Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment.Methods: Multilevel multinomial regression analysis controlling for (...) age, gender, ethnicity, and referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; meanAge = 13.66 years] using anonymised administrative data from young people's mental health services.Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement. Similarly, they were less likely to transfer or end treatment for other reasons than by case closure due to mutual agreement.Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services. (shrink)

This study uses data from the Ghana Demographic and Health Survey of 1993 to examine factors determining the use of maternal–child health services in rural Ghana. The MCH services under study are: use of a doctor for prenatal care; soliciting four or more antenatal check-ups; place of delivery; participation in family planning. Bivariate and multivariate techniques are employed in the analyses. The analyses reveal that the use of MCH services tends to be shaped mostly (...) by level of education, religious background and region of residence, and partially by ethnicity and occupation. The implications of these results are discussed. (shrink)

Parents play an integral role in the mental health service provision of children and adolescents, and they can have significant effects on the outcomes of youth. A growing body of research has linked parents’ own mental health status to numerous outcomes for their children, and recent guidelines have emerged recommending the assessment of parent psychopathology when treating child patients. However, these recommendations present a range of ethical considerations. Mental health professionals must determine if the assessment of (...) a parent is empirically supported and that an assessment procedure appropriate for parents can be feasibly implemented. They must also respect the autonomy and confidentiality of parents while ensuring that assessment findings can be translated to meaningful benefits for child patients. This article details and discusses each of these concerns within the context of the relevant principles and standards of the 2016 American Psychological Association’s Code of Ethics. Further, it provides guidelines, relevant clinical examples, and an applied model for mental health professionals to consider the ethical implications of assessing parent mental health when serving child patients. (shrink)

Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services. Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of (...) this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area. (shrink)

Through a case study, this paper addresses ethical issues and dilemmas faced by a Family Therapist working in a Child and Adolescent Mental Health Service (CAMHS) in the National Health Service. When there are legal and societal obligations on parents/carers to ensure that the needs of children and young people are met within a family context, working with a young person in a health care setting oriented to the individual raises ethical dilemmas around consent. When the (...) values of young people and their parents conflict, legal, ethical and political issues can be raised. These have implications for the duties of health care professionals and the rights, interests and autonomy of the individual young people and their parents. The importance of justice to CAMHS practitioners' ethical decision-making about when to prioritize the individual over the family, or vice versa, is emphasized. (shrink)

SummaryThis paper examines the role of health knowledge in the association between mothers' education and use of maternal and child health services in Ghana. The study uses data from a nationally representative sample of female respondents to the 2008 Ghana Demographic and Health Survey. Ordered probit regression models evaluate whether women's health knowledge helps to explain use of three specific maternal and child health services: antenatal care, giving birth with the supervision (...) of a trained professional and complete child vaccination. The analyses reveal that mothers' years of formal education are strongly associated with health knowledge; health knowledge helps explain the association between maternal education and use of health services; and, net of a set of stringent demographic and socioeconomic controls, mothers' health knowledge is a key factor associated with use of health services. (shrink)

This book presents a unique classification and review of various mental health and learning issues. The authors link current education and child and youth mental health reforms to make the case for improving services to address barriers to learning.

Background Current requirements for ethical research in Canada, specifically the standard of active or signed parental consent, can leave Indigenous children and youth with inequitable access to research opportunities or health screening. Our objective was to examine the literature to identify culturally safe research consent processes that respect the rights of Indigenous children, the rights and responsibilities of parents or caregivers, and community protocols. Methods We followed PRISMA guidelines and Arksey and O’Malley’s approach for charting and synthesizing evidence. We (...) searched MEDLINE, PsycINFO, ERIC, CINAHL, Google Scholar, Web of Science, Informit Indigenous Collection, Bibliography of Native North Americans, and Sociological Abstracts. We included peer-reviewed primary and theoretical research articles written in English from January 1, 2000, to March 31, 2022, examining Indigenous approaches for obtaining informed consent from parents, families, children, or youth. Eligible records were uploaded to Covidence for title and abstract screening. We appraised the findings using a Two-Eyed Seeing approach. These findings were inductively coded using NVivo 12 and analyzed thematically. Results We identified 2,984 records and 11 eligible studies were included after screening. Three key recommendations emerged: addressing tensions in the ethics of consent, embracing wise practices, and using relational approaches to consent. Tensions in consent concerned Research Ethics Board consent requirements that fall short of protecting Indigenous children and communities when culturally incongruent. Wise practices included allowing parents and children to consent together, land-based consenting, and involving communities in decision-making. Using relational approaches to consent embodied community engagement and relationship building while acknowledging consent for Indigenous children cannot be obtained in isolation from family and community. Conclusions Very few studies discussed obtaining child consent in Indigenous communities. While Indigenous communities are not a monolith, the literature identified a need for community-driven, decolonized consent processes prioritizing Indigenous values and protocols. Further research is needed to examine nuances of Indigenized consent processes and determine how to operationalize them, enabling culturally appropriate, equitable access to research and services for all Indigenous children. (shrink)

