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Foster care children tend to have greater physical and mental health needs compared to those of their peers who are not in foster care due to many challenges that threaten their well-being. Yet, owing to frequent placement changes, their treatment may be fragmented. Moreover, if foster children are unable to provide important information about their own health status, and the same cannot be obtained from their families of origin, the resulting incomplete and/or inconsistent health history puts them at risk for unrecognized problems and conflicting diagnoses. Paradoxically, foster parents and resource providers often request psychotropic medications for children and youth in their care as a means of managing their behaviors. The phenomenon of inappropriate polypharmacy arises due in part to the difficulties related to integrating trauma-informed principles into the care process. It is further exacerbated by the complexity of intersecting systems in which child welfare case workers need to communicate including foster and biological parents, social service agencies, and advocates. In this second paper, we report on the same intervention as that discussed in the first paper, focusing on the effectiveness of the live 2-hour face-to-face training for child welfare staff and the 3-month web-based curriculum for leadership personnel in improving the participants' trauma responsiveness.1. What are the child welfare staff's perceptions of their own knowledge, attitudes, and communication behaviors associated with medications used to treat mental health symptoms and monitoring for side-effects of psychotropic medication use in children? 2. What is the level of trauma responsiveness among child welfare staff?The ABC Medication Scale was employed to measure staff knowledge, attitudes, and behaviors associated with medications used to treat mental health symptoms before and after the intervention to determine if the training resulted in any improvements. Individual- and organizational-level trauma responsiveness was rated on a continuum of the Missouri Model: A Developmental Framework for Trauma-Informed Approaches. Artifacts of the web-based curriculum and qualitative interview data were analyzed by applying grounded theory methods.There was a significant increase in The ABC Medication Scale scores following the training. The qualitative findings further revealed that majority of the participants rated themselves as "trauma aware" or "trauma responsive" on the Missouri Model, while indicating that their agencies could work harder to become more fully trauma-informed. As trauma-informed child welfare workforce that understands the complexity and advocacy requirements of psychotropic medication management is needed, further longitudinal research is required is to assess the training effects over time. In particular, the aim should be to establish (a) how knowledge and attitude shifts correlate with greater degrees of trauma responsiveness, and (b) if and how such trainings translate into improved systems of support.

The phenomenon of inappropriate polypharmacy among the foster care population arises in part due to the challenges related to integrating trauma-informed principles into service delivery. It is further exacerbated by the complexity of intersecting systems in which child welfare case workers need to communicate, including foster and biological parents, social service agencies, and advocates. Yet, there is limited research about trauma-informed psychotropic medication management interventions for child welfare staff. This pilot study was conducted to evaluate a trauma-informed psychotropic medication management intervention and is reported in two manuscripts, pertaining respectively to the facilitators and barriers to learning, and perceived individual and institutional trauma responsiveness. The intervention comprised of a 2-hour-long training session for child welfare staff and a 3-month web-based curriculum for leadership personnel, aiming to increase their understanding of trauma-informed psychotropic medication management. In the first paper, we report on the facilitators and barriers to learning, grouped into three categories: teacher attributes, learner attributes, and situational factors. In the second paper, in addition to trauma responsiveness ratings, we also provide a detailed account of one participant's life experience and perceptions of the intervention provided, as an exemplar of the psychosocial facets of resilience. The ABC Medication Scale scores that measured staff knowledge, attitudes, and behaviors associated with medications used to treat mental health symptoms showed a significant change in scores following training. Based on these findings, we provide practical solutions to address situational factors that are worth considering when providing training for child welfare staff. PAPER 1 ABSTRACT: THE FACILITATORS AND BARRIERS TO LEARNING ABOUT TRAUMA-INFORMED MEDICATION MANAGEMENT: Given that foster care children experience many challenges that threaten their well-being, their physical and mental health needs tend to be greater than those of their peers who are not in foster care. However, owing to the transient nature of the foster care placements, as well as continuous changes in medical providers and counselors, the screenings, supportive interventions, and treatments they receive may be fragmented. This is particularly problematic when considering that many of these children are medicated as a means of managing their behavior. Moreover, children in foster care are also more vulnerable to having the medications and diagnoses accumulate due to frequent placement changes and lack of treatment continuity. Our research was guided by the question "What are the facilitators and barriers to learning about trauma-informed psychotropic medication management?" We developed an intervention to address the issue of inappropriate polypharmacy and examined the facilitators and barriers to learning using a mixed methods design. The facilitators to learning were instructor-specific (e.g., reputation, teaching style, capacity for selecting and implementing relevant resources), learner-specific (altruism, capacity to see personal relevance in the learning situation, desire for knowledge/competence, career advancement/recognition-seeking), and situational (immediacy/on-demand resources, reinforcement of pleasant learning experience). Barriers were largely situational (workload and family demands). Based on these findings, we provide practical strategies for addressing situational factors that are worth considering when designing training curricula aimed at child welfare staff.

Surrogacy techniques allow for the birth of children who are then raised by parents who may have no genetic or biological connection with them at all. Italian legislation on medically assisted procreation bans such practices, under national criminal codes, and yet the intended parents’ ability to legally register children born abroad via surrogacy has not been affected by such legislation. Italian jurisprudence has acknowledged the parental status of same-sex couples, following the same path outlined by the European Court of Human Rights. The paper’s author elaborates on court decision n. 145/2018, from the Naples Court of Appeals, which has stated that surrogacy children may be connected to their intended parents merely by virtue of “mental” elements, based on affection, harmony and listening enjoyed by the child within the family setting. The author is critical of that view, in light of conflicting research findings on children growing up in same-sex families. In that regard, the author argues that even though homosexual couples may well turn out to be good parents, families made up of fathers and mothers still constitute the best scenario for the children, from a social perspective. It is however necessary for lawmakers to step in and better regulate an utterly sensitive area of law, one that might engender adverse repercussions on the children’s well-being, in terms of growth and psychological development, following their becoming part of homosexual families. (www.actabiomedica.it)

