Operating Principles and Competencies for Engagement in Global/Local Settings.

This article reviews operating principles to guide engagement with local and global partners aimed at improving child health status. In the realms of research, education, clinical care, and administration, these principles are part of an organizing framework to be paired with faculty competencies that address the values/ethics of engagement, specific roles/responsibilities of partners, effective communication strategies among partners, the value of teamwork, and a full understanding of special considerations. Readers are referred to examples of prior advocacy work and implementation research models.

Violence Against Children: Recognition, Rights, Responses.

All forms of violence against children (VAC) are violations of children's rights. Traditional definitions of child maltreatment do not address the rapidly evolving global spectrum of VAC. In this article, we offer an expanded definition of VAC that integrates the principles of child rights, clinical medicine, and public health. The authors further expand the socioecological model to establish a trans-societal sphere, composed of root-cause determinants of VAC, including climate change, globalization, armed conflict, etc. A child rights-based taxonomy of VAC is also presented. The authors conclude with recommendations to address VAC in the domains of clinical practice, systems development, and policy generation.

Outcomes and outputs affiliated with Children's Advocacy Centers in the United States: A scoping review.

BACKGROUND: The Children's Advocacy Center (CAC) model is the predominant multidisciplinary model that responds to child sexual abuse (CSA) in the United States (US). While the CAC model has made important contributions in case coordination and referrals for specialty services, little is known about child- or family-oriented outcomes. OBJECTIVE: Explore the trends and gaps involving outcome and output measures affiliated with CACs in the US. PARTICIPANTS & SETTING: A scoping review of the literature was conducted on English language articles published between 1985-2019 that involved CACs and children less than 18 years of age. METHODS: An electronic database search using the terms "Children's Advocacy Center(s)," "Child Advocacy Center(s)," and "CAC(s)" identified titles and abstracts. Data from articles selected for full text review were evaluated by a multidisciplinary team using a mixed methods approach. RESULTS: Measures of CAC impact frequently focus on service and programmatic outputs with person-centered outcomes left often reported. The most prevalent output measures related to case prosecution and forensic interviews. Person-centered outcomes most commonly emphasized child mental health and caregiver satisfaction. The majority of articles were limited by weak or unspecified study designs. CONCLUSION: The current literature on CACs suggests that while they are successful in coordinating services and facilitating referrals, little is known about how engagement with CACs impacts short- and long-term outcomes for children and families. Further research beyond cross sectional or quasi-experimental designs is necessary to better understand how variability in CAC structure, function, and resources can be optimized to meet the needs of the diverse communities that they serve. This is especially salient given the national dissemination of the CAC model. Without such additional studies, knowledge will remain limited regarding the enduring impacts of CACs on the lives of those impacted by CSA.

Accountability in protection of children against violence: Monitoring and measurement.

Violence against children (VAC) is a pervasive and persistent injustice around the world. Thirty years after the adoption of the United Nations Convention on the Rights of the Child (CRC), the right of children to be protected against all forms of violence is still routinely violated. It is only within the last twenty years that the scope of this problem has been studied; as many point out, understanding the scope of the problem through comprehensive data collection is necessary to improve child protection. Data collection and data quality have improved drastically over this time. The Office of the High Commissioner on Human Rights recommends using comprehensive indicator systems that collect data on States Parties' structure- and process-related commitments to fulfil human rights, and on the outcomes of these commitments. However, most existing indicator sets on VAC fall short of this comprehensive approach, often focusing only on structural or outcome indicators. An international team of child rights experts is now developing GlobalChild, which will be an online platform consisting of comprehensive sets of structure-, process-, and outcome-related indicators for all 41 substantive rights of the CRC. This system will advance data collection, facilitate the monitoring function of the Committee on the Rights of the Child, and enable research on many rights of children, including their right to protection against violence. VAC is a complex problem, and protection against VAC is a right that is indivisible from other rights under the CRC. Therefore, a comprehensive and systematic approach is required to improve accountability to children around the world.

Thirty years of the CRC: Child protection progress, challenges and opportunities.

The CRC has a challenging and ambitious agenda in relation to the protection of children from all forms of violence, particularly the large and increasing numbers of children affected by natural disasters, armed conflict, trafficking, poverty and increasing inequality, displacement and trafficking. In this article, we outline some of the issues in the implementation and understanding of the Convention and highlight three major international developments over the last decade: the adoption of General Comment No 13, the work of the Special Representative of the Secretary General on Violence Against Children, and the adoption of the 2030 Agenda for Sustainable Development by the UN General Assembly in 2005. We also identify four broad domains in which the Convention can and is being used to enhance efforts to ensure the protection of children based on a rights framework - advocacy and litigation, policy design, service delivery and research and monitoring methodology - rather than a welfare-based approach. The key to a rights-based approach in efforts to protect children is a focus on children's right to be involved in decision-making - and in research - that affect their lives.

