The Disaster Information Needs of Families of Children with Special Healthcare Needs: A Scoping Review

A Virtual Home Preparedness Intervention Centered on Children and Youth With Special Health Care Needs

OBJECTIVE

Children and youth with special health care needs (CYSHCN) require additional considerations for staying safe in emergencies. Our team of clinicians and preparedness professionals developed and tested a virtual home preparedness intervention (VHPI) in families with CYSHCN receiving care in a statewide medical home network.

METHODS

The VHPI comprised 1) a pre/post interview covering fire safety, emergency evacuation, sheltering in place, and informing emergency responders of the child/youth's care needs; 2) a resource packet containing emergency planning templates and information on local supports; and 3) individualized referrals coordinated through the medical home/community partners. Eligible CYSHCN had medical technology reliance, physical/mobility needs, communication/intellectual challenges, and/or vision/hearing loss. Preparedness was measured as pre/post affirmed rates of 19 items from the interview and as mean composite scores of these items; associations were evaluated using generalized estimating equations-based regression for repeated measures.

RESULTS

The pre and post-VHPI interviews were completed by 170 and 148 participants, respectively. Significant individual-item gains included having a current Emergency Information Form for the child/youth (31% [pre] to 47% [post] affirmed) and assembling an evacuation kit (50% to 68%). The mean preparedness score was 13.33/19 items affirmed at baseline and increased to 14.96 post-VHPI (P < .01). In the adjusted regression model, the post-intervention preparedness score remained significantly higher than pre-VHPI, with mean increases of 1.22 preparedness steps affirmed for homeowners and 1.85 for renters.

CONCLUSIONS

Preparedness scores improved post-VHPI in families with CYSHCN. Future work should address incorporating the VHPI into care visits in the medical home.

Emergency and disaster preparedness among children and youth with disabilities and chronic conditions, their caregivers and service providers: a scoping review

PURPOSE

People with disabilities, especially children and youth, are often not considered in emergency and disaster preparedness planning, which leaves them vulnerable and at a higher risk of the negative effects of natural and human caused disasters. The purpose of this study was to understand the extent of emergency and disaster preparedness and factors influencing preparedness among children and youth with disabilities and chronic conditions, their caregivers and service providers.

METHODS

Our scoping review involved searching six international databases that identified 1146 studies of which 27 met our inclusion criteria.

RESULTS

The studies in this review involved 2613 participants (i.e., children, parents, educators and clinicians) across nine countries over a 20-year period. Our results highlighted the following trends: (1) the extent of emergency preparedness; (2) factors affecting emergency preparedness; and (3) interventions to enhance preparedness.

CONCLUSIONS

Our findings underscore the critical need for more attention to emergency preparedness for children and youth with disabilities, their families and service providers and their inclusion in planning.

Communication in disasters to support families with children with medical complexity and special healthcare needs: a rapid scoping review

Disasters can disrupt normal healthcare processes, with serious effects on children who depend upon regular access to the health care system. Children with medical complexity (CMC) are especially at risk. These children have chronic medical conditions, and may depend on medical technology, like feeding tubes. Without clear, evidence-based processes to connect with healthcare teams, families may struggle to access the services and supports they need during disasters. There is limited research about this topic, which has been pushed forward in importance as a result of the COVID-19 pandemic. The authors therefore conducted a rapid scoping review on this topic, with the intention to inform policy processes. Both the peer-reviewed and gray literatures on disaster, CMC, and communication were searched in summer 2020 and spring 2021. Twenty six relevant articles were identified, from which four main themes were extracted: 1. Cooperative and collaborative planning. 2. Proactive outreach, engagement, and response. 3. Use of existing social networks to connect with families. 4. Return to usual routines. Based on this review, good practices appear to involve including families, professionals, other stakeholders, and children themselves in pre-disaster planning; service providers using proactive outreach at the outset of a crisis event; working with existing peer and neighborhood networks for support; employing multiple and two-way communication channels, including social media, to connect with families; re-establishing care processes as soon as possible, which may include virtual connections; addressing mental health issues as well as physical functioning; and prioritizing the resumption of daily routines. Above all, a well-established and ongoing relationship among children, their caregivers, and healthcare teams could reduce disruptions when disaster strikes.

