The threshold of child protection notifications is higher in municipalities with a high level of risk factors - Is this evidence of the inverse intervention law?

BACKGROUND: Child protection notifications aim to secure the wellbeing of children. However, there is a large variation in the implementation of notifications across the municipalities in Finland. OBJECTIVE: This article explores whether the threshold of child protection notifications is higher in municipalities with a high level of socio-economic risk factors, as assumed by the inverse intervention law. PARTICIPANTS AND SETTING: The study is based on the system-level data of Finnish municipalities, and their socio-economic indicators for the period of 2010-2021. METHODS: A cluster analysis is used to group Finnish municipalities, based on the level of socio-economic risk factors, and a panel regression analysis, to verify whether these factors act as risk factors or as driving forces of inverse intervention law. RESULTS: The municipalities with a high level of risk factors have the higher threshold level for child protection notifications compared to other municipalities. In all municipalities, the share of single-parent families acts as a risk factor, while the share of residents with higher education acts as a driver of the inverse intervention law. Reduction of unemployment and income inequalities are also recognised as drivers of this law, but only in municipalities with a relatively higher level of risk factors. CONCLUSIONS: This study promotes the inverse intervention law, and contribute to the understanding of the driving forces of this law. Further, there is a difference in the threshold level of child protection notifications among municipalities which is based on their socio-economic context. Children are in an unequal position in relation to the municipality in which they live.

A tale of two cases - investigating reasoning in similar cases with different outcomes.

Why is it that some care order cases result in the child being removed from parental care, while in others she is not, despite the cases being similar? This paper investigates how decision-makers reason and justify different outcomes for similar cases, by an analysis of four pairs of judgments (from Norway, Estonia, and Finland) about care orders, using thematic analysis. The comparison is within the pairs and not across countries. I find that the variance in outcome and reasoning seems to be a result of discretionary evaluations: risk, cooperation of the parents, and the potential of services to alleviate the situation are interpreted differently in the cases and lead to different outcomes. This appears to be a legitimate use of the discretionary space available to the decision-makers. The decisions are justified with 'good reasons' mostly related to threshold, the least intrusive intervention principle, and the best interests of the child. Such justifications are suitable to provide accountability and legitimacy, but the reasoning is at times lacking transparency and thoroughness. The reasoning is longer in the non-removal cases, suggesting that more thorough reasoning is required when the decision-makers depart from the most common outcome.

Low levels and determinants of appropriate complementary feeding practices among children aged 6-23 months from Tigray, Ethiopia: a community-based cross-sectional study.

INTRODUCTION: Complementary feeding is considered appropriate when introduced timely at 6 months of age, and where it fulfils the minimum meal frequency, minimum dietary diversity and minimum acceptable diet. Sufficient evidence is available on the different individual indicators of appropriate complementary feeding. OBJECTIVE: This study was conducted to assess the prevalence and determinants of appropriate complementary feeding practices among children aged 6-23 months in Tigray, Northern Ethiopia. DESIGN AND SETTING: A community-based cross-sectional study was conducted in 52 districts of Tigray. PARTICIPANTS: A total of 5321 children aged 6-23 months were included using stratified two-stage random sampling. RESULTS: Approximately 19% of children received appropriate complementary feeding. Maternal residence in urban areas (adjusted OR (AOR) 1.26; 95% CI 1.062 to 1.489), maternal education (AOR 1.34; 95% CI 1.111 to 1.611), antenatal care (ANC) visits (AOR 1.75; 95% CI 1.343 to 2.281), household food security (AOR 2.81; 95% CI 2.367 to 3.330) and provision of colostrum to newborns (AOR 1.76; 95% CI 1.139 to 2.711) were found predictors of appropriate complementary feeding. Moreover, children in the 12-17 and 18-23 months age groups were 1.3 (AOR 1.30; 95% CI 1.083 to 1.551) and 1.7 (AOR 1.73; 95% CI 1.436 to 2.072) times more likely to receive appropriate complementary feeding respectively, compared with children aged 6-11 months. CONCLUSIONS: Appropriate complementary feeding practices among children aged 6-23 months remain unacceptably low in Tigray. Recommendations to improve nutrition outcomes include counselling on age-appropriate complementary feeding, education for girls and women, targeting families through food security initiatives, provision of nutrition education on appropriate complementary feeding practices during ANC visits, supporting mothers to initiate breastfeeding within the first hour of delivery and crafting context-based messaging for rural families.

