Whose Rights Count? Negotiating Practice, Policy, and Legal Dilemmas Regarding Infant-Parent Contact When Infants are in Out-of-Home Care.

This article takes a human rights perspective with a view to articulating the infant's perspective when the infant has been subjected to abuse, neglect, or both and is reliant on the state to ensure his or her health and well-being. When a young child is removed from parental care, important and often difficult decisions have to be made about subsequent contact between child and parent. We consider a number of dilemmas which may arise for practitioners when they are assisting child welfare decision makers in relation to contact, and acknowledge the limited empirical follow-up studies of the impact of child welfare practice and legal decisions on infant outcomes. We draw on the significant and substantive evidence base about infant emotional and cognitive development and infant-parent attachment relationships as well as infant mental health to illuminate the infant's subjective experience in these practice dilemmas. We describe innovations in practice from various countries, which seek to shed light on the challenges often associated with contact.

A feasibility randomised controlled trial of the New Orleans intervention for infant mental health: a study protocol.

Child maltreatment is associated with life-long social, physical, and mental health problems. Intervening early to provide maltreated children with safe, nurturing care can improve outcomes. The need for prompt decisions about permanent placement (i.e., regarding adoption or return home) is internationally recognised. However, a recent Glasgow audit showed that many maltreated children "revolve" between birth families and foster carers. This paper describes the protocol of the first exploratory randomised controlled trial of a mental health intervention aimed at improving placement permanency decisions for maltreated children. This trial compares an infant's mental health intervention with the new enhanced service as usual for maltreated children entering care in Glasgow. As both are new services, the trial is being conducted from a position of equipoise. The outcome assessment covers various fields of a child's neurodevelopment to identify problems in any ESSENCE domain. The feasibility, reliability, and developmental appropriateness of all outcome measures are examined. Additionally, the potential for linkage with routinely collected data on health and social care and, in the future, education is explored. The results will inform a definitive randomised controlled trial that could potentially lead to long lasting benefits for the Scottish population and which may be applicable to other areas of the world. This trial is registered with ClinicalTrials.gov (NC01485510).

Prospective, randomized controlled assessment of the short- and long-term efficacy of a hearing conservation education program in Canadian elementary school children.

OBJECTIVE: To assess the efficacy of a hearing conservation program in changing acoustic risk-taking and hearing conservation behaviors in elementary school children. STUDY DESIGN: Prospective, randomized, mixed design controlled study. METHODS: Participants were grade-six students from 16 Vancouver School Board schools. Differences between the intervention and control group responses on a behavioral questionnaire were measured at baseline, and then at 2 weeks and 6 months after administration of a hearing conservation program (Sound Sense™). RESULTS: The intervention resulted in significant interactions for improved earplug use at dances (P = .019), rock concerts (P = .001), with percussion musical instruments (P = .002), and electric guitars (P = .028) at 2 weeks postintervention relative to baseline. Improvements in children's earplug use at dances (P = .041), rock concerts (P = .0024), and with power lawn mowers (P = .043) at 6 months postintervention relative to baseline were also observed. Behavior in the intervention group compared to control group improved in earplug use with any "other noises" at 2 weeks (P = .001), and 6 months (P = .022) relative to baseline. There was a tendency in the intervention group to reduce the duration of use of personal music devices at 2 weeks and 6 months after the hearing conservation program, which was nonsignificant. CONCLUSION: The Sound Sense™ hearing conservation program improved earplug use practices in elementary school children in the short and long term. The development, implementation and evaluation of a community-based health promotion project around hearing loss can serve as a tremendous opportunity for students to develop their knowledge and skills in health advocacy.

Quick, simple measures of family relationships for use in clinical practice and research. A systematic review.

BACKGROUND: Family functioning has been implicated in the onset of child and adult psychopathology. Various measures exist for assessing constructs in the areas of parent-child relationships, parental practices and discipline, parental beliefs, marital quality, global family functioning and situation-specific measures. OBJECTIVES: To identify systematically all questionnaire measures of family functioning appropriate for use in primary care and research. METHODS: A systematic literature review was conducted, following PRISMA guidelines and searching 14 bibliographic databases using pre-determined filters, to identify family functioning measures suitable for use in families with children from 0 to 3 years old. RESULTS: One hundred and seven measures of family functioning were reported and tabulated and the most commonly used measures were identified. CONCLUSIONS: There are numerous measures available demonstrating characteristics, which make them suitable for continued use. Future research is needed to examine the more holistic measurement of family functioning using integration of multi-informant data.

