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Background--Sudden cardiac death in children is a rare but devastating event. Experts have debated the merits of community - based screening programs using an ECG and targeting 2 potential high-risk groups: school-aged children initiating stimulant medications to treat attention - d eficit/hyperactivity disorder and adolescents particip ating in sports. Methods and Results--Simulation models incorporating detailed prevalence, sensitivity and specificity, and treatment algorithms were built to determine the cost-effectiveness of targeted sudden cardiac death screening. Clinical care algorithms were constructed for asymptomatic children initiating stimulants for attention-deficit/hyperactivity disorder (8 years of age) or participating in sports (14 years of age) and presenting with a positive ECG finding suggestive of 1 of the 3 most common pediatric disorders causing sudden cardiac death and identifiable by ECG. Information to develop simulation model assumptions was drawn from the existing literature, Medicaid fees, and expert judgment. Sensitivity analyses examined parameter ranges to identify influential sources of uncertainty. Outcomes included costs and lost life-years caused by condition-related mortality. Our models estimate that screening for all 3 conditions simultaneously would reduce sudden death risk by 3.6 to 7 . 5 X 1 0-5 with projected life expectancy increases of 0.8 to 1.6 days per screened individual. The incremental cost-effectiveness of screening is $91 000 to $204 000 per life-year. Sensitivity analysis showed that assumed disease prevalence, baseline mortality, and the relative risk of mortality resulting from stimulant medication use and sports participation had the greatest impact on estimated cost-effectiveness. Conclusion--Results based on assumptions favoring sudden cardiac death screening indicated that its cost is high relative to its health benefits. INSET: CLINICAL PERSPECTIVE. [ABSTRACT FROM AUTHOR]

The American Academy of Pediatrics recommends comprehensive assessments for children entering foster care. These children may be placed with biological parents, kin, or in nonrelative foster care. It is not known whether health-related needs differ by placement. Chart abstractions were conducted of child welfare and medical records of 1542 children, ages 3 months to 5 years 11 months, admitted to San Diego's sole emergency shelter/receiving facility from April 1, 1998, through June 30, 1999, for investigation of alleged maltreatment. Children were discharged to three placement types: biological parents (28.5%), kinship caregivers (28.4%), or nonrelative foster parents (43.1%). Overall, 86.7% of children studied demonstrated physical, developmental, or mental health needs, with more than half displaying two or more problems. More than half of the children had a "Suspect" score on the Denver-II; 70.3% of children with "Suspect" scores were found to have delay on a developmental evaluation. Almost one tenth of the sample were diagnosed with one or more mental health conditions. Few differences were found for physical, developmental, or mental health concerns by placement. Results suggest that young children placed with biological parents or in kinship care have similar needs to those of children placed with foster parents. This study confirms the importance of comprehensive assessments for young children removed from their homes, regardless of placement. It also illustrates a need for standardized assessment criteria, particularly for developmental and mental health status, and for collaborative care models for all young children entering the child welfare system, regardless of their placement following investigation. [ABSTRACT FROM AUTHOR]

Research over the past two decades has consistently documented the high rates of young children entering the child protective services/child welfare system with developmental and mental health problems. There is an emerging evidence base for the role of early intervention services in improving outcomes for children with developmental and mental health problems in the general population that heavily relies on accurate and appropriate screening and assessment practices. The Child Welfare League of America, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry have all published guidelines concerning the importance of comprehensive assessments and appropriate referral to early intervention services for children entering out-of-home care. Recent federal legislation (P.L. 108-36) calls for increased collaboration between child welfare and public agencies to address the developmental and mental health needs of young children in foster care. This paper provides a framework for health, developmental, and mental health professionals seeking to partner with child welfare to develop and implement programs addressing these critical issues. [ABSTRACT FROM AUTHOR]

Underidentification of developmental delays among young children involved with child welfare/child protective services (CW) is problematic. Caregivers of young children involved with CW may help increase identification of young children with developmental delays, but the accuracy of caregiver identification in this population and whether this varies by caregiver type is not known. This study uses data from the National Survey of Child and Adolescent Well-Being to determine if (1) caregivers of young children involved with CW accurately identify children with developmental delays and (2) foster caregivers are better able to identify developmental delays compared with other caregivers. Close to half the children had a delay in language, cognitive, and/or adaptive behavior (45%). Overall sensitivity for caregiver identification was 35% (95% confidence interval [CI]: 29%, 41%); specificity was 84% (95% CI: 80%, 87%). After controlling for certain child and caregiver characteristics, in-home caregivers had 0.15 times the odds of identifying a child with a developmental delay compared with foster caregivers (95% CI 0.1, 0.4). Results suggest that caregiver identification of developmental delays is specific but not sensitive, and that foster caregivers were more likely to identify a child with a developmental delay compared with in-home caregivers. Policy implications include improving educational programs regarding child development and developmental services for foster, kinship, as well as in-home caregivers in the hopes of increasing sensitivity of caregiver identification of developmental delays for the population of young children involved with CW.

The impact of caregiver education level on endorsement of attention-deficit hyperactivity disorder (ADHD) symptoms for inattention (IA) and hyperactivity-compulsivity (HA) in a sample of high-risk youths was examined. Participants were 1347 caregivers of varying educational backgrounds who completed the ADHD module of the Diagnostic Interview Schedule for Children IV. The relationship of caregiver education to ADHD symptom endorsement was examined in three sets of analyses in which IA and HA symptoms were simultaneously regressed on caregiver years of education. Both multivariate analysis of covariance and logistic regression analyses revealed significantly lower rates of IA symptom endorsement by caregivers with less education, while there was no effect for HA symptoms. A multiple indicator multiple cause (MIMIC) model analysis also revealed that caregiver years of education was significantly positively associated with IA but not with HA symptoms, even when other demographic factors were controlled. There is a clear effect of caregiver education on ADHD symptom endorsement patterns, raising concerns that demographic factors related to symptom measurement may contribute to discrepancies in the assessment and treatment of ADHD.