Search

Children living in poverty are at an increased risk for maltreatment. Social safety net (SSN) programs with antipoverty objectives may reduce child maltreatment through pathways such as reduced food insecurity, lessened caregiver stress, and improved caregiving behaviors and ability to meet children's basic needs. The objective of this study is to conduct a systematic review of evidence on the ability of SSN programs to reduce child maltreatment in the United States (U.S.). This systematic review was conducted using PRISMA protocol. Among studies published between 1996–2022, the initial search returned 1,873 articles, and 27 papers were included in the final analysis. Abstracts were identified primarily on June 24th, 2022, and extraction and synthesis of data was conducted in 2022–2023. Of the 27 papers assessed, 16 studies found that SSN programs were protective against child maltreatment. Three of the reviewed studies found no effect of safety net programs, 4 studies presented mixed findings, and 4 studies found adverse impacts in terms of child maltreatment outcomes. When restricting to high-quality studies only, 10 out of 12 found protective impacts and none found adverse impacts on child maltreatment. SSNs are associated with protective effects against child maltreatment. Expansion of SSN programs would likely have positive benefits beyond poverty-related objectives, including reducing incidence of child maltreatment. [ABSTRACT FROM AUTHOR]

• Standard medical and behavioral treatment for encopresis is not always effective. • Some children resist toilet training due to fear of defecation outside a diaper. • A diaper fading protocol was used to train four children with toilet refusal. • The protocol flexibly adapted to individual patient needs. Childhood constipation and painful defecation is common, affecting 68% to 86% of children. Over 90% withhold stool, some only defecating in a diaper. Behavioral therapy is effective for encopresis, but there is minimal research on treating toilet avoidance. This study investigates a novel protocol to eliminate diapers in children with toilet avoidance. A diaper fading protocol was used with four children with toilet avoidance. Children were instructed to defecate in the bathroom, moving progressively closer to the toilet until they eventually sat on the toilet with the diaper. As needed, diapers were then faded by cutting increasingly wider slits in the base of the diaper so that stool could pass into the toilet. The cut widened until the diaper was eliminated entirely. Four children (three boys, average 5.22 years old) successfully completed toilet training using the diaper fading protocol in an average of 9.75 sessions. Delivery of treatment via telehealth was shown to be effective. The diaper fading protocol effectively and flexibly assisted toilet training in four children with stool withholding and toileting avoidance. Future work should investigate whether caregivers can utilize the protocol without ongoing support, or on a consultation basis only, to reduce the burden on health care workers with long waitlists. [ABSTRACT FROM AUTHOR]

Background: Burn care is centralized in highly specialized burn centers in Europe. These centers are of limited capacity and may be overwhelmed by a sudden surge in case of a burn mass casualty incident. Prior incidents in Europe and abroad have sustained high standards of care through well-orchestrated responses to share the burden of care in several burn centers. A burn mass casualty incident in Romania in 2015 sparked an initiative to strengthen the existing EU mechanisms. This paper aims to provide insight into developing a response plan for burn mass casualties within the EU Civil Protection Mechanism.Methods: The European Burns Association drafted medical guidelines for burn mass casualty incidents based on a literature review and an in-depth analysis of the Romanian incident. An online questionnaire surveyed European burn centers and EU States for burn mass casualty preparedness.Results: The Romanian burn mass casualty in 2015 highlighted the lack of a burn-specific mechanism, leading to the late onset of international transfers. In Europe, 71% of respondents had existing mass casualty response plans, though only 35% reported having a burn-specific plan. A burns response plan for burn mass casualties was developed and adopted as a Commission staff working document in preparation for further implementation. The plan builds on the existing Union Civil Protection Mechanism framework and the standards of the WHO Emergency Medical Teams initiative to provide 1) burn assessment teams for specialized in-hospital triage of patients, 2) specialized burn care across European burn centers, and 3) medevac capacities from participating states.Conclusion: The European burn mass casualty response plan could enable the delivery of high-level burn care in the face of an overwhelming incident in an affected European country. Further steps for integration and implementation of the plan within the Union Civil Protection Mechanism framework are needed. [ABSTRACT FROM AUTHOR]

