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Cross-sector collaborations are increasingly being relied upon to improve accessibility of prevention and support services for marginalized communities reported to the child protection system. However, little is known about the feasibility, implementation, and impact of such collaborations. This study begins to address this gap by describing the challenges faced by a child protection agency and community organization who partnered to reduce the overrepresentation of Black children reported to the child protection agency through implementation of a parenting support program. Six semi-structured interviews were conducted with all members of a stakeholder committee, representing both the child protection agency and community organization. Critical race theory (CRT) informed the qualitative approach. Three major themes were identified demonstrating how the child protection agency's organizational context, lack of socio-political support and organizational culture posed significant implementation challenges for the partnership. These findings raise important considerations for cross-sector collaborations aiming to reduce overrepresentation and racial disparity within child protection systems. [ABSTRACT FROM AUTHOR]

Background: Ethiopia's high neonatal mortality rate led to the government's 2013 introduction of Community-Based Newborn Care (CBNC) to bring critical prevention and treatment interventions closer to communities in need. However, complex behaviors that are deeply embedded in social and cultural norms continue to prevent women and newborns from getting the care they need. A demand creation strategy was designed to create an enabling environment to support appropriate maternal, newborn, and child health (MNCH) behaviors and CBNC. We explored the extent to which attitudes and behaviors during the prenatal and perinatal periods varied by the implementation strength of the Demand Creation Strategy for MNCH-CBNC.Methods: Using an embedded, multiple case study design, we purposively selected four kebeles (villages) from two districts with different levels of implementation strength of demand creation activities. We collected information from a total of 150 key stakeholders across kebeles using multiple qualitative methods including in-depth interviews, focus group discussions, and illness narratives; sessions were transcribed into English and coded using NVivo 10.0. We developed case reports for each kebele and a final cross-case report to compare results from high and low implementation strength kebeles.Results: We found that five MNCH attitudes and behaviors varied by implementation strength. In high implementation strength kebeles women felt more comfortable disclosing their pregnancy early, women sought antenatal care (ANC) in the first trimester, families did not have fatalistic ideas about newborn survival, mothers sought care for sick newborns in a timely manner, and newborns received care at the health facility in less than an hour. We also found changes across all kebeles that did not vary by implementation strength, including male engagement during pregnancy and a preference for giving birth at a health facility.Conclusions: Findings suggest that a demand creation approach-combining participatory approaches with community empowering strategies-can promote shifts in behaviors and attitudes to support the health of mothers and newborns, including use of MNCH services. Future studies need to consider the most efficient level of intervention intensity to make the greatest impact on MNCH attitudes and behaviors. [ABSTRACT FROM AUTHOR]

Results of community-based childhood obesity intervention programs do not provide strong evidence for their effectiveness. In this study, we evaluated the effect of the Thao-Child Health Program (TCHP), a community-based, multisetting, multistrategy intervention program for healthy weight development and lifestyle choices. In four Catalan cities, a total of 2250 children aged 8 to 10 years were recruited. Two cities were randomly selected for the TCHP intervention, and two cities followed usual health care policy. Children were selected from 41 elementary schools. Weight, height, and waist circumference were measured at baseline and after a mean follow-up of 15 months. Physical activity and adherence to the Mediterranean diet were measured with validated questionnaires. Generalized estimating equations (GEE) models were fitted to determine the intervention's effect on body mass index (BMI) z-score, waist-to-height ratio, Mediterranean diet adherence, and physical activity. Fully adjusted models revealed that the intervention had no significant effect on the BMI z-score, incidence of general and abdominal obesity, Mediterranean diet adherence, and physical activity. Waist-to-height ratio was significantly lower in controls than in the intervention group at follow-up (p < 0.004).Conclusions: The TCHP did not improve weight development, diet quality, and physical activity in the short term. What is Known: • There is inconsistent evidence for the efficacy of school-based childhood obesity prevention programs. • There is little evidence on the efficacy of childhood obesity intervention programs in other settings. What is New: • This paper contributes information about the efficacy of a multisetting and multistrategy Community Based Intervention (CBI) program that uses the municipality as its unit of randomization. • This CBI had no effect on the prevention and treatment of childhood obesity in the short term. [ABSTRACT FROM AUTHOR]