The role of the Committee on the Rights of the Child in monitoring child abuse and neglect.

This article illuminates the important role the Committee on the Rights of the Child played in monitoring child abuse and neglect in the implementation of the now thirty years old Convention on the Rights of the Child (CRC). Attention is first given to the core mandate of the Committee: the monitoring of the progress made and the remaining difficulties in the implementation of the CRC in each of its 196 State parties. The remainder of the article considers how the Committee has attempted to provide guidance in addressing child abuse and neglect through specific recommendations given to individual State parties in its Concluding Observations, thorough considerations presented at the Days of General Discussion, and in the Committee's General Comments.

Strengthening child agency to prevent and overcome maltreatment.

This paper examines the inter-relationship between the rights to protection and to participation that are embodied in the UN Convention on the Rights of the Child. Considerable investment has been made over the past 30 years, from local to global levels, in listening to children, affording them opportunity to speak out and to hold adults to account in the realisation of their rights. This experience has highlighted the extent to which listening to children is not only right in principle, but is also a necessary and invaluable means through which to strengthen protection from violence, exploitation and abuse. Only by listening to children it is possible to fully understand the nature, scale and impact of violence in their lives and to develop appropriate responses and services. Only if children can speak out about the violence or abuse they face, does it become possible to challenge it and end impunity for those who seek to hurt children. The right to participate is not only fundamental to children's dignity, and sense of self-esteem and selfefficacy, but is also a vital dimension of their protection. However, in most countries around the world, multiple barriers impede its realisation. If violence against children is to be ended, investment is now needed in measures to build an enabling environment in which every child, including the very young, children with disabilities and those from the most marginalised communities, is able to contribute meaningfully to the decisions that impact on their lives, and to challenge violations of their rights.

Una revisión meta-analítica de las respuestas en escalas clínicas y reestructuradas del MMPI-2/MMPI-2-RF de padres en disputa por la custodia / A meta-analytical review of the responses in the MMPI-2/MMPI-2-RF clinical and restructured scales of parents in child custody dispute

La evaluación de las capacidades parentales para el ejercicio de la guarda y custodia de los hijos incluye el ajuste psicológico y la psicopatología. En esta evaluación, además, se ha de sospechar disimulación. El instrumento psicométrico de referencia para dicha evaluación es el MMPI. Para conocer de lo informado por los progenitores en disputa por la custodia nos planteamos una revisión meta-analítica de las escalas clínica y las escalas clínicas reestructuradas. Encontramos 21 estudios primarios con progenitores (se descartaron los diseños de simulación de progenitores en disputa) de los que obtuvieron 291 tamaños del efecto para las escalas clínicas y 1 para las reestructuradas. Los resultados mostraron un tamaño del efecto promedio positivo, significativo, y generalizable en las escalas Hy, Pd y Pa; negativo, significativo y generalizable en las escalas Ma y Si y no generalizable en las escalas Pt y Sc; y un tamaño del efecto promedio insignificante en las escalas Hs y D. Se estudió el género como moderador, no hallándose diferencias entre padres y madres. Se discuten las implicaciones de los resultados para la práctica forense

Parental attribute evaluation in relation to child custody comprises psychological and psychopathology. Additionally, defensiveness must be suspected on this setting. The worldwide reference psychometric measurement instrument for this purpose is the MMPI. With the aim of knowing the responses of parents litigating by child custody, a meta-analytic review of the responses to clinical and restructured scales was performed. A total of 21 primary studies (studies with a simulation design i.e., participants were instructed to answer as parents litigating by child custody were found were disregarded) were found, obtaining 291 effect sizes for clinical scales and 1 for restructured scales. The results showed positive, significant and generalizable mean true effect size in the Hy, Pd and Pa scales; a negative, significant and generalizable in the Ma and Si scales, and non-generalizable in the Pt y Sc scales; and a trivial mean true effect size in the Hs and D scales. Parent gender was studied as a moderator having no found differences between the responses of mothers and fathers. The implications of the results for forensic evaluation practices are discussed

The Role of Pediatricians in Global Health.

Ninety percent of the world's children live in low- and middle-income countries, where barriers to health contribute to significant child morbidity and mortality. The American Academy of Pediatrics is dedicated to the health and well-being of all children. To fulfill this promise, this policy statement defines the role of the pediatrician in global health and provides a specific set of recommendations directed to all pediatricians, emphasizing the importance of global health as an integral function of the profession of pediatrics.

