Global oral health policies and recommendations for children with special health care needs and their applicability and effectiveness during the COVID -19 pandemic: a systematic review.

AIM: This systematic review aims to assess effectiveness of oral health policies, recommendations and guidelines in safeguarding oral health of children with special healthcare needs during COVID-19. BACKGROUND: This systematic review evaluated the adaptation of global oral health policies for children with special healthcare needs (SHCN) during the COVID-19 pandemic, to provide evidence-based insights to inform policymakers and healthcare providers amid the ongoing global health crisis. The study focused on assessing the effectiveness of these adaptations in ensuring equitable access to quality dental care for this vulnerable group. METHODS: A PRISMA guided online search through LILIACS, PubMed, Scopus, COCHRANE and grey literature was conducted. The search strategy incorporated a combination of subject headings (MeSH terms) and free-text terms related to "oral health," "dental health," "policy," "effectiveness," "dental practice guidelines," "oral health policies," and "special care needs children." Eligibility criteria included oral health policies, recommendations and guidelines targeting individuals/children with special care needs. Both qualitative and quantitative studies published in English from 2008 to 2023 were included. RESULTS: Sixteen guidelines, recommendations and policies, from six authorities were identified. These documentations addressed six different areas mentioned broadly as comprehensive care, ethical considerations, preventive and therapeutic measures, equity, patient-centric treatment, and reducing disparities signaling a paradigm shift. International collaborations and standardization of guidelines indicated a unified approach. The review also emphasized on a commitment to continuous improvement through quality measurement, systematic referral management, and needs assessment. With the exception of two documents, the remaining guidelines did not address COVID-19 or provide specific adaptations for it. The lack of emphasis on individual condition was notable, as the guidelines generally took a more generalized approach toward individuals with special healthcare needs. CONCLUSIONS: In conclusion, this review assessed the impact of COVID-19 on oral healthcare for individuals with special needs. It underscores global and local efforts for equitable access, patient-centric care, and preventive measures. The lessons learned advocate for a resilient, inclusive healthcare framework capable of meeting diverse needs. PROSPERO REGISTRATION: CRD 42023452475.

Family health partners in regional network structures (NEST): A non-randomized controlled trial among parents of chronically ill and disabled children.

BACKGROUND: The overarching project goal is to evaluate the effectiveness of a cross-sectoral and cross-service provider offering professional support for families with chronically ill and disabled children: so-called Family Health Partners (in German: 'Familien-Gesundheits-Partner' or FGP). This needs-oriented service, which is anchored in regional networks, aims to provide 'holistic' support for families with children in need of care. METHODS: We are carrying out a non-randomized controlled trial with four points of measurement (t0-t3 in 18 months), beginning in January 2022. Both intervention and control group include 102 families. Primary outcome measure is the quality of life, secondary outcomes are resilience factors and associated measures as well as the access to care. Multilevel regression models will be used to analyze the longitudinal data. DISCUSSION: The strength of this study is that it looks at the health and resilience of all family members involved by examining how a FGP can influence the entire family system with regard to increasing quality of life, resilience and self-efficacy. The network structures of FGP also open up better to previously unknown regional supply offers. There are, however, a number of limitations (e.g. type of outcomes, sample size). TRIAL REGISTRATION: This study was first registered on the German Clinical Trials Register before enrolment of participants started (ID: DRKS00027465, 4 January 2022). In order to promote its dissemination, it was also retrospectively registered on ClinicalTrials.gov (ID: NCT05418205, 14 June 2022).

The effect of mandala art therapy on the comfort and resilience levels of mothers who have children with special needs: A randomized controlled study.

