Financial support policies as a mechanism to reduce child welfare involvement.

None.

Who Is Caring for Health Care Workers' Families Amid COVID-19?

Amid the COVID-19 pandemic, women in medicine, including faculty, residents, medical students, and other health care workers (HCWs), are facing unparalleled challenges. The burdens of pandemic-associated increases in domestic and caregiving responsibilities, professional demands, health risks associated with contracting COVID-19, and the resulting psychosocial distress have exacerbated existing gender disparities at home, at work, and in academia. School and day care closures have created additional childcare needs, primarily for women, yet little support exists for parents and families. These increased childcare and domestic responsibilities have forced women HCWs, who make up the overwhelming majority of the workforce, to adapt their schedules and, in some cases, leave their jobs entirely. In this article, the authors detail how COVID-19 has exacerbated existing childcare accessibility and affordability issues as well as gender disparities. They argue that unless government and health care organization support for childcare increases, families, specifically women and children, will continue to suffer. Lack of access to affordable childcare can prevent HCWs from doing their jobs, including conducting and publishing academic scholarship. This poses incalculable risks to families, science, and society. COVID-19 should serve as a call to action to all sectors, including the government and health care organizations, to prioritize childcare provision and increase support for women HCWs, both now during the pandemic and going forward.

Very Low Food Security Among Low-Income Households With Children in California Before and Shortly After the Economic Downturn From COVID-19.

We examined levels of very low food security (VLFS) among low-income households with children in California before and shortly after the economic downturn from coronavirus disease 2019 (COVID-19). Households were randomly sampled in 2018, 2019, and 2020; 11,653 mothers were administered the US Department of Agriculture 6-item Food Security Survey Module. Post-COVID-19 (April 27 to July 21, 2020, a period when stay-at-home restrictions were eased in the state), 14.0% of mothers reported VLFS versus 19.3% pre-COVID-19 (November 21, 2019, to March 14, 2020) (P = .003), 22.2% in 2019 (P < .001), and 19.0% in 2018 (P = .004). Existing systems to quickly obtain food assistance benefits in California and new federal benefits available in response to COVID-19 may have reduced VLFS.

A Child Development Fund Program, Emotional Development, and Poverty Reduction.

OBJECTIVES: We aim to examine the effects of the Child Development Fund (CDF) program on the long-term psychological, health, social, and financial development of children in poverty. METHODS: The current study was a 4-year follow-up survey study (the follow-up study) of a nonrandomized controlled trial (the first study), conducted in 2019 and 2015, respectively, in Hong Kong. Subjects were 902 young adults who were from families living in poverty and receiving financial assistance from the government and who had completed the first study. Approximately 61% of the subjects (N = 546) completed the current follow-up study. RESULTS: Of the 546 subjects (46% male), 335 (61%; CDF participants) completed the CDF program between 2011 and 2015, and 211 (39%; CDF nonparticipants) were matched controls in the first study. The mean age was 20.64 years (SD = 2.72). After adjustments of covariates, the CDF participants reported fewer behavioral problems, higher levels of study motivation, higher levels of hope, and more positive attitudes toward their future education. The CDF participants also perceived greater social support from significant others and reported greater amounts of money saved every month. After further adjustments, CDF participants showed greater improvements in health-related quality of life related to emotional functioning. A considerable number of families of the CDF participants who were working for a living were no longer reliant on financial assistance from the government. CONCLUSIONS: The positive effects of the CDF program on children in poverty could be sustained throughout adolescence to young adulthood. Findings warrant the promotion of the program to reach more children.

'When will I be free': Lessons from COVID-19 for Child Protection in South Africa.