The provision of community-based child welfare services (CCW) in a managerialist climate in Aotearoa New Zealand (ANZ) necessitates constantly renegotiated contractual partnerships, service targeting and measured outcomes. Reflective supervision is essential to counter the perceived negative impacts of managerialism on CCW work. Within this environment, there is a struggle to ensure supervision provides reflective spaces for social workers to develop in their work with service users despite the demands of meeting organisational imperatives. This article reports on a qualitative study which critically analyses the espoused theory and theories-in-use [Argyris, C., & Schön, D. (1974). Theory in practice: Increasing professional effectiveness. San Francisco, CA: Jossey Bass.] about reflective supervision held by social workers practising in the demanding environment of CCW. In the first phase of the research reported here, nine key informants who had both considerable experience in CCW and academic experience in ANZ were interviewed about the nature of reflective supervision in CCW social work. Findings indicate that social workers working in CCW settings are influenced by factors associated with self-awareness, relationships, organisational and professional obligations within a changing and risk-averse managerial environment. Key informants assert that social workers from CCW backgrounds need reflective supervision to engage in self-reflection, consider wider socio-cultural factors and to critically develop social-justice-informed practice with service users. [ABSTRACT FROM AUTHOR]

This paper presents an in-depth case study of the dynamic processes of mutual adjustment that occurred between two professional teams participating in a multicomponent community-based intervention ( CBI). Drawing on the concept of social regularities, we focus on patterns of social interaction within and across the two microsystems involved in delivering the intervention. Two research strategies, narrative analysis and structural network analysis, were used to reveal the social regularities linking the two microsystems. Results document strategies and actions undertaken by the professionals responsible for the intervention to modify intersetting social regularities to deal with a problem situation that arose during the course of one intervention cycle. The results illustrate how key social regularities were modified in order to resolve the problem situation and allow the intervention to continue to function smoothly. We propose that these changes represent a transition to a new state of the ecological intervention system. This transformation appeared to be the result of certain key intervening mechanisms: changing key role relationships, boundary spanning, and synergy. The transformation also appeared to be linked to positive setting-level and individual-level outcomes: confidence of key team members, joint planning, decision-making and intervention activities, and the achievement of desired intervention objectives. [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency has been linked to an increased risk of osteoporosis. Vitamin D deficiency has reached high levels in the Saudi population, but there is conflicting evidence both in the Saudi population, and worldwide, regarding the existence of a correlation between these low vitamin D levels and reduced BMD (bone mineral density), or osteoporosis. Objective: The objective of this study was primarily to determine whether there was a correlation between vitamin D deficiency and osteoporosis in the Saudi population. We aimed to investigate whether the high levels of vitamin D deficiency and insufficiency would translate to higher prevalence of osteoporosis, and whether there is a correlation between vitamin D levels and bone mineral density. Materials and methods: This was a community based cross sectional study conducted in the Family Medicine Clinics at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. Electronic records of 1723 patients were reviewed. Laboratory and radiology results were collected, including vitamin D levels, calcium levels, and bone mineral density scan results. Results: Among the whole population, 61.5% had moderate to severe vitamin D deficiency with levels less than 50nmol/L. 9.1% of the population had osteoporosis, and 38.6% had osteopenia. Among the whole population, there was no significant correlation between spine or total femoral BMD and serum 25(OH) D. Conclusion: Vitamin D deficiency is prevalent in the Saudi population. However, no correlation has been found between vitamin D deficiency and reduced bone mineral density in any age group, in males or females, Saudis or Non-Saudis, in our population in Riyadh, Saudi Arabia. [ABSTRACT FROM AUTHOR]

Mobile phone applications may enhance the delivery of critical health services and the accuracy of health service data. Yet, the opinions and experiences of frontline health workers on using mobile apps to track pregnant and recently delivered women are underreported. This evaluation qualitatively assessed the feasibility, usability, and acceptability of a mobile Client Data App for maternal, neonatal, and child client data management by community health nurses (CHNs) in rural Ghana. The mobile app enabled CHNs to enter, summarize, and query client data. It also sent visit reminders for clients and provided a mechanism to report level of care to district officers. Fourteen interviews and two focus groups with CHNs, midwives, and district health officers were conducted, coded, and thematically analyzed. Results indicated that the app was easily integrated into care, improved CHN productivity, and was acceptable due to its capacity to facilitate client follow-up, data reporting, and decision-making. However, the feasibility and usability of the app were hindered by high client volumes, staff shortages, and software and device challenges. Successful integration of mobile client data apps for frontline health workers in rural and resource-poor settings requires real-time monitoring, program investments, and targeted changes in human resources. [ABSTRACT FROM AUTHOR]

