After-school child care programs

When the public, elected officials, and child advocates focus on the risks and opportunities inherent in after-school hours, discussions quickly hone in on the benefits that after-school programs might offer. This article points out, however, that parents and children consider a wide variety of options for the after-school hours. Children may be with a parent or relative, they may go to lessons or play sports, they may spend time alone or with friends. For many children, this pattern of activities is reflective of their families' resources and neighborhood surroundings as well as their own needs and interests. Drawing on recent studies, this article documents children's experiences in different settings, discusses the variable quality of after-school programs, and indicates how program participation and exposure to self-care can affect children's adjustment in elementary school.     

After-school programs for low-income children: promise and challenges

Children's out-of-school time, long a low-level source of public concern, has recently emerged as a major social issue. This, in turn, has heightened interest in the heterogeneous field of after-school programs. This article provides a profile of after-school programs for low-income children, focusing on supply and demand, program emphases, and program sponsors and support organizations. It also discusses the major challenges facing the field in the areas of facilities, staffing, and financing. Details and examples are drawn from the ongoing evaluation of a specific after-school program initiative called MOST (Making the Most of Out-of-School Time), which seeks to strengthen after-school programs in Boston, Chicago, and Seattle. Looking ahead, the article highlights the pros and cons of options for increasing coverage to reach more low-income children, strengthening programs, expanding funding, and articulating an appropriate role for after-school programs to fill in the lives of low-income children.     

Families with school-age children

Most working parents face a common dilemma--how to care for their children when they are not in school but the parents are at work. In this article Kathleen Christensen, Barbara Schneider, and Donnell Butler describe the predictable and unpredictable scheduling demands school-age children place on working couples and single working parents. The authors assess the potential capacity of schools to help meet the needs of working families through changes in school schedules and after-school programs and conclude that the flexibility parents need to balance family-work responsibilities probably cannot be found in the school setting. They argue that workplaces are better able than schools to offer the flexibility that working parents need to attend to basic needs of their children, as well as to engage in activities that enhance their children's academic performance and emotional and social well-being. Two types of flexible work practices seem especially well suited to parents who work: flextime arrangements that allow parents to coordinate their work schedules with their children's school schedules, and policies that allow workers to take short periods of time off--a few hours or a day or two-to attend a parent-teacher conference, for example, or care for a child who has suddenly fallen ill. Many companies that have instituted such policies have benefited through employees' greater job satisfaction and employee retention. Yet despite these measured benefits to employers, workplaces often fall short of being family friendly. Many employers do not offer such policies or offer them only to employees at certain levels or in certain types of jobs. Flexible work practices are almost nonexistent for low-income workers, who are least able to afford alternative child care and may need flexibility the most. Moreover the authors find that even employees in firms with flexible practices such as telecommuting may be reluctant to take advantage of them, because the workplace culture explicitly or implicitly stigmatizes or penalizes employees for choosing these work arrangements. The authors conclude by making a case for creating a workplace culture that supports flexibility. Such a culture, they argue, would enable working parents to better meet the responsibilities of their jobs as they care for and build strong relationships with their children.     

A bi-state, metropolitan, school-based immunization campaign: lessons from the Kansas City experience.

INTRODUCTION: Through school-based immunization programs, large numbers of children can be vaccinated in a cost-effective manner. Information from successful programs can be valuable to communities, schools, or pediatric health care providers considering the implementation of a school-based immunization program. The purpose of this study was to identify factors considered key to the success of a large bi-state, metropolitan, multi-school district, school-based, hepatitis B immunization program. METHOD: Immunizations were offered to 14,865 sixth-grade students in 16 school districts at 123 public and private school buildings. Personnel from 6 health departments and numerous volunteers administered the vaccines. Twenty-two semistructured interviews were conducted with a representative sample of program participants from schools, health departments, and the coordinating immunization coalition. A qualitative, grounded theory analysis was performed using data from the interviews. RESULTS: The following categories emerged and were considered important issues in the success of a school-based program: organization, time, obtaining consent, educational opportunity, school support, and student tracking. DISCUSSION: School-based immunization programs can be successful, but they require a coordinated effort with school support to meet the challenges of obtaining consent and tracking students.     

