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Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

Drawing on key concepts from childhood studies, this chapter provides a theoretical grounding for children's participation rights in research on maltreatment. The chapter discusses the sociology of childhood, tracing how it brought a focus to children's participation in research, and introduces the concepts of adultism and childism to help critique children's participation in research on maltreatment. The chapter is framed by a familiar debate on tensions between children's right to participate and their right to protection. It explores the relevance of these debates for research on child maltreatment. Through its discussion, the chapter explores key issues that have traditionally led to children being kept out of research on child maltreatment. It argues that children's participation is key to advancing knowledge on child maltreatment and fundamentally a way to uphold children's human rights. The concepts introduced in this chapter are threaded and explored throughout the subsequent chapters of the book, in their examination and reflections on children's participation in research on maltreatment.

The paper aims to recommend legal and regulatory reforms to better prevent child abuse in childcare institutions in Hong Kong.

A summary of investigation report and news reports are referred to in describing the abuse incidents which occurred in a children’s residential home. Routine Activity Theory (RAT) is used as the framework for identifying the causes. Local and overseas legislation, regulations, case law, and policies are analysed to provide recommendations for reforms.

There are systematic failures such as workload issues, inadequate supervision, and the absence of continuing professional development (CPD) that contributed to the incidents. The regulations governing the operation of childcare centres and criminal laws against child abuse are long overdue for an update in Hong Kong. On the institutional side, this paper recommends enacting regulations that mandate CPD, lower the staff-to-child ratio, and strengthen the Social Welfare Department’s (SWD) supervisory powers over childcare centres. From the criminal law perspective, it is recommended that “reasonable chastisement” be abolished as a defence of corporal punishment, and that there be new offences for failure to report suspected child abuse incidents and causing or allowing the death/serious harm of a child.

The child abuse incidents, occurring in a childcare institution, have drawn wide public concern. Reform is required to protect vulnerable children and regain public confidence.

The purpose of this study was to explore 232 service providers’ and policymakers’ experiences of supporting children’s well-being during the pandemic, across sectors, in 22 countries – including Kenya, the Philippines, South Africa, India, Scotland, Sweden, Canada and the USA, in the last quarter of 2020.

A smartphone survey delivered via a custom-built app containing mostly open-ended questions was used. Respondents were recruited via professional networks, newsletters and social media. Qualitative content analysis was used.

The findings reveal numerous system-level challenges to supporting children’s well-being, particularly virus containment measures, resource deficiencies and inadequate governance and stakeholder coordination. Those challenges compounded preexisting inequalities and poorly affected the quality, effectiveness and reach of services. As a result, children’s rights to an adequate standard of living; protection from violence; education; play; and right to be heard were impinged upon. Concurrently, the findings illustrate a range of adaptive and innovative practices in humanitarian and subsistence support; child protection; capacity-building; advocacy; digitalisation; and psychosocial and educational support. Respondents identified several priority areas – increasing service capacity and equity; expanding technology use; mobilising cross-sectoral partnerships; involving children in decision-making; and ensuring more effective child protection mechanisms.

This study seeks to inform resilience-enabling policies and practices that foster equity, child and community empowerment and organisational resilience and innovation, particularly in anticipation of future crises.

Using a novel approach to gather in-the-moment insights remotely, this study offers a unique international and multi-sectoral perspective, particularly from low- and middle-income countries.

There is more to primary care than solely medical and nursing services. Models of Child Health Appraised (MOCHA) explored the role of the professions of pharmacy, dental health and social care as examples of affiliate contributors to primary care in providing health advice and treatment to children and young people. Pharmacies are much used, but their value as a resource for children seems to be insufficiently recognised in most European Union (EU) and European Economic Area (EEA) countries. Advice from a pharmacist is invaluable, particularly because many medicines for children are only available off-label, or not available in the correct dose, access to a pharmacist for simple queries around certain health issues is often easier and quicker than access to a primary care physician or nursing service. Preventive dentistry is available throughout the EU and EEA, but there are few targeted incentives to ensure all children receive the service, and accessibility to dental treatment is variable, particularly for disabled children or those with specific health needs. Social care services are an essential part of health care for many extremely vulnerable children, for example those with complex care needs. Mapping social care services and the interaction with health services is challenging due to their fragmented provision and the variability of access across the EU and EEA. A lack of coherent structure of the health and social care interface requires parents or other family members to navigate complex systems with little assistance. The needs of pharmacy, dentistry and social care are varied and interwoven with needs from each other and from the healthcare system. Yet, because this inter-connectivity is not sufficiently recognised in the EU and EEA countries, there is a need for improvement of coordination and with the need for these services to focus more fully on children and young people.

