Interprofessional Collaboration in Finnish Residential Child Care: Challenges in Incorporating and Sharing Expertise Between the Child Protection and Health Care Systems

Many children taken into care tend to be in need of psychiatric treatment as well as child protection services, and thus the professional expertise of both systems must be coordinated in their care. However, it is widely known across Europe that collaboration between child protection services and mental health services is not working well and the outcomes for looked-after children are poor. In spite of drastic need for knowledge, interprofessional collaboration between residential workers and mental health practitioners is poorly explored in international research. Most importantly, very little is known about shared expertise in multi-agency teams between these systems. Based on the analysis of interprofessional focus group interviews (eight interviews with 17 practitioners) in Finland, it is claimed that both sides have unrealistic expectations and perceptions of the other professional grouping and its facilities to help high-need children. The study also indicates that the collaboration assumes an equality of status and responsibilities between the professionals that does not always exist amongst residential child care practitioners and mental health professionals. The analysis suggests that the concept of residential child care work itself needs more empirical research to strengthen the interprofessional competencies and enhance child-centred integrated care.     

Caregiver Participation in Community-Based Mental Health Services for Children Receiving Outpatient Care

Caregiver participation in child mental health treatment has been associated with better youth outcomes, but little is known about the amount and type of caregiver participation in usual care services for children. This study examined 1,255 caregivers’ reports of their participation in the outpatient services their children received through a large, public mental health system in the Southwest. The majority of the caregivers reported that they participated in their child’s services. Extent of participation was associated with several factors including children’s physical health and caregivers’ primary language, satisfaction with the services, feelings of support, and perceptions of barriers to participation. The findings offer some encouragement for the contextual fit for many evidence-based interventions that focus on caregiver involvement, and highlight which caregivers may need greater encouragement to participate in their child’s care.     

The health-related quality of life of children and adolescents in home-based foster care

Objective To compare the health-related quality of life (HRQL) of 326 children and adolescents aged 6–17 years living in home-based foster care in metropolitan Adelaide, South Australia with the HRQL of a random sample of 3,582 children aged 6–17 years living in the community in Australia. Method In both groups, HRQL was assessed using the 50-item version of the Child Health Questionnaire (CHQ-PF50) completed by caregivers/parents, and the 87-item self-report version of the Child Health Questionnaire (CHQ-CF87) completed by 13–17 year olds. Results Young people in home-based foster care had significantly poorer HRQL in a wide range of different domains than those in the general community. Furthermore, among children in home-based foster care, those with mental health problems had significantly poorer HRQL in many domains than those without mental health problems. Demographic and placement characteristics of the children in home-based foster care were not significantly associated with differences in HRQL. Conclusion The findings highlight the importance of providing services and resources to improve the quality of life of children living in home-based foster care. All results of the analyses discussed in this paper are available upon request.     

河北省赵县孕产妇和儿童健康管理现状研究

目的：调查分析河北省赵县基本公共卫生服务项目中孕产妇和儿童健康管理实施现状,为改进服务质量提供研究资料和建议。方法根据国家基本公共卫生服务规范要求的服务内容设计调查问卷,主要包括体格检查、化验和咨询指导,现场观察乡镇卫生院妇幼保健人员的产前保健和儿童保健服务过程,并对保健人员进行访谈以了解其对自己的工作量、收入和提供喂养咨询指导的看法。结果调查共观察了88名孕妇的产前保健和194名儿童的保健服务。产前保健中有80％以上的孕妇进行了体格检查,但进行实验室化验者不足5％。保健人员很少提供咨询指导,没有孕妇得到母乳喂养方面的指导。儿童保健中98．5％的儿童测量了体重和身长,但分别只有6．2％和4．6％对照生长标准曲线进行了评价。只有21．6％的儿童家长接受了喂养指导。结论赵县基本公共卫生服务项目中产前保健和儿童保健的体格检查部分工作开展较好,但实验室化验和咨询指导方面的服务质量有待提高;保健人员反映工作量大、收入低,同时需要更多高质量的培训。     

Grandparenting: Roles and responsibilities and its implications for kinship care policies

