The “syndrome of the post-premature child”: a study of its significance -- Part I

Prematurity has the greatest influence upon frequency and degree of mechanical disturbances uncovered by the Test of Imitation of Gestures. The authors look for the significance of this syndrome at various levels:

1. Possible organic damage to the central nervous system structures, through the tonic and motor disturbances checked out by the neurological examination.
2. In the disturbances of the early development of posturomotor abilities.
3. Deviant and delayed development of the cognitive factors (spatial and temporal structuring).
4. Emotional and relationship development.

The investigations were carried out on a sample group of prematurely born children and a control group group of children born at term.

After observing certain behavior disorders which occur among normal children -- mild disorders which become less obvious with age -- the authors show that frequent and gross disturbances which appear in the first months of life and persist beyond the age of 6 years distinguish the premature child. In this same group, however, delays in mental development noted early in life often disappear entirely by the age of 4 years, even among children who were born very prematurely.

The authors then isolated the most typical disturbances found among the premature children, with stress on factors of pathology, maturation, adjustment, and environment.

The authors study the relationship between the disturbances described above and the various aspects of the neurological examinations which enable them to objectify the dynamic factors of the body adjustment to the external world and to other people. The hypothesis that a fundamental relationship exists between disturbances of adjustment and the genesis of the “post-premature child syndrome”, develops from the comparison between the psychological and neurological data in their longitudinal evolution.

Commenting on the relevance of these findings for the care of premature children, the authors stress the value of motor training and remedial education for overcoming the disturbances of spatial structuration and body schema.     

Psychological screening in the course of the health control of four-year-old children

The health control of four-year-old Swedish children will include an examination of possible psychologtcal abnormalities and defects. The methods which have been worked out for this purpose by a committee of the Social Council include two main components. A nurse will carry out an interview with the child's caretaker and then evaluate the child's behavior. In addition, a physician will make an attempt to evaluate the child's development. The “risk children” will then be selected for further psychological investigation.

An attempt has been made to test the efficiency of the screening methods mentioned. The evaluations by the child care centers have been compared to more comprehensive clinical-psychological investigations and the results show good agreement between the two teams.

The Investigation has been carried out at PBU, Stockholm (Chief physician Hans Curman, psychologist Lillian Gottfarb).     

NIGERIAN CHILDREN'S PERSPECTIVE OF URBAN LIFE QUALITY

The Convention on the Rights of the child put in place some set of standards to ensure that in all consenting countries every child is wanted, healthy, educated, safe and loved. Nigeria is one of the countries that has taken some steps to put into practice the accepted rights.

Two hundred children (100 boys and 100 girls) in primary schools in four urban centres were served with questionnaires requesting their views on issues bordering on their well being and quality of life, in such areas as:

1. quality of education
2. space for movement and play
3. food and clean water for drinking and washing
4. play equipment and materials and
5. loving care giver.

The children's responses showed that provision was not made for recreational space for play, the quality of education is poor, there was no provision for play equipment and material and in most cases the adult-child ration was low. Children also complained of polluted environment.

Suggestions were made for the provision of adequate play parks for recreational purposes for the children. Suggestion is also made for government to pay more attention to the well being and health of the children.     

Co-operating to protect children -shifting the thresholds

It is now 30 years since Kempe delivered his watershed address to the American Academy of Paediatricians graphically describing the battered child syndrome. In the 30 years that followed elaborate child protection procedures, supported by strong legal powers, have developed not only in the UK and the USA but also in may countries around the world. In the last 5 years or so, however, there has been another great watershed. Independently in both the USA and in the UK, evidence has accumulated which is questioning the efficacy of our elaborate child protection systems. For social workers in the UK the history is familiar; the child abuse inquiries leading on to the Cleveland Inquiry, on going scandals in residential care and concern about the outcomes for children in the public care system, and, finally, the recent message from the Department of Health in 1995 “Child Protection - Messages from Research”. Less familiar will be the concerns which emerged in the USA. There, following the introduction of mandatory reporting which in some states is mandatory even for civil citizens, there was a huge rise in the number of children reported (3 million reported in 1992 of which less than half were substantiated). This largely incapacitated the child protection agencies and led to large numbers of children being admitted into the public care. In 1990 the US Advisory Board on Child Abuse and Neglect concluded that there was an urgent need to develop new approaches.

