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1.
Infant Ment Health J ; 41(3): 411-425, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32057134

RESUMO

This study explored the prevalence of expulsion in home-based child care (HBCC) settings using a nationally representative sample of HBCC providers from the National Survey of Early Care and Education. In addition to prevalence, enrollment and provider characteristics that predicted expulsion were examined. Although there is increasing awareness of the prevalence of early childhood suspension and expulsion in early care and education settings and the negative effects it has on children's development, few studies have included or focused on HBCC, where many children receive care. This study highlights that many home-based providers, especially listed providers, report that they expelled at least one child within the last year. Significant predictors of expulsion emerged, including enrollment characteristics such as caring for children with disabilities, enrolling more children, and caring for children unrelated to the provider. Provider characteristics, including years of experience, provider education, and provider age, also predicted provider report of expulsion. These results provide insight as to possible strategies that may be effective in reducing expulsion rates in this caregiving context.


Assuntos
Cuidado da Criança , Intervenção Educacional Precoce , Serviços de Assistência Domiciliar , Criança , Cuidado da Criança/ética , Cuidado da Criança/métodos , Cuidado da Criança/psicologia , Cuidado da Criança/estatística & dados numéricos , Desenvolvimento Infantil , Pré-Escolar , Intervenção Educacional Precoce/ética , Intervenção Educacional Precoce/métodos , Intervenção Educacional Precoce/estatística & dados numéricos , Saúde da Família , Feminino , Previsões , Serviços de Assistência Domiciliar/organização & administração , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Masculino , Saúde Mental , Determinação de Necessidades de Cuidados de Saúde , Prevalência
2.
Soc Sci Res ; 85: 102364, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31789196

RESUMO

Mexican-origin families face complex ethnic and immigration-based barriers to enrollment in early childhood education programs. As such, reducing barriers to enrollment for this population requires a better understanding of how Mexican-origin families work with, against, or around both general and group-specific constraints on educational opportunities. Using the Early Childhood Longitudinal Study-Birth Cohort, this study tailored broad social theory to the experience of Mexican-origin families to examine associations between human capital considerations and early childhood education enrollment within this population. Results supported the hypothesis that human capital considerations would be associated with early childhood care and education and provide limited evidence for the expectation that this link would be stronger for Mexican-origin families.


Assuntos
Intervenção Educacional Precoce/estatística & dados numéricos , Americanos Mexicanos , Escolas Maternais/estatística & dados numéricos , Pré-Escolar , Grupos de Populações Continentais , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Fatores Socioeconômicos , Estados Unidos
3.
Matern Child Health J ; 24(2): 204-212, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31828576

RESUMO

OBJECTIVES: The primary goal was to examine outcomes of Part C early intervention (EI) referrals from a high-risk infant follow-up program and factors associated with success. A secondary aim was to determine how many referred children not evaluated by EI would have likely qualified by either automatically meeting state eligibility criteria with a condition associated with "high-probability" for developmental delays or having test scores evidencing developmental delays. METHODS: Participants included 77 children referred directly to EI from a high-risk infant follow-up program. Scores on the Bayley Scales of Infant and Toddler Development-III, basic demographics, and medical variables were extracted from electronic medical records. Information regarding referral outcomes was gathered via follow-up phone calls to EI programs several months after referral. RESULTS: Results indicate 62% of EI referrals resulted in evaluation, with 69% of those evaluated being found eligible for services. Overall, 34% of referrals resulted in EI enrollment. Of those who were not evaluated, 71% were likely to have qualified based on state eligibility criteria. Follow-up phone call results indicated the majority of families not evaluated (64%) were never successfully contacted by the EI program. CONCLUSIONS: Findings from the present study illustrate the extent of challenges in connecting families with needed EI services and indicate an opportunity for improvement in EI referral processes to increase enrollment for eligible children. Improved communication between referral sources and service providers could support enrollment with detailed documentation of prior testing and explicit reasons for referral. Follow-up calls to confirm receipt of referral may also be necessary.