Several intersectoral community approaches targeting childhood obesity (IACOs) have been launched in the Netherlands. Translation of these approaches into practice is however arduous and implementation. We therefore studied the implementation of five IACOs in the Netherlands for one-and-a-half years. IACO implementation was evaluated via an adapted version of the MIDI questionnaire, consisting of 18 theory-based constructs. A response rate of 62% was obtained. A hierarchical multivariate linear regression model was used to analyse our data; the final regression model predicted 65% of the variance in adherence. Higher levels of self-efficacy, being an implementer embedded in community B, and having more than 1 year of experience with IACO implementation were associated with higher degrees of adherence. Formal ratification of implementation by management and being prescribed a higher number of activities were related to lower degrees of adherence. We advise that, when designing implementation strategies, emphasis should be placed on the enhancement of professionals' self-efficacy, limitation of the number of activities prescribed and allocation of sufficient time to get acquainted and experienced with IACO implementation. Longitudinal studies are needed to further evaluate interaction between and change within critical determinants while progressing through the innovation process. [ABSTRACT FROM AUTHOR]

Resilience studies typically privilege the views and assumptions of minority-world research. One way to circumvent this is through methodologies that give voice to the experiences of majority-world youth. Our aim in this article is to reflect critically on the use of community-based participatory video (CBPV) to understand and promote resilience processes in 28 black South African adolescent girls. The girls, aged from13 to19 years, were recruited by social workers and teachers collaborating with the South African Pathways to Resilience Project. The findings suggest that CBPV does champion participant-directed understandings of resilience. However, the findings also draw attention to the difficulties of realising the potential of the social change inherent in CBPV, and the complexity of stimulating deep reflection in the girl participants. [ABSTRACT FROM AUTHOR]

Healthcare professionals are challenged with reversing the current childhood obesity epidemic as well as preventing its occurrence among future generations. This paper describes a community-academic partnership that implemented clinical guidelines in a medically underserved elementary school in Alabama. Quantitative and qualitative evaluation methods, pretests, posttests, health screenings, and surveys were used to establish a screening and prevention program and to create a collaboration between a rural county school system and a local school of nursing university. Outcomes indicate this evidence-based, multi-pronged approach may accelerate the progress toward the prevention of childhood obesity. [ABSTRACT FROM AUTHOR]

Early integration of pediatric palliative care (PPC) for children with life-threatening conditions and their families enhances the provision of holistic care, addressing psychological, social, spiritual, and physical concerns, without precluding treatment with the goal of cure. PPC involvement ideally extends throughout the illness trajectory to improve continuity of care for patients and families. Although current PPC models focus primarily on the hospital setting, community-based PPC (CBPPC) programs are increasingly integral to the coordination, continuity, and provision of quality care. In this review, the authors examine the purpose, design, and infrastructure of CBPPC in the United States, highlighting eligibility criteria, optimal referral models to enhance early involvement, and fundamental tenets of CBPPC. This article also appraises the role of CBPPC in promoting family-centered care. This model strives to enhance shared decision making, facilitate seamless handoffs of care, maintain desired locations of care, and ease the end of life for children who die at home. The effect of legislation on the advent and evolution of CBPPC also is discussed, as is an assessment of the current status of state-specific CBPPC programs and barriers to implementation of CBPPC. Finally, strategies and resources for designing, implementing, and maintaining quality standards in CBPPC programs are reviewed. [ABSTRACT FROM AUTHOR]

This article addresses the question of the structure of local child welfare activities in light of community-level factors. It poses the following research questions: how are different community-level factors related to child welfare client structures in communities and what is the extent to which these factors explain structural differences? The applied theoretical framework is based on social disorganization and strain theories as well as human developmental approach. The data has been collected from two Finnish national databases and it consists of variables containing 257 Finnish municipalities. The method of analysis is multinomial logistic regression. The results suggest that the local child welfare structures are tied to social disorganization, policing and culture as well as to the intensity of control in the communities. In general, the more fragile the communal structures, the more last-resort child welfare there is in the community. Combining fragile communal structures with weak dependency ratio and high proportion of social workers, the more intense the level of child welfare statistics indicated. The results indicate that the theoretical framework for the application of child welfare activity analysis is justified, but they also suggest that it requires further development through both context-bound reflection and application. [ABSTRACT FROM AUTHOR]