The answer put forward in this country and the USA has been the rediscovery of targeted preventive approaches. Central to these approaches is what we call family support and what is called social support in the USA.

Child protection is an important and demanding activity

- research and our own limited local information does pose serious questions about the efficacy of the process;

- this points to the need for reviews by area child protection committees;

- research also tells us important things about the characteristics of families involved especially about their social and economic circumstances. These need to be addressed.

Addressing these needs requires several things

- a good individual assessment and population assessment to plan appropriate services;

- a sound interagency/multiprofessional approach;

- maximising all the resource options and taking a broader view of the task - as well as mainstream services as currently arranged, we need to embrace a community development approach and to view die families involved in terms of their inclusion or exclusion from society and address these shortfalls.

We are only at the threshold of the implementation of the Order and we need to approach it with a broad vision.     

Parental health and stress in families with a child who has multiple disabilities

The presence of a disabled child is known to increase family stress and parental ill-health. However, it is unclear the extent to which support services can alleviate this.

Families using two, short-break services - both residential and domiciliary - formed the study population (N = 68). Measures were taken using standardised instruments of children's development and maladaptive behaviours, parental stress, parental health and the supports that the families received from services, professionals and relatives and friends.

Significant proportions of these service users were stressed and had high levels of psychiatric morbidity. The sole predictor of stress was parental ill-health which in turn was linked with children who had higher scores on motor skills and the presence of other disabled dependants in the family. Families who were most stressed or in poorer health received no greater amounts of support.

The findings reinforced the complexity of disentangling the relationships between family needs and service supports. They also suggest that existing presumptions about more services reducing family stress are too simplistic. It is argued that the meaning of support for families needs to be critically reviewed along with an examination of the coping strategies used by families. This should result in better matching of support services to individual family needs.     

The impact of mothers' perception of child care services and utilization

To examine the impact of mothers' perception of the roles of pre-primary institutions and what motivates them to choose a particular child care service, 138 working mothers and 20 proprietors of nursery schools and day care centers were interviewed. The facilities available to children in the centers studied was also assessed.

The results suggested that these mothers' expected these institutions to play custodial functions as well as to provide early childhood education. This knowledge could guide proprietors and other interested organizations in the provision of appropriate child care programmes to meet the needs of mothers and their children.

The demand for nursery/day care services in Nigeria has become very high due to the increasing number of women in the workforce.     

Parental participation at child protection case conferences: An evaluation of practice in north and west belfast

Parental participation at child protection case conferences is still a relatively new and contentious phenomenon. In January 1994 a strategy for this process was implemented in North and West Belfast Health and Social Services Trust and this research was undertaken in order to monitor and evaluate this new way of working.

Structured interviews were carried out with twenty-two parents and a postal questionnaire was sent to six main professional groups (field social workers, non-field social workers, police, doctors, teachers, and community nurses). The questionnaire achieved a response rate of 68% (i.e. 108 returned out of 160).

The results indicate that a positive start has been made to the participation of parents at case conferences and that this was generally welcomed by parents and professionals. Parents do not appear to be “emotionally damaged” by participation and the results indicate that they have a clearer understanding of concerns and a greater commitment to plans as a result of attending. Parental participation also does not appear to affect the focus and purpose of case conferences and indeed, professionals mainly found the presence of parents helpful to conferences.

The research highlighted deficiencies in the preparation of parents, a general feeling of inhibition amongst professionals, and a divergence in the views of parents and professionals as to whether or not participation should be full or partial. A number of conclusions for policy and practice are reached in light of die findings.     

