Reviewing child deaths - Learning from the American experience

Current systems for investigating child deaths in England, Wales and Northern Ireland have come under intense scrutiny in recent years and questions have been raised about the accuracy of child death investigations and resulting statistics. Research has highlighted the ways in which multidisciplinary input can contribute to investigative and review processes, a perspective which is further supported by recent UK policy developments. The experience of creating multidisciplinary child death review teams (CDRTs) in America highlights the potential benefits the introduction of a similar system might have. These benefits include improved multi-agency working and communication, more effective identification of suspicious cases, a decrease in inadequate death certification and a broader and more in-depth understanding of the causes of child deaths through the systematic collection and analysis of data. While a lack of funding, regional coordination and evaluation limit the impact of American CDRTs, the positive aspects of this process make it worthwhile, and timely, to consider how such a model might fit within our own context. Current policy developments such as the Home Office review of coroner services, the Children Bill and related Department for Education and Skills (DfES) work on developing screening groups demonstrate that strides have been made in respect of introducing a multidisciplinary process. Similarly, the development of local protocols for the investigation and/or review of child deaths in England, Wales and Northern Ireland highlights an increased focus on multidisciplinary processes. However, key issues from the American experience, such as the remit of CDRTs/screening panels, the need for national coordination and the importance of rigorous evaluation, can inform the development of a similar process in the UK. Copyright ©2005 John Wiley & Sons, Ltd.

New challenges faced by carers during their child's hospital admission under segregation

Introduction
This paper presents the results of a qualitative study of CF family carers at the Belfast Paediatric CF Centre. The aim of this study was to describe the carer experience of their child’s admission to hospital under segregated care arrangements, and to highlight the meaning of segregation and cross infection from the carer perspective.

Method
Carers of children with CF who were admitted for two week IV antibiotic treatment during the study period were eligible to participate in this qualitative study. A consecutive series of eligible carers were approached in order of admission and within the time constraints of KR who was present two days each week. Recruitment of carers ended when no new themes emerged. Ten carers, 9 mothers and 1 couple, were interviewed about their experiences (mean age of child: 11.8 years; range: 1-17 years). Interpretative Phenomenological Analysis (IPA) was used to analyse and interpret the interview data.

Results and discussion
Balancing demands and dilemmas was the main contextual theme or experience of being a carer of a child with CF, and particularly so during admission to hospital. Many decisions were required every day that resulted in ‘double binds’ comprising uncertainty and stress. Three secondary themes captured the essence of carers’ experiences specifically related to segregation: managing risk and uncertainty; the burden of admission; and getting through each day. These themes will be described with examples illustrating the challenges faced by carers during their child’s hospitalisation, and the impact of segregation upon carers.

Walking the Tightrope: Using Power and Authority in Child Welfare Supervision

Recognizing the importance of understanding the way in which supervisors in child welfare perceive their administrative responsibilities and use of power and authority, an exploratory study was conducted. Supervisors in child welfare agencies in urban and rural settings participated in focus groups and discussed the impact of macro and micro factors on their performance. Policy changes, including using new approaches to child welfare, and organizational culture had a major affect on the way they offered supervision. At the micro level, their use of power was related to elements in their relationships with frontline workers and their own professional development. Implications for child welfare practice and for new and experienced supervisors are presented.

Incorporation of the United Nations Convention on the Rights of the Child in Law: A Comparative Review

Incorporation in law is recognised as key to the implementation of the UNCRC. This article considers the ways in which a variety of countries have chosen to incorporate the CRC, drawing on a study conducted by the authors for UNICEF-UK. It categorises the different approaches adopted into examples of direct incorporation (where the CRC forms part of domestic law) and indirect incorporation (where there are legal obligations which encourage its incorporation); and full incorporation (where the CRC has been wholly incorporated in law) and partial incorporation (where elements of the CRC have been incorporated). Drawing on evidence and interviews conducted during field visits in six of the countries studied, it concludes that children’s rights are better protected – at least in law if not also in practice – in countries that have given legal status to the CRC in a systematic way and have followed this up by establishing the necessary systems to support, monitor and enforce the implementation of CRC rights.

Reducing Child Protection Error in Social Work: Towards an Holistic-Rational Perspective

Social work in the United Kingdom remains embroiled in concerns about child protection error. The serious injury or death of vulnerable children continues to evince much consternation in the public and private spheres. Governmental responses to these concerns invariably draw on technocratic solutions involving more procedures, case management systems, information technology and bureaucratic regulation. Such solutions flow from an implicit use of instrumental rationality based on a ‘means-end’ logic. While bringing an important perspective to the problem of child protection error, instrumental rationality has been overused limiting discretion and other modes of rational inquiry. This paper argues that the social work profession should apply an enlarged form of rationality comprising not only the instrumental-rational mode but also the critical-rational, affective-rational and communicative-rational forms. It is suggested that this combined, conceptual arsenal of rational inquiry leads to a gestalt which has been termed the holistic-rational perspective. It is also argued that embracing a more rounded perspective such as this might offer greater opportunities for reducing child protection error.