The "Spirit of New Orleans": translating a model of intervention with maltreated children and their families for the Glasgow context.

Children in care have higher rates of mental health problems than the general population and placement instability contributes to this. Children are both most vulnerable to the effects of poor quality care and most responsive to treatment in the early weeks and months of life yet, in the UK, permanency decisions are generally not in place until around the age of four. We aimed to understand the components of an innovative system for assessing and intervening with maltreated children and their families developed in New Orleans and to consider how it might be implemented in Glasgow, UK. During and after a visit to New Orleans by a team of Glasgow practitioners, eight key interviews and meetings with New Orleans and Glasgow staff were audio-recorded. Qualitative analysis of verbatim transcripts identified key themes. Themes highlighted shared aspects of the context and attitudes of the two teams, identified gaps in the Glasgow service and steps that would be needed to implement a version of the New Orleans model in Glasgow. Our discussions with the New Orleans team have highlighted concrete steps we can take, in Glasgow, to make better decision-making for vulnerable children a reality.

The work of health visitors and school nurses with children with psychological and behavioural problems.

AIM: This paper is a report of a study to describe the workload of health visitors and school nurses in relation to children and young people with psychological, emotional or behavioural problems, and to identify perceived challenges, obstacles and sources of satisfaction associated with this aspect of their work. BACKGROUND: There is little published information on the work performed by non-specialist community nurses with children and young people who have psychological, emotional and behavioural problems. METHOD: We analysed data from a survey conducted in 2002 - 2003 of 1049 Scottish professionals working with children and young people. Data included quantitative responses and free-text describing the cases seen by respondents. Responses from a sub-sample of 71 health visitors and 100 school nurses were analysed using a combination of descriptive statistics and analysis of themes emerging from the text. FINDINGS: Although community-based nurses saw a relatively small number of children with psychological, emotional or behavioural problems each week, dealing with these problems took up a disproportionate amount of time. The commonest types of problem were self-harm, externalizing behaviours and family difficulties. Few respondents had received specific training in child and adolescent mental health but most expressed a wish to receive such training. CONCLUSION: The work of health visitors and school nurses in caring for children with mental health problems is substantial and important. Development of their public health role should not be at the expense of this important contribution. There is a need for rigorous evaluation of nursing mental health interventions among children and young people.

Which is mightier, the tuning fork or the bone oscillator?

INTRODUCTION: It is important to differentiate cochlear implant candidates with profound sensorineural hearing loss from those with profound mixed hearing loss. The latter include patients with far advanced otosclerosis and chronic otitis media who may be better treated with ossiculoplasty and conventional amplification than with cochlear implantation. Otologists have observed that a dentally placed tuning fork can be heard by some patients whose sensorineural thresholds are beyond the limits of a bone oscillator placed on the mastoid. We hypothesized that tuning forks may be able to deliver a strongerintensity bone-conducted signal than a conventional mastoid-placed oscillator. OBJECTIVE: To measure the maximum bone-conduction signal intensities of a mastoid-placed bone oscillator and tuning forks placed on the forehead, mastoid, and teeth. METHOD: The maximum signal intensity of a mastoid-placed bone oscillator and tuning forks at various locations (mastoid, forehead, teeth) was measured using behavioural masking level differences at three frequencies (250, 500, and 1000 Hz). RESULTS: The peak intensity of a dental bone-conducted tuning fork signal is greater than that delivered by a mastoid-placed bone oscillator (at least 20.5 dB HL at 250 Hz, 16.5 dB HL at 500 Hz, and 8.5 dB HL at 1000 Hz; p <.001) at all three frequencies tested. At some frequencies, the bone oscillator's maximum perceived level is greater than the peak perceived level of the tuning fork when placed on the forehead or mastoid. CONCLUSIONS: In addition to pure-tone audiometry, all patients being considered for cochlear implantation should be evaluated with maximally vibrating tuning forks applied to the teeth. If the signal is audible, other surgical procedures may need to be considered before proceeding with cochlear implantation.