Aims In this study we evaluated indicators of the feasibility, reliability, and validity of the Child Health Questionnaire-Child Form (CHQ-CF). We compared the results in a subgroup of adolescents who completed the standard paper version of the CHQ-CF with the results in another subgroup of adolescents who completed an internet version, i.e., an online, web-based CHQ-CF questionnaire. Methods Under supervision at school, 1,071 adolescents were randomized to complete the CHQ-CF and items on chronic conditions by a paper questionnaire or by an internet administered questionnaire. Results The participation rate was 87%; age range 13–7 years. The internet administration resulted in fewer missing answers. All but one multi-item scale showed internal consistency reliability (Cronbach’s α > 0.70). All scales clearly discriminated between adolescents with no, a few, or many self-reported chronic conditions. The paper administration resulted in statistically significant, higher scores on 4 of 10 CHQ-CF scales compared with the internet administration (P < 0.05), but Cohen’s effect sizes d were ≤0.21. Mode of administration interacted significantly with age (P < 0.05) on four CHQ-CF scales, but Cohen’s effect sizes for these differences were also ≤0.21. Conclusion This study supports the feasibility, internal consistency reliability of the scales, and construct validity of the CHQ-CF administered by either a paper questionnaire or online questionnaire. Given Cohen’s suggested guidelines for the interpretation of effect sizes, i.e., 0.20–.50 indicates a small effect, differences in CHQ-CF scale scores between paper and internet administration can be considered as negligible or small.

Although there have been major advances in the treatment of childhood cancer with an overall survival rate of more than 70%, cancer continues to be the leading cause of death in children resulting from disease. In 1998, 2,500 children in the United States died of cancer-related causes. Each year cancer kills more children than asthma, diabetes, cystic fibrosis, congenital anomalies, and acquired immu nodeficiency syndrome combined. The Association of Pediatric Oncology Nurses (APON) is the leading professional organization for nurses caring for children and adolescents with cancer and their families. The highest standards of nursing practice are achieved through education, research, certification, advocacy, and affiliation. It is the position of APON that pain in the child dying of cancer can be effectively managed. This can be accomplished by making the prevention and alleviation of pain a primary goal, partnering with the patient and parents, and aggressively using appropriate pharmacologic and non-pharmacologic interven tions. The pediatric oncology nurse has an essential role in the child's pain management at the end of life through nursing assessment, identifying expected outcomes, and performing and evaluating interventions.

The marked rise in allergies during the past decade has been increasingly perceptible for school personnel. A quarter of Swedish parents of children with allergies are unsatisfied with the school environment and how the schools are organized around their children. The Association of School Physicians has, together with six other medical, teaching and patient organizations, developed written guidelines for the management of asthma and allergies in Swedish schools. The aim was to regulate the responsibility of the school and its personnel for students with asthma and allergies, and to strengthen safety arrangements within schools. A secondary aim was to describe how the curriculum, teaching equipment, excursions, and other school activities, could be arranged appropriately and safely for students with asthma and allergies. Five-hundred copies of the document were circulated to all of Sweden's municipalities, county councils and pediatric departments. There was general agreement regarding the schools' responsibility that no child should risk becoming ill or having exacerbation of symptoms due to conditions at school. Recommendations regarding smoking on school premises and the use of perfumes were criticised. The strength of this document is that all organizations actively involved with schools have agreed upon these recommendations. This document serves to suggest a minimum level of activities thus ensuring that even students with asthma and allergies will receive appropriate schooling.

Faigenbaum, AD, Kraemer, WJ, Blimkie, CJR, Jeffreys, I, Micheli, LJ, Nitka, M, and Rowland, TW. Youth resistance training: Updated position statement paper from the National Strength and Conditioning Association. J Strength Cond Res 23(5): S60-S79, 2009-Current recommendations suggest that school-aged youth should participate daily in 60 minutes or more of moderate to vigorous physical activity that is developmentally appropriate and enjoyable and involves a variety of activities (). Not only is regular physical activity essential for normal growth and development, but also a physically active lifestyle during the pediatric years may help to reduce the risk of developing some chronic diseases later in life (). In addition to aerobic activities such as swimming and bicycling, research increasingly indicates that resistance training can offer unique benefits for children and adolescents when appropriately prescribed and supervised (). The qualified acceptance of youth resistance training by medical, fitness, and sport organizations is becoming universal ().Nowadays, comprehensive school-based programs are specifically designed to enhance health-related components of physical fitness, which include muscular strength (). In addition, the health club and sport conditioning industry is getting more involved in the youth fitness market. In the U.S.A., the number of health club members between the ages of 6 and 17 years continues to increase () and a growing number of private sport conditioning centers now cater to young athletes. Thus, as more children and adolescents resistance train in schools, health clubs, and sport training centers, it is imperative to determine safe, effective, and enjoyable practices by which resistance training can improve the health, fitness, and sports performance of younger populations.The National Strength and Conditioning Association (NSCA) recognizes and supports the premise that many of the benefits associated with adult resistance training programs are attainable by children and adolescents who follow age-specific resistance training guidelines. The NSCA published the first position statement paper on youth resistance training in 1985 () and revised this statement in 1996 (). The purpose of the present report is to update and clarify the 1996 recommendations on 4 major areas of importance. These topics include (a) the potential risks and concerns associated with youth resistance training, (b) the potential health and fitness benefits of youth resistance training, (c) the types and amount of resistance training needed by healthy children and adolescents, and (d) program design considerations for optimizing long-term training adaptations. The NSCA based this position statement paper on a comprehensive analysis of the pertinent scientific evidence regarding the anatomical, physiological, and psychosocial effects of youth resistance training. An expert panel of exercise scientists, physicians, and health/physical education teachers with clinical, practical, and research expertise regarding issues related to pediatric exercise science, sports medicine, and resistance training contributed to this statement. The NSCA Research Committee reviewed this report before the formal endorsement by the NSCA.For the purpose of this article, the term children refers to boys and girls who have not yet developed secondary sex characteristics (approximately up to the age of 11 years in girls and 13 years in boys; Tanner stages 1 and 2 of sexual maturation). This period of development is referred to as preadolescence. The term adolescence refers to a period between childhood and adulthood and includes girls aged 12-18 years and boys aged 14-18 years (Tanner stages 3 and 4 of sexual maturation). The terms youth and young athletes are broadly defined in this report to include both children and adolescents.By definition, the term resistance training refers to a specialized method of conditioning, which involves the progressive use of a wide range of resistive loads and a variety of training modalities designed to enhance health, fitness, and sports performance. Although the term resistance training, strength training, and weight training are sometimes used synonymously, the term resistance training encompasses a broader range of training modalities and a wider variety of training goals. The term weightlifting refers to a competitive sport that involves the performance of the snatch and clean and jerk lifts.This article builds on previous recommendations from the NSCA and should serve as the prevailing statement regarding youth resistance training. It is the current position of the NSCA that

