What are children's trusts? Early findings from a national survey

BACKGROUND: The Children Act 2004 and National Service Framework for Children, Young People and Maternity Services require fuller integration of health, education and social services for children and young people in England and Wales. The UK government supported the establishment of 35 experimental children's trust pathfinders (henceforth called children's trusts) in England. METHODS: A questionnaire was completed by managers in all 35 children's trusts a year after their start. Children's trust documents were examined. Census and performance indicators were compared between children's trust areas and the rest of England. RESULTS: Children's trust areas had demographic and social characteristics typical of England. All children's trusts aimed to improve health, education and social services by greater managerial and service integration. All had boards representing the three sectors; other agencies' representation varied. Two-thirds of children's trusts had moved towards pooling budgets in at least some service areas. At this stage in their development, some had prioritized joint procurement or provision of services, with formal managerial structures, while others favoured an informal strategic planning, co-ordination and information sharing approach. The commonest priorities for services development were for disabled children (16 children's trusts), followed by early intervention (11) and mental health services (8). CONCLUSIONS: The diverse strategies adopted by these 35 children's trusts during their first year is due to their own characteristics and to the way government strategy developed during this period. Whilst some prioritized organizational development, joint financing and commissioning, and information sharing, others laid more emphasis on mechanisms for bringing front-line professionals closer together. Their experiences are of value to others deciding how best to integrate children's services.     

Crossing the organisational divide: family support services

The 1989 Children Act has consolidated and in some cases considerably extended the duties and responsibilities of social services departments. A major departure from earlier approaches is a central and explicit focus on the need for family support work, which is now to be undertaken within a broader framework than in the 1963 and 1980 legislation. In addition to the emphasis on providing services for children in their own families, there are new requirements for local authorities to work in partnership with voluntary agencies and other key statutory organisations, particularly health authorities and trusts. The 1989 Act needs to be reviewed in the context of parallel legislation, especially the NHS and Community Care Act (1990) which puts new emphasis on the process of planning, through the mandatory requirement for community care plans. Children's services plans are comparable although without mandatory requirement. A picture is slowly emerging of the extent to which social services departments, and health authorities and trusts are collaborating to plan and provide services. This paper outlines the new legislative framework; reviews the evidence available from the national study of the implementation of Section 17 of the Children Act (the ‘children in need’ clauses) on social services and health planning activities; reviews the SSI (1994) survey on children's service plans, providing a case example of policy and practice in one local authority; and assesses the progress made so far.     

Maternal general health and children's cognitive development and behaviour in the early years: findings from the Millennium Cohort Study

Background Mothers often experience physical and psychological difficulties during the post‐natal period and these may continue through the early years of raising children and have negative effects on engagement and caregiving. Pathways between maternal depression, parental engagement and caregiving and children's subsequent development have been described in longitudinal studies; yet, less is known about how other aspects of maternal health may influence children's development. Methods A longitudinal analysis within the Millennium Cohort Study was conducted including 7906 families from England. Maternal general health and psychological well‐being were assessed when their children were 9 months and 3 years old, socio‐demographic characteristics were assessed at 9 months, and engagement and caregiving were assessed at 3 years. These were examined as predictors of children's learning and development and behaviour at age 5. Results There are clear associations between maternal general health and children's development with regard to both learning and development and behaviour. These effects are reduced if psychological distress is taken into account; yet, maternal general health maintains importance as a predictor for children's subsequent development. There is evidence of an association via engagement and caregiving which links maternal health to children's development and evidence of the influence of underlying socio‐demographic disadvantage. Conclusion General maternal health as well as psychological well‐being during the early years of raising children may be influential for children's development. This study suggests the need for a broader recognition of maternal health as well as psychological well‐being as a foundation for family well‐being, and speaks to support for mothers in maintaining engagement and caregiving for their children during periods of ill health.     

National survey of the injury prevention activities of children's centres

Children's centres were established across England to provide a range of services including early education, social care and health to pre‐school children and their families. We surveyed children's centres to ascertain the activities they were undertaking to prevent unintentional injuries in the under fives. A postal questionnaire was sent to a sample of children's centre managers (n = 694). It included questions on current activities, knowledge and attitudes to injury prevention, health priorities and partnership working. Responses were received from 384 (56%) children's centres. Overall, 58% considered unintentional injury prevention to be one of the three main child health priorities for their centre. Over half the respondents (59%) did not know if there was an injury prevention group in their area, and 21% did not know if there was a home safety equipment scheme. Knowledge of how child injury deaths occur in the home was poor. Only 11% knew the major cause of injury deaths in children under five. Lack of both staff time and funding were seen as important barriers by children's centre staff to undertake injury prevention activities. Nearly all stated that training (97%) and assistance with planning injury prevention (94%) would be helpful to their centres. Children's centres need further support if they are to effectively tackle this important public health area.     