Substance misuse by birth parents: Outcomes for children and young people placed into out-of-home-care.

BACKGROUND: There is inconsistent evidence regarding the effect of birth parent substance use on developmental outcomes for children placed into out-of-home-care (OOHC). OBJECTIVE: This study aims to examine how parental substance use affects outcomes of Australian children in out-of-home care, adjusting for key demographic, social and system factors. PARTICIPANTS AND SETTING: Four waves of survey data were collected for children and young people who agreed to participate in the Pathways of Care Longitudinal Study (POCLS) between 2011 and 2018. The study sample included 1,506 children and young people (792 with a history of parental substance misuse) aged 9 months to 17 years who participated in at least one wave of the POCLS and had linked administrative data from the Department of Communities and Justice (DCJ), NSW, Australia. METHODS: Multilevel longitudinal models were used to analyse the relationship of child developmental outcomes (physical health, socio-emotional wellbeing, and verbal and non-verbal cognitive ability) with parental substance misuse in their child protection history. Each model included adjustments for child demographics, family socio-economic status, child protection system factors and the unbalanced panel. RESULTS: Children in OOHC with a history of parental substance misuse were more likely to be in the typical range for verbal cognitive development compared to those in OOHC without this history. In addition, younger (9 months to 5 years) children with a record of parental substance misuse exhibited significantly more typical fine and gross motor skill development than those without this history. CONCLUSIONS: Concerns that children in OOHC with a history of parental substance misuse may be more affected with regards to early-stage physical development, and later verbal cognitive development than those without this history in OOHC, may not be justified.

Socioeconomic risk and the longitudinal child lifetime prevalence of child protection involvement.

BACKGROUND: North American studies find that geographic indicators of disadvantage, such as concentrated poverty, significantly increase the risk of child protection involvement. Despite having one of the most extensive family support systems and progressive income redistribution policies in North America, the Canadian province of Québec still faces geographic variations in socioeconomic conditions that remain a major risk factor for child protection involvement. OBJECTIVE: This study asks how child protection involvement is distributed across socioeconomically distinct geographic areas of the province. Drawing from prior literature, we hypothesize that the highest level of child protection involvement across childhood (age 0-17) is found in the lowest socioeconomic areas. PARTICIPANTS & SETTING: This is a population-based prevalence study using administrative child protection data spanning the years 2000 to 2017 across Québec. METHODS: We constructed cumulative risk life tables of first instances of child protection events (report confirmation, compromised security or development, and out-of-home placement). Prevalence rates were mapped onto 10,650 Census dissemination areas divided into three tiers according to a validated socioeconomic status (SES) index. RESULTS: The highest childhood prevalence of confirmed child protection reports, finding of compromised security or development, and out-of-home placement was found in the lowest SES areas. Rates in low SES areas can be over twice the rates in high SES areas. CONCLUSIONS: Area-level socioeconomic vulnerability remains a robust predictor of child protection involvement even in a socially progressive context. Our findings underscore that without targeted pediatric and family services, as well as poverty-alleviation programs for high-need families in high-need areas, even well-intentioned systems may fall short of reaching the families most in need.

Mentalisation-based online intervention for psychologically distressed parents: protocol of a non-randomised feasibility trial of the Lighthouse Parenting Programme-Online (LPP-Online).