The impact of climate change related extreme weather events on people with pre-existing disabilities and chronic conditions: a scoping review

PURPOSE

People with disabilities experience a disproportionate impact of extreme weather events and there is a critical need to better understand the impact that climate change has for them. Most previous reviews focus on the risk of acquiring a new disability or injury after a climate-related event and not the impact on people with pre-existing disabilities or chronic conditions, which is the purpose of this study.

METHODS

We conducted a scoping review while searching seven international databases that identified 45 studies meeting our inclusion criteria.

RESULTS

The studies included in our review involved 2 337 199 participants with pre-existing disabilities and chronic conditions across 13 countries over a 20-year period. The findings demonstrated the following trends: (1) the impact on physical and mental health; (2) the impact on education and work; (3) barriers to accessing health and community services (i.e., lack of access to services, lack of knowledge about people with disabilities, communication challenges, lack of adequate housing); and (4) coping strategies (i.e., social supports and connecting to resources) and resilience.

CONCLUSIONS

Our findings highlight the critical need for rehabilitation clinicians and other service providers to explore opportunities to support their clients in preparing for climate-related emergencies.

Communications for US Populations With Limited English Proficiency During Infectious Disease Outbreaks: A Scoping Review

The COVID-19 pandemic has highlighted the need for research about communicating with populations who have limited English proficiency in the United States during infectious disease outbreaks. These populations have experienced significantly worse health outcomes during emergencies, including the COVID-19 pandemic, and evidence-based risk communications are critical to protecting their health. To support improved development of emergency communications for these communities, we conducted a scoping review that examined the extent of research available, with an intent to identify which communications topics are covered in the literature and where research gaps exist. Following the JBI framework, with reporting guided by the PRISMA extension for scoping reviews, 6 electronic databases were systematically searched in October 2022. The inclusion criteria for articles selected were: data collected between 2009 and 2022, published in English, and focused on communications pertaining to emergency infectious disease outbreaks (eg, H1N1 influenza, Zika virus, COVID-19) for populations with limited English proficiency. Of 2,049 articles identified through the search, 31 met the inclusion criteria and were selected for review. We identified major limitations in the evidence base: a majority of studies were conducted only among Spanish speakers or during the COVID-19 pandemic, and most used qualitative or nonrandom samples. Most studies documented basic language barriers in communications, but there was little exploration of more nuanced barriers, such as cultural relevance or social context. Ahead of future outbreaks, more research is urgently needed to examine the information landscapes of populations with limited English proficiency, to inform the development of more effective communications strategies from public health institutions and others.

Children's Psychological Reactions to Wildfires: a Review of Recent Literature

PURPOSE OF REVIEW

This review aims to synthesize currently available literature regarding the impact of wildfire on mental health, specifically the psychological reactions of children to wildfires. The information gathered from this review will help health experts understand and address the mental health needs of children during wildfire disasters and may serve as a base for future studies to evaluate evidence-based public health responses to mitigate adverse outcomes.

RECENT FINDINGS

The results identified post-traumatic stress disorder (PTSD), anxiety, depression, stress, alcohol/substance misuse, hopelessness, low resilience, reduced quality of life, and self-esteem as the psychological conditions manifesting in children and adolescent post-wildfire disaster. PTSD was the most evaluated psychological reaction in the participants (7 out of eight studies). This review highlights that deleterious mental health effects, such as PTSD, depression, anxiety, and suicidality, can persist in children for years post-wildfire disaster. Factors such as gender, direct exposure to the wildfire, re-traumatization, and resilience informed or ameliorated the severity of the impact of wildfire on children and adolescents. Our findings further emphasize the need for multi-year funding and programs to support children and adolescents' mental health, including children with disabilities in the communities that have experienced wildfire disasters.

Climate Change and Child Health Equity

The climate crisis is a major public health threat for children, disproportionately affecting the most vulnerable populations. Climate change causes a myriad of health issues for children, including respiratory illness, heat stress, infectious disease, the effects of weather-related disasters, and psychological sequelae. Pediatric clinicians must identify and address these issues in the clinical setting. Strong advocacy from pediatric clinicians is needed to help prevent the worst effects of the climate crisis and to support the elimination of use of fossil fuels and enactment of climate-friendly policies.

Current Situation of Disaster Preparedness for Effective Response in Japanese Special Needs Schools

OBJECTIVE

Schools may serve as shelters in the event of a disaster, but little is known about the requirements of children with disabilities in such situations. This study, therefore, aimed to investigate disaster preparedness in Japanese special needs schools depending on the designation of welfare shelters.