COMMUNITY VENTURES IN RURAL HEALTH: THE ESTABLISHMENT OF COMMUNITY HEALTH TRUSTS IN SOUTHERN NEW ZEALAND

ABSTRACT: During the 1990s, a shortage of funds and a competitive market for public sector health services created both threats and opportunities for rural health services in New Zealand. In three of the four regional funding areas, rural health services experienced increased levels of closure or privatisation. In the fourth area, the Southern Region, the initiative of the community and the response of the funder combined to produce an alternative response; the formation of community health trusts that allowed local communities to own their own health facilities and to contract to run the services. Through a survey of community trusts this research analyses the process of trust formation and assesses the critical success factors in the community (local leadership, local financial and other commitment, involvement of local professionals, learning from each other, local operational efficiency) which allowed the trusts to survive and thrive.     

Young children's explorations: young children's research?

‘Exploration' is recognised as research behaviour; anecdotally, as an early years' teacher, I witnessed many young children exploring. However, young children's self-initiated explorations are rarely regarded as research by adult researchers and policy-makers. The exclusion of young children's autonomous explorations from recognition as research conflicts with ‘new sociology’ perspectives positioning children as social actors. These tensions have driven a small-scale interpretive study, developed with children aged four to eight years in three ‘good’ schools in England to investigate (1) Do children aged four to eight years in three Early Childhood Education and Care settings explore?; (2) If so, what are their explorations and what effects and affects them?; and (3) Do young children's explorations count as epistemology? Findings indicate that in settings where ‘free-flow’ play characterised practice, four- to five-year-old children engaged in exploration, but its quality was affected by several factors, including variable levels of children's autonomy. Seven- to eight-year-old children in a teacher-directed setting explored less than the four- to five-year-old children, but were frequently observed ‘off-task’, pursuing self-initiated explorations.     

Australian children's food and drink preferences: Implications for health professionals

Aim: Children's food and drink preferences play an important role in determining their consumption behaviours, but data pertaining to Australian children's preferences are lacking. The present study investigated children's preferences and health practitioners' assumptions relating to these preferences. Methods: Five hundred and twenty‐four Australian primary schoolchildren completed a written survey to explore their food and drink preferences and 576 health professionals (HPs) participated in an online survey to identify their perceptions of children's preferences. The traffic light system of food classification was used to determine the healthiness of the foods and drinks nominated as favourites by children and HPs. Data were analysed using chi‐square tests to assess the extent to which children's and HPs' responses differed. Differences according to socio‐demographic variables were investigated. Results: Children's reported preferences were healthier than HPs expected. Younger children had healthier preferences than their older peers, and girls chose healthier items than boys. Children from the medium socioeconomic schools preferred healthier foods compared with their low socioeconomic peers, but low socioeconomic children preferred healthier drinks compared to medium socioeconomic children. There were no differences between the HPs' results according to demographic variables. Conclusions: Given that children are reporting preferences for healthy options yet intakes of healthy foods are suboptimal among Australian children, efforts to improve the health status of Australian children should include strategies to encourage adults to make healthy foods and drinks more available and accessible.     

The Model of Children's Active Travel (M-CAT): a conceptual framework for examining factors influencing children's active travel

Background: The current decline in children's participation in physical activity has attracted the attention of those concerned with children's health and wellbeing. A sustainable approach to ensuring children engage in adequate amounts of physical activity is to support their involvement in incidental activity such as active travel (AT), which includes walking or riding a bicycle to or from local destinations, such as school or a park. Understanding how we can embed physical activity into children's everyday occupational roles is a way in which occupational therapists can contribute to this important health promotion agenda. Aims: To present a simple, coherent and comprehensive framework as a means of examining factors influencing children's AT. Methods: Based on current literature, this conceptual framework incorporates the observable environment, parents' perceptions and decisions regarding their children's AT, as well as children's own perceptions and decisions regarding AT within their family contexts across time. Conclusion: The Model of Children's Active Travel (M‐CAT) highlights the complex and dynamic nature of factors impacting the decision‐making process of parents and children in relation to children's AT. The M‐CAT offers a way forward for researchers to examine variables influencing active travel in a systematic manner. Future testing of the M‐CAT will consolidate understanding of the factors underlying the decision‐making process which occurs within families in the context of their communities.     

