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Lewis LR, Lopez RA, Hunt RH, Hodel AS, Gunnar MR, Thomas KM. Impacts of early deprivation on behavioral and neural measures of executive function in early adolescence. Brain Cogn 2024; 179:106183. [PMID: 38850899 DOI: 10.1016/j.bandc.2024.106183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/02/2024] [Accepted: 05/26/2024] [Indexed: 06/10/2024]
Abstract
Children reared in institutional settings experience early deprivation that has lasting implications for multiple aspects of neurocognitive functioning, including executive function (EF). Changes in brain development are thought to contribute to these persistent EF challenges, but little research has used fMRI to investigate EF-related brain activity in children with a history of early deprivation. This study examined behavioral and neural data from a response conflict task in 12-14-year-olds who spent varying lengths of time in institutional care prior to adoption (N = 84; age at adoption - mean: 15.85 months, median: 12 months, range: 4-60 months). In initial analyses, earlier- and later-adopted (EA, LA) youth were compared to a group of children raised in their biological families (non-adopted, NA). NA youth performed significantly more accurately than LA youth, with EA youth falling in between. Imaging data suggested that previously institutionalized (PI) youth activated additional frontoparietal regions, including dorsolateral prefrontal cortex, as compared to NA youth. In addition, EA youth uniquely activated medial prefrontal regions, and LA uniquely activated parietal regions during this task. A separate analysis in a larger group of PI youth examined whether behavioral or brain measures of EF varied with the duration of deprivation experienced. Duration of deprivation was negatively associated with activation of default mode network (DMN) regions. Overall, results suggest that there are lasting effects of deprivation on EF, but that those who are removed from institutional care earlier may be able to recruit additional neural resources as a compensatory mechanism.
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Affiliation(s)
- Lydia R Lewis
- Institute of Child Development, University of Minnesota, 51 East River Rd., Minneapolis, MN 55455, USA.
| | - Raquel A Lopez
- Institute of Child Development, University of Minnesota, 51 East River Rd., Minneapolis, MN 55455, USA
| | - Ruskin H Hunt
- Institute of Child Development, University of Minnesota, 51 East River Rd., Minneapolis, MN 55455, USA
| | - Amanda S Hodel
- Institute of Child Development, University of Minnesota, 51 East River Rd., Minneapolis, MN 55455, USA
| | - Megan R Gunnar
- Institute of Child Development, University of Minnesota, 51 East River Rd., Minneapolis, MN 55455, USA
| | - Kathleen M Thomas
- Institute of Child Development, University of Minnesota, 51 East River Rd., Minneapolis, MN 55455, USA
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Baptista J, Grangeia H, Negrão M, Camilo C, Ornelas S, Nogueira S, Pastor I, Gaspar A, Soares I, Alves S. The All4Children project to assess the initial implementation of the Integrated Model of Family Foster Care in Portugal: A description of the study protocol. PLoS One 2024; 19:e0304244. [PMID: 38787886 PMCID: PMC11125499 DOI: 10.1371/journal.pone.0304244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The All4Children project addresses the urgent need to transition from institutionalization to family-based care for out-of-home children in Portugal. Despite evidence highlighting the detrimental effects of institutionalization, only a small percentage of children (less than 4%) are currently placed in family foster care in the country. In response to European directives for deinstitutionalization, Portuguese legislation now prioritizes non-kinship family foster care as the preferred alternative for young children in need of care. To facilitate this transition, the Integrated Model of Family Foster Care (MIAF) was developed, offering a comprehensive framework covering the entire spectrum of family foster care. OBJECTIVE This research aims to investigate the initial implementation stage of the MIAF to promote high-quality family foster care in Portugal. METHOD The study will conduct a mixed-method and longitudinal research project in family foster care agencies across different regions of Portugal, focusing on evaluating the implementation and outcomes of the MIAF model using a multi-informant and multi-method approach. The participants will include caseworkers, children aged 0-9 years entering foster care, and their respective foster families enrolled in the MIAF program. Process evaluation will assess fidelity, feasibility, appropriateness, and acceptability of MIAF modules, while outcome evaluation will examine child safety, stability, well-being, as well as foster family well-being and quality of relational care. OUTCOMES The insights gained from this research initiative will serve as a foundation for the ongoing enhancement of MIAF. Consequently, this project has the capacity to advance evidence-based child welfare practices by refining processes and strategies to better serve vulnerable children and youth. CONCLUSION Facilitated by a multidisciplinary team, this project will contribute to advancing research in the field, enhancing practice, and informing policy during a pivotal stage of deinstitutionalization in Portugal.
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Affiliation(s)
- Joana Baptista
- Instituto Universitário de Lisboa (Iscte-IUL), CIS-Iscte, Lisbon, Portugal
| | - Helena Grangeia
- ProChild CoLAB, Guimarães, Portugal
- Research Centre for Justice and Governance (JusGov), Braga, Portugal
| | | | - Cláudia Camilo
- Instituto Universitário de Lisboa (Iscte-IUL), CIS-Iscte, Lisbon, Portugal
| | | | | | - Isabel Pastor
- Santa Casa da Misericórdia de Lisboa, Lisbon, Portugal
| | - Ana Gaspar
- Santa Casa da Misericórdia de Lisboa, Lisbon, Portugal
| | - Isabel Soares
- School of Psychology, University of Minho, Braga, Portugal
| | - Stephanie Alves
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
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Campos MT, do Nascimento LJ, Barreira AK, Colares V. Parenting styles and dental caries in Brazilian children and adolescents in foster care. Eur Arch Paediatr Dent 2024:10.1007/s40368-024-00909-3. [PMID: 38739262 DOI: 10.1007/s40368-024-00909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/22/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE This study aimed to analyse parenting styles as a possible factor associated with caries in foster children and adolescents who had been victims of domestic violence. METHODS The study was carried out in nine foster shelters in Recife, Northeast Brazil, with a sample of 88 participants aged 8 to 17 years old. Data were collected through intraoral examinations to verify deft/DMFT indices, applying the Demandingness and Responsiveness Scales to determine parenting styles. In turn, sociodemographic data were retrieved from records filed at the institutions. Descriptive analysis was performed, with the Mann-Whitney and Kruskal-Wallis tests being used to compare the categories of numerical variables. RESULTS The mean deft/DMFT was of 3.78 in children (8 and 9 years old) and 1.93 in adolescents (10 years old and older). Overall, the index was of 2.31. Neglect was the main reason for the children's admission to foster care, while neglectful was the most prevalent parenting style. CONCLUSION Children of indulgent parents had higher caries indices in both deciduous and permanent teeth, while children of authoritative (permanent teeth) and authoritarian parents (deciduous teeth) had the lowest caries indices. However, no significant associations were found between caries and parenting styles.
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Affiliation(s)
- M T Campos
- Programa de Pós-Graduação em Odontologia da Faculdade de Odontologia de Pernambuco FOP/UPE), Universidade de Pernambuco (UPE), Recife-PE, Brasil.
| | - L J do Nascimento
- Programa de Pós-Graduação em Odontologia da Faculdade de Odontologia de Pernambuco FOP/UPE), Universidade de Pernambuco (UPE), Recife-PE, Brasil
| | - A K Barreira
- Departamento de Odontopediatria, Universidade Federal de Pernambuco (UFPE), Recife-PE, Brasil
| | - V Colares
- Programa de Pós-Graduação em Odontologia da Faculdade de Odontologia de Pernambuco FOP/UPE), Universidade de Pernambuco (UPE), Recife-PE, Brasil
- Departamento de Odontopediatria, Universidade Federal de Pernambuco (UFPE), Recife-PE, Brasil
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Myllyaho T, Siira V, Wahlberg KE, Hakko H, Taka-Eilola T, Läksy K, Tikkanen V, Roisko R, Niemelä M, Räsänen S. Associations of Duration of Preadoption Out-of-home Care, Genetic Risk for Schizophrenia Spectrum Disorders and Adoptive Family Functioning with Later Psychiatric Disorders of Adoptees. Child Psychiatry Hum Dev 2024; 55:350-360. [PMID: 35962879 PMCID: PMC10891258 DOI: 10.1007/s10578-022-01411-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
Abstract
The objective was to examine the impacts of duration of preadoption out-of-home care and adoptive family functioning on later psychiatric morbidity of adoptees with high (HR) and low (LR) genetic risk for schizophrenia spectrum disorders. The study uses nationwide data from the Finnish Adoptive Family Study of Schizophrenia. The study population in this substudy consisted of 43 h adoptees and 128 LR adoptees. Of these adoptees, 90 had spent 0-6 months and 81 over 6 months in preadoption out-of-home care. The family functioning of adoptive families was assessed based on Global Family Ratings and psychiatric disorders on DSM-III-R criteria. The results showed that among the adoptees with over 6 months in preadoption out-of-home care, the likelihood for psychiatric disorders was significantly increased in HR adoptees compared to LR adoptees. In adoptees with 6 months or less in preadoption out-of-home care, an increased likelihood for psychiatric disorders was found among those living in adoptive families with dysfunctional processes. These findings indicate that especially for HR children, a well-functioning early caregiving environment is crucial in terms of subsequent mental wellbeing. The results emphasize that when adoption is necessary, early placement and well-functioning adoptive family environment are beneficial to children.
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Affiliation(s)
- Toni Myllyaho
- Unit of Clinical Neuroscience, Psychiatry, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.
| | - Virva Siira
- Faculty of Education, University of Oulu, P.O. Box 2000, 90014, Oulu, Finland
| | - Karl-Erik Wahlberg
- Unit of Clinical Neuroscience, Psychiatry, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
| | - Helinä Hakko
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, 90014, Oulu, Finland
| | - Tiina Taka-Eilola
- Unit of Clinical Neuroscience, Psychiatry, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Department of Psychiatry, Basic Health Care District of Kallio, Oulu, Finland
| | - Kristian Läksy
- Unit of Clinical Neuroscience, Psychiatry, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
| | - Ville Tikkanen
- Unit of Clinical Neuroscience, Psychiatry, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
| | - Riikka Roisko
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, 90014, Oulu, Finland
| | - Mika Niemelä
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, 90014, Oulu, Finland
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
| | - Sami Räsänen
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, 90014, Oulu, Finland
- Faculty of Medicine, Research Unit of Clinical Neuroscience, Psychiatry, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
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Onayemi OM, Hapunda G. Socio-ecological drivers of vulnerabilities of children living within orphan homes and the implications for their nurturance care. Front Public Health 2023; 11:1203510. [PMID: 38148875 PMCID: PMC10749914 DOI: 10.3389/fpubh.2023.1203510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/16/2023] [Indexed: 12/28/2023] Open
Abstract
At the heart of the Sustainable Development Goals (SDG) is the vision to "leave no one behind, and to see that all children survive, thrive and transform. However, some categories of children may remain left behind owing to their disproportionate exposure to the risk of threats and deficit of attention to the social and ecological climate that characterizes the various systems in which they are found. This study is concerned with one major question: Despite diverse local and international instruments that favor full nurturance and development of children, what social forces play as threat to full nurturance care in the context of children living in Orphan homes? Nurturing care framework and Brofenbrener's ecological system theory were adopted as the analytical frameworks. Research design was exploratory. Data were collected through sessions of in-depth-interview with orphanage managers, caregivers, and social workers on the socio-ecology drivers of threat to children living within the orphan home space and its implications for nurturance care across the various complex systems of the child's environment. The study found various factors across the complex systems of child development - microsystem, mesosystem, exosystem, microsysm and lastly, chronosystem- which undermine caregivers' delivery and increases children's vulnerability and risk of missing out on effective nurturance care. These vulnerabilities are endemic realities of social, and bio-ecologcal space in which child development occurs. This study recommends specialized interventions and policy directives relevant for each identified threat. It also calls for a stronger political will in improving the conditions of this category of the children while within the orphan home space and ultimately, actions towards deinstitutionalization of children.
