Family Self-Sufficiency Program Outcomes for Participants Enrolling During and After the Great Recession

Utilizing administrative data from the Family Self-Sufficiency (FSS) Program operated by the Denver Housing Authority, four program outcomes, (a) savings and escrow growth, (b) credit and debt reduction, (c) employment and earnings, and (d) positive exits from subsidized housing, are examined to assess if any differences exist between participants ( n = 424) who enrolled during or after the Great Recession. Propensity score matching with replacement was employed to match FSS enrollees. Compared to post-Great Recession enrollees, results suggest that enrollees entering the program during the Great Recession were more likely to reduce their monthly contractual debt and derogatory debt, increase monthly earned income, and remain in the FSS Program longer. Findings suggest that attaining participant financial capability goals is possible during severe economic shocks and may provide vulnerable families with additional capacity to weather such shocks.

Improving Child Development Screening: Implications for Professional Practice and Patient Equity

Introduction and Objectives: A pediatric group with 25 clinics and 150 providers used multifaceted approaches to implement workflow processes and an electronic health record (EHR) flowsheet to improve child developmental screening. The key outcome was developmental screening done for every patient during 3 periods between ages 8 and 36 months. Identification of developmental concerns was the secondary study outcome. Screening rates and referrals were hypothesized to be optimized for children regardless of demographic backgrounds. Methods: During preventive visits, developmental screens targeted patients in age groups 8 to 12, 13 to 24, and 25 to 36 months. EHRs were analyzed for screening documentation, results, and referrals by patient demographics. Fifteen pediatric professionals were interviewed about their qualitative experiences. Quality improvement interventions included appointing clinic champions, training staff about the screening process and responsibilities, using a standardized tool, employing plan-do-study-act cycles, posting EHR prompts, providing financial incentives, and monitoring screening rates using control charts. Results: Within 25 months, screening rates improved from 60% to >95% within the 3 preventive visit age groups for a total of more than 30 000 children. Professionals valued the team process improvements. Children enrolled in Medicaid, black children, and those living in lower income zip codes had lower screening rates than privately insured, white children, and those living in higher income areas. Ages and Stages Questionnaire 3rd edition results were significantly different by gender, race/ethnicity, insurance, and income categories across all groups. Referral rates varied by race/ethnicity and zip code of residence. Conclusions: This project resulted in an effective and efficient process to improve child developmental screening that was valued by pediatric professionals. Analyses of patient demographics revealed disparities in services for the most vulnerable families. Ongoing quality improvement, health services research, and advocacy offer hope to improve health equity.

Supporting Premature Infants’ Oral Feeding in the NICU—A Qualitative Study of Nurses’ Perspectives

One major task in the neonatal intensive care unit (NICU) involves ensuring adequate nutrition and supporting the provision of human milk. The aim of this study was to explore nurses’ experiences of the oral feeding process in the NICU when the infant is born extremely or very preterm. We used a qualitative inductive approach. Nine nurses from three family-centered NICUs were interviewed face-to-face. The interviews were transcribed verbatim and analyzed using content analysis. Five sub-categories and two generic categories formed the main category: ‘A complex and long-lasting collaboration.’ The nurses wished to contribute to the parents’ understanding of the feeding process and their own role as parents in this process. The nurses’ intention was to guide and support parents to be autonomous in this process. They saw the family as a team in which the preterm infant was the leader whose needs and development directed the feeding and the parents’ actions in this process. Written and verbal communication, seeing all family members as important members of a team and early identification of the most vulnerable families to direct the emotional and practical feeding support accordingly can strengthen the feeding process in the NICU.

One year of child neurology telemedicine: a data-driven analysis of 14,820 encounters

Introduction Determining the long-term impact of telemedicine in care across the diagnostic and age spectrum of child neurology during the COVID-19 pandemic and with the re-opening of outpatient clinics. Methods An observational cohort study of 34,837 in-person visits and 14,820 telemedicine outpatient pediatric neurology visits between October 1, 2019 and April 9, 2021. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates and demographic factors. Results 26,399 patients were observed in this study (median age 11.4 years [interquartile range, 5.5-15.9]; 13,209 male). We observed a higher proportion of telemedicine for epilepsy (ICD10 G40: OR 1.4, 95% CI 1.3-1.5) and a lower proportion for movement disorders (ICD10 G25: OR 0.7, 95% CI 0.6-0.8; ICD10 R25: OR 0.7, 95% CI 0.6-0.9). Infants were more likely to be seen in-person after re-opening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 0.6, 95% CI 0.6-0.7). Racial and ethnic minority populations and those with highest social vulnerability had lower rates of telemedicine participation throughout the pandemic (OR 0.8, 95% CI 0.8-0.8; OR 0.7, 95% CI 0.7-0.8). Discussion Telemedicine implementation was followed by continued use even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young children and patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.