社区居家养老意愿下居住方式和子女支持对老年人基层卫生服务需求的影响

目的:探讨居住方式和子女支持对老年人基层卫生服务需求的影响,使基层卫生服务更具针对性,以满足不同居家类型老年人的卫生服务需求。方法:利用2016年中国老年社会追踪调查数据,采用负二项Hurdle回归模型(NBH模型)分析。结果:与子女同住会显著提高城乡居家老年人对基层卫生服务的需求(P<0.05),子女经济支持则会显著降低需求(P<0.05);当老年人至少具有一项基层卫生服务需求时,子女情感支持会显著降低其对基层卫生服务的需求(P<0.05)。此外,户口、自评健康、是否有慢病、ADL水平、子女数都是社区居家养老老年人基层卫生服务需求的影响因素(P<0.05)。结论和建议:家庭照护在社区居家养老中发挥着重要作用,应将家庭责任融入社区居家健康养老制度中去;基层医疗卫生机构应根据居家养老老年人的家庭特征,有针对性的提供服务;应当关注农村老年人、失能老年人、患有慢病老年人的需求,丰富基层医疗卫生机构的服务内容,提升服务质量,更好的满足具有社区居家养老意愿老年人的医疗卫生需求。     

The impact of a complex care clinic in a children's hospital

Background The number of medically complex and fragile children (MCFC) cared for in children's hospitals is growing, necessitating the need for optimal care co‐ordination. The purpose of this study was to describe the impact of a nurse practitioner/paediatrician‐run complex care clinic in a tertiary care hospital on healthcare utilization, parental and primary care provider (PCP) perceptions of care and parental quality of life. Methods MCFC and their parents were recruited for ambulatory follow‐up by the hospital team to complement care provided by the PCP in this mixed methods single centre pre‐ or post‐evaluative study. Parents participated in semi‐structured interviews within 48 h of discharge; further data were collected at 6 and 12 months. Healthcare utilization was compared with equal time periods pre‐enrolment. Parental health was assessed with the SF‐36; parental perceptions of care were assessed using the Larsen's Client Satisfaction Questionnaire and the Measure of Processes of Care; PCPs completed a questionnaire at 12 months. Parental and PCP comments were elicited. Comparisons were made with baseline data. Results Twenty‐six children and their parental caregivers attended the complex care clinic. The number of days that children were admitted to hospital decreased from a median of 43 to 15 days, and outpatient visits increased from 2 to 8. Mean standardized scores on the SF‐36 increased (improved) for three domains related to mental health. A total of 24 PCPs responded to the questionnaire (92% response); most found the clinic helpful for MCFC and their families. Parents reported improvements in continuity of care, family‐centredness of care, comprehensiveness and thoroughness of care, but still experienced frustrations with access to services and miscommunication with the team. Conclusion A collaborative medical home focused on integrating community‐ and hospital‐based services for MCFC is a promising service delivery model for future controlled evaluative studies.     

Perceived instrumental support and children's health across the early life course

A large, venerable literature demonstrates the importance of social relationships and social support for health, though much less research examines whether the benefits of social support to mothers extend to children. This paper examines the relationship between mothers' perceptions of instrumental support and children's health using longitudinal data from the U.S. Fragile Families and Child Wellbeing Study (N = 4342), a cohort of American children born in urban areas to mostly unmarried parents. Results suggest mothers' perceptions of instrumental support is positively associated with children's overall health, and this finding persists despite controlling for a host of individual-level characteristics of mothers and children (including a lagged indicator of children's health) and in fixed-effect models. Mothers' economic security and mothers' wellbeing attenuate some, but not all, of the association between perceived instrumental support and children's overall health. In addition, the link between perceived instrumental support and three specific indicators of health – asthma, overweight/obese, and number of emergency room visits – falls to statistical insignificance after accounting for individual-level characteristics, suggesting these associations result from social selection processes. Taken together, these findings suggest the beneficial health consequences of social support may extend to children across the early life course and demonstrate the need to better understand mothers' reports of children's overall health.     

