Search Results (55)

A growing number of research studies show that children spend less time in natural environments, which may have detrimental effects on children’s mental and physical health. This study explores changes in children’s (6–12 years) use of nearby nature and constraints on playing in nature between 2013 and 2023. We apply an ecological approach, including individual, social, and structural constraints on outdoor play. The study is based on national surveys of parents reporting child play behavior for eight activity categories and nineteen categories of constraints/motivation. Findings reveal a decreasing tendency for time spent on all activity categories and increasing constraints for 17 of 19 categories during the study period. Our ecological approach reveals that there is less time for children’s nature use in contemporary society, and activities are more common in built areas than in nature. The survey identifies some important socio-cultural differences regarding gender, age, and residential setting. In future research, the focus should be on how reduced connection to nature affects children’s mental and physical health, and beyond this, how it affects the understanding of and care for nature among future generations. Full article

Background/Objectives: Residential treatment represents an important level of care for adolescents with severe and/or treatment-refractory obsessive–compulsive disorder (OCD). Despite accumulating evidence supporting the treatment efficacy and cost-effectiveness of insurance-based intensive OCD treatment in residential settings, few data exist that characterize the population of adolescent patients utilizing this level of care. As a result, residential treatment may be poorly understood by patients, their families, and referring providers, which may delay appropriate treatment for adolescents with OCD. Here, we characterize the patient population at an intensive residential treatment center (RTC) and partial hospitalization program (PHP) for adolescents (Mage = 15.23) with a primary diagnosis of OCD. Methods: We examine quantitative data collected from 168 adolescents admitted to the McLean OCD Institute for Children and Adolescents for the treatment of primary OCD or a related disorder over a three-year period. We also conduct analyses on a subset of patients (n = 120) who participated in the Child and Adolescent Routine Evaluation (CARE) Initiative (McLean Child Division-Wide Measurement-Based Care Program) to further characterize this patient population with a lens toward additional comorbidities and factors impacting prognosis. Results: The current paper describes the severity of symptom presentation, comorbidities, psychotropic medication profiles, and disruption to personal and family functioning. Analyses also include the prevalence of OCD subtypes and co-occurrence among varied presentations. Conclusions: In addition to identifying common clinical presentations in an RTC/PHP, this paper further aims to detail best practices and clinical rationale guiding a specialty RTC/PHP to inform families, providers, and payors about the individuals that most benefit from this level of care. Full article

Attachment is an emotional bond based on the first relationships formed between people. In the case of institutionalized children, it is more difficult to establish a secure attachment bond with an adult. The figure of the institutional caregiver is key to promoting secure attachment and emotional support for these vulnerable children. This paper examines children in residential care (0–17 years), their relationship with attachment, and the figure of the institutional caregiver in relation to attachment. We conduct a systematic review of the scientific literature (SLR) carried out using the PRISMA method. The results suggest that institutionalized children are more likely to have behavioral problems because of the type of attachment they develop, and that institutional caregivers mediate attachment through their competence. In conclusion, institutional caregivers are an essential support figure in the life of residential care centers; because of this, these professionals must have adequate working conditions and receive ongoing training and support. Also, it would be necessary to analyze the appropriate skills of institutional caregivers to make appropriate intervention with the minors. Full article

This study investigates the effect of urban forests in reducing particulate matter (PM) concentrations and its subsequent impact on the number of asthma care visits. Understanding the mechanisms behind the relationship between the greenness of blocking forests and the reduction in PM is crucial for assessing the associated human health benefits. This study analyzed the influencing factors for reducing long-term PM₁₀ concentrations, utilizing the vegetation index and meteorological variables. Results showed that the reduction in PM₁₀ began in 2011, five years after the establishment of the blocking forest. The annual mean PM₁₀ concentrations decreased significantly, driven primarily by summer wind speed and summer Enhanced Vegetation Index (EVI), explaining approximately 62% of the variation. A decrease in the number of asthma care visits was observed, similar to the trend of PM₁₀ reduction in the residential area and the increase in the greenness of the blocking forest. The influx of PM into the city, primarily driven by prevailing northwesterly winds, may have been mitigated by the growing blocking forest, contributing to a reduction in asthma-related medical visits among urban residents. In particular, since the onset of the COVID-19 pandemic in 2020, the increase in the PM_2.5/PM₁₀ ratio in residential areas has become more closely linked to the increase in asthma-related medical visits. It suggests another PM_2.5 emission source in the residential area. The number of asthma care visits among children (under 11) and the elderly (over 65) exhibited a strong positive correlation with PM₁₀ levels and a negative correlation with the Normalized Difference Vegetation Index (NDVI). This suggests a link between air quality improvement from the greenness of blocking forests with their capacity to capture PM and respiratory health outcomes, especially for the vulnerable groups to asthma. These findings highlight the need to manage pollutant sources such as transportation and the heating system in residential areas beyond industrial emissions as the point pollution source. The management policies have to focus on protecting vulnerable populations, such as children and the elderly, by implementing small-sized urban forests to adsorb the PM_2.5 within the city and establishing blocking forests to prevent PM₁₀ near the industrial complex. Full article