The Positives of Caregiving: Mothers’ Experiences Caregiving for a Child With Autism

Most research in the field of autism focuses on the medical and psychological characteristics of the disability. Research that focuses on caregiving emphasizes the stresses and pathological features associated with having a child with autism. As such, the more positive aspects of caregiving have been left in abeyance, portraying caregiving and autism as characterized by only negative experiences, prognoses, and outcomes. Based on mothers’ reflections, this article reports on some of the positives of caregiving. The findings provide a glimpse into a seldom studied side of caregiving—events and experiences appraised by mothers in a positive and sometimes joyous light—and the impact they have on mothers’ experiences. Furthermore, practical implications for social service professionals and families are discussed.

The importance of the gestation period for welfare of lambs: Maternal stressors and lamb vigour and wellbeing

The prenatal period is of critical importance in defining how individuals respond to their environment throughout life. Stress experienced by pregnant females has been shown to have detrimental effects on offspring behaviour, health and productivity. The sheep has been used extensively as a model species to inform human studies. However, in the farmed environment, the consequences for the lamb of the imposition of prenatal stresses upon the ewe have received much less attention. The stressors that pregnant ewes are most frequently exposed to include sub-optimal nutrition and those related to housing, husbandry and environment which may be either acute or chronic. A systematic review of the literature was adopted to identify material which had production-relevant maternal stressors and lamb outcomes. The current review focussed upon the lamb up to weaning around the age of 100 days and the results clearly demonstrate that stressors imposed upon the ewe have implications for offspring welfare and performance. Maternal under-nutrition (UN) in the last third of pregnancy consistently impaired lamb birth-weight and subsequent vigour and performance, while earlier UN had a variable effect on performance. Feeding the ewe above requirements did not have positive effects on lamb performance and welfare. Social and husbandry stressors such as transport, shearing, mixing and physiological treatments designed to mimic acute stress which would be considered disadvantageous for the ewe had positive or neutral effects for the lamb, highlighting a potential conflict between the welfare of the ewe and her lamb. This review also identified considerable gaps in knowledge, particularly in respect of the impact of disease upon the ewe during pregnancy and interactions between different stressors and the responses of ewe and lamb.

Parent-child agreement and prevalence estimates of diagnoses in childhood: direct interview versus family history method.

Diagnostic information on children is typically elicited from both children and their parents. The aims of the present paper were to: (1) compare prevalence estimates according to maternal reports, paternal reports and direct interviews of children [major depressive disorder (MDD), anxiety and attention-deficit and disruptive behavioural disorders]; (2) assess mother-child, father-child and inter-parental agreement for these disorders; (3) determine the association between several child, parent and familial characteristics and the degree of diagnostic agreement or the likelihood of parental reporting; (4) determine the predictive validity of diagnostic information provided by parents and children. Analyses were based on 235 mother-offspring, 189 father-offspring and 128 mother-father pairs. Diagnostic assessment included the Kiddie-schedule for Affective Disorders and Schizophrenia (K-SADS) (offspring) and the Diagnostic Interview for Genetic Studies (DIGS) (parents and offspring at follow-up) interviews. Parental reports were collected using the Family History - Research Diagnostic Criteria (FH-RDC). Analyses revealed: (1) prevalence estimates for internalizing disorders were generally lower according to parental information than according to the K-SADS; (2) mother-child and father-child agreement was poor and within similar ranges; (3) parents with a history of MDD or attention deficit hyperactivity disorder (ADHD) reported these disorders in their children more frequently; (4) in a sub-sample followed-up into adulthood, diagnoses of MDD, separation anxiety and conduct disorder at baseline concurred with the corresponding lifetime diagnosis at age 19 according to the child rather than according to the parents. In conclusion, our findings support large discrepancies of diagnostic information provided by parents and children with generally lower reporting of internalizing disorders by parents, and differential reporting of depression and ADHD by parental disease status. Follow-up data also supports the validity of information provided by adolescent offspring.