RESUMEN Introducción: Son escasos los servicios en salud mental dentro del contexto escolar que permitan una integración intersectorial para superar la brecha de falta de asistencia en salud mental en la población infanto - juvenil, aun cuando, es en la escuela donde se detectan mayoritariamente los problemas de salud mental. Objetivo: Comentar el uso de servicios de salud mental en el ambiente escolar en relación con los trastornos mentales y trastornos subumbrales. Método: El presente resultado se obtiene a partir del (...) “Estudio de Prevalencia Comunitaria de Trastornos Psiquiátricos y Utilización de Servicios de la Población Infanto-Juvenil Chilena”. La muestra estuvo representada por sujetos entre 4 y 18 años. La información sobre el uso de servicio de salud mental se recogió con una versión modificada de la Escala Service Assesment for Children and Adolescent. Se realizó un modelo de regresión logística para analizar cinco áreas del uso de servicios en el ambiente escolar, las cuales se correlacionaron con diagnósticos de trastorno mentales y trastorno subumbral de ansiedad, disruptivo y depresión en el último año. Resultados: Las escuelas se enfrentan a grandes desafíos sobre cómo proporcionar apoyo efectivo de salud mental para los estudiantes, que presentan algún tipo de trastorno mental o trastorno subumbral. Discussión: Las instituciones educativas requieren ser visualizadas como una entidad que podría satisfacer las necesidades que se advierten de manera urgente en atención, prevención y promoción de problemas mentales en la población infanto- juvenil, si se vinculan de forma más directa con los servicios de salud mental. ABSTRACT Introduction: Mental health services are scarce within the school context that allow intersectoral integration to overcome the gap in mental health care in the child and adolescent population, being the school where mental health problems are mostly detected. Objective: to know the use of mental health services in the school environment in relation to mental disorders and subthreshold disorders. Method: The present secondary study is carried out from the "Study of Community Prevalence of Psychiatric Disorders and Utilization of Services of the Chilean Child-Youth Population". The sample was represented by subjects between 4 and 18 years old. Information on the use of mental health service was collected with a modified version of the Service Assessment Scale for Children and Adolescents. A logistic regression model was performed to analyze five areas of the use of services in the school environment, which were correlated with diagnoses of mental disorders and subthreshold anxiety, disruptive and depression disorder in the last year. Results: Schools face great challenges on how to provide effective mental health support for students, who present some type of mental disorder or subthreshold disorder. Discusion: Educational institutions need to be visualized as an entity that could meet the needs that are urgently noticed in attention, prevention and promotion of mental problems in the child and adolescent population, if it is linked more directly with health services. (shrink)

El presente texto se inscribe dentro de la temática dirigida a la investigación sobre la violencia intrafamiliar. Tiene como objetivo sistematizar aspectos históricos y teóricos inherentes al estudio del maltrato infantil y sus consecuencias en el ámbito social y familiar para su detección y tratamiento en el nivel de atención primaria de los servicios de salud en Cuba. Mediante una revisión bibliográfica se logró concretar un análisis documental de materiales y textos en soporte digital e impreso que condujo a los (...) acercamientos teórico e histórico del fenómeno en el ámbito internacional y nacional, para su conceptualización, la determinación de su tipología y el establecimiento de sus consecuencias; elementos imprescindibles del saber profesional del futuro egresado de las ciencias médicas, en función de su desempeño en los diferentes niveles de atención de salud, en especial, la atención primaria. The text falls within the research on intrafamiliar violence subject matter. Its objective is to systematize historical and theoretical aspects inherent to the study of child abuse and its consequences within the social and domestic scopes for its detection and treatment in the Cuban primary health care services. By means of a bibliographic review, a documentary analysis of electronic and printed form materials and texts was summarized. It led to theoretical and historical approaches to the phenomenon within the national and international scopes for its conceptualization, the establishment of its typology and consequences. They are essential elements of the professional knowledge of future medical sciences graduates towards their performance in different health care levels, especially in primary health care. (shrink)

In everyday conversations, people put forward versions of events and provide supporting evidence to build a credible case. In environments where there are potentially competing versions, case-building may take a more systematic format. Specifically, we conducted a rhetorical analysis to consider how in child mental health settings, families work to present a credible ‘doctorable’ reason for attendance. Data consisted of video-recordings of 28 families undergoing mental health assessments. Our findings point to eight rhetorical devices utilised in this (...) environment to build a case. The devices functioned rhetorically to add credibility and authenticate the case being built, which was relevant as the only resource available to families claiming the presence of a mental health difficulty in the child was their spoken words. In other words, the ‘problem’ was something constructed through talk and therefore the kinds of resources used were seminal in decision-making. (shrink)