The ability to adapt interpersonal interactions to temperamental characteristics is essential for high-quality care. We analyzed how temperamental and self-regulation differences among children in residential care were related to the affective relationships and discipline styles of their caregivers. A total of 144 children aged 9–16 years (42.6% boys) and their caregivers from 22 residential care homes (Spain) participated. The Early Adolescent Temperament Questionnaire-Revised (EATQ-R) was used to assess temperament, the Affect Scale and Rules and Demands Scale was used to assess children’s perceptions of affective relationships and discipline styles among their caregivers, and BRIEF-2 was used to assess children’s self-regulation. Perceived warmth/communication was significantly higher than criticism/rejection and children perceived more inductive than rigid or permissive styles. Temperamental-scale fear was positively related to warmth/communication and an inductive style, and negatively related to criticism/rejection and a rigid style, whereas high-intensity pleasure showed the opposite pattern. In addition, some self-regulation and temperament scales explained 26% of the perception of warmth/communication, while others explained 15% of the variability of the rigid discipline style used by care workers. These results can help care workers to adjust their educational strategies according to the temperamental characteristics of this specific population. Full article

(1) Background: Residential care (RC) for children and youth should provide a holistic experience of growing up. Currently, RC homes face many challenges, highlighting the need for validated, innovative interventions. D’AR-TE is a pilot project aimed at creating an innovative intervention model for children and youth in RC, promoting protective factors through activities designed to enhance personal skills, socialization, and relationship building. The project spanned three years, focusing on two main areas: “Promoting the SELF” (including Sports, Art, and Virtual Reality) and “Promoting the US” (group activities with families and non-institutionalized peers). (2) Methods: To validate the D’AR-TE model, 46 children and youth in RC, aged between 6 and 20 years, were assessed. They were divided into an experimental group (26 participants) and a control group (20 participants). The evaluation, conducted at the beginning and end of the project, focused on cognitive and neuropsychological domains. (3) Results: By the end of D’AR-TE, the experimental group showed statistically significant improvements, including decreased aggression perception, increased social support, enhanced self-concept, and better cognitive and emotional performance. (4) Conclusions: These results suggest that D’AR-TE had a positive impact and could be a valid and replicable model for children and youth in RC. Full article

This article explores existing learning gaps concerning optimal ways to support children within and beyond secure care in England and Wales, with a specific focus on Secure Children’s Homes (SCHs). Insights from key stakeholders working in SCHs are often omitted from research despite being fundamental to understanding both challenges and best-practice initiatives. The Children’s Residential Care Research Network, which is a collaboration between the authors, aims to develop novel research with stakeholders working across the secure children’s estate and expand the extant literature to inform the design and build of future Secure Children’s Homes (SCH) through a Child-First lens. The research presented here involves a mixed-methods approach gathering rich qualitative data from participants across the sector. Fifty-three participants engaged in participatory methodologies, focus groups, and interviews, which led to a large data set. Thematic analysis identified three key themes to inform the design and build of new SCHs. SCHs should (i) be close to home to enable family involvement and continuity of care, (ii) feel like a home, and (iii) be flexible and adaptive to changing needs. These findings are feeding into the design of two new homes in England as well as the refurbishment of existing provision and can also influence future expansion of the secure estate. The research also contributes to knowledge about how the Child-First tenets can be engaged to improve outcomes for children deprived of their liberty, both in and outside the youth justice system. Full article