Many position stands and review papers have refuted the myths associated with resistance training (RT) in children and adolescents. With proper training methods, RT for children and adolescents can be relatively safe and improve overall health. The objective of this position paper and review is to highlight research and provide recommendations in aspects of RT that have not been extensively reported in the pediatric literature. In addition to the well-documented increases in muscular strength and endurance, RT has been used to improve function in pediatric patients with cystic fibrosis and cerebral palsy, as well as pediatric burn victims. Increases in children’s muscular strength have been attributed primarily to neurological adaptations due to the disproportionately higher increase in muscle strength than in muscle size. Although most studies using anthropometric measures have not shown significant muscle hypertrophy in children, more sensitive measures such as magnetic resonance imaging and ultrasound have suggested hypertrophy may occur. There is no minimum age for RT for children. However, the training and instruction must be appropriate for children and adolescents, involving a proper warm-up, cool-down, and appropriate choice of exercises. It is recommended that low- to moderate-intensity resistance exercise should be done 2–3 times/week on non-consecutive days, with 1–2 sets initially, progressing to 4 sets of 8–15 repetitions for 8–12 exercises. These exercises can include more advanced movements such as Olympic-style lifting, plyometrics, and balance training, which can enhance strength, power, co-ordination, and balance. However, specific guidelines for these more advanced techniques need to be established for youth. In conclusion, an RT program that is within a child’s or adolescent’s capacity and involves gradual progression under qualified instruction and supervision with appropriately sized equipment can involve more advanced or intense RT exercises, which can lead to functional (i.e., muscular strength, endurance, power, balance, and co-ordination) and health benefits.

The emergency room (ER) represents the main system entry for crises-based health care visits. It is estimated that 2% to 10% of children visiting the ER are victims of child abuse and neglect (CAN). Therefore, ER personnel may be the first hospital contact and opportunity for CAN victims to be recognised. Early diagnosis of CAN is important, as without early identification and intervention, about one in three children will suffer subsequent abuse. This educational paper provides the reader with an up-to-date and in-depth overview of the current screening methods for CAN at the ER. Conclusion: We believe that a combined approach, using a checklist with risk factors for CAN, a structured clinical assessment and inspection of the undressed patient (called ‘top–toe’ inspection) and a system of standard referral of all children from parents who attend the ER because of alcohol or drugs intoxication, severe psychiatric disorders or with injuries due to intimate partner violence, is the most promising procedure for the early diagnosis of CAN in the ER setting.

Background Feasibility studies are often a helpful prelude to constructing fundable research proposals. Where the intended research is in a foreign country, focuses on a vulnerable population, and is aggravated by political and pragmatic challenges, feasibility studies become essential. Albinism, a genetic condition of reduced melanin synthesis, is a major public health issue in southern Africa. Whilst much is known about the health needs of children with albinism, little is understood about how to address these effectively in low income countries. Further, the child care and protection needs of children with albinism are largely unexplored. Zimbabwe's current political and economic climate presents additional challenges to research on the topic. Method The technical, economic, legal, collaborative, operational, schedule and political feasibilities (acronym TELCOSP) to undertaking a study on children with albinism in Zimbabwe were explored over a six week period of fieldwork in the country. Results Using the TELSCOSP framework allowed a deconstruction of each challenge to provide innovative solutions. The economic and legal feasibility aspects presented some difficulties that will require flexibility and perseverance to overcome. Conclusion With the assistance of the local communities and people with albinism in Zimbabwe, the obstacles appear surmountable. The feasibility study provided a productive framework for addressing potential challenges in studying the needs of Zimbabwe's children living with albinism.

‘I returned and saw under the sun, that the race is not to the swift, nor the battle to the strong, neither yet bread to the wise, nor yet riches to men of understanding, nor yet favour to men of skill; but time and chance happeneth to them all.’ Ecclesiastes 9.11.

Technology-enhanced training such as virtual simulations can be effective only to the extent evidence-based principles of learning are integrated into their training platforms. Assuming skill acquisition is the target of training, programs should include time and space for repeated practice opportunities structured through evidence-based learning theories (Amodeo et al. in Adm Soc Work 33:423-438, 2009). Essential learning attributes derived from Cognitive Load Theory (Sweller in Cognit Sci 12:257-285, 1988) and the Theory of Deliberate Practice (Ericsson et al. in Psychol Rev 100:363-406, 1993) can effectively integrate into virtual simulations intended to build expertise. Virtual Home Simulation (VHS) and Virtual Motivational Interviewing (VMI) are presented in this paper as an approach to develop virtual simulations that provide child welfare workers a means to deliberately practice essential skills toward competence before entering the workforce. This paper reviews the development process, specific design aspects, and lessons learned as a guide on how to integrate effective learning attributes. Implications for using virtual simulations, including cost-benefits, measuring performance over time, and addressing training complications due to Covid-19 or similar obstacles, are also provided.

This study exploits a natural experiment to investigate the impact of land reform on the fertility outcomes of households in rural Ethiopia. Public policies and customs created a situation where Ethiopian households could influence their usufruct rights to land via a demographic expansion of the family. The study evaluates the impact of the abolishment of these pronatal property rights on fertility outcomes. By matching aggregated census data before and after the reform with administrative data on the reform, a difference-in-differences approach between reform and non-reform districts is used to assess the impact of the reform on fertility outcomes. The impact appears to be large. The study estimates that women in rural areas reduced their life-time fertility by 1.2 children due to the reform. Robustness checks show that the impact estimates are not biased by spillovers or policy endogeneity.

