Search Results (47)

Background: Lead (Pb) exposure remains a significant public health concern, particularly among women of childbearing age, because of its adverse effects on maternal–child health. Although lead-glazed ceramics (LGC) for cooking or storing food are a well-recognized source of Pb exposure in Mexico, other environmental and household sources remain insufficiently characterized. Objective: To identify environmental and household factors associated with elevated blood lead levels (BLLs) among women of childbearing age participating in a community-based screening in Mexico City. Methods: We conducted a cross-sectional analysis of 158 women aged 18–40 years. Capillary BLLs were measured using the LeadCare^® II system. Participants completed a structured questionnaire assessing potential Pb sources of exposure. Elevated BLL was defined as ≥3.5 µg/dL. Associations between exposure sources and elevated BLL were evaluated using multivariable logistic regression adjusted for sociodemographic and lifestyle factors. Shapley decomposition was used to estimate the relative contribution of each exposure source to the model. Results: The prevalence of elevated BLLs was 31%. Women reporting both past and current use of LGC had higher odds of elevated BLLs than women who had never used LGC (adjusted OR = 9.43; 95% CI: 1.85–48.15). Living in or regularly visiting a recently remodeled home (adjusted OR = 3.21; 95% CI: 1.45–7.11) and living near a highway (adjusted OR = 2.41; 95% CI: 1.07–5.48) were also independently associated with elevated BLLs. LGC use was the largest contributor to the model performance (47.46%), followed by home remodeling (31.78%) and proximity to highways (20.76%). Conclusions: Our findings support LGC as an important source of Pb exposure while identify home remodeling and residential proximity to highways as additional sources associated with elevated BLLs. Together, these findings broaden the understanding of Pb exposure pathways among women of childbearing age and support the need for prevention and screening strategies. Full article

Children in residential care constitute a particularly vulnerable group at high risk of developing emotional and behavioral difficulties as a consequence of adverse experiences and dysfunctional family environments. Identifying risk and protective factors is essential for designing interventions tailored to their needs; however, the available research remains limited and does not always provide the evidence required to guide effective programs within the child protection system. The aim of this study was to examine the prevalence of emotional and behavioral problems among children in residential care and to analyze the role of family factors, sex, and age in these difficulties. The sample consisted of 210 children aged 6 to 18 years institutionalized in residential care centers and supervised apartments. A cross-sectional design was employed, administering the Strengths and Difficulties Questionnaire (SDQ) along with an ad hoc questionnaire to collect socio-family variables. The results reveal a high prevalence of emotional and behavioral difficulties. The multivariable models explained between 8.1% and 29.4% of the variance in emotional and behavioral functioning and showed that age, sex, exposure to gender-based violence, parental substance use, and parental intellectual disability were associated with specific emotional and behavioral dimensions. The study highlights the need to develop and implement educational and therapeutic programs aimed at strengthening children’s emotional regulation, addressing behavioral difficulties, and considering family-related adversity in intervention planning. Full article

Currently, there is a lack of sufficient research regarding spirituality in the lives of young people in youth care contexts. In this study, youth care refers to various forms of either voluntary or mandatory support and care for young people (children and teenagers) and their educators for growing-up problems, parenting problems, and psychological, psychosocial, and behavioral problems or intellectual disabilities. The available research is not systematically gathered in an overview. Against this background, this article presents a systematic literature review based on the following main research question: What insights can be distilled from scholarly peer-reviewed journal articles published from January 2000–July 2025 regarding spiritual formation in youth care? The results of the review study were based on 41 journal articles. Half of these articles thematize the foster care context. The other articles are spread over other youth care contexts, including psychiatric care, child and youth welfare, residential care, social work, and services for unaccompanied minors. Most of the articles presented empirical research. Three major themes can be defined that connect most articles: (a) the discussion of religion and spirituality as naturally present in the lives of children and the need or right to recognize that dimension and to facilitate continuity in it; (b) the question or the hypothesis that religion and spirituality can promote well-being, including the finding that this does not always appear unambiguous, up to and including attention to the harmful effects of religion and spirituality; and (c) the question of whether and how religion and spirituality can be used more instrumentally in youth care services to provide the best possible care to young people. The article discusses these findings, and recommendations for youth care professionals and follow-up research are presented. Full article