Assuntos
Deficiências do Desenvolvimento/terapia , Intervenção Educacional Precoce/normas , Encaminhamento e Consulta/normas , Criança , Pré-Escolar , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/psicologia , Intervenção Educacional Precoce/métodos , Intervenção Educacional Precoce/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Desenvolvimento de Programas/métodos , Desenvolvimento de Programas/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Risco , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Washington/epidemiologia
4.
Clin Pediatr (Phila) ; 58(11-12): 1224-1231, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31387391

RESUMO

This study is a secondary analysis of an observational prospective case series of 50 infants with severe bronchopulmonary dysplasia that describes patient factors associated with the time between initial hospital discharge and referral to early intervention (EI) services. It also evaluates associations between (1) timing of EI referral and reception of EI services and (2) early referral to EI and developmental outcomes at 18 to 36 months corrected age. The results demonstrated that a referral from a neonatologist versus a pediatrician was associated with fewer days between discharge and EI referral. Earlier EI referrals were associated with a shorter time to intake evaluation and service initiation. The Bayley-III (Bayley Scales of Infant and Toddler Development, 3rd Edition) scores at 24 months corrected age (n = 28) were not associated with timing of EI referral. In conclusion, an early referral to EI promoted earlier evaluation and initiation of EI services and should be standard for high-risk infants.


Assuntos
Displasia Broncopulmonar/complicações , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/terapia , Intervenção Educacional Precoce/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Tempo
5.
J Autism Dev Disord ; 49(7): 2956-2964, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31016676

RESUMO

Funding for early intensive behavioral intervention (EIBI) for children with autism spectrum disorder is rapidly expanding. Yet we know little about children's utilization, and research on inequities in utilization is lacking. We examined the relationship between utilization during the first year of EIBI and (a) child race-ethnicity and (b) neighborhood characteristics. Using a sample of children eligible for a Medicaid waiver through a novel policy of presumptive eligibility (N = 108), we estimated a series of two-level growth curve models. Children's average utilization ranged between 24 and 48% of weekly hours, and utilization did not differ by race-ethnicity or neighborhood during the first year. Findings underscore the need to monitor utilization of EIBI and warrant research on the feasibility of EIBI provision in the general population.


Assuntos
Transtorno do Espectro Autista/terapia , Terapia Comportamental/estatística & dados numéricos , Intervenção Educacional Precoce/estatística & dados numéricos , Criança , Pré-Escolar , Grupos Étnicos , Feminino , Humanos , Masculino , Características de Residência , Estados Unidos
6.
Acad Pediatr ; 19(7): 722-732, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30797897

RESUMO

OBJECTIVE: Describe children's diagnostic, social, and functional characteristics associated with the use of core early intervention (EI) services. METHODS: The sample included infants and toddlers (N = 2045) discharged from an urban EI program (2014-2016). Adjusted logit models estimated the marginal effects and 95% confidence intervals (CIs) of receipt of any of the 4 core EI services, controlling for the child's developmental condition type, race and ethnicity, primary language, sex, insurance type, age at referral, and functional performance at EI entry. Adjusted median regression estimated EI core service intensity controlling for child characteristics. RESULTS: The median per-child EI service intensity was less than 3 h/mo (median, 2.7; interquartile range, 2.1-3.5). Children whose primary language was English were 6% more likely to receive occupational therapy (marginal effect = 0.063; 95% CI, 0.010-0.115). Compared to infants, 1- to 2-year-old children were less likely to receive physical therapy and occupational therapy but more likely to receive speech therapy. Compared to infants, 1-year-olds received more intensive speech therapy (ß = 0.42; 95% CI, 0.10-0.70), and 2-year-olds received less intensive occupational therapy (ß = -0.70; 95% CI, -1.35 to -0.10). Children's functional performance at EI entry was significantly associated with the receipt and intensity of EI services. CONCLUSIONS: Many EI-enrolled children received low-intensity services, a result that was associated with the primary language of the caregiver and the child's age and functional status. Results suggest the need for interventions to improve service delivery for vulnerable EI subgroups.