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Affiliation(s)
| | - Given Hapunda
- Department of Psychology, University of Zambia, Lusaka, Zambia
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Engel de Abreu PMJ, Kumsta R, Wealer C. Risk and protective factors of mental health in children in residential care: A nationwide study from Luxembourg. CHILD ABUSE & NEGLECT 2023; 146:106522. [PMID: 37922618 DOI: 10.1016/j.chiabu.2023.106522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/04/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Children who grow up in residential care are at high risk for mental health problems. Existing studies have focused on negative mental health indicators and risk factors. There has been less emphasis on identifying protective factors, particularly those associated with positive mental health outcomes. OBJECTIVE This study explores positive and negative dimensions of mental health and their links to risk and protective factors in children who have experienced early adversity and trauma and have been placed in residential care. PARTICIPANTS AND SETTINGS Children aged 11 to 18 (N = 264) were recruited from residential care homes in Luxembourg, a small, high-income European country. METHODS The children completed self-report questionnaires on mental health, perceived stress, school pressure, and participation. Residential care workers provided information on demographic factors, developmental and care history, and pre-care experiences of early adversity and trauma. RESULTS Confirmatory factor analysis indicated that subjective well-being, internalising problems, and externalising problems are separate yet interconnected components of mental health. Multiple Indicators Multiple Causes models showed that individual, contextual, and psychosocial predictors contribute differentially to positive and negative mental health outcomes. CONCLUSIONS Using a national sample of children in residential care in Luxembourg, this research indicates that subjective well-being, internalising problems, and externalising problems are distinct but related aspects of mental health. 'Child participation' and 'school pressure' displayed strong links with positive mental health outcomes and may serve as a potential path for improving public health interventions for children in care.
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Affiliation(s)
- Pascale M J Engel de Abreu
- Cognitive and Socio-Emotional Development Group, Department of Humanities, University of Luxembourg, Maison des Sciences Humaines 11, Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg.
| | - Robert Kumsta
- Laboratory for Stress and Gene-Environment Interplay, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Maison des Sciences Humaines 11, Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg.
| | - Cyril Wealer
- Cognitive and Socio-Emotional Development Group, Department of Humanities, University of Luxembourg, Maison des Sciences Humaines 11, Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg.
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Katz C, Attrash-Najjar A, Cohen N, Glucklich T, Jacobson M, Varela N, Priolo-Filho SR, Bérubé A, Chang OD, Collin-Vézina D, Fouché A, Haffejee S, Katz I, Maguire-Jack K, Massarweh N, O'Reilly M, Tiwari A, Truter E, de Andrade Vieira RV, Walker-Williams H, Zibetti MR, Werkele C. Child protective services and out-of-home Care for Children during COVID-19: A scoping review and thematic analysis. CHILD ABUSE & NEGLECT 2023:106540. [PMID: 38008657 DOI: 10.1016/j.chiabu.2023.106540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/15/2023] [Accepted: 11/07/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic challenged child protection and posed new risks for child maltreatment (CM). Moreover, governmental efforts worldwide prioritized mitigating the spread of the virus over ensuring the welfare and protection of families and children. This neglect caused hardship for many vulnerable children, including those in out-of-home care (OOHC), and challenged the functionality of child protective services (CPS). However, only limited research has investigated the impact of COVID-19 on OOHC and CPS and explored how CPS overcame the challenges of helping children in OOHC. OBJECTIVE This review aims to address this gap in the research to unveil the 'positive legacy' left by CPS in their work with children in OOHC during COVID-19. METHOD This review utilized three stages of analysis, including a scoping review followed by two rounds of thematic analysis. The scoping review was carried out in six languages: English, Hebrew, Arabic, French, Portuguese, and Spanish. The first round of thematic analysis found eight relevant articles for this review. The second round of thematic analysis found three themes related to this paper's aim in the context of COVID-19. RESULTS Three main themes were identified: 1) decision-making and OOHC, 2) difficulties in procedures related to OOHC placement, and 3) handling challenges of OOHC. CONCLUSIONS The discussion emphasizes the crucial role of preserving children's rights, hearing their voices and needs, and considering their safety and well-being when planning policies and practices to protect them. It also emphasizes society's responsibility to acknowledge contextual factors in child protection.
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Affiliation(s)
- Carmit Katz
- Bob Shapell School of Social Work, Tel Aviv University, Chaim Levanon 30, Tel Aviv 69978, Israel.
| | - Afnan Attrash-Najjar
- Bob Shapell School of Social Work, Tel Aviv University, Chaim Levanon 30, Tel Aviv 69978, Israel.
| | - Noa Cohen
- Bob Shapell School of Social Work, Tel Aviv University, Chaim Levanon 30, Tel Aviv 69978, Israel
| | - Talia Glucklich
- Bob Shapell School of Social Work, Tel Aviv University, Chaim Levanon 30, Tel Aviv 69978, Israel
| | - Ma'ayan Jacobson
- Haruv Institute, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, Israel.
| | - Natalia Varela
- Faculty of Social and Human Sciences, Externado University, Calle 12 No. 1-17 Este, Bogotá, Colombia.
| | - Sidnei Rinaldo Priolo-Filho
- Laboratório de Pesquisa, Prevenção e Intervenção em Psicologia Forense - Universidade Tuiuti do Paraná, Brazil
| | - Annie Bérubé
- The Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Canada.
| | - Olivia D Chang
- School of Social Work, University of Michigan, 1080 S. University Ave., Ann Arbor, MI 48109, USA.
| | - Delphine Collin-Vézina
- The Centre for Research on Children and Families, McGill University, Suite 106, Wilson Hall, 3506 University Street, Montreal, Quebec H3A 2A7, Canada.
| | - Ansie Fouché
- Department of Social Wellbeing, United Arab Emirates University, P.O. Box 15551, Al Ain, Abu Dhabi, United Arab Emirates; North-West University, Vanderbijlpark Campus, COMPRES research entity, Gauteng, South Africa.
| | - Sadiyya Haffejee
- Centre for Social Development in Africa, University of Johannesburg, South Africa.
| | - Ilan Katz
- Social Policy Research Centre (SPRC), University of New South Wales, Sydney, NSW 2052, Australia.
| | - Kathryn Maguire-Jack
- School of Social Work, University of Michigan, 1080 S. University Ave., Ann Arbor, MI 48109, USA.
| | - Nadia Massarweh
- The Al-Qasemi Academic College of Education, P.O. Box 124, Baqa-El-Gharbia 3010000, Israel
| | - Michelle O'Reilly
- School of Media, Communication, and Sociology, University of Leicester and Leicestershire Partnership NHS Trust, UK.
| | - Ashwini Tiwari
- The Institute of Public and Preventive Health, Augusta University, 1120 15th St, Augusta, GA 30912, USA.
| | - Elmien Truter
- North-West University, Vanderbijlpark Campus, COMPRES research entity, Gauteng, South Africa.
| | | | - Hayley Walker-Williams
- North-West University, Vanderbijlpark Campus, COMPRES research entity, Gauteng, South Africa.
| | | | - Christine Werkele
- The Offord Centre for Child Studies, McMaster University, 1280 Main St. W. - MIP 201A, Hamilton, ON L8S 4K1, Canada.
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Devaney J, Power L, Jacobs P, Davidson G, Hiller R, Martin J, McCartan C, McCusker P, McGuire R, Phillips A, Roesch‐Marsh A, Thapar A. An agenda for future research regarding the mental health of young people with care experience. CHILD & FAMILY SOCIAL WORK 2023; 28:960-970. [PMID: 38505819 PMCID: PMC10947327 DOI: 10.1111/cfs.13015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/21/2022] [Accepted: 02/06/2023] [Indexed: 03/21/2024]
Abstract
Young people who are currently or were previously in state care have consistently been found to have much higher rates of mental health and neurodevelopmental difficulties than the general youth population. While a number of high-quality reviews highlight what research has been undertaken in relation to the mental health of young people with care experience and the gaps in our knowledge and understanding, there is, until now, no consensus, so far as we aware, as to where our collective research efforts should be directed with this important group. Through a series of UK wide workshops, we undertook a consultative process to identify an agreed research agenda between those with lived experience of being in care (n = 15), practitioners, policy makers and researchers (n = 59), for future research regarding the mental health of young people with care experience, including those who are neurodiverse/have a neurodevelopmental difficulty. This consensus statement identified 21 foci within four broad categories: how we conceptualize mental health; under-studied populations; under-studied topics; and underused methodologies. We hope that those who commission, fund and undertake research will engage in this discussion about the future agenda for research regarding the mental health of young people with care experience.
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Affiliation(s)
- John Devaney
- School of Social and Political ScienceUniversity of EdinburghEdinburghUK
| | - Luke Power
- School of Social and Political ScienceUniversity of EdinburghEdinburghUK
| | - Paula Jacobs
- School of Social and Political ScienceUniversity of EdinburghEdinburghUK
- Health SciencesUniversity of StirlingStirlingUK
| | - Gavin Davidson
- School of Social Sciences, Education and Social WorkQueen's University BelfastBelfastUK
| | - Rachel Hiller
- Department of PsychologyUniversity of BathUK
- Clinical, Educational & Health PsychologyUniversity College LondonUK
| | - Joanna Martin
- Wolfson Centre for Young People's Mental Health, Division of Psychological Medicine and Clinical NeurosciencesCardiff UniversityUK
| | - Claire McCartan
- School of Social Sciences, Education and Social WorkQueen's University BelfastBelfastUK
| | - Pearse McCusker
- School of Social and Political ScienceUniversity of EdinburghEdinburghUK
| | - Rosie McGuire
- Clinical, Educational & Health PsychologyUniversity College LondonUK
| | | | | | - Anita Thapar
- Wolfson Centre for Young People's Mental Health, Division of Psychological Medicine and Clinical NeurosciencesCardiff UniversityUK
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Hiilamo A, Keski-Säntti M, Niemelä M, Ristikari T. The increasing association between child poverty and children in out-of-home care - an ecological longitudinal analysis of Finnish municipalities in the period 1992-2021. CHILD ABUSE & NEGLECT 2023; 145:106395. [PMID: 37595326 DOI: 10.1016/j.chiabu.2023.106395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND International evidence indicates that child poverty increases the risk of child welfare intervention needs but Finland, paradoxically, has low child poverty rates and high child welfare intervention rates. We investigate the extent to which the rate of social assistance use in families with children, as a proxy for child poverty, can be associated with the rate of children in out-of-home care in Finnish municipalities. METHODS Data on the annual rate of social assistance use and out-of-home care were drawn from national registers for 216 Finnish municipalities from 1992 to 2021. Linear regression models were utilised to investigate the extent to which the social assistance use rate explained child out-of-home care rates, both spatially and temporally, across municipalities and years while adjusting for the unemployment rate. RESULTS The rate of out-of-home care increased from some 700 to 1600 per 100,000 children over the period 1992-2021. A percentage point higher rate of the social assistance use was associated with 44-72 more children placed in out-of-home care per 100,000 children, net of the unemployment rate. This association was stronger in more recent time periods. A smaller association was observed within municipalities over time: a percentage point increase in social assistant use was linked to some 4-25 more children placed in out-of-home care per 100,000 children. CONCLUSION Out-of-home care is increasingly concentrated in Finnish municipalities with high rates of families receiving social assistance. Preventative child welfare interventions are therefore required in areas with higher rates of economic difficulties among families.