“caught in the middle” exploring children and young people's experience of domestic violence

This document seeks to explore children's experiences of domestic violence and the effects such violence may have on their lives, both in the short term and in the long term. It draws on the conclusions of various studies in this area which have been carried out in America and the United Kingdom. It aims to raise awareness of the complexity of this issue and to highlight the importance of support for both women and children who may be survivors of domestic violence. The document highlights a number of issues, namely

How children and young people may experience domestic violence;

Identification of links between domestic violence and child abuse;

The impact domestic violence may have on mothering;

The effects domestic violence may have on children and young people's lives;

The legitimacy of the cycle of violence theory;

Issues to be considered when assessing the possible impact of domestic violence on children and young people.     

Child Care Providers' Experiences Caring For Sick Children: Implications For Public Policy

This study examines the experiences of preschool and school-age child care providers regarding sick child care.

In-depth, semi-structured interviews were conducted of child care providers at every city-sponsored preschool and afterschool program in an urban area in the United States. In addition, random sampling was used to identify home-based child care providers from a list obtained through a child care resources center. In spite of rules requiring that sick children be kept home, child care providers repeatedly described sick children whose health problems made it impossible to provide adequate care for the sick child at the same time as caring for the well children in their care. Problems arose for a range of reasons, including inability to provide sufficient attention to the sick child-s needs, inability to keep a sick child clean and well hydrated in the case of vomiting and diarrhea, spread of infectious diseases, and inability to care for healthy children adequately when meeting the needs of sick children.

International public health policy implications for child care and paid family leave are discussed.     

“Missing Milestones”

Missing milestones are known to be a normal variant of development. The purpose of our study is to find if missing milestones always lead to normal development?

METHODS

This is a prospective case study on seven patients referred for motor developmental problems from July 1997 to February 1998 and then followed over a 2-year period. On each attendance, the multi-disciplinary team assessed children

RESULTS

We present a case series of seven children with “missing motor milestones”. Six of the seven, had tactile defensiveness but absent parachute reflexes on presentation

At the end of the two year period, 3 infants had normal development (Group I). One was discharged after 7 months. The second one had speech problems most likely secondary to her bilateral serous otitis media, with no other developmental problems. The third child acquired age appropriate milestones before the care was transferred to another hospital. Of the four in Group II, three developed global developmental delay and the fourth was diagnosed to have multiple cavernous haemangiomata in the brain. The pre-school alert panel was alerted for two of them possibly needing future help in school

Five of the seven children in our study were still being followed up after two years

CONCLUSIONS

Missing milestones in a subject can be a benign variation of normal motor development. However, they may also be the first sign to appear in children with neuro-developmental disorders

Tactile defensiveness may be the most useful early sign to enable the early diagnosis of non-weight bearing children with 'missing milestones'     

Methodological Reflections on Using the Early Childhood Environment Rating Scale as a Measure to Make Cross-National Evaluations of Quality

How useful is the Early Childhood Environment Rating Scale (ECERS) as a research instrument in making cross-national comparisons of the quality of nurseries?

The paper briefly outlines the ECERS and discusses the extent to which it can be used as a universal evaluative tool to measure quality. The author reflects on her use of the ECERS scale in cross-national contexts, to comment on its advantages and its limitations.

The author used the ECERS as part of a qualitative investigation into nursery provision and practice between 1991 and 1994 in cities in fourcountries, New York, (USA) Harnosand, (Sweden), Arezzo (Italy) and Barcelona (Spain). The nurseries in which the author carried out observations and interviews were chosen by contacts in the countries concerned for both their willingness to participate and for their representativeness. A minimum of four institutions which took children under three were visited for at least half a day in each city.

The author uses examples derived from this research to argue that while the scale may have some advantages in that, ratings can be undertaken in two hours, and the scale can provide comparison measures on a number of criteria which child care professionals have agreed are significant, it also has a number of disadvantages. Because the scale is empirically rather than theoretically based and is not explicit about the evaluative categories, which underlie it, its use can obscure rather than illuminate, what different countries see as the most significant aspects of their care and education provision.

The paper concludes that we need to develop measurement tools which explicitly state the values and theoretical perspectives behind their construction.     

