Childhood vaccination in a squatter area of Manila: coverage and providers

In 1988 a vaccination coverage cluster survey was performed in a squatter area of Manila, Philippines. 24% of the surveyed children (aged 1-2 years) were fully immunized and 19% not immunized. 60% of the children were vaccinated through private organization. The dropout rates of these children were significantly lower than those of the children vaccinated through governmental agencies. This suggests that services have to be provided by agencies that are based in the squatter area. Efforts for improved coverage should focus on lowering the high dropout rates and strengthening coordination between the governmental and the various private health agencies that provide vaccination service in this squatter area. The survey also indicated approaches to strengthening collaboration between different service providers.     

Program priorities of crippled children's agencies: a survey

State Crippled Children's (CC) programs are known for their diversity in organization and varying coverage of diagnostic categories. Relatively little information is available concerning the programmatic priorities of CC agencies. To identify the activities central to the mission of State CC agencies, a survey was undertaken. Results from the survey revealed considerable unanimity among CC directors in identifying activities deemed to be very important to their agencies' missions. However, CC program directors indicated that their agencies were unable to spend sufficient amounts of time working on many of these activities. With few exceptions, the same activities were accorded high priority regardless of the particular organizational type of CC program and regardless of the tenure of the director. Directors of CC programs were also consistent in identifying activities that were relatively less important to their agencies' missions, including activities related to community-based care. Together with improvements in the treatment of childhood chronic illness, changes in the availability and financing of specialty medical care have substantially altered the problems that now face State CC programs. Despite major differences across the State CC programs, survey results reflect a broad consensus among CC directors concerning the current role of their agencies in the care of children with special health needs. Such a consensus may be an important element in gaining the additional resources needed to address current problems and to ensure high quality of care for these children and their families.     

National Survey of State Children’s Mental Health Directors: Current Status and Future Directions

State agencies play a critical role in addressing the mental health needs of children and youth. Significant changes underway throughout the nation at the federal and state levels have led to questions about the role of state children’s mental health (CMH) agencies and the effects of these changes on children’s services. The purpose of this study was to examine the current status of state offices for CMH with regard to structure and responsibilities and to identify what state CMH directors express as opportunities and challenges for CMH at the state level. CMH directors or their representatives from 46 states, 1 US territory, and D.C. completed an online survey developed to address the specific aims of this study. Findings highlight the importance of a strong state structure to support CMH and opportunities for reform and system change, particularly related to the Affordable Care Act and expansion of Systems of Care.     

Factors Associated with Collaboration Among Agencies Serving Children with Complex Chronic Conditions

Our objective was to identify agency-level factors that increase collaborative relationships between agencies that serve children with complex chronic conditions (CCC). We hypothesized that an agency will collaborate with more partners in the network if the agency had a coordinator and participated in a community coalition. We surveyed representatives of 63 agencies that serve children with CCC in Forsyth County, North Carolina about their agencies’ collaborations with other agencies. We used social network analytical methods and exponential random graph analysis to identify factors associated with collaboration among agencies. The unit of analysis was the collaborative tie (n = 3,658) between agencies in the network. Agencies participating in a community coalition were 1.5 times more likely to report collaboration than agencies that did not participate in a coalition. Presence of a coordinator in an agency was not associated with the number of collaborative relationships. Agencies in existence for a longer duration (≥11 vs. ≤10 years; adjusted odds ratio (aOR): 2.1) and those with a higher proportion of CCC clientele (aOR: 2.1 and 1.6 for 11–30 % and ≥31 % compared to ≤10 %) had greater collaboration. Care coordination agencies and pediatric practices reported more collaborative relationships than subspecialty clinics, home-health agencies, durable medical equipment companies, educational programs and family-support services. Collaborative relationships between agencies that serve children with CCC are increased by coalition participation, longer existence and higher CCC clientele. Future studies should evaluate whether interventions to improve collaborations among agencies will improve clinical outcomes of children with CCC.     

Protecting children's health. CHA's immunization program helps organizations increase vaccination rates in their communities

In response to the increasing outbreaks of vaccine-preventable diseases in the United States, the Catholic Health Association (CHA) has developed a new resource to help its members launch programs that will increase immunization rates among children in their service area. Vaccines are the building blocks of basic primary care. But society and the healthcare system have erected barriers that prevent children from being fully immunized. Impediments include missed opportunities, cost barriers, and facility and resource barriers. Catholic healthcare providers can help eliminate these barriers and ensure that all children in their service areas are vaccinated by assessing their immunization resources, seeking out unvaccinated children, and collaborating with community organizations and agencies. CHA's immunization campaign will guide Catholic healthcare providers as they protect children from preventable diseases. Immunization may help reduce the costs of emergency and acute care for conditions that could have been prevented.     