BACKGROUND: COVID-19 has highlighted and amplified structural inequalities; drawing attention to issues of racism, poverty, xenophobia as well as arguably ineffective government policies and procedures. In South Africa, the pandemic and the resultant national lockdown have highlighted the shortcomings in the protection and care of children. Children in alternative care are particularly at risk as a result of disrupted and uncoordinated service delivery. OBJECTIVE: The aim of this study was to explore the experiences and impact of the pandemic and the resulting social isolation on the wellbeing and protection of children living in a residential care facility. METHODS AND PARTICIPANTS: We used qualitative, participatory approaches - specifically draw-and-write methods - to engage with 32 children (average age = 13.5 years) living in a residential care facility in Gauteng. FINDINGS: Children in care demonstrated an awareness of the socio-economic difficulties facing communities in South Africa, and shared deep concerns about the safety, well-being and welfare of parents and siblings. Although they expressed frustration at the lack of contact with family members, they acknowledged the resources they had access to in a residential care facility, which enabled them to cope and which ensured their safety. DISCUSSION AND CONCLUSION: We focus our discussion on the necessity of a systemic response to child welfare, including a coordinated approach by policy makers, government departments and child welfare systems to address the structural factors at the root of inequality and inadequate, unacceptable care. This response is essential not only during COVID-19 but also in pre- and post-pandemic context.

Influence of publicly funded conditional cash transfer programms on utilization patterns of healthcare services for acute childhood illness.

BACKGROUND: Conditional cash transfers are widespread and effective for utilization of targeted health services, but there is little evidence of their influence on the utilization of non-targeted or extended general healthcare services. Using data from a population-based health utilization survey, we evaluated the influence of conditional cash transfers for maternal and immunization services on the utilization of healthcare services for acute childhood illnesses. METHODS: Participants included mothers or primary caretakers of children <2 y of age residing in 2407 households in urban Vellore, Tamil Nadu, India. Mothers of children with illness in the preceding month were interviewed on presenting symptoms, provider choice and beneficiary status of maternal and immunization-based conditional cash transfer programs. RESULTS: Of 2407 children <2 y of age, about 48% reported being beneficiaries of maternal and immunization-based conditional cash transfers. Beneficiary status was associated with an increased use of public services (adjusted relative risk [aRR] 3.14 [95% confidence interval {CI} 1.96 - 5.02]) but not the use of private services (aRR 1.42 [95% CI 0.97 - 2.08]) relative to home or informal care. CONCLUSIONS: Our findings indicate financial incentives for use of maternal and immunization services could have an indirect, non-targeted effect on utilization of formal healthcare for acute childhood illnesses.

Socio-demographic predictors of well-being in United Kingdom adolescents, and the impact of well-being on a range of health-related outcomes.

The deleterious impact of low mental well-being, and higher levels psychological symptoms (collectively well-being), on concurrent and prospective health outcomes has elsewhere been demonstrated. Further, variables such as conurbation and deprivation have been found to be related to mental and physical heath. This study used data from a longitudinal study to examine which demographic predicted well-being scores, and how scores on these constructs were related to six health-related outcomes. Participants were adolescents (N = 4,956; Male = 2376[48%]), from 72 High Schools in Northern Ireland. Three waves of data were gathered on mental well-being, psychological symptoms, subjective life expectancy (living to age 35 and age 75 years), self-rated health, frequency of physical exercise, and lifetime use of cigarettes and cannabis. Results showed that both well-being scores were significantly associated with gender cross-sectionally, but demographic variables did not predict changes in well-being longitudinally. Both well-being measures were significantly associated with health outcomes cross-sectionally, with mental well-being (over time) predicting life subjective life expectancy, self-rated health, and addictive behaviors, while psychological symptoms (over time) predicted the former two, but not addictive behaviors. Overall, the relationship between mental well-being, psychological symptoms, and the health outcomes assessed, was small in terms of effect size.

Comprehensive Cost Analysis of First Step Next for Preschoolers with Disruptive Behavior Disorder: Using Real-World Intervention Data to Estimate Costs at Scale.