Children are particularly vulnerable to the impacts of climate change. Despite this, relatively little attention is paid to building their capacity to manage the impacts of climate change they experience now and those they will experience in future. While child-centred approaches are starting to emerge in the field of community-based adaptation, these approaches are almost exclusively used by child-focused organizations. This article argues that mainstreaming children's needs and capacities into broader adaptation efforts can lead to more sustainable outcomes that can help to build long-term community-level adaptive capacity. A series of short examples from the field are used to highlight the different contexts in which child-centred approaches to community-based adaptation are taking place and some outcomes achieved to date. The article concludes that while there is a growing body of anecdotal evidence that taking a child-centred approach to community-based adaptation can build the adaptive capacity of children and also provide benefits to entire communities, there is no solid evidence-base proving that what has worked in a growing number of cases is more broadly applicable, translatable to other regions or sustainable in the absence of direct project support. The article recommends that collaborative efforts between researchers and practitioners should be launched to gather this evidence. [ABSTRACT FROM AUTHOR]

This article highlights important dimensions of public theology and shows how the identified dimensions are relevant to the specific situation of informal early childhood development (ECD) facilities in a South African urban setting. The article considers the contributions and challenges of informal community-based ECD on the basis of research conducted in the Rustenburg/Phokeng area of the North West province of South Africa. It critically discusses the sociocultural discourses and legislation regulating ECD centres, by focusing on the constraints put on informal ECD service providers. It concludes by considering ways in which urban public theology should act to serve, strengthen and advocate this vitally important, yet informal, sector. [ABSTRACT FROM AUTHOR]

This study sought to implement outcomes monitoring and to review outcome data from a community-based rehabilitation program for maltreated children and adolescents in São Paulo, Brazil. Maltreated children and adolescents (N = 452) were enrolled in The Equilibrium Program (TEP), a multidisciplinary community-based rehabilitation program. About half (n = 230) of the participants were successfully evaluated using the Children's Global Assessment Scale (C-GAS) at entry, 3, and/or 6 months later. Analysis of outcomes used hierarchical linear modeling of functional change from baseline. With a baseline C-GAS score of 51.7 (SD = 14.22), average improvement was 2.8 and 5.5 points at 3 and 6 months, respectively (reflecting small to moderate effect sizes = 0.20 and 0.39). Improvement was associated with Problems related to upbringing (p < .02) at entry and absence of Physical abuse (p < .05) and Negative life events in childhood (p < .05) but was not associated with sociodemographics or any specific psychiatric diagnosis. This study showed that outcomes monitoring is feasible in a community-based program in a developing country. Although there was no untreated control group for comparison and specific evidence-based treatments were not used, it is notable that significant improvement, with small to moderate effect size, was observed. [ABSTRACT FROM AUTHOR]

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While there is a large difference in the number of young inhabitants in the Netherlands and Germany, their child protection frameworks are quite similar. In both countries, child protection services are mainly focused on youth aged 0 to 18 and regulations are aimed at clients' responsibility and their active involvement during care. Youth care services consist of community-based services, day treatment and out-of-home care services, which include foster care and residential care. The history of out-of-home care services in both countries is characterized by similar developments. Over the last four decades, similar trends in residential care, towards more small-scale forms of residential care, smaller residential group sizes, and increasing professionalization of staff have emerged. Over the last two decades, a comparable trend towards increasing professionalization can be seen in the context of foster care in both countries. In addition, the number of youths in out-of-home care increased in both countries over the last decade, specifically in foster care. Over the last decade, more studies have been conducted in residential care than in foster care in both countries. Despite similar trends and developments in out-of-home care practice, research mainly shows differences in applied topics and methods between Germany and the Netherlands. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of this study was to test the hypothesis that community-based environmental change intervention prevents undesirable weight gain in children. Method: The method used in this study was a two-year, non-randomized, controlled trial (2003–2005) using community-based participatory methodology in three diverse cities in Massachusetts: one intervention and two socio-demographically-matched control communities (pooled for analysis). Children (n=1028), with a mean age=7.61+1.04years participated. Interventions were made to improve energy balance by increasing physical activity options and availability of healthful foods (Year 1). To firmly secure sustainability, the study team supported policies and shifted intervention work to community members (Year 2). Results: Change in body mass index z-score (BMIz) was assessed by multiple regression, accounting for clustering within communities and adjusting for baseline covariates. Sex-specific overweight/obesity prevalence, incidence and remission were assessed. Over the two-year period, BMIz of children in the intervention community decreased by −0.06 [p=0.005, 95% confidence interval: −0.08 to −0.04] compared to controls. Prevalence of overweight/obesity decreased in males (OR=0.61, p=0.01) and females (OR=0.78, p=0.01) and remission increased in males (OR 3.18, p=0.03) and females (OR 1.93, p=0.03) in intervention compared to controls. Conclusion: Results demonstrate promise for preventing childhood obesity using a sustainable multi-level community-based model and reinforce the need for wide-reaching environmental and policy interventions. [Copyright &y& Elsevier]