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Affiliation(s)
| | | | - Mika Niemelä
- Faculty of Medicine, Research Unit of Population Health, University of Oulu, Oulu, Finland
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Tangcharoensathien V, Iamsirithaworn S, Rittirong J, Techanimitvat S, Vapattanawong P, Apiratipanya L, Chanthama T, Rueangsom P. Children orphaned from COVID-19 in Thailand: maximize use of civil registration database for policies. Front Public Health 2023; 11:1260069. [PMID: 37915817 PMCID: PMC10616892 DOI: 10.3389/fpubh.2023.1260069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023] Open
Abstract
Orphans, especially those who experience maternal loss at a young age, face significant long-term negative impacts on their lives and psychological well-being, extending beyond the age of 18. As of July 2023, the global death toll of COVID-19 has reached 6.9 million, leaving behind an unknown number of orphans who require immediate attention and support from policymakers. In Thailand, from April 2020 to July 2022, the total number of COVID-19-related deaths reached 42,194, resulting in 4,139 parental orphans. Among them, 452 (10.9%) were children under the age of five, who are particularly vulnerable and necessitate special policy attention and ongoing support. While the provision of 12 years of free education for all and Universal Health Coverage helps alleviate the education and health expenses borne by households supporting these orphans, the monthly government support of 2,000 Baht until the age of 18 is insufficient to cover their living costs and other education-related expenditures. We advocate for adequate financial and social support for COVID-19 orphans, emphasizing the importance of placing them with relatives rather than institutional homes. In the context of post-pandemic recovery, this perspective calls upon governments and global communities to estimate the number of orphans and implement policies to safeguard and support them in the aftermath of COVID-19.
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Affiliation(s)
| | | | - Jongjit Rittirong
- Institute for Population and Social Research, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | | | - Patama Vapattanawong
- Institute for Population and Social Research, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | | | - Thiphaphon Chanthama
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Putthipanya Rueangsom
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
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Shawar YR, Shiffman J. Global priority for the care of orphans and other vulnerable children: transcending problem definition challenges. Global Health 2023; 19:75. [PMID: 37817245 PMCID: PMC10566118 DOI: 10.1186/s12992-023-00975-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/26/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Tens of millions of children lack adequate care, many having been separated from or lost one or both parents. Despite the problem's severity and its impact on a child's lifelong health and wellbeing, the care of vulnerable children-which includes strengthening the care of children within families, preventing unnecessary family separation, and ensuring quality care alternatives when reunification with the biological parents is not possible or appropriate-is a low global priority. This analysis investigates factors shaping the inadequate global prioritization of the care of vulnerable children. Specifically, the analysis focuses on factors internal to the global policy community addressing children's care, including how they understand, govern, and communicate the problem. METHODS Drawing on agenda setting scholarship, we triangulated among several sources of data, including 32 interviews with experts, as well as documents including peer-reviewed literature and organizational reports. We undertook a thematic analysis of the data, using these to create a historical narrative on efforts to address children's care, and specifically childcare reform. RESULTS Divisive disagreements on the definition and legitimacy of deinstitutionalization-a care reform strategy that replaces institution-based care with family-based care-may be hindering priority for children's care. Multiple factors have shaped these disagreements: a contradictory evidence base on the scope of the problem and solutions, divergent experiences between former Soviet bloc and other countries, socio-cultural and legal challenges in introducing formal alternative care arrangements, commercial interests that perpetuate support for residential facilities, as well as the sometimes conflicting views of impacted children, families, and the disability community. These disagreements have led to considerable governance and positioning difficulties, which have complicated efforts to coordinate initiatives, precluded the emergence of leadership that proponents universally trust, hampered the engagement of potential allies, and challenged efforts to secure funding and convince policymakers to act. CONCLUSION In order to potentially become a more potent force for advancing global priority, children's care proponents within international organizations, donor agencies, and non-governmental agencies working across countries will need to better manage their disagreements around deinstitutionalization as a care reform strategy.
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Affiliation(s)
- Yusra Ribhi Shawar
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.
- Johns Hopkins University, Paul H. Nitze School of Advanced International Studies, Washington, D.C, USA.
| | - Jeremy Shiffman
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University, Paul H. Nitze School of Advanced International Studies, Washington, D.C, USA
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12
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Neville SE, Okunoren O, Crea TM. Youth Who Have Lived in Alternative Care in Nigeria, Zambia, and Zimbabwe: Mental Health and Violence Outcomes in Nationally Representative Data. JAACAP OPEN 2023; 1:141-150. [PMID: 37982091 PMCID: PMC10656048 DOI: 10.1016/j.jaacop.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Objective We explore whether having previously lived in alternative care (foster, kinship, and/or residential care) is linked to sexual risk-taking, mental health, and experiencing violence in Nigerian, Zambian, and Zimbabwean youth ages 13-17 living in households with or without their biological parents, and assess the utility and limitations of existing data. Method This study is a secondary analysis of nationally-representative Violence Against Children Surveys (N=6,405). Logistic regressions examined the effect of alternative care experience on the odds of poor outcomes, controlling for covariates including parental care status, orphanhood, and household assets. Results In both bivariate and multivariate analyses, having lived in alternative care in the last five years was associated with lowered odds mental distress (OR=0.25, 95% CI: [0.10, 0.61], p=.002), and higher odds of sexual risk taking (OR=1.70, 95% CI: [1.11, 2.59], p=.014), caregiver physical abuse (OR=1.81, 95% CI: [1.30, 2.50], p<.001), caregiver emotional abuse (OR=1.75, 95% CI: [1.20, 2.54], p=.004), and peer violence (OR=1.57, 95% CI: [1.09, 2.26], p=.015). It was not associated with suicidality, self harm, or sexual assault after controlling for covariates. Conclusion Youth who have lived in alternative care in the last five years may benefit from programs that address violence, self-harm, and sexual risk taking behavior, even if they are now in families. To better understand children outside parental care, national data collection efforts should distinguish between residential and family-based care.
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Affiliation(s)
| | | | - Thomas M Crea
- Boston College School of Social Work, Newton, Massachusetts
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13
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King LS, Guyon-Harris KL, Valadez EA, Radulescu A, Fox NA, Nelson CA, Zeanah CH, Humphreys KL. A Comprehensive Multilevel Analysis of the Bucharest Early Intervention Project: Causal Effects on Recovery From Early Severe Deprivation. Am J Psychiatry 2023; 180:573-583. [PMID: 37211832 PMCID: PMC10751847 DOI: 10.1176/appi.ajp.20220672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The Bucharest Early Intervention Project is the first randomized controlled trial of foster care as an alternative to institutional care. The authors synthesized data from nearly 20 years of assessments of the trial to determine the overall intervention effect size across time points and developmental domains. The goal was to quantify the overall effect of the foster care intervention on children's outcomes and examine sources of variation in this effect, including domain, age, and sex assigned at birth. METHODS An intent-to-treat approach was used to examine the causal effects of the randomized controlled trial for 136 children residing in institutions in Bucharest, Romania (baseline age, 6-31 months) who were randomly assigned to either foster care (N=68) or care as usual (N=68). At ages 30, 42, and 54 months and 8, 12, and 16-18 years, children were assessed for IQ, physical growth, brain electrical activity (EEG), and symptoms of five types of psychopathology. RESULTS Participants provided 7,088 observations across follow-up waves. Children assigned to foster care had better cognitive and physical outcomes and less severe psychopathology than did those who received care as usual. The magnitude of these effect sizes remained stable across development. The foster care intervention most influenced IQ and disorders of attachment/social relatedness. CONCLUSIONS Young children benefit from placement in families after institutional care. The benefits of foster care for previously institutionalized children were remarkably stable across development.
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Affiliation(s)
- Lucy S. King
- Tulane University School of Medicine, Department of Psychiatry and Behavioral Sciences, New Orleans, LA
| | | | - Emilio A. Valadez
- University of Maryland, Department of Human Development and Quantitative Methodology, College Park, MD
| | | | - Nathan A. Fox
- University of Maryland, Department of Human Development and Quantitative Methodology, College Park, MD
| | - Charles A. Nelson
- Boston Children’s Hospital/Harvard Medical School, Boston, MA
- Harvard Graduate School of Education, Cambridge, MA
| | - Charles H. Zeanah
- Tulane University School of Medicine, Department of Psychiatry and Behavioral Sciences, New Orleans, LA
| | - Kathryn L. Humphreys
- Tulane University School of Medicine, Department of Psychiatry and Behavioral Sciences, New Orleans, LA
- Vanderbilt University, Department of Psychology and Human Development, Nashville, TN
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Howard AH, Dadirai Gwenzi G, Newsom L, Gebru BT, Gilbertson Wilke N. The Relationship between Sense of Belonging and Well-Being Outcomes in Emerging Adults with Care Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6311. [PMID: 37444158 PMCID: PMC10341974 DOI: 10.3390/ijerph20136311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/19/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
Robust social resources that lead to a healthy sense of belonging are imperative during emerging adulthood. However, young adults with alternative care experience, such as residential or foster care, often lack the social resources necessary to transition to adulthood successfully. Though some research has examined the importance of social resources in this population, less is known about a sense of belonging, which is associated with these social resources. The current study examined the association between care experience, belonging, and well-being outcomes among emerging adults (n = 703) who were separated from their biological parents during care and received alternative care in 16 nations. The presence of belonging was associated with type of alternative care, age at separation, and reason for separation. There was also an association between belonging and well-being outcomes, including homelessness and suicidal ideation. Adults lacking a sense of belonging reported higher rates of homelessness and suicidal ideation, lower life satisfaction, and lower resilience. The study has global implications for enhancing social support for emerging adults with care experience in order to facilitate a sense of belonging as a social resource.