Background/Objectives: Migrant children in family detention facilities often experience frequent relocations and prolonged stays in precarious living conditions. This frequent relocation results in fragmentation of necessary medical care, leading to delays and inadequate medical care. We aim to highlight the critical need for comprehensive medical documentation in immigration detention facilities, a fragmented health care system and potential harm to these children without appropriate medical documentation. Methods: We conducted a retrospective review of 165 medical records from children detained at the Karnes County Family Residential Center between June 2018 and October 2020 to evaluate the adequacy of pediatric medical documentation in an Immigration and Customs Enforcement (ICE) family detention facility. Specific areas of interest included acute care, nutrition, immunization, developmental screening, and tuberculosis screening. Simple descriptive statistics were used to analyze the data. Results: Only 25% of 418 acute medical care visits included specific diagnoses. There was no documentation regarding follow-up recommendations upon release. 97% of children had a chest X-ray completed for tuberculosis screening, however no follow-up recommendations were documented for those with granulomas. Vaccination histories were inconsistently documented. No nutritional categorizations were completed despite 16% of children being at risk for malnutrition or already malnourished. Conclusions: Our findings revealed significant gaps in documentation, particularly in medical decision-making and clinical reasoning. In a fragmented medical system, inadequate documentation can result in avoidable errors in diagnosis and management. Improving documentation practices is crucial to ensure that all children, regardless of immigration status, receive quality healthcare aligned with national and international standards. Full article

This article identifies community-based alternatives to secure care being utilised in The Netherlands, Canada, Hawaii and Scotland. These countries offer ways to not only reduce or eliminate the need to deprive children and young people of their liberty in secure care but also reduce rates of child removal and alternative care placements. Secure care is the containment of children and young people, often subject to child protection interventions and residing in residential care, in a locked facility when they pose a significant risk of harm to the community and themselves. An admission to secure care exposes children to restrictive practices, such as seclusion, use of force and restraint. Jurisdictions have an ethical imperative, and often legislative obligation, to ensure there are less intrusive community-based supports available, which could be utilised instead of a secure care admission where possible. However, there is little research on what alternatives effectively divert secure care admissions. Hawaii, Canada, The Netherlands and Scotland demonstrate how countries can reduce the number of vulnerable children deprived of their liberty and exposed to restrictive practices by enhancing research linkages, responding to the voice of lived experience, and positioning secure care and alternatives within system-wide reform. Full article

A total of 10% of children looked after in residential care in Scotland are aged 5–11. Although there has been a significant amount of information published about the care trajectories of adolescents in residential care, there is limited information about the experiences of younger children. In this paper, we explore the care trajectories and nature of care received by 5–11-year-olds identified as being in need of residential care. Our results show that younger children who enter residential care have significant trauma histories and experience significant levels of emotional and behavioural dysregulation that foster carers find challenging to manage, resulting in recurrent placement breakdowns. Residential care, particularly small-group-sized care that adopts social pedagogical and psychotherapeutic approaches, was considered beneficial for addressing the psychosocial and emotional needs of younger children. Despite these findings, there were concerns about the long-term use of residential care for younger children. Our results highlight that there is a need to improve access to paediatric mental health services for children in family-based placements. There is also a need to invest in better training and support for foster carers looking after children in severe distress. Community-based outreach services and in-home respite services provided by residential care teams are one way this could be achieved. Finally, in order to promote earlier and more timeous use of residential care, there is a need to shift societal views around residential care being a placement of last resort to rather being a place of recovery and healing that should sometimes be used as a placement of first resort. Full article

This study investigates the impact of the Neurosequential Model of Therapeutics (NMT) in child and adolescent psychiatric care, addressing a gap in current clinical methodologies that tend to focus on single problems rather than the interconnected nature of many real-life mental health issues. The study was conducted in a residential setting over an extended period, including children aged 7–13, to observe the effects of implementing NMT. The children presented with complex symptoms and multiple diagnoses. The methods incorporated the NMT approach, emphasizing individualized treatment plans based on each child’s unique brain development, and aimed at addressing multiple, interconnected problems simultaneously. Results from multilevel model analyses of behavioral difficulties, measured using the Child Behavior Checklist (CBCL), revealed substantial improvements in treatment effectiveness post-NMT implementation. Despite the limitations, such as a non-randomized participant selection and limited sample size, the findings strongly suggest that NMT enhances care effectiveness in real-world clinical settings, particularly for children with complex mental health issues. The study concludes that relationally oriented milieu therapy, and specifically the NMT approach, holds great promise for advancing pediatric psychiatric care, advocating for its broader application and further research to refine and substantiate its efficacy. Full article

