American Academy of Pediatrics. Committee on Hospital Care. Child life services

Child life programs have become the standard in large pediatric settings to address the psychosocial concerns that accompany hospitalization and other health care experiences. Child life programs facilitate coping and the adjustment of children and families in 3 primary service areas: 1) providing play experiences; 2) presenting developmentally appropriate information about events and procedures; and 3) establishing therapeutic relationships with children and parents to support family involvement in each child's care. Although other members of the health care team share these responsibilities for the psychosocial concerns of the child and the family, for the child life specialist, this is the primary role. The child life specialist focuses on the strengths and sense of well-being of children while promoting their optimal development and minimizing the adverse effects of children's experiences in a hospital setting.     

Urban elementary school personnel's perceptions of student health and student health needs.

OBJECTIVE: To determine the perceptions of school personnel with regard to urban students' health and health needs as part of a planning process for development and implementation of school-linked health services. METHODS: A self-administered, close-ended questionnaire was given to 294 schoolteachers and school staff to assess school personnel perceptions of 1) health needs of students, 2) priority of need for health services or programs delivered on-site or off-site, and 3) selected factors suspected to affect implementation of new school health services. RESULTS: A total of 72% of teachers and 77% of staff completed the survey. The most highly ranked need by school personnel was mental health, followed by violence and anger management and physical abuse and domestic violence. The most commonly requested services on-site and off-site were for physical abuse or domestic violence, mental health, and drug or other substance abuse. Only 40% of teachers and staff rated current health services as excellent or good. A total of 72% of teachers and staff had some level of discomfort with their current responsibilities regarding the health of students. Parental involvement was reported to be quite low, with only 9% of teachers and staff rating it as excellent or good. CONCLUSIONS: he greatest health care need identified by these elementary school personnel was not for management of chronic or acute physical health conditions, but for mental health services and programs to meet the emotional and psychosocial needs of students. When implementing school-linked or school-based mental health services, focus needs to be placed on 3 areas: 1) education of school health and educational personnel regarding common mental health issues, 2) development of systems that improve knowledge of and connection with mental health resources inside and outside the school, and 3) development of systems that improve communication within the school and between the school and parents regarding health services.     

The role of the pediatrician in rural emergency medical services for children

In rural America, pediatricians can play a key role in the development, implementation, and ongoing supervision of emergency medical services for children. Pediatricians may represent the only source of pediatric expertise for a large region and are a vital resource for rural physicians (eg, general and family medicine, emergency medicine), other rural health care professionals (physician assistants, nurse practitioners, emergency medical technicians), and local emergency medical services medical directors. They can provide education about management and prevention of pediatric illness and injury; appropriate equipment for the acutely ill or injured child; and acute, chronic, and rehabilitative care. In addition to providing clinical expertise, the pediatrician may be involved in quality assurance, clinical protocol development, and advocacy and may serve as a liaison between emergency medical services and other entities working with children (eg, school nurses, child care centers, athletic programs, and programs for children with special health care needs).     

Determinants of Career Satisfaction Among Pediatric Hospitalists: A Qualitative Exploration

ObjectiveTo characterize determinants of career satisfaction among pediatric hospitalists working in diverse practice settings; to develop a framework to conceptualize factors influencing career satisfaction.MethodsSemistructured interviews were conducted with community and tertiary care hospitalists, using purposeful sampling to attain maximum response diversity. We used closed- and open-ended questions to assess levels of career satisfaction and its determinants. Interviews were conducted by telephone, recorded, and transcribed verbatim. Emergent themes were identified and analyzed using an inductive approach to qualitative analysis.ResultsA total of 30 interviews were conducted with community and tertiary care hospitalists, representing 20 hospital medicine programs and 7 Northeastern states. Qualitative analysis yielded 657 excerpts, which were coded and categorized into 4 domains and associated determinants of career satisfaction: 1) professional responsibilities; 2) hospital medicine program administration; 3) hospital and health care systems; and 4) career development. Although community and tertiary care hospitalists reported similar levels of career satisfaction, they expressed variation in perspectives across these 4 domains. Although the role of hospital medicine program administration was consistently emphasized by all hospitalists, community hospitalists prioritized resource availability, work schedule, and clinical responsibilities, while tertiary care hospitalists prioritized diversity in nonclinical responsibilities and career development.ConclusionsWe illustrate how hospitalists in different organizational settings prioritize both consistent and unique determinants of career satisfaction. Given associations between physician satisfaction and health care quality, efforts to optimize modifiable factors within this framework, at both community and tertiary care hospitals, may have broad impacts.     