Background: Hospitalized children have the right to “partake in practices related to their treatment and care.” Midwives and nurses have important roles and responsibilities regarding the protection and enforcement of these rights, such as providing information and advocating for children. Objectives: This study aims to determine the attitudes of midwives and nurses toward their roles and responsibilities in the implementation of child rights in healthcare services and the factors affecting their attitudes. Methods: This descriptive cross-sectional study included 122 (...) midwives and nurses in total. The data were collected through a questionnaire. Ethical considerations: Written permission was obtained from an ethics committee in the center of the city where the research was conducted. Results: The mean age of the participants was 36.70 ± 8.03 years; 58.9% of midwives and nurses stated that they understood the child’s consent about the treatment by looking at the child’s facial expression; 36% of midwives and nurses stated that children could not participate in decisions regarding their own health. It was observed that obtaining the child’s consent in matters related to treatment does not make any difference between midwives and nurses. The rate of the midwives stating that they would report suspicious violence-neglect and abuse was found to be higher. Conclusion: The variables of the unit of employment, the state of having children, choosing the profession and practicing in it willingly, and getting training on children’s rights make a difference in terms of children’s rights in healthcare services. Midwives and nurses should be reminded of child rights in healthcare services through regular in-service training programs. (shrink)

This article provides a conversation analytic description of a two-part structure, ‘I don’t want X, I want/just want Y’. Drawing on a corpus of recordings of family mealtimes and television documentary data, I show how speakers use the structure in two recurrent environments. First, speakers may use the structure to reject a proposal regarding their actions made by an interlocutor. Second, speakers may deliver the structure following a co-interactant’s formulation of their actions or motivations. Both uses decrease the likelihood of (...) challenge in third-turn position. When responding to multi-unit turns speakers routinely deal with the last item first. The value of ‘I want Y’ is to formulate an alternative sense of agency which undermines the preceding turn and shifts the trajectory of the ongoing sequence. The article contributes to work in discursive psychology as I show how speakers may formulate their ‘wants’ in the service of sequentially unfolding social interaction. (shrink)

The essays in this special issue of HEC Forum provide reflections that make explicit the implicit anthropology that our current pandemic has brought but which in the medical ethics literature around COVID-19 has to a great extent ignored. Three of the essays are clearly “journalistic” as a literary genre: one by a hospital chaplain, one by a medical student in her pre-clinical years, and one by a fourth-year medical student who reports her experience as she completed her undergraduate clerkships and (...) applied for positions in graduate medical education. Other essays explore the pandemic from historical, sociological, and economic perspectives, particularly how triage policies have been found to be largely blind to structural healthcare disparities, while simultaneously unable to appropriately address those disparities. Central issues that need to be addressed in triage are not just whether a utilitarian response is the most just response, but what exactly is the greatest good for the greatest number? Together, the essays in this special issue of HEC Forum create a call for a more anthropological approach to understanding health and healthcare. The narrow approach of viewing health as resulting primarily from healthcare will continue to hinder advances and perpetuate disparities. Health outcomes result from a complex interaction of various social, economic, cultural, historical, and political factors. Advancing healthcare requires contextualizing the health of populations amongst these factors. The COVID-19 pandemic has made us keenly aware of how interdependent our health as a society can be. (shrink)

The COVID-19 pandemic underscores society’s reliance on women both on the frontline and at home, while simultaneously exposing structural inequalities across every sphere, from health to the econom...

The UN Convention of the Rights of the Child (CRC) in the 1990s becomes a landmark and has now been ratified by every other country of the world. Bring hope for a better world—for all children was highlighted as one of the most far-sighted human right instrument in the convention. Yet access to basic livelihood needs such as clean drinking water, primary health services, primary education, recreation and other urban infrastructure becomes a nightmare for millions of children (...) and youth in the developing world and particularly in metropolitan cities in India. The Indian children are living in varying residential environment, comprised of residential colonies of rich, high-raised flats of middle and low-income groups and the economically weaker sections living in slums and squatter colonies. The conventional method of planning residential neighbourhood lacks in indentifying the varying needs of children while building urban infrastructure. As a result there is a large gap in getting access to basic livetihood needs for children of rich and poor. The basic question becomes, is the urban child and youth population just as a numerical variable in planning infrastructure needs in metropolitan cities? This article attempts to analyse the situation in some of the selected residential areas in Delhi. (shrink)

The Medicaid Early and Periodic Screening, Diagnostic and Treatment benefit offers health care coverage specifically targeted to meet the needs to low-income children and children with disabilities. This article provides a brief overview of EPSDT and then discusses how states are working to bring vision, hearing, and oral health services to children through EPSDT.

