Spirituality in Child and Youth Care: Considering Spiritual Development and “Relational Consciousness”

In response to the identification of spiritual development as part of children's lives in both the United Nations Convention on the Rights of the Child (1991) and the Association for Child and Youth Care Practice's document: Competencies for Professional Child and Youth Work Practitioners (Mattingly & Stuart, 2001), this paper considers a theoretical model of children's spirituality, relational consciousness, as proposed by Hay and Nye (1998). The paper encourages the introduction of a framework for understanding and exploring spiritual development in child and youth care research and practice that respects the cultural and social diversity of both religious and nonreligious settings and the lifespan developmental processes of children.     

Youth and Youth Coordinators’ Perspectives on Youth Involvement in Systems of Care

To increase understanding of the current status of youth involvement in Substance Abuse and Mental Health Services Administration-funded system-of-care communities, focus groups with youth and youth coordinators were conducted as part of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. Using focus group discussions as the primary qualitative data analysis method, these discussions addressed the ways in which youths are involved in their communities, the role of youth coordinators, the challenges that hinder youth participation, and strategies for overcoming these challenges. Discussions revealed that the most common form of youth involvement is through youth groups, and that apart from these groups, youth participation is largely absent. Key challenges to youth involvement include stigma and lack of support from system-of-care administrators and staff.     

Mental Health Literacy: A Conceptual Framework for Future Inquiry into Child and Youth Care Professionals’ Practice with Suicidal Adolescents

Knowledge and beliefs about mental disorders; attitudes that promote help-seeking; knowledge of risk factors and causes, treatments and self-help, and professional help available are all elements of mental health literacy. The complexities of practice with suicidal adolescents and young people suffering from mental health concerns require conceptual frameworks, such as mental health literacy, that can adequately identify professionals’ strengths and educational needs. In light of current research, this paper identifies Child and Youth Care (CYC) professionals as optimally situated to prevent adolescent suicide, examines adolescent help-seeking as an element of mental health literacy central to CYC practice, explores additional elements of mental health literacy relevant to CYC practice, and offers suggestions for future inquiry into CYC professionals’ mental health literacy in practice with suicidal adolescents.     

HIV Care Cascade Among Adolescents in a “Test and Treat” Community-Based Intervention: HPTN 071 (PopART) for Youth Study

PurposeThe PopART for Youth (P-ART-Y) study was nested within the HPTN 071 (PopART) trial, a three-arm community randomized trial in 21 communities in Zambia and South Africa. The P-ART-Y study evaluated the acceptability and uptake of a combination HIV prevention package among young people. We report on the HIV care cascade for adolescents aged 10–19 years from 14 communities receiving the full HIV prevention package in Zambia and South Africa.MethodsAdolescents were offered participation in the PopART intervention, which included universal home-based HIV testing, linkage to care, antiretroviral therapy (ART) adherence, and other services. Data were collected from September 2016 to December 2017, covering the third round (R3) of the intervention.ResultsWe enumerated (listed) 128,241 adolescents (Zambia: 95,295 and South Africa: 32,946). Of the adolescents offered HIV testing, 81.9% accepted in Zambia and 70.3% in South Africa. Knowledge of HIV status was higher among older adolescents and increased from 31.4% before R3 to 88.3% at the end of R3 in Zambia and from 28.3% to 79.5% in South Africa. Overall, there were 1,710 (1.9%) adolescents identified as living with HIV by the end of R3 (515 new diagnoses and 1,195 self-reported). Of the new diagnoses, 335 (65.0%) were girls aged 15–19 years. The median time to initiate ART was 5 months. ART coverage before and after R3 increased from 61.3% to 78.7% in Zambia and from 65.6% to 87.8% in South Africa, with boys having higher uptake than girls in both countries.ConclusionsThe PopART intervention substantially increased coverage toward the first and second UNAIDS 90-90-90 targets in adolescents.     

Stability and Change of Adolescents’ Aggressive Behavior in Residential Youth Care

Background

Aggression in residential youth care institutions is a frequent problem.

Objective

The present short-term longitudinal study examined individual and institutional predictors of aggression in a group of 198 adolescents placed in open, semi-secure and secure residential institutions from the perspective of the importation and deprivation model.

Methods

A total of 198 adolescents in residential youth care filled in questionnaires regarding group climate and aggression with a 3 month interval. Hierarchical multiple regression analyses were performed to test the degree to which individual and contextual factors predict aggression.