METHODS

A questionnaire was distributed to schools nationwide. The respondents (authorities from 531 schools) answered questions about their jobs, disaster experiences, the school type, its students' disabilities, its designation as a welfare shelter, its evacuation readiness, and the items of a disaster prevention awareness scale. Differences in preparedness among schools and the relationship between preparedness and designation as a welfare shelter were determined.

RESULTS

Most respondents had never experienced a natural disaster. Schools had insufficient resources to cope with disasters. While the majority (68.2%) had resources for children to stay overnight, a substantial minority of schools (31.8%) did not. No differences were found in preparedness among schools with different types of children with disabilities. Schools designated as welfare shelters were significantly better prepared than others.

CONCLUSIONS

Special needs schools in Japan have limited disaster preparedness. The designation of schools as welfare shelters may increase their preparedness for disasters.

Communication Preferences of Parents and Caregivers of Children and Youth With Special Healthcare Needs During a Hypothetical Infectious Disease Emergency

Children and youth with special healthcare needs are at risk for severe consequences during infectious disease emergencies. Messages for parents and caregivers from trusted sources, via preferred channels, that contain the information they need, may improve health outcomes for this population. In this mixed methods study, we conducted a survey (N = 297) and 80 semistructured interviews, with 70 caregivers of children and youth and 10 young adults with special healthcare needs, between April 2018 and June 2019 in Pennsylvania. The survey presented 3 scenarios (ie, storm, disease outbreak, radiation event); the interviews included questions about storms and an outbreak. This article addresses only the disease outbreak data from each set. Participants were recruited through convenience samples from an urban tertiary care children's hospital and practices in a statewide medical home network. In this article, we summarize the preferred information sources, channels, and content needs of caregivers of children and youth with special healthcare needs during an infectious disease emergency. Nearly 84% of caregivers reported that they believe their child's doctor is the best source of information. Other preferred sources include medical experts (31%); the US Centers for Disease Control and Prevention (30%); friends, family, and neighbors (21%); and local or state health and emergency management (17%). Pediatric healthcare providers play an important role in providing information to parents and caregivers of children and youth with special healthcare needs during an infectious disease emergency. Public health agencies can establish health communication plans that integrate medical practices and other reliable sources to promote the dissemination of accurate information from trusted messengers.

Evaluating Burn Recovery Outcomes in Children with Neurodevelopmental Symptoms

Neurodevelopmental symptoms (NS) including attention and behavioral problems, developmental delays, intellectual disabilities and learning problems are prevalent in children with burn injuries. The presence of NS may predispose children to poorer burn injury recovery outcomes compared to children without these symptoms (non-NS). The Multi-Center Benchmarking Study (MCBS) monitored recovery outcomes in children with burn injuries in real time utilizing the Burn Outcomes Questionnaire (BOQ). The objective of this study was to retrospectively assess the long term burn recovery outcomes in NS patients versus non-NS patients from the MCBS population. This study assessed parent-reported BOQ outcomes in a sample of 563 patients aged 5 to 18 years who were admitted for burn injuries to a pediatric burn center. A subsample of patients had reported NS (n=181). Analyses compared BOQ outcomes within the NS subsample and the non-NS subsample (n=382) across three longitudinal points post-discharge. The prevalence rate of NS was 32.1% in the full sample. Findings revealed statistically significant improvement in the recovery curves in all five BOQ subscales for the non-NS group and all subscales except for Compliance for the NS group across all longitudinal points. When compared to non-NS patients, NS patients had significantly poorer burn recovery outcomes on the Satisfaction and Compliance subscales. Although it is important to educate all clinicians, parents, and children on burn prevention efforts, targeted education is necessary for children with NS since they may be at greater risk for burn injury as well as worse recovery outcomes.

Psychological effects of the 2017 California wildfires on children and youth with disabilities

The psychological effects of disasters on children with disabilities are understudied, despite evidence towards increased risk for complications after other types of trauma exposure. This study investigated the experience of children and youth with disabilities exposed to the 2017 Northern California wildfires, with a particular focus on psychological reactions. In-depth interviews were conducted with parents of 14 children and youth with disabilities one year post-disaster. Thematic analysis was used to analyze the interviews. Parents described the wildfires as traumatic events for both themselves and their children. Children and youth exhibited stress, grief, and other emotional and behavioral reactions during evacuation, in the immediate aftermath, and one year post-disaster. Navigating disability-related needs, such as accessible housing, contributed to parent stress post-disaster. School and community-based mental health efforts are described, along with a call for increased attention to disaster-related reactions in children with developmental disabilities. Suggestions for improving preparedness and response efforts that better support children with disabilities and their families post-disaster are given.