Child welfare clinics established in a rural Jamaican community for research purposes are described. These special clinics were able to devote more resources to the care of their children than is usual, yet the growth and health of these children were very similar to those in another group to whom this service was not available and who attended routine government welfare clinics only infrequently.

Understanding Child and Adolescent Behaviour in the Classroom is a vital guide for pre-service and in-service teachers, providing the tools to respond effectively and ethically to child and adolescent behaviour that is of concern. In this innovative book, expert authors offer 'positive rules' that will assist educators in their classroom practice. Key practical issues that are addressed include: • Building a purposeful and emotionally and psychologically positive classroom culture • Recognising and responding to children who present with social, (...) emotional and behavioural difficulties • Using research to inform and enrich classroom practice around student conduct • Working collegially to respond to the social, emotional and/or behavioural needs of individual students, including those needs associated with poor mental health and/or child protection Cutting-edge research from psychology, behavioural science and education is accessibly presented to help develop professional expertise and knowledge in the area of child and adolescent behaviour. (shrink)

A significant international development agenda in the practice of nurses supporting families with young children focuses on establishing partnerships between professionals and service users. Qualitative data were generated through interviews and focus groups with 22 nurses from three child and family health service organisations, two in Australia and one in New Zealand. The aim was to explore what is needed in order to sustain partnership in practice, and to investigate how the concept of practice architectures can help understand (...) attempts to enhance partnerships between nurses and families. Implementation of the Family Partnership Model (FPM) is taken as a specific point of reference. Analysis highlights a number of tensions between the goals of FPM and practice architectures relating to opportunities for ongoing learning; the role of individual nurses in shaping the practice; relationships with peers and managers; organisational features; and extra‐organisational factors. The concept of practice architectures shows how changing practice requires more than developing individual knowledge and skills, and avoids treating individuals and context separately. The value of this framework for understanding change with reference to context rather than just individual’s knowledge and skills is demonstrated, particularly with respect to approaches to practice development focused on providing additional training to nurses. (shrink)

In Lesotho, the risk of mother-to-child-transmission (MTCT) of HIV is substantial; women of childbearing age have a high HIV prevalence rate (26·4%), low knowledge of HIV status and a total fertility rate of 3·5 births per woman. An effective means of preventing MTCT is to reduce unwanted fertility. This paper examines the unmet need for contraception to limit and space births among HIV-positive women in Lesotho aged 15–49 years, using the 2004 Lesotho Demographic and Health Survey. HIV-positive women (...) have their need for contraception unmet in almost one-third of cases, and multivariate analysis reveals this unmet need is most likely amongst the poor and amongst those not approving of family planning. Urgent action is needed to lower the level of unmet need and reduce MTCT. A constructive strategy is to improve access to family planning for all women in Lesotho, irrespective of HIV status, and, more specifically, integrate family planning with MTCT prevention and voluntary counselling and testing services. Copyright © Cambridge University Press 2008. (shrink)

Research involving recently deceased humans that are physiologically maintained following declaration of death by neurologic criteria—or ‘research involving the recently deceased’—can fill a translational research gap while reducing harm to animals and living human subjects. It also creates new challenges for honouring the donor’s legacy, respecting the rights of donor loved ones, resource allocation and public health. As this research model gains traction, new empirical ethics questions must be answered to preserve public trust in all forms of tissue donation (...) and in the practice of medicine while respecting the legacy of the deceased and the rights of donor loved ones. This article suggests several topics for immediate investigation to understand the attitudes and experiences of researchers, clinical collaborators, donor loved ones and the public to ensure research involving the recently deceased advances ethically. (shrink)

There is an increasing tendency for administrators and government to expect both the health services and the education service to 'show results' for the investment of public money in them. One response to this has been the growing commitment to 'health promotion', where measurable objectives may be set in terms of desired behaviour (stopping smoking, breast self-examination, child immunisation etc) and where evaluation can be made on the evidence of statistical improvement. Health workers use the (...) term 'promotion' in a variety of ways which seem to be as confusing to them as they are to their clients --the general public. Since successful promotion is likely to depend on the 'hard sell' (and since the methodology and aims of this may be incompatible with those of health education) this paper looks at some of the questions which the customer might wish to ask the salesman before deciding whether or not to buy. (shrink)

The upbringing of infants in native communities is the concern of authorities and researchers for being a vulnerable population segment. The purpose of the study was to analyze child rearing styles of an Amuesha community in the Peruvian jungle. The phenomenological design allowed interviewing amuesha mothers from Oxapampa in Pasco, until reaching saturation. It was found as results that child rearing practices conform to sociocultural patterns, such as identity and communal heritage culture, which are in extinction due to (...) the presence of exotic factors; in addition to a demand to the State for better education and health services. (shrink)

