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The interactions between public health and criminal justice (CJ) involvement are receiving increased attention. Although incarceration rates in the United States appear to be stabilizing after decades of rapid increase, they remain the highest in the world (Tsai & Scommegna, 2012). An estimated one in every 107 adults was incarcerated in 2011 (Glaze & Park, 2012). Estimates increase to one in 31 with the addition of persons under community supervision (Pew Center On The States, 2009). Public policy decisions and uneven law enforcement have led to endemic levels of CJ involvement in many low-income African American communities (Clear, 2007). The incarcerated population shows disparities in chronic medical conditions (Binswanger, Krueger, & Steiner, 2009), infectious diseases (Harzke et al., 2010), substance dependence and mental health disorders (James & Glaze, 2005). Incarcerated women, when compared to incarcerated men and community-residing women, have a significantly higher prevalence of medical, mental health, and substance dependence disorders (Binswanger et al., 2010). On the last day of 2010, approximately 113, 000 women resided in state and federal prisons, a 646% increase from 1980 (Guerino, Harrison, & Sabol, 2011). The rise in incarceration rates over the past three decades has created a multigenerational public health problem. Approximately 60% of incarcerated women report having an average of 2 children (Glaze & Maruschak, 2008). An estimated 6–10% of women are pregnant upon incarceration (Clarke, Phipps, Tong, Rose, & Gold, 2010). While women represent a smaller proportion of the incarcerated population than men, women are more likely to have been their child’s primary caregiver before their last arrest (Glaze & Maruschak, 2008). Incarcerated mothers also overwhelmingly report that they intend to care for their children after release (Stringer & Barnes, 2012). Children of incarcerated women are at higher risk of behavioral health problems than their peers (Lee, Fang, & Luo, 2013). This population is also more likely to have later personal CJ contact (Huebner & Gustafson, 2007). Affected children also experience parental separation, and often parental illicit substance use, mental illness, and domestic violence, all of which are adverse childhood experiences associated with morbidity and premature mortality (Brown et al., 2009). Prison Nurseries A variety of parenting programs within prisons attempt to address these multigenerational effects. Parenting classes of varying designs are now offered in prison settings (Hoffmann, Byrd, & Kightlinger, 2010). For incarcerated women with infants, eight U.S. states currently have a prison nursery, a special unit on which eligible incarcerated women with infants live together (Goshin & Byrne, 2009). This is in contrast to the more prevalent policy of removing infants from the mothers within 48 hours of birth. General eligibility criteria are that a woman be pregnant on incarceration and have no history of crimes against children (Women’s Prison Association, 2009). Women convicted of violent offenses are automatically excluded in most states. Lengths of stay range from 1– 36 months, with most programs allowing 12–18 months. Current U.S. programs are described as enriched, developmentally appropriate environments staffed by corrections officers and civilian professionals, including nurses (Fearn & Parker, 2004). Group prenatal and parenting courses are required in most facilities (Goshin & Byrne, 2009). These may be delivered by fellow incarcerated mothers (peer facilitators), professional staff, or through collaborations with community-based organizations. Other resources include: lactation support; civilian experts in child development; a day care center allowing mothers to attend counseling, drug treatment, educational and vocational programs; and advocates who facilitate contact with family members who do not reside in the nursery. Longitudinal research in the oldest U.S. prison nursery showed positive child outcomes during the nursery and after release. Development during infancy and toddlerhood was within normal limits across domains (Byrne, 2010). Attachment was more likely to be secure than what would be expected by the high proportion of insecurity and unresolved trauma in the mothers’ backgrounds (Byrne, Goshin, & Joestl, 2010). During the preschool period, children who had lived with their mothers in the prison nursery had lower anxious-depressed behavior problem scores than a comparison group of children who were separated from their mothers in infancy or toddlerhood because of incarceration (Author, in Press). Criminal recidivism, or the return to a correctional institution after release, threatens these positive outcomes. Recidivism and drug relapse were the most common causes of separation in dyads released from this prison nursery (Byrne, Goshin, & Blanchard-Lewis, 2012). Criminal Recidivism as a Public Health Nursing Outcome Given the connection between health and CJ contact, recidivism is an important public health outcome. An estimated 95% of all prisoners are released (Hughes & Wilson, 2003). Institutional factors within correctional settings create increased risk for injury, infectious disease, and other health threats, potentially leaving people sicker upon exit than entry (Ludwig, Cohen, Parsons, & Venters, 2012). Health conditions untreated during incarceration further complicate the reentry period. After release, those experiencing health problems may continue to cycle in and out of correctional institutions at great cost to their own wellbeing, and the wellness of their families and communities (Baillargeon, Binswanger, Penn, Williams, & Murray, 2009). Most women released from the general prison population will have subsequent CJ contact. Almost 60% will be rearrested, 38% will be reconvicted, and 30–45% will return to prison within three years (Cloyes, Wong, Latimer, & Abarca, 2010b; Deschenes, Owen, & Crow, 2006). More extensive history of prior arrests, incarceration for property or drug crimes, African American race, younger age, substance dependence, and mental illness are associated with recidivism (Cloyes, Wong, Latimer, & Abarca, 2010a; Deschenes, et al., 2006). Reporting dependent children has not been associated with decreased recidivism in women released from the general prison population (Huebner et al., 2010). In incarcerated mothers with a history of substance dependence, self reported expectation to live with children after release has also not been found to significantly affect recidivism after controlling for important confounders (Robbins, Martin, & Surratt, 2009). Recidivism rates appear lower for women released from prison nurseries (Carlson, 2009; Rowland & Watts, 2007). Research on recidivism in this population has thus far been limited by small sample sizes, short follow-up time frames, and unsystematic data sources, or a lack of specification for all three. Recidivism has also been analyzed dichotomously without regard to timing. Prevention and delay of recidivism are both important goals. Predictors of time to recidivism in this population have also not been explored. Finally, the effect on recidivism of prison nursery specific policy issues, such as length of stay and whether a woman’s child is released before her, has received no attention. Research Questions and Hypotheses The aim of this exploratory study was to analyze three-year recidivism in women who co-resided with their infants in X prison nursery. We hypothesized that time to recidivism would be directly associated with younger age at release, history of substance dependence, clinically significant depressive symptomatology during the nursery stay, release of the child without his or her mother, and being in the prison nursery for violation of parole conditions after a previous prison release.