Encuesta a posgrados de pediatría sobre conocimiento y aplicación de los derechos de los niños y adolescentes en la práctica clínica / Survey of postgraduate pediatrics students on knowledge and application of children and adolescents rights in clinical practice / Pesquisa entre estudantes de pós-graduação em pediatria sobre conhecimento e aplicação dos direitos de crianças e adolescentes na prática clínica

La concepción de niñez y adolescencia es una construcción socio-histórica que ha evolucionado en el tiempo. En el paradigma actual se reconocen como sujetos de derecho. El cambio en el modelo de atención debe implicar prácticas basadas en este paradigma Objetivos: Describir el conocimiento de los médicos que cursan el posgrado de Pediatría sobre las normativas de derechos de los niños y adolescentes y conocer su percepción sobre la aplicación del enfoque de derechos en la práctica clínica. Metodología: encuesta anónima administrada por los investigadores o vía e-mail a estudiantes de posgrados de pediatría. Se exploran tres dimensiones: conocimiento de la existencia de normativas sobre derechos de niños y adolescentes y su utilización en la resolución de problemas en la práctica, y aplicación del enfoque de derechos en las prácticas clínicas de los encuestados y observada en otros integrantes del equipo de salud. Resultados: Se administraron 180 encuestas, respondieron 77 (43%). 97.4% refirieron conocer la existencia de alguna de las normativas, de estos 25.3% no las aplica en la resolución de problemas. La mayoría de los médicos refieran observar la vulneración de los derechos en su etapa de formación. Conclusiones: a pesar del conocimiento de existencia de normativas, existen dificultades para que las prácticas clínicas tengan un enfoque de derechos respetando a los niños, niñas y adolescentes como sujetos de derechos.

The conception of childhood and adolescence is a social and historical construction that has evolved over the time. In the current paradigm, they are recognized as subjects of rights. The change in the attention care model should imply practices based on this paradigm. Objectives: describe the knowledge of physicians enrolled in postgraduate pediatric courses on the rights of children and adolescents and know their perception on the application of the rights approach in clinical practice Methodology: anonymous survey administered by researchers or by email to postgraduate pediatrics students. Three categories are explored: knowledge of the existence of regulations on the rights of children and adolescents and their use in the resolution of problems in practice, application of the rights approach in the clinical practices of the respondents and observed in other members of the healthcare team. Results: 180 surveys were conducted, 77 responded (43%). Whereas 97.4% reported knowing the existence of some of the regulations, 25.3% do not apply them in the resolution of problems. Most physicians report that they observe the violation of rights in their training stages. Conclusions: despite knowledge of the existence of regulations, there are difficulties to effectively conduct a rights-based approach that respects children and adolescents as subjects of rights.

A concepção de infância e adolescência é uma construção sócio-histórica que evoluiu ao longo do tempo. No paradigma atual, crianças e adolescentes são reconhecidos como sujeitos de direitos. A mudança no modelo de cuidados deve implicar práticas baseadas nesse paradigma Objetivos: Descrever o conhecimento dos médicos matriculados no curso de pós-graduação pediátrica sobre os direitos das crianças e adolescentes e conhecer sua percepção da aplicação da abordagem de direitos humanos na prática clínica. Metodologia: Pesquisa anônima administrada por pesquisadores ou via e-mail aos estudantes do curso pós-graduação pediátrica. São exploradas três dimensões: conhecimento da existência de regulamentos sobre os direitos das crianças e adolescentes, seu uso na resolução de problemas na prática e aplicação da abordagem de direitos nas práticas clínicas dos entrevistados e dos outros membros da equipe de saúde. Resultados: foram realizadas 180 pesquisas, 77 responderam (43%). 97,4% relataram saber a existência de qualquer um dos regulamentos, destes 25,3% não os aplicam na resolução de problemas. A maioria dos médicos relata observar a violação dos direitos na fase de treinamento. Conclusões: Apesar do conhecimento da existência de regulamentos, há dificuldades para que as práticas clínicas tenham uma abordagem baseada em direitos respeitando crianças e adolescentes como sujeitos de direitos.