From threat to opportunity: a Head Start program's response to state-funded pre-K

Early childhood education and childcare have traditionally been dominated by nonprofit and other grant-funded agencies. However, public education agencies are increasingly involved with early childhood education through state funded pre-K program initiatives. As public pre-school programming has steadily expanded, programs such as Head Start have to compete for enrollment. As funds for these programs are tied directly to enrollment, the sustainability of these programs is uncertain. Not all such agencies view state funded pre-K as a threat however. Some have seized this as an opportunity to improve service delivery through interagency collaboration. This case study examines the partnership between an urban school district and its local Head Start program. Responding, in part, to the potential threat from state-funded Pre-K, Head Start partnered with the school district to provide enhanced services to Head Start eligible children in the district's early childhood education programs. Through an examination of secondary data and staff surveys, the collaboration is first evaluated in terms of the use of best practices. The success of the collaboration is measured through teacher and administrator perceptions. From these results, specific recommendations for early education and childcare providers are offered.     

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.     

Impact of HIV infection/AIDS on social service agencies serving children and youth in Toronto

There are few data on how HIV infection/AIDS affects social service agencies serving children and youth. We conducted a survey of 24 provincially funded agencies in the Metro Toronto area and discovered that 36 clients and 9 staff members were HIV-infected. Our data strongly suggest that these agencies were ill equipped to cope with issues surrounding HIV infection/AIDS. Inadequacy or absence of policy and procedures resulted in confusion regarding issues such as HIV testing, need to know, confidentiality, duty to warn, staff and client education, and universal precautions for infection control. In order to effectively deal with the psychosocial, legal, ethical and education needs of clients and staff, agencies must be pro-active in developing policy and procedure.     

Interventions to increase children's booster seat use: a review

BACKGROUND: In children aged 4 to 8 years, booster seats are estimated to reduce by 59% the odds of sustaining clinically significant injuries during a motor vehicle crash, compared to using ordinary vehicle seat belts. Given the safety benefits of booster seats, public health and traffic safety agencies recommend their use for children aged 4 to 8 years traveling in motor vehicles, until the vehicle seat belt can fit them properly. Despite these benefits, booster seat use remains low. Interventions aimed at promoting the use of booster seats for children aged 4 to 8 years have been implemented, but there is little evidence regarding their effects. METHODS: The Cochrane methodology was used to assess the effects of interventions to increase booster seat use for children aged 4 to 8 years. The reviewers searched online databases, scanned reference lists, hand-searched journals, and contacted relevant agencies and researchers for both randomized controlled trials and controlled before-and-after evaluation studies. The search concluded in 2005 and was not restricted by publication status or language. RESULTS: The search yielded 1350 potential studies. Of these, five studies involving 3070 individuals met the inclusion criteria. Interventions were generally effective in increasing booster seat use among children aged 4 to 8 years. Education paired with incentive or distribution programs produced more consistent results than education-only interventions that targeted parents, children, or both. CONCLUSIONS: Incentives or the distribution of free booster seats combined with education increase the use of booster seats.     

Combating childhood obesity: a survey of laws affecting the built environments of low-income and minority children

Childhood overweight and obesity have reached epidemic proportions, with nearly one of every three children in the USA being affected. That factors in the built environment are closely correlated to childhood obesity has become increasingly evident. Negative built environment factors disproportionately affect poor and minority children. This paper examines the current research on the state of childhood overweight and obesity and surveys the built environment factors that have been linked to the problem. Analyzing the built environment from a legal perspective, this paper identifies how zoning, legislation, public/private partnerships, and contracts are being used at the local, state, and federal levels to combat the epidemic of childhood obesity. Using these tools, local, state, and federal government agencies are increasing access to healthy food, decreasing the density of unhealthy food sources, and increasing physical activity resources for children. Whereas some of the programs are geared toward minority and low-income children, many apply to children across the socioeconomic and demographic spectrum.     