The Pediatric Anesthesia NeuroDevelopment Assessment research group at Columbia University Medical Center Department of Anesthesiology has conducted biannual national Symposia since 2008 to evaluate study data and invigorate continued thinking about unresolved issues of pediatric anesthesia neurotoxicities. The third Symposium extended the dialogue between pediatric anesthesiologists and surgeons in panel presentations and discussions by four surgical specialists. This paper reports the prevailing opinions expressed by a pediatric general surgeon, urologist, plastic surgeon and ophthalmologist and explores factors related to delayed operative intervention, need for multiple procedures, and parental concerns.

Objective:Using data from a multi-site study of parent–child symptom reporting concordance, this secondary analysis explored the role of parent self-efficacy related to pain management for seriously ill school-age children and adolescents.Method:In the initial study, 50 children and adolescents who were expected to survive 3 years or less were recruited along with their parent/primary caregiver. Parent self-report data were used in this secondary analysis to describe parent self-efficacy for managing their child's pain, caregiver strain, mood states, and perception of the child's pain; to explore relationships among these variables; and to determine predictors of greater self-efficacy.Results:Parents expressed a wide range of self-efficacy levels (Chronic Pain Self-Efficacy Scale; possible range 10–100, mean 76.2, SD 14.7) and higher levels on average than reported previously by family caregivers of adult patients. Caregiver Strain Index scores were markedly high (possible range 0–13, mean 8.1, SD 3.8) and inversely correlated with self-efficacy (r = −0.44, p = 0.001). On the Profile of Mood States parents reported more negative moods (t = 4.0, p t = −5.0, p R2 = 0.51).Significance of results:Findings advance knowledge of parent self-efficacy in managing the pain of a child with life-threatening illness. Results can be used to design supportive interventions enhancing parents’ caregiving roles during their child's last stages of life.

We report attachment classifications in a sample of pregnant women incarcerated in a state prison with a nursery program. Analyses were based on 69 women serving sentences for felony crimes who were followed from the birth of their child to completion of the prison nursery co-residence. They completed the Adult Attachment Interview shortly after entering the program and scales measuring depression, perceived parenting competency, and social support at study entry (Time 1) and program completion (Time 2). Incarcerated mothers had higher rates of insecure attachment than previous low-risk community samples. Compared with dismissing and secure mothers, preoccupied mothers reported higher levels of depressive symptoms, lower parenting competency, and lower satisfaction with social support at the conclusion of the nursery program. Higher scores on unresolved loss and derogation were associated with a history of substance abuse; higher scores on unresolved trauma were associated with depressive symptoms at program completion.