The 54th ANZAAS (Australian and New Zealand Association for the Advancement of Science) Congress was held at the Australian National University in Canberra in May 1984. Seven papers were presented by staff of the Social Welfare Research Centre. Most were presented in the Social Welfare section, established at the 1983 Congress; others were in associated areas such as sociology and women's studies. In reading this publication it is also necessary to bear in mind that some papers are reporting on findings and conclusions of research recently completed by the staff at the Centre, while others are drawing tentative conclusions from exploratory work in progress. The intention in publishing these is to stimulate ideas and discussion., Reports and Proceedings; 47

Background The process of transition to adult life of youth with a record of protection is crucial to overcome the difficulties to achieve an independent life. Objective This research aims to analyze the conditions under which protected youth are emancipated, as well as the factors that facilitate emancipation. Method A qualitative study was performed with three samples: longitudinal follow-ups with youths when they exit the system and during 12 months (N = 24); life stories of youths who have exited the child welfare system at least 2 years ago and a maximum of 5 years ago (N = 22); interviews with professionals conducting their intervention in adolescent protection resources (N = 18). Results The results indicate that protective action is not enabling youths’ learning in normalized contexts, which negatively affects the conditions under which emancipation occurs. The experience of the protective action conditions the tendency to benefit from the post-majority socio-educational accompaniment. Conclusions The importance of socio-educational intervention continuing during the first moments of emancipation, providing professional accompaniment to the entire collective, is highlighted.

ObjectiveTo determine whether children exposed to a greater variety of acts of parent-to-child physical and psychological maltreatment will be at greater risk of consuming obesogenic foods at a higher frequency.DesignSurvey research using a longitudinal panel design.SettingIn-home interviews with primary caregivers in twenty large US cities.ParticipantsA national sample of at-risk children and their families who participated in the Fragile Families and Child Wellbeing Study (FFCWS).ResultsChild maltreatment emerged as a statistically significant (PConclusionsA major implication of the present study is that child maltreatment prevention efforts should be reflected in interventions that seek to diminish unhealthy eating practices among children. Multi-professional teams can work together on obesity prevention not only via education but also by considering the interconnectedness of obesogenic food consumption and experiences of maltreatment.

This study investigated the association between mental health problems and academic and behavioral school functioning for adolescent girls in the child welfare system and determined whether school engagement and future orientation meditated the relationship. Participants were 231 girls aged between 12 and 19 who had been involved with the child welfare system. Results indicated that 39% of girls reported depressive symptoms in the clinical range and 54% reported posttraumatic symptoms in the clinical range. The most common school functioning problems reported were failing a class (41%) and physical fights with other students (35%). Participants reported a mean number of 1.7 school functioning problems. Higher levels of depression and PTSD were significantly associated with more school functioning problems. School engagement fully mediated the relationship between depression and school functioning and between PTSD and school functioning, both models controlling for age, race, and placement stability. Future orientation was not significantly associated with school functioning problems at the bivariate level. Findings suggest that school engagement is a potentially modifiable target for interventions aiming to ameliorate the negative influence of mental health problems on school functioning for adolescent girls with histories of abuse or neglect.

Background: In Hong Kong, with an increasing number of children experiencing mental health issues, there is a need to not only develop innovative interventions but also develop comprehensive prevention interventions so as to reduce their anxiety symptoms and enhance their emotional management and interpersonal relationships. Objective: The aim of this study was to determine the effectiveness of The Adventures of DoReMiFa, an integration model of the cognitive-behavioral approach and positive psychology by using digital game–based and school-based mental health enhancement intervention to magnify the social and emotional health and well-being of the school children in Hong Kong aged 9 to 11 years. Methods: A quasi-experimental design method was used to evaluate this digital game and school-based intervention. The Adventures of DoReMiFa was piloted in 4 primary schools where students were allocated to either an intervention or a control group. The participants were assessed at pre- and postintervention with a 6-month follow-up measuring their mental health knowledge, levels of anxiety symptoms, positive and negative thinking, perspective-taking, and self-esteem. Results: A total of 459 primary school students from 4 primary schools participated in the study. The response rate on the questionnaires answered on the Web was up to 85.1% (391/459). Compared with the control group, the intervention group was found to have significant association with improved mental health knowledge at the time immediately after the intervention (beta=.46; P=.01) and in the 6-month postintervention period (beta=.66; P

Setting: Although an important part of the evidence base in health, systematic reviews are not always easy to find. Difficulties are compounded when interventions under review are “social and environmental” (that is, targeting wider determinants of health). The authors explored searches from a descriptive map containing thirty-two systematic reviews evaluating the effectiveness of social and environmental interventions for childhood obesity. Questions: Which sources give the highest yield of relevant reviews per 100 records? What is the value of searching databases that index literature beyond the “health” arena when looking for data on the effectiveness of social and environmental interventions? Methods: The authors analyzed search results from nineteen databases and calculated the precision and the relative and unique contribution of each source. Results: Searches of specialist systematic review databases—Database of Abstracts of Reviews of Effects (DARE), Database of Promoting Health Effectiveness Reviews (DoPHER), and Health Technology Assessment (HTA)—had the highest precision, although MEDLINE, CINAHL, and PsycINFO located many additional reviews. The Cochrane Database of Systematic Reviews should be searched for health-related reviews. Searches of education, transportation, social policy, and social sciences databases did not identify additional reviews. Searching websites and bibliographies was important. Conclusions: Searches for review-level evidence could profitably start with the specialist review databases. Searches of the major health-related databases are essential, but database searching beyond them may not identify much additional evidence. Internet and hand-search remain important sources of reviews not found elsewhere. Comparison of the results with previous research suggests that appropriate sources for locating primary and secondary evidence may be different.