INTRODUCTION: Online-based interventions provide a low-threshold way to reach and support families. The mentalisation-based Lighthouse Parenting Programme is an established intervention aimed at preventing psychopathological development in children. The objective of this study is to examine the feasibility of an online adaptation of the Lighthouse Parenting Programme (LPP-Online), evaluating (a) recruitment capability, compliance, acceptability and satisfaction with the intervention; (b) the psychometric properties of and the acceptability regarding the adjunct psychological evaluation; and (c) the employed materials and resources. The study will also obtain a preliminary evaluation of participants' responses to the intervention. METHOD AND ANALYSIS: In this monocentric, one-arm, non-randomised feasibility trial, n=30 psychologically distressed parents with children aged 0 to 14 years will participate in the LPP-Online for a duration of 8 weeks. The intervention consists of online group sessions and individual sessions, 38 smartphone-based ecological momentary interventions (EMI), and psychoeducational materials (website, booklet). At baseline (T0) and the end of the intervention (T1), parents complete self-report questionnaires as well as 7-day ecological momentary assessments (EMA) via smartphone. During the intervention, additional EMA are completed before and after the daily EMI. An interview regarding parents' subjective experience with the intervention will be conducted at T1. The feasibility of the intervention, the psychological evaluation and the resources will be examined using descriptive and qualitative analyses. The preliminary evaluation of the parents' response to the intervention will be conducted by analysing pre-post changes in questionnaire measures and the 7-day EMA as well as data of additional EMA completed before and after the daily EMI. ETHICS AND DISSEMINATION: Ethical approval of the study has been obtained from the local ethics board (Faculty of Behavioural and Cultural Studies, University of Heidelberg). Consent to participate will be obtained before starting the assessments. Results will be disseminated as publications in peer-reviewed scientific journals and at international conferences. REGISTRATION DETAILS: German Clinical Trials Register (DRKS00027423), OSF (https://doi.org/10.17605/OSF.IO/942YW).

U.S. State rates of newborns reported to child protection at birth for prenatal substance exposure.

BACKGROUND: In the U.S., the opioid epidemic has revitalized national attention to newborns with prenatal substance exposure (PSE). These newborns and their caregivers have specific health and treatment needs and frequently interact with multiple systems, including child protection systems (CPS). METHODS: This study calculated rates of newborns (less than 15 days old) reported to CPS per 1,000 births due to PSE by state and year using data from the National Child Abuse and Neglect Data System (NCANDS). Given the lack of a clear definition of PSE reports in the data, we calculated rates using three different definitions. To examine the relationship between different state laws regarding the mandated reporting of PSE and PSE reports rates, we used panel data analysis. RESULTS: Rates of newborn reports more than doubled between 2011 and 2019. There was extensive state variability of rates including some states that were consistently more than 100 % greater than and others consistently more than 150 % less than the annual national mean. Reporting rates were not associated with state requirements to report PSE, but were positively associated with rates of diagnosed neonatal abstinence syndrome. CONCLUSION: State-level inconsistencies in identification, reporting, and CPS responses prevent a clear understanding of the scope of the affected population and service needs.

Online sexual abuse of children with disabilities: Analyzing reports of social workers' case files in Israel.

BACKGROUND: Online child sexual abuse (OCSA) is a growing social concern. However, its manifestations among children with disabilities (CWDs), who face an increased risk of sexual abuse, remain largely unexamined. OBJECTIVE: This study aims to fill this gap by examining professionals' perspectives of the OCSA of CWDs through their work at the 105 Hotline, an Israeli national call center that accepts queries and reports of the cyber victimization of minors. METHODS: A mixed methods research design was employed. A quantitative analysis was performed on 114 case files involving the OCSA of CWDs, followed by a thematic content analysis of 23 follow-up files by social workers. RESULTS: The quantitative findings revealed various characteristics of the survivors, their families, and OCSA. The qualitative analysis revealed that professionals indicate multiple interrelated risk factors for the OCSA of CWDs on three levels: child, related to the child's characteristics and disability traits; family, referring to familial complexities, parenting challenges, and socio-economic position; and relational, referring to the online abusive relationships between the perpetrator and the survivor. Furthermore, the online platform comprised characteristics that enhanced the risk of OCSA of CWDs. CONCLUSIONS: The understanding that the OCSA of CWDs as a compounded risk that encompasses personal and environmental risk dimensions is necessary and should guide all professionals' decisions and actions. There is also an urgent need for governmental and community efforts to develop measures, policies, and support systems to reduce OCSA risks for CWDs. Moreover, knowledge and interventions should be developed for professionals and parents of CWDs to improve the identification and response to this overlooked phenomenon.