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Affiliation(s)
- Amanda Hiles Howard
- Department of Psychology, Samford University, 800 Lakeshore Dr., Homewood, AL 35229, USA
| | - Getrude Dadirai Gwenzi
- Department of Social Work, University of Zimbabwe, 630 Churchill Avenue, Harare, Zimbabwe
| | - Lindsey Newsom
- Department of Psychology, Samford University, 800 Lakeshore Dr., Homewood, AL 35229, USA
| | - Belay T. Gebru
- Hope for the Fatherless, 558 Castle Pines Parkway, Castle Pines, CO 80108, USA
| | - Nicole Gilbertson Wilke
- CAFO Center on Applied Research for Vulnerable Children and Families, 505 Los Arces Monteflor II Cayma, Arequipa, Peru
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15
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Evans R, MacDonald S, Trubey R, Noyes J, Robling M, Willis S, Boffey M, Wooders C, Vinnicombe S, Melendez-Torres GJ. Interventions targeting the mental health and wellbeing of care-experienced children and young people in higher-income countries: Evidence map and systematic review. Syst Rev 2023; 12:111. [PMID: 37393358 PMCID: PMC10315047 DOI: 10.1186/s13643-023-02260-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/26/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND The mental health and wellbeing of care-experienced children and young people (i.e. foster care, kinship care, residential care) is poorer than non-care-experienced populations. The Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) aimed to synthesise the international evidence base for interventions targeting subjective wellbeing, mental health and suicide amongst care-experienced young people aged ≤ 25 years. METHODS For the first phase of the review, we constructed an evidence map identifying key clusters and gaps in interventions and evaluations. Studies were identified through 16 electronic databases and 22 health and social care websites, in addition to expert recommendations, citation tracking and screening of relevant systematic reviews. We charted interventions and evaluations with a summary narrative, tables and infographics. RESULTS In total, 64 interventions with 124 associated study reports were eligible. The majority of study reports were from the USA (n = 77). Interventions primarily targeted children and young people's skills and competencies (n = 9 interventions), the parental functioning and practices of carers (n = 26), or a combination of the two (n = 15). While theoretically under-specified, interventions were largely informed by theories of Attachment, Positive Youth Development, and Social Learning Theory. Current evaluations prioritised outcomes (n = 86) and processes (n = 50), with a paucity of study reports including theoretical descriptions (n = 24) or economic evaluations (n = 1). Interventions most frequently targeted outcomes related to mental, behavioural or neurodevelopmental disorders, notably total social, emotional and behavioural problems (n = 48 interventions) and externalising problem behaviours (n = 26). There were a limited number of interventions targeting subjective wellbeing or suicide-related outcomes. CONCLUSIONS Future intervention development might focus on structural-level intervention theories and components, and target outcomes related to subjective wellbeing and suicide. In accordance with current methodological guidance for intervention development and evaluation, research needs to integrate theoretical, outcome, process and economic evaluation in order to strengthen the evidence base. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020177478.
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Affiliation(s)
- Rhiannon Evans
- DECIPHer, School of Social Sciences, Cardiff University, SPARK, Maindy Road, Cardiff, CF24 4HQ, UK.
| | - Sarah MacDonald
- DECIPHer, School of Social Sciences, Cardiff University, SPARK, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Rob Trubey
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | | | - Simone Willis
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
| | - Maria Boffey
- DECIPHer, School of Social Sciences, Cardiff University, SPARK, Maindy Road, Cardiff, CF24 4HQ, UK
| | | | - Soo Vinnicombe
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
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Scherer N, Banks R, Murko M, Chisholm D. Better Health, Better Lives? 10-Years on From the World Health Organization's Declaration on the Health of Children With Intellectual Disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:501-515. [PMID: 35263241 PMCID: PMC10164235 DOI: 10.1177/17446295221076687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
It is now 10 years since the European Declaration on the Health of Children and Young People with Intellectual Disabilities and their Families: Better Health - Better Lives was adopted by the World Health Organization. Through discussions with key informants and an online literature review, we reflect on actions and progress made in line with this Declaration to improve the health and wellbeing of children with intellectual disabilities and their families. Despite finding positive examples of policy, legislation and practice in support of children with intellectual disabilities, there are clear gaps and areas for improvement. Countries must continue to take action, as supported by the World Health Organization and other such organisations, in order to support children with intellectual disabilities in realising their fundamental human rights.
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Affiliation(s)
- Nathaniel Scherer
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Roger Banks
- Learning Disability and Autism Programme, NHS England, London, UK
| | - Melita Murko
- Mental Health Unit, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Daniel Chisholm
- Mental Health Unit, World Health Organization Regional Office for Europe, Copenhagen, Denmark
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17
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The Relationship Between Spirituality and Resilience and Well-being: a Study of 529 Care Leavers from 11 Nations. ADVERSITY AND RESILIENCE SCIENCE 2023; 4:177-190. [PMID: 36816809 PMCID: PMC9918825 DOI: 10.1007/s42844-023-00088-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/13/2023]
Abstract
Research has found that individuals who were separated from parental care and experienced alternative care settings during childhood are more likely to have poor outcomes as adults. This highlights the importance of understanding factors that are related to resilience and well-being for care leavers. A growing body of research has supported the importance of spirituality in our understanding of resilience and well-being. However, little work to date has examined the relationship of spirituality to outcomes in care leavers. The current study investigated the relationships between spirituality, resilience, well-being, and health in a sample of 529 care leavers from 11 nations. It also examined how different themes of spirituality were related to specific outcome variables. Data revealed that spirituality was significantly associated with higher life satisfaction, better mental and physical health, and more resilience even when accounting for current age, gender, age at separation, Human Development Index scores, and childhood adversity. Furthermore, findings indicate that different themes of spirituality are related to specific outcome variables, even when accounting for demographic information. Findings indicate that spirituality may play an important role in resilience and well-being for care leavers. Implications and limitations are discussed.
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18
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Aarah-Bapuah M, Sarpomaa Oppong S, Ohenewaa Yawson A, Dzansi G, Adjorlolo S. Covid-19 and mental health of children and adolescents: A systematic review. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2111849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Millicent Aarah-Bapuah
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon Accra, Ghana
- School of Nursing and Midwifery, University for Development Studies, Tamale Ghana
| | - Stella Sarpomaa Oppong
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon Accra, Ghana
- Nursing and Midwifery Training College, Hohoe, Ghana
| | - Anita Ohenewaa Yawson
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon Accra, Ghana
- Korle-bu Teaching Hospital, Department of Anaesthesia, Surgical Ground Floor ICU, Accra, Ghana
| | - Gladys Dzansi
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Samuel Adjorlolo
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon Accra, Ghana
- Research and Grant Institute of Ghana, Accra, Ghana
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19
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Learning from the Implementation of the Child Nutrition Program: A Mixed Methods Evaluation of Process. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121965. [PMID: 36553408 PMCID: PMC9777218 DOI: 10.3390/children9121965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/26/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
Nutrition and feeding interventions are important for children’s growth and development. Holt International’s Child Nutrition Program (CNP) is a child nutrition and feeding intervention. This study aims to describe and explore the implementation of CNP in Mongolia and the Philippines using mixed methods including qualitative and quantitative data analysis. The analysis framework was guided by the WHO’s Monitoring the Building Blocks of Health Systems. Key informant interviews (KIIs) were conducted, transcribed, translated and coded. Knowledge, Attitude and Practice Surveys (KAPS) and pre-/post-tests from routine program audit data were analyzed. Analysis of nutrition (Mongolia: 95% CI: 7.5-16.6 (p = < 0.0001), Philippines: 95% CI: 7.6-15.7 (p= < 0.0001)) and feeding (Mongolia: 95% CI: 11.7-23.9 (p = < 0.0001), Philippines: 95% CI: 6.6-16.9 (p = < 0.0001)) tests indicate improvement post-training in both countries. KAPS indicate changes in desired practices from pre-training to post-training. Thematic analysis of KIIs highlight essential components for program implementation and effectiveness, including strong leadership, buy-in, secure funding, reliable supply chains, training and adequate staffing. This evaluation of program implementation highlights successful strategies and challenges in implementing CNP to improve the health of children in Mongolia and the Philippines. Lessons learned from the implementation of CNP can inform growth of the program, scaling strategies and provide insights for similar interventions.
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Kooijmans R, Langdon PE, Moonen X. Assisting children and youth with completing self-report instruments introduces bias: A mixed-method study that includes children and young people's views. METHODS IN PSYCHOLOGY 2022. [DOI: 10.1016/j.metip.2022.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Muacevic A, Adler JR, Bhaskaran J, Akter M, Watts T. Review of the Current Knowledge of Reactive Attachment Disorder. Cureus 2022; 14:e31318. [PMID: 36514636 PMCID: PMC9736782 DOI: 10.7759/cureus.31318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/11/2022] Open
Abstract
Reactive attachment disorder (RAD), classified under Trauma and Stressor Related Disorders in the DSM-5 manual, is a childhood psychiatric illness due to familial or social neglect or due to maltreatment. It is characterized by an inhibited and withdrawn social and emotional behavior toward an adult caregiver, typically before the age of 5. Neurobiological changes in patients with RAD have been shown to be substantially significant with features such as loss of grey matter volume and neurotransmitter deficiencies that not only impact the ability to form healthy attachments but also increase the risk of comorbidities such as depression and anxiety. Different theories, including the current mediation hypothesis and learning theory of attachment, showed childhood maltreatment from caregivers and desensitization toward deficiencies in social development in children from special education teachers to be key components in the development of RAD. Patients with RAD had an increased risk of developing psychiatric comorbidities, including learning disabilities and mood disorders. Institutionalized care and childhood maltreatment have a significant impact on the development of RAD. RAD is an underdiagnosed and underreported condition with significant repercussions that can severely impact the development of a child. By being able to raise awareness and promote further research into refining the diagnostic methodology, treatment protocols, and long-term follow-up, children afflicted with this condition may be able to develop better socio-emotional bonds and reduce the incidence of comorbidities such as depression and attention deficit hyperactivity disorder.
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22
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Baker J, Kendal S, Berzins K, Canvin K, Branthonne‐Foster S, McDougall T, Goldson B, Kellar I, Wright J, Duxbury J. Mapping review of interventions to reduce the use of restrictive practices in children and young people's institutional settings: The CONTRAST study. CHILDREN & SOCIETY 2022; 36:1351-1401. [PMID: 36588794 PMCID: PMC9790399 DOI: 10.1111/chso.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/14/2022] [Accepted: 04/27/2022] [Indexed: 06/17/2023]
Abstract
Restrictive practices are often used harmfully with children in institutional settings. Interventions to reduce their use do not appear to have been mapped systematically. Using environmental scanning, we conducted a broad-scope mapping review of English language academic databases, websites and social media, using systematic methods. Included records (N = 121) were mostly from the United States and contained details of 82 different interventions. Children's participation was limited. Reporting quality was inconsistent, which undermined claims of effectiveness. Overall, despite a multitude of interventions, evidence is limited. Leaders should consider the evidence, including children's perspectives, before introducing poorly understood interventions into children's settings.
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Affiliation(s)
| | | | | | | | | | - Tim McDougall
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | | | | | | | - Joy Duxbury
- Manchester Metropolitan UniversityManchesterUK
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23
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Wade M, Carroll D, Fox NA, Zeanah CH, Nelson CA. Associations between Early Psychosocial Deprivation, Cognitive and Psychiatric Morbidity, and Risk-taking Behavior in Adolescence. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:850-863. [PMID: 33629920 PMCID: PMC8384982 DOI: 10.1080/15374416.2020.1864737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Early psychosocial deprivation increases the risk of later cognitive and psychiatric problems, but not all deprived children show these difficulties. Here, we examine the extent to which psychosocial deprivation increases the risk of later cognitive and psychiatric difficulties and the downstream consequences of this for risk-taking behavior in adolescence. METHOD Children abandoned to institutions early in life were randomly assigned to care-as-usual or a foster care intervention during infancy. A separate group of never-institutionalized children was recruited as a comparison sample. The current follow-up study included 165 children (51% female), 113 with a history of institutionalization and 52 with no such history. At age 12, caregivers reported on children's psychiatric difficulties, and their IQ was assessed by standardized testing. At 16 years, risk-taking behavior was assessed from youth self-reports. RESULTS Latent profile analysis revealed three subgroups of children with varying levels of cognitive and psychiatric difficulties: Low-Morbidity (n = 104, 62.7%), Medium-Morbidity (n = 46, 27.9%), and High-Morbidity (n = 15, 9.4%). Nearly half of the institutionalized children belonged to the High- or Medium-Morbidity subgroups; and institutionally-reared children were significantly more likely to belong to one of these profiles than never-institutionalized children. Compared to the Low-Morbidity subgroup, membership in the Medium-Morbidity profile was associated with higher levels of risk-taking behavior at age 16 years. CONCLUSIONS Children who experience psychosocial deprivation are considerably more likely to present with elevated cognitive and psychiatric difficulties in early adolescence and, for some children, this elevation is linked to heightened risk-taking behavior in later adolescence.