Within a larger intervention study, attachment was assessed with the Strange Situation Procedure for 30 infants who co-resided with their mothers in a prison nursery. Sixty percent of infants were classified secure, 75% who co-resided a year or more and 43% who co-resided less than a year, all within the range of normative community samples. The year-long co-residing group had significantly more secure and fewer disorganized infants than predicted by their mothers’ attachment status, measured by the Adult Attachment Interview, and a significantly greater proportion of secure infants than meta-analyzed community samples of mothers with low income, depression, or drug/alcohol abuse. Using intergenerational data collected with rigorous methods, this study provides the first evidence that mothers in a prison nursery setting can raise infants who are securely attached to them at rates comparable to healthy community children, even when the mother’s own internal attachment representation has been categorized as insecure.

The purpose of this study was to examine the prevalence and characteristics of children experiencing a continuum of inadequate sleep and its associations with child, family, and environmental variables.A secondary analysis of weighted responses of 68,418 parents or caregivers of children aged 6 to 17 years participating in the 2003 National Survey of Children's Health was conducted. Inadequate sleep was categorized as mild, moderate, or severe.Approximately one third of parents reported their child's sleep inadequacy as mild (18.6%), moderate (6.8%), or severe (5.8%). Age (P.001), fair/poor health status (P.001), frequent depressive symptoms (P.001), and high parental stress (P.001) demonstrated a progressive relationship from adequate to severe inadequate sleep. Controlling for child, family, and environment variables, parents of children with inadequate sleep were more likely to report frequent child depressive symptoms, high parental stress, and violent family conflict style.Sleep inadequacy affects 15 million American children, 6 million at a moderate or severe level. Identification of inadequate sleep should prompt further assessment of its associated factors-depressive symptoms, parental stress, and family conflict-for targeted clinical intervention.

Recent animal studies have shown that commonly used anesthetic agents may have serious neurotoxic effects on the developing brain. The purpose of this study was to assess the association between surgery for hernia repair and the risk of behavioral and developmental disorders in young children. We performed a retrospective cohort analysis of children who were enrollees of the New York State Medicaid program. Our analysis involved following a birth cohort of 383 children who underwent inguinal hernia repair during the first 3 years of life, and a sample of 5050 children frequency-matched on age with no history of hernia-repair before age 3. After controlling for age, sex, and complicating birth-related conditions such as low birth weight, children who underwent hernia repair under 3 years of age were more than twice as likely as children in the comparison group to be subsequently diagnosed with a developmental or behavioral disorder (adjusted hazard ratio 2.3, 95% confidence interval 1.3, 4.1). Our findings add to recent evidence of the potential association of surgery and its concurrent exposure to anesthetic agents with neurotoxicity and underscore the need for more rigorous clinical research on the long-term effects of surgery and anesthesia in children.

Background: In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). Methods: This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews. Results: The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs. Conclusions: The incongruence in perspectives offered by members of CHMTs and mid-level providers points to deficient HRH management practices, which contribute to poor practice environments in acute obstetric settings in Tanzania. Our findings indicate that members of CHMTs require additional support to adequately fulfill their HRH management role. Further research conducted in low-income countries is necessary to determine the appropriate package of interventions required to strengthen the capacity of members of CHMTs.

