Consistency between provision, outcomes and functioning needs in statutory documents for young children with developmental disabilities in England.

BACKGROUND: It is widely accepted that early childhood intervention for children with disabilities should address the assessment-intervention cycle holistically. Documenting both assessment and intervention is important to support provision effectively. In England, the official document that describes needs and provision for children with special educational needs and disabilities is the Education Health and Care plan. This document requires inter-professional collaboration and a focus on children's holistic participation, rather than diagnosis. AIM: To examine the consistency between provision, outcomes and needs of young children with disabilities in England, as described in their Education Health and Care plans. METHODS: The plans of 68 young children were examined and the relationships between documented needs, outcomes and provision actions analysed. RESULTS: provision is more related to children's individual needs, than to their diagnoses, when needs are described in sufficient detail; interdisciplinarity leads to higher quality documentation of provision and outcomes. However, more needs to be done to support professionals in developing higher quality needs descriptions and interdisciplinary collaborations. IMPLICATIONS: Training and interdisciplinarity with a common language between professionals have the potential to improve currently observed challenges regarding consistency between provision, needs and outcomes.

Perineal outcomes and its associated variables of water births versus non-water births: a cross-sectional study / Desfechos perineais e as variáveis associadas no parto na água e no parto fora da água: estudo transversal

Abstract Objectives: to describe the perineal outcomes of women who had delivered in water and out of water. Methods: a cross-sectional and quantitative study developed in a public hospital in Setúbal, Portugal. The population was of women who participated in the "Water Birth Project" in the period from 2011 to 2014, which gave birth in water and out of water. 104 women were selected according to established inclusion criteria. The groups were compared according to the following variables: demographics, obstetric information, delivery care and perineal outcomes. The data were analyzed in the Stata(r) software, with descriptive and bivariate statistics (chi-square and Fisher's test). Results: the medical records of 73 women who gave birth in water and 31 women who gave birth out of water were studied. Water deliveries were significantly associated with fewer perineal lacerations, lower rates of episiotomy, and shorter delivery time. Conclusions: the results of the study suggest that childbirth in water has a protective effect against severe third or fourth degree perineal tears, during fetal expulsion in water.

Resumo Objetivos: descrever os resultados perineais de mulheres que tiveram parto na água e fora da água. Métodos: estudo transversal e quantitativo desenvolvido em um hospital público de Setúbal, Portugal. A população foi de mulheres que participaram do "Projeto Parto na Água", no período de 2011 a 2014, que deram à luz na água e fora da água. Foram selecionadas para o estudo 104 mulheres de acordo com os critérios de inclusão estabelecidos. Os grupos foram comparados de acordo com as seguintes variáveis: demografia, informação obstétrica, assistência ao parto e resultados perineais. Os dados foram analisados no software Stata(r), com estatísitica descritiva e bivariada (qui-quadrado e teste de Fisher). Resultados: foram estudados os prontuários de 73 mulheres que deram à luz na água e 31 mulheres que deram à luz fora da água. Os partos na água foram significativamente associados a menos lacerações perineais, menores taxas de episiotomia e menor tempo de parto. Conclusão: os resultados do estudo sugerem que o parto na água tem um efeito protetor contra lacerações perineais severas de terceiro ou de quarto grau durante a expulsão fetal na água.

Evaluating the quality of outcomes defined for children with Education Health and Care plans in England: A local picture with global implications.

Recently, the Children and Families Act 2014 was introduced in England to regulate provision for children with disabilities. According to this policy, statements of special educational needs were replaced with education, health and care plans, which should include high-quality, holistic and participation-focused outcomes to regulate provision; this change aligns with international recommendations regarding provision for children with disabilities. This study aimed to evaluate the outcomes defined for children with education, health and care plans in England. 236 Education Health and Care plans were included in the analysis, providing 2813 outcomes to be examined, which came from 11 local authorities and 42 schools and belong to 69 girls and 167 boys from 4 to 21 years of age. The outcomes were independently rated by two experienced researchers using a Goal Functionality Scale. Inter-rater agreement was calculated for 10% of the outcomes. Most outcomes were considered not to be functional or high-quality; differences in quality were found between local authorities, types of school, type of outcome, and the children's main need. There are important quality concerns regarding the outcomes that have been designed for children with disabilities in England, which should be addressed through standardised training and guidelines on procedures.

Linking the early development instrument with the ICF-CY.

Objective: The International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) provides a universal taxonomy to describe functioning. One of the most relevant applications of the ICF has been the development of code-sets for particular contexts/situations, such specific age groups. An important step in research around child assessment and intervention is to identify extant measures that can assess the essential functioning features for each age range. This study aims to map the Early Development Instrument (EDI) with the ICF-CY and to identify the functioning dimensions regarded by experts as essential in the age range 3-5 that are covered by this instrument. Method: A systematic deductive content analysis procedure was used in the mapping process. Results: Most of EDI items were mapped to Activities and Participation and the majority of Activities and Participation regarded as essential from 3 to 5 years are assessed by the EDI; only some essential Environmental Factors and Body Functions are covered. Conclusion: The mapping process between the EDI and the ICF has shown that the EDI should be complemented with other measures with a focus on Body Functions and Environmental Factors, in order to facilitate a holistic description of the child.