Supporting language and cognitive development of infants and young children living in children's homes in Turkey

Aim The purpose of the present study was to improve language and cognitive development of infant and young children residing in institutional settings in Turkey. Method In Study I, there were 12 children with a mean age of 35 months in the intervention group and 12 children with a mean age of 36 months in the control group. Results When both groups' pre‐test post‐test general development t scores and cognitive and language sub‐domain developmental gaps were compared, neither the time nor the time by group interactions were significant. Nevertheless, both groups' developmental gap appeared to decline. In Study II, children were recruited from the same institution and randomly assigned to the intervention and control groups. Results indicated that infants and children who were in the intervention group showed a decline in the language and cognitive development gaps, whereas the control group children's developmental gaps were increased. Conclusions It can be concluded that by increasing the quality of care in children's homes infants' and young children's development can be enhanced.     

Younger children's (three to five years) perceptions of being in a health-care situation

Younger children are common users of health-care services. Their perspective on a health-care situation and their ways of communication differ from that of adults. There is a shortness of research of younger children's perceptions of health-care situations. The knowledge that exists indicates the importance of involving the child's perspective to enable understanding and to offer appropriate support. This paper aimed to describe how younger children perceive to be in a health-care situation. Semi-structured interviews, analysed phenomenographically, were used. The main findings revealed that children view themselves as actors, as either main or co-actors, in a health-care situation. Parents and professionals are also understood as actors. The children's perceptions enable professionals to create a mutual understanding which will give openings for increased involvement of the children and an improved level of the children's health literacy.     

A before and after study of integrated training sessions for children's health and care services

Recent UK policy drivers such as the National Collaboration for Integrated Care and Support and Making Every Contact Count prioritise integrated care, an approach that seeks to provide more coordinated and seamless health and social care. In children's services, despite many partners, there are challenges around integrating care. A deprived borough of London ran short training and networking sessions for services supporting children and young people. This study examined whether intersectoral training would improve participants' knowledge of local services and joint working (including communication, navigation and confidence in collaboration). As part of a service evaluation, the study utilised a pre–post Likert scale survey design for each training session, a 1‐month follow‐up survey, and telephone interviews with a subsample of participants. The educational intervention was three sets of 1.5 hr educational workshops from December 2016 to February 2017. There were 302 attendances from 202 individuals from the health (n = 99), education (n = 145), social care (n = 39) and voluntary (n = 19) sectors. The pre and post surveys found significant increases in self‐assessed knowledge of health/education/social care/voluntary services and in some elements of joint working. However, these increases were not sustained in any domain after 1 month of follow‐up. There was also no difference in self‐assessments amongst those who attended three sessions compared to those who attended one or two. Telephone interviewees highlighted networking as being helpful and suggested that informative tasks and diverse attendance would be beneficial in future. To conclude, this study suggests that although short‐learning sessions may seem to improve immediate knowledge and some elements of joint working in the short term, any gains are not sustained in the long term. The cost effectiveness of such schemes is in doubt but may be improved by a more targeted delivery of content.     

The substance and sources of young children's healthy eating and physical activity knowledge: implications for obesity prevention efforts

Background The prevalence of overweight among young children is increasing at an alarming rate. Global efforts to address the issue can benefit from understanding how young children's experiences across multiple contexts shape their perspectives of healthy weight. Methods This qualitative study examines the substance and sources of young American children's knowledge related to healthy eating, physical activity and media practices. Role play and semi‐structured interviews were conducted in child‐care settings with 81 children aged 3–5 who represented diverse socio‐economic statuses and ethnic backgrounds. Results Children demonstrated better understanding of the benefits of healthy eating compared with physical activity. Snacks and beverages consumed outside mealtime were less likely to be healthy even among the 40% of children who demonstrated an understanding of healthy nutrition. The majority of children's leisure activity selections involved media and minimally active pursuits. Three quarters of the children were unable to articulate reasons for healthy choices or identify the sources of their health understandings. The media was listed as source of health information more frequently than adults. Conclusion Obesity prevention efforts targeting young children need to use consistent messaging across all contexts in which children develop in order to increase their understanding that physical activity and eating choices support health. Efforts need to counter inaccurate information and address the rationale for health practices. Key gaps in young children's understanding include: the importance of drinking water, that snacks are part of nutritional intake and the benefits of engaging in physical activities.     