Parental incarceration can be devastating for families. Children may experience difficulties, and the stress on caregivers who take on unexpected childrearing is high. The authors implemented and evaluated a family-level intervention with caregivers and children experiencing parental (typically maternal) incarceration in a community setting. The authors partnered with a community-based organization serving families with an incarcerated parent to conduct a pilot trial of the Strengthening Families Program ( SFP). Process evaluation indicated high implementation fidelity, satisfaction, engagement, and attendance. Outcome evaluation results indicated positive changes in family-level functioning, caregivers' positive parenting, and caregiver depression symptoms from pre- to postintervention, with some changes retained at follow-up 4 months later. Implications for preventive interventions with children of incarcerated parents and their caregivers, are discussed. [ABSTRACT FROM AUTHOR]

ABSTRACT Background There are three options in Florida for young people with mental health needs who require out-of-home treatment: community-based group homes, foster families and inpatient group facilities. Prior research has suggested that young people in group settings have poorer criminal justice outcomes, perhaps attributable to negative peer effects in group environments. Aims To compare arrest rates during and after out-of-home treatment for youth across the three settings. To test the hypothesis that arrest rates during treatment are independently related to arrest rates after treatment, after allowing for pre-treatment characteristics and placement type. Methods Florida Medicaid claims data were used to identify children and adolescents in out-of-home mental health care from 2003-2007. These were then matched with Florida Department of Juvenile Justice and Law Enforcement records. Propensity score matching was used to allow for observed differences between youth in different treatment settings. Multinomial logistic regression models were used to test relationships between arrest rates. Results Unadjusted arrest rates for youth in therapeutic group home care were higher than in psychiatric inpatient units or foster care during and after treatment. Arrests during the treatment episode accounted for a substantial proportion of the difference in arrests after out-of-home treatment. After accounting for differences in arrest rates during treatment, the group versus non-group nature of the treatment setting per se was not a strong determinant of arrest after the treatment episode. Conclusions and implications for practise Attention to the causes of higher arrest rates in group homes, which may include peer contagion and staff policies, could improve outcomes. For youths without a major psychiatric disorder, therapeutic foster care may be better than community-based group care. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

There is increasing evidence of the effectiveness of continued care after reentry for those who have participated in prison-based substance abuse treatment. This article presents results from analyses of program and comparison group data from two community-based programs that implemented a culturally adapted version of the Creating Lasting Family Connections (CLFC) curriculum. Both programs sought to strengthen individuals (and their families) recently reentering the community after incarceration. Results suggested that the first program had effects on increasing HIV knowledge and spirituality, while reducing intentions to binge drink and recidivism. The second program similarly showed effects on recidivism, and participants also showed an increase in nine separate relationship skills. The policy implications of the results are discussed. [ABSTRACT FROM PUBLISHER]