Results

Very limited support was found for the effect of contextual factors; only repression showed a trend, predicting direct aggression, while gender composition of the living groups yielded a small effect. Girls placed in same-gender groups showed lower levels of indirect (relational) aggression compared to adolescents placed in mixed-gender or boys-only groups, even when controlled for gender and initial levels of aggression. Type of institution (i.e., level of security) did not predict differences in aggression. In particular individual characteristics of the adolescents were associated with later aggression, including initial levels of aggression, showing substantial 3 months stability, age and gender of the adolescents.

Conclusions

These findings are in line with research showing that aggression is relatively stable. Very limited support for environmental effects was found.

     

Influences on Parents’ Child Care Choices: A Comparative Analysis of Preschool and Long Day Care Users

Background

This paper investigates Australian parents’ child care decision-making, including the motivational and influential factors that they attribute to their choice. Research demonstrates that child care decision making is multifaceted, involving a combination of child-related, personal, familial and contextual considerations. Existing research has tended to compare centre-based child care users with those using family-based options, and has not examined differences in the decision-making of parents who using different centre-based options.

Objective

This study compared the characteristics and child care choices of parents using long day care (LDC) with those using preschool services to determine (1) whether they differ demographically and (2) if their reported child care decision-making motivations and influences diverge.

Method

Participants were 1418 parents who completed a nationally-distributed survey in which they provided demographic information, specified their reasons for choosing to use child care, and rated the importance of factors that influenced their child care choice.

Results

LDC parents had, on average, younger children, worked longer hours and resided in areas with lower socioeconomic resources than preschool parents. When compared with preschool parents, those using LDC were more likely to nominate pragmatic factors as influencing their child care decision making. External pressures, mainly related to educational outcomes, were more salient for preschool than LDC parents. However, both groups of parents similarly rated child-centred factors as the most important overall influence.

Conclusion

Our findings add complexity to current understandings of parents’ child care decision making by showing that parents should not be treated as a homogenous group by policy makers, providers, and researchers.

     

Family Child Care Providers’ Nutrition Practices and Policies: Happy Healthy Homes

ObjectiveDetermine the impact of family child care home providers’ nutrition knowledge, confidence, and perceived barriers on program nutrition best practices and written nutrition policies.MethodsCross-sectional analysis of self-reported surveys of 49 female providers in Oklahoma City analyzed with Spearman correlation, multivariate linear and logistic regression (α < 0.05).ResultsConfidence and barriers were significantly correlated (r_s(47) = −0.4, P = 0.004). Independent variables explained 36% of practices (r² = 0.357). Nutrition knowledge (standard β = 0.442, P = 0.001) and confidence (standard β = 0.358, P = 0.008) were significantly associated with practices; barriers were not. No significant association between independent variables and written policies resulted.Conclusions and ImplicationsProvider nutrition knowledge and confidence appear to be suitable targets to improve nutrition practices. Further research can evaluate possible influences on the presence and quality of family child care home written nutrition policies and specific nutrition policy topics associated with healthier nutrition practices.     

Can the Medical Home Eliminate Racial and Ethnic Disparities for Transition Services Among Youth with Special Health Care Needs?

The Medical Home (MH) is shown to improve health outcomes for Youth with Special Health Care Needs (YSHCN). Some MH services involve Transition from pediatric to adult providers to ensure YSHCN have continuous care. Studies indicate racial/ethnic disparities for Transition, whereas the MH is shown to reduce health disparities. This study aims to (1) Determine the Transition rate for YSHCN with a MH (MH Transition) nationally, and by race/ethnicity (2) Identify which characteristics are associated with MH Transition (3) Determine if racial/ethnic disparities exist after controlling for associated characteristics, and (4) Identify which characteristics are uniquely associated with each race/ethnic group. National survey data were used. YSCHN with a MH were grouped as receiving Transition or not. Characteristics included race, ethnicity (Non-Hispanic (NH), Hispanic), sex, health condition effect, five special health care need categories, education, poverty, adequate insurance, and urban/rural residence. Frequencies, chi-square, and logistic regression were used to calculate rates and define associations. Alpha was set to 0.05. About 57.0% of YSHCN received MH Transition. Rates by race/ethnicity were 59.0, 45.5, 60.2, 41.9, and 44.6% for NH-White, NH-Black, NH-Multiple race, NH-Other, and Hispanic YSHCN, respectively. Disparities remained between NH-White and NH-Black YSHCN. All characteristics except urban/rural status were associated. Adequate insurance was associated for all race/ethnic groups, except NH-Black YSHCN. Almost 57.0% of YSHCN received MH Transition. Disparities remained. Rates and associated characteristics differed by race/ethnic group. Culturally tailored interventions incorporating universal factors to improve MH Transition outcomes are warranted.     