Assuntos
Deficiências do Desenvolvimento/terapia , Intervenção Educacional Precoce/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Terapia Ocupacional/estatística & dados numéricos , Modalidades de Fisioterapia/estatística & dados numéricos , Fonoterapia/estatística & dados numéricos , Pré-Escolar , Deficiências do Desenvolvimento/epidemiologia , Utilização de Instalações e Serviços , Feminino , Humanos , Lactente , Masculino , Fatores Socioeconômicos
7.
J Autism Dev Disord ; 49(5): 2173-2183, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30701434

RESUMO

Health coverage of early intensive behavioral intervention (EIBI) for children with autism spectrum disorder is expanding. Yet there is no longitudinal research on patterns of or inequities in utilization of EIBI. We integrated state administrative records with Medicaid and Census data for children enrolled in an EIBI Medicaid waiver (N = 730) to identify and describe the type and prevalence of treatment utilization trajectories, and to examine the association between trajectory types and (a) child race-ethnicity and (b) neighborhood racial composition, poverty, affluence, and urbanicity. We identified four utilization trajectories (Low, Low-Moderate, Moderate, and High users). Race-ethnicity and neighborhood affluence were associated with trajectory membership. As coverage expands, policy makers should consider strategies to improve overall treatment utilization and enhance equity.


Assuntos
Transtorno do Espectro Autista/terapia , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Utilização de Instalações e Serviços , Disparidades em Assistência à Saúde , Características de Residência/estatística & dados numéricos , Adolescente , Transtorno do Espectro Autista/reabilitação , Terapia Comportamental/estatística & dados numéricos , Criança , Pré-Escolar , Intervenção Educacional Precoce/estatística & dados numéricos , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Estados Unidos
8.
J Learn Disabil ; 52(3): 220-231, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30694092

RESUMO

Despite concerted efforts to improve the reading skills of English language learners (ELLs), it remains unclear if the interventions they have been receiving produce any positive results. Thus, the purpose of this meta-analysis was to examine how effective reading interventions are in improving ELLs' reading skills and what factors may influence their effectiveness. Twenty-six studies with reported outcomes for pretest and posttest were selected, and four moderators (group size, intensity of intervention, students' risk status, and type of intervention) were coded. The results of random-effects analyses showed that the reading interventions had a large effect on ELLs' reading accuracy ( d = 1.221) and reading fluency ( d = 0.802) and a moderate effect on reading comprehension ( d = 0.499). In addition, for real-word reading accuracy, intervention groups composed of more than five students were less effective than groups composed of two to five students, and longer intervention sessions were less effective than shorter ones. Overall, our findings suggest that reading interventions have positive effects on ELLs' reading skills, and they should not be delayed until these students have reached a certain level of oral English proficiency.


Assuntos
Intervenção Educacional Precoce , Idioma , Aprendizagem , Avaliação de Processos e Resultados em Cuidados de Saúde , Leitura , Criança , Pré-Escolar , Intervenção Educacional Precoce/estatística & dados numéricos , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos
9.
J Cancer Educ ; 34(1): 59-65, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-28801880

RESUMO

Cervical cancer is a major cause of death among women especially in developing nations. It can be prevented through screening yet many women are unaware of screening options. Nurses are in vantage position to provide cervical cancer screening (CCS) information and services especially in antenatal clinics. The purpose of this study is to evaluate the effects of an educational intervention (EI) on nurses' knowledge and attitude towards providing CCS information. This quasi-experimental study was conducted in eight health facilities in Ibadan, Nigeria. The facilities were randomly divided into intervention group (IG) and control group (CG). A total of 133 consenting nurses (60 in the IG and 73 in the CG) participated. Baseline data were collected using self-administered questionnaire. The nurses in the IG received the EI and both groups were administered with a post-test questionnaire after 6 months. Data were analysed using chi square and Student's t test at p = 0.05. Nurses' mean age was 41.7 years. Knowledge scores for the IG (11.8 ± 3.3) and CG (11.7 ± 3.3) were comparable at baseline (p = 0.901) but was significantly higher among nurses in the IG (14.63 ± 3.12) than CG (12.7 ± 3.5) at 6 months PI (p = 0.01). More nurses in the IG had high level of knowledge than CG. There was no significant difference in their attitude at baseline and at PI. There was a significant association between knowledge and attitude towards providing cervical cancer screening information (p < 0.000). Education improved knowledge of nurses on cervical cancer screening. Regular education programmes for nurses may result in improved counselling on major health issues like cancer.