Background: Hepatocellular carcinoma (HCC) poses a significant public health challenge in Australia, with poorer survival observed in non-metropolitan populations. This study investigated whether survival disparities persist between non-metropolitan and metropolitan patients if only those with early-stage HCC treated at metropolitan tertiary referral centres are considered. Methods: We performed a retrospective cohort study across ten Australian tertiary centres involving patients with a new diagnosis of Barcelona Clinic Liver Cancer (BCLC) stage 0 or A, recorded from 1 January 2016 to 31 December 2020. Residential postcodes were entered using the Modified Monash (MM) model to define metropolitan versus non-metropolitan residence. The primary endpoint was adjusted for all-cause mortality. Results: Our study included 854 patients (metropolitan n = 612, and non-metropolitan n = 242) with a median follow-up of 42.6 months. We found no significant survival or mortality differences between the two groups with the unadjusted Kaplan–Meier survival analysis (log-rank test p = 0.612) and with the Cox proportional hazards regression analysis (adjusted HR 0.93, 95% CI 0.64–1.34, p = 0.690). As expected, tumour burden, Child–Pugh Score, and Charlson Comorbidity Index (CCI) were significant predictors of mortality. Conclusions: Our findings suggest that previously observed survival disparities may stem from delayed diagnosis and reduced access to tertiary care in non-metropolitan regions and highlight the need for improved HCC surveillance and referral pathways, particularly for rural and Indigenous communities, to mitigate geographic inequities. Full article

Young people in residential care settings hold distinct preferences regarding their relationships with key adults, including caseworkers and caregivers. However, their perspectives are not consistently assessed or effectively integrated into case planning. Evaluating this integration is essential for fostering positive adjustment and placement stability. Given that residential care represents the predominant child welfare intervention in Portugal, this study adapts and validates an existing instrument for use with youth in residential care institutions, providing evidence of its validity and reliability. Self-report questionnaires—the Positive Residential Care Integration (PRCI) scale (an adapted Positive Home Integration scale) and Strengths and Difficulties Questionnaire—were administered to 511 youth (279 girls and 232 boys), aged 12 to 24 years, across 46 Portuguese residential care institutions. The study examined the face validity, discriminant validity, and reliability of the PRCI scale. Confirmatory factor analysis indicated good model fit, supporting a unidimensional six-item structure. Correlation analyses demonstrated associations with psychological adjustment and sociodemographic variables. The PRCI scale showed satisfactory psychometric properties, confirming its reliability for assessing youth integration in residential care. Cross-gender measurement invariance was also confirmed. These findings underscore the instrument’s relevance and validity for evaluating integration within residential settings and provide valuable guidance for caregivers, professionals, and caseworkers in child welfare services. Full article

There is very limited information available on secure care in Australia. There is no national oversight, standards, or data collection mechanisms. This article aims to outline which Australian states and territories deliver secure care, provide an overview of these interventions, identify trends and outlying practice, and highlight the human rights implications. A comparative systemic methodology was utilised, gathering qualitative data on secure care across Australian states and territories to compare and analyse. The findings are presented descriptively, and a qualitative content analysis was completed. This article identifies that there is secure care in all states and territories in Australia except Tasmania, South Australia, and Queensland. The content analysis identified that the Northern Territory and New South Wales do not have secure care legislation, and that the Australia Capital Territory and New South Wales are the only jurisdictions that require a specific secure care judicial order to authorise admissions. Victoria, the Northern Territory, and Western Australia utilise ‘administrative detention’ to authorise a secure care admission—this is when the admission to secure care of children with the involvement of child protection is authorised by the government, not through a court order via the judicial system. A consequence of the use of administrative detention is that children ‘in care’ in Australia are being deprived of their liberty without legal representation or access to the right to appeal in a court of law. There is minimal publicly available admission data on secure care in Australia. This article argues that secure care’s welfare-based position, conceptualisation, and discourse simultaneously obscures visibility, legitimises depriving children of their liberty and the use of restrictive measures, and undermines a rights-based approach to children experiencing extreme vulnerability. The use of administrative detention undermines system accountability, and the legal safety of children admitted to secure care in Australia. This is placing the rights of children in secure care in Australia as secondary to the management of organisational risk. Full article

Young people under the care of child protection agencies are at increased risk of entering the criminal justice system. Residential youth organisations support young people who are unable to reside with their families or in foster care. Youth workers in these environments ensure the safety and wellbeing of young people in their care, consequently supporting the wellbeing of the overall community. This research explored the views and experiences of Queensland residential youth workers via a focus group interview. The data captured a thick description of service delivery practices. Constructivist Grounded Theory was used to conceptualise a theoretical framework based on the various empirical realities of participants. The findings highlight occasions where complex power dynamics had damaging consequences for youth workers and young people. Participants explored systemic constraints and structural inequalities, thus detailing the implications of top-down organisational structures on their service delivery, safety, and outcomes for young people. Participants were concerned about the implications of interrupted attachment and young people’s progression into crime. Practice recommendations centre around improving the disconnection between front-line realities and systemic hierarchies. Residential out-of-home care service delivery should focus on building community connection and belonging; mental, emotional and physical safety; collaborative care; and support. Full article

This paper proposes a structured design framework and system architecture for a non-intrusive spatial system aimed at supporting child behavior in everyday domestic environments. Rooted in ethical considerations, our approach defines four core behavior-guided design strategies: routine recovery, emotion-responsive adjustment, behavioral transition induction, and external linkage. Each strategy is meticulously translated into a detailed system logic that outlines input conditions, trigger thresholds, and feedback outputs, designed for implementability with ambient sensing technologies. Through a comparative conceptual analysis of three sensing configurations