First evaluation of The Down Lisburn Trust Befriending scheme for young people leaving care

The Down Lisburn Trust befriending scheme was initially set up in October 1998, this piece of research was conducted in April 2000 and is the first evaluation of the scheme.

The purpose of this research study was to evaluate the benefits of the befriending scheme for young people 'looked after' or leaving the care of Down Lisburn Trust. This was achieved by collecting the retrospective views of the young people and their befrienders in relation to how the befriending scheme has benefited them.

As the befriending scheme is a relatively new project, the subjects used in the study were from the first intake of participants on the scheme. This comprised of 5 young people and 6 befrienders. In order to obtain the relevant information, questionnaires were devised for the young people and the befrienders.

The findings of this research study indicated that the befriending scheme benefits those young people in care and leaving care, by providing them with someone to talk to and help them pursue their interests. Also it has ensured there was someone to support them through difficult familial relationships, life in care and/or life after care. The findings also highlighted the need for clearer procedures and follow up in relation to the ending of befriending relationships to ensure that this already vulnerable group of young people are not damaged further.

The findings of this study agree with the findings of other research studies dating from the early 1980's, regarding the plight of young people in care and leaving care.

The Adolescence Team was established in 1990/91 and provides an integrated, specialised service to young people aged between 14 and 21 years old living within the Down Lisburn Trust area. It also provides a supported continuum of care, which enables young people who have been or are in care to live independently and safely in the community. It aims to do so by providing the following services; individual counselling, family work, assessment, mediation/negotiation, preparation for leaving care, aftercare support, group work, and child protection investigations. The following is an overview of the first evaluation of the scheme.     

Characteristics of successful directors of for-profit child care centers

The need for quality child care is a national concern of increasing interest to parents, child care providers, employers, and policy-makers in the United States. One of the newest entries in child care options available for consumers is for-profit daycare chains. As for-profit chains increase in both number and size, they will receive increased research attention. Few studies have examined for-profit centers in general or the background characteristics of their directors specifically.

The purpose of this research was to develop a profile of directors of for-profit child care centers and to investigate whether certain background variables, such as level of education, differentiated “successful” from “unsuccessful” directors. Data were collected on 362 child care directors employed during a three-year period with a nation-wide daycare chain in the United States.     

A Retrospective Critical Analysis of Family Support in Practice within a Residential Care Setting

The article is based on a practice task, which was completed as part of the Higher Diploma/Masters in Family Support Studies at NUI Galway. The practice task explored in this article was conducted in a residential care unit that specialised in working with children and families. The care team based in the unit strived to provide more than traditional residential care, recognising that though the child was no longer residing at home, the family was still central in the child's life and thus should be included in all aspects of the child's development. As the unit was in a period of transition, there was concern among the team that in adapting to the change, the level of reflective practice decreased. The author, in responding to the concerns of the team, identified a reflective task that incorporated the strengths within the team yet would provide an opportunity to evaluate practice.

The practice task identified was a reflective workshop in which the care team concentrated on one piece of practice and evaluated its impact on the child and family. The workshop examined speech and language work that the unit had engaged in and case vignettes were identified to facilitate a reflective discussion. The article begins with locating the practice task in family support theory and highlighting the principles of family support that were reflected in the task. The task reflected five of the practice principles of family support as outlined by Dolan et al. (2006). The primary principle reflected in the task and explored in this article is the importance of building measures of evaluation into practice based on the outcomes of service users. The article highlights the importance of reflection and how a reflective approach promotes greater levels of partnership and consultation with the service users and their families.     

The treatment of psychological problems experienced by the children of police officers in Northern Ireland

This paper will discuss the recent establishment of the Police Rehabilitation and Retraining Trust's Child and Adolescent Therapy Service. This service was set up in response to an expressed need within the police family to provide evidenced-based psychological therapies for child and adolescent psychopathology caused either directly by service-related incidents or indirectly via parental psychopathology. Officers receiving treatment within the Trust's Adult Psychological Therapies Service frequently expressed distress and guilt regarding the impact their service and related symptoms had on their children. In addition, officers reported a reluctance to utilise existing statutory child and adolescent mental health services.