Assuntos
Atitude do Pessoal de Saúde , Detecção Precoce de Câncer/estatística & dados numéricos , Intervenção Educacional Precoce/estatística & dados numéricos , Instalações de Saúde/normas , Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras e Enfermeiros/psicologia , Enfermagem Oncológica/educação , Neoplasias do Colo do Útero/diagnóstico , Adulto , Detecção Precoce de Câncer/psicologia , Avaliação Educacional , Feminino , Humanos , Pessoa de Meia-Idade , Nigéria/epidemiologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Gravidez , Inquéritos e Questionários , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/psicologia , Adulto Jovem
10.
Child Dev ; 90(3): 859-875, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-28834544

RESUMO

Extensive research has explored the ability of young children to learn about the causal structure of the world from patterns of evidence. These studies, however, have been conducted with middle-class samples from North America and Europe. In the present study, low-income Peruvian 4- and 5-year-olds and adults, low-income U.S. 4- and 5-year-olds in Head Start programs, and middle-class children from the United States participated in a causal learning task (N = 435). Consistent with previous studies, children learned both specific causal relations and more abstract causal principles across culture and socioeconomic status (SES). The Peruvian children and adults generally performed like middle-class U.S. children and adults, but the low-SES U.S. children showed some differences.


Assuntos
Desenvolvimento Infantil/fisiologia , Intervenção Educacional Precoce , Aprendizagem/fisiologia , Pobreza , Classe Social , Pensamento/fisiologia , Adulto , Pré-Escolar , Comparação Transcultural , Intervenção Educacional Precoce/estatística & dados numéricos , Feminino , Humanos , Masculino , Peru , Pobreza/estatística & dados numéricos , Estados Unidos
11.
Phys Occup Ther Pediatr ; 39(2): 151-167, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30211625

RESUMO

AIM: To determine current UK pediatric physiotherapist (PT) and occupational therapist (OT) management of perinatal stroke. DESIGN: Web-based cross-sectional survey. METHODS: Participants were members of the Association of Paediatric Chartered Physiotherapists and Occupational Therapists specialist section: children young people and families working with infants. Items covered prioritization of referrals, assessments, therapy approaches aimed at the upper limb, and parental support. RESULTS: 179 therapists responded. 87.2% of PTs and 63.0% of OTs managed infants with perinatal stroke. Infants with clinical signs of motor dysfunction at referral were prioritized for early initial assessment. The most frequently used assessments were the Alberta Infant Motor Scale (AIMS) and Bayley Scales of Infant Development (BSID). Of PTs and OTs, 41.9 and 40.0% used no standardized assessments. Frequently used therapy interventions were Bobath/Neurodevelopmental Therapy (NDT), positioning aids and passive movements. 88.1% of therapists would choose a bilateral rather than unilateral (affected side) therapy approach for infants with perinatal stroke aged up to 6 months. Of PTs and OTs, 56.9 and 57.1% provided psychological support to families. CONCLUSIONS: Assessment and provision of therapy services following perinatal stroke is variable. Increased use of standardized assessments and centralized data collection regarding service provision for high-risk infants is recommended.