Investigating the impact of Out-of-Home Care on early childhood development.

BACKGROUND: Early childhood development is influential for life course capability. Children exposed to child maltreatment and at high risk of harm may be removed for their safety, but the effect on child development is uncertain. OBJECTIVES: To assess developmental vulnerability at school commencement across five developmental domains to ascertain whether removal of children with substantiated maltreatment to foster/kinship care is likely protective, or not, of developmental vulnerabilities. METHODS: The study drew on linked-data for a South Australian population birth cohort (2003 to 2014) N = 74,751. For children exposed to substantiated child maltreatment meeting study criteria (N = 2011, mean age = 5.7 years, 50.7 % boys), the effect of placement in foster/kinship care (N = 666) on developmental vulnerability was explored using generalized linear models, adjusted for child and family covariates, maltreatment severity and propensity score. RESULTS: Children placed in care had a reduced risk of developmental vulnerability on the Physical Health and Wellbeing (aRR = 0.73 [0.64, 0.84]), Language and Cognitive Skills (school based) (aRR = 0.79 [0.68, 0.92]), and Communication Skills and General Knowledge (aRR = 0.81 [0.70, 0.94]) domains, compared to children who were not removed. However, these children had increased risk of vulnerability on Social Competence (aRR = 1.14 [1.01, 1.29]) and Emotional Maturity (aRR = 1.20 [1.05, 1.37]) domains. CONCLUSIONS: These findings suggest placement in out-of-home care supported physical health and wellbeing, communication and cognitive but not social and emotional early childhood development. These results highlighting the need for professional therapeutic support for children in care and better attending to the physical development, communication and cognitive skills in maltreated children remaining at home.

Screening for adverse social conditions in child healthcare settings: protocol for a systematic review.

INTRODUCTION: Adverse social conditions affect children's development and health outcomes from preconception throughout their life course. Early identification of adverse conditions is essential for early support of children and their families. Healthcare contacts with children provide a unique opportunity to screen for adverse social conditions and to take preventive action to identify and address emerging, potentially harmful or accumulating social problems. The aim of our study is to identify and describe available screening tools in outpatient and inpatient healthcare settings that capture social conditions that may affect children's development, health or well-being. METHODS AND ANALYSIS: We will conduct a systematic review and will report the results following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. A systematic search of three databases (PubMed (Ovid), PsycInfo (EBSCOhost) and Web of Science Core Collection (Clarivate)) for English-language and German-language articles from 2014 to date will be conducted. We will include peer-reviewed articles that develop, describe, test or use an instrument to screen children for multiple social conditions in paediatric clinics or other outpatient or inpatient child healthcare settings. Key study characteristics and information on screening tools will be extracted and presented in structured tables to summarise the available evidence. We will assess the methodological quality of the instruments with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. ETHICS AND DISSEMINATION: Ethical approval is not required for this study as we will not be collecting any personal data. Dissemination will consist of publications, presentations, and other knowledge translation activities.

Separation at birth due to safeguarding concerns: Using reproductive justice theory to re-think the role of midwives.

Separation at birth due to safeguarding concerns is a deeply distressing and impactful event, with numbers rising across the world, and has devastating outcomes for birth mothers and their children. It is one of the most challenging aspects of contemporary midwifery practice in high-income countries, although rarely discussed and reflected on during pre- and post-registration midwifery training. Ethnic and racial disparities are prevalent both in child protection and maternity services and can be explained through an intersectional lens, accounting for biases based on race, gender, class, and societal beliefs around motherhood. With this paper, we aim to contribute to the growing body of critical midwifery studies and re-think the role of midwives in this context. Building on principles of reproductive justice theory, Intersectionality, and Standpoint Midwifery, we argue that midwives play a unique role when supporting women who go through child protection processes and should pursue a shift from passive bystander to active upstander to improve care for this group of mothers.