The current literature with regard to grandparents providing care to their grandchildren, whether on an informal basis or when the children are under the auspices of children's protection services (state-mandated intervention), highlights a number of issues or concerns for the caregivers. In the province of Newfoundland and Labrador (Canada), there is a focus on giving priority to grandparents (and significant others) as caregivers, which is embedded in the current child welfare legislation. There appears to be an underlying assumption that grandparents are willing and able to provide such care. However, no research has been completed in order to gain an understanding of some of the dynamics of caregiving by grandparents in this province. The authors are interested in grandparents as potential caregivers, particularly with regard to children who may come under the auspices of children's protection services. In addition, the policies and practices appear to be incongruent with current research, concerns and issues. This province is unique in that it has the fastest-growing senior population, the highest median age for seniors in Canada and has a high number of young families that have moved to other provinces to work. This research will provide insight into the willingness and ability of grandparents to provide care to their grandchildren, whether through informal or formal care (state intervention), as well as implications for current policies and practices.     

城市流动人口妇幼保健服务项目对流动儿童保健状况的改善作用

【目的】 分析城市流动人口妇幼保健服务项目对流动儿童保健状况的改善作用。 【方法】 采取分层整群抽样方法抽取朝阳区和大兴区共11个街乡,实施为期5年的流动人口妇幼保健项目。项目终期,在项目点随机抽取部分流动儿童进行入户问卷调查,与基线调查比较。 【结果】 共调查流动儿童1 005名。结果显示:1)流动儿童看护人对儿童保健服务和知识的知晓率明显提高;2)流动儿童对保健服务的利用明显改善,建册率、儿童保健覆盖率和儿童系统管理率比基线时明显提高,升幅分别为71.7%、76.2%和87.5%;3)流动儿童健康状况明显改善,腹泻、咳嗽2周罹患率比基线明显降低。 【结论】 流动人口妇幼保健服务项目的实施对提高流动儿童看护人保健知识水平、改善流动儿童保健服务和健康状况具有明显的促进作用。     

Working on the interface: identifying professional responses to families with mental health and child-care needs

The gaps between mental health and child-care services constitute a recognised barrier to providing effective services to families where parents have mental health problems. Recent guidance exhorts professionals to coordinate and collaborate more consistently in this area of work. The present study aimed to identify the barriers to inter-professional collaboration through a survey of 500 health and social care professionals. The views of 11 mothers with severe mental health problems whose children had been subject to a child protection case conference were also interrogated through two sets of interviews. The study found that communication problems were identified more frequently between child care workers and adult psychiatrists than between other groups. Communication between general practitioners and child-care workers was also more likely to be described as problematic. While there was some support amongst practitioners for child-care workers to assume a coordinating or lead role in such cases, this support was not overwhelming, and reflected professional interests and alliances. The mothers themselves valued support from professionals whom they felt were 'there for them' and whom they could trust. There was evidence from the responses of child-care social workers that they lacked the capacity to fill this role in relation to parents and their statutory child-care responsibilities may make it particularly difficult for them to do so. The authors recommend that a dyad of workers from the child-care and community mental health services should share the coordinating key worker role in such cases.     

Foster and Adoptive Parent Perspectives on Needs and Services: a Mixed Methods Study

Caring for children with complex needs severely stresses foster and adoptive parents, but few studies have examined their perspectives on needs and services. To examine parental views, the authors analyzed four focus groups (n = 27 participants) and one state-wide survey (n = 512 respondents, 42% of 1206 contacted) of foster and adoptive parents in one state. Results highlighted inadequate communication between providers and families, cultural and legal barriers, needs for parent training and preparation, the importance of several types of parent supports, and needs for specialized mental health treatment for the children. Surveyed parents identified children’s behavior problems as their top challenge, and over half rated the availability of mental health providers who treat attachment and family as insufficient. The findings suggest specific areas in which state leaders could enhance training and supports for child welfare staff and foster and adoptive parents and improve mental health services for children in foster and adoptive care.     

‘You opened our eyes’: care‐giving after learning a child’s positive HIV status in rural South Africa