BACKGROUND: The study was conducted in order to determine the effect of mandala therapy applied to mothers who have children with special needs on the mothers' comfort and resilience levels. METHODS: The study was conducted as a randomized controlled study at a special education school in Turkey. The study sample consisted of 51 mothers (24 mothers in the experimental group and 27 mothers in the control group) who had children with special needs. A 16-h mandala therapy was applied to the mothers in the experimental group. Identifying Information Form, General Comfort Questionnaire and Adult Resilience Scale were used as data collection tools. RESULTS: According to the regression analysis performed in order to explain the difference between the first and third measurements of General Comfort Questionnaire, mandala art therapy was found to be effective, and the model established was determined to be statistically significant. It was also determined that the change that occurred between the third and first measurements performed in order to identify the change in the general comfort levels of the individuals was higher in the experimental group in comparison to the control group (P < 0.05). It was seen that the mothers' mean scores obtained from the Adult Resilience Scale total scale and its subscales significantly increased in the second and third measurements (P < 0.05) but that the increase in the mean scores of the control group was not significant (P > 0.05). CONCLUSIONS: Mandala Art Therapy is a method that improves the comfort levels and resilience of mothers who have children with special needs. It might be beneficial for mothers to perform these applications at special education schools in collaboration with nurses.

Exploring Music Therapy Research in Preschool Settings that Include Children with Disabilities: A Scoping Review.

With an increasing number of developed nations adopting elements of the social model of disability, early childhood intervention practice has evolved to place greater emphasis on an inclusive, ecological, and strength-based framework. Recent music therapy literature seems to align with this shift in policy and demonstrates how family-centered strategies can be promoted in homes. Although music therapy researchers have conducted studies in kindergartens and childcares, which are also fundamental naturalistic settings for children with disabilities, the overall breadth and nature of practice in these settings is unclear and has not been collated. This scoping review aims to identify the key characteristics of music therapy research in preschool settings that include children with disabilities, subsequently identifying key publication details, participants, therapeutic aims, outcome measures, study designs, preschool settings, delivery models, and choice of music therapy methods. A total of 19 peer-reviewed journal articles from 1988 to 2020 met inclusion and exclusion criteria, with more than half of the studies published during the last 15 years. Evaluation of these 19 studies reveals how funding policies and educational systems seem to inherently inform the application of music therapy research in early learning centers. Developmental perspectives and objectivist study designs underpin many of the included sources, with majority of the outcomes demonstrating music therapy's positive impact upon a child's development. Researchers outside of the United States should give greater focus to early childhood and collect data from preschools within their respective countries to broaden awareness on how music therapy can support children with disabilities in naturalistic settings.

Clinical application and feasibility of utilizing the PEDI-CAT to assess activity and participation among children receiving physical therapy incorporating hippotherapy.

BACKGROUND: Hippotherapy (HPOT) is a physical therapy (PT) treatment tool using equine movement to improve mobility for children with movement impairments. Although research suggests HPOT improves body structure and function, there is limited evidence regarding its impact on activity and participation outcomes in a clinical setting. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) may be useful in HPOT settings to highlight changes in activity and participation. PURPOSE: 1) Evaluate the PEDI-CAT's sensitivity to changes in activity and participation among children receiving PT using HPOT; 2) determine feasibility of administering the PEDI-CAT in a HPOT setting; and 3) examine how PEDI-CAT scores influence clinical decision-making. METHODS: Participants (N = 34) were children who attended weekly PT using HPOT for 6 months. The PEDI-CAT was completed for all participants by a parent or caregiver at initial treatment (T1) and 6 months later (T2). A linear mixed effects model was used to evaluate changes in scores over time. Team meetings occurred monthly to discuss how PEDI-CAT scores impacted treatment. RESULTS: There were significant improvements across 3 PEDI-CAT domains between T1 and T2 for all children with small effect sizes and nonsignificant changes noted within two diagnostic subgroups with small-to-medium effect sizes. The PEDI-CAT was completed by all participants without interrupting treatment flow. PEDI-CAT score reports enriched therapist-client conversations increasing shared decision-making. CONCLUSION: PTs who treat children using HPOT may feasibly use the PEDI-CAT to assess changes in activity level outcomes and to assist clinical decision-making.