Manual de atendimento às crianças e adolescentes vítimas de violência / Manual assistance to child victims of violence

Lançado em 2011 pela Sociedade de Pediatria de São Paulo (SPSP) com o apoio do Conselho Federal de Medicina (CFM), o primeiro Manual de atendimento às crianças e adolescentes vítimas de violência atingiu plenamente seus objetivos, mostrando a importância do tema e conscientizando não só os pediatras, mas todos os profissionais de saúde e aqueles que prestam atenção à criança e ao adolescente. O sucesso daquela edição, demonstrado pelo rápido esgotamento de sua tiragem e pelos infinitos acessos eletrônicos e downloads, aliado à necessidade de atualização e ampliação dos temas correlacionados, conduziu à imperativa redação de um novo texto. Nesta segunda edição, o número de capítulos e colaboradores convidados aumentou, aliando- -se aos profissionais que participaram da publicação anterior. Todos, mestres e conhecedores do assunto, se aprofundaram na discussão de cada tema, trazendo, além de um levantamento bibliográfico atualizado, discussões baseadas em suas experiências profissionais diárias, o que, sem dúvida, enriqueceu sobremaneira o conteúdo deste livro. Tenho a plena convicção de que esta obra fará com que cada um de seus leitores se torne apto a identificar não só os casos consumados de violência contra a criança e o adolescente, como também as potenciais situações de risco, para que possam orientar e mostrar o melhor caminho, permitindo medidas de proteção às vítimas e a prevenção para este mal tão avassalador.

Desnutrición en niños y niñas de la etnia Wayuu: entre lo ético, lo propio y pertinente / Malnutrition in children of the Wayuu ethnicity: among the ethical, the unique and the relevant

La desnutrición ha cobrado la vida de un importante número de niños y niñas de la etnia wayuu que habitan en el departamento de La Guajira en Colombia. Esa situación existe y persiste sin que los decisores o la sociedad civil tomen acciones que reviertan el problema, mostrando total indiferencia y falta de solidaridad. En el país en general y en La Guajira en particular, es evidente la vulneración de los derechos de los niños y las niñas, como sujetos que se construyen en el presente y cuyo futuro no puede ser preparado sin su participación, el apoyo de sus familias, sus comunidades y las organizaciones civiles e instituciones del Estado. Es importante la solidaridad de la sociedad, puesto que los indígenas requieren respuestas, teniendo en cuenta las consideraciones éticas para su atención. Quienes solicitan se hagan efectivos los derechos que tanto se proclaman por distintos medios y que se han convertido sólo en sueños, puesto que la realidad es otra (AU).

Malnutrition has claimed the lives of a great quantity of children of the Wayuu ethnicity, who live in La Guajira department, in Colombia. This situation has existed for a long time without the action of the decision makers or the social society to solve the problem, showing total indifference and lack of solidarity. In the country in general and particularly in La Guajira, it is evident the violation of the rights of the children as subjects that are in the formation process at that moment of their lives, and whose future could not be granted without their participation and the support of their families, their communities, the civilian organizations and the State institutions. It is important the society's solidarity, because native people require answers and attention, taking into account ethical consideration. There are many people asking for making effective the rights that are so widely proclaimed by different means and have become just dreams, because they are another thing in real life (AU).

Desnutrición en niños y niñas de la etnia Wayuu: entre lo ético, lo propio y pertinente / Malnutrition in children of the Wayuu ethnicity: among the ethical, the unique and the relevant

La desnutrición ha cobrado la vida de un importante número de niños y niñas de la etnia wayuu que habitan en el departamento de La Guajira en Colombia. Esa situación existe y persiste sin que los decisores o la sociedad civil tomen acciones que reviertan el problema, mostrando total indiferencia y falta de solidaridad. En el país en general y en La Guajira en particular, es evidente la vulneración de los derechos de los niños y las niñas, como sujetos que se construyen en el presente y cuyo futuro no puede ser preparado sin su participación, el apoyo de sus familias, sus comunidades y las organizaciones civiles e instituciones del Estado. Es importante la solidaridad de la sociedad, puesto que los indígenas requieren respuestas, teniendo en cuenta las consideraciones éticas para su atención. Quienes solicitan se hagan efectivos los derechos que tanto se proclaman por distintos medios y que se han convertido sólo en sueños, puesto que la realidad es otra (AU).

Malnutrition has claimed the lives of a great quantity of children of the Wayuu ethnicity, who live in La Guajira department, in Colombia. This situation has existed for a long time without the action of the decision makers or the social society to solve the problem, showing total indifference and lack of solidarity. In the country in general and particularly in La Guajira, it is evident the violation of the rights of the children as subjects that are in the formation process at that moment of their lives, and whose future could not be granted without their participation and the support of their families, their communities, the civilian organizations and the State institutions. It is important the society's solidarity, because native people require answers and attention, taking into account ethical consideration. There are many people asking for making effective the rights that are so widely proclaimed by different means and have become just dreams, because they are another thing in real life (AU).