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Affiliation(s)
- Mark Wade
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON, Canada
| | - Devon Carroll
- Boston Children’s Hospital of Harvard Medical School, Boston, MA
| | - Nathan A. Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD
| | - Charles H. Zeanah
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA
| | - Charles A. Nelson
- Boston Children’s Hospital of Harvard Medical School, Boston, MA
- Harvard Graduate School of Education, Boston, MA
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McTavish JR, McKee C, MacMillan HL. Foster children's perspectives on participation in child welfare processes: A meta-synthesis of qualitative studies. PLoS One 2022; 17:e0275784. [PMID: 36215294 PMCID: PMC9550086 DOI: 10.1371/journal.pone.0275784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
The objective of this meta-synthesis was to systematically synthesise qualitative research that explores foster children's perspectives on participation in child welfare processes. Searches were conducted in Medline (OVID), Embase, PsycINFO, and Social Science Citation Index. Children in non-kinship foster care in any setting (high-income, middle-income, low-income countries) who self-reported their experiences of care (removal from home, foster family processes, placement breakdown) were eligible for inclusion. Selected studies took place in 11 high-income countries. A total of 8436 citations were identified and 25 articles were included in this meta-synthesis. Studies summarized the views of 376 children. Children had been in foster care between two weeks and 17 years. Findings synthesize 'facets' of children's participation (e.g., being asked vs making decisions), as well as children's perceived barriers and facilitators to participation. A main priority for children was the quality of their relationships, especially in terms of values (e.g., fairness, honesty, inclusivity). No one way of participating in child welfare processes is better than another, as some children more clearly expressed a desire for passive listening roles and others indicated a desire for active roles in decision-making. However, meaningful adults in foster children's lives have a responsibility to act in a way that strengthens the emphasis on children's needs and voices.
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Affiliation(s)
- Jill R. McTavish
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada,* E-mail:
| | - Christine McKee
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Harriet L. MacMillan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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25
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Foster care leads to sustained cognitive gains following severe early deprivation. Proc Natl Acad Sci U S A 2022; 119:e2119318119. [PMID: 36095188 PMCID: PMC9499516 DOI: 10.1073/pnas.2119318119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study examined longitudinal data from the Bucharest Early Intervention Project, a randomized controlled trial of foster care as an alternative to institutional care following exposure to severe psychosocial deprivation. We report data from 135 participants assessed in early adulthood (age 18 y). We find that 16 y after randomization occurred, those who had been randomized to high-quality foster care had significantly higher IQ scores (9 points, 0.6 SD) than those randomized to care as usual. Mediation analyses provide evidence that the causal effect of the intervention on cognitive ability in early adulthood could be explained, in part, by higher-quality caregiving and attachment security. These findings indicate that early investment in family care as an alternative to institutional care leads to sustained gains in cognitive ability. Fostering caregiving relationships is a likely mechanism of the intervention. In addition, exploratory analyses indicate that stable placements throughout childhood are associated with the greatest long-term gains in cognitive ability. Whether early interventions for infants and young children lead to lasting change has significant implications for decisions to invest in programs aimed at improving children's developmental outcomes.
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DeLacey E, Allen E, Tann C, Groce N, Hilberg E, Quiring M, Kaplan T, Smythe T, Kaui E, Catt R, Miller R, Gombo M, Dam H, Kerac M. Feeding practices of children within institution‐based care: A retrospective analysis of surveillance data. MATERNAL & CHILD NUTRITION 2022; 18:e13352. [PMID: 35318809 PMCID: PMC9218330 DOI: 10.1111/mcn.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/25/2022] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
Abstract
There is limited information on the feeding practices of 9.42 million children living within institution‐based care (IBC) worldwide. Poor feeding practices can predispose or exacerbate malnutrition, illness and disability. Here we describe the feeding practices of children living within IBC based on a retrospective analysis of records from 3335 children, 0–18 years old, participating in Holt International's Child Nutrition Program (CNP), from 36 sites in six countries. Data analysed included demographic information on age, sex, feeding practices, disabilities and feeding difficulties. Descriptive statistics were produced. A generalised linear model explored associations between feeding difficulties and disability and 2 × 2 tables examined feeding difficulties over time. An additional set of feeding observations with qualitative and quantitative data was analysed. At baseline, the median age of children was 16 months (0.66–68 months) with 1650/3335 (49.5%) females. There were 757/3335 (22.7%) children with disabilities; 550/984 (55.9%) were low birth weight; 311/784 (39.7%) were premature; 447/3113 (14.4%) had low body mass index and 378/3335 (11.3%) had feeding difficulties. The adjusted risk of having a feeding difficulty was 5.08 ([95% confidence interval: 2.65–9.7], p ≤ 0.001) times greater in children with disabilities than those without. Many children saw their feeding difficulties resolve after 1‐year in CNP, 54/163 (33.1%) for children with disabilities and 57/106 (53.8%) for those without disabilities. Suboptimal hygiene, dietary and feeding practices were reported. In conclusion, feeding difficulties were common in IBC, especially among children with disabilities. Supporting safe interactive mealtimes for children living within IBC should be prioritised, to ensure overall health and development. Feeding difficulties are common among children living in institution‐based care (IBC), particularly but not exclusively among those children with disabilities. Suboptimal feeding practices were common in IBC and encompassed inadequate hygiene, limited support for self‐feeding, reading children's feeding cues (especially around pacing and satiety), addressing feeding difficulties, such as difficulty chewing or swallowing. These should be prioritised in training and supervision for caregivers. Addressing the needs of this vulnerable group should include support for safe feeding techniques. These should be prioritised to help ease the transition into eventual family‐based care if we are to move towards deinstitutionalizing children and strengthening families.
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Affiliation(s)
- Emily DeLacey
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine University of London London UK
- Nutrition and Health Services Holt International Eugene Oregon USA
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine University of London London UK
| | - Elizabeth Allen
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine University of London London UK
| | - Cally Tann
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine University of London London UK
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine University of London London UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene & Tropical Medicine University of London Entebbe Uganda
- Department of Neonatal Medicine University College London Hospitals NHS Trust London UK
| | - Nora Groce
- UCL International Disability Research Centre, Department of Epidemiology and Public Health University College London London UK
| | - Evan Hilberg
- Nutrition and Health Services Holt International Eugene Oregon USA
| | - Michael Quiring
- Nutrition and Health Services Holt International Eugene Oregon USA
| | - Tracy Kaplan
- Nutrition and Health Services Holt International Eugene Oregon USA
| | - Tracey Smythe
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine University of London London UK
- International Centre for Evidence in Disability, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine University of London London UK
| | - Erin Kaui
- Nutrition and Health Services Holt International Eugene Oregon USA
| | - Rachael Catt
- Nutrition and Health Services Holt International Eugene Oregon USA
| | - Raeanne Miller
- Nutrition and Health Services Holt International Eugene Oregon USA
| | - Maijargal Gombo
- Nutrition and Health Services Holt International Eugene Oregon USA
| | - Hang Dam
- Nutrition and Health Services Holt International Eugene Oregon USA
| | - Marko Kerac
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine University of London London UK
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine University of London London UK
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Yang F, Wen J, Huang N, Riem MME, Lodder P, Guo J. Prevalence and Related Factors of Child Posttraumatic Stress Disorder during COVID-19 Pandemic: A Systematic Review and Meta-analysis. Eur Psychiatry 2022; 65:e37. [PMID: 35726735 PMCID: PMC9280924 DOI: 10.1192/j.eurpsy.2022.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Fan Yang
- School of Public Health, Peking University Health Science Center, No.38 Xue yuan Rd., Haidian District, Beijing, P.R. China, 100191
| | - Jiaxing Wen
- School of Public Health, Peking University Health Science Center, No.38 Xue yuan Rd., Haidian District, Beijing, P.R. China, 100191
| | - Ning Huang
- School of Public Health, Peking University Health Science Center, No.38 Xue yuan Rd., Haidian District, Beijing, P.R. China, 100191
| | - Madelon M E Riem
- Behavioral Science Institute, Radboud University, The Netherlands.,Clinical Child & Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paul Lodder
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Jing Guo
- School of Public Health, Peking University Health Science Center, No.38 Xue yuan Rd., Haidian District, Beijing, P.R. China, 100191
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Wagner B, Reuter L, van Noort BM. Internet-Based Prevention Program of Victimization for Youth in Care and Care Leavers (EMPOWER YOUTH): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e34706. [PMID: 35700035 PMCID: PMC9240930 DOI: 10.2196/34706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/10/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The global estimate of the number of children in institutional care is around 5 million, with around 1 million of these children living in Europe. In Germany, about 75,000 children and adolescents find themselves in the foster care system and about 93,000 additional children and adolescents are living in institutions. Traumatic experiences and neglect in childhood are highly prevalent among these youth in care and are related to severe long-term effects. Childhood maltreatment and abuse can increase the risk of future victimization experiences. Although youth in care are at risk of victimization or revictimization, no specific evidence-based prevention program has been designed to address these specific needs. OBJECTIVE This study aims to evaluate the efficacy of a newly developed 6-module internet-based prevention program of victimization for youth in care, named EMPOWER YOUTH. METHODS In a randomized controlled trial, the intervention group will be compared to a waiting-list control group with an unblinded 1:1 allocation ratio. Assessments will take place before randomization (baseline) and at follow-up 18 weeks after baseline (ie, 12 weeks after finishing the last module of the program). The primary endpoint is the number of victimization, and online and offline bullying experiences (composite score) at the 18-week follow-up. Secondary endpoints are risk-taking behavior, aggressive tendencies, empathy, prosocial behavior, depressiveness, and loneliness at follow-up. The expected outcome requires a sample size of 156 subjects to achieve a power of 80%. Assuming a 30% dropout rate at follow-up, we require 225 participants to be allocated to the trial. Participants are youth in care, that is, adolescents in foster care, adopted adolescents, or young care leavers aged 14 to 21 years. RESULTS Ethical approval was granted by the Ethics Committee of the Medical School Berlin in March 2021 (MSB-2021/55). Recruitment started in September 2021 and is planned until November 2022. The results are expected to be published in January 2023. CONCLUSIONS Given the increased likelihood for future victimization experiences among youth in care, there is a strong need for a low-threshold intervention specifically for this high-risk age group. There are no existing nationwide mental health programs exclusively for youth in care in Germany. TRIAL REGISTRATION German Clinical Trials Register DRKS00024749; https://tinyurl.com/tjaahayw. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34706.
