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This chapter examines social variations in parent dissatisfaction with children’s medical care and tests whether greater dissatisfaction is associated with less preventive care and unmet medical need.

The 2007 National Survey of Children’s Health (NSCH) is a nationally representative cross-sectional sample of parents of U.S. children age 0–17 years (N=78,523). We use a combination of ordinary least squares (OLS) and binary logistic regression to analyze parent dissatisfaction, preventive care, and unmet medical need.

Our results indicate that parents’ dissatisfaction scores are significantly higher for racial/ethnic minorities, non-English speakers, lower socioeconomic status (SES) respondents, and the uninsured. Furthermore, parent dissatisfaction has a significant and robust association with lack of preventive care and reports of unmet medical need.

Due to the cross-sectional research design, we were unable to determine whether dissatisfaction caused parents to delay children’s medical care, thus resulting in a lack of annual preventive care and greater unmet needs.

Although there is extensive research on adult perceptions of their own medical care, few sociological studies have examined parents’ perceptions about their children’s care. Yet, there is substantial evidence that parents transmit health-related attitudes, beliefs, and behaviors to their children. As with adult patients, parent satisfaction with their child’s medical care is stratified by social characteristics; however, we also find a strong association between dissatisfaction and use of other important health services. It may be the case that when parents feel that they did not receive satisfactory care, they are more likely to delay, or to forgo, preventive and other health services.

Using Andersen’s (1968) behavioral model of health services use as a guiding conceptual framework, this study examined how receipt of family-centered care relates to the perceived family challenges for families of children with autism spectrum disorder (ASD).

Data from the 2009–2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) were analyzed for 812 parents of children with ASD.

Multiple regression analyses provided substantive statistical evidence that a child’s race, the adequacy of a family’s insurance, and the stability of child’s health care needs significantly contributed to predicting his or her receipt of family-centered care. Further results suggested a relationship between receipt of family-centered care and the perception of challenge for these families; families receiving family-centered care perceive fewer challenges and feel less unmet need for child health services.

Family-centered professionals provide critical voices in the development of policies and programs geared toward improving the health outcomes of children with ASD and their families.

Children’s voices are seldom heard directly. Most often, children, particularly young children, are represented by adults acting on their behalf who may or may not best represent the child’s views or best interests. This can be beneficial or problematic, if the child’s needs are not appreciated or recognised. This chapter looks at the changing attitudes to listening to young people, and the growing recognition of the value of children’s needs, as well as the growing voices of the children themselves, who make their needs increasingly clear. The results of our Models of Child Health Appraised (MOCHA) interviews with children and young people via the DIPEx International organisation give us clear direction as to the importance children using primary care services place on being taken seriously, being listened to and being able to make their own decisions. Other researchers asked input from primary care professionals on children’s autonomy and how the current and future primary care systems can best address the needs of young people, as well as the placing of these issues in a wider cultural context, and how this influences and is influenced by children’s choices. Finally, we look at how the MOCHA country agents have reported the assessment of the importance and function of listening to young people in our research.

The child is at the centre of all Models of Child Health Appraised research and indeed all primary care delivery for children. Appraising models of primary care for children is incomplete without ensuring that experiences of primary care, design, treatment, management and outcomes are optimal for the child. However, the principle of child centricity is not implicit in many healthcare systems and in many aspects of life, yet it is extremely important for optimal child health service design and child health. By exploring the changing concept of ‘childhood’, we understand better the emergence of the current attitude towards children and their role in today’s Europe and the evolution of child rights. Understanding child centricity, and the role of agents acting on behalf of the child, allows us to identify features of children’s primary care systems that uphold the rights of a child to optimum health. This is placed against the legal commitments made by the countries of the European Union and European Economic Area to ensure that children’s rights are respected.

The chapter investigates: (1) Do married parents efficiently allocate time to children’s health care? (2) Are parents willing to sacrifice consumption for health improvements at an equal rate for all family members? (3) How does family structure affect health trade-offs parents make? (4) Are parental choices consistent with maximization of a single utility function?

A model is specified focusing on how parents allocate resources between consumption and goods that relieve acute illnesses for family members. Equivalent surplus functions measuring parental willingness to pay to relieve acute illnesses are estimated using data from a stated-preference survey.

Results provide limited support for the prediction that married parents allocate time to child health care according to comparative advantage. Valuations of avoided illness vary between family members and are inconsistent with the hypothesis that fathers’ and mothers’ choices reflect a common utility function.

Prior research on children’s health valuation has relied on a unitary framework that is rejected here. Valuation researchers have focused on allocation of resources between parents and children while ignoring allocation of resources among children, whereas results suggest significant heterogeneity in valuation of health of different types of children and of children in different types of households.

Results may provide a justification on efficiency grounds for policies to provide special protection for children’s health and suggest that benefit–cost analyses of policies affecting health should include separate estimates of the benefits of health improvements for children and adults.