Deterrents to Intercountry Adoption in Britain

Some local authority social workers in Britain have used their responsibility to make parental assessments to deter parents from adopting abroad. Prospective parents of foreign children may respond to these deterrents by making unauthorized adoptions. Central government officials have condemned both unauthorized adoptions and the obstructive policies towards intercountry adoption found in some local authorities. Prospects for reform depend partly on changing attitudes, and partly on expanding the role of independent intercountry adoption agencies.     

Children's environmental health--an international perspective

Parents in all countries want and deserve safe and healthy environments for their children. Children in all countries need, as part of normal growth and development, regular and frequent opportunities to interact with their environments as they learn to crawl, run, climb, swim, and explore. Environmental scientists and regulators recognize that environmental hazards are not contained by international borders. This is of special concern for children, because they are intrinsically at greater risk, compared to adults. They have different opportunities for exposure, greater response to certain toxicants, and less empowerment to alter their environments. There is a growing awareness that adverse health effects in children can adversely affect a country's future productivity and well-being. Multiple government agencies, NGOs, and advocates are mobilizing to address these concerns. A sustained concerted effort will be needed to afford equitable and effective environmental health protection to the world's children, present and future.     

Vulnerability of internally displaced children in disaster relief camps of Pakistan: issues,challenges, and way forward

Pakistan is a developing country with the second highest infant and child mortality rates in South Asia. During the past years this region has undergone several humanitarian emergencies that have negatively affected all the aspects of health and development of young children. During these emergencies relief camps are set up by governmental and non-governmental agencies with the aim of meeting the physical needs of the targeted community by providing basic health care (first aid), food, water, and shelter. As these services do not adequately address children's rights, all aspects of their health (physical, mental, social, and spiritual) and development, therefore, internally displaced children in the disaster relief camps of Pakistan are highly vulnerable to having a negative impact on all aspects of their health, brain development, learning, coping, and competence. Hence, to enable these children to develop their maximum potentials, cope positively, and become resilient, a well-thought child-care programme is recommended in the disaster relief camps of Pakistan.     

Salt and Sugar: Two Enemies of Healthy Blood Pressure in Children

The prevalence of essential arterial hypertension in children and adolescents has grown considerably in the last few decades, making this disease a major clinical problem in the pediatric age. The pathogenesis of arterial hypertension is multifactorial, with one of the components being represented by incorrect eating habits. In particular, excessive salt and sugar intake can contribute to the onset of hypertension in children, particularly in subjects with excess weight. Babies have an innate predisposition for sweet taste, while that for salty taste manifests after a few weeks. The recent modification of dietary styles and the current very wide availability of salt and sugar has led to an exponential increase in the consumption of these two nutrients. The dietary intake of salt and sugar in children is in fact much higher than that recommended by health agencies. The purpose of this review is to explore the mechanisms via which an excessive dietary intake of salt and sugar can contribute to the onset of arterial hypertension in children and to show the most important clinical studies that demonstrate the association between these two nutrients and arterial hypertension in pediatric age. Correct eating habits are essential for the prevention and nondrug treatment of essential hypertension in children and adolescents.     

Health visiting and pre-school children with behavioural problems in the County of South Glamorgan: an exploratory study

Summary This study surveys firstly, using a modified semantic differential technique, how a sample of health visitors in the County of South Glamorgan perceived different behavioural problems in preschool children. A selection of visiting records, covering a 1-year period, is also studied. Results from the semantic-differential indicate that health visitors perceive eating and sleeping as the most common problem areas. Hyperactivity and sleeping problems are seen as being the most difficult to deal with and the most disruptive to family life. Although health visitors generally feel it is necessary to follow up children with behaviour problems, they find these difficult to resolve. About one third of children are referred to other agencies. Visiting records reveal that children with hyperactivity and sleeping problems receive the highest number of visits from health visitors and that there is little improvement in these children over a period of 1 year. An extension of the health visitor's role and training to include behavioural treatments for pre-school children is discussed.     

The status of low-income neighborhoods in the post-welfare reform environment: mapping the relationship between poverty and place

It has long been recognized that children and adults living in poverty are at risk for a number of negative outcomes. As inequality in the distribution of wealth, income and opportunity has grown in the U.S. during the post-welfare reform era, impoverished children and their families have tended to become increasingly concentrated in urban low-income neighborhoods. Research evidence demonstrates that living in these neighborhoods affects family well-being in several key areas: economic and employment opportunity, health and mental health condition, crime and safety, and children's behavioral and educational outcomes. Using the neighborhood indicator approach, public and nonprofit social service agencies will be better positioned to develop a comprehensive and integrated service delivery model at the neighborhood level by using neighborhood assessment to locate services and utilize neighborhood intervention strategies.     