Screening for visual disorders in pre-primary school

Children's vision develops very early on in life and constitutes their first connection with their surroundings. Recommendations emphasise the importance of early screening to improve learning at school. The pre-primary school period, between the ages of 3 and 6 is the ideal time for this. Child care nurses thereby have an important role to play in terms of health education and orientation.     

Role of the school nurse in providing school health services

The school nurse has a crucial role in the seamless provision of comprehensive health services to children and youth. Increasing numbers of students enter schools with chronic health conditions that require management during the school day. This policy statement describes for pediatricians the role of the school nurse in serving as a team member in providing preventive services, early identification of problems, interventions, and referrals to foster health and educational success. To optimally care for children, preparation, ongoing education, and appropriate staffing levels of school nurses are important factors for success. Recommendations are offered to facilitate the working relationship between the school nurse and the child's medical home. This statement has been endorsed by the National Association of School Nurses.     

PNPs as catalysts in child care policymaking.

Dramatic socioeconomic changes in American family life, along with welfare reform, school readiness initiatives, and research on the relationship between child development and child care, have generated new interest in child care policy. Pediatric nurse practitioners and other pediatric nurses have much to contribute to the formulation of national, state, and local child care policies, especially if they are knowledgeable of key policies and regulatory issues. This article outlines these concepts with an eye toward promoting how pediatric nurses might reclaim their role as catalysts for promoting high-quality child care.     

The Impact of the COVID-19 Pandemic on Children/Youth With Special Health Care Needs: A School Nurse's Perspective

School nurses repeatedly have been stretched to the limits over the past few years with the COVID-19 pandemic—managing not only routine daily care of students but also juggling those unique needs of children and youth with special health care needs, especially for those who also lost a parent/caregiver from COVID-19. This article provides background demographic information on how the COVID-19 pandemic affected these children, along with a specific case report of a middle school student with attention deficit hyperactivity disorder who also experienced the loss of a parent from COVID-19. Specific practical suggestions are discussed on how school nurses proactively and collaboratively can assist these students whose lives were permanently changed by the life-changing event of losing a parent/caregiver from COVID-19.     

Survey of parents, nurses, and school principals on their perceptions of the controversial role of schools in health promotion

BACKGROUND: The aim of this paper was to study the perceptions of parents, nurses, and school principals of the role of the health services in elementary schools. METHODS: A questionnaire was distributed to the heads of parents' committees, school nurses, and school principals of 35 randomly selected elementary public schools in Israel. Respondents were asked to qualify the degree of importance of the traditional and contemporary roles of the school health-care team. RESULTS: Response rates were 80.0% for parents, 100% for nurses, and 97.1% for principals. All respondents agreed that both the traditional and new roles are very important. Nurses rated three interconnected roles significantly lower than parents and school principals: 'Evaluation of students with behavioral problems', 'Evaluation of students with low academic performance', and 'Follow up and care of students with behavioral problems and low performance'. CONCLUSIONS: Nurses, parents and school principals in Israel agree that the traditional roles of health teams in elementary schools, that is, providing first aid and ensuring school hygiene, are very important. Most are ready to accept a move from an illness-based to a social-based model, with less time spent on screening and surveillance and more on identifying and managing special needs of children and staff.     

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.     

PHYSICAL MASS EXAMINATIONS IN THE SCHOOL HEALTH SERVICE

Abstract. At 7 years of age, all 649 children in a school district underwent a physical examination, a vision screening and an auditory screening. The purpose of the present study was to analyse the value of the routine physical examination within the school health services. In 15% of the children functionally important health problems were found. Visual defects were most common, comprising 7.5%, then came physical health problems such as motor disturbances, obesity, bacteriuria in 6.5%, and hearing defects in 1%. About half of the important health problems were previously known. Most disorders of importance were detected by the nurse's screening examination and rather few by the doctor's physical examination. It seems advisable to introduce screening procedures in the hands of nurses also for the physical examination. The role of the school physician in the general health surveillance would then be mainly to control and verify specific observations or suspicions of disease or handicap noted by the school nurse. His time and attention could instead be directed towards important tasks, which are now often neglected, e.g. health education, and care of sick and handicapped children in the school setting.     