A pediatrician's guide to climate change-informed primary care

Despite the urgency of the climate crisis and mounting evidence linking climate change to child health harms, pediatricians do not routinely engage with climate change in the office. Each primary care visit offers opportunities to screen for and support children burdened with risks to health that are increasingly intense due to climate change. Routine promotion of healthy behaviors also aligns with some needed-and powerful-solutions to the climate crisis. For some patients, including those engaged in athletics, those with asthma and allergies, or those with complex healthcare needs, preparedness for environmental risks and disasters worsened by climate change is a critical component of disease prevention and management. For all patients, anticipatory guidance topics that are already mainstays of pediatric best practices are related closely to needed guidance to keep children safe and promote health in the setting of compounding risks due to climate change. By considering climate change in routine care, pediatricians will be updating practice to align with evidence-based literature and better serving patients. This article provides a framework for pediatricians to provide climate-informed primary care during the structure of pediatric well child and other visits.

Children and Adolescents with Disabilities and Exposure to Disasters, Terrorism, and the COVID-19 Pandemic: a Scoping Review

PURPOSE OF REVIEW

This paper reviews the empirical literature on exposures to disaster or terrorism and their impacts on the health and well-being of children with disabilities and their families since the last published update in 2017. We also review the literature on studies examining the mental health and functioning of children with disabilities during the COVID-19 pandemic.

RECENT FINDINGS

Few studies have examined the effects of disaster or terrorism on children with disabilities. Research shows that children with disabilities and their families have higher levels of disaster exposure, lower levels of disaster preparedness, and less recovery support due to longstanding discriminatory practices. Similarly, many reports of the COVID-19 pandemic have documented its negative and disproportionate impacts on children with disabilities and their families. In the setting of climate change, environmental disasters are expected to increase in frequency and severity. Future studies identifying mitigating factors to disasters, including COVID-19; increasing preparedness on an individual, community, and global level; and evaluating post-disaster trauma-informed treatment practices are imperative to support the health and well-being of children with disabilities and their families.

Renal Crisis in Children during Armed Conflict

Armed conflicts continue to occur in some regions of the globe, mostly in developing countries. These man-made disasters affect all segments of the population; however, some groups are more vulnerable and suffer more seriously from the unfavorable consequences of such conflicts. Among these, the pediatric population deserves special attention because they cannot protect themselves, and hence carry a higher threat of injuries and probability of death during conflicts. In addition, children who do survive the disaster are more prone to exploitation. Pediatric victims, including those who sustain acute kidney injury or those suffering from chronic kidney disease before armed conflicts, face higher risks of morbidity and mortality as a result of treatment problems, specifically limited dialysis options. Displaced children, forced to flee their homes as a result of armed conflicts, are also at risk for various health problems because they may not find ideal circumstances for disease treatment. Making preparations in anticipation of armed conflicts, such as disaster-relief scenarios and action plans, may be useful to decrease the death toll in these children, who are dependent on their caregivers for survival. Adopting principles of disaster nephrology may contribute to improved survival chances of pediatric kidney patients in chaotic circumstances.

An Evaluation of the Literacy Demands of Online Natural Disaster Preparedness Materials for Families

OBJECTIVE

Natural disasters are becoming increasingly common, but it is unclear whether families can comprehend and use available resources to prepare for such emergencies. The objective of this study was to evaluate the literacy demands of risk communication materials on natural disasters for US families with children.

METHODS

In January 2018, we assessed 386 online self-directed learning resources related to emergency preparedness for natural disasters using 5 literacy assessment tools. Assessment scores were compared by information source, audience type, and disaster type.

RESULTS

One-in-three websites represented government institutions, and 3/4 were written for a general audience. Nearly 1-in-5 websites did not specify a disaster type. Assessment scores suggest a mismatch between the general population's literacy levels and literacy demands of materials in the areas of readability, complexity, suitability, web usability, and overall audience appropriateness. Materials required more years of education beyond the grade level recommended by prominent health organizations. Resources for caregivers of children generally and children with special health care needs possessed lower literacy demands than materials overall, for most assessment tools.

CONCLUSIONS

Risk communication and public health agencies could better align the literacy demands of emergency preparedness materials with the literacy capabilities of the general public.