While the long-term societal costs for youth with disruptive behavior disorders are well documented, there is a dearth of information about the comprehensive costs of implementing even the most well-regarded early intervention programs, and the costs of scaling effective interventions are even less well understood. This study estimated the costs of delivering and disseminating First Step Next (FSN), an established tier two school-based early intervention, in preschool and kindergarten settings, including the training and ongoing technical assistance that support sustained, high-quality implementation. Using the Ingredients Method, we estimated (a) the per student costs of implementation, (b) the incremental cost of offering FSN to an additional student, and (c) the cost to disseminate FSN to 40 preschool and kindergarten students, including a sensitivity analysis to examine potential areas of cost savings. The per child cost to implement the FSN intervention with 29 triads in two cohorts was $4330. The incremental cost per additional student was only $2970, highlighting efficiencies gained once intervention infrastructure had been established. The cost of disseminating the intervention to a single cohort of 40 students was $170,106, or $4253 per student. The range in sensitivity analysis was $3141-$7829 per student, with variability in personnel wages having the greatest impact on cost estimates. This research expands on existing literature by providing a more comprehensive understanding of the cost of effective disruptive behavior interventions based on real-world implementation data, using these data to estimate dissemination costs, and showing how dissemination costs are particularly sensitive to personnel wages.

Considering the child welfare system burden from opioid misuse: research priorities for estimating public costs.

The negative impact of opioids on those who misuse them has been widely documented. Despite significant spillover effects in the form of elevated rates of child maltreatment and child welfare system (CWS) involvement for children affected by parental opioid misuse, the public costs of opioid misuse to the CWS remain largely undocumented. This work seeks to understand the value and limitations of public data in estimating the costs of the opioid epidemic on the CWS. National data from federal sources are combined with best estimates of the association between opioid misuse and child services system utilization. The limitations of this work are explored, and future research priorities are outlined. Ultimately, this work illustrates the need to (1) improve data quality related to parental opioid misuse and CWS linkages; (2) better estimate the number of children and families coming into contact with the CWS as a result of parental opioid misuse; (3) improve predictions of CWS trajectories, including investigation, service provision, and foster care entry among this population; and (4) better estimate the CWS costs associated with patterns of system involvement resulting from parental opioid misuse. This information is crucial to ensuring the production of high-quality system involvement and cost projections related to the opioid crisis.

A Systematic Review of the Evaluation of Interventions to Tackle Children's Food Insecurity.

PURPOSE OF REVIEW: To synthesise the research which has sought to evaluate interventions aiming to tackle children's food insecurity and the contribution of this research to evidencing the effectiveness of such interventions. RECENT FINDINGS: The majority of studies in this review were quantitative, non-randomised studies, including cohort studies. Issues with non-complete outcome data, measurement of duration of participation in interventions, and accounting for confounds are common in these evaluation studies. Despite the limitations of the current evidence base, the papers that were reviewed provide evidence for multiple positive outcomes for children participating in attended and subsidy interventions, inter alia, reductions in food insecurity, poor health and obesity. However, current evaluations may overlook key areas of impact of these interventions on the lives and outcomes of participating children. This review suggests that the current evidence base which evaluates food insecurity interventions for children is both mixed and limited in scope and quality. In particular, the outcomes measured are narrow, and many papers have methodological limitations. With this in mind, a systems-based approach to both implementation and evaluation of food poverty interventions is recommended.

Immunization Coverage of Children in Care of the Child Welfare System in High-Income Countries: A Systematic Review.

CONTEXT: Children in care of the child welfare system tend to underutilize preventive health services compared with other children. The purpose of this systematic review was to assess current knowledge regarding immunization coverage levels for children in the child welfare system and to determine barriers and supports to them utilizing immunization services. EVIDENCE ACQUISITION: Articles published in Medline, Embase, Cochrane Library, CINAHL, SocINDEX, and ERIC from January 1, 2000 to October 13, 2017 were searched. Thesis and conference databases and relevant websites were also examined. Studies were included if written in English, from high-income countries, and addressed immunizations for children in the child welfare system. Independent dual screening, extraction, and quality appraisal were conducted between October 2016 and December 2017, followed by narrative synthesis. EVIDENCE SYNTHESIS: Of 2,906 records identified, 33 met inclusion criteria: 21 studied coverage, two studied barriers/supports, and ten studied both. Nineteen studies were moderate or high quality and thus included in the narrative synthesis; 15 studied coverage, one studied barriers/supports, and three studied both. Most studies found lower coverage among children in child welfare. The few studies that explicitly studied barriers/supports to immunization identified that a collaborative and coordinated approach between health and social services was key to service delivery to this population. CONCLUSIONS: This review highlights that children in care of the child welfare system are at risk of poor immunization coverage. There is a need for high-quality studies on this issue, with a focus on assessing supports/barriers to immunization in this population.