Assuntos
Terapia Ocupacional/estatística & dados numéricos , Modalidades de Fisioterapia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Extremidade Superior/fisiopatologia , Estudos Transversais , Intervenção Educacional Precoce/estatística & dados numéricos , Seguimentos , Humanos , Lactente , Recém-Nascido , Terapeutas Ocupacionais , Fisioterapeutas , Acidente Vascular Cerebral/terapia , Reino Unido
12.
Psychiatr Serv ; 69(11): 1175-1180, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30256184

RESUMO

OBJECTIVE: The authors sought to determine whether a multicomponent, community-based program for preventing maternal depression also promotes engagement with mental health services for individuals with persistent symptoms. METHODS: Mothers of children enrolled in Head Start were randomly assigned between February 2011 and May 2016 to Problem-Solving Education (PSE) (N=111) or usual services (N=119) and assessed every two months for 12 months. RESULTS: Among 230 participants, 66% were Hispanic; 223 participants were included in the analysis. For all PSE participants, engagement with specialty mental health services increased from approximately 10% to 21% between two and 12 months. The PSE group was more likely than the control group to be engaged in specialty services at 12 months (adjusted odds ratio [AOR]=2.36, 95% confidence interval [CI]=1.07-5.20), and the rate of engagement with specialty services over time (treatment × time interaction) favored PSE (p=.016). Among PSE participants with persistent depressive symptoms over the follow-up period, engagement with specialty services increased from 12% (two months) to approximately 46% (12 months), whereas among control group participants, engagement fluctuated between 24% and 33%, without a clear trajectory pattern. At 12 months, PSE participants with persistent symptoms were more likely to engage with specialty care compared with their counterparts in the control group (AOR=6.95, CI=1.50-32.19). The treatment × time interaction was significant for the persistently symptomatic subgroup (p=.029) but not for the episodically symptomatic or the asymptomatic subgroups. CONCLUSIONS: Embedding mental health programs in Head Start is a promising strategy to engage parents with depressive symptoms in care, especially those with persistent symptoms.


Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Transtorno Depressivo Maior/terapia , Intervenção Educacional Precoce/organização & administração , Mães , Avaliação de Processos e Resultados em Cuidados de Saúde , Adulto , Boston , Pré-Escolar , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Transtorno Depressivo Maior/prevenção & controle , Intervenção Educacional Precoce/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Lactente , Adulto Jovem
13.
J Acad Nutr Diet ; 118(11): 2081-2093, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30064879

RESUMO

BACKGROUND: Early childhood educators have the potential to influence children's dietary outcomes through daily interactions. However, existing research suggests that educator practices are often suboptimal. Previous research has often focused on individual characteristics that affect practices. There is less study of contextual influences of practices of early childhood educators. OBJECTIVE: The purpose of this study was to understand and describe contextual factors evident in narratives of early childhood educators influencing mealtime and nutrition promotion practices. We use the Promoting Action on Research Implementation in Health Services framework to consider how contextual factors related to practices of early childhood educators. DESIGN: This cross-sectional, qualitative study collected data through in-depth interviews with early childhood educators. Analyses of the data reflected a factist perspective and semantic approach to complete thematic content analysis of in-depth interviews. PARTICIPANTS: The study used a stratified purposive sampling approach to recruit 28 educators to balance across educator role, agency type (Head Start vs state-funded), and obesity prevalence in the community. Early childhood educators were mostly lead teachers (62%), between the ages of 30 and 49 (82.1%), and white (75%) or African American (14.3%). RESULTS: The coders identified three primary themes: Mealtime Structures, Resources, and Classroom/Center Atmosphere. Mealtime Structures associated with detrimental practices included cafeteria meals with rigid schedules. Mealtime Structures associated with evidence-based practices (EBPs) included classroom meal service. Resources associated with detrimental practices included limited funding. Resources associated with EBPs included meals paid for early childhood educators and classroom food experiences. Classroom/Center Atmosphere factors associated with detrimental practices included poor food offerings and policies that conflicted (eg, allowing children to bring in outside foods). Classroom/Center Atmosphere factors associated with EBPs included clarity around meal service rules and healthy, appealing food offerings. CONCLUSIONS: This study highlighted that it may be difficult for an early childhood educator to adopt and maintain EBPs in certain contexts.