Percepções de familiares sobre uma rede de cuidados de saúde mental infantojuvenil / Family perceptions about a children's mental health network / Percepciones familiares sobre una red de atención de salud mental infantojuvenil

Este artigo pretende conhecer como a rede de cuidados em saúde tem se operacionalizado a partir da percepção de familiares de crianças com demanda de cuidado em saúde mental (SM). Foram realizados dois grupos focais, um com familiares da Atenção Básica (AB) e outro com familiares do Centro de Atenção Psicossocial Infantojuvenil (CAPSij), totalizando 15 participantes. Seguiu-se com a análise lexical do tipo classificação hierárquica descendente, com o auxílio do software R Interface, a fim de análises multidimensionais de textos e questionários (IRaMuTeQ), resultando em cinco classes: A Pílula Mágica; Forças e Fraquezas dos serviços; Procurando por ajuda; Aceitando o diagnóstico da criança e Onde procurei ajuda. Os resultados apontam para dificuldades presentes na AB em identificar e manejar situações de Saúde Mental Infantojuvenil (SMIJ), por meio de uma lógica ainda medicalizante. Ressalta-se que a escola é apresentada como lugar de destaque na produção da demanda por cuidado e a família ainda é pouco convocada à construção das ações. Conclui-se, então, que avanços ainda são necessários para operacionalização de um cuidado pautado nas diretrizes da política de SMIJ.(AU)

This article aims to know how the healthcare network has been operationalized from the perception of family members of children with demand for mental health care (MH). Two focus groups were held, one with family members from Primary Care (PC) and the other with family members from the Child Psychosocial Care Center (CAPSij), totaling 15 participants. A lexical analysis of the descending hierarchical classification type was performed with the help of the software R Interface for multidimensional analyzes of texts and questionnaires (IRAMUTEQ), resulting in five classes: The Magic Pill; Strengths and Weaknesses of services; Looking for help; Accepting the child's diagnosis; and Where did I look for help. The results point to difficulties present in PC in identifying and managing situations of mental health in children and adolescents (MHCA), with a medicalization logic. Note that the school is presented as a prominent place in producing the demand for care, and the family is still not very much involved in the actions. It is, thus, concluded that advances are still needed for operationalization of care guided by MHCA policy guidelines.(AU)

Este artículo tuvo por objetivo conocer cómo opera una red asistencial a partir de la percepción de familiares de niños con demanda de atención en salud mental (SM). Se realizaron dos grupos focales, uno con familiares de Atención Primaria (AP) y otro con familiares del Centro de Atención Psicosocial Infantojuvenil (CAPSij), totalizando 15 participantes. Se realizó análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), lo que resultó en cinco clases: "La píldora mágica"; "Fortalezas y debilidades de los servicios"; "En busca de ayuda"; "Aceptar el diagnóstico del niño" y "¿Dónde busqué ayuda?". Los resultados apuntan las dificultades presentes en AP para identificar y manejar situaciones de salud mental infantojuvenil (SMIJ) mediante una lógica aún medicalizante. La escuela tiene un lugar destacado en la producción de la demanda de cuidados y la familia aún no está muy involucrada en la construcción de acciones. Se concluye que se necesitan avances para ofertar una atención guiada por lineamientos de la política del SMIJ.(AU)

Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

Orientação a pais por chamadas de áudio durante a pandemia de covid-19 / Support for parents via audio calls during the covid-19 pandemic / Orientación de los padres mediante llamadas de audio durante la pandemia de covid-19