At the current rate of decline in infant mortality, India is unlikely to achieve the Millennium Development Goal on child survival. Integrated Management of Neonatal and Childhood Illness (IMNCI), adapted from the global Integrated Management of Childhood Illness to enhance the focus on newborns and on community health workers, is the central strategy within the National Reproductive and Child Health Programme to address high infant mortality. This paper assessed the progress of IMNCI in India, identified the programme bottlenecks, and also assessed the effect on coverage of key newborn and childcare practices. Programme data were analyzed to ascertain the implementation status; rapid programme assessment was conducted for identifying the programme bottlenecks; and results of analysis of two rounds of district-level household surveys were used for comparing the change in the coverage of child-health interventions in IMNCI and control districts. More than 200,000 community health workers and first-level healthcare providers were trained during 2005-2009 at a variable pace across 223 districts. Of the reported births (n = 1,102,573), 65.5% were visited by a trained worker within 24 hours, and 63.1% were visited three times within 10 days. Poor supervision and inadequate essential supplies affected the performance of trained workers. During 2004-2008, 12 early-implementing districts had covered most key newborn and child practice indicators compared to the control districts; however, the difference was significant only for care-seeking for acute respiratory infection (net difference: 17.8%; 95% confidence interval 2.3-33.2, p0.026). Based on the early experience of IMNCI implementation in different states of India, measures need to be taken to improve supportive supervision, availability of essential supplies, and monitoring of the programme if the strategy has to translate into improved child survival in India.

Objective: To examine the role of tobacco use in creating financial hardship for New Zealand (NZ) low income households with children. Data: The 1996 NZ census (smoking prevalence by household types), Statistics NZ (household spending surveys 1988-98), and NZ Customs (tobacco released from bond 1988-98). Main outcome measures: Proportion of children in households with smokers and ≤$NZ15 000 gross income per adult. Proportion of spending on tobacco of second lowest equivalised household disposable income decile and of solo parent households. Results: In ≤$NZ15 000 gross income per adult households with both children and smokers, there were over 90 000 children, or 11% of the total population aged less than 15 years. Enabling second lowest income decile households with smokers to be smoker-free would on average allow an estimated 14% of the non-housing budgets of those households to be reallocated. Conclusions: The children in low income households with smokers need to be protected from the financial hardship caused by tobacco use. This protection could take the form of more comprehensive government support for such households and stronger tobacco control programmes. A reliance on tobacco price policy alone to deter smokers is likely to have mixed outcomes—for example, increased hardship among some of these households. The challenge for tobacco control is to move from a sole focus on "doing good" towards incorporating the principle of "doing no harm".

Background A high prevalence of prenatal alcohol exposure has been reported among children in care and thus, the risk of fetal alcohol spectrum disorder (FASD) in this population is high. Objective The purpose of the current study was to estimate the number of children (0–18 years) in care with FASD and to determine the associated cost by age group, gender, and province/territory in Canada in 2011. Methods The prevalence of children in care by province/territory was obtained from the Canadian Child Welfare Research Portal, and the number of children in care with FASD for each province/territory was estimated from available epidemiological studies. In order to calculate the total cost per province/territory, the cost per individual per day, by age group, was applied to the respective number of children in care with FASD. Results The estimated number of children in care with FASD ranged from 2,225 to 7,620, with an annual cost of care ranging from $57.9 to $198.3 million Canadian dollars (CND). The highest overall cost ($29.5 to $101.1 million CND) was for 11–15 year-olds. Conclusion The study findings can be used to demonstrate the substantial economic burden that FASD places on the child welfare system. Attention towards the needs of this population and prevention efforts to reduce FASD incidence in Canada, and other countries are urgently needed.

Objective: To identify factors that may increase the risk of a sexually victimised adolescent boy developing sexually abusive behaviour. Design: Sexually victimised boys who had sexually abused other children were compared with sexually victimised boys who had not done so. Setting: Social services departments in south east England were invited to refer sexually abused and sexually abusing boys to a London postgraduate teaching hospital. Subjects: 25 adolescent boys aged between 11 years and 15 years and 11 months. Main outcome measures: Adjusted odds ratios estimated from unconditional logistic regression. Results: Unadjusted odds rations for witnessing (8.1) as well as experiencing (18.0) intrafamilial violence and discontinuity of care (7.2) discriminated boys who had sexually abused from others who were solely victims of sexual abuse. Only the adjusted odds ratios for witnessing intrafamilial violence (39.7)discriminated the two groups. Conclusions: The risk of adolescent boys who have been victims of sexual abuse engaging in sexually abusive behaviour towards other children is increased by life circumstances which may be unrelated directly to the original abusive experience, in particular exposure to a climate of intrafamilial violence. Our findings have implications for the management of boys found to have been sexually abused and raise important questions about the possibility of secondary prevention of subsequent abusive behaviour in those at greatest risk.

Objective: To investigate the association between social circumstances in childhood and mortality from various causes of death in adulthood. \ud Design: Prospective observational study. \ud Setting: 27 workplaces in the west of Scotland. \ud Subjects: 5645 men aged 35-64 years at the time of examination. \ud Main outcome measures: Death from various causes. \ud Results: Men whose fathers had manual occupations when they were children were more likely as adults to have manual jobs and be living in deprived areas. Gradients in mortality from coronary heart disease, stroke, lung cancer, stomach cancer, and respiratory disease were seen (all PConclusions: Adverse socioeconomic circumstances in childhood have a specific influence on mortality from stroke and stomach cancer in adulthood, which is not due to the continuity of social disadvantage throughout life. Deprivation in childhood influences risk of mortality from coronary heart disease and respiratory disease in adulthood, although an additive influence of adulthood circumstances is seen in these cases. Mortality from lung cancer, other cancer, and accidents and violence is predominantly influenced by risk factors that are related to social circumstances in adulthood.

The final instalment of the National Service Framework (NSF) for Children, Young People and Maternity Services was published in September 2004 (Department of Health (DoH), 2004). This is part of the Government's commitment to children exemplified in its Green Paper, Every Child Matters (Department for Education and Skills, 2003). This document sets out the Government's proposals for reforming the delivery of services for children, young people and families, augmenting existing measures to ensure that children at risk of harm and neglect are protected and enabled to develop their full potential.