Originalarbeiten / Original Articles. Skills Lab Pädiatrie: Stärken kommunikativer Fertigkeiten für das Gespräch mit psychosozial belasteten Familien / Pediatric Skills Lab: Strengthening Communication Skills for the Conversations with Psychologically burdened Families.

Pediatric Skills Lab: Strengthening Communication Skills for the Conversations with Psychologically burdened Families To identify psychosocially burdened families early and motivate them to seek further assistance is a central aspect of pediatric preventivemedicine.The aim of the feasibility study was to develop the Pediatric Skills Lab to promote methods for identifying and addressing psychosocially burdened families, and to evaluate it. Thirteen primary care pediatricians participated in two trials of the Pediatric Skills Lab, an interdisciplinary developed two-part digital training.They answered questions regarding their work with psychosocially burdened families and their satisfaction with the Pediatric Skills Lab. Overall, there was a high level of satisfaction reported with the Pediatric Skills Lab. Specifically, the presentation of results on the effects of psychosocial stressors, the practical exercises, and the exchange with colleagues during the interactive webinar were highly praised. Criticisms included, for example, the short duration of practical exercises and the lack of sufficient examples and live demonstrations. The Pediatric Skills Lab is a training concept tailored to meet the existing needs. With widespread implementation, it could enhance psychosocial care provision. Consideration should be given to extending the duration of the training to allow formore practical exercises. Future studies building upon this feasibility study should examine the effects of the training. Additionally, ways to integrate the Pediatric Skills Lab into existing curricula formedical education should be explored.

Characteristics of children aged 5 and under presenting with ingestion: An analysis of cases from a tertiary child protection unit.

AIM: This study aimed to determine what proportion of children presenting to a tertiary children's hospital with ingestion were referred for child protection assessment, and to describe the characteristics of the referred group. METHODS: This is a retrospective case series study of children who presented to a tertiary children's hospital between 1 January 2016 and 31 December 2020 with ingestion (poisoning). Demographic and clinical data were collected from the electronic medical record and patients who underwent child protection assessment were identified. The child protection group was compared to the whole cohort. The child protection group had psychosocial data gathered and descriptively analysed. RESULTS: Two hundred and three patients were included. The most common substances ingested were over-the-counter medications (45%) followed by prescription medications (41%). Most patients were discharged from the emergency department (70%). Of the 203 patients, 24 (11.8%, 95% CI 7.72-17.08) were referred to the child protection unit. A significant proportion of these patients had a history of parental depression (64%) and other mental health conditions (41%), parent separation (77%) and domestic violence in the home (64%). CONCLUSION: The patients assessed by the child protection team had high prevalence of psychosocial risk factors that also place the patients at risk of child abuse and neglect. Most of the other patients did not have a psychosocial history documented in the medical record, and this group likely contains a high proportion of vulnerable children. By screening patients presenting with ingestion we may be able to identify children at risk and provide opportunities for protective intervention.

Análisis del desarrollo infantil temprano según el marco de cuidado cariñoso y sensible, por quintiles de riqueza y regiones de Argentina (2019-2020) / Analysis of early childhood development according to the nurturing care framework, by wealth quintiles and regions of Argentina (2019­2020)

Introducción. Uno de los principales desafíos para la primera infancia es brindar cuidados adecuados que reduzcan desigualdades y promuevan desarrollo infantil temprano (DIT). El objetivo del trabajo fue describir relaciones entre los cuidados que reciben niños y niñas de 3 y 4 años, según el marco para el cuidado cariñoso y sensible (NC, por sus siglas en inglés), y sus niveles de DIT en Argentina, considerando región y quintiles de riqueza. Población y métodos. Estudio analítico observacional de corte transversal, a partir de las bases de datos de la Encuesta Nacional de Niñas, Niños y Adolescentes (MICS) Argentina 2019-2020. Se seleccionaron 11 indicadores de NC y se estimó el nivel de DIT utilizando el Índice de Desarrollo Infantil Temprano (ECDI) para un análisis estadístico descriptivo. Resultados. En 2638 niños y niñas de 3 y 4 años evaluados, el promedio de acceso a indicadores de cuidados fue del 79,1 %; el acceso fue alto en 7 indicadores (entre el 84,2 % y el 97,9 %) y medio en 4 (entre el 46,9 % y el 65,1 %); la mayor frecuencia fue contar con registro de nacimiento (97,9 %) y la menor, la cobertura de seguro de salud (46,9 %). El 87,9 % alcanzó niveles adecuados de ECDI. Los resultados registran diferencias según quintiles de riqueza y regiones. Conclusiones. Los resultados evidencian desigualdades de acceso a cuidados y en DIT adecuado de niños y niñas de 3 y 4 años de áreas urbanas de Argentina según la región donde viven y el nivel de riqueza de sus hogares.