Caregivers of young children identified as HIV positive, residing in Agincourt, rural South Africa were advised of their child’s status. How was this knowledge received, and how did it influence care‐giving and support? Interviews were conducted in May to June 2008 with caregivers of HIV positive children aged 1–5 years, 1 year following the child’s HIV test and disclosure of status. Drawing on data from 31 semi‐structured questionnaires and 21 in‐depth interviews, we describe caregivers’ attitudes, reactions, fears and aspirations after learning a child’s HIV status, the perceived usefulness of the knowledge, barriers to care‐giving and support received. Sociodemographic data collected through the questionnaire were analysed using Stata. Qualitative data were coded in NVIVO 8 and analysed inductively to identify themes and their repetitions and variations. Although almost half of the caregivers responded negatively initially, 1 year later, almost all had accepted and valued knowing their child’s HIV status as this had enhanced their competency in care‐giving. Counselling from health providers and personal spirituality helped caregivers to accept the child’s status and cope with its implications. Most caregivers had high aspirations for the child’s future, despite some expressed difficulties associated with care‐giving, including financial constraints, information gaps and barriers to healthcare. The results indicate an opportunity for paediatric HIV screening in communities with high HIV prevalence. This would facilitate early uptake of available interventions, so enhancing the survival of HIV positive children.     

Diagnosing attention‐deficit hyperactivity disorder (ADHD) in children involved with child protection services: are current diagnostic guidelines acceptable for vulnerable populations?

Children involved with child protection services (CPS) are diagnosed and treated for attention‐deficit hyperactivity disorder (ADHD) at higher rates than the general population. Children with maltreatment histories are much more likely to have other factors contributing to behavioural and attentional regulation difficulties that may overlap with or mimic ADHD‐like symptoms, including language and learning problems, post‐traumatic stress disorder, attachment difficulties, mood disorders and anxiety disorders. A higher number of children in the child welfare system are diagnosed with ADHD and provided with psychotropic medications under a group care setting compared with family‐based, foster care and kinship care settings. However, children's behavioural trajectories change over time while in care. A reassessment in the approach to ADHD‐like symptoms in children exposed to confirmed (or suspected) maltreatment (e.g. neglect, abuse) is required. Diagnosis should be conducted within a multidisciplinary team and practice guidelines regarding ADHD diagnostic and management practices for children in CPS care are warranted both in the USA and in Canada. Increased education for caregivers, teachers and child welfare staff on the effects of maltreatment and often perplexing relationship with ADHD‐like symptoms and co‐morbid disorders is also necessary. Increased partnerships are needed to ensure the mental well‐being of children with child protection involvement.     

A Preliminary Analysis of the Receipt of Mental Health Services Consistent With National Standards Among Children in the Child Welfare System

Objectives. We sought to examine the extent to which children in the child welfare system receive mental health care consistent with national standards.Methods. We used data from 4 waves (3 years of follow-up) of the National Survey of Child and Adolescent Well-Being, the nation''s first longitudinal study of children in the child welfare system, and the Area Resource File to examine rates of screening, assessment, and referral to mental health services among 3802 youths presenting to child welfare agencies. Weighted population-averaged logistic regression models were used to identify variables associated with standards-consistent care.Results. Only half of all children in the sample received care consistent with any 1 national standard, and less than one tenth received care consistent with all of them. Older children, those exhibiting externalizing behaviors, and those placed in foster care had, on average, higher odds of receiving care consistent with national standards.Conclusions. Adverse consequences of childhood disadvantage cannot be reduced unless greater collaboration occurs between child welfare and mental health agencies. Current changes to Medicaid regulations that weaken entitlements to screening and assessment may also worsen mental health disparities among these vulnerable children.Ensuring that children in the child welfare system receive high-quality mental health services has been a policy priority for the past 2 decades, and professional organizations have proposed standards of care specifically tailored for this population. However, there is no information on the extent to which children in the child welfare system actually receive care that is consistent with these national standards.Attention to standards-consistent mental health care is important because children in the child welfare system have very high needs for mental health services. Nearly half of all children coming into contact with child welfare agencies nationally have clinically significant emotional or behavioral problems,¹ and 40% to 60% of children in the child welfare system may have a psychiatric diagnosis.² Local and regional studies have also documented high rates of problems across several domains among these children.^3–5 Children in foster care have between 10 and 20 times the rate of utilization of mental health services when compared with children maintained within their homes,^6–8 and national estimates suggest that the point prevalence of psychotropic medication use is 13.5%⁹—far above the 4% seen among privately insured children¹⁰ and the 5% to 6% seen among Medicaid-enrolled children.^11,12Given this magnitude of service use and the unique vulnerabilities of children in child welfare, the Child Welfare League of America proposed standards for the provision of health and mental health services for children in foster care in 1988.¹³ The American Academy of Pediatrics proposed similar standards in 1994 and in 2002,^14,15 as did the American Academy of Child and Adolescent Psychiatry in 2001.^16,17 These recommendations are highly convergent with regard to mental health care and suggest that all children should receive a mental health screening when placed into foster care, a subsequent comprehensive mental health assessment by a mental health professional within a month of being placed into foster care, and a systematic, coordinated approach to the delivery of services to meet children''s ongoing mental health needs.These standards since have been operationalized for use by child welfare agencies and extended to children who are not placed in foster care. For example, the Council on Accreditation, presumably informed by the literature documenting significant mental health needs among non–foster-care child welfare populations,¹ evaluates child protective services agencies on their case-management abilities, including needs assessment and the provision of counseling and intensive mental health services.¹⁸ These standards govern processes of care—not quality of clinical care—and are primarily designed to assist child welfare agencies in implementing organizational structures and processes that can improve child well-being. Passage of the 1997 Adoption and Safe Families Act^19–21 provided additional federal impetus to standards development, and states are currently evaluated on the extent to which children “receive adequate services to meet their … mental health needs.”²²Despite professional consensus and federal legislation and regulation, there is little information on whether children in the child welfare system actually receive care that is consistent with these standards. In 2002, Halfon et al. reported on the overall inadequacy of services available to children in foster care²³; a key informant survey of state and county mental health agencies found that only one third of all mental health agency respondents reported being aware of these standards²⁴; and another study found that fewer than half of all counties had policies regarding mental health assessments for children in child welfare.²⁵ However, there was no information obtained at the child level to determine whether this lack of knowledge and policymaking adversely affects the care received by individual children.In an attempt to quantify the extent to which children in the child welfare system receive mental health services consistent with national standards, we analyzed data from the first national study of children coming into contact with child welfare agencies—the National Survey of Child and Adolescent Well-Being (NSCAW). We conducted longitudinal data analyses to estimate the prevalence of standards-consistent care among this national sample and identify child-, caregiver-, and caseworker-level characteristics that place children at most risk for receiving care inconsistent with these national standards. Through these analyses we attempt to provide policy guidance for child welfare and child mental health policymakers to better construct systems of care for these highly vulnerable children.     