'What ever happened to breakdancing?' : transnational b-boy/b-girl networks, underground video magazines and imagined affinities

In 1997, Paul Gilroy was able to write: "I have been asking myself, whatever happened to breakdancing" (21), a form of vernacular dance associated with urban youth that emerged in the 1970s. However, in the last decade, breakdancing has experienced a massive renaissance in movies (You Got Served), commercials ("Gotta Have My Pops!") and documentaries (the acclaimed Freshest Kids). In this thesis, 1 explore the historical development of global b-boy/bgirl culture through a qualitative study involving dancers and their modes of communication. Widespread circulation of breakdancing images peaked in the mid-1980s, and subsequently b-boy/b-girl culture largely disappeared from the mediated landscape. The dance did not reemerge into the mainstream of North American popular culture until the late 1990s. 1 argue that the development of major transnational networks between b-boys and b-girls during the 1990s was a key factor in the return of 'b-boying/b-girling' (known formerly as breakdancing). Street dancers toured, traveled and competed internationally throughout this decade. They also began to create 'underground' video documentaries and travel video 'magazines.' These video artefacts circulated extensively around the globe through alternative distribution channels (including the backpacks of traveling dancers). 1 argue that underground video artefacts helped to produce 'imagined affinities' between dancers in various nations. Imagined affinities are identifications expressed by a cultural producer who shares an embodied activity with other practitioners through either mediated texts or travels through new places. These 'imagined affinities' helped to sustain b-boy/b-girl culture by generating visual/audio representations of popularity for the dance movement across geographical regions.

Back to Basics: Exploring gestural habits as cues for anticipating self-injurious episodes in a child with Autism and Deafness

This research project is a longitudinal qualitative case study. It contributes to an understanding of self-injurious behaviour (SIB) by inviting the reader through the narrative of the lived experience of a fifteen year old child-informant and the network of individuals in his life. The value and importance of a case-study is that it focuses on the authenticity of the experience of living with disability. Through the use of detailed field observations, interviews and photo documents, the study thoroughly explores three main areas: quality of movements, potential cues as pre-cursors to episodes of self-injury, and purposeful communication. The research begins with a review of literature on Autism, Deafness and Self-injury, formulates the research design and orientation of Physical Education, Phenomenology and Semiotics, and then systematically explores four distinct phases in the analytical process. The aim was to explore self-injurious episodes in the child informant in hopes to translate the meaning of the behaviour and potentially utilize this to provide more opportunities for adapted physical activity. The findings reveal distinct patterns of movement cues utilized for different purposes. The implications of the findings are self-injurious episodes in the child informant are preceded by distinct patterns of movement that are potentially communicative. Suggested future direction of the research is expanding the scope to other disabilities for which verbal communication is challenging, and standardizing the translating tools to assist in understanding the communication of movement.

Deconstructing Child Youth Care: an autoethnographic exploration of physical restraints in children’s residential settings

This thesis is written through the front-line perspective of a child/youth worker who has experienced ‘rupture’ in her personal understanding of the Child Youth Care (CYC) practice. Using a collection of personal journal entries written about her individual experiences of CYC education, mentorship/training, front-line residential practice and frequently used interventions, this thesis takes the reader (and the writer) on a discovery of prominent discourses that exist within the residential CYC profession. Focusing on the use of physical restraints on children by residential Child/Youth Workers, this research project utilizes Deconstructive Discourse Analysis and Liberation Psychologies to illustrate a critical examination of power-knowledge and scientific/medical discourses in CYC practice. By focusing on Foucault’s concepts of disciplinary power, binary division and theory of panopticism, the writer seeks to explore a personal reflection and comprehension of how power is used to assert control over children/youth through mental health treatment and physical interventions.

Parental separation and child adjustment : longitudinal perspective and risk factors

Malgré de nombreuses études qui soutiennent l'idée que les enfants ayant vécu la rupture de leurs parents rencontrent un plus haut niveau de difficultés affectives et comportementales que les enfants de familles intactes, certaines questions restent à éclaircir. Notamment, les données empiriques existantes ne conduisent pas à des conclusions précises quant au moment exact de l’apparition de ces difficultés. De plus, ce n'est pas clair si ces difficultés sont associées à la séparation en soi, ou à bien d'autres facteurs liés à la séparation. Cette thèse est constituée de deux articles empiriques. Le premier examine l’adaptation de l’enfant avant et après la séparation en fonction du sexe et de l'âge au moment de la séparation. Le second article présente une étude qui a pour objectif de départager l’importance des facteurs parentaux et contextuels et celle de la séparation parentale pour expliquer l’adaptation de l’enfant. Les participants proviennent de l'Étude Longitudinale du Développement des Enfants du Québec (ÉLDEQ, 1998-2006). À chaque enquête de l'ÉLDEQ, une entrevue structurée réalisée auprès de la mère a permis d'évaluer les niveaux d’hyperactivité/impulsivité, d’anxiété et d’agressivité physique de l’enfant. Pendant cette entrevue, les mères ont également répondu à des questions sur la qualité de leurs pratiques parentales et sur le revenu du ménage. Finalement, un questionnaire auto-administré à la mère a permis d'évaluer ses propres symptômes de dépression et d'anxiété. La première étude inclus 143 enfants de familles séparées et 1705 enfants de familles intactes. Deux sous-groupes ont été créés selon que l’enfant ait vécu la séparation entre 2 et 4 ans, ou entre 4 et 6 ans. L’adaptation de l'enfant a été évaluée à un temps de mesure avant la séparation et à deux temps de mesure après la séparation. Les résultats de cette première étude démontrent qu’avant la séparation, les enfants de familles intactes et séparées ne se distinguent pas significativement quant à leurs niveaux d’hyperactivité/impulsivité et d’anxiété. Par contre, ces difficultés deviennent significativement plus élevées chez les enfants de familles séparées après la rupture des parents. D’autres parts, le niveau d’agressivité physique est plus élevé chez les enfants de la séparation indépendamment du temps de mesure. Finalement, les différences entre les deux groupes d’enfants ne dépendent pas du sexe ou de l’âge au moment de la séparation. La deuxième étude inclus 358 enfants de 8 ans qui ont vécu la séparation de leurs parents, et 1065 enfants du même âge provenant de familles intactes. Après avoir contrôlé pour le sexe de l’enfant, les résultats ont démontré que lorsqu’on tient compte de la contribution des symptômes maternels de dépression et d'anxiété, de la qualité des pratiques parentales et du revenu du ménage dans l’adaptation de l’enfant, la séparation parentale ne demeurent plus liée aux niveaux d’anxiété et d'agressivité physique de l’enfant. Par contre, la relation entre la séparation parentale et l’hyperactivité/impulsivité de l’enfant demeure significative. Les résultats présentés dans les articles sont discutés ainsi que leurs implications.