O distanciamento social ocasionado pela pandemia de Covid-19 levou a profundas mudanças na rotina das famílias com crianças pequenas, aumentando o estresse no ambiente doméstico. Este estudo analisou a experiência de planejamento e implementação de um projeto de extensão universitária que ofereceu orientação a pais com filhos de 0 a 11 anos por meio de chamadas de áudio durante a pandemia. O protocolo de atendimento foi desenvolvido para atender às necessidades de famílias de baixa renda e listava problemas específicos relacionados ao confinamento em casa e ao fechamento das escolas seguidos por uma variedade de estratégias de enfrentamento. A análise de 223 queixas relatadas pelos usuários em 130 ligações revelou que 94% dos problemas referidos pelos pais foram contemplados pelo protocolo de atendimento e estavam relacionados aos problemas externalizantes (39%) ou internalizantes (26%) das crianças ou ao declínio do bem-estar subjetivo dos pais (29%). Serviços de apoio devem orientar os pais quanto ao uso de práticas responsivas e assertivas que promovam o bem-estar emocional da criança e estabeleçam expectativas comportamentais em contextos estressantes. A diminuição dos conflitos entre pais e filhos resultante do uso dessas estratégias tende a reduzir o sofrimento dos pais, aumentando sua sensação de bem-estar subjetivo. Recomenda-se ampla divulgação dessas iniciativas e seguimento dos casos.(AU)

The social distancing the COVID-19 pandemic entailed has led to profound changes in the routine of families with young children, increasing stress in the home environment. This study analyzed the experience of planning and implementing a university extension program that offered support to parents with children from 0 to 11 years old via audio calls during the COVID-19 pandemic. The service protocol was developed to meet the needs of low-income families and listed specific problems related to home confinement and school closure followed by a variety of coping strategies. The analysis of 223 complaints reported by users in 130 calls revealed that 94% of the problems reported by parents were addressed by the protocol and were related to children's externalizing (39%) or internalizing (26%) problems or to the decline in parents' subjective well-being (29%). Support services should guide parents on the use of responsive and assertive practices that promote the child's emotional well-being and set behavioral expectations in stressful contexts. The reduction in conflicts between parents and children resulting from the use of these strategies tends to reduce parents' suffering, increasing their sense of subjective well-being. Wide dissemination of these initiatives and case follow-up are recommended.(AU)

La distancia social causada por la pandemia de COVID-19 condujo a cambios profundos en la rutina de las familias con niños pequeños, aumentando el estrés en el entorno del hogar. Este estudio analizó la experiencia de planificar e implementar un proyecto de extensión universitaria que ofreció orientación a los padres con niños de cero a 11 años a través de llamadas de audio durante la pandemia COVID-19. El protocolo de atención se desarrolló para satisfacer las necesidades de las familias de bajos ingresos y enumeró problemas específicos relacionados con el confinamiento en el hogar y el cierre de la escuela, seguido de una variedad de estrategias de afrontamiento. El análisis de 223 quejas informadas por los usuarios en 130 llamadas reveló que el 94% de los problemas informados por los padres fueron abordados por el protocolo de atención y estaban relacionados con los problemas de externalización (39%) o internalización (26%) de los niños o la disminución del bienestar subjetivo de los padres (29%). Los servicios de apoyo deberían aconsejar a los padres sobre el uso de prácticas receptivas y asertivas que promuevan el bienestar emocional del niño y establezcan expectativas de comportamiento en contextos estresantes. La reducción de los conflictos entre padres e hijos como resultado del uso de estas estrategias tiende a reducir el sufrimiento de los padres, aumentando su sensación de bienestar subjetivo. Se recomienda una amplia difusión de estas iniciativas y seguimiento de casos.(AU)

Uso del método de observación: una propuesta de aplicación al análisis de estrategias de resolución de problemas en niños con discapacidad / Use of observational method: a proposal for application to the analysis of problem-solving strategies in children with disabilities

El presente trabajo se ocupa de evaluar posibilidades del método de observación aplicado al análisis de estrategias de resolución de problemas en niños con discapacidad mediante juegos y tareas estructuradas. El marco teórico de referencia de esta contribución está representado por la teoría de la resolución de problemas, que contiene los principales procesos que intervienen en la gestión de los problemas y que nosotros aplicamos al desarrollo cognitivo y metacognitivo atípico. Junto con tres tareas diferentes estructuradas(Torre de Hanoi, Tetris y Bloques de construcción), usamos dos listas de comportamientos para codificar estrategias de resolución de problemas adoptadas por niños y/o adolescentes con desarrollo atípico. La aplicación de este tipo de observación con el uso de listas de comportamientos podría ser útil para crear en relación entre la investigación cualitativa y cuantitativa para mejorar el conocimiento de las estrategias de resolución de problemas y competencias metacognitivas en niños desarrollados atípicos(AU)

