Access to health and rights of children in street situations and working children: a scoping review.

BACKGROUND: Street and working children (SWC) and young people (YP) are highly vulnerable to violence, exploitation, hazardous environments and human rights violations. While the UN Committee on the Rights of the Child and the International Labour Organisation provide some guidance, there is limited information on their right to healthcare. This study aims to identify enablers and barriers to healthcare access for SWC and document associated rights violations. METHODS: From 2000 to the present, we conducted systematic searches for SWC (0-18 years) in databases including MEDLINE, PsycINFO, EBSCO, PUBMED and PROQUEST, using broad search terms related to street children, working children, healthcare access and rights. The searches were supplemented by grey literature and hand searches. Two independent reviewers finalised the included studies, and data were analysed using a rights-based framework with narrative analysis and thematisation. RESULTS: The initial search yielded 7346 articles (5972 for street children and 1374 for working children), with 35 studies (18 for street children and 17 for working children) included in the review. Most studies on working children (13/17) focused on trafficking/commercial exploitation. Studies were predominantly from Africa, followed by the USA, Asia, the UK and Canada, with only two employing a rights framework. SWC face barriers such as cost, distance, visibility/accessibility of services, stigma, seclusion, threats of violence, lack of legal documents, crisis-oriented healthcare use and self-medication. Enablers included agency, self-efficacy, positive relationships with adults and proactive healthcare use when accessible. Emergency departments are frequently accessed by SWC, indicating a need for healthcare professionals to be trained and sensitised. Holistic and comprehensive healthcare is essential. CONCLUSION: Significant research gaps exist, with many SWC populations under-represented. SWC share healthcare access barriers with other marginalised groups. Healthcare for SWC must be tailored to their unique needs and strengths and be holistic and trauma-informed.

Children in street situations' access to healthcare: qualitative findings from the Street Child World Cup 2022.

BACKGROUND: Children in street situations (those who live or work on the street) are known to face barriers in accessing healthcare. METHODS: The study combined a remote survey with 33 adult non-governmental organisation (NGO) staff members, in-depth interviews with staff members of 11 NGOs and 4 formerly street-connected adult young leaders and a questionnaire with 30 street-connected children from 15 countries participating in the Street Child World Cup event in Qatar in 2022. Data were analysed using thematic analysis. RESULTS: The participating children have strong connections with supportive organisations and do tend to seek adult assistance when they are ill or injured, refuting the assertion of adult participants and the literature that children in street situations only seek healthcare in emergencies. Some barriers that children in street situations face when seeking healthcare are likely shared by other disadvantaged groups, including the cost of care, long waiting times, the quality of public healthcare and discrimination based on socioeconomic status. Children in street situations may face further discrimination based on assumptions about their lives, their appearance or hygiene levels. Identity documents are highlighted in the literature as a major barrier but seemed less important to the participants. Both adult and child participants emphasised the need for an accompanying adult to find appropriate services and be treated. CONCLUSIONS: This study highlights the important work of organisations supporting street-connected children to access healthcare both during and after their time working or living on the street. It concludes that while some of the barriers to accessing healthcare that children in street situations face are not specific to this group, the absence of an adult caregiver differentiates many street-connected children from other disadvantaged groups. This also signals differences among children in street situations, with those with connections to family or organisations having more support.

"There are talibés and talibés": Exploring the boundaries of the category of talibés who beg.

BACKGROUND: In Dakar and other urban centres in Senegal, young boys begging in the streets are commonly assumed to be talibés, or students of the Qur'an. OBJECTIVE: This study intends to explore the boundaries of the discursive construction of talibés (who beg) in Senegal. PARTICIPANTS AND SETTING: 72 participants including Qur'anic teachers, staff and volunteers of international, national and local NGOs and associations, and representatives of state structures and international institutions, in Dakar, Rufisque and Saint Louis, Senegal. METHODS: This qualitative study is based on doctoral field research conducted during the period of October 2017-July 2018. The main method of enquiry was semi-structured interviews and group discussions (n = 62), supplemented with observation and document review. RESULTS: The findings demonstrate the following themes: firstly, the category of talibé is often assumed to refer to those who beg, despite recognition that many children studying the Qur'an do not beg. Secondly, children who are assumed not to be learning the Qur'an are frequently still labelled as talibés. Thirdly, talibés who beg are differentiated from other boys who beg on the basis of assumptions of criminality (of others) and control (over talibés). CONCLUSIONS: Although talibé is understood to mean student of the Qur'an, those who beg all day and purportedly do not learn the Qur'an at all have come to be the dominant representation of a talibé used in development discourse. This has implications for the collection of data about these children as well as the interventions designed in response to this problematisation.

A Survey of Stress and Burnout in Forensic Mental Health Nursing.

BACKGROUND: Although it is known that forensic mental health nurses (FMHNs) work in a stressful environment, their experience of stress and burnout remains largely unexplored. AIM: The study aimed to measure levels of burnout and workplace stressors experienced by FMHNs. METHODS: A survey of 205 FMHNs was undertaken. Respondents completed the Maslach Burnout Inventory and the Nursing Stress Scale. FINDINGS: Fifty-seven FMHNs completed the survey, representing a response rate of 27.8%. Only five respondents (8.8%) experienced high levels of burnout across all three Maslach Burnout Inventory subscales. The most reported workplace stressors were related to "workload," "conflict with other nurses," and "conflict with physicians." A correlation between total Nursing Stress Scale score and both "emotional exhaustion" and "cynicism" were found (r = 0.45, p < 0.001, and r = 0.34, p < 0.011, respectively), indicating that FMHNs who reported higher workplace stress are at an increased risk of burnout. CONCLUSION: Most FMHNs in the current study experienced moderate levels of burnout, although they continued to feel self-assured in their practice and found their work rewarding. Consistent with other nursing populations, the FMHNs in this study reported feeling stressed by their workload and as the result of conflict with other nurses and physicians. IMPLICATIONS FOR CLINICAL FORENSIC NURSING PRACTICE: Reduced well-being, associated with stress and burnout, may lead to increased absences from work and the delivery of poor-quality forensic mental health consumer care. The implementation of staff well-being strategies is recommended to address stress and burnout in FMHNs.

Evaluation of a totally smoke-free forensic psychiatry in-patient facility: practice and policy implications.

OBJECTIVE: To evaluate the impact of implementing a smoke-free policy in an Australian high-security forensic psychiatry in-patient hospital. METHODS: Focus groups (n=21) and surveys with both patients (n=45) and staff (n=111; 53.2% nurses) elicited participants' experience of and attitudes towards an introduced smoke-free policy. A follow-up survey elicited the impact of the policy on 15 patients' smoking practice after discharge. RESULTS: Eighty-five per cent of patients stated it was easier to quit smoking when no one else smoked. Over half the discharged patients surveyed (58%) continued to not smoke after discharge, despite almost half the staff (41%) perceiving that patients were unlikely to quit long-term. Smoking staff were significantly more pessimistic than non-smoking staff. Many patients (69%) perceived that their health had improved as a result of not smoking. Most staff (80%) viewed nicotine dependence treatment as important, but fewer (66%) felt confident to support patients to stop smoking. Increased patient violence and management difficulties expected by staff were not realised. CONCLUSIONS: A smoke-free policy can be successfully implemented in forensic psychiatry in-patient units. Nursing staff are a large and important group who need particular support to implement a smoke-free policy into practice effectively, particularly those who are smokers. Continuity of care as part of a coordinated policy and service response is needed.