Background:Studies of school-based anti-obesity interventions have yielded inconsistent results. Using growth screening data from a school administrative database, we re-evaluated an obesity prevention strategy that was previously reported to have a beneficial effect on weight status of a sample of students in grades 5-7.Methods:Ten K-8 schools (five control and five intervention) participated in a 2-year cluster-randomized trial of a multi-component nutrition education intervention. We obtained student height and weight data for 6 consecutive school years and imputed missing baseline and follow-up measurements (53% and 55%, respectively) and defined the target population based on the intent-to-treat principle. We analyzed changes in body mass index (BMI) Z-scores via mixed-effects linear regression and in the prevalence of overweight/obesity via conditional logistic regression. We also assessed incidence and remission of overweight/obesity and long-term effects.Results:We analyzed data for 8186 (96%) K-8 students in the 10 schools (4511 in intervention; 3675 in control). From baseline to the end of the intervention period, mean increases in BMI Z-score were 0.10 and 0.09 in the control and intervention groups, respectively (P=0.671). The prevalence of overweight/obesity increased by 3% in both groups (P=0.926). There was no significant intervention effect on the incidence or remission of overweight/obesity. Among 5469 students who attended study schools during both years of the intervention, there was no significant intervention effect. Furthermore, there was no long-term effect among students with up to 2 years of data beyond the end of the intervention.Conclusion:Using routinely collected data for the entire target population, we failed to confirm earlier findings of an intervention effect observed in a subset of students in grades 5-7. Volunteer bias in the prior evaluation and/or measurement error in the routinely collected data are potential reasons for the discrepant findings. [ABSTRACT FROM AUTHOR]

Abstract: WHO/UNICEF currently recommend that childhood malaria and pneumonia be managed together in the community; most African countries are in the process of developing this policy. We conducted a cross-sectional study to determine maternal awareness of general danger signs of childhood illnesses and the prevalence, determinants and sources of pre-hospital treatment by mothers during their child''s acute respiratory illness in a poor urban community in south-western Nigeria. A total of 226 mothers were interviewed. Only 4.9% of the mothers were aware of the two pneumonia symptoms: difficult breathing and fast breathing. About 75% of the children were given pre-hospital medication at home and only 16.5% of them received the drugs within 24 hour of symptom recognition. Drug shops/patent medicine vendors (PMVs; 70.6%) were the most common source of care. Wishing to try home management first (46.6%); waiting for the child to improve (14.4%) and lack of money (31.6%) delayed care-seeking. Older maternal age (aOR 2.3; 95% CI 1.2–4.4) and having a child with cough and difficult and/or fast breathing (aOR 2.3; 95% CI 1.1–5.2) were positive predictors of pre-hospital treatment. Maternal education and adequately equipping PMVs could improve prompt access to integrated community-based child health services in Nigeria. [Copyright &y& Elsevier]

Background. Ready-to-use food in the form of biscuits (RUF-Nias biscuit) was locally produced for rehabilitation of moderately and mildly wasted (weight-for-height z-score ≥ -3 to < -1.5 SD) children on Nias Island, Indonesia. Daily programs were performed in semiurban settings, and weekly programs took place in rural areas. Objective. To analyze the cost of daily and weekly distribution and supervision of RUF-Nias biscuit programs. Methods. The costs of the daily and weekly programs were derived from the financial report and interviews with program implementers and participating households. Costs were calculated on the basis of total rehabilitation costs per child per day required to achieve a target weight-for-height z-score ≥ -1.5 SD in daily and weekly programs. Results. Institutional costs to the implementing organization were similar for both programs (approximately US$4 per child per day). The daily programs resulted in a significantly higher proportion of recovered children (78.6% vs. 65.4%) and higher weight gain (3.7 vs. 2.2 g/kg/day) than the weekly programs. About 6% to 7% of the total cost of the programs was accounted for by locally produced RUF-Nias biscuits. The social cost borne by the community for the weekly programs was about half that for the daily programs. Conclusions. The daily programs achieved better results for the implementing organization than the weekly programs; however, the weekly programs were preferred by the community because of the lower time constraints and the lower opportunity cost of time. The willingness of community and household members to invest their time in more intensive activities in the daily programs led to better program outcomes [ABSTRACT FROM AUTHOR]

THE PURPOSE OF THIS STUDY was to explore how connections between families, communities and educators can be facilitated in teacher education courses through the use of playgroups. Barriers to building relationships, as well as the perceived benefits of these relationships to families and pre-service teachers, were also explored. Participants were involved in weekly university-based community playgroups. Focus group interviews were conducted and the constant comparative method was used to analyse interview transcripts. Themes of `Constraints' and `Enablers' emerged from pre-service teachers' transcripts, indicating that they were initially uncomfortable with community and family involvement but eventually made connections as to why this was important. The theme of `positive relationship building' emerged from parents' transcripts, indicating that they saw building relationships with families and communities as an important role of early childhood educators. Implications for the importance of authentic learning situations for fostering these relationships in teacher education courses are discussed. [ABSTRACT FROM AUTHOR]