Talking “truth”: Predictors and Consequences of Conversations about a Youth Antismoking Campaign for Smokers and Nonsmokers

Using data from the Legacy Media Tracking Survey II, this study investigated relations among youth's evaluations of the “truth” antismoking campaign, campaign-related interpersonal discussion, and campaign-relevant outcomes (n = 8,000). Regression analyses showed that smokers were less likely to have discussed the campaign than nonsmokers, and this effect was mediated by negative campaign evaluation. However, smokers with a negative evaluation of the campaign were more likely to talk about it than were nonsmokers reporting negative evaluation. Nonsmokers who talked about the campaign had beliefs, attitudes, and intentions in greater agreement with campaign messages than those who did not talk about the campaign. For smokers, talking about the campaign was associated with beliefs, attitudes, and intentions in greater agreement with campaign messages, but only if associated with positive campaign evaluation. For smokers with a negative campaign evaluation, talking about the campaign was associated with beliefs and attitudes counter to the campaign messages.     

Defining “Rural” for Veterans’ Health Care Planning

Purpose: The Veterans Health Administration (VHA) devised an algorithm to classify veterans as Urban, Rural, or Highly Rural residents. To understand the policy implications of the VHA scheme, we compared its categories to 3 Office of Management and Budget (OMB) and 4 Rural-Urban Commuting Area (RUCA) geographical categories. Method: Using residence information for VHA health care enrollees, we compared urban-rural classifications under the VHA, OMB, and RUCA schemes; the distributions of rural enrollees across VHA health care networks (Veterans Integrated Service Networks [VISNs]); and how each scheme indicates whether VHA standards for travel time to care are met for the most rural veterans. Results: VHA's Highly Rural and Urban categories are much smaller than the most rural or most urban categories in the other schemes, while its Rural category is much larger than their intermediate categories. Most Highly Rural veterans live in VISNs serving the Rocky Mountains and Alaska. Veterans defined as the most rural by RUCA or OMB are distributed more evenly across most VISNs. Nearly all urban enrollees live within VHA standards for travel time to access VHA care; so do most enrollees defined by RUCA or OMB as the most rural. Only half of Highly Rural enrollees, however, live within an hour of primary care, and 70% must travel more than 2 hours to acute care or 4 hours to tertiary care. Conclusions: VHA's Rural category is very large and broadly dispersed; policy makers should supplement analyses of Rural veterans’ health care needs with more detailed breakdowns. Most of VHA's Highly Rural enrollees live in the western United States where distances to care are great and alternative delivery systems may be needed.     

Predictors of Home-Based Child Care Providers’ Participation in Professional Development Workshops and Coaching

Background

Little is known about factors that influence home-based child care providers’ participation in professional development. Factors that predict participation in activities that are designed to promote the utilization and maintenance of skills taught are of particular interest.

Objective

Our aim was to examine factors in the home-based child care context that might influence participation in professional development, including demographic variables, working conditions, preintervention skills and training, perceptions of workshop usefulness, and interpersonal factors such as job-related stress and depressive symptoms.

Methods

In this exploratory study, we examined predictors of participation among 67 home-based child care providers in Oregon, USA, who took part in the intervention group of a randomized efficacy study on a multiphase professional development program to promote preschoolers’ positive social development.

Results

Latent class analysis of participation resulted in three distinct groups: those who participated in the initial three workshops (WS), those who participated in workshops plus maintenance activities (consultation and a booster session, WS+), and those with little to no participation (NP). The NP group was too small to include in further analysis. A multivariate logistic regression model with child care provider education, number of preschool-age children enrolled in care, child-to-caregiver ratio, and self-reported stress included as predictors significantly improved classification in the WS+ group compared to the WS group.

Conclusions

These findings offer a preliminary look at the unique factors influencing home-based child care providers’ participation in extended professional development. Relevancy of content to child care providers’ situations appears to be important.     

Academy of Nutrition and Dietetics Benchmarks for Nutrition in Child Care 2011: Are Child-Care Providers across Contexts Meeting Recommendations?