Objective: To identify characteristics associated with delayed/forgone care for children with special health care needs (CSHCN) in New York State (NYS) as reported by their parents. Methods: Data come from NYS participants in the 2000–2002 National Survey of Children with Special Health Care Needs. Data were analyzed using weighted bivariate and multivariate regression models. The dependent variable was report of delayed/forgone routine health care. Independent variables included illness characteristics, potential and actual access to care, and provider care characteristics. Results: In NYS, 8.4% reported delayed/forgone health care for their child. Parents of children with delayed/forgone care were more likely to report that their child was uninsured (adjusted odds ratio [aOR] 3.8, 95% confidence interval [CI] 1.3–11.8), had experienced interrupted health insurance (aOR 3.9, 95% CI 1.5–9.7), or their child’s insurance was not adequate for CSHCN (aOR 3.6, 95% CI 1.4–9.1). Further, these parents were more likely to report that providers never spend adequate time (aOR 6.3, 95% CI 1.2–34.4), provide sufficient information (aOR 8.0, 95% CI 2.5–25.0), act as partners in care (aOR 6.7, 95% CI 2.3–19.7), or display cultural sensitivity (aOR 5.4, 95% CI 1.2–24.3). Conclusions: An estimated 40,771 NYS CSHCN experience delayed/forgone routine health care. Their families report two noteworthy barriers: inadequate or discontinuous insurance coverage and poor communication with health-care providers. Access to care for CSHCN can be improved by increasing consistent comprehensive insurance coverage and increasing sensitivity in relationships between health care providers and families of CSHCN.

Funding mechanisms that require a mentor provide a unique opportunity to implement the research mentoring that is recognized as increasingly important in nursing. Little has been written about how to create and sustain the roles of mentor and principal investigator within a funded arrangement. This article analyzes one research mentoring relationship focused on maternal-infant interaction research and implemented through the Federal KO1 (Mentored Research Scientist Development Award) grant mechanism. Methods used are personal reflections on the 4-year mentorship experience and literature review using the National Library of Medicine database from 1990 to 2001. The mentoring relationship within the National Institutes of Health KO1 award is characterized by the personal commitment, common interests, and long-term professional development that are essential qualities of traditional mentoring but differs in that it is structured by the aims, activities, and length of each award. Effective participation requires organization, focus, and self-direction on the part of the mentored principal investigator and expertise, altruism, and generativity on the part of the mentor. A grant-based mentoring relationship can provide mutual benefits to the researcher and mentor but both must attend to sustaining and enriching the relationship.

Background: The numerous parent-child interaction measures available include few that are appropriate to brief clinical encounters or to research settings where time, cost, space, and subject burden are critical factors. Objectives: This study compares the newer Mother-Infant Communication Screening (MICS) with the established Nursing Child Assessment Satellite Training (NCAST) Teaching Scale (NCAT). Methods: Theoretical foundations, development, administration, support, and published psychometrics for the two scales are contrasted. Videotapes of 171 caregiver-child interactions in an urban, Hispanic, high-risk sample (children aged 5 months to 36 months) were scored by two trained coders who had established inter-rater reliabilities of .90 (NCAT) and .85 (MICS). Results: Validity correlation coefficients were r = .504, p < .001 for total scores and r =.492, p

Background Nurses in Vietnam, as is typical of many low-income countries, are hampered from impacting health outcomes by low occupational status, overcrowded hospitals and few career development opportunities. In order to understand the current practice environment encountered by nurses in Vietnam in the most realistic way, we listened to the voices of nurses currently performing nursing roles in Vietnam. Purpose The purpose of this study was to explore the emic (insider) perspectives on cultural meaning applied by nurses at a northern Vietnamese women�s hospital to influence professional practice and interpret experience. Design A micro-ethnography approach was used. Methods Seven nurses and one vice-Dean of a school of nursing were interviewed. Data collection consisted of open-ended interviews, participant observation and journal recordings. Spradley�s (1979, 1980) Development Research Sequence was used to guide data collection and analysis. Results/Findings Five themes emerged. These were the big number of patients is a burden for nurses; nurses do not, cannot make their own decisions (but they can and do); my feeling depends on doctor's feeling; nurses learn more from doctor; and just a few nurses can attend the [Vietnamese Nurses Association] meeting. Conclusion The experiences described by the nurses and the vice-Dean of a nursing school reflect the challenges of practicing nursing in one Vietnamese hospital and the resourcefulness of nurses in overcoming those challenges. Recurrent themes highlight the need to better position nurses in Vietnam to advance towards full expression of the professional nursing role.