Introduction. One of the main challenges for early childhood is to provide adequate care to reduce inequalities and promote an early childhood development (ECD). The objective of this study was to describe the relationship between the care provided to children aged 3 and 4 years according to the nurturing care (NC) framework and their ECD levels in Argentina, considering the region and wealth quintiles. Population and methods. This was an observational, cross-sectional analytical study based on data from the National Survey of Children and Adolescents (MICS) of Argentina 2019­2020. A total of 11 NC indicators were selected; the level of ECD was estimated using the Early Childhood Development Index (ECDI) for a descriptive, statistical analysis. Results. In 2638 children aged 3 and 4 years assessed, the average access to care indicators was 79.1%; access was high for 7 indicators (between 84.2% and 97.9%) and middle for 4 indicators (between 46.9% and 65.1%); the highest and lowest frequency corresponded to having a birth certificate (97.9%) and health insurance coverage (46.9%), respectively. Adequate ECDI levels were observed in 87.9%. Results show differences by wealth quintile and region. Conclusions. The results evidence inequalities in terms of access to care and an adequate ECD of children aged 3 and 4 years from urban areas of Argentina, depending on the region where they live and their household wealth level.

Families in transition (FIT) study protocol: feasibility, acceptability and preliminary effects of a group-based parent training in parents of youth in psychiatric residential treatment.

INTRODUCTION: Although adolescents make treatment gains in psychiatric residential treatment (RT), they experience significant difficulty adapting to the community and often do not sustain treatment gains long term. Their parents are often not provided with the necessary support or behaviour management skillset to bridge the gap between RT and home. Parent training, a gold standard behaviour management strategy, may be beneficial for parents of these youth and web-based parent training programmes may engage this difficult-to-reach population. This study focuses on a hybrid parent training programme that combines Parenting Wisely (PW), a web-based parent training with facilitated discussion groups (Parenting Wisely for Residential Treatment (PWRT)). This study aims to: (1) establish the feasibility and acceptability of PWRT, (2) evaluate whether PWRT engages target mechanisms (parental self-efficacy, parenting behaviours, social support, family function) and (3) determine the effects of PWRT on adolescent outcomes (internalising and externalising behaviours, placement restrictiveness). METHODS AND ANALYSIS: In this randomised control trial, parents (n=60) will be randomly assigned to PWRT or treatment as usual. Each week for 6 weeks, parents in the PWRT condition will complete two PW modules (20 min each) and attend one discussion group via Zoom (90 min). Adolescents (n=60) will not receive intervention; however, we will evaluate the feasibility of adolescent data collection for future studies. Data from parents and adolescents will be collected at baseline, post intervention (6 weeks post baseline) and 6 months post baseline to allow for a robust understanding of the longer-term effects of PWRT on treatment gain maintenance. ETHICS AND DISSEMINATION: The study has been approved by The Ohio State University Institutional Review Board (protocol number 2022B0315). The outcomes of the study will be shared through presentations at both local and national conferences, publications in peer-reviewed journals and disseminated to the families and organisations that helped to facilitate the project. TRIAL REGISTRATION NUMBER: NCT05764369 (V.1, December 2022).

PRESOLRE: study protocol for a primary school-based, cluster randomised controlled trial of three sun exposure risk prevention strategies on Reunion Island.