This article presents a brief description of a longitudinal study of system-level change, offers observations about what has been learned about the evolution of systems of care from the unique and qualified perspectives of the group of site visitors who gathered the data for the study, and identifies a set of issues that needs to be addressed to advance the system of care model in community based care of children and youth with behavioral health needs and their families. The article describes the system of care assessment portion of the national evaluation of the Federal Children's Mental Health Initiative and presents a brief summary of accumulated findings from the assessments conducted in communities funded in six successive waves of awards to provide context for the site visitors' observations and the authors' recommendations. The authors draw upon the expert observations of the site visitors, who represent many different disciplines and backgrounds, which suggest that, as a set of guiding principles, the system of care philosophy and approach seem to have become accepted standards of program practice and system operation in the funded sites, although implementation is uneven across principles and sites. The article concludes with the authors' identification of high-level system issues that must be addressed more effectively if systems of care are to come to scale. [ABSTRACT FROM AUTHOR]

This article describes how a system of care operated by a county government agency used a fiscal crisis as the opportunity to reform its children's system. A cross-system response to the crisis is outlined that includes a system of care framework coupled with a business model, inter-departmental collaboration and leadership, the use of strategic reinvestment strategies, and a quality improvement system that focuses on key indicators. Implementation of the system change is described with a specific focus on cross-system entry points, financing strategies that re-allocate funds from deep-end programs to community-based services, and management oversight through the use of performance indicators to monitor and support effectiveness. This article examines the results of the system change, including the diversion of youth from system penetration, the reduction in residential treatment bed days, the re-allocation of these savings to community-based services, and the outcomes of children who were diverted from residential care and served in the community. The article offers a number of recommendations for other communities contemplating system change. [ABSTRACT FROM AUTHOR]

Background/Objective:Psychosocial stimulation (PS) and food supplementation (FS) improve development of malnourished children. This study evaluates the effects of a community-based approach of PS and FS on growth and development of severely malnourished children.Subjects/Methods:Severely underweight hospitalised children aged 6-24 months (n=507) were randomly allocated on discharge to five groups: (i) PS, (ii) FS, (iii) PS+FS, (iv) clinic-control and (v) hospital-control. PS included play sessions and parental counselling on child development. This was done at each fortnightly follow-up visit, that is, every second week, for 6 months at community clinics. FS included distribution of cereal-based food packets (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplementation, health-education and growth monitoring. Children's development was assessed using revised version of Bayley Scales of Infant Development at baseline and after 3 and 6 months of intervention. Anthropometry was measured using standard procedure.Results:Comparing groups with any stimulation with those with no stimulation there was a significant effect of stimulation on children's mental development index (group*session interaction P=0.037, effect size=0.37 s.d.) and weight-for-age Z-score (group*session interaction P=0.02, effect size=0.26 s.d.). Poor levels of development and nutritional status were sustained, however, due to their initial very severe malnutrition. There was no effect on motor development and linear growth.Conclusion:Children receiving any stimulation showed a significant benefit to mental development and growth in weight. More intensive intervention with longer duration is needed to correct their poor developmental levels and nutritional status. [ABSTRACT FROM AUTHOR]

Summary Childhood obesity is a complex issue and needs multistakeholder involvement at all levels to foster healthier lifestyles in a sustainable way. ' Ensemble Prévenons l' Obésité Des Enfants' (EPODE, Together Let's Prevent Childhood Obesity) is a large-scale, coordinated, capacity-building approach for communities to implement effective and sustainable strategies to prevent childhood obesity. This paper describes EPODE methodology and its objective of preventing childhood obesity. At a central level, a coordination team, using social marketing and organizational techniques, trains and coaches a local project manager nominated in each EPODE community by the local authorities. The local project manager is also provided with tools to mobilize local stakeholders through a local steering committee and local networks. The added value of the methodology is to mobilize stakeholders at all levels across the public and the private sectors. Its critical components include political commitment, sustainable resources, support services and a strong scientific input - drawing on the evidence-base - together with evaluation of the programme. Since 2004, EPODE methodology has been implemented in more than 500 communities in six countries. Community-based interventions are integral to childhood obesity prevention. EPODE provides a valuable model to address this challenge. [ABSTRACT FROM AUTHOR]