吉林省四平市2009—2013年妇幼卫生工作数据分析

目的通过对2009—2013年四平市妇幼卫生保健服务数据整理、审核、汇总和分析,掌握全市妇幼卫生工作数据,为卫生行政部门制定相应干预措施提供重要依据。方法收集2009—2013年间,四平市所辖7个县（市）区上报的妇幼卫生信息年报表、孕产妇、儿童死亡报告卡等数据进行分析研究。结果四平市儿童保健服务指标总体连续5年都有不同程度上升。2013年7岁以下儿童保健覆盖率为90．10％、3岁以下儿童系统管理率为89．83％。孕产妇保健服务各项指标均有上升,2013年系统管理率89．60％、住院分娩率100％。结论四平市近5年来儿童保健与孕产妇保健服务水平不断提高,婴儿死亡率逐年下降,孕产妇死亡率前3年逐年下降,2013年出现波动,上升幅度很大。提示妇幼卫生工作取得较好效果,但也存在一定问题,要重点加强孕产妇保健系统管理工作,特别是高危重症孕产妇的抢救与管理。     

Supporting family engagement with child and adolescent mental health services: A scoping review

A key challenge facing the mental health field is connecting children and families to services when symptoms first appear. Multiple barriers inhibit timely access to treatment, and interventions to resolve barriers to care are not common among health and social care organisations. To address this research‐to‐practice gap this study undertook a scoping review of the empirical literature aimed at identifying key factors in the social ecology of families which influence family engagement with child and adolescent mental health services, then identifying and describing models of intervention designed to help facilitate access to care. Forty studies published between 1 January 2000 and 28 February 2019 were reviewed. Key factors associated with child and adolescent mental health service engagement included family attitudes towards mental illness and help seeking, the flexibility and availability of needed services, community attitudes and stigma surrounding mental illness and mental health treatment, and the degree of coordination and integration across systems of health and social care. Models of intervention to facilitate engagement with mental health services included family outreach, telephone and digital health strategies, and integrated care approaches. Empirical support is strongest for family outreach and integrated care, although telephone and digital health strategies are underexplored with children and families and a potentially promising avenue for future research. To support family engagement with child and adolescent mental health services health and social care organisations should be prepared to identify barriers in their local practice settings and integrate efficacious engagement approaches into their continuum of available services.     