This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of children. Such (...) models of health care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of children. Such (...) models of health care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

The current thesis discusses how tools for analysing power are developed predominately for adults, and thus remain underdeveloped in terms of understanding injustices related to age, ethnicity/race and gender in childhoods. The overall aim of this dissertation is to inscribe a discourse of intersecting social injustices as relevant for childhoods and child welfare, and by interlinking postcolonial, feminist, and critical childhood studies. The dissertation is set empirically within the policy and practice of Swedish child welfare, here exemplified by (...) the assessment framework Barns Behov i Centrum. It aims to explore how Swedish child welfare, as a field of knowledge, modes of knowing and knowing subjects, constitutes an arena for claims and responses to intersecting social justice issues. The material consists of BBIC primers and selected samples from, a total of 283 case reports from a Swedish social service agency. The case reports address assessments of children. This dissertation is based on four qualitative studies using discourse analysis, as well as analysis inspired by thematic and case-study methodology. Two studies focus on child welfare discourses in BBIC documents involving social problems and violence, and two studies are based on child welfare case reports. Studies I­­-II address child welfare policy and practice by analysing the conditions required for children to participate, in terms of children’s moral status and in terms of status of ‘evidencing’ needs for protection. Studies III­­-IV explore this further from the perspective of intersecting and embodied social injustices in childhoods. Together, the studies interconnect child welfare as a field of knowledge, modes of knowing and knowers with child welfare as a moral arena for claims to rights, recognition, and social justice. The synthesised findings point to child biowelfare, in which justice discourses are largely absent. Biowelfare is informed by a mode of knowing and ‘evidencing’ risks to children’s health and development, which are confined to scientific predicting-believing, seeing-believing by professionals and a moral economy of care, all of which constrain the idea that injustices are structural and intersecting. Biowelfare primarily responds to children as ‘speaking’ biological bodies, rather than as voices of justice. In this sense, injustices of an epistemological nature are interconnected with social injustices. When issues of justice are mobilised in case reports and policy, they come across as rather ‘unjust’, primarily confined to the sphere of the family home of racialised children and not connected to ‘general’ children. In addition to intersections of age, ethnicity/race and gender, class and health are fundamental to recognition and protection in biowelfare. Finally, the dissertation indicates the need for a moral economy which responds to intersecting social injustices such as racial, gender-based and ageist violence in childhoods, and violations of children’s bodily integrity. (shrink)

In this paper an economics approach to assessing community values in health care priority setting is examined. The approach is based on the concept of ‘willingness to pay’ (WTP). Eighty two parents were interviewed with regard to three aspects of provision of child health services. For each aspect a choice of two courses of action was presented. Parents were asked which course of action they preferred and what was the maximum amount of money they would be (...) prepared to pay for this rather than their less preferred option. WTP responses are acceptable to the majority of respondents and appear to ‘behave’ in accordance witha priori expectations. A method of assessing the influence of ability to pay on preferences and WTP is outlined. Preferences and WTP do not appear to have been unduly distorted by ability to pay. Use of WTP data does have the potential to provide health care purchasers and providers with information on intensity as well as direction of the preferences of members of the community. (shrink)

A major issue facing the health of both minors and young adults in the United States is the often unintentional lack of confidentiality maintained in the provision of sensitive health services. Studies have shown that access to confidential care is crucial for minors seeking preventive care and treatment for sensitive services. Evidence demonstrates that many minors will not seek health care if confidentiality cannot be ensured, which can have significant negative health implications; this finding (...) can be extended to young adults covered under their parents health plans. Young adults, not just minors, also often forgo important sensitive services when they face a breach of confidentiality, which most likely occurs when their parents have access to the adult child's health information.Currently, private insurance companies generally send the policyholder an explanation of benefits whenever a service is provided under a plan. EOBs generally include information identifying the patient, provider, type of care received, total charge for services, amount paid by the insurance company, and any financial obligation of the policyholder. (shrink)

As the largest labour flow in human history, the recent rise in migration in China has opened up unprecedented opportunities for millions of Chinese to rearrange their lives. At the same time, this process has also posed great challenges to Chinese migrants, especially female migrants, who not only face a bias against ‘outsiders’ but also have a greater need for reproductive health-related services in their migratory destinations. Based on data collected via multiple sources in Shanghai, China’s largest metropolis, (...) this study profiles the changing characteristics of female migrants, presents data on self-reported symptoms of reproductive health-related problems and knowledge on reproductive health issues, compares maternal and child health measures between migrants and local residents, and examines factors related to reproductive health knowledge and migrants’ access to health care in urban china. Results of this study show a relatively low level of self-reported reproductive health problems among female migrants, coupled with a relatively high level of ignorance in knowledge related to STD. both self-reported health status and knowledge of reproductive health are related to migrants’ educational attainment and length of stay in the urban destination. This study also finds ample evidence that female migrants’ access to urban health care is limited by a number of institutional barriers. (shrink)