Assuntos
Dieta Saudável/métodos , Intervenção Educacional Precoce/métodos , Promoção da Saúde/métodos , Refeições , Adulto , Grupo com Ancestrais do Continente Africano , Creches , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Estudos Transversais , Intervenção Educacional Precoce/estatística & dados numéricos , Meio Ambiente , Grupo com Ancestrais do Continente Europeu , Prática Clínica Baseada em Evidências , Preferências Alimentares , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Pobreza , Professores Escolares/estatística & dados numéricos , Ensino/psicologia
14.
Prax Kinderpsychol Kinderpsychiatr ; 67(5): 462-480, 2018 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-29992868

RESUMO

One Size Fits All? Using Psychosocial Risk Assessments to Predict Service Use in Early Intervention and Prevention Early intervention and prevention services offer a variety of programs. At the same time, program participants differ widely in their service use. This study aims at investigating the prognostic validity of psychosocial risk assessments in predicting the participants' service use. The psychosocial risk assessment "Heidelberg Stress Scale" is used to predict aspects of service use (dosage, attrition, intervention content, working relationship). Service use data of N = 1.514 participants of a home-visiting program will be analyzed via Machine-Learning-Algorithms. Dosage and intervention content can be predicted with psychosocial risk assessments. The classification strength is small. Global and continuous risk scales have a prognostic advantage over single categorical risk items. Financial burden has a significant influence on every aspect of service use. Psychosocial risk assessments provide additional information that can support intervention planning. Yet, these instruments should be supplemented by additional diagnostic information.


Assuntos
Adaptação Psicológica , Intervenção Educacional Precoce/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Relações Pais-Filho , Psicometria/estatística & dados numéricos , Medição de Risco/estatística & dados numéricos , Ajustamento Social , Adolescente , Algoritmos , Criança , Pré-Escolar , Feminino , Alemanha , Visita Domiciliar/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Gravidez , Fatores Socioeconômicos , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricos
15.
Pediatrics ; 142(1)2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29875180

RESUMO

BACKGROUND AND OBJECTIVES: Timely provision of developmental services can improve outcomes for children 0 to 3 years old with developmental delays. Early Intervention (EI) provides free developmental services to children under age 3 years; however, data suggests that many children referred to EI never connect to the program. We sought to ensure that 70% of patients referred to EI from an academic primary care clinic serving a low-income population were evaluated within 120 days of referral. METHODS: Recognizing that our baseline system of EI referrals had multiple routes to referral without an ability to track referral outcome, we implemented a multifaceted referral process with (1) a centralized electronic referral system used by providers, (2) patient navigators responsible for processing all EI referrals submitted by providers, and (3) a tracking system postreferral to facilitate identification of patients failing to connect with EI. RESULTS: The percentage of patients evaluated by EI within 120 days increased from a baseline median of 50% to a median of 72% after implementation of the systems (N = 309). After implementation, the centralized referral system was used a median of 90% of the time. Tracking of referral outcomes revealed decreases in families refusing evaluations and improvements in exchange of information with EI. CONCLUSIONS: Rates of connection to EI improved substantially when referrals were centralized in the clinic and patient navigators were responsible for tracking referral outcomes. Knowledge of EI intake processes and relationships between the practice and the EI site are essential to ensure successful connections.


Assuntos
Deficiências do Desenvolvimento/reabilitação , Intervenção Educacional Precoce/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Pré-Escolar , Intervenção Educacional Precoce/métodos , Feminino , Humanos , Lactente , Masculino , Fatores de Tempo
16.
Child Abuse Negl ; 79: 454-464, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29547838

RESUMO

Increasing access to early care and education (ECE) for children in the child welfare system (CWS) remains a critical issue in the United States, as the numbers of young children entering this system steadily increases. Mounting evidence suggests that participation in at least some types of ECE can mitigate the need for child welfare supervision. Moreover, ECE participation has been linked to positive developmental and school readiness outcomes, lower rates of foster placement, and greater placement stability for children in the CWS. Despite this research, ECE is not widely used by this population. This study informs recent local and federal efforts to increase ECE utilization among children in the CWS by exploring the perspectives of three stakeholder groups (child welfare caseworkers, ECE providers, and parents/caregivers) regarding the benefits of CWS-supervised children's participation in ECE for 1) the children themselves, 2) their parents/caregivers, and 3) their caseworkers. A total of ten focus groups were conducted with these stakeholders in a large urban area in the western U.S. (n = 79). Meeting transcripts were analyzed with Atlas TI software to identify themes. Results highlight multiple ways in which participants perceived ECE as being beneficial for CWS-supervised children, as well as for their parents/caregivers, and caseworkers. These findings offer suggestions for ways to motivate caseworkers and parents/caregivers to enroll CWS-supervised children in ECE by educating them about benefits, not only for the children, but also for themselves.


Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Serviços de Proteção Infantil/estatística & dados numéricos , Bem-Estar da Criança/estatística & dados numéricos , Intervenção Educacional Precoce/estatística & dados numéricos , Cuidadores , Criança , Pré-Escolar , Utilização de Instalações e Serviços , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Pais , Estados Unidos
17.
Matern Child Health J ; 22(4): 494-500, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29388114

RESUMO

Objectives To determine whether participation in a home visiting program increases and expedites utilization of early intervention services for suspected developmental delays. Methods Children participating in Every Child Succeeds (ECS), a large home visiting (HV) program serving greater Cincinnati, between 2006 and 2012, were propensity score matched to a sample of children identified from birth records who did not receive services from ECS. Data were linked to early intervention (EI) data acquired from the Ohio Department of Health. Descriptive statistics were employed to evaluate success of the matching. Chi square and log-rank tests evaluated whether the proportion of children accessing EI and the time to EI services differed for families participating in HV compared to eligible children not participating. Logistic regression and Cox proportional hazards regression modeled the associations. Results Among 3574 HV and 3574 comparison participants, there was no difference in the time to EI service utilization; however a higher percentage of HV participants accessed services. Overall, 6% of the HV group and 4.3% of the comparison group accessed services (p = 0.001). Modeling revealed an odd ratio = 1.43 [95% confidence interval (CI) 1.16-1.78, p value = 0.001] and hazard ratio = 1.42 [95% CI 1.15-1.75, p value = 0.001]. Differences in utilization were greatest directly after birth and between approximately 2 and 3 years. Conclusions for Practise Participation in home visiting was associated with greater utilization of EI services during two important developmental time points, demonstrating that home visiting may serve as an important resource for facilitating access to early intervention services.


Assuntos
Deficiências do Desenvolvimento/terapia , Intervenção Educacional Precoce/estatística & dados numéricos , Acesso aos Serviços de Saúde , Visita Domiciliar , Mães/psicologia , Cuidado Pós-Natal , Estudos de Coortes , Deficiências do Desenvolvimento/epidemiologia , Feminino , Serviços de Assistência Domiciliar , Humanos , Lactente , Masculino , Ohio , Gravidez , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos
18.
BMC Pediatr ; 18(1): 65, 2018 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-29452576

RESUMO

BACKGROUND: In Africa, a high proportion of children are at risk for developmental delay. Early interventions are known to improve outcomes, but they are not routinely available. The Rwandan Ministry of Health with Partners In Health/Inshuti Mu Buzima created the Pediatric Development Clinic (PDC) model for providing interdisciplinary developmental care for high-risk infants in rural settings. As retention for chronic care has proven challenging in many settings, this study assesses factors related to retention to care after 12 months of clinic enrollment. METHODS: This study describes a retrospective cohort of children enrolled for 12 months in the PDC program in Southern Kayonza district between April 2014-March 2015. We reviewed routinely collected data from electronic medical records and patient charts. We described patient characteristics and the proportion of patients retained, died, transferred out or lost to follow up (LTFU) at 12 months. We used Fisher's exact test and multivariable logistic regression to identify factors associated with retention in care. RESULTS: 228 children enrolled in PDC from 1 April 2014-31 March 2015, with prematurity/low birth weight (62.2%) and hypoxic ischemic encephalopathy (34.5%) as the most frequent referral diagnoses. 64.5% of children were retained in care and 32.5% were LTFU after 12 months. In the unadjusted analysis, we found male sex (p = 0.189), having more children at home (p = 0.027), health facility of first visit (p = 0.006), having a PDC in the nearest health facility (p = 0.136), referral in second six months of PDC operation (p = 0.006), and social support to be associated (100%, p < 0.001) with retention after 12 months. In adjusted analysis, referral in second six months of PDC operation (Odds Ratio (OR) 2.56, 95% CI 1.36, 4.80) was associated with increased retention, and being diagnosed with more complex conditions (trisomy 21, cleft lip/palate, hydrocephalus, other developmental delay) was associated with LTFU (OR 0.34, 95% CI 0.15, 0.76). As 100% of those receiving social support were retained in care, this was not able to be assessed in adjusted analysis. CONCLUSIONS: PDC retention in care is encouraging. Provision of social assistance and decentralization of the program are major components of the delivery of services related to retention in care.


