If not now, then when? The importance of intervening early to provide family-based environments for all children

Avaliação do desenvolvimento neuropsicomotor de lactentes expostos ao HIV a partir do modelo da CIF

RESUMO Este estudo objetivou sistematizar e construir um checklist com instrumentos de avaliação do desenvolvimento infantil de acordo com o modelo biopsicossocial da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) de lactentes nas idades entre 4 e 12 meses expostos ao HIV. Trata-se de um estudo observacional, analítico e longitudinal. Foram utilizados na avaliação e descritos de acordo com as categorias dos domínios da CIF a escala Bayley de desenvolvimento infantil III; o questionário Affordances no Ambiente Domiciliar para o Desenvolvimento Motor - Escala Bebê; o critério de classificação econômica Brasil; e a ficha de avaliação com histórico do lactente. Os instrumentos trabalhados neste estudo contemplam os componentes de estrutura e funções corporais; atividades e participação; e fatores ambientais e pessoais. A descrição dos instrumentos de avaliação do desenvolvimento infantil de lactentes expostos ao HIV, por meio dos constructos e domínios da CIF, permitiu construir um raciocínio clínico durante a avaliação, enfatizando a vigilância do desenvolvimento infantil e a funcionalidade no primeiro ano de vida.

Assessment of the neuropsychomotor development of HIV-exposed infants using the ICF model

ABSTRACT This study aimed to systematize and build a checklist with tools to assess child development according to the biopsychosocial model of the International Classification of Functioning, Disability, and Health (ICF) of infants exposed to HIV, aged from 4 to 12 months. This is an observational, analytical, and longitudinal study. Bayley-III Scale of Infant and Toddler Development; Affordances in the Home Environment for Motor Development-Infant Scale; Brazilian Criteria of Economic Classification; and infant’s history used in the assessment were described according to the ICF domain categories. The tools used in this study include the components of body structure and functions; activities and participation; environmental and personal factors. The description of the assessment tools in the child development of infants exposed to HIV-by the constructs and domains of the ICF-allowed for the construction of clinical reasoning during the assessment, emphasizing the surveillance of child development and functioning in their first year of life.

Forecasting childhood adversities from conditions of birth

BACKGROUND

Childbirth presents an optimal time for identifying high-risk families to commence intervention that could avert various childhood health and social adversities.

OBJECTIVE

We sought to establish the minimum set of exposures required to accurately predict a range of adverse childhood outcomes up to the age of 13 years, from a set of 14 individual and familial risk exposures evident at the time of birth.

METHODS

Participants were 72,059 Australian children and their parents drawn from a multi-register population cohort study (data spanning 1994-2018). Risk exposures included male sex, young mother (aged ≤21 years), no (or late first; >16 weeks) antenatal visit, maternal smoking during pregnancy, small for gestational age, preterm birth, pregnancy complications (any of hypertension, diabetes mellitus, gestational diabetes or pre-eclampsia), >2 previous pregnancies of ≥20 weeks, socio-economic disadvantage, prenatal child protection notification, and maternal or paternal mental disorder or criminal offending history. Individual outcomes included early childhood developmental vulnerability (age 5 years), sustained educational underachievement (age 8 and 10 years), mental disorder diagnoses, substantiated childhood maltreatment, and contact with the police as a victim or person-of-interest up to age 13-14 years.

RESULTS

Risk exposures at birth predicted individual childhood outcomes with fair to excellent accuracy: the area under the receiver operating characteristic curves ranged between 0.60 (95% CI 0.58, 0.62) for childhood mental disorder and 0.83 (95% CI 0.82, 0.85) for substantiated child maltreatment. The presence of five or more exposures characterised 12-25% of children with one or more adverse outcomes and showed high predictive certainty for models predicting multiple outcomes, which were apparent in 9% of the population.

CONCLUSIONS

Up to a quarter of the neonatal population at risk of multiple adverse outcomes can be detected at birth, with implications for population health screening. However, cautious implementation of these models is warranted, given their relatively low positive predictive values.

More Money, More Problems? Addressing the Funding Conditions Required for Rights-Based Child Welfare Services in England

Policymakers and academics continue to debate the criteria used in formulas to allocate funding to children’s services, but few studies have considered how well the results of these formulas align with rights-based entitlements and commitments after implementation. This research measured correspondence between local authority spending per child and levels of income deprivation, special educational needs, and child development from 2011–2019 to assess the extent to which funding matches local authorities’ statutory responsibilities to provide support to children ‘in need’ under the Children Act 1989. There was weak and worsening correspondence between funding and needs, especially for preventative services.