INTRODUCTION: Reunion Island, a French overseas department, is located in the southern hemisphere, close to the Capricorn tropic. This island has a multicultural and multiethnic population of 860 000 inhabitants, a quarter of whom are at high risk of developing skin cancer due to intense ultraviolet radiation. Melanoma is responsible for the majority of skin cancer deaths. The early prevention of melanoma is based on sun protection in childhood, but French regulations are not adapted to the environmental conditions of this tropical region.The main objective of our study is to evaluate the effectiveness of three sun protection programs conducted in Reunionese primary schools through a pupil knowledge questionnaire. METHODS AND ANALYSIS: PRESOLRE is an interventional, open-label, cluster-randomised controlled trial, in four parallel arms, that is being conducted throughout 2022-2023 on Reunion Island. The trial design assumes an escalation interventional effect using: first, a control arm without proposed intervention (arm 1); second, an arm whose classes are encouraged to use the validated educational programme 'Living With the Sun' (LWS) (arm 2); third, an arm whose classes are encouraged to use both 'LWS' combined with 'Mission Soleil Réunion's sun protection awareness programme (arm 3); fourth, an arm benefiting from an intervention similar to arm 3, combined with the distribution of hats, sunglasses and sun creams (arm 4). In all, 1780 pupils from 18 classes of 20 pupils, on average, will be included. Randomisation applies to the classes of pupils (so defined as clusters). The primary outcome is based on the proportion of correct answers to the knowledge questions after the awareness programme, compared between the four arms using a linear mixed model with random intercept. ETHICS AND DISSEMINATION: The study obtained ethics approval in 2022 (ID: 2022-A00350-43). Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05367180.

Constructing the 'zero family': Breaking the intergenerational transmission of maltreatment from the perspective of care-experienced parents.

BACKGROUND: Several studies have explored the mechanisms of intergenerational transmission of child maltreatment (ITCM), which also involves care-experienced parents; however, what is less explored is their direct experience, especially regarding resilience processes. OBJECTIVE: Developing the theoretical framework of ITCM through an exploration of the perspectives of those who appear to have interrupted it. PARTICIPANTS AND SETTING: A sample of 27 Italian parents - with experience in foster and/or residential care - who have broken the ITCM, completed an in-depth interview between May 2021 and February 2023. METHODS: A Constructivist Grounded Theory (Charmaz, 2014) approach was adopted in carrying out the interviews, which focused on daily experiences of parenting (Morgan, 2011) and on factors perceived as supporting ITCM interruption. Data were analyzed using open, focused and theoretical coding; the analysis itself was discussed with a consultive board of care-experienced parents. RESULTS: The study highlighted important aspects that, from parents' perspectives, play a role in breaking ITCM: for instance, how their parenting experience is a challenging process of constructing what they term 'zero family'. Furthermore, starting a family from scratch requires coming to terms with the past, re-imagining oneself as a parent, and managing the complexity of everyday life despite such tensions. CONCLUSIONS: The results throw light on how the transition to parenthood itself is perceived as a significant developmental opportunity for the interruption of ITCM. However, many problems persist, foregrounding the relevance of discussing possible supports to strengthen parenting agency and skills. Such a discussion should therefore be increasingly informed by ecological approaches and parents' perspectives (also on everyday practices and life contexts), thus avoiding the risk of pathologizing responses.

Disease burden and risk factors of children aged 0-14 years in China: a retrospective study on data from the Global Burden of Disease Study 2019.