Acceso de las familias a las unidades de internación de Neonatología en Iberoamérica: una realidad a mejorar / Family access to Neonatal Intensive Care Units in Latin America: A reality to improve

INTRODUCCIÓN: El ingreso de la familia en UCIN trae beneficios al RN y su familia, como eje de la atención humanizada. OBJETIVO: Conocer el estado actual sobre acceso de padres y familias en UCIN de Iberoamérica. MÉTODOS: Estudio transversal en 15 países de Iberoamérica. Dos cuestionarios: 1) para enfermeros jefes con tareas de gestión y conducción, y 2) para enfermeros en tarea asistencial. Se exploró sobre características y modalidades de funcionamiento; uso de guías de acceso, opinión personal sobre derecho a ingresar, riesgos, interferencias o colaboración relacionadas al ingreso, y papel de enfermería en las decisiones. Líderes de enfermería de cada país identificaron contactos y obtuvieron autorización según regulaciones de cada país. Las repuestas fueron analizadas en forma centralizada sin identificación del participante. RESULTADOS: Seiscientos cuarenta cuestionarios; respuesta en 226 (35%). Entre 52 UCIN, el 63% dispone de lugar para estancia de madres (solo el 27% durante la noche); en el 31 (60%) existen carteles que indican sobre horarios fijos para «visitas» de padres. El ingreso irrestricto existe en solo 19 UCIN (36%); para hermanos y abuelos es más restringido (en el 29% no es posible). Entre las 174 enfermeras, el 76% considera que las madres deben acceder siempre, pero estos porcentajes disminuyen para padres, hermanos y abuelos; el 77% opina que enfermería favorece y el 35% que dificulta el acceso. Adicionalmente, el 48% opina que el ingreso interfiere con tareas de enfermería. CONCLUSIÓN: Es necesario un cambio cultural en las UCIN de Iberoamérica para que se respeten los derechos de los RN y sus familias durante la internación

INTRODUCTION: Family access to NICUs has benefits for the newborn (NB) and family, as the main way of humanised care. OBJECTIVE: To determine the current state of parents and families access to NICUs in Latin America. METHODS: A cross-sectional study was conducted in 15 countries using two questionnaires: 1) directed at head nurses with management and supervision activities, and 2) nurses with care tasks. The features and modes of functioning were examined; the use access guides, personal opinion on the rights to enter, risks, interference, or collaboration as regards the patient, and nursing role in decisions. Nursing leaders of each country identified contacts and obtained authorisation under the regulations of each country. The responses were analysed centrally with the participants remaining anonymous. RESULTS: Out of 640 questionnaires issued, responses were received by 226 (35%). Among 52 NICU, 63% have a place for mothers to stay (only 27% overnight), and in 31 (60%) there are notices with fixed schedules for visiting the NB. Unrestricted access exists in only 19 NICU (36%), but for siblings and grandparents it is more restricted (it is not possible in 29%). Among the 174 nurses that responded, 76% feel that mothers should always have access, but these percentages decrease for fathers, siblings and grandparents. A large majority (77%) believe that nursing staff would favour access, and 35% would make it difficult. In addition, 48% believed that access interferes with nursing care. care. CONCLUSION: A cultural change is needed in the NICUs in Latin America in order to respect the rights of newborns and their families during hospitalization

Whole School, Whole Community, Whole Child-Calling School Nurses to Action.

The Whole School, Whole Community, Whole Child model released in 2015 as a collaboration between associations focuses renewed attention on the importance of improved physical, emotional, and social health to student learning. The model replaces and expands upon the Coordinated School Health Model that has been widely implemented in schools since the late 1980s. NASN celebrates this new model and calls school nurses to action in advocating for the implementation of this model in their communities. This article not only introduces this new model to school nurses but shares examples of school nurse advocacy initiatives.

Beliefs and Recommendations Regarding Child Custody and Visitation in Cases Involving Domestic Violence: A Comparison of Professionals in Different Roles.

Research is lacking on differing perspectives regarding custody cases involving domestic violence (DV). In a survey of judges, legal aid attorneys, private attorneys, DV program workers, and child custody evaluators (n = 1,187), judges, private attorneys, and evaluators were more likely to believe that mothers make false DV allegations and alienate their children. In response to a vignette, evaluators and private attorneys were most likely to recommend joint custody and least likely to recommend sole custody to the survivor. Legal aid attorneys and DV workers were similar on many variables. Gender, DV knowledge, and knowing victims explained many group differences.