Community-based domestic violence services

Community-based domestic violence services have grown significantly since their emergence in the 1970s. Now more than 2,000 in number, domestic violence organizations have expanded their range of programs. In addition to crisis-oriented services, such as telephone hot lines and temporary shelter, many of these agencies provide legal, health, mental health, or vocational services or referrals, and assistance in finding housing, relocating, and planning for safety. Most recently, in response to increasing knowledge about the deleterious effects of exposure to domestic violence on children, community-based service providers have developed programs addressing children's mental health, health, educational, and safety needs. This article describes and analyzes trends in service delivery by these community-based organizations to children affected by domestic violence. It concludes that, although there has been significant growth in services, substantial segments of the target population still are not reached, and most organizations do not yet have a sufficient range of services to meet children's diverse needs. Challenges posed by inadequate funding, needs for specialized staffing, and a dearth of data on the efficacy of current intervention programs hamper domestic violence service providers' ability to meet children's needs. However, this article highlights promising new directions in service delivery. Community-based domestic violence organizations increasingly are using innovative strategies to address children's service needs. These agencies are expanding community outreach efforts and attempts to educate the public and professionals about domestic violence and children. In addition, these organizations are building important collaborative relationships with other agencies concerned with children's welfare, such as child protective services, law enforcement, schools, and health care facilities. These and related developments suggest cautious optimism that future years will see continuing progress in attempts by community-based organizations to address the needs of children whose well-being is jeopardized by their exposure to domestic violence.     

Welfare reform and child care options for low-income families

For the changes under welfare reform to positively affect children, the gains that mothers make from employment must lead to improvements in children's daily settings at home, in child care, at school, or in the community. This article focuses on the role child care can play in promoting the development of, and life opportunities for, low-income children. Key observations include: Total federal and state funding for child care for welfare and working poor families has increased dramatically since welfare reform, from $2.8 billion in 1995 to $8.0 billion in 2000. The majority of welfare mothers tend to rely on informal child care arrangements when first participating in welfare-to-work programs, but as they move off welfare and into more stable jobs, they are more likely to choose a center or a family child care home. Although children from poor households stand to benefit the most from high-quality care, they are less likely to be enrolled in high-quality programs than are children from affluent families, partly due to uneven access to high-quality options in their neighborhoods. Less than one-quarter of all eligible families use child care subsidies, and usage varies widely across states and local areas reflecting various barriers to access and scarcity of quality center-based care. The authors conclude that to achieve welfare reform's ultimate goal of breaking the cycle of intergenerational poverty and dependence on government benefits, welfare-to-work programs should promote learning and development among children in welfare and working poor families by increasing access to high-quality child care in low-income neighborhoods.     

Why and how to invest in neonatal health

The proportion of neonatal deaths in children has significantly increased, comprising at present almost 40% of all the nearly 11 million deaths of children under the age of five. In order to further reduce child mortality, substantial prompt attention to and reductions in neonatal mortality and morbidity are necessary. The reasons for insufficient investment in neonatal care are mostly based on incorrect assumptions about the importance, cost, and difficulty of tackling the issue. Further research is needed on the cost-effectiveness of neonatal interventions, but there is sufficient knowledge and evidence on the range, effect and cost-effectiveness of interventions to support significant increase in investments and broader programmatic implementation of available approaches. The continuum of care that follows the life-cycle is part of a high impact program delivery, supported by enabling environment, encompassing strong political commitment and strengthened comprehensive health system, from community level to clinical services. The international community needs to increase its funding and extend programs in close coordination with national health programs that are translated into partnerships at national and international level.     

The role of school nursing in the united states

Changes in the health care needs of American children over the past two centuries have engendered school health programs. Issues related to the role and responsibilities of school nurses within these programs have existed from the beginning. Current societal pressure for schools to assume even greater responsibility for providing health care has necessitated a precise definition of these roles and responsibilities. The purpose of this article is to review existing literature related to school nursing in this country and to describe the results of a study documenting state mandates for health education programs and the role of nurses within these programs.     