Objective To evaluate the influence of the early phase of Project Fives Alive!, a national child survival improvement project, on key maternal and child health outcomes. Design The evaluation used multivariable interrupted time series analyses to determine whether change categories tested were associated with improvements in the outcomes of interest. Participants The evaluation used program and outcome data from interventions focused on health-care staff in 27 facilities. Setting Northern Ghana. Intervention The project uses a quality improvement (QI) approach whereby process failures are identified by health staff and process changes are tested in the health facilities and corresponding communities to address those failures. Main Outcome Measures The maternal health outcomes were early antenatal care attendance and skilled delivery, and the child health outcomes were underweight infants attending child wellness clinics, facility-level neonatal mortality and facility-level infant mortality. Results Postnatal care changes for the first 1–2 days of life ( β = 0.10, P = 0.07) and the first 6–7 days of life ( β = 0.10, P = 0.07) were associated with a higher rate of visits by underweight infants to child wellness clinics. There was an association between the early pregnancy identification change category with increased skilled delivery ( β = 1.36 P = 0.07). In addition, a greater number of change categories tested was associated with increased skilled delivery ( β = 0.05, P = 0.01). Conclusion The QI approach of testing and implementing simple and low cost locally inspired changes has the potential to lead to improved health outcomes at scale both in Ghana and other low- and middle-income countries.

Indicators of family care for development are essential for ascertaining whether families are providing their children with an environment that leads to positive developmental outcomes. This project aimed to develop indicators from a set of items, measuring family care practices and resources important for caregiving, for use in epidemiologic surveys in developing countries. A mixed method (quantitative and qualitative) design was used for item selection and evaluation. Qualitative and quantitative analyses were conducted to examine the validity of candidate items in several country samples. Qualitative methods included the use of global expert panels to identify and evaluate the performance of each candidate item as well as in-country focus groups to test the content validity of the items. The quantitative methods included analyses of item-response distributions, using bivariate techniques. The selected items measured two family care practices (support for learning/stimulating environment and limit-setting techniques) and caregiving resources (adequacy of the alternate caregiver when the mother worked). Six play-activity items, indicative of support for learning/stimulating environment, were included in the core module of UNICEF's Multiple Cluster Indictor Survey 3. The other items were included in optional modules. This project provided, for the first time, a globally-relevant set of items for assessing family care practices and resources in epidemiological surveys. These items have multiple uses, including national monitoring and cross-country comparisons of the status of family care for development used globally. The obtained information will reinforce attention to efforts to improve the support for development of children.

J Clin Hypertens (Greenwich). 2012; 14:372–382. ©2012 Wiley Periodicals, Inc. The prevalence of hypertension in children and adolescents is increasing, especially in obese and ethnic children. The adverse long‐term effects of hypertension beginning in youth are known; therefore, it is important to identify young patients who need intervention. Unfortunately, measuring blood pressure (BP) is difficult due to the variety of techniques available and innate biologic variation in BP levels. Ambulatory BP monitoring may overcome some of the challenges clinicians face when attempting to categorize a young patient’s BP levels. In this article, the authors review the use of ambulatory BP monitoring in pediatrics, discuss interpretation of ambulatory BP monitoring, and discuss gaps in knowledge in usage of this technique in the management of pediatric hypertension.

J Clin Hypertens (Greenwich). 2012; 14:396–400. ©2012 Wiley Periodicals, Inc. Shorter‐interval (6‐hour) ambulatory blood pressure monitoring (ABPM) has been shown to correlate well with 24‐hour ABPM in adults, but this has not been studied in children. The authors selected 131 patients aged 9 to 18 who underwent 24‐ABPM from 2000–2008. Six‐hour intervals beginning at different start times were compared with the daytime and 24‐hour period, with subset analysis for normotensive and hypertensive patients. Concordance correlation coefficients (CCCs) were used to assess for agreement. Among normotensive patients, the mean difference between daytime and 6‐hour intervals ranged from −0.1 mm Hg to 0.0 mm Hg for diastolic blood pressure (DBP) and −1.1 mm Hg to 0.6 mm Hg for systolic blood pressure (SBP) with CCCs of 0.88 to 0.93 for DBP and 0.93 to 0.96 for SBP. For hypertensive patients, mean difference ranged from −0.6 to 1.3 mm Hg for DBP and −0.8 to 1.1 mm Hg for SBP with CCCs of 0.89 to 0.98 for DBP and 0.86 to 0.95 for SBP. Shorter‐interval monitoring correlates significantly with full daytime monitoring in children, allowing for assessment of blood pressure with improved convenience.

J Clin Hypertens (Greenwich). 2012; 14:383–387. ©2012 Wiley Periodicals, Inc. The past decade of investigation into the pharmacologic treatment of hypertension in children has been rewarding. The studies have shown that blood pressure medications effectively reduce blood pressure in children with hypertension and that these agents are generally well tolerated with few treatment‐related adverse effects. While we have advanced our capacity to make rational therapeutic decisions, future efforts must be directed towards comparing the effectiveness of the different classes of antihypertensive agents and studies evaluating the impact of antihypertensive agents on outcome.

A S a member of both the Committee on Ethics of the American College of Obstetricians and Gynecologists (ACOG) and a member of the Committee on Bioethics of the American Academy of Pediatrics (AAP), I have had a unique opportunity to compare the recent ACOG statement and the in-preparation AAP position paper on surrogate motherhood. 1,2 The updated and revised ACOG committee opinion entitled "Ethical Issues in Surrogate Motherhood" is a rational, reasoned, and helpful policy proposal. The statement neither encourages nor discourages the practice, but acknowledges the existence and likely continuance of surrogate arrangements. The opinion attempts to formulate both a conceptual framework and practical guidelines to protect the potentially vulnerable participating parties. The theme of the opinion is the anticipation of problems through open and explicit dialogue. The ACOG model attempts to balance reproductive freedoms, choice, and the rights of parents to procreate and rear a child against obstetric concerns about free and uncoerced consent, the assessment of risks and benefits, pregnancy management, access, and financial arrangements. The ACOG Committee on Ethics has chosen to view surrogate motherhood as a preconception or prenatal adoption. The AAP Committee on Bioethics had a more difficult time arriving at a consensus opinion on the ethical issues in surrogate motherhood. The AAP has chosen the best interests of the child as an important standard for judging the ethics of surrogate arrangements. The best-interests standard requires a careful analysis of the impact of surrogacy on children and their families. The best-interests standard has been applied by the AAP in previous policy statements concerning childhood maltreatment and the termination of life support for handicapped newborns. When an attempt is made to apply the best-interests standard to the new reproductive technologies and alternative parenting arrangements, the analysis is problematic. In what significant ways is surrogate motherhood different from other variant custody, adoption, foster care, or alternative parenting arrangements? How does one assess the best interests of the child when that child has yet to even have been created? What do we know about the effect of surrogate motherhood on the well-being of children and their families? Focusing on the best interests of the child in judging surrogate motherhood has led to controversy about the burdens and benefits of such arrange© 1991 by The Jacobs Institute of Women's Health 1049-3867/91/$3.50