Animal studies have documented that exposure of the developing brain to commonly used anesthetic agents induces neurotoxicity and late abnormal neurobehavioral functions as adults. Results from clinical studies have all been analyzed using existing data sets, and these studies produced inconsistent results. To provide more definitive evidence to address the clinical relevance of anesthetic neurotoxicity in children, an interdisciplinary team of investigators designed and developed the Pediatric Anesthesia NeuroDevelopment Assessment (PANDA) project. We present pilot study results in 28 sibling pairs recruited and tested at the Columbia University Medical Center (CUMC) and Children's Hospital of Boston (CHB) for the PANDA project.The PANDA project uses an ambidirectional cohort design. We performed prospective neuropsychological assessment in 28 exposed-unexposed sibling pairs from 6 to 11 years of age. The exposed siblings were ASA 1 or 2 and had received a single episode of anesthesia for inguinal hernia repair before the age of 36 months and the unexposed siblings had no anesthesia before the age of 36 months. All the sibling pairs were English speaking and were 36 weeks of gestational age or older. Each sibling pair underwent a direct testing using the Wechsler Abbreviated Scale of Intelligence (WASI) and the NEuroPSYchological Assessment, second edition (NEPSY II), and the parents completed questionnaires related to behavior using CBCL and Conners rating. Data are presented as means±SD. We conducted descriptive analyses of the demographic data. We compared both the exposed and the unexposed sibling groups on WASI and NEPSY II, and total and T scores from CBCL and Conners rating were analyzed as continuous data using the paired t test between the two groups. A P0.05 was considered significant.After the Institutional Review Board approval for the study at both CUMC and CHB, the full PANDA study protocol was implemented to perform a pilot feasibility study. Our success rate was 96.7% in obtaining detailed medical and anesthesia records in our historical cohort. The scores for verbal IQ (exposed=106.1±16.3, unexposed=109.2±17.9), performance IQ (exposed=109.1±16.0, unexposed=113.9±15.9), and full IQ (exposed=108.2±14.0, unexposed=112.8±16.8) were comparable between the siblings. There were no differences between the two groups in T scores for any of the NEPSY II subdomains, CBCL, or Conners rating. An abstraction protocol with web-based electronic data capture forms also was developed in conjunction with the International Center for Health Outcomes and Innovation Research (InCHOIR).The pilot study provided useful information for feasibility to recruit the sample size and to obtain relevant clinical data. For the final study protocol, both the neuropsychological battery and the age range for testing were revised. Our results confirmed the feasibility of our study approach and yielded pilot data from neuropsychological testing.

Objective:The objective of this study was to develop a clinically relevant tool to assess parental engagement in decision making and planning for seriously ill children during palliative care consultations. Although little is known about the structure and process of planning meetings between parents and providers, less is known about the nature of parental engagement as it relates to decision making ability in pediatric end-of-life care. Using attachment and caregiving as a framework, this study clarified important dimensions of parental engagement.Method:Using a multi-phase, template-matching technique, both literature and pediatric palliative care consultation data were analyzed, iteratively reviewed, matched, and categorized to create a measure of parental engagement. The attachment paradigm serves as the theoretical framework for the study, which focuses on parental engagement in decision making as a caregiving system function. Attachment and related literatures as well as coping and pediatric palliative care literatures were used in the initial conceptual sampling phase.Results:The study yielded two groups of findings. The first set of findings centered on the findings of the literature and consultation template-matching phases of the work. These two phases yielded a conceptual model of parental engagement as a psychobehavioral complex consisting of three dimensions: information-centered dialogue, insightful participation, and achievement of a collaboratively agreed-upon plan. The final phases consisted of creation of a 9 point Parental Engagement Scale, scoring of the consultations, and establishment of initial inter- rater reliability at .80. Psychometric testing continues.Significance of results:Parental engagement in decision making is a critical area for study and intervention. If we can support parents in their caregiving executive functions while understanding the psychological and emotional underpinnings of the caregiving system and parental engagement itself, we can move inquiry forward in understanding parental needs for intervention during this most profoundly challenging time.

Self-injurious behaviors (SIBs) are a common coping mechanism in the adolescent population. A marked increase in SIB has been seen in recent years, yet effective treatment remains elusive.This study aims to review current theoretical perspectives and treatment options that reflect a biopsychosocial framework.Selected multidisciplinary literature related to SIB.A 6-month multidisciplinary approach targeting the unique physical, emotional, and social needs of a 14-year-old girl in residential treatment led to the complete cessation of SIB.