School re-entry of the pediatric heart transplant recipient

Pediatric cardiac transplant has become increasingly frequent in the last decade and survival rates have improved remarkably. Outcome research on this population suggests that the majority of children have the capacity for healthy adaptation although 25-40% have been shown to have some type of psychiatric difficulties. As school plays a major role in these children's lives, early intervention and close liaison with schools is indicated to reduce psychological morbidity, enhance adaptation within the school environment and enhance overall adjustment. This paper proposes a model for a school re-entry program for this population. The school re-entry program is aimed at children who are undergoing cardiac transplant and will be entering or re-entering the school system. They may range in academic age from preschool to college level and have been attending private or public schools with placements in regular education programs, regular education programs with resource support, special education programs, and alternative school programs. Others may not have been attending school because of the severity of their medical condition and have been receiving in-home tutoring. Each child is offered school re-entry assistance by a multi-disciplinary team composed of members from the Cardiology Transplant Service. The re-entry program includes cognitive and psychosocial assessment, liaison with the child's school pre- and post-transplant, academic planning and provision of academic, emotional, and behavioral support before, during, and immediately after transplant, a school re-entry visit, and an ongoing school consultation. The goal is to address issues necessary for a successful school re-entry including appropriate academic placement and support, psychosocial adjustment, education of school personnel and ongoing health needs of the student. The next step is to formally evaluate the efficacy of this program in successful school re-entry.     

Early childhood development in deprived urban settlements

Poverty, the root cause of the existence of slums or settlement colonies in urban areas has a great impact on almost all aspects of life of the urban poor, especially the all-round development of children. Examples from countries, across the globe provide evidence of improved early child development, made possible through integrated slum improvement programs, are few in numbers. The observed 2.5% prevalence of developmental delay in the less than 2 year olds of deprived urban settlements, the presence of risk factors for developmental delay like low birth weight, birth asphyxia, coupled with poor environment of home and alternate child care services, highlights the need for simple cost effective community model for promoting early child development. This review on early child development focuses on the developmental status of children in the deprived urban settlements, who are yet to be on the priority list of Governments and international agencies working for the welfare of children, the contributory nature-nurture factors and replicable working models like infant stimulation, early detection of developmental delay in infancy itself, developmental screening of toddlers, skill assessment for preschool children, school readiness programs, identification of mental sub-normality and primary education enhancement program for primary school children. Further, the review probes feasible intervention strategies through community owned early child care and development facilities, utilizing existing programs like ICDS, Urban Basic Services and by initiating services like Development Friendly Well Baby Clinics, Community Extension services, Child Development Referral Units at district hospitals and involving trained manpower like anganwadi/creche workers, public health nurses and developmental therapists. With the decentralization process the local self-government at municipalities and city corporations are financially equipped to be the prime movers to initiate, monitor and promote early child development programs, to emerge as a part and parcel of community owned sustainable development process.     

Sick child care: A developmental perspective

Sick child care programs provide an alternative when mildly ill children are excluded from their regular child care program. Although infectious disease implications have been addressed, tittle attention has been directed to the potentially negative consequences of care by unfamiliar providers in unfamiliar settings. Appropriate options for care during illness must be based not only on the physical but the emotional and developmental needs of young children.     

Establishing special needs car seat loan program

Car seat loan and rental programs have provided many families with low-cost access to child restraints. When an infant or child is unable to be accommodated in a standard car seat or seat belt owing to physical or medical problems, parents of these children have few, if any available resources. The establishment and operation of a loan program at the Indiana University School of Medicine for children who are medically fragile is reviewed in this article. This program was developed by the Automotive Safety for Children Program at the James Whitcomb Riley Hospital for Children, Indiana University Medical Center, to meet the special transportation needs of children with respiratory, orthopaedic, and other medical and physical difficulties. A summary table is included to highlight restraints that have performed satisfactorily during dynamic crash tests and are used to meet patient transportation needs at Riley Hospital. Guidelines for establishing and maintaining a child restraint loan program for children with special needs are outlined to encourage replication of this effort.     

Facilitators and Barriers to Implementation of School-Based Telehealth Asthma Care: Program Champion Perspectives

ObjectiveAsthma is one of the most common chronic conditions of childhood, conferring an immense burden on children and their caregivers. School-based telehealth approaches for asthma care provide the opportunity to deliver convenient, cost-effective care to more children in the school setting. Our study objective was to characterize school-based telehealth asthma program delivery experiences and examine barriers and facilitators to telehealth program implementation.MethodsInterviews were conducted with telehealth program staff and school stakeholders in nine schools engaged in a school-based telehealth asthma program. A structured interview guide was designed using the Exploration, Adoption/Preparation, Implementation, Sustainment (EPIS) framework. A template analysis qualitative approach was used to identify themes related to implementation processes.ResultsInterviews identified key telehealth implementation strategies including building relationships, marketing and provision of technical assistance, education and support to aid program delivery. Key facilitators to successful program implementation included strong partnerships between the telehealth and school teams, a shared commitment to enhancing access to asthma care for children, and strong nurse leadership. Primary barriers to implementation included lack of family/caregiver involvement and competing demands for nurses.ConclusionsThis study identified barriers and facilitators to implementing a school-based telehealth asthma program that can be used to guide education, training and support strategies to enhance program delivery. Recommended implementation strategies include building strong program-school partnerships, creating a shared vision to improve access to care, and building engagement in families and communities while supporting nurse leaders and family involvement with training and resources. These results can help guide future telehealth interventions.     