Health of caregivers in child care

BACKGROUND: Child care workers play an important role in caring for children attending child care yet there is little research regarding their health. METHODS: The study consisted of focus groups with child care workers and a survey, conducted as part of a larger study known as the Healthy Child Care Study, which focused on children. The study investigated carers working in formal child care [long day care (LDC) and family day care (FDC)]. RESULTS: Questionnaires to caregivers in centres showed that 86% had taken sick leave in the previous year and 75% of staff had taken leave for infectious illness. Carers in FDC reported that 24% had taken sick leave in the previous year and 12% of carers had taken leave for infectious illness. Of responding caregivers from centres, 22% were cigarette smokers while in FDC homes, 8% of carers smoked. In focus groups, carers reported that their major areas of health concern were stress, infectious illness and physical trauma such as lifting injuries. CONCLUSIONS: Child care workers in LDC took more sick leave than those in FDC but this is not necessarily due to more illness. Child care workers are a diverse and important group that require further research.     

Rural physical health care services for people with serious mental illness: A nursing perspective

Objective: To understand nurse perspectives on the physical health needs of their mental health clients and how well rural services are meeting their overall care needs. Design: Focus groups with semistructured format. Setting: Community mental health care in a regional and rural district of Queensland. Participants: Thirty‐eight nurses in public mental health care. Results: The major themes were (i) stigma of mental illness, (ii) barriers to accessing physical health care services, (iii) nurse adaptations under demands, and (iv) community and integration towards better overall health. Nurses integrate overall care and foster its continuity for people with physical and mental co‐morbidity and can be supported much better in sustaining this. Conclusion: Access and continuity of physical health care experienced by all Australians is exacerbated for people in rural areas. Physical health of people with serious mental illness residing in remote Australia needs to be a national health priority.     

Discrepancy between expected and actual child support payments: predicting the health and health-related quality of life of children living in low-income, single-parent families

Objective Although the amount and frequency of child support payments received by single parents are often erratic and fluctuate, no study to date has quantitatively explored how the discrepancy between expected and actual payments relates to child health. This study aims to examine whether the discrepancy between expected and actual child support payments predicts a range of child health outcomes, including global health, health‐related quality of life, involvement in activities and parental psychological distress. Methods This study used results from the Longitudinal Study of Australian Children, which included a sample of parents of children aged 4–5 years (n = 4983). The questionnaire was completed by the parent who spent the most time with the child and knew the child best. From the 4983 families, 332 low‐income single parents reliant on welfare with a formal or informal child support order in place were identified. Results After controlling for income, the discrepancy between expected and actual child support predicted school functioning, conduct problems, total mental health problems and involvement in activities. Discrepancy between expected and actual child support payments did not predict the remaining health‐related quality of life domains, mental health domains, global child health or parental psychosocial distress. Conclusion This was the first study to examine how the discrepancy between expected and actual child support payments relates to child health, providing important data on the effectiveness of the child support system for children's well‐being. These findings highlight the potential impact of the discrepancy on school functioning, conduct problems, total mental health problems and involvement in activities.     

The case for enhanced educational supports for children in public care: An integrative literature review of the educational pathway of children in care

For many years, the adult outcomes of young people who have grown up in foster care have been an object of broad concern. Numerous studies show that young adults who were former foster children lagged behind their community peers on a number of socio-economic indicators. Educational attainment is seen as a key developmental outcome and one that is highly associated with positive adult adjustment. Most young people today undertake a gradual process of becoming independent, but this emancipation process is very different and often traumatic for young people who age out of child protection care. This review considers the published literature that explores the educational and associated outcomes of children who leave the care of child protective services.     

Integrating Family Visitation and Risk Evaluation: A Practical Bonding Model for Decision Makers

The number of children in foster care remains high, and most disturbing are the numbers of children whose abuse continues after system intervention. Faced by these challenges, child welfare legislation and policy have shifted away from the earlier standard of “reasonable efforts” toward reunification for children in foster care to a standard in which “the best interests of the child” have priority. The new goal calls for greater use of assessment tools in locating those families deemed to be “at risk” for further abuse. Here, we apply a family bonding perspective to address the practical side of risk assessment for those children already in foster care. We present a conceptual model that attaches numerical value to the various components of the parent–child bond and demonstrate how the model can be operationalized during supervised visitations. Using data from a family visitation center, we demonstrate the model's potential for interagency collaboration in the permanency placement decision‐making process.