The impact of the constantly changing political landscape on this population will be examined as the general decrease of an overt terrorist threat allows an opportunity for police families to count the cost the 'troubles' have had on their mental health and to assess what support is required. But the uncertainty of what level of covert threat remains continues to impact directly on family life.

This paper will examine the clinical approaches adopted by this specialist service, in particular Cognitive Behavioural Therapy and Eye Movement Desensitisation and Reprocessing. It will examine how an ongoing and current threat of further trauma impacts on treatment provision and on the establishment of the therapeutic alliance. Primary and secondary stressors unique to this population will be explored, and their impact on treatment, along with how these trauma-related problems might manifest themselves in a variety of disorders.

While the Child and Adolescent Therapy Service exists specifically to provide treatment for police children, the service aims to establish links with statutory services in an attempt to ensure that police families will be able to utilise existing resources, gradually moving away from the feelings of community isolation expressed by some police families.     

Who cares?—Supporting parents in the care of children in Hong Kong

The paper addresses the following questions: Why are children placed in residential care? What problems do the parents have in caring for their children at home? What services have been used by the parents in seeking solutions to these problems? Are parents' personal resources so inadequate that the risk of removing a child into care must be taken?

The study involved a sampling of the parents of children who were placed in residential care facilities. The findings indicated that most children were placed in residential care because the parents lacked the tangible resources necessary for them to bring up the children themselves. The findings challenge the simplistic assumption that only children who are orphaned or of irresponsible parents are placed in residential care, and prompt social workers to reflect on the practical means to support parents in the care of children in Hong Kong.     

Integration: Quality in care and education for the young disabled child

The presentation aims to examine the criteria of quality for care and education programmes for young disabled children in integrated early childhood settings. The conceptual and practical issues which influence quality programmes will be discussed with particular reference to the Integration Programmes operated throughout South Australia in early childhood centres.

The Integration Programmes, developed to enable and support the integrated or normalised development of young children has as its specific 'target' group individual children who are 'too delayed or disabled' to be able to fully participate or participate without direct assistance in community based early childhood programmes. Some of these children are extremely disabled and others' handicapping conditions are exacerbated by severe lack of other available community resources, isolation and other factors.

Integration is more than 'being there'—it is a complex process based upon the recognition of human value and human rights. For greater insight into the Integration Programmes an appraisal of the following aspects will be provided.

• the principles of integration

• the goals of integration

• the dimensions of integration.

The dimensions of integration will be placed in relation to the indicators of quality in early childhood programmes. The juxtaposing of these parameters of quality will lead to the emergence of guidelines for practical goalsetting and evaluation hallmarks of excellence in integration.     

Recovery work with child victims of sexual abuse: A framework for intervention

With each high profile case of sexual assault perpetrated against a child there generally follows a media driven reaction narrowly focusing on stranger danger or paedophile activity The difficulty is that this can present the false impression that therein lies the greatest danger to our children.

The situation with which parentdcarers, and professionals, are faced with in dealing with cases of child sexual abuse is much more complex for a variety of reasons. These include the fact that such abuse is mostly perpetrated by a member of the family or a close friend of the family or child; there are many cases of crossgenerational and sibling abuse; there is often fragmentation of families following disclosure; the immense challenge to strongly held beliefs regarding familv, society and religious values; and thaf a child's coping strategies often involves blocking out the abuse, disassociation and extreme forms of self-harm.

Much good literature exists on the phenomenon of child sexual abuse. However, there is a lack of written material on models of therapeutic intervention, and to engage in this area of work in the absence of a well thought-out framework for intervention would be highly irresponsible and dangerous. The purpose of this paper is to discuss the issue of intervention and in setting out a framework for intervention, the premise is followed that the child is not abused in isolation, but within a family and community context. For this reason theoretical considerations relating to victim impact, family functioning, social learning and developmental stages will be viewed as underpinning practice.