Who gets coached? A qualitative inquiry into community clinicians’ decisions to use caregiver coaching

Clinicians’ beliefs about an intervention’s fit with an individual family influence whether they use it with that family. The factors that influence clinicians’ decisions to implement evidence-based practices for young autistic children have yet to be evaluated systematically. These factors may partially account for the significant disparities in quality of and access to early intervention. We examined disparities in clinicians’ reported use of caregiver coaching, an evidence-based practice, with families from minoritized or structurally marginalized groups, and the perceived reasons for those disparities, to assess the factors that influence clinicians’ use of caregiver coaching. We conducted semi-structured interviews with 36 early intervention clinicians from publicly funded early intervention agencies in two distinct geographic regions in the United States. Clinicians identified social and structural factors, including perceived family characteristics and stigma, that influenced their beliefs about the fit of coaching with families from minoritized or structurally marginalized groups. These findings point to the presence of beliefs that likely exacerbate disparities in access to evidence-based practices and reduce the quality of care for minoritized families of young autistic children. These findings highlight the need to develop and deploy equity-focused implementation strategies to improve both access to and quality of evidence-based practices for young autistic children from minoritized groups. Lay abstract Providers’ beliefs about an intervention’s fit with a family can affect whether or not they use that intervention with a family. The factors that affect providers’ decisions to use evidence-based practices for young autistic children have not been studied. These factors may play a role in the major differences we see in the quality of and access to early intervention services in the community. We looked at differences in providers’ use of caregiver coaching, an evidence-based practice, with families from minority or vulnerable backgrounds, and the possible reasons for those differences. We did this to figure out what factors affect providers’ use of caregiver coaching. We interviewed 36 early intervention providers from early intervention agencies in two different parts of the United States. Providers pointed out things like what they thought about a family’s circumstances that affected their beliefs about how well coaching fits with minority and vulnerable families. Our findings bring attention to these beliefs that likely make accessing evidence-based practices for minority and vulnerable families harder and lessen the quality of care for these families of young autistic children. These findings highlight the need to come up with and use strategies to improve both access to and the quality of evidence-based practices for young autistic children from minority and vulnerable groups.

Effects of an Early Childhood Training Program on Vulnerable Children’s Outcomes: An Exploratory Study

This exploratory study assessed the effect of an innovative early childhood training approach on the development of children attending an early childhood education and care drop-in centre called Halte-garderie du Coeur offered by a general and vocational college. The direct beneficiaries of the services were children aged four months to five years, who had either experienced maltreatment or were from recently immigrated refugee families. This article presents a mixed methods exploratory and comparative evaluation study based on multiple data sources, including standardized developmental scales measuring child development, data from structured questionnaires with parents and program staff, and interviews with parents and staff. Participants included two cohorts of children and their parents, involving a total of 25 children, 16 parents, and four professionals. The results show that a significant proportion of children attending Halte-garderie du Coeur made gains in their emotional, affective, and social development between the start and end of each of two 12-week sessions. The effects seen in children were consistent with those set out in the program theory. To explain these results, we hypothesize that the training program helped students to develop specific skills that allowed them to positively influence children’s development particularly for children from vulnerable families.

“Wipe them out”! The Social Construction of Children’s Centres

The future for Children’s Centres in England looks bleak.. A change in government in the UK in 2010 saw a change in political perspective that was manifested in one way as austerity. The effects of austerity impacted on a range of public services including Children’s Centres. Children’s Centres also came under government scrutiny resulting in a change of focus in their activities from a core offer of providing services to having a core purpose. The study used a flexible qualitative design to produce a critical discourse analysis about the social construction of Children’s Centres. A range of publicly available documents were gathered to provide naturalistic data relating to Children’s Centres. In addition, six Children’s Centre workers were purposefully selected to take part in a semi structured focus group interview. The subsequent analysis of the document and interview data revealed a range of rhetorical devices used by speakers to construct their perceptions of Children’s Centres. These constructions were organised under four dominant discourses; a discourse of recognition, a discourse of pragmatism, a discourse of pessimism and a discourse of change. One common factor in these four discourses was the role of the UK government. Children’s Centres did not appear to get recognition for some the work they did with families but there was a pragmatism about what Children’s Centres could provide during a period of austerity. There was pessimism about what was happening to Children’s Centres especially in relation to vulnerable families but what seemed inevitable was Children’s Centres were changing.

An Evaluation of the Quality of Parent–Child Interactions inVulnerable Families That Are Followed by Child Protective Services: A Latent Profile Analysis

In the current study, an observational procedure, recorded in video, was used to evaluate the quality of parent–child interactions in a sample of vulnerable Portuguese families (n = 47) with school-aged children followed by Child Protective Services (CPS). The study sought to explore if the families presented different profiles of parent–child interaction quality, and to characterize such profiles in terms of discrete behaviors observed, parenting outcome variables, and families’ sociodemographic and CPS referral characteristics. The parent-child dyads took part in a 15 minutes structured task and parents completed self-report measures (affection, parenting behaviors, and stress). Discrete behaviors of parents and children during interactions were coded with a micro-analytic coding procedure. The global dimensions of the parents’ interactions were coded with a global rating system. A latent profile analysis, estimated with global dimensions, identified two subgroups, one subgroup in which parents displayed higher quality interactions (n = 12), and another subgroup in which parents displayed lower quality interactions (n = 35). Further analyses comparing the subgroups determined that the higher quality subgroup presented more positive behaviors, and the lower quality subgroup presented more negative behaviors during the interactions. No further differences or associations were found regarding the parenting outcome variables, and the families’ sociodemographic and CPS referral characteristics. The findings are in line with prior studies, suggesting that vulnerable families may frequently present depleted parent–child interactions. However, given the small sample size, future studies should replicate the described procedures and analyses in larger sample sizes.

CONDITION OF THE ORAL CAVITY OF SOCIALLY VULNERABLE CHILDREN LIVING IN BATUMI

Based on all discussed, we can clearly indicate that in the city of Batumi, the oral - health of children, coming from socially vulnerable families, are not satisfactory, which at the later stage leads to several diseases. The reasons behind this development are the followings: the low educational rate and non-accessibility to dental and financial assistance services. Recommendations for overcoming this problem include: 1. Increasing accessibility to dental services; 2. Providing high quality medical services, in general; 3. Establishing State - Private cooperation model.