"Creative Financing": Funding Evidence-Based Interventions in Human Service Systems.

Implementation and sustainment of evidence-based interventions (EBIs) is influenced by outer (e.g., broader environments in which organizations operate) and inner (e.g., organizations, their administrators, and staff) contexts. One important outer-context element that shapes the inner context is funding, which is complex and unpredictable. There is a dearth of knowledge on how funding arrangements affect sustainment of EBIs in human service systems and the organizations delivering them, including child welfare and behavioral health agencies. This study uses qualitative interview and focus group data with stakeholders at the system, organizational, and provider levels from 11 human service systems in two states to examine how stakeholders strategically negotiate diverse and shifting funding arrangements over time. Study findings indicate that, while diverse funding streams may contribute to flexibility of organizations and possible transformations in the human service delivery environment, a dedicated funding source for EBIs is crucial to their successful implementation and sustainment.

Traumatic Injuries in Pediatric Surgery in the Medical-epidemiological-economic Aspect.

BACKGROUND: The aim of this study was to present the medical, epidemiological and economic aspects of traumatic injuries in children and adolescents. The literature on the subject is scarce. MATERIAL AND METHODS: A retrospective analysis was performed on the data of 1,138 children treated at the Department of Pediatric Surgery, Stefan Zeromski Specialized Hospital in Kraków between 2012 and 2016 on account of head, abdominal and pelvic, chest, testicular and musculoskeletal injuries. Age, sex, circumstances and type of the injury as well as concomitant damage were analyzed. RESULTS: Musculoskeletal injuries accounted for 68% of all the injuries analysed. The mean age of the patients was 6.3 years. The main causes of injury were same-level fall (30%), fall from a height (22.5%), road accidents (8%), and sports injuries (19%). 36% and 29% of the patients sustained injuries at home and at or near school, respectively. CONCLUSIONS: 1. Traumatic injuries in children and adolescents are the most common cause of admissions to pediatric surgery departments, with musculoskeletal injuries being the most frequent among them. 2. Injuries occur most frequently at or near home or school. 3. The cost of treatment and hospital stay of patients with musculoskeletal injuries accounted for 50% of the total cost of treatment in the Department of Pediatric Surgery. 4. There is a need to develop and implement preventive and educational programs for parents, guardians, teachers and children to prevent injuries.

Effects of Financial Incentives on Saving Outcomes and Material Well-Being: Evidence From a Randomized Controlled Trial in Uganda.

The use of savings products to promote financial inclusion has increasingly become a policy priority across sub-Saharan Africa, yet little is known about how families respond to varying levels of savings incentives and whether the promotion of incentivized savings in low-resource settings may encourage households to restrict expenditures on basic needs. Using data from a randomized controlled trial in Uganda, we examine: 1) whether low-income households enrolled in an economic-empowerment intervention consisting of matched savings, workshops, and mentorship reduced spending on basic needs and 2) how varied levels of matching contributions affected household savings and consumption behavior. We compared primary school-attending AIDS-affected children (N = 1,383) randomized to a control condition with two intervention arms with differing savings-match incentives: 1:1 (Bridges) and 1:2 (Bridges PLUS). We found that: 1) 24 months post-intervention initiation, children in Bridges and Bridges PLUS were more likely to have accumulated savings than children in the control condition; 2) higher match incentives (Bridges PLUS) led to higher deposit frequency but not higher savings in the bank; 3) intervention participation did not result in material hardship; and 4) in both intervention arms, participating families were more likely to start a family business and diversify their assets.