The purpose of this paper is to present the results of a scoping review on the implementation of Article12 in health care. The scoping review will provide a summary and overview of the key concepts and published literature on this topic internationally. Article 12 of the United Nations Convention on the Rights of the Child (1989) states that children have a right to express their views, to have them heard and for their views to be given due weight in all matters that affect them. Despite increased calls for Article 12 to be given attention in health care, there is little evidence to suggest this has been well implemented and embedded in Australian health-care delivery. The scoping review was undertaken to provide a summary and overview of the key concepts and published literature on this topic internationally.

A five-step methodological framework described by Arksey and O’Malley (2005) was used to undertake the scoping review. Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used as a guideline for undertaking the study selection.

Children are still not routinely involved in health-care decision-making, are frequently left out of service planning and evaluation and the perception that they lack the capability to make rational decisions persists.

While there has been a focus on research that investigates children’s participation in health-care decision-making in recent years, there is little that directs attention specifically to the implementation of Article 12, particularly in Australian health care. Recommendations are made for further research in these areas.

Using a mixed methodology comprising interviews, case file analysis and descriptive statistics, this study aims to examine the experiences of all 43 young people in Wales subject to secure accommodation orders between 1st April 2016 and 31st March 2018.

Children in the UK aged 10–17 years who are deemed to be at a significant level of risk to themselves or others may be subject to a secure accommodation order, leading to time spent in a secure children’s home (SCH) on welfare grounds. Following a rise in the number of children in Wales referred to SCHs for welfare reasons, this paper describes these young people’s journeys into, through and out of SCHs, giving insight into their experiences and highlighting areas for policy and practice improvements.

Findings indicate that improvements in mental health support and placement availability are key in improving the experiences of this particularly vulnerable group of young people throughout their childhood.

Other practical implications of the study’s findings, such as improvements in secure transport arrangements, are also discussed.

While the findings are limited by the reliance on self-report methods and the size of the study, namely, the small number of young people with experience of SCHs who were able to participate, the findings build on the existing knowledge base around children’s residential accommodation and provide new insights into how best to support these children.

Models of Child Health Appraised (MOCHA) was a wide-ranging, multi-disciplinary and multi-method study that aimed to identify the best models of provision of primary care for the children of the European Union. The research has identified two main conclusions: (1) The depth of interdependency of health, economy and society. Primary care needs to be an active partner in public debate about current child health concerns. It should orientate more effectively in addressing wider societal influences on child health through advocacy and collaborative intersectoral public health approaches with those agencies responsible for public and community health if it is to address effectively issues such as childhood obesity, mental health and vaccine hesitancy. As part of this, it needs to address its workforce composition and skills, not least in two-way communication. (2) The European Community has many visions and commitments to children and child health policies, but their effectiveness is largely unfulfilled. The Commission can strengthen its impact on children’s health and healthcare services within current remits and resources by focusing on a number of key fields: planned and structured research, providing insight into optimal human resources and skills in child primary care, developing and using ethical means of listening to children’s views, remedying the invisibility of children in data, measuring the quality of primary care from a child-centric perspective, understanding the economics of investing in children’s health, developing e-health standards and evaluation, collaborative and harmonised use of downloaded research databases, understanding and respecting children’s rights and equity, and appreciating and allowing for children’s evolving autonomy as they grow up. An optimal model of primary care for children is proactive, inclusive, corporately linked, based on and providing robust evidence, and respects the wider determinants of health and children’s involvement in their health trajectory.

The purpose of this paper is to report the preliminary evaluation findings of an integration programme in the children’s health care sector in the North West of England. The programme was led by the local Clinical Commissioning Group (CCG) utilising a semi-autonomous working group model. It comprised horizontal and vertical integration. The evaluation reflects the emerging policy context of CCG leadership in the field of health care planning and commissioning.

The evaluation used a mixed method observational study design to obtain the views and opinions of stakeholders and measured their change over time. A series of initial semi-structured interviews was conducted with purposively selected key professionals in strategic positions to assist in designing a survey instrument. An online survey was launched at programme inception and repeated at five months. Respondents were members of five implementation working groups. Survey responses were subjected to a descriptive analysis and tests of correlation.

The data showed high levels of commitment and perceptions of shared vision and goals amongst respondents which were relatively stable over time. Responses also indicated that the programme was perceived to have a considerable impact on collaborative work but that this initial effect decreased over time. There were no significant attitudinal differences across sectors or professional groups.

The study demonstrates the strengths and weaknesses of the multi-agency working group model to implement change. Whilst confirming initial positive effects of integration programmes on collaborative work, over time this appears to wear off to be replaced by increased levels of skepticism amongst participants. The author findings have implications for service commissioners and service planners engaging in vertical or horizontal integration of children’s services.