Maternal perceptions of children's weight status

Background Several studies have addressed mothers' perceptions of their children's weight status; however, there is no investigation on Portuguese children (a country with one of the highest levels of children's overweight and obesity in Europe). The aim of this study was to quantify maternal misclassification of child weight status in a sample of Portuguese children aged 9 to 12 years, according to gender, family income, and maternal weight status, education level and age. Methods Data were collected in a school‐based study (school year 2009/2010) in northern Portugal with 499 urban children (236 girls; 47.3%). Body mass index was calculated from measurements of height and weight [body mass (kg)/height (m²)]. Mothers' perceptions of child's weight status, age, height and weight were accessed by a questionnaire. Children's age, gender and socio‐economic status were extracted from the schools' administrative record systems. Cohen's Kappa was used to analyse the misperceptions and the agreement between children's objectively measured weight status and mothers' perception of their child's weight status. Results The prevalence of underweight, overweight and obesity in children was 4.6%, 25.5% and 6.4%, respectively. A proportion of 65.2% of underweight and 61.6% of overweight/obese children were misclassified by their mothers. For the majority of variables presented, the values of agreement were fair (k ranged from 0.257 to 0.486), but were statistically significant. Significant differences in the percentages of mothers who correctly classified their children's weight status were only found among the most educated in the overweight/obese group and among the normal‐weight mothers in the underweight group. Conclusions Many mothers do not properly recognize their children's weight status and frequently underestimate their children's body size.     

Multi-jurisdictional expert opinion for improving children's environmental health protection

Expert opinion from Canada, the United States and European Union countries was solicited to examine the regulatory and non-regulatory approaches used to protect children's environmental health. Thirty-five experts were interviewed by telephone from June 2004 to March 2005 using an open-ended survey questionnaire. Experts were asked to name legislative and non-legislative tools used to protect children's environmental health in their jurisdiction as well as the effectiveness of approaches taken, barriers, facilitators, methods of evaluation, and recommendations for improving children's health protection. A number of common themes were revealed by experts in different countries as well as novel approaches that could be used to improve children's environmental health. Determining what types of governance and non-governance instruments are most effective based on experience from other jurisdictions, allows for the determination of common, effective, policy choice from shared children's health environmental risks. It also provides a broad classification of different approaches that have been used for children's environmental health. Three main areas suggested for strengthening children's environmental health protection included: research and surveillance, institutional organization, and regulatory capacity.     

Gaining children's perspectives: A multiple method approach to explore environmental influences on healthy eating and physical activity

In order to inform local action for health improvement, this pilot study used multiple methods to explore children's perspectives of environmental influences on their eating and physical activity. Thirty-nine children aged 9–11 years from a North London local authority took photos, drew maps, and attended focus groups. We found that the approach engaged children and that each of the methods returned useful, complementary information. The results highlighted a number of areas for local policymakers and practitioners to consider when developing work to prevent childhood obesity. We conclude that these methods of gaining children's views should be further developed and tested.     

Going upstream: Social inequality and children's health

This study explores the impact of income inequality on the health of children. We examine the direct effects of income inequality and the mediating effects of income inequality via poverty concentration at local levels. We use a multilevel study design incorporating individual level data from the 1988 Child Health Supplement to the National Health Interview Survey supplemented with aggregate data from the 1990 Census of Population STF3A economic/ demographic files. Measures of income inequality are constructed at the county level and poverty concentration at the county and neighbourhood level. Multiple indicators are used to examine child health including physiologic, functional status, and psychological measures and behavior and school problems. The association between income inequality and child health was examined using logistic regression models. Direct effects of income inequality were observed for school suspension and indirect effects for chronic conditions, learning disabilities, emotional and behavior problems, school suspension, health status and seeing a counsellor/psychiatrist. To assess whether income inequality works through challenging the integrity of local economic institutions, we also examine whether inequality and poverty concentration at the neighbourhood level or the larger administrative unit influence children's access to health insurance. Income inequality was found to exert both a direct and an indirect effect on children's health insurance status. These findings specifically provide evidence of the effects of income inequality on children's health, and more generally demonstrate that higher level contextual factors need to be incorporated into research in order to enhance our understanding of the determinants of children's health.     

Model Programs Addressing Perinatal Drug Exposure and Human Immunodeficiency Virus Infection: Integrating Women's and Children's Needs

Many of the efforts to address perinatal drug exposure and human immunodeficiency virus infection have been influenced by a perspective of conflict between the interests of mother and infant. This article highlights several programs that integrate women''s and children''s services while dealing with these health issues. It discusses the challenges encountered by these programs, such as funding restrictions, institutional barriers, professional attitudes, regulatory constraints, and local political issues. It presents strategies for overcoming these barriers including the creative coordination of funding streams, innovative relationships with child protective agencies, effective collaboration with other agencies, and advocacy on behalf of clients and programs, and makes recommendations for certain policy changes, which could foster the development of programs that serve women and children together.