing health care settings increasingly shaped by economic forces. The lessons learned by RIGEC for the development and implementation of teamwork training include the importance of defining team membership, dealing with the shifting shoals of the health care system, understanding individuals and systems under stress, and redefining the objectives of teamwork training.     

Mothers in methadone treatment and their involvement with the child protection system: A replication and extension study

Objectives

Although a high level of involvement with the child protection system has been identified in families where parental substance use is a feature, not all such parents abuse or neglect their children or have contact with the child protection system. Identifying parents with substance-use histories who are able to care for their children without intervention by the child protection system, and being able to target interventions to the families who need them the most is important. This study interviewed a relatively large sample of mothers about their histories, their children and their involvement with the child protection system. We hypothesized that mothers in opioid pharmacological treatment who are involved with child protection services are different in characteristics to those mothers who are not involved.

Methods

One hundred and seventy-one women, with at least one child aged under 16 years, were interviewed at nine treatment clinics providing pharmacological treatment for opioid dependence across Sydney, Australia.

Results

Just over one-third of the women were involved with child protection services at the time of interview, mostly with children in out-of-home care. Logistic regression analyses revealed that factors which significantly increased the likelihood of the mother being involved with the child protection system were: (1) having a greater number of children, (2) being on psychiatric medication, and (3) having less than daily contact with her own parents.

Conclusions

This study replicates and extends the work of Grella, Hser, and Huang (2006) and the limited literature published to date examining the factors which contribute to some substance-using mothers becoming involved with the child protection system while others do not. The finding that mental health problems and parental supports (along with the number of children) were significantly associated with child protection system involvement in this study, indicates a need for improved interventions and the provision of treatment and support services if we are to reduce the involvement of the child protection system with these families.     

Collaborative learning processes in the context of a public health professional development program: a case study

The health promotion laboratory (HPL – Canada) is a public health professional development program building on a collaborative learning approach in order to support long-term practice change in local health services teams. This study aims to analyse the collaborative learning processes of two teams involved in the program during the first year of implementation. Based on a multiple case study design involving observations, interviews, and documentary sources, the study: (1) describes the learning process by which each team built a common understanding of the problem at hand and developed an intervention to address it; (2) identifies factors that facilitated or hindered these processes; and (3) proposes a cross-case explanation of the collaborative learning process in the HPL. The results demonstrate that the two teams learned by expanding their repertoire of actions, albeit experiencing different processes. Results point to the central role of shared mental models and key influencing factors, such as commitment and participation (team cohesion), team climate (psychological safety), and leadership style. Unlike previous studies on team learning that concentrated on existing teams in organisations, the current research studied purposely created teams working at transforming their practices and showed that they can successfully learn if specific conditions are achieved.     

Crisis intervention teams in the schools

When a crisis occurs in the school setting, school officials must be prepared to handle the situation effectively and efficiently. One of the ways school officials can handle a crisis situation is through the use of crisis intervention teams. The steps in establishing a crisis intervention team in a school setting include: determining goals, performing a needs assessment, finding model programs, developing a membership pool, developing a training program, preparing and maintaining a list of resources and plans for support services, establishing a communication network, designating a base of operations, planning team meetings, keeping records, and implementing the phases of debriefing. A crisis management scenario is presented and discussed in terms of the steps.