Background: We examined correlates of infant morbidity and mortality within the first 3 months of life among HIV-exposed infants receiving post-exposure antiretroviral prophylaxis in South Africa. Methods: We conducted a prospective cohort study of 848 mother–child dyads. Multivariable Cox proportional hazards models were used. Results: The main causes of infant morbidity were gastrointestinal and respiratory infections. Morbidity was higher with infant HIV infection (HR: 2.61; 95% CI: 1.40–4.85; p = 0.002) and maternal plasma viral load (PVL) >100 000 copies ml−1 (HR: 1.87; 95% CI: 1.01–3.48; p = 0.048), and lower with maternal age 100 000 copies ml−1 (HR: 6.93; 95% CI: 1.64–29.26; p = 0.008). Infant feeding status did not influence the risk of morbidity nor mortality. Conclusions: Future interventions that minimize pediatric HIV infection and reduce maternal viremia, which are the main predictors of child health soon after birth, will impact positively on infant health outcomes.

Zinc for the treatment of childhood diarrhoea was introduced in a pilot area in southern Mali to prepare for a cluster-randomized effectiveness study and to inform policies on how to best introduce and promote zinc at the community level. Dispersible zinc tablets in 14-tablet blister packs were provided through community health centres and drug kits managed by community health workers (CHWs) in two health zones in Bougouni district, Mali. Village meetings and individual counselling provided by CHWs and head nurses at health centres were the principal channels of communication. A combination of methods were employed to (a) detect problems in communication about the benefits of zinc and its mode of administration; (b) identify and resolve obstacles to implementation of zinc through existing health services; and (c) describe household-level constraints to the adoption of appropriate home-management practices for diarrhoea, including administration of both zinc and oral rehydration solution (ORS). Population-based household surveys with caretakers of children sick in the previous two weeks were carried out before and four months after the introduction of zinc supplementation. Household follow-up visits with children receiving zinc from the health centres and CHWs were conducted on day 3 and 14 after treatment for a subsample of children. A qualitative process evaluation also was conducted to investigate operational issues. Preliminary evidence from this study suggests that the introduction of zinc does not reduce the use of ORS and may reduce inappropriate antibiotic use for childhood diarrhoea. Financial access to treatments, management of concurrent diarrhoea and fever, and high use of unauthorized drug vendors were identified as factors affecting the effectiveness of the intervention in this setting. The introduction of zinc, if not appropriately integrated with other disease-control strategies, has the potential to decrease the appropriate presumptive treatment of childhood malaria in children with diarrhoea and fever in malaria-endemic areas.

Concern about high rates of leukaemia and non-Hodgkin's lymphoma among children and young adults living near certain nuclear establishments in the United Kingdom has led to a series of population based case-control studies. 1 2 All these studies have investigated the possibility that the excesses were related to parental employment in those establishments, but the statistical power to detect anything other than extreme associations was very low owing to the rarity of employment in the nuclear industry (coupled with the rarity of the outcome). Moreover, if harmful parental occupational exposures were to exist it is unlikely that their effect would be restricted to cancer among workers' children; such exposures might be expected to influence a broader spectrum of reproductive problems, including infertility, miscarriage, and congenital malformations. These other aspects of reproduction remain largely unexplored. The nuclear industry family study was set up to examine the occupational histories of a large cohort of nuclear industry workers in relation to all aspects of their reproduction and children's health. A full …

Studies have shown inverse associations between childhood social class and mortality,1 and others have shown higher mortality in children in care. 2 3 However, to our knowledge, only one study has investigated mortality in children in care with results specific to sex and cause of death.3 Mortality in that study was higher than expected among boys, although mortality related to age at the time of death was not reported.3 In Finland, children are cared for within the child protection system up to the age of 18. Our specific interest lies in whether mortality before age 18 in children in care is higher than expected on the basis of figures for the general population, reflecting failure in the child protection system, or whether mortality is increased from age 18, reflecting difficulties in adapting to independent living. The basic data source was the Finnish …

Although more data on maternal and child health are being collected locally, the amount of data available nationally has fallen over the past decade.1 Central sources of data exist in England and Wales, but clinical data are limited (Office for National Statistics registrations) or of poor quality (maternity hospital episode system, patient episode data Wales).2 Only Northern Ireland (child health record system) and Scotland (Scottish Morbidity Record—SMR2) provide good quality data on maternal and child health.3 If national data were available, trends in health care as well as morbidity and mortality for rare conditions could be analysed. National data would also be useful to the confidential inquiry into stillbirths and deaths in infancy (CESDI)—the survey that covers fetal and infant deaths between 20 weeks' gestation and 1 year in England, Wales, and Northern Ireland. The numerator data collected through the survey's rapid reporting process cannot be interpreted without national denominator data. In recognition of this need, …

This paper examines the academic research discourse on strengths-based practice in child welfare. A gap in the literature exists concerning systematic research studies addressing strengths-based practices with families in the child welfare system. Therefore, the aim of this paper is to examine how a strengths-based approach facilitates working relationships between child welfare services and families. A systematic review was performed following the principles of the PRISMA statement and included 11 peer-reviewed articles, published in English, in academic journals from multiple scientific databases, reporting primary research. Strengths-based skills were found to be essential to fostering a stronger rapport with families and to building relationships with them. Furthermore, strengths-based approaches facilitate personal engagement, which can increase the sense of empowerment and encourage families to find solutions and to make decisions about their own lives. One of the study’s findings suggests that in the process of empowering families, workers themselves learned to empower themselves. Workers shifting towards strengths-based thinking enhanced their sense of self-empowerment, which increased their knowledge and skills to help empower families. The findings of this review indicate that the strengths-based perspective reported from the studies facilitates positive interaction between workers and families, including collaboration and the building of relationships.