Purpose: Children who exhibit the confusing symptom patterns associated with sensory processing deficits are often seen first by primary care providers, including family and pediatric nurse practitioners (NPs). The purpose of this article is to alert NPs to the state of the science for these disorders and to the roles NPs could play in filling the knowledge gaps in assessment, treatment, education, and research. Data sources: Literature searches using PubMed and MedLine databases and clinical practice observations. Conclusions: Sensory integration disorders have only begun to be defined during the past 35 years. They are not currently included in the DSM IV standard terminology, and are not yet substantively incorporated into most health disciplines’ curricula or practice, including those of the NP. Implications for practice: NPs are in a unique position to test hypothesized terminology for Sensory Processing Disorder (SPD) by contributing precise clinical descriptions of children who match as well as deviate from the criteria for three proposed diagnostic groups: Sensory Modulation Disorder (SMD), Sensory Discrimination Disorder (SDD), and Sensory-Based Motor Disorder (SBMD). Beyond the SPD diagnostic debate, for children with sensory deficit patterns the NP role can incorporate participating in interdisciplinary treatment plans, refining differential diagnoses, providing frontline referral and support for affected children and their families, and making both secondary prevention and critical causal research possible through validation of consistently accepted diagnostic criteria.

The purpose of this study was to describe pediatric nurses' projected responses to children's pain as described in vignettes of hospitalized children and to explore nurse characteristics that might influence those responses. A survey was mailed to a national random sample of 700 RNs, and 334 nurses responded. The survey included case reports of three hospitalized school-aged children experiencing pain. Nurses were asked to rate their perceptions of the children's pain levels and to indicate how much analgesia they would recommend. Contrary to earlier studies, in response to the scenarios, nurses in this sample perceived high levels of pain, said they would administer doses of analgesia close to the maximum prescribed by physicians, and recommended an array of non-pharmacologic methods to treat pain. Variation in pain perceptions and decisions was not related to key personal and professional characteristics of the nurses, including their education level, race/ethnicity, age, years of clinical experience, and receipt of continuing education about pain. Findings from this large national study suggest that most nurses would make appropriate decisions relating to the treatment of children's pain, perhaps reflecting changes in the emphasis on pain management.

The purpose of this study was to examine whether nurses' recommendations for managing children's pain were influenced by stereotypes based on children's personal attributes. Three vignettes, in which hospitalized children's sex, race, and attractiveness were experimentally manipulated, were mailed to a national random sample of 700 pediatric nurses; 334 nurses responded. Responses to vignette questions indicated little evidence of stereotyping. Nurses perceived similar levels of pain and recommended similar pain treatments, regardless of sex, race, and attractiveness. Nurses, on average, perceived children's pain at levels consistent with the children's self-reports and recommended assertive analgesic and non-pharmacologic pain management strategies. The results appear consistent with prevailing views on providing adequate pain treatment for children.

The study describes quality of life as perceived by parents and measured by the Child Health Questionnaire (CHQ-28) for a convenience sample of 33 HIV-infected children age 5 to 18 years cared for at home on complex antiretroviral drug regimens. When compared with normative data on healthy U.S. children, parent reports for the HIV-infected children did not differ significantly on the following CHQ concepts: role/social related to emotional, behavioral or physical problems; bodily pain; behavior; mental health; self-esteem; impact on parental time; family activities; and family cohesion. Parents perceived their children to be functioning at a level significantly lower than the norm in general health (t −6.47, p = .000), physical functioning (t −2.37, p = .024), and physical summary (t −3.80, p = .001). Parental impact-emotional was impressively higher than the norm (t −3.74, p = .001). Differences were independent of gender, primary language, ethnicity, and Centers for Disease Control and Prevention clinical classifications for pediatric HIV disease.

The purpose of this report is to expand the psychometric properties of the Child Health Questionnaire parent report short form (CHQ-28) as a measure of well-being for children with chronic illness. The purposive sample included 33 HIV-infected children ages 5–18 years who were patients of a comprehensive specialty clinic in an urban Northeast medical center and were cared for at home on complex anti-retroviral drug regimens. Parents reported the children’s functioning in multiple domains using the American Spanish (one-third) or English (two-thirds) versions of the CHQ-28. Internal consistencies ranged from Cronbach’s alpha of 0.62–0.83. Correlations between the physical and psychosocial summary scores and their components supported the instrument’s conceptualization of health although some overlap between domains was demonstrated. Differences between the CHQ profile for healthy norm children and this clinical sample were logically consistent with the disease characteristics. Individual scales of the CHQ-28 show promise as research outcome measures for health related quality of life in children living in the community with HIV disease and perhaps could be useful for studies of children with other chronic illness.