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Affiliation(s)
- Birgit Wagner
- Department of Psychology, Medical School Berlin, Berlin, Germany
| | - Laurence Reuter
- Department of Psychology, Medical School Berlin, Berlin, Germany
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Souverein F, Hales H, Anderson P, Argent SE, Bartlett A, Blower A, Delmage E, Enell S, Eske Henriksen A, Koomen K, Oostermeijer S. Mental health, welfare or justice: An introductory global overview of differences between countries in the scale and approach to secure placements of children and young people. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2022; 32:238-247. [PMID: 35419900 PMCID: PMC9544918 DOI: 10.1002/cbm.2234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Estimates suggest that over a million children per year are deprived of their liberty across the world. Little is known about the types, ethos or distribution of secure beds in which they are detained. AIM This study aims to provide quantitative data with background information, to explore similarities and differences across jurisdictions, and to inform critical inquiry into key concepts and practices. METHODS Data was obtained using an opportunistic sample of affluent countries, derived from an emerging academic/practice network of senior professionals. Depending on jurisdiction, data was already in the public domain or specifically requested. Data requests were related to the nature and size of health, welfare and criminal justice elements of secure beds and recent occupancy. Key professionals working in child secure settings, within jurisdictions, provided commentary on local approaches. RESULTS Data was incomplete but allowed for comparisons between 10 jurisdictions. The proportions of the populations of children and young people detained varied by jurisdiction as did their distribution across variations of secure settings. Not all jurisdictions had all three kinds of secure settings. Definitions of secure beds varied depending on the use of relational, procedural or physical security. CONCLUSION Findings are tentative but suggestion solely considering numerical descriptions of children's detention is misleading; our study highlights ways in which comparative studies may be improved. Within reported jurisdictions, the framework of health, welfare and justice was meaningful but this may not hold true with a wider international application of this method. Open interrogation of this data would be enhanced by the inclusion of children's perspectives.
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Affiliation(s)
- Fleur Souverein
- Department of child and adolescent psychiatrieAmsterdam University Medical School, Locatie VUmcAmsterdamThe Netherlands
| | | | | | | | - Annie Bartlett
- Institute of Medical and Biomedical EducationSt. George's UniversityLondonUK
| | | | | | - Sofia Enell
- Department of Social WorkLinnaeus UniversityVäxjöSweden
| | | | | | - Sanne Oostermeijer
- School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
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Seker S, Boonmann C, Gerger H, Jäggi L, d'Huart D, Schmeck K, Schmid M. Mental disorders among adults formerly in out-of-home care: a systematic review and meta-analysis of longitudinal studies. Eur Child Adolesc Psychiatry 2022; 31:1963-1982. [PMID: 34169369 PMCID: PMC9663399 DOI: 10.1007/s00787-021-01828-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/13/2021] [Indexed: 01/26/2023]
Abstract
While children and adolescents placed in child welfare or juvenile justice out-of-home care show higher prevalence rates of mental disorders compared to the general population, it remains unclear whether this pattern persists into adulthood. A quantitative synthesis of existing studies is lacking. The aim of this meta-analysis was to estimate the prevalence rates for mental disorders among adults with a foster or residential child welfare or juvenile justice care history, comparing them where possible to rates among the general population. PubMed, PsycInfo, EMBASE, and Web of Science were systematically searched for epidemiological studies published up to 28 October 2020. Nineteen studies, totaling 604,257 participants, met our inclusion criteria. Random-effects models were used for prevalence rates and odds ratios (OR) of mental disorders, and study quality was rated. A prevalence rate of 30% [95% CI (23.36, 37.36)] for any mental disorder in adults with a child welfare care history was found (3-17% for specific disorders). A prevalence rate of 45% [95% CI (42.38, 47.38)] for any mental disorder was found in adults with a juvenile justice care history (6-66% for specific disorders). For out-of-home placement history, adult mental disorders were significantly higher than in the general population (OR = 1.33-2.76). Studies differed in terms of methodology and the disorder groups considered, so heterogeneity between effect sizes ranged from low to high. Our findings suggest that the high risk that mental health issues will persist in adults with an out-of-home placement history needs to be taken seriously in the transition from adolescence to adulthood. The care systems involved need to collaborate and to be aware of these risks.
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Affiliation(s)
- Süheyla Seker
- Department of Child and Adolescent Psychiatry Research, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland.
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatry Research, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Heike Gerger
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lena Jäggi
- Division of Personality and Developmental Psychology, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Delfine d'Huart
- Department of Child and Adolescent Psychiatry Research, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatry Research, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Marc Schmid
- Department of Child and Adolescent Psychiatry Research, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
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31
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Sariaslan A, Kääriälä A, Pitkänen J, Remes H, Aaltonen M, Hiilamo H, Martikainen P, Fazel S. Long-term Health and Social Outcomes in Children and Adolescents Placed in Out-of-Home Care. JAMA Pediatr 2022; 176:e214324. [PMID: 34694331 PMCID: PMC8546624 DOI: 10.1001/jamapediatrics.2021.4324] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Children who are placed in out-of-home care may have poorer outcomes in adulthood, on average, compared with their peers, but the direction and magnitude of these associations need clarification. OBJECTIVE To estimate associations between being placed in out-of-home care in childhood and adolescence and subsequent risks of experiencing a wide range of social and health outcomes in adulthood following comprehensive adjustments for preplacement factors. DESIGN, SETTING, AND PARTICIPANTS This cohort and cosibling study of all children born in Finland between 1986 and 2000 (N = 855 622) monitored each person from their 15th birthday either until the end of the study period (December 2018) or until they migrated, died, or experienced the outcome of interest. Cox and Poisson regression models were used to estimate associations with adjustment for measured confounders (from linked population registers) and unmeasured familial confounders (using sibling comparisons). Data were analyzed from October 2020 to August 2021. EXPOSURES Placement in out-of-home care up to age 15 years. MAIN OUTCOMES AND MEASURES Through national population, patient, prescription drug, cause of death, and crime registers, 16 specific outcomes were identified across the following categories: psychiatric disorders; low socioeconomic status; injuries and experiencing violence; and antisocial behaviors, suicidality, and premature mortality. RESULTS A total of 30 127 individuals (3.4%) were identified who had been placed in out-of-home care for a median (interquartile range) period of 1.3 (0.2-5.1) years and 2 (1-3) placement episodes before age 15 years. Compared with their siblings, individuals who had been placed in out-of-home care were 1.4 to 5 times more likely to experience adverse outcomes in adulthood (adjusted hazard ratio [aHR] for those with a fall-related injury, 1.40; 95% CI, 1.25-1.57 and aHR for those with an unintentional poisoning injury, 4.79; 95% CI, 3.56-6.43, respectively). The highest relative risks were observed for those with violent crime arrests (aHR, 4.16; 95% CI, 3.74-4.62; cumulative incidence, 24.6% in individuals who had been placed in out-of-home care vs 5.1% in those who had not), substance misuse (aHR, 4.75; 95% CI, 4.25-5.30; cumulative incidence, 23.2% vs 4.6%), and unintentional poisoning injury (aHR 4.79; 95% CI, 3.56-6.43; cumulative incidence, 3.1% vs 0.6%). Additional adjustments for perinatal factors, childhood behavioral problems, and traumatic injuries, including experiencing violence, did not materially change the findings. CONCLUSIONS AND RELEVANCE Out-of-home care placement was associated with a wide range of adverse outcomes in adulthood, which persisted following adjustments for measured preplacement factors and unmeasured familial factors.
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Affiliation(s)
- Amir Sariaslan
- Social and Public Policy Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland,Department of Child Psychiatry, University of Turku, Turku, Finland,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Antti Kääriälä
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland,International Max Planck Research School for Population, Health and Data Science, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Mikko Aaltonen
- University of Eastern Finland Law School, University of Eastern Finland, Joensuu, Finland,Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Heikki Hiilamo
- Social and Public Policy Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland,Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
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Seker S, Bürgin D, d’Huart D, Schmid M, Schmeck K, Jenkel N, Fegert JM, Steppan M, Boonmann C. Der Verlauf von psychischen Problemen bei fremdplatzierten Kindern und Jugendlichen bis in deren Erwachsenenalter. KINDHEIT UND ENTWICKLUNG 2022. [DOI: 10.1026/0942-5403/a000365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Fremdplatzierte Kinder und Jugendliche sind psychisch hoch belastet, jedoch ist der Verlauf von psychischen Problemen bis in deren Erwachsenenalter weitgehend unbekannt. Fragestellung: Die Prävalenz und der Verlauf von psychischen Problemen bei fremdplatzierten Kindern und Jugendlichen bis ins Erwachsenenalter wurden in dieser Studie untersucht und mögliche Prädiktoren identifiziert. Methode: 164 Kinder und Jugendliche wurden während der Fremdplatzierung und im Erwachsenenalter längsschnittlich mittels Selbstbeurteilungsfragebogen auf psychische Gesamtauffälligkeit, internalisierende und externalisierende Probleme untersucht. Ergebnisse: 62.2 % der Kinder und Jugendlichen zeigten auffällige Werte für die Gesamtauffälligkeit wohingegen es im Erwachsenenalter noch 35.7 % waren. Die stärksten Prädiktoren für die jeweiligen Skalen im Erwachsenenalter waren die psychischen Probleme im Kindes- und Jugendalter. Mädchen zeigten eine erhöhte Wahrscheinlichkeit für internalisierende Probleme im Erwachsenenalter im Vergleich zu Jungen. Diskussion und Schlussfolgerung: Die psychischen Probleme bei fremdplatzierten Kindern und Jugendlichen verringerten sich bis ins junge Erwachsenenalter, dennoch blieb ein beachtlicher Teil chronisch auffällig. Implikationen für die Forschung und Praxis werden diskutiert.
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Affiliation(s)
- Süheyla Seker
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
| | - David Bürgin
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Ulm
| | - Delfine d’Huart
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
| | - Marc Schmid
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
| | - Klaus Schmeck
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
| | - Nils Jenkel
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
| | - Jörg M. Fegert
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Ulm
| | - Martin Steppan
- Abteilung für Persönlichkeits- und Entwicklungspsychologie, Fakultät für Psychologie, Universität Basel, Schweiz
| | - Cyril Boonmann
- Kinder- und jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Schweiz
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DeLacey E, Hilberg E, Allen E, Quiring M, Tann CJ, Groce NE, Vilus J, Bergman E, Demasu-Ay M, Dam HT, Kerac M. Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoring. BMJ Open 2021. [PMCID: PMC8719208 DOI: 10.1136/bmjopen-2021-050371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives The aim of this study is to fill a key information gap on the nutrition-related epidemiology of orphaned and vulnerable children living within institution-based care (IBC) across six countries. Design A retrospective analysis with Shewhart control charts and funnel plots to explore intersite and over time variations in nutritional status. Setting We conducted a retrospective analysis of records from Holt International’s Child Nutrition Programme from 35 sites in six countries; Mongolia, India, Ethiopia, Vietnam, China and the Philippines. Participants Deidentified health records from Holt International’s online nutrition screening database included records from 2926 children, 0–18 years old. Data were collected from 2013 to 2020 and included demographic and health information. Results At initial screening, 717 (28.7%) children were anaemic, 788 (34.1%) underweight, 1048 (37.3%) stunted, 212 (12.6%) wasted, 135 (12%) overweight or obese and 339 (31%) had small head circumference. Many had underlying conditions: low birth weight, 514 (57.5%); prematurity, 294 (42.2%) and disabilities, 739 (25.3%). Children with disabilities had higher prevalence of malnutrition compared with counterparts without disabilities at baseline and 1-year screenings. There was marked intersite variation. Funnel plots highlight sites with malnutrition prevalence outside expected limits for this specific population taking into consideration natural variation at baseline and at 1 year. Control charts show changes in site mean z-scores over time in relation to site control limits. Conclusions Malnutrition is prevalent among children living within IBC, notably different forms of undernutrition (stunting, underweight, wasting). Underlying risk factors are also common: prematurity, low birth weight and disability. Nutrition interventions should take into account the needs of this vulnerable population, especially for infants and those with disabilities. Using control charts to present data could be especially useful to programme managers as sites outside control limits could represent: problems to be investigated; good practices to be shared.