The new South African constitution commits the government to guarantee "basic health services" for every child under 18. Primary health care for pregnant women and children under six and elements of essential primary health care have received priority. At present, there is little analysis of the moral considerations involved in making choices about more advanced or costly health care which may, arguably, also be "basic". This paper illustrates some of the tensions in setting priorities (...) for a just macro-allocation of children's health care, given the realities of need and scarce resources, and the commitment to equality of basic opportunities. (shrink)

Background: Visual technologies are central to youth culture and are often the preferred communication means of adolescents. Although these tools can be beneficial in fostering relations, adolescents’ use of visual technologies and social media also raises ethical concerns. Aims: We explored how school public health nurses identify and resolve the ethical challenges involved in the use of visual technologies in health dialogues with adolescents. Research design: This is a qualitative study utilizing data from focus group discussions. Participants and (...) research context: We conducted focus group discussions using two semi-structured discussion guides with seven groups of public health nurses working in Norwegian school health services. The data were collected during January and October 2016. Discussions were audio recorded, transcribed, and coded into themes and subthemes using systematic text condensation. Ethical considerations: The leader of the public health nursing service who agreed to provide access for the study and the Norwegian Center for Research Data that reviewed and approved the study. All participants gave informed consent. Findings: In adolescents’ use of visual materials with public health nurses, ethical concerns were raised regarding suicide ideations, socially unacceptable content, violation of privacy, and presentations of possible child neglect. The nurses utilized their professional knowledge and experience when identifying and navigating these ethical dilemmas; they resolved ethical uncertainties through peer discussion and collaboration with fellow nurses and other professionals. Discussion: We discussed the findings in light of Annemarie Mol’s interpretation of the ethics of care. Mol expands the notion of ethical care to include the action of technologies. Conclusion: Although the increasing use of visual technologies offered benefits, school nurses faced ethical challenges in health dialogues with adolescents. To address and navigate these ethical issues, they relied on their experience and caring practices based on their professional ethics. Uncertainties were resolved through peer dialogue and guidance. (shrink)

“Only about 25 percent of the employees in child-care operations around the country have had professional training in dealing with children.”—_Newsweek_ This book is a proven, practical approach to providing that training at a minimum of expense and disruption of services. Written for trainers, it may profitably be used by any individual who wants to know more about positive methods for working with children. The information provided here has been used extensively to train child-care providers throughout Illinois. (...) Covered in detail are discipline, professionalism, child and adult communication, child development, observation, assessment, play, nutrition, health and safety, parent involvement and education, child abuse, developmental care, and organization of the environment. Illinois Governor James Thompson, former DCFS Director Gregory Coler, and DCFS Director Gordon Johnson have all endorsed these materials by continuing to recommend them for day-care training in Illinois. (shrink)

Background: The brief generic Multicultural Quality of Life Index is a culturally informed self-report 10-item questionnaire used to measure health-related quality of life. QoL is an important outcome measure in guiding healthcare and is held as a substantial parameter to evaluate the effectiveness of healthcare. Attention Deficit Hyperactivity Disorder in children might negatively influence the parents’ QoL. Having a validated questionnaire to measure QoL for this population will therefore be a vital first step in guiding healthcare for parents of (...) children with ADHD. We aimed to examine the reliability and validity of the Norwegian version of the MQLI in a sample of parents of children with ADHD.Methods: In a cross-sectional study, 128 parents of children with ADHD were recruited from four outpatient clinics within the Child and Adolescents Mental Health Services in Norway. They completed the MQLI along with an alternative well-being scale, the Five-item World Health Organization Well-being Index, and a form including demographic variables. Reliability and validity of the MQLI were examined. We conducted a factor analysis and calculated internal consistency and the correlation between the MQLI and the WHO-5.Results: Factor analysis of the parents reported MQLI yielded a one-factor solution. For the MQLI, Cronbach’s alpha was 0.73. The correlation between the two measures of MQLI and WHO-5 was high, reflecting convergent validity since the association between the two measures was strong.Conclusion: Results from this study support the reliability and validity of the Norwegian version of the MQLI for assessment of quality of life in parents of children with ADHD with good psychometric properties. Study findings support the use of the questionnaire in CAMHS. (shrink)