This paper explores how the propensity of social workers to make a direct and unmitigated connection between good intentions, rational thought, and good outcomes form a white noise barrier that substantially interferes with our ability to see negative outcomes resulting directly or indirectly from our works. The paper begins with outlining the harm experienced by Aboriginal children before moving to explore how two fundamental philosophies that pervade social service practice impact Aboriginal children: 1) an assumption of pious motivation and effect and 2) a desire to improve others. Finally, the paper explores why binding reconciliation and child welfare is a necessary first step toward developing social work services that better support Aboriginal children and families.

This paper focuses on the life experiences of children with chronic disease, a group whose invisibility involves particular challenges in their relationship with professionals in important life contexts, such as family, school and hospital. The study includes two complementary phases: i) Phase 1, composed of 15 interviews with parents, education and health professionals and two focus group discussions with children, and children and their mothers; and ii) Phase 2, which included self-report questionnaires administered to parents (n = 152) and children with chronic disease (n = 176). Based on a mixed methodology, this study combines quantitative and qualitative methods assuming that plural approaches allow for a deeper understanding of the life conditions of children with chronic disease and their families. The results reinforce the reproduction of social stereotypes and the tendency to focus on the individual ability to solve problems, which still remain to be circumscribed to the people’s chronic disease sphere. Moreover, this paper reveals the central role that inclusive contexts have on children’s wellbeing.

Despite contested definitions, trauma is often conceptualized as an event that shocks or overloads human systems, shaping memory and meanings as the body and mind attempt to cope and survive. Adoption is often the presumed redress for childhood trauma. Thus, few scholars have examined how, or if, some conditions of adoption or the status itself might involve unique traumas or adversities.In this paper, I argue that the condition of being transracially adopted can represent intersectional minoritized statuses, which in turn activate potentially distinct formations of epistemic trauma- structurally and relationally transmitted harms to a person as a knower and to their capacities for claiming, making sense of, and healing through their lived experiences.I draw from my personal and professional standpoints as a black, mixed-race, woman who was transracially adopted from public foster care as an infant, became a child welfare caseworker and later, a child welfare scholar.Using a critical and reflexive autoethnographic method I ask how theories of epistemic injustice might help to highlight conditions tied to the status "transracial adoptee" that distinguish adoption-specific trauma. By reflexively analyzing my experiences in the context of extant theory and research, this paper brings theories of epistemic injustice into conversation with an emic perspective on adoption.In my experience, "transracial adoptee" and "mixed race" operated as statuses that occasioned epistemic injustices. I propose these conditions can become traumatic when they chronically and structurally disenfranchise claiming and cultivating folkways essential to one's healing and resilience across the life course.This paper is a call to invest in advancing epistemologies of adoption and theories of trauma that are anchored within diverse adoption experiences. I also invite future scholarship to explore epistemic injustice in adoption as trauma, and to identify and disrupt the many spaces in which it may be enacted culturally, relationally, familially, and in a society through its laws, policies, practices, and scientific knowledge.

A significant number of youth in the United States experience traumatic events that substantially increase the risk of physical and behavioral health problems across the life span. This public health concern warrants concerted efforts to promote trauma-informed, evidence-based practices that facilitate recovery. Although youth-focused trauma-specific treatments exist, determining effective ways to disseminate and implement these services-so that they are available, accessible, and sustainable-poses an ongoing challenge. This paper describes a comprehensive model for such implementation, the community-based learning collaborative (CBLC), developed as part of Project BEST, a four-phase statewide initiative to promote trauma-focused practices. The CBLC augments the learning collaborative model by including clinical and nonclinical (i.e., broker) professionals from multiple service organizations within a targeted community. CBLCs aim to build capacity for sustained implementation of trauma-focused practices by promoting interprofessional collaboration among those involved in the coordination and provision of these services. This paper describes the iterative development of the CBLC by examining participant completion data across the three completed phases of Project BEST (N = 13 CBLCs; 1,190 participants). Additionally, data from Project BEST's third phase (N = 6 CBLCs; 639 participants) were used to evaluate changes in the frequency of specific practices, pre- to post-CBLC, and post-CBLC perceived utility of CBLC components. High participant completion rates, significant increases in reported trauma-focused practices, and positive ratings of the CBLC's utility provisionally support the feasibility and efficacy of the model's final iteration. Implications for implementation and CBLC improvements are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Przedmiotem artykułu jest analiza zagadnienia dopuszczalności posługiwania się wizerunkiem małego dziecka oraz dopuszczalności publikowania tego wizerunku w taki sposób, by działania te nie godziły w zasadę dobra dziecka. Autorka podejmuje próbę udzielenia odpowiedzi na pytanie, czy wyrażenie przez przedstawiciela ustawowego zgody na publikację wizerunku małego dziecka, w szczególności noworodka i niemowlęcia, może być postrzegane jako działanie sprzeczne z dobrem dziecka. Rozważania obejmują problematykę wykorzystania wizerunku człowieka z czasu jego życia płodowego oraz wykorzystania wizerunku małego dziecka przez rodziców przez umieszczanie go na portalach społecznościowych. The subject of this paper as an analysis of the permissibility of using a picture of a small child and a publication of such a picture, which may only be allowed if the child welfare has been protected. An attempt is made to answer the question whether a consent granted by a representative of a state authority to publish a picture of a child, an infant, or a newborn baby in particular, may amount to an act contrary to child welfare. The deliberations of the paper include issues such as using a picture of a human being from foetal life, or parents placing a picture of their small child on a social network page.