This paper is concerned with evaluating the possibilities of the observational method applied to the analysis of problem-solving strategies in children with disabilities through structured tasks. The theoretical framework of reference for this contribution is represented by the theory of problem-solving, containing the main processes involved in problem management,which we apply to atypical cognitive and metacognitive development. Together with three different structured tasks (Tower of Hanoi, Tetris, and Building Blocks), we used two lists of behaviors to code problem-solving strategies adopted by children and/or adolescents with atypical development. The application of this type of observation with the use of lists of behaviors could be useful to create a link between qualitative and quantitative research to improve the knowledge of problem-solving strategies and metacognitive competencies in atypically developed children(AU)

[SPECIFIC ASPECTS OF THE LEGISLATIVE CONSOLIDATION OF THE INSTITUTION OF EARLY CARE FOR CHILDREN WITH DISABILITIES].

For the purposes of this work, children with disabilities include disabled children or children aged 0 to 8 years who are not recognized as disabled in the prescribed manner, but who have temporary or permanent deviations in physical and (or) mental development (hereinafter - children with disabilities). The legislative basis for the implementation of the rights and opportunities of children with disabilities and their families is constituted by constitutional provisions that enshrine state guarantees for the protection of childhood, motherhood, paternity, family (part 1 of article 38, paragraph "g.1" of part 1 of article 72 of the Constitution of the Russian Federation). An early start of comprehensive care for children with disabilities contributes to the maximum possible achievements in the development of the child, maintaining his health, as well as successful socialization and inclusion of the child in the educational environment with subsequent integration into society. The research material was the international treaties and regulatory legal acts of the Russian Federation on providing early assistance to children with disabilities. The work used a set of methods of scientific knowledge, including general scientific methods: analysis, synthesis, induction, deduction, special: comparative, formal legal, etc. Legislative consolidation of the institution of providing early assistance to children with disabilities can be carried out by amending the existing legislative acts or by adopting a separate regulatory legal act of the legislative level that establishes the legal basis for providing early assistance. This article outlines the directions for improving legal regulation in terms of legislative consolidation of the institution of providing early assistance to children with disabilities by amending the current legislative acts of the federal level.

Lived experiences of parents of children with disabilities engaged in a support group incorporating equines.

BACKGROUND: Parenting a child with disabilities comes with significant challenges to parental quality of life, often resulting in decreased physical, mental, and social health when compared to parents who raise typically developing children. AIMS: To address the needs of this population a 10-week interdisciplinary support group, based in attachment theory and incorporating equines, was developed called Taking the Reins of Self-care. METHODS AND PROCEDURES: Designed to utilize the human-equine bond, the support group facilitated development of self-care strategies to increase quality of life of 6 parents of children with disabilities in the United States OUTCOMES AND RESULTS: Qualitative phenomenological analysis of field notes and parent interviews revealed the following themes: confirming the horse as an emotional confidant, creating a safe haven, re-affirming identity, nourishing the emotional self, and meeting the challenge. CONCLUSIONS AND IMPLICATIONS: Analysis of Taking the Reins of Self-care substantiates the value of complimentary therapeutic approaches, attachment theory and the human-equine bond, and supports further investigation of the benefits of specialized parental support groups to enrich the experience of raising a child with disabilities.

A Blueprint for Change: Guiding Principles for a System of Services for Children and Youth With Special Health Care Needs and Their Families.