Parents and guardians in child protection systems are in unequal power relationships with child protection practitioners. This relationship is experienced as exclusionary or even oppressive by many parents and guardians. For families and communities in the child protection system who experience intersectional discrimination and disadvantage, such as people with intellectual disabilities and First Nations people, this unequal relationship and subsequent potential exclusion and oppression can be even more profound. A growing body of literature indicates that advocacy can (...) assist in addressing unequal relationships in other contexts, such as involuntary mental health. This paper explores the role of representational advocacy in supporting parents in child protection settings through a case study of an advocacy service in Victoria, Australia. Using a human rights framework to guide the analysis, the paper highlights how advocacy can help support rights, but that broader structural change will be required to consistently uphold the rights of parents. (shrink)

Child poverty reduction is one of the most important and urgent tasks that requires attention in most regions of the world, nations and Anambra state specifically. The population of impoverished children is progressively increasing in Nigeria because of economic recession and poor security situations that lead to displacement and death of their parents. Although children constitute half of the entire population, commensurate attention is not given to them to match the dimensions of poverty they face. This study argued that (...) child poverty is multidimensional, evidenced in lack of safe drinking water, adequate nutrition, shelter, decent sanitation, medical advice or health services and education, to mention a few. The article highlighted the laudable efforts of the United Nations International Children’s Emergency Fund and Anambra government and maintained that multiple strategies can help in solving this problem. To complement these efforts, the enforcement of biblical policies or principles about children’s rights would in no small measure reduce child poverty. It was concluded that a proper repositioning of children would be matched with implementation of biblical strategies. Biblical intervention could help children socially, mentally and psychologically and in their general well-being. Biblical principles would erase wrong socio-cultural notions about children. (shrink)

BackgroundFollowing the SARS pandemic, jurisdictions around the world began developing ethical resource allocation frameworks for future pandemics—one such framework was developed by Thompson and colleagues. While this framework offers a solid backbone upon which decision-makers can rest assured that their work is driven by rigorous ethical processes and principles, it fails to take into account the nuanced experiences and interests of children and youth (i.e., young people) in a pandemic context. The current COVID-19 pandemic offers an opportunity to re-examine this (...) framework from young people’s perspectives, informed by advances in childhood ethics and children’s rights.Main bodyIn this paper, we revisit the Thompson et al. framework and propose adaptations to the ethical processes and values outlined therein. This work is informed by expertise in clinical ethics and literature related to impacts of COVID-19 and other pandemics on the health and well-being of children around the world, though with particular attention to Canada. During the processes of drafting this work, stakeholders were consulted—aligned with the approach used by Thompson and colleagues—to validate the interpretations provided. We also propose a new principle, namely practicability, to indicate the complex balance between what is possible and what is convenient that is required in ethically sound decisions in the context of services affecting young people. We outline and discuss the strengths and limitations of our work and indicate next steps for scholars in the areas of childhood studies and child health.ConclusionEfforts to ensure frameworks are truly child-inclusive should be the status-quo, so pandemic impacts and policy implications can be considered in advance of emergency preparedness contexts. (shrink)

Background: The aim of this study was to investigate associations between demographic and clinical variables and duration of untreated psychosis (DUP) in a sample of cases of psychosis across an adult early intervention in psychosis service and a child and adolescent community team. Method: Cross-sectional baseline data for cases of psychosis across the two teams on the caseload at a given time point were collected, including age of onset, gender, ethnicity, referral route, and DUP. Results: The median DUP across (...) the entire sample was 91 days, while those patients with initial treatment for psychosis from the child and adolescent team had a median DUP of 69 days. Using multiple linear regression, there were two variables that showed a significant association with DUP: referral route (p < .001), and age of onset, with earlier age of onset associated with shorter DUP (p = .015). Conclusion: These findings are discussed in relation to possible explanatory factors, with particular focus on service-level variables and pathways to care. It is suggested that the involvement of child and adolescent teams is vital to the work of early intervention in psychosis services. (shrink)

In this chapter we argue that the four principles of medical ethics -- beneficence, non-maleficence, respect for autonomy and justice (Beauchamp & Childress, 2001; Gillon, 1985), a new Family Interest Principle (introduced below) and a consideration of ‘capacity’ provide a reasoned practice guide for work with mothers experiencing health problems, focussing here on mental health when a parent is a patient. Our concern is the relationship of the clinician with a parent and through the parent their child. (...) Ethics of service provision or services planning (e.g. Culyer, 2001; McLachlan, 2005; see also Newbigging and Paul, chapter xxx), or the provision of other services (e.g. education, child protection) although intensely relevant to this area are not addressed in this chapter nor will we deal with the complex aspects of medical ethics relating to the treatment of children (Baines, 2008). We use the term ‘parent’ to refer to any adult person who fulfils a substantive parental role with a child. Defining what counts as a family will in certain circumstances be contentious. There are diverse patterns of family arrangements that may be influenced by cultural, political economic and temporal factors. For the purposes of our discussion, we define a family in terms of its role in childrearing, as a group of at least one adult and at least one child, living together in long term relationships on an ongoing basis with vested interest in the well being of each of the family members. (shrink)