From an ethical point of view, the inclusion of children and young people in research is problematic due to their inability to give informed consent and meaningfully express their views. The ethical aspects of research are multiplied if the research participant might have experienced child abuse, neglect, exploitation, or other forms of violence or assisted in such acts. Talking about victimization might be difficult and generate a sense of betrayal of attachment figures. On the other hand, the usual ethical procedure of asking parents or other caretakers to give consent for their children to discuss issues of maltreatment gives them the power to act as gatekeepers to stop children from participating in research. Therefore, researchers should contemplate if parental consent should be waived and how research can be developed to mobilise children's agency and ensure their meaningful cooperation in researching different aspects of violence that affect them. This chapter presents and critically analyses different research examples and discusses their ethical dimensions from a children's rights perspective. The research questions start with discussing the utility of consulting children in research on maltreatment; the gatekeeping role of caregivers; the distress and harm eventually caused to children and young people by participation in research and the benefits of participation for children. The survey examples discussed lead to the conclusions that research on maltreatment might sometimes cause distress; caregivers' power to refuse consent for their children's participation in research on maltreatment can alter epidemiologic data and impede children's right to express their opinion on issues that are central to their lives and therefore, it should be waived; consulting children is essential for collecting data on and improving responses to child maltreatment; and children's contribution to research on maltreatment depends on the adopted methodologies of the research, more advanced forms of participation, and training children to express their opinions, thus enriching scientific knowledge and promoting change.

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.

This study aims to gain a comprehensive understanding of adolescent’s experiences of individual school social work counselling in Swedish elementary schools.

The study encompasses interviews with 16 adolescents about their experiences of individual counselling with school social workers (SSWs). The data was analysed using conventional content analysis.

The main result was the adolescents’ desire “to navigate to shore” to speak freely about their whole lives with a professional SSW and find a “ safe haven,” […] where a trusting professional cared for and comforted them in counselling. The counselling contact contributed to increased knowledge about oneself. The results reveal the importance of the SSWs paying attention and listening to the adolescents’ narratives. The creation of a coherent life narrative enables to finally end counselling and “Cast off.”

The results highlight the importance of Swedish SSWs focusing on individual counselling sessions with adolescents to provide a setting for growth.

This paper aims to investigate infant sensory patterns and their associations with previous perinatal loss, maternal-foetal attachment and postnatal maternal sensory patterns.

In a prospective cohort study, women with and without perinatal loss (N = 57) were recruited from an Australian public hospital. Participants were surveyed during pregnancy (maternal-foetal attachment, loss) and again postnatally (maternal/infant sensory patterns). Chi-square tests and logistic regression analyses controlling for previous perinatal loss were conducted with infant sensory patterns as outcome variables.

“More than typical” infant low registration was associated with poorer quality of maternal-foetal attachment. “More than typical” infant sensory seeking was associated with previous perinatal loss and higher levels of maternal sensory seeking. “More than typical” infant sensory sensitivity was linked with previous perinatal loss, poorer quality of maternal-foetal attachment and higher maternal low registration. “More than typical” infant sensory avoidance was associated with poorer quality of maternal-foetal attachment and higher levels of maternal sensory sensitivity.

To support more typical infant sensory patterns, results point to the potential benefit of occupational therapists supporting pregnant women with previous perinatal loss; facilitating favourable maternal-foetal attachment; and educating new mothers on how their sensory patterns impact on interactions with their infant. Sensory modulation strategies that consider the sensory patterns of both mother and infant may be beneficial to promote engagement in co-occupations.

These findings are the first to suggest that previous perinatal loss, poorer quality of maternal-foetal attachment and higher levels of maternal postnatal sensory patterns represent risk factors for infant sensory patterns that are “more than typical.”

The COVID-19 pandemic is certain to have an unprecedented impact on the global population, but marginalized and vulnerable groups in low-income countries (LICs) are predicted to carry the largest burden. This study focuses on the implications of COVID-19-related measures on three population groups in India, including (1) migrant laborers (of which a majority come from Scheduled Castes (SCs) and Scheduled Tribes (STs), as well as Other Backward Classes (OBCs)), (2) children from low-income families and, (3) refugees and internally displaced persons (IDPs).

This study adopts a sequential mixed-method research design. A desk-based study of a selection of government reports was undertaken on the COVID-19-related mitigation measures. The desk study was followed by in-depth interviews with purposively recruited high-ranking experts in specific sectors of policy implementation and service delivery across the country.

The outcomes of this study shed light on (1) the most urgent needs that need to be addressed per population group, (2) the variety of state-level responses as well as best practices observed to deal with mitigation issues and (3) opportunities for quick relief as well as more long-term solutions.

The COVID-19 pandemic has not only reduced people's means of maintaining a livelihood but has simultaneously revealed some of India's long-standing problems with infrastructure and resource distribution in a range of sectors, including nutrition and health, education, etc. There is an urgent need to construct effective pathways to trace and respond to those people who are desolate, and to learn from – and support – good practices at the grassroot level.

The current study contributes to the discussion on how inclusive public health might be reached.