Home health services in New Hampshire.

While home health services have traditionally been an underused component of the health care system, current trends suggest the desirability of expanding these services. These trends include an increase in the number of elderly who need the benefits of home care, the recognition that long-term chronic illnesses require appropriate management at home, and concern that patients have access to care at the level most appropriate to their illnesses. In New Hampshire, 41 certified home health agencies offer services. Little systematic research has been conducted on the kinds of services they provide and the patients seen by their staffs. Patient encounter data were collected from a sample of eight agencies for a 4-week period. Staff of the agencies used the patient contact record developed by the National Functional Task Analysis Cooperative Study to collect data. The data reflected differences among the agencies in the size of the populations they serve, organizational characteristics, reasons for patients'' visits, expected sources of the revenue that supported them, and the diagnosis of the patients they cared for. The agencies served areas with populations ranging from 1,000 to 40,000. The staffs ranged from 1 to 14 full-time persons. Two were public agencies; the others had voluntary sponsorship. When data on reasons for visits were averaged for the eight agencies, it was shown that 72% of the visits were made for disease control activities such as care for a chronic or acute condition or for treatment or a laboratory test. Disease prevention activities such as a checkup for adults, children, prenatal or postnatal care, or health education accounted for only 24% of the visits. This result may indicate that, in areas short of physician manpower, the community health nurse is taking on increasing responsibility for medical care as well as health and education. Reimbursement for the visits came from Medicare, 25%; Medicaid-welfare, 14%; the patients, 18%; and health insurance, 3%. For 35% of the visits there was no charge; they were underwritten by community resources.     

Partners in pediatric palliative care: a program to enhance collaboration between hospital and community palliative care services

The provision of high-quality palliative care services to dying children and their families often requires extensive collaboration between hospital-based and community-based care teams. This article describes the origins and development of the Partners in Pediatric Palliative Care program, which has provided pediatric-specific educational offerings and fostered joint endeavors between a palliative care service located in a tertiary care children's hospital and a wide range of hospice and home care agencies in 5 states. The Partners in Pediatric Palliative Care program is evaluated in terms of the favorable ratings that attendees have given the educational components, the relatively modest direct costs of mounting the regional meetings, and the expanded capacity to provide home-based palliative services to children and families who desire them. The Partners in Pediatric Palliative Care program provides another feasible means for hospitals and community agencies to work together to improve pediatric palliative care.     

Nutrient profiling of foods: creating a nutrient-rich food index

Nutrient profiling of foods, described as the science of ranking foods based on their nutrient content, is fast becoming the basis for regulating nutrition labels, health claims, and marketing and advertising to children. A number of nutrient profile models have now been developed by research scientists, regulatory agencies, and by the food industry. Whereas some of these models have focused on nutrients to limit, others have emphasized nutrients known to be beneficial to health, or some combination of both. Although nutrient profile models are often tailored to specific goals, the development process ought to follow the same science-driven rules. These include the selection of index nutrients and reference amounts, the development of an appropriate algorithm for calculating nutrient density, and the validation of the chosen nutrient profile model against healthy diets. It is extremely important that nutrient profiles be validated rather than merely compared to prevailing public opinion. Regulatory agencies should act only when they are satisfied that the scientific process has been followed, that the algorithms are transparent, and that the profile model has been validated with respect to objective measures of a healthy diet.     

Sex education and family planning services for adolescents in foster care

Representatives of public child-welfare agencies in 48 states were surveyed to determine their states' policies for meeting the sexual development and family planning needs of teenagers served by the agencies. Only nine states have a formal written policy dealing with this area of child welfare, and just two of the states have a comprehensive policy. A handful of states have deliberately avoided addressing the issue. Officials in other states believe that a formal policy would be counterproductive, arguing that a low-key approach is the best way to deal with the needs of the teenagers they serve. Finally, some state child-welfare officials admit that they have not given the issue much thought. Twenty-nine states offer foster parents special training in adolescent sexuality, and 19 offer such training to caseworkers; however, only five states mandate such training for foster parents and only four do so for caseworkers. Southern states are the most likely to have written policies, while western states are the least likely; western states also are the least likely to offer or mandate special training for caseworkers in contact with teenagers. The officials surveyed also identified a number of institutional barriers that prevent their agencies from developing and implementing policies to deal with the sexual development needs of children in state care.