Background: Children and young people (CYP) in care experience poorer physical health and overall wellbeing in comparison to their peers. Despite this, relatively little is known about what their oral health needs and behaviours are. The aim of this scoping review was to provide a global perspective on the oral health status and behaviours of CYP in care and care leavers. It also aimed to synthesise interventions that have been trialled in this population to improve oral health. Methods: Five databases were searched, Ovid Embase, Ovid MEDLINE, CINAHL (EBSCOhost), SocINDEX (EBSCOhost) and Dentistry and Oral Sciences Source (EBSCOhost), alongside grey literature sources up to January 2023. Eligibility criteria were studies that (i) reported on children and adolescents aged 25 years or younger who are currently in formal/informal foster or residential care and care leavers, (ii) pertained to oral health profile, behaviours or oral health promotion interventions (iii) and were published in the English language. Thematic analysis was used to develop the domains for oral health behaviours and interventions. Results: Seventy-one papers were included. Most papers were published from very high or medium Human Development Index countries. CYP in care were found to experience high levels of decay, dental trauma, periodontal disease and poorer oral health-related quality of life. Oral health behaviours included limited oral health self-care behaviours and a lack of oral health-based knowledge. The trialled interventions involved oral health education, supervised brushing and treatment or preventative dental care. Conclusions: This scoping review reveals that CYP in care experience poorer oral health in comparison to their peers. They are also less likely to carry out oral health self-care behaviours. This review highlights a scarcity of interventions to improve the oral health of this population and a paucity of evidence surrounding the oral health needs of care leavers. Full article

Residential education often both challenges and reinforces the norms and systems supporting children and young people’s need for homely environments. In this context, studies on pupils’ sense of home when attending residential schools provide a ground for exploring broader infrastructures of care available to them as they move through different spaces. Drawing on autoethnography, life-story interviews, and semi-structured interviews, we illustrate how, for children within the Latvian residential school system, homeliness may be found at a relative’s apartment, school bus or youth center affected by how each of the spaces relates to children’s safety and control, privacy, community, identity, everyday life, and time. While normative discourses remain fixated on home as a family space where infrastructures of care can be limited, but educational settings emphasize control as a measure for safety without being attentive to peer-to-peer relationships, children’s agency in achieving a sense of homeliness becomes fragmented and stronger in some places more than others. Full article

It is widely recognised that trauma-informed care is fundamental to meeting the needs of children who experience residential care. Service design is central to this, and the aim of this article is to illustrate the experiences of 13 young people who have lived within group care settings, to highlight how a service’s capacity can impact on children’s needs being met. Using findings from a PhD thesis engaging 18–29-year-olds in Scotland, the research used a mixed methodological approach of questionnaires and semi-structured interviews to elicit young people’s retrospective care experiences. The findings show that the number of children within a setting can adversely affect the feeling of being emotionally and practically supported, resulting in some children feeling that their needs were not fully met. This will offer insight to practitioners, managers and decision makers who are engaged in the delivery and development of children’s services. Background: The United Nations Convention on the Rights of the Child (UNCRC) articles 3, 9 and 20 and Scotland’s Independent Care Review state what children should expect from authorities and services responsible for providing alternative care. The ambition for Scotland’s children is that they “grow up loved, safe, and respected so that (they) realise their full potential”. For those who spend a period of their childhood growing up in residential care, they should experience a relational, trauma-informed and caring approach from staff. Full article

Family-centered care is widely considered as best practice in pediatric rehabilitation. We aimed to investigate parents’ perception of the family-centeredness of health care services for their children with cerebral palsy (CP) using the Arabic Measure of Processes of Care-20 (AR-MPOC-20). We also explored factors related to the child (sex, secondary impairments, and gross motor classification system level) and environment (family and residential region) that may influence the family-centeredness of services in Saudi Arabia. This was a cross-sectional study of 223 children with CP (age 6 months–18.2 years, M = 6.2 + 3.7 years) and their parents. Generally, parents perceived services as less family-centered. The lowest average score was for ‘Providing General Information’ (M = 2.9 ± 1.5), while ‘Respectful and Supportive Care’ had the highest average (M = 4.6 ± 1.8). Factors influencing the provision of family-centered care included being a female child and a mother’s educational level. In addition, all subscales of AR-MPOC-20 differed by region, p < 0.001, except for ‘Providing Specific Information’ which did not significantly differ by region p = 0.163. Clinicians should consider the families’ need for information regarding their children’s condition and available services, with special attention to the mothers of female children and mothers with low levels of education. Full article