School-Age Children's Wellbeing and School-Related Needs During the COVID-19 Pandemic

Background and ObjectivesThe COVID-19 pandemic and related school closures may have disrupted school-related supports and services important to children's wellbeing. However, we lack national data about US children's wellbeing and family priorities for school-related services. We sought to determine 1) children's social-emotional wellbeing and 2) needs and priorities for school-based services in the 2021–2022 school year among a US sample of parents of school-aged children.MethodsIn June 2021, we surveyed 1504 parents of children enrolling in grades K-12 in the 2021–2022 school year participating in the Understanding America Study, a nationally representative probability-based Internet panel of families completing regular internet-based surveys (Response rate to this survey was 79.2%). Parents completed the Strengths and Difficulties Questionnaire and reported their needs for school-related services regarding “support getting healthcare”, “mental wellness support”, “food, housing, legal or transportation support”, and “learning supports and enrichment.” Weighted regressions examined associations among wellbeing, needs, and sociodemographic characteristics.ResultsApproximately one-quarter of children had deficits in hyperactivity (26.1%), one-third in peer problems (32.6%), and 40% in prosocial areas. Most parents (83.5%) reported a school-related need, with 77% reporting learning supports and enrichment needs and 57% reporting mental wellness needs. The highest priority needs were for tutoring, socialization, increased instructional time, coping with stress, and physical activity.ConclusionsUS school children have high social-emotional and school-related needs. Investments in schools are urgently needed, particularly for learning supports and mental wellness, to meet the high demand for services and parents’ priorities to support child health and wellbeing.     

Child care and the pediatrician

Working parents and child care programs are here to stay. The pediatrician has many opportunities to advocate for children concerning child care, both in encounters with parents in the office and in roles played in the community. By focusing attention on the determinants of the quality of child care, the pediatrician can minimize the risks and enhance the potential benefits of child care program participation.     

Child care program directors' level of knowledge about asthma and factors associated with knowledge

Although asthmatic children spend a significant amount of time in child care programs, little is known about child care program directors' knowledge about asthma and what factors influence directors' level of knowledge about asthma. A telephone interview was conducted with directors of a randomly selected sample of all licensed child care centers and group day care homes in Connecticut. Directors of most child care programs were willing to admit asthmatic children to their programs, but their knowledge about asthma needs to be improved. Directors who have served for long periods of time may be a target group for additional education about asthma.     

A teaching tool for children in self care

Because of the high divorce rate and the increasing number of working mothers, many U.S. children come from families in which parent(s) are unavailable for 2 to 3 hours after school, when the parent(s) are still at work. Although many communities have after-school care programs, many children do not have access to these. Such children must return to empty houses and face loneliness, boredom, and the risk of personal harm. To assist these children to avoid harm, the authors devised a tool to teach age-appropriate “survival skills” to 6- to 9-year-old children in their classrooms (after parental consent). This article describes the authors' experience and the teaching tool.     

Transmission of tuberculosis from a seven-year-old child in a Sydney school

OBJECTIVES: To determine whether a 7-year-old child with extrapulmonary and pulmonary tuberculosis (TB) and direct smear positive sputum for acid-fast bacilli was infectious to home and school contacts, and to ascertain potential adult sources of infection for these contacts. METHODS: Contact tracing by Mantoux testing was conducted on 220 children at a primary school and after-school care facility, and 59 selected adults considered potential sources of infection. RESULTS: The participation rate for the children was 98% and 92% for the adults. Mantoux positivity (induration >/= 10 mm, or >/= 15 mm with previous BCG) among children was 13% at the school (anticipated rate 2-3%), 26% among school staff, and 7% among children at the after-school care centre where the index case attended. One exposed adult hospital staff member converted from Mantoux negative to positive. No other cases of TB disease were detected among children or adults tested. CONCLUSION: Although spread of TB from children to others is rare, the findings of this investigation indicate that transmission of TB from a young child to other children and an adult may have occurred, and that sputum testing and contact tracing for sputum smear positive children should be considered.