Global services and support for children with developmental delays and disabilities: Bridging research and policy gaps.

Pamela Collins and colleagues explain the research and policy approaches needed globally to ensure children with developmental delays and disabilities are fully included in health and education services.

The role of health systems and policy in producing behavior and social change to enhance child survival and development in low- and middle-income countries: an examination of the evidence.

Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence. Studies were eligible if an intervention addressed policy or health systems interventions, measured relevant behavioral or health outcomes (e.g., nutrition, childhood immunization, malaria prevention and treatment), used at least a moderate quality research design, and were implemented in low- or middle-income countries. Policy or systems interventions able to produce behavior change reviewed included media (e.g., mass media, social media), community mobilization, educational programs (for caregivers, communities, or providers), social marketing, opinion leadership, economic incentives (for both caregiver and provider), health systems strengthening/policy/legislation, and others. Recommendations for policy, practice, and research are given based on fairly strong data across the areas of health service delivery, health workforce, health financing, governance and leadership, and research.

What are the most effective early response strategies and interventions to assess and address the immediate needs of children outside of family care?

OBJECTIVES: Children outside of family care face increased risk of threats to their well-being, have lower educational achievement, and experience adverse developmental outcomes. While it is generally accepted that early response and intervention is critical to reducing the risk of harm for children who have been separated from their families, it is not always clear what the most effective early response strategies are for assessing and addressing their immediate needs. The purpose of this review was to identify evidence-based early response strategies and interventions for improving the outcomes of children outside of family care, including children of and on the street, institutionalized children, trafficked children, children affected by conflict and disaster, and who are exploited for their labor. METHODS: A multi-phased, systematic evidence review was conducted on peer-reviewed and gray literature, which yielded a total of 101 documents that met the inclusion criteria and were reviewed. RESULTS: Overall there is a weak evidence base regarding assessment and early response interventions for children living outside of family care. Few studies included careful outcome measures or comparison groups. Although few proven interventions emerged, the review identified several promising early interventions and approaches. In emergency settings, family tracing and reunification is a highly effective response in regard to separated children, whereas placing children in institutional care is problematic, with the possible exception of time-limited placements of formerly recruited children in interim care centers. Livelihood supports are promising in regard to preventing and responding to children living outside family care. Other promising interventions include psychosocial support, including the use of traditional cleansing rituals as appropriate, educational supports such as Child Friendly Spaces, the maintenance of family connectedness for children of or on the streets, the use of community-based approaches that aid social integration, and approaches that enable meaningful child participation. A recurrent theme was that to be effective, all assessments and interventions must fit the context. CONCLUSION: A strong need exists for strengthening the evidence base regarding the effectiveness of early assessments and responses to children living outside family care and for using the evidence to guide operational policy and practice. Recommendations regarding policy, practices, and research emerged from the review process.

Latent structure of eating disorder symptoms: a factor analytic and taxometric investigation.

OBJECTIVE: The latent structure of eating disorder symptoms, as defined by DSM-IV, was tested in a group of 341 women with and without an eating disorder diagnosis. METHOD: The study group consisted of 201 participants with a diagnosis of anorexia nervosa, bulimia nervosa, binge eating disorder, or eating disorder not otherwise specified; 24 comparison subjects who were obese but did not have an eating disorder diagnosis; and 116 normal-weight comparison subjects. The presence and severity of DSM-IV eating disorder symptoms was assessed with the semi-structured Interview for the Diagnosis of Eating Disorders-IV. The study group was randomly divided into two subgroups for factor analytic studies, and the data were subjected to exploratory and confirmatory factor analysis. Pilot taxometric analyses were used to examine whether the obtained factors represented true dimensions or latent discrete classes. RESULTS: In exploratory factor analyses with data from subgroup 1, three factors were found to account for 66% of the variance in eating disorder symptoms: binge eating, fear of fatness/compensatory behaviors, and drive for extreme thinness. Confirmatory factor analysis cross-validated this factor structure with data from subgroup 2. The eating disorder groups and comparison groups were found to differ on at least one of the three factors. The results of the taxometric analyses were inconsistent with a strictly dimensional model of eating disorders and suggested that some features may be dimensional whereas others may be taxonic (discrete). DISCUSSION: The eating disorders, as defined by DSM-IV, can be conceptualized as having three latent features. Taxometric tests found empirical support for conceptualizing bulimia nervosa and binge eating disorder as discrete syndromes.