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Affiliation(s)
- Emily DeLacey
- Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Nutrition & Health Department, Holt International, Eugene, Oregon, USA
- Centre for Maternal Adolescent Reproductive and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Evan Hilberg
- Nutrition & Health Department, Holt International, Eugene, Oregon, USA
| | - Elizabeth Allen
- Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Michael Quiring
- Nutrition & Health Department, Holt International, Eugene, Oregon, USA
| | - Cally J Tann
- Centre for Maternal Adolescent Reproductive and Child Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nora Ellen Groce
- International Disability Research Centre, University College London, London, UK
| | - James Vilus
- Holt Haiti Country Office, Holt International, Port-au-Prince, Haiti
| | - Ethan Bergman
- Department of Health Sciences, Central Washington University, Ellensburg, Washington, USA
| | - Merzel Demasu-Ay
- Nutrition Department, Kaisahang Buhay Foundation, Inc, Quezon City, Philippines
| | - Hang T Dam
- Nutrition & Health Department, Holt International, Eugene, Oregon, USA
| | - Marko Kerac
- Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Maternal Adolescent Reproductive and Child Health, London School of Hygiene and Tropical Medicine, London, UK
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Sánchez-Luque B, Martínez-Angulo P, Cantón-Habas V, Ventura-Puertos PE. Care and Rearing of Institutionalized Girls in Arequipa, Peru: An Ethnographic Approach. J Transcult Nurs 2021; 33:190-198. [PMID: 34784813 DOI: 10.1177/10436596211057898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Institutional care for children is a global phenomenon. Despite its advantages, common threats have been described. In Peru, more than 70% of institutionalized children/adolescents have living parents who cannot take care of them. The study aims to understand the care/rearing of institutionalized girls in Arequipa, Peru. METHODOLOGY Ethnographic design, with a sample integrated by 27 institutionalized girls. Data collected based on participant observation and semi-structured interviews. The analysis followed the Method of Constant Comparisons. RESULTS Five main themes were found: (a) The little house (foster home) is better than my house; (b) They take care of me-even when I am sick-; (c) But . . .; (d) What I have lived is what I am; (e) Happiness fits in this little house. DISCUSSION An ethnography of care/rearing practices could be helpful for a better understanding of the dimensions of the life of institutionalized girls living in developing countries.
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Affiliation(s)
- Berta Sánchez-Luque
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Córdoba, Spain
| | - Pablo Martínez-Angulo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Córdoba, Spain
| | - Vanesa Cantón-Habas
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Córdoba, Spain
| | - Pedro E Ventura-Puertos
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Córdoba, Spain
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Abstract
From the beginning, theories of attachment and caregiving have given rise to questions about minimum and maximum numbers of attachment figures. The child's tendency to direct attachment behavior to a specific figure rather than to whoever is nearby has led to the idea of monotropy, suggesting that a child would thrive best with one special attachment figure. From an evolutionary perspective kinship caregiving networks are more plausible as they would increase the chances of survival, and in hunter-gatherer and agricultural communities paternal care and kinship networks providing care for young children were indeed common. A recent development in cultural evolution is the invention of organized day care and children's homes and institutions. Although the attachment network may increase in size with the child's cognitive development, research on institutionalized care demonstrates that high numbers of caregivers preclude secure attachments. The limiting factor to attachment networks may however not be the number of caregivers, but the opportunities for the child to learn contingencies in social relationships that have an attachment component.
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Braitstein P, DeLong A, Ayuku D, Ott M, Atwoli L, Galárraga O, Sang E, Hogan J. Association of Care Environment With HIV Incidence and Death Among Orphaned, Separated, and Street-Connected Children and Adolescents in Western Kenya. JAMA Netw Open 2021; 4:e2125365. [PMID: 34529063 PMCID: PMC8446813 DOI: 10.1001/jamanetworkopen.2021.25365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE In 2015, there were nearly 140 million orphaned children globally, particularly in low- and middle-income regions, and millions more for whom the street is central to their everyday lives. A total of 16.6 million children were orphaned because of deaths associated with HIV/AIDS, of whom 90% live in sub-Saharan Africa. Although most orphaned and separated children and adolescents in this region are cared for by extended family, the large number of children requiring care has produced a proliferation of institutional care. Few studies have investigated the association between care environment and physical health among orphaned and separated youths in sub-Saharan Africa. OBJECTIVE To examine the association of care environment with incident HIV and death among orphaned and separated children and adolescents who were living in charitable children's institutions, family-based settings, and street settings in western Kenya over almost 10 years. DESIGN, SETTING, AND PARTICIPANTS The Orphaned and Separated Children's Assessments Related to Their Health and Well-Being (OSCAR) project was an observational prospective cohort study conducted in Uasin Gishu County, Kenya. The cohort comprised 2551 orphaned, separated, and street-connected children from communities within 8 administrative locations, which included 300 randomly selected households (family-based settings) caring for children who were orphaned from all causes, 19 charitable children's institutions (institutional settings), and a convenience sample of 100 children who were practicing self-care on the streets (street settings). Participants were enrolled from May 31, 2010, to April 24, 2013, and were followed up until November 30, 2019. EXPOSURES Care environment (family-based, institutional, or street setting). MAIN OUTCOMES AND MEASURES Survival regression models were used to investigate the association between care environment and incident HIV, death, and time to incident HIV or death. RESULTS Among 2551 participants, 1230 youths were living in family-based settings, 1230 were living in institutional settings, and 91 were living in street settings. Overall, 1321 participants (51.8%) were male, with a mean (SD) age at baseline of 10.4 (4.8) years. Most participants who were living in institutional (1047 of 1230 youths [85.1%]) or street (71 of 91 youths [78.0%]) settings were double orphaned (ie, both parents had died). A total of 59 participants acquired HIV infection or died during the study period. After adjusting for sex, age, and baseline HIV status, living in a charitable children's institution was not associated with death (adjusted hazard ratio [AHR], 0.26; 95% CI, 0.07-1.02) or incident HIV (AHR, 1.49; 95% CI, 0.46-4.83). Compared with living in a family-based setting, living in a street setting was associated with death (AHR, 5.46; 95% CI, 2.30-12.94), incident HIV (AHR, 17.31; 95% CI, 5.85-51.25), and time to incident HIV or death (AHR, 7.82; 95% CI, 3.48-17.55). CONCLUSIONS AND RELEVANCE In this study, after adjusting for potential confounders, no association was found between care environment and HIV incidence or death among youths living in institutional vs family-based settings. However, living in a street setting vs a family-based setting was associated with both HIV incidence and death. This study's findings suggest that strengthening of child protection systems and greater investment in evidence-based family support systems that improve child and adolescent health and prevent youth migration to the street are needed for safe and beneficial deinstitutionalization to be implemented at scale.
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Affiliation(s)
- Paula Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Epidemiology and Medical Statistics, School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH) Program, Eldoret, Kenya
| | - Allison DeLong
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - David Ayuku
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Mary Ott
- Department of Pediatrics, Faculty of Medicine, Indiana University, Indianapolis
| | - Lukoye Atwoli
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- Dean’s Office, Aga Khan University Medical College, East Africa, Nairobi, Kenya
| | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Edwin Sang
- Academic Model Providing Access to Healthcare (AMPATH) Program, Eldoret, Kenya
| | - Joseph Hogan
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
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Omari F, Chrysanthopoulou SA, Embleton LE, Atwoli L, Ayuku DO, Sang E, Braitstein P. The impact of care environment on the mental health of orphaned, separated and street-connected children and adolescents in western Kenya: a prospective cohort analysis. BMJ Glob Health 2021; 6:bmjgh-2020-003644. [PMID: 33789867 PMCID: PMC8016077 DOI: 10.1136/bmjgh-2020-003644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction The effect of care environment on orphaned and separated children and adolescents’ (OSCA) mental health is not well characterised in sub-Saharan Africa. We compared the risk of incident post-traumatic stress disorder (PTSD), depression, anxiety and suicidality among OSCA living in Charitable Children’s Institutions (CCIs), family-based care (FBC) and street-connected children and youth (SCY). Methods This prospective cohort followed up OSCA from 300 randomly selected households (FBC), 19 CCIs and 100 SCY in western Kenya from 2009 to 2019. Annual data were collected through standardised assessments. We fit survival regression models to investigate the association between care environment and mental health diagnoses. Results The analysis included 1931 participants: 1069 in FBC, 783 in CCIs and 79 SCY. At baseline, 1004 participants (52%) were male with a mean age (SD) of 13 years (2.37); 54% were double orphans. In adjusted analysis (adjusted HR, AHR), OSCA in CCIs were significantly less likely to be diagnosed with PTSD (AHR 0.69, 95% CI 0.49 to 0.97), depression (AHR 0.48 95% CI 0.24 to 0.97), anxiety (AHR 0.56, 95% CI 0.45 to 0.68) and suicidality (AHR 0.73, 95% CI 0.56 to 0.95) compared with those in FBC. SCY were significantly more likely to be diagnosed with PTSD (AHR 4.52, 95% CI 4.10 to 4.97), depression (AHR 4.72, 95% CI 3.12 to 7.15), anxiety (AHR 4.71, 95% CI 1.56 to 14.26) and suicidality (AHR 3.10, 95% CI 2.14 to 4.48) compared with those in FBC. Conclusion OSCA living in CCIs in this setting were significantly less likely to have incident mental illness, while SCY were significantly more, compared with OSCA in FBC.
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Affiliation(s)
- Felicita Omari
- Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Lonnie E Embleton
- Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Lukoye Atwoli
- Mental Health, Moi University College of Health Sciences, Eldoret, Kenya
| | - David O Ayuku
- Behavioral Sciences, Moi University College of Health Sciences, Eldoret, Kenya
| | - Edwin Sang
- Data Management and Biostatistics, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Paula Braitstein
- Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
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Korom M, Dozier M. The importance of responsive parenting for vulnerable infants. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2021; 61:43-71. [PMID: 34266571 DOI: 10.1016/bs.acdb.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The quality of the early caregiving context sets the stage for the developing child's long term developmental trajectory. Infants are born highly dependent on parents and other caregivers for critical input for developing brain and behavioral systems. When infants experience early adversity, they are at risk for difficulties regulating behavior, emotions, and physiology. Parenting interventions have been developed to enhance parental responsiveness, thereby enhancing child outcomes. One such program, Attachment and Biobehavioral Catch-up (ABC), is a home visiting intervention designed to enhance parenting nurturance and sensitivity. In this paper, we will consider the importance of parental sensitivity and developmental consequences of sensitive and insensitive care. We will then describe interventions that target parental responsiveness and intervention effectiveness, focusing primarily on ABC. Public policy recommendations related to the importance of parental responsiveness will then be discussed.
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Affiliation(s)
- Marta Korom
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States.