The Academy of Nutrition and Dietetics (Academy) recommends feeding practices for child-care providers to establish nutrition habits in early childhood to prevent obesity. With >12 million US children in child care, little is known about child-care providers’ feeding practices. The purpose of this study was to examine child-care providers’ feeding practices to assess whether providers met the Academy’s benchmarks and whether attainment of benchmarks varied across child-care contexts (Head Start, Child and Adult Care Food Program [CACFP], and non-CACFP). Cross-sectional data was collected in 2011 and 2012 from 118 child-care providers who completed self-administered surveys regarding their feeding practices for 2- to 5-year-old children. χ² tests and analysis of variance were used to determine variation across contexts. Head Start providers sat more frequently with children during meals (P=0.01), ate the same foods as children (P=0.001), and served meals family style (P<0.0001) more often compared with CACFP and non-CACFP providers. Head Start providers (P=0.002), parents (P=0.001), and children (P=0.01) received more nutrition-education opportunities compared with CACFP and non-CACFP. Head Start providers encouraged more balance and variety of foods (P<0.05), offered healthier foods (P<0.05), modeled healthy eating (P<0.001), and taught children about nutrition (P<0.001) compared with CACFP and non-CACFP providers. Providers across all three contexts used significantly more non-internal than internal mealtime verbal comments (P<0.0001). Head Start providers had greater compliance with the Academy’s benchmarks compared with CACFP and non-CACFP providers. Possible reasons for this compliance might be attributed to Head Start nutrition performance standards and increased nutrition-training opportunities for Head Start staff. Head Start programs can serve as a model in implementing the Academy’s benchmarks.     

Creating “Well-Functioning” Residential Care and Defining Its Place in a System of Care

This article presents a model for understanding the elements and dynamics of a well-functioning residential group care resource based upon the study of 10 group care residences over a 14-month period. In addition, seven characteristics related to the differential use of foster care and residential care are presented. Finally, five key processes suggested as necessary for the creation of a system of care for young people are offered for consideration.     

Parent Website Engagement and Health Equity Implications in a Child Care–Based Wellness Intervention

ObjectiveTo evaluate demographic differences in parent website engagement in a child care–based wellness intervention.DesignParent-reported demographic characteristics and observed website engagement were averaged by child care centers participating in the web-based intervention arm of a cluster randomized controlled trial of wellness interventions.Setting and ParticipantsParents of preschoolers in 17 Maryland child care centers.Main Outcome MeasuresWebsite engagement: (1) webpage views, (2) average time on webpage, and (3) intervention activity completion.InterventionParents received access to a website containing content on wellness-promoting topics (eg, parenting, nutrition, physical activity) and their child care center's activities.AnalysisCross-sectional differences in website engagement by demographic characteristics were assessed using ANOVA.ResultsCenters with a high proportion of parents who identified as other than non-Hispanic White and had less than a bachelor's degree had significantly fewer webpage views, and completed significantly fewer intervention activities compared with centers with parents who were predominantly non-Hispanic White and had more than a bachelor's degree.Conclusions and ImplicationsDemographic differences in parents’ child care center website engagement represent disparities that could contribute to health inequities in parents’ access to wellness-promoting material. Future efforts could identify factors that eliminate demographic disparities in parent engagement in web-based interventions.     

Books and Toddlers in Child Care: Under What Conditions are Children Most Engaged?

Background

Although shared book reading is seen as an effective way to support children’s early literacy and language development, less is known about the factors associated with toddlers’ engagement with books.

Objective

The goal of the current study was to examine younger and older toddlers’ engagement with books during one-on-one reading with a teacher in an interactive versus non-interactive manner and during independent exploration.

Method

Using single-case design, the study examined how engagement among toddlers (N = 6) in a childcare classroom varied under different book reading/exploration conditions.

Results

Results indicated that overall engagement was greater when teachers read interactively compared to when children explored books on their own, with this effect differing for younger versus older toddlers.

Conclusions

Understanding how teachers reading to younger and older toddlers is associated with children’s engagement with books compared to children’s engagement when exploring books on their own can inform early care and education reading practices with toddlers. Implications for book reading with toddlers in group childcare are discussed.

     

Care for Nurses Only? Medicine and the Perceiving Eye

In this paper I introduce a theoretical framework on care developed by the Norwegian nurse and philosopher Kari Martinsen, and I argue that this approach has relevance not only within nursing, but also within clinical medicine. I try to substantiate this claim by analysing some of the key concepts in this approach, and I illustrate the potential clinical relevance of this approach by applying it in relation to two care scenarios. Finally, I discuss some of the concerns that have been raised in relation to the aim of highlighting care in medicine.