Violence towards formal and informal caregivers is a frequently occurring and complex international hazard in healthcare that has a negative impact on the physical and psychological health states of caregivers. However, little is known about the prevalence and type of violence towards formal and informal caregivers by care recipients in the home care settings. The aim of this review is to obtain insight into the prevalence of violence by home care recipients against formal and informal caregivers in home care settings and the types and consequences of violence. A systematic review was conducted between March and May 2023 using the PubMed, EMBASE, CINAHL, and PsycINFO databases. A methodological quality appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). Data collection was performed until May 2023. Out of 1087 screened articles, a total of 10 full texts were included after the screening process. Findings demonstrate that workplace violence is an understudied area of research. The few studies found in this review showed high prevalence rates of violence with risk for physical and mental injuries for formal caregivers. No information at all on violence against informal caregivers was available. Strategies for prevention and intervention against violence in the home care setting must be developed. To develop strategies, it is important to have more insight in the prevalence and types of violence. It is also important to explore violence against informal caregivers in research. Violence towards formal caregivers in home care settings is a common risk that negatively impacts the health status of caregivers. What is already known about the topic? • Workplace violence has a negative impact on the physical and psychological health state of formal caregivers. • There is a lack of knowledge on care recipient violence towards formal and informal caregivers in the home care setting. What this paper adds • No study was found that studied violence against informal caregivers; this review demonstrates the importance of exploring this topic. • In home care settings, formal caregivers are exposed to types of workplace violence that have little or no presence in the hospital setting • Sexual harassment and sexual aggression towards formal caregivers in the home care setting are underreported in the literature. [ABSTRACT FROM AUTHOR]

Terminally ill patients experience high symptom burden at the end of life (EoL), even when receiving hospice care. In the U.S., family caregivers play a critical role in managing symptoms experienced by patients receiving home hospice services. Yet, most caregivers don't receive sufficient support or formal training in symptom management. Therefore, providing additional visits and education to caregivers could potentially improve outcomes for both patient and caregiver. In response, we developed the Improving Home hospice Management of End-of-life issues through technology (I-HoME) intervention, a program designed for family caregivers of home hospice patients. This paper describes the intervention, study design, and protocol used to evaluate the intervention. The I-HoME study is a pilot randomized controlled trial aimed at reducing patient symptom burden through weekly tele-visits and education videos to benefit the patient's family caregiver. One hundred caregivers will be randomized to hospice care with (n = 50) or without (n = 50) the I-HoME intervention. Primary outcomes include intervention feasibility (e.g., accrual, attrition, use of the intervention) and acceptability (e.g., caregivers' comfort accessing the tele-visits and satisfaction). We will also examine preliminary efficacy using validated patient symptom burden and caregiver outcome measures (i.e., burden, depression, anxiety, satisfaction). The trial is evaluating a novel symptom management intervention that supports caregivers of patients receiving home hospice services. The intervention employs a multi-pronged approach that provides needed services at a time when close contact and support is crucial. This research could lead to advances in how care gets delivered in the home hospice setting. • Home hospice caregivers play a critical role in managing symptoms at the EoL. • I-HoME is a novel symptom management intervention aimed at reducing symptoms. • The intervention employs a multi-pronged approach to support caregivers in hospice. [ABSTRACT FROM AUTHOR]

Children with Developmental Coordination Disorder (DCD) are at high risk for mental health disorders, stemming from challenges participating in motor activities. Parents of children with DCD report increased caregiver burden exacerbated by insufficient support and services for their child. A paucity of literature exists on parent and child mental health associated with a DCD diagnosis. To explore parent perceptions of their child's mental health, and the impact of DCD on family and parental mental health. Implementation of a secondary analysis using the impACT for DCD, a cross-sectional online survey of parents of children with self-reported suspected or confirmed diagnosis of DCD living in British Columbia, Canada. Data analysis included descriptive and inferential statistics and content analysis. Of the 237 participants, more than one third of parents (36%) rated their own mental health to be fair or poor, and the majority (90%) expressed concern for their child's mental health. Themes emerged on the impact of DCD on child, parent, and family, influenced by access to resources. Standard of care for DCD needs to include services and supports that address caregiver burden and mental health of children with DCD and their families. This paper explores parent perceptions of their child(ren)'s and their own mental health when raising a child with DCD in British Columbia (BC). In BC, there is a lack of research on the mental health challenges families face when their child has a diagnosis of DCD. Amongst health care providers, there tends to be a focus on DCD as a motor disorder, with limited understanding and acknowledgement of the mental health component for children and their families. Thus, this study will inform health-care providers, parents, educators, and policy makers on parent-identified mental health needs and the essential services and supports. Unique to this study was the inclusion of a descriptive and exploratory content analysis, providing a holistic understanding of parents' perceptions regarding the impact of DCD on their children and themselves. Our results revealed that parents perceive significant inter-connected impacts of DCD on the child, parents, and family, leading to poor mental health for parents and their child(ren). Limited access to resources and supports results in a negative trajectory for family mental health and well-being. Study results indicate the critical importance of addressing mental health, in addition to motor challenges. Healthcare providers need to adopt a family-centred approach to address the physical and psychosocial impairments associated with DCD, ensuring positive outcomes for children and their families. • Children with DCD and their families experience mental health challenges. • Interventions should address both motor and psychological functions linked to DCD. • Family-centred care needs to address parental mental health and caregiver burden. • A standard of care is crucial to address the needs of children & families with DCD. [ABSTRACT FROM AUTHOR]