Training subspecialty nurses in developing countries: methods,outcome, and cost

BACKGROUND: As infections are controlled in developing countries, other pediatric subspeciality programs such as oncology become increasingly important. A major impediment to the development of such programs is a lack of trained nurses. Therefore, education of pediatric subspecialty nurses becomes a priority. PROCEDURE: We describe three models we have used for education of pediatric oncology nurses: a short series of classes or lectures with additional training of key nurses, an expanded 12 week series of classes at centers combining didactic and clinical instruction and a regional residential school offering regular 12 week courses in theory and clinical practice. RESULTS: Cost analysis showed that the cost per nurse trained was, respectively, 3,700; 4,350; and 5,500 US dollars. Early effectiveness indicators show that retention rates are high, home institutions are satisfied, and nurses trained shared their knowledge with other nurses and improved nursing practices. CONCLUSIONS: Programs to teach subspecialty nursing in developing countries are effective and can improve medical care. Such programs should be based on past experience and evaluated as to cost and effectiveness.     

Transdisciplinary Service Delivery in School Environments

Recent developments within the field of special education have resulted in a dramatic increase in the number of health related professionals, particularly physical and occupational therapists, entering the school system. These professionals are currently providing a wide variety of “related services” to handicapped children and young adults. The transdisciplinary service delivery model has been widely advocated as the most effective system for developing programs of comprehensive services for the developmentally disabled within the school environment. The transdisciplinary approach is reviewed and three potential areas of conflict frequently encountered in implementation of the model are discussed.     

Psychosocial issues in primary care of lesbian, gay, bisexual, and transgender youth

Lesbian, gay, bisexual, and transgender youth are at risk for a multitude of physical, emotional, and social health problems. During the past decade it has been well documented that these youth have higher-than-average rates of depression, suicide attempts, substance abuse, sexually transmitted diseases, school failure, family rejection, and homelessness. The focus of this article is to outline skills and strategies that can assist the health practitioner in creating an optimal health care experience for sexual minority youth. Models of individual and family adaptation, a clinical path, and a referral list are presented. Current health care delivery sites are examined, and recommendations are given for improvement of both practitioner skills and health care programs targeting these youth.     

The hospital nurse practitioner in pediatrics. A new expanded role for staff nurses

The Hospital Nurse Practitioner Program in Pediatrics at the University of Colorado Health Sciences Center, Denver, prepared staff nurses for a new and expanded role as health care providers in hospital settings. With the use of their increased skills and greater decision-making responsibilities, hospital nurse practitioners admitted patients to the hospital, assessed both the initial clinical status and subsequent changes in the patient's condition, wrote relevant orders, performed a variety of technical procedures (including many previously reserved to house staff and other physicians), ordered and interpreted laboratory studies, counseled patients and families, discharged patients, and provided other traditional nurse practitioner skills. Hospital nurse practitioners had an improved collaborative relationship with physicians. This program showed that hospital nurse practitioners can be as significant in affecting the health care that patients receive on the general units of hospitals, as are nurse practitioners who deliver care and services to ambulatory patients.     

Children with chronic conditions: Educators' views

The purpose of this qualitative, exploratory study was to identify the concerns and resource needs of educators for effectively teaching children with chronic health conditions. Semistructured audiotaped telephone interviews were conducted with 23 teachers and six principals from urban and rural public schools, grades K-12. The interview included questions in four areas: (a) experiences with children with chronic health conditions, (b) concerns in providing educational services to these children, (c) resources used by educators, and (d) recommendations regarding how information and services can best be provided to educators. The most common concerns were unanticipated medical emergencies and increased absence rates. The major resource for these educators was the school nurse. Educators preferred information specific to a child in their class, provided to them by the school nurse. Results suggest that interventions for teachers are more likely to be effective when they are coordinated with the school nurse and focus on the impact of the condition on a child's ability to function in the classroom. Subsequent research is necessitated to determine effective strategies for specialty nurses to aid school nurses in providing optimum care for these children.     

