Temporary Assistance For Needy Families: Sanctioning And Child Support Compliance Among Black Families In Illinois.

Temporary Assistance for Needy Families (TANF) is a federal cash welfare program for low-income, working families with children in the United States that requires participation with child support enforcement, if one parent is noncustodial, to receive the cash benefit. Cash assistance has been linked to improved child health and academic achievement, but sanctions to benefits can increase health risks. Our community-engaged, mixed-methods research project sought to identify barriers to TANF among families with young children in Illinois. In this study we analyzed TANF sanctions related to child support enforcement, using analysis of TANF administrative data and semistructured interviews with TANF customers. We conducted logistic regression and Fisher's test to explore demographic differences in sanctioning and sanction types. Black families were 111 percent more likely than White families to receive at least one sanction in 2018-19. Black families who were enrolled in TANF received more sanctions for child support noncompliance (2018: 42 percent; 2019: 50 percent) than White families (2018: 30 percent; 2019: 34 percent). Mothers who were survivors of intimate partner violence voiced particular challenges with child support compliance. Policy recommendations include shifting to alternative cash assistance models and removing pass-through funding so that families receive the full child support benefit.

Effectiveness and tolerability of mirabegron in children with overactive bladder: A retrospective pilot study.

AIMS: Mirabegron has promising results for OAB symptoms in adults, although the potential for cardiovascular side effects has caused concern. Efficacy and tolerability in children have not been extensively studied. Effectiveness, tolerability, and side effects of Mirabegron are reported in children with refractory OAB. METHODS: A retrospective review of children receiving Mirabegron between February 2014 and November 2018 was completed. Frequency, urgency, nocturnal (NE), and daytime incontinence (DI) were analyzed at baseline and 6 months. RESULTS: 70 children (50 females), median age 15 [range 8-16] years, commenced Mirabegron 25 mg (n = 29) or 50 mg (n = 41). 37 (53%) were still receiving treatment at 6 months: monotherapy n = 30, and combination therapy n = 7 (Solifenacin n = 4, Desmopressin n = 2, both n = 1). Where undertaken, blood pressure monitoring and ECGs were normal. For patients on monotherapy, 6 of 17 (35%) had improvement in NE, 11 of 19 (58%) in DI, 12 of 20 (60%) in frequency, and 8 of 21 (38%) in urgency symptoms. For patients receiving combination therapy, 2 of 6 (33%) had improvement in NE, 2 of 4 in DI (50%), 2 of 4 (50%) in frequency, and 4 of 6 (67%) had improvement in urgency. Reasons for treatment discontinuation (entire cohort) were: ineffectiveness (n = 28), worse symptoms (n = 4) and/or adverse reactions (n = 7), including dry mouth (n = 2), headaches (n = 4), dizziness (n = 1), nausea/vomiting (n = 3), increased seizures (n = 1), and rash (n = 1). CONCLUSION: Mirabegron improved symptoms in 70% of patients with refractory OAB. A prospective RCT should be the next step to establish the role of Mirabegron for the treatment of OAB in children. LEVEL OF EVIDENCE: Level II.

Developing an intervention for optimizing end of life care in any setting.

The gold standards of care created within the hospice setting are not always effectively influencing national, regional or local policy. This struggle is something which the public health sector has successfully contended with. In particular an approach known as Health in All Policies (HiAP) has been developed to lay down the rules of engagement and guide the exchange between organisations from all sectors. This synergy allows for an exploration of the possibilities of utilising HiAP within end of life care. In particular this study will look at how the HiAP can be adapted to better integrate end of life care throughout the population. Objectives are: (I) to investigate HiAP as an intervention; (II) to develop a framework for implementing a HiAP approach to end of life care; (III) to evaluate the possible impacts of changing the manner in which end of life care integrates within England. This presentation aims to unpick how HiAP guide exchanges between organisations from all sectors. Using this it then explores how we could use this to optimise end of life care.