OBJECTIVES: This study aimed to analyse the current status, trends and risk factors of disease burden from 1990 to 2019 among Chinese children. DESIGN AND PARTICIPANTS: It was a retrospective study on data from the Global Burden of Disease Study 2019 (GBD 2019). Data of disease burden and risk factors were extracted from the GBD 2019. Children were divided into two groups of <5 and 5-14 years. Data were analysed using GBD results query tool, Excel and Pareto analysis. PRIMARY OUTCOME MEASURES: Disability-Adjusted Life Years (DALYs) and deaths. RESULTS: The overall disease burden for both children <5 years and those aged 5-14 years significantly decreased from 1990 to 2019. For children aged <5 years, in 2019, the leading cause of deaths and DALYs were 'neonatal disorders', and the top risk factor was 'low birth weight'. Compared with data of 1990, the ranking of causes of deaths and DALYs in 2019 saw the most significant increase for 'HIV/AIDS and sexually transmitted infections' and 'skin and subcutaneous diseases' respectively. Conversely, the ranking of deaths/DALYs causes that dropped most significantly was 'nutritional deficiencies'. For children aged 5-14, in 2019, the leading deaths and DALYs causes were 'unintentional injuries' and 'mental disorders' respectively. The top risk factors were 'alcohol use' and 'short gestation', respectively. The ranking of deaths and DALYs causes rose most significantly were 'HIV/AIDS and sexually transmitted infections' and 'neonatal disorders', respectively. Conversely, the ranking of deaths causes that dropped most significantly were 'other infectious diseases', 'enteric infections' and 'nutritional deficiencies'. For DALYs, the causes that dropped most significantly in ranking were 'other infectious diseases'. CONCLUSIONS: The disease burden of children has significantly changed from 1990 to 2019, with notable differences between children aged <5 and 5-14 years. To optimise the allocation of health resources, it is necessary to adjust management strategies based on the latest disease burden.

Examining relationships between adverse childhood experiences and coping during the cost-of-living crisis using a national cross-sectional survey in Wales, UK.

OBJECTIVES: Adverse childhood experiences (ACEs) can affect individuals' resilience to stressors and their vulnerability to mental, physical and social harms. This study explored associations between ACEs, financial coping during the cost-of-living crisis and perceived impacts on health and well-being. DESIGN: National cross-sectional face-to-face survey. Recruitment used a random quota sample of households stratified by health region and deprivation quintile. SETTING: Households in Wales, UK. PARTICIPANTS: 1880 Welsh residents aged ≥18 years. MEASURES: Outcome variables were perceived inability to cope financially during the cost-of-living crisis; rising costs of living causing substantial distress and anxiety; and self-reported negative impact of rising costs of living on mental health, physical health, family relationships, local levels of antisocial behaviour and violence, and community support. Nine ACEs were measured retrospectively. Socioeconomic and demographic variables included low household income, economic inactivity, residential deprivation and activity limitation. RESULTS: The prevalence of all outcomes increased strongly with ACE count. Perceived inability to cope financially during the cost-of-living crisis increased from 14.0% with 0 ACEs to 51.5% with 4+ ACEs. Relationships with ACEs remained after controlling for socioeconomic and demographic factors. Those with 4+ ACEs (vs 0 ACEs) were over three times more likely to perceive they would be unable to cope financially and, correspondingly, almost three times more likely to report substantial distress and anxiety and over three times more likely to report negative impacts on mental health, physical health and family relationships. CONCLUSIONS: Socioeconomically deprived populations are recognised to be disproportionately impacted by rising costs of living. Our study identifies a history of ACEs as an additional vulnerability that can affect all socioeconomic groups. Definitions of vulnerability during crises and communications with services on who is most likely to be impacted should consider childhood adversity and history of trauma.

Impacts on paediatricians testifying in cases of child maltreatment: protocol for a systematic review.

INTRODUCTION: Paediatricians perform medical assessments for children in cases of suspected child maltreatment. Due to their role with statutory child protection agencies and police, paediatricians may be asked to testify in court about child protection and criminal justice matters. To the authors' knowledge, there has been no previous systematic review of the literature synthesising the evidence on the impacts on paediatricians testifying in cases of child maltreatment. METHODS AND ANALYSIS: A search strategy comprising indexed and key terms will be applied to six electronic reference databases from inception to May 2023: Medline, EMBASE, PsycINFO, CINAHL, Criminal Justice Abstracts and Cochrane Library. Two reviewers will independently screen titles and abstracts and full-text articles against predefined eligibility criteria to identify studies of interest. Conflicts will be independently adjudicated by a third reviewer. ETHICS AND DISSEMINATION: Since the systematic review methodology aims at synthesising information from available publications, this study does not require ethical approval. An article reporting the results of the systematic review will be submitted for publication in a scientific journal, presented at relevant conferences and used in subsequent stakeholder consultations.