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Ma Z, Idris S, Zhang Y, Zewen L, Wali A, Ji Y, Pan Q, Baloch Z. The impact of COVID-19 pandemic outbreak on education and mental health of Chinese children aged 7-15 years: an online survey. BMC Pediatr 2021; 21:95. [PMID: 33627089 PMCID: PMC7903034 DOI: 10.1186/s12887-021-02550-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 02/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The emerging of psychological problems triggered by COVID-19 particularly in children have been extensively highlighted and emphasized, but original research in this respect is still lagging behind. Therefore, we designed this study to evaluate the impact of COVID-19 pandemic on mental health and the effectiveness and attitudes towards online education among Chinese children aged 7-15 years. METHODS A detailed questionnaire, comprising of 62 questions was designed and parents or caretakers of 7 to 15 years old children were invited to participate via WeChat, a multi-purpose messaging, social media and mobile payment app, which is widely used by the Chinese population. A total of 668 parents across different regions of China were included. RESULTS During COVID-19 pandemic, 20.7 and 7.2% children report experiencing post-traumatic stress disorder (PTSD) and depressive symptoms due to the COVID-19 pandemic. PTSD and SMFQ-P scores are significantly higher in middle school and boarding school students compared to primary and day school students. Multiple logistic regression analysis revealed that school system and province of origin are factors significantly associated with developing PSTD symptoms. 44.3% respondents feel online education is effective in gaining knowledge and improving practical and communications skills. 78.0% believe the online education system is efficient. Overall 79.8% respondents are satisfied and children can adapt to this new education system. During the COVID-19 pandemic, we found 1 in five children have PTSD and 1 in 14 children have depressive symptoms. CONCLUSION In summary, COVID-19 epidemic has caused PTSD and depression symptoms among Chinese children aged 7 to 15 years. In general, a large proportion of respondents are satisfied with online education, but still a substantial proportion of students are not comfortable with this new form of learning. Authorities should optimize online education systems and implement effective interventions to cope with the psychological effects of COVID-19 on children, as it is affecting the global population and remains uncertain when it will end.
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Affiliation(s)
- Zhongren Ma
- China-Malaysia National Joint Laboratory, Biomedical Research Center, Northwest Minzu University, Lanzhou, China
| | - Sakinah Idris
- China-Malaysia National Joint Laboratory, Biomedical Research Center, Northwest Minzu University, Lanzhou, China
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Yinxia Zhang
- China-Malaysia National Joint Laboratory, Biomedical Research Center, Northwest Minzu University, Lanzhou, China
| | - Liu Zewen
- China-Malaysia National Joint Laboratory, Biomedical Research Center, Northwest Minzu University, Lanzhou, China
| | - Amaad Wali
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, Yunnan, China
| | - Yunpeng Ji
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Qiuwei Pan
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Zulqarnain Baloch
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, Yunnan, China.
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Buggs SA, Webster DW, Crifasi CK. Using synthetic control methodology to estimate effects of a Cure Violence intervention in Baltimore, Maryland. Inj Prev 2021; 28:61-67. [DOI: 10.1136/injuryprev-2020-044056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/03/2022]
Abstract
ObjectiveTo estimate the long-term impact of Safe Streets Baltimore, which is based on the Cure Violence outreach and violence interruption model, on firearm violence.MethodsWe used synthetic control methods to estimate programme effects on homicides and incidents of non-fatal penetrating firearm injury (non-fatal shootings) in neighbourhoods that had Safe Streets’ sites and model-generated counterfactuals. Synthetic control analyses were conducted for each firearm violence outcome in each of the seven areas where Safe Streets was implemented. The study also investigated variation in programme impact over time by generating effect estimates of varying durations for the longest-running programme sites.ResultsSynthetic control models reduced prediction error relative to regression analyses. Estimates of Safe Streets’ effects on firearm violence varied across intervention sites: some positive, some negative and no effect. Beneficial programme effects on firearm violence reported in prior research were found to have attenuated over time.ConclusionsFor highly targeted interventions, synthetic control methods may provide more valid estimates of programme impact than panel regression with data from all city neighbourhoods. This research offers new understanding about the effectiveness of the Cure Violence intervention over extended periods of time in seven neighbourhoods. Combined with existing Cure Violence evaluation literature, it also raises questions about contextual and implementation factors that might influence programme outcomes.
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Humphreys KL, Guyon-Harris KL, Tibu F, Wade M, Nelson CA, Fox NA, Zeanah CH. Psychiatric outcomes following severe deprivation in early childhood: Follow-up of a randomized controlled trial at age 16. J Consult Clin Psychol 2020; 88:1079-1090. [PMID: 33370132 DOI: 10.1037/ccp0000613] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Early psychosocial deprivation is associated with increased risk for psychopathology, yet few studies have examined outcomes in adolescents. METHOD At baseline (M age 22 months), 136 children from Bucharest, Romania, living in large institutions, were randomized into foster care (FCG) or to care as usual (CAUG). Caregivers completed psychiatric interviews regarding their children (52 FCG; 51 CAUG) at age 16 years (M = 16.67 years; SD = 0.78) to assess past year diagnoses and symptom counts. In addition, never-institutionalized community comparison children (n = 47) were included. RESULTS Ever-institutionalized children had higher rates of meeting criteria for any psychiatric disorder and higher symptom counts of internalizing, externalizing, attention-deficit/hyperactivity, and substance use disorders compared to never-institutionalized children (ps < .05). Using intent-to-treat analyses, we found that children in the CAUG had more than twice the rate of psychiatric disorders than children in the FCG (OR = 2.48, 95% CI [1.12, 5.48]). Furthermore, children in foster care who remained in their original placement did not significantly differ in their rates of psychiatric disorders compared to never-institutionalized children. CONCLUSIONS There are many ways children can be separated from parents, including placement into institutional care. The current findings indicate that such placements are associated with significant risks for psychopathology. Moreover, we provide causal evidence for the long-lasting positive effect of foster care in reducing the risk of psychopathology in adolescence, especially among those in stable placements. These results provide strong evidence that early and stable placements into quality foster care may mitigate risk for psychopathology following severe early psychosocial deprivation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Mark Wade
- Department of Applied Psychology and Human Development, University of Toronto
| | - Charles A Nelson
- Department of Pediatrics, Boston Children's Hospital/ Harvard Medical School
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park
| | - Charles H Zeanah
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine
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Shi G, Huang J, Pi M, Chen X, Li X, Ding Y, Zhang H. Impact of early Coronavirus Disease 2019 pandemic on pediatric cardiac surgery in China. J Thorac Cardiovasc Surg 2020; 161:1605-1614.e4. [PMID: 33419537 PMCID: PMC7704339 DOI: 10.1016/j.jtcvs.2020.11.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study aimed to provide an insight into the impact of the early outbreak of the novel Coronavirus Disease 2019 on the care management for patients with congenital heart disease. METHODS This study respectively enrolled a cohort of surgical patients who underwent surgery in 2018 (group I), 2019 (group II), and 2020 (group III) and a cohort of follow-up patients who had follow-up in 2017 (group A), 2018 (group B), and 2019 (group C) in 13 children hospitals. RESULTS During the Coronavirus Disease 2019 era, there was a significant decrease in total surgical volume and a change in case mix in terms of an increase in the proportion of emergency operations. Decrease in migration scale index was correlated to the decrease in both surgical volume (r = 0.64, P = .02) and outpatient visit volume (r = 0.61, P = .03). There was a significantly higher proportion of patients who had follow-up through the internet or phone in group C (26.4% vs 9.6% in group B and 8.9% in group A; P < .0001). There was no statistical difference in death or rehospitalization among the 3 follow-up groups (P = .49). There was higher parents' anxiety score (P < .0001) and more use of telemedicine (P = .004) in group C compared with groups A and B. CONCLUSIONS The Coronavirus Disease 2019 pandemic has resulted in a considerable decrease in total surgical volume and a change of case mix, which seems to be related to the strict traffic ban. Follow-up through the online medical service appears to be an effective alternative to the conventional method.
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Affiliation(s)
- Guocheng Shi
- Department of Cardiothoracic Surgery, Heart Center and Shanghai Institution of Pediatric Congenital Heart Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Clinical Research Center, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jihong Huang
- Department of Cardiothoracic Surgery, Heart Center and Shanghai Institution of Pediatric Congenital Heart Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Clinical Research Center, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingan Pi
- Department of Cardiothoracic Surgery, Wuhan Children's Hospital, Wuhan, Hubei, China
| | - Xinxin Chen
- Department of Cardiothoracic Surgery, Guangzhou Woman and Children's Hospital, Guangzhou, Guangdong, China
| | - Xiaofeng Li
- Department of Cardiac Surgery, Beijing Children's Hospital, National Center for Children Health, Beijing, China
| | - Yiqun Ding
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
| | - Hao Zhang
- Department of Cardiothoracic Surgery, Heart Center and Shanghai Institution of Pediatric Congenital Heart Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Wilke NG, Howard AH, Pop D. Data-informed recommendations for services providers working with vulnerable children and families during the COVID-19 pandemic. CHILD ABUSE & NEGLECT 2020; 110:104642. [PMID: 32753231 PMCID: PMC7392096 DOI: 10.1016/j.chiabu.2020.104642] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic and associated response measures have led to unprecedented challenges for service providers working with vulnerable children and families around the world. OBJECTIVE The goal of the present study was to better understand the impact of the pandemic and associated response measures on vulnerable children and families and provide data-informed recommendations for public and private service providers working with this population. PARTICIPANTS AND SETTING Representatives from 87 non-government organizations (NGOs) providing a variety of direct services (i.e. residential care, family preservation, foster care, etc.) to 454,637 vulnerable children and families in 43 countries completed a brief online survey. METHODS Using a mixed methods design, results examined 1) ways in which children and families have been directly impacted by COVID-19, 2) the impact of the pandemic on services provided by NGOs, 3) government responses and gaps in services for this population during the pandemic, and 4) strategies that have been effective in filling these gaps. RESULTS Data revealed that the pandemic and restrictive measures were associated with increased risk factors for vulnerable children and families, including not having access to vital services. The NGOs experienced government restrictions, decreased financial support, and inability to adequately provide services. Increased communication and supportive activities had a positive impact on both NGO staff and the families they serve. CONCLUSIONS Based on the findings, ten recommendations were made for service providers working with vulnerable children and families during the COVID-19 pandemic.
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van IJzendoorn MH, Bakermans-Kranenburg MJ, Duschinsky R, Fox NA, Goldman PS, Gunnar MR, Johnson DE, Nelson CA, Reijman S, Skinner GCM, Zeanah CH, Sonuga-Barke EJS. Institutionalisation and deinstitutionalisation of children 1: a systematic and integrative review of evidence regarding effects on development. Lancet Psychiatry 2020; 7:703-720. [PMID: 32589867 DOI: 10.1016/s2215-0366(19)30399-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Marinus H van IJzendoorn
- Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands; Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Robbie Duschinsky
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nathan A Fox
- Department of Psychology, University of Maryland, College Park, MD, USA
| | | | - Megan R Gunnar
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Dana E Johnson
- Divisions of Neonatology and Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Charles A Nelson
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Harvard Graduate School of Education, Cambridge, MA, USA
| | - Sophie Reijman
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Guy C M Skinner
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Charles H Zeanah
- Institute of Infant and Early Childhood Mental Health, Tulane University School of Medicine, New Orleans, LA, USA
| | - Edmund J S Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK; Department of Child and Adolescent Psychiatry, Aarhus University, Aarhus, Denmark.
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Institutionalisation and deinstitutionalisation of children 2: policy and practice recommendations for global, national, and local actors. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:606-633. [PMID: 32589873 PMCID: PMC7311356 DOI: 10.1016/s2352-4642(20)30060-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 12/03/2022]
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Zeanah CH, Humphreys KL. Global prevalence of institutional care for children: a call for change. THE LANCET. CHILD & ADOLESCENT HEALTH 2020; 4:343-344. [PMID: 32151316 DOI: 10.1016/s2352-4642(20)30055-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Charles H Zeanah
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA 70112, USA.
| | - Kathryn L Humphreys
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA 70112, USA; Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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