Children and youth with special health care needs (CYSHCN) and their families continue to face challenges in accessing health care and other services in an integrated, family-centered, evidence-informed, culturally responsive system. More than 12 million, or almost 86%, of CYSHCN ages 1-17 years do not have access to a well-functioning system of services. Further, the inequities experienced by CYSHCN and their families, particularly those in under-resourced communities, highlight the critical need to address social determinants of health and our nation's approach to delivering health care. To advance the system and prioritize well-being and optimal health for CYSHCN, the Health Resources and Services Administration's Maternal and Child Health Bureau, with input from diverse stakeholders, developed a set of core principles and actionable strategies for the field. This article presents principles and strategies in the Blueprint for Change: Guiding Principles for a System of Services for CYSHCN and Their Families (Blueprint for Change), which acknowledges the comprehensive needs of CYSHCN, a changing health care system, and the disparities experienced by many CYSHCN. Four critical areas drive the Blueprint for Change: health equity, family and child well-being and quality of life, access to services, and financing of services. Although discussed separately, these critical areas are inherently interconnected and intend to move the field forward at the community, state, and federal levels. Addressing these critical areas requires a concerted, holistic, and integrated approach that will help us achieve the goal that CYSHCN enjoy a full life from childhood through adulthood and thrive in a system that supports their families and their social, health, and emotional needs, ensuring their dignity, autonomy, independence, and active participation in their communities.

The effect of pet therapy on the stress and social anxiety levels of disabled children: A randomized controlled trial.

OBJECTIVE: Pet therapy is an effective method in reducing stress and anxiety levels in the treatment and care of children. This study aimed to determine the effects of pet therapy on the stress and social anxiety levels of physically disabled children. METHOD: This study was a single-blind randomized controlled experimental study with a pre-test, post-test and follow-up design. The study was carried out between November 2019 and September 2020 in two separate Special Education and Rehabilitation Centers with a total of 44 physically disabled children, 23 in the control and 21 in the intervention group, who met the inclusion criteria. The NCT number of this study is NCT04231799. The data of the study were obtained through Personal Information Form (PIF), the Perceived Stress Scale (PSS), the Social Anxiety in Children Scale-Revised Version (SACS-R) and blood pressure measurements. A pet therapy program was applied to the intervention group. Apart from the standard training given in the rehabilitation center, no intervention was made on the control group RESULTS: After the pet therapy program intervention, it was found that there was a decrease in the mean PSS and SACS-R scores of the children in the intervention group, and this decrease was significant compared to the individuals in the control group (p<0.05). CONCLUSION: It was determined that the pet therapy program was an effective intervention in reducing the stress and social anxiety levels of the physically disabled children.

Disabled children and young people up to 25 with severe complex needs: integrated service delivery and organisation across health, social care and education

This guideline covers support for disabled children and young people with severe complex needs, from birth to 25 years. It aims to encourage education, health and social care services to work together and provide more coordinated support to children and young people, and their families and carers.

Impact of hippotherapy on the life habits of children with disabilities: a systematic review.

PURPOSE: The aim was to document the effects of hippotherapy on the 12 life habits of children with various disabilities. MATERIALS AND METHODS: A systematic review using PRISMA guidelines was conducted to identify relevant studies. Five databases were consulted. Inclusion criteria were: 2-to-18 years old; therapy provided by a PT, OT or SLP/SLT; variables relevant to life habits as defined by the Human Development Model - Disability Creation Process. Quality was analyzed using a quantitative studies critical review form developed by the McMaster University Occupational Therapy Evidence-Based Practice Research Group. Levels of evidence were evaluated using the Oxford Centre for Evidence-Based Medicine guidelines. RESULTS: The investigations' overall quality ratings were excellent (n = 5 studies), acceptable (n = 10) and poor (n = 8); the evidence levels were 2/high (n = 2), 3/moderate (n = 3) and 4/low (n = 18). This systematic review suggests an observable connection between hippotherapy and improvements in three habits (mobility, communication, interpersonal relationships). CONCLUSION: The findings provide support for hippotherapy as a therapy with a positive impact on three categories of life habits. Further research is warranted for education, housing, nutrition, personal care and recreation (only 3 studies), as well as community and spiritual life, employment, physical fitness and psychological well-being and responsibility (no studies). Implications for rehabilitationOccupational, physical and speech language therapists must continue to intervene with children with developmental delays related to various diagnoses as demonstrated by 15 studies involving hippotherapy rated from acceptable to excellent quality.Given improvements, therapists should pursue hippotherapy in mobility, communication, interpersonal relationships, as established specifically by five studies with moderate to high evidence.Given three studies in hippotherapy, therapists are encouraged to document improvement in other life habits such as education, housing, nutrition, personal care and recreation.