The national ethical guidelines relevant to assisted reproductive technology have recently been reviewed by the National Health and Medical Research Council. The review process paid particular attention to the issue of non-medical sex selection, although ultimately, the updated ethical guidelines maintain the pre-consultation position of a prohibition on non-medical sex selection. Whilst this recent review process provided a public forum for debate and discussion of this ethically contentious issue, the Victorian case of JS and LS v Patient Review Panel (...) [2011] VCAT 856 provides a rare instance where the prohibition on non-medical sex selection has been explored by a court or tribunal in Australia. This paper analyses the reasoning in that decision, focusing specifically on how the Victorian Civil and Administrative Tribunal applied the statutory framework relevant to ART and its comparison to other uses of embryo selection technologies. The Tribunal relied heavily upon the welfare-of-the-child principle under the Assisted Reproductive Treatment Act 2008. The Tribunal also compared non-medical sex selection with saviour sibling selection. Our analysis leads us to conclude that the Tribunal’s reasoning fails to adequately justify the denial of the applicants’ request to utilize ART services to select the sex of their prospective child. (shrink)

Effective November 1, 2002, the federal Department of Health and Human Services reclassified developing fetuses as “unborn children,” thereby providing health insurance benefits for prenatal care under the State Children's Health Insurance Program. By broadening the current definition of “child” —and thus expanding SCHIP insurance coverage — DHHS hopes to increase the number of low-income pregnant women who receive prenatal services. As noted by one commentator, the new rule represents the first time “any federal (...) policy has defined childhood as beginning at conception.”In an attempt to improve access to publicly funded health insurance for poor children not covered by Medicaid, Congress established SCHIP a 10-year, $40 billion program jointly funded by federal and state governments. Through a series of block grants, SCHIP allows states to either expand income-eligibility for their existing Medicaid program or to create a separate child health program to decrease the number of uninsured poor and near-poor children. (shrink)

Effective November 1, 2002, the federal Department of Health and Human Services reclassified developing fetuses as “unborn children,” thereby providing health insurance benefits for prenatal care under the State Children's Health Insurance Program. By broadening the current definition of “child” —and thus expanding SCHIP insurance coverage — DHHS hopes to increase the number of low-income pregnant women who receive prenatal services. As noted by one commentator, the new rule represents the first time “any federal (...) policy has defined childhood as beginning at conception.”In an attempt to improve access to publicly funded health insurance for poor children not covered by Medicaid, Congress established SCHIP a 10-year, $40 billion program jointly funded by federal and state governments. Through a series of block grants, SCHIP allows states to either expand income-eligibility for their existing Medicaid program or to create a separate child health program to decrease the number of uninsured poor and near-poor children. (shrink)

Although the obesity epidemic appears to have affected all segments of the U.S. population, its impact on children with special health care needs has received little attention. “Children with special health care needs” is a term used in the U.S. to describe children who come to the attention of health care providers and policy makers because they need different services and supports than other children. Government, at both the federal and state levels, has long felt a (...) particular responsibility for safeguarding the health of children with special needs. The definition “children with special health care needs,” in fact, was developed by a work group established by the U.S. Maternal and Child Health Bureau to assist states in their efforts to develop community systems of services for children with complex medical and behavioral conditions. (shrink)

Despite its profound importance for individuals and populations, children’s mental health remains under-appreciated as a public policy priority, to a degree that violates children’s rights. Using a working definition of policymaking as collective ethical decision-making for the one and the many, we elaborate by describing an individual child’s story and reviewing the pertinent population health research evidence. We then outline three central public health ethical challenges: addressing the high prevalence and impact of childhood mental disorders; addressing (...) the avoidable social adversities that underlie many childhood mental disorders; and addressing stark shortfalls in prevention and treatment services for children. We end with discussing opportunities for progress, including addressing the attendant children’s rights issues. (shrink)

This article considers whether there is a parental obligation to comply with child health advice which is aimed at the general population and grounded in population-based research. Drawing upon the concept of role obligations, I argue that there is a temptation to use child health advice as a set of rules to which parents are morally obligated to comply, but that this temptation should be resisted. Using the case of Safe Sleep recommendations, designed to reduce the (...) risk of sleep-related infant deaths, I present three reasons for doubting that parents are obligated, as a matter of course, to comply with child health advice. I suggest that, rather than compliance, deliberation about child health advice is obligatory, and that parents should have reasons for not following credible child health advice. (shrink)