This paper examines racial and ethnic disparities in continuation of mental health services for children and youth in California and how English language proficiency moderates the effect of race/ethnicity on the continuation of service. While previous research indicated racial/ethnic or geographic disparities in accessing mental health services among children and youth, few studies specifically focused on the continuation of mental health care. The authors used administrative data from California county mental health services users under age 25. Applying logistic regression, English language proficiency was found to be the major determinant of continuation of mental health services in this age group. With the exception of children of Asian descent, non-English speaking children and youth of diverse racial/ethnic background were significantly less likely to continue receiving mental health services compared with White English-speaking peers, even after controlling for sociodemographic, clinical and county characteristics. [ABSTRACT FROM AUTHOR]

Abstract: A disproportionate number of families served in child welfare are families of color. But relatively few strategies for helping families of color have been monitored for their impact. This article reports early findings from a Los Angeles County based public child welfare office that has continuously developed, tracked, and has now begun to assess strategies supporting preservation and reunification of families of color. Some promising trends revealed by a four year data period include the reduction of number of African-American children within the caseload, reductions in substantiated referrals and removals. The most recently developed strategy, which uses specialized four person case management teams, was evaluated through the use of a comparison group. Public agency data revealed that families served by the team, compared with families served through customary agency services, had improved outcomes, including a higher percentage of cases closed with the child remaining in the home, and greater permanency exits from foster care. Additionally the data revealed that the case management team developed to mitigate disproportionality among African-American families also improved outcomes for Hispanic/Latino families. [Copyright &y& Elsevier]

Abstract: Mental health service underutilization among African American adolescents is well documented, yet not fully understood. Discordance between adolescents and their parents on perceived need for seeing a counselor for an emotional need or psychiatrist for psychiatric or medical services may help explain low service use among this population. This exploratory, prospective study examined the relationship between parent–adolescent concordance on perceived need for emotional counseling or psychiatric services and mental health service use. The relationships between gender and perceived service need and concordance and adolescent severity of depressive symptoms were also explored. Parent–adolescent dyads (n=108) receiving community-based adolescent outpatient mental health services responded to interview questions concerning their perception of whether an emotional counselor and a psychiatrist were needed in the past six months. Findings revealed low parent–adolescent concordance on perceived need for an emotional counselor and a psychiatrist. A greater proportion of adolescents reported a need than parents. There was no association between gender and perceived need for an emotional counselor and a psychiatrist. Lower rates of parent–adolescent concordance were found among youth reporting elevated depressive symptoms compared to youth reporting normal range symptoms. Concordant dyads kept a higher number of appointments than discordant dyads. Implications for clinical social work practice and future research are discussed. [Copyright &y& Elsevier]

Please cite this paper as: Lassi ZS, Bhutta ZA. Unfolding the universe of newborn health interventions: the role of innovative community-based strategies. BJOG 2011;118 (Suppl. 2):18-21. [ABSTRACT FROM AUTHOR]

This paper examines the sustainability and outcome of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) as delivered by practitioners in a community-based child protection program who had received training in the model several years earlier. Formerly described as Abuse-Focused CBT, AF-CBT is an evidence-based treatment (EBT) for child physical abuse and family aggression/conflict that was included in the National Child Traumatic Stress Network's initial EBT dissemination efforts in 2002. Seven practitioners participated in a year-long learning collaborative in AF-CBT and in similar training programs for 4 other EBTs. The agency's routine data collection system was used to document the clinical and adjustment outcomes of 52 families presenting with a physically abused child who received their services between 2 and 5 years after the AF-CBT training had ended. Measures of the use of all 5 EBTs documented their frequency, internal consistency, and intercorrelations. Controlling for the unique content of the other four EBTs, the amount of AF-CBT Abuse-specific content delivered was related to improvements on standardized parent rating scales (i.e., child externalizing behavior, anger, anxiety, social competence) and both parent and clinician ratings of the child's adjustment at discharge (i.e., child more safe, less scared/sad, more appropriate with peers). The amount of AF-CBT General content was related to a few discharge ratings (better child prognosis, helpfulness to parents). These novel data provide suggestive evidence for the sustainability and clinical benefits of AF-CBT in an existing community clinic serving physically abused children and their families, and are discussed in the context of key developments in the treatment model and dissemination literature. [Copyright &y& Elsevier]