Actitudes hacia el VIH/SIDA, el cáncer y la enfermedad de Alzheimer

Esta revisión de la literatura tuvo como objetivo describir las actitudes hacia el VIH/SIDA, el cáncer y la Enfermedad de Alzheimer desde el modelo tripartito. Se revisaron 109 artículos publicados entre 2005 y 2015 en algunas bases de datos especializadas y herramientas de análisis de impacto. También se incluyeron fuentes secundarias ampliándose la búsqueda a los últimos 20 años (1995-2015). Los resultados mostraron que la mayoría de los estudios realizados sobre las actitudes hacia estas tres enfermedades son de tipo cuantitativo y la información se analizó con base en los componentes del modelo tripartito. Algunos aspectos sociodemográficos como el sexo y la edad están asociados con las actitudes hacia las tres enfermedades y predominan las creencias erróneas sobre ellas respecto a sus causas, curso y tratamiento. También predominan actitudes negativas hacia las tres enfermedades y las conductas e intenciones conductuales son diversas hacia cada una de ellas. No se hallaron antecedentes empíricos del estudio de la estructura de las actitudes propuesta por el modelo tripartito hacia las tres enfermedades. La Salud Pública ha liderado la investigación con base en el modelo de conocimientos, actitudes y prácticas propuesto por la OMS.

Rural-urban disparities in child nutrition in Bangladesh and Nepal

Background The persistence of rural-urban disparities in child nutrition outcomes in developing countries alongside rapid urbanisation and increasing incidence of child malnutrition in urban areas raises an important health policy question - whether fundamentally different nutrition policies and interventions are required in rural and urban areas. Addressing this question requires an enhanced understanding of the main drivers of rural-urban disparities in child nutrition outcomes especially for the vulnerable segments of the population. This study applies recently developed statistical methods to quantify the contribution of different socio-economic determinants to rural-urban differences in child nutrition outcomes in two South Asian countries – Bangladesh and Nepal. Methods Using DHS data sets for Bangladesh and Nepal, we apply quantile regression-based counterfactual decomposition methods to quantify the contribution of (1) the differences in levels of socio-economic determinants (covariate effects) and (2) the differences in the strength of association between socio-economic determinants and child nutrition outcomes (co-efficient effects) to the observed rural-urban disparities in child HAZ scores. The methodology employed in the study allows the covariate and coefficient effects to vary across entire distribution of child nutrition outcomes. This is particularly useful in providing specific insights into factors influencing rural-urban disparities at the lower tails of child HAZ score distributions. It also helps assess the importance of individual determinants and how they vary across the distribution of HAZ scores. Results There are no fundamental differences in the characteristics that determine child nutrition outcomes in urban and rural areas. Differences in the levels of a limited number of socio-economic characteristics – maternal education, spouse’s education and the wealth index (incorporating household asset ownership and access to drinking water and sanitation) contribute a major share of rural-urban disparities in the lowest quantiles of child nutrition outcomes. Differences in the strength of association between socio-economic characteristics and child nutrition outcomes account for less than a quarter of rural-urban disparities at the lower end of the HAZ score distribution. Conclusions Public health interventions aimed at overcoming rural-urban disparities in child nutrition outcomes need to focus principally on bridging gaps in socio-economic endowments of rural and urban households and improving the quality of rural infrastructure. Improving child nutrition outcomes in developing countries does not call for fundamentally different approaches to public health interventions in rural and urban areas.