Assuntos
Intervenção Educacional Precoce/estatística & dados numéricos , Perda de Seguimento , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Intervenção Educacional Precoce/organização & administração , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Análise Multivariada , Estudos Retrospectivos , Serviços de Saúde Rural/organização & administração , Ruanda
19.
Child Dev ; 89(1): 264-279, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-27868191

RESUMO

One-quarter of the Head Start population has a mother who participated in the program as a child. This study uses experimental Head Start Impact Study (HSIS) data on 3- and 4-year-olds (N = 2,849) to describe multigenerational Head Start families and their program experiences. In sharp contrast to full-sample HSIS findings, Head Start has large, positive impacts on cognitive and socioemotional development through third grade among the children of former participant mothers, including improved mathematics skills and reductions in withdrawn and aggressive behavior. Evidence suggests that differences in program impacts between single- and multigenerational Head Start families are driven largely by differences in family resources and home learning environments.


Assuntos
Sucesso Acadêmico , Comportamento Infantil , Desenvolvimento Infantil , Intervenção Educacional Precoce/estatística & dados numéricos , Mães/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Comportamento Problema , Adulto , Pré-Escolar , Feminino , Humanos , Masculino
20.
Acad Pediatr ; 18(4): 468-474, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28780329

RESUMO

OBJECTIVE: To evaluate the effect of community-based early intervention (EI) services the on functional outcomes of high-risk infants at school age. METHODS: This was a retrospective cohort study using data from the US Department of Education's National Early Intervention Longitudinal Study. Participants were enrolled in 1997 to 1998 with follow-up through 5 years and had a neonatal intensive care unit (NICU) admission, birth weight >400 g, and gestational age >23 weeks. Kindergarten outcomes were teacher assessments of academic and physical skills compared with classmates. Because treatment assignment is determined according to level of clinical need, we used repeated measures, marginal structural models with inverse probability of treatment weighting to account for confounding by indication. RESULTS: Of 405 participants, 47% had academic ratings average/above average and 71% had physical skills ratings average/above average. Odds of average/above average academic skills were lower for those with delayed EI enrollment (adjusted odds ratio [aOR], 0.65; 95% confidence interval [CI], 0.43-0.99) and trending, although not significantly, higher for those with greater service duration (aOR, 1.47; 95% CI, 0.98-2.22) and breadth (odds ratio, 1.74; 95% CI, 0.95-3.20). Odds of average/above average physical skills were lower for those with delayed EI enrollment (aOR, 0.61; 95% CI, 0.40-0.93) and higher for those with greater intensity (aOR, 1.06; 95% CI, 1.00-1.13) and breadth (aOR, 1.86; 95% CI, 1.03-3.35), approaching significance for those with greater service duration (aOR, 1.41; 95% CI, 0.96-2.09). CONCLUSIONS: Longer, more intense services were associated with higher kindergarten skills ratings in children at risk for disabilities. Our novel findings support the effectiveness of large-scale EI programs and reinforce the importance of referral after NICU discharge.


Assuntos
Sucesso Acadêmico , Intervenção Educacional Precoce/estatística & dados numéricos , Destreza Motora , Pré-Escolar , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal , Estudos Longitudinais , Masculino , Razão de Chances , Estudos Retrospectivos , Fatores de Tempo
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