How can quality improvement enhance the lives of children with disabilities?

Much attention has aided measurement and improvement in the quality of health care during the past two decades, with new ways to define and measure quality, recognition that doing so can identify strategies to enhance care, and systematic efforts by both government and private insurers to apply these principles. In this article, James Perrin reviews these gains. Although children have benefited, these quality measurement efforts have focused mainly on adult health care. Now, two recent federal programs promise to expand quality measurement of child health care. Enacted in 2009, the Children's Health Insurance Program Reauthorization Act provides systematic support for efforts to develop and implement a set of child health quality measures. This federal support represents the first major public investment in improving child health care quality. The Affordable Care Act, which became law in 2010, extends those activities by focusing attention on improving care for people with chronic conditions, including new ways to organize care using teams of doctors, nurses, and others focused on improving chronic care outcomes. For children especially, this team care should also focus on prevention of chronic conditions and their consequences. Despite these significant efforts to expand quality measurement among children and youth, Perrin finds that most measures and improvement activities focus on children without chronic conditions, and few measures of chronic conditions go beyond examining what kinds of monitoring children with specific conditions receive. Only limited attention is paid to how well the children are functioning. A number of networks working with children with specific chronic health conditions (such as cancer, cystic fibrosis, and sickle cell disease) have developed effective measures of functioning for children with those conditions and active programs to improve such outcomes. These networks offer the best examples of how to improve care and outcomes for young people with disabilities. Broadening their impact to larger numbers of children with disabilities will require developing measures of functioning and quality of life and targeting interventions and efforts to improve those outcomes.     

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.     

1. PERSPECTIVES ON ADOLESCENT MEDICINE: CONCEPTS AND PROGRAM DESIGN

ABSTRACT
The concepts and goals of a program in adolescent medicine should include development of a capability to focus on current health needs of youth in a variety of settings; to plan clinical services to meet those needs with the flexibility necessary to respond to changing future requirements; and to deliver service within such a context while simultaneously creating a milieu conducive to education and investigation into the very process and definition of adolescence.
The Division of Adolescent Medicine at Montefiore Hospital and Medical Center was designed 7 years ago to fulfill these goals and consequently may serve others as a functional model for health care delivery to teenagers. The Division is comprised of: (1) a 37 bed in-patient unit; (2) a hospital-based ambulatory program including general diagnostic and follow-up services, as well as a specialty service capability in the areas of gynecology and family planning, cardiology, gastroenterology and nutrition; (3) primary care health services within teenage detention and prison facilities; (4) addictive disease diagnostic and treatment programs; (5) school health programs from intermediate school through college levels, and (6) the division also performs supportive and consultative functions for a variety of community-based agencies. Within the programatic design approximately 70,000 adolescents have been served.
The cornerstone of the educational and investigative efforts has been the concept that all of the above six functional units are clinical laboratories and classrooms so that training and research activities are integral parts of each of the service areas.
This program design is continually undergoing revision and refinement so as to remain ever-responsive to new and emerging problems to meet additional training demands and, most importantly, to permit and encourage creativity, and growth among patients and staff.     

Teaching about schools during pediatric residency.

OBJECTIVE: Several published guidelines have suggested that primary care pediatricians include school issues as part of regular health supervision visits. Few residency training programs include systematic education about educational issues that affect children's lives and success in school. The goal of this study was to evaluate a short curriculum on Children In School that was included as part of the 2-month required rotation in developmental-behavioral pediatrics. METHODS: A questionnaire was designed to assess 1) pediatric residents' attitudes about the importance of making school issues part of their practice, 2) pediatric residents' self-perceived knowledge about central concepts, and 3) pediatric residents' self-perceived skills.Participants.-Twenty-one of the 22 pediatric residents in 1 training program completed the questionnaire at the beginning of their first residency year and again during the final 3 months of their third (last) year. RESULTS: Residents assessed that their knowledge and skills relating to children in school were increased consistently (P < .001). Because they considered pediatricians' responsibilities to help improve children's school success to be important even before the program, there was little opportunity for improvement in ratings of "importance" over time. CONCLUSIONS: A relatively short teaching module introduced in the context of the developmental-behavioral pediatrics rotation can improve residents' self-assessed skills and knowledge about children in school.