Oral health education and promotion in special needs children: Systematic review and meta-analysis.

OBJECTIVE: To review the effectiveness of oral health education and oral health promotion interventions for children and adolescents with intellectual and developmental disabilities (IDD), in ensuring optimal gingival health, caries experience and oral health-related quality of life, compared to no interventions or alternative interventions. METHODS: A systematic review was conducted to identify published studies from four databases (Medline, PsycINFO, CINAHL and ERIC). Randomised or quasi-randomised controlled trials were included. Two independent reviewers performed risk of bias and qualitative analysis. Meta-analysis was performed as appropriate. RESULTS: Eight treatment comparisons were identified. There was low certainty evidence that fluoride interventions provided long-term reductions in caries in those with IDD; and there was some evidence that chlorhexidine albeit with low certainty provided short-term and long-term reductions in plaque and gingivitis. There was moderate certainty evidence for short-term reductions in dental plaque from the use of modified toothbrushes, but not compelling evidence for powered toothbrushes. CONCLUSIONS: Most studies provided a low quality of evidence, and so any adaptations made to oral health practices of individuals with IDD need to consider their individual needs. PROSPERO registration: CRD42019145784.

Relationship of Gratitude and Coping Styles with Depression in Caregivers of Children with Special Needs.

This is a cross-sectional, descriptive and correlational study aiming to reveal the relationship of gratitude and coping styles with depression in caregivers of children with special needs. As a result of the study, which was conducted with 330 caregivers, it was determined that the caregivers' level of gratitude was high. In this study, it was found that the caregivers used mostly turning to religion, planning, positive reinterpretation, and instrumental social support as coping styles respectively. It was established that there was a significant correlation between caregivers' depression level and gender, education level, level of gratitude, focus on and venting of emotions, substance use, behavioural disengagement, positive reinterpretation, using emotional social support and planning coping styles. The depression disclosure level was found to be 17.8%. For holistic nursing care, the assessment of spiritual care and spiritual needs of caregivers is very important because of its positive effect on mental health.

Framing the front door: co-creating a home health care assessment of service need for children with disabilities.

This paper details the co-creation of a home health assessment tool for children with disabilities in the context of state-level systems change from traditional Medicaid to Medicaid managed care. A community based, sequential, mixed methods design was used to co-develop the assessment. A process evaluation highlighted community members' experiences with Medicaid managed care. Community members identified issues related to appropriateness of items and loss of services and recommended a dual assessment process to address concerns. Results indicated that 72% of items functioned well. Community members felt that organizational policies and the accuracy of clinical information obtained during assessment processes led directly to loss of services. Co-creating the assessment with caregivers of children with disabilities led to a comprehensive, person-centered, and holistic tool. The process buttressed several concrete systems and policy actions to improve home health care for children with disabilities in Medicaid managed care.

Effects of Nature-Based Group Art Therapy Programs on Stress, Self-Esteem and Changes in Electroencephalogram (EEG) in Non-Disabled Siblings of Children with Disabilities.

The purpose of the present study was to examine changes in brain waves, stress, and self-esteem after a continuous eight-week nature-based art therapy program in the forest in non-disabled siblings of children with disabilities. A total of 29 participants participated in this study (art therapy program group, n = 18; control group, n = 11). The art therapy program group received eight weekly sessions of art therapy lasting 60 min each. Pre- and post-test results showed positive changes in the brain function index and stress levels of the participants in the art therapy program group. On the self-esteem scale, overall and social self-esteem increased significantly. In conclusion, creative activities in the forest can increase resistance to diseases through mechanisms that relieve stress and increase self-esteem. If art therapy that emphasizes somatosensory experience, creative expression, and self-motivation is accompanied by forest activities, this combined intervention can elicit positive physical and psychological changes.