The Internet of Health Things (technologies for exchanging data) is crucial in helping promote health and wellbeing. Family caregivers of people with Alzheimer's can significantly benefit from the Internet of Health Things by enabling caregivers to participate in programs from home to help manage their stress and distress in their caregiver role. This paper reports the results of a techno-economic analysis and a life cycle assessment comparing a video-communication delivered intervention designed to decrease the stress and distress of caregivers of people with Alzheimer's and related dementias to a hypothetical in-person delivery of the same intervention. Results indicated that the virtual intervention, compared to the hypothetical in-person intervention, was associated with lower participant costs yet, potentially more expensive from an organizational/provider perspective. Environmentally, the virtual intervention had lower carbon emissions than the hypothetical in-person delivery of the intervention. Furthermore, video-communication delivery of the intervention has the potential to reduce some of the hassles of looking for respite to attend caregiving interventions and allow caregivers to join from their preferred location across the country. [ABSTRACT FROM AUTHOR]

1. Describe the current prevalence and involvement of caregivers in community-based palliative care randomized controlled trials (RCTs) 2. Identify caregiver outcomes assessed in RCTs that engaged caregivers The growing movement toward the provision of health services in community settings expands opportunities for over 47 million American caregivers to more closely engage with their adult care recipients. Community-based palliative care (CBPC) interventions offer potentially effective responses to the need for accessible, affordable palliative care delivery in communities. However, no comprehensive review of the literature has been identified that evaluates how CBPC randomized controlled trials (RCTs) involve caregivers in their interventions. The aims of this systematic review are to evaluate the prevalence and involvement of caregiver engagement in CBPC RCTs and to describe the caregiver outcomes measured in RCTs that engage caregivers. A search of Embase, PubMed, CINAHL, and PsychInfo databases was completed in July 2021 using caregiving and CBPC search terms. Inclusion was limited to CBPC RCTs conducted in at least one US site. Quality assessment was completed using the Cochrane Risk of Bias Tool for Randomized Controlled Trials. This systematic review integrated a narrative synthesis to describe the review's findings. Twenty-six published papers describing 22 RCTs met inclusion criteria. In the five studies that reported caregiver data, caregiver burden and quality of life were the most frequently evaluated outcomes. Of the studies involving caregivers, the trials provided highly heterogeneous definitions of caregiving, and the involvement of caregivers in interventions varied widely across studies. Interventions provided verbal education, coaching, or support to caregivers. Only one study explicitly identified the caregiver as a member of the intervention's interdisciplinary team. This systematic review highlights the wide variability in CBPC RCT interventions and limited assessment of caregiver outcomes. As patient care is increasingly provided through community- and home-based services, this review underscores the need for more comprehensive research related to caregiver involvement and outcomes in CBPC interventions. [ABSTRACT FROM AUTHOR]

Background 'Open Dialogue' is a social network model of crisis and continuing mental healthcare which involves elements of service delivery such as immediate response and a style of therapeutic meeting called network meetings. Although there are indications from non-randomised studies that it may help people in their recovery from severe mental health crises and improve long-term outcomes, this has yet to be tested in a randomised controlled trial. Methods This paper outlines the protocol for a multi-site cluster-randomised control trial assessing the clinical and cost-effectiveness of Open Dialogue compared to treatment as usual (TAU) for individuals presenting in crisis to six mental health services in England. The primary outcome is time to relapse, with secondary outcomes including measures of recovery and service use. Participants will be followed-up for two years, with data collected from electronic medical records and researcher-led interviews. The analysis will compare outcomes between treatment groups as well as investigating potential mediators of effect: shared decision-making and social network quality and size. Carers of a subsample of participants will be asked about their experiences of shared decision-making, carer burden, and satisfaction. Discussion This trial will provide evidence of whether Open Dialogue services implemented in the English mental health system is an effective alternative to current care and may have important implications for the organization of community mental health services. Trial registration : retrospectively registered (108 participants recruited of 570 target) on 20/12/2019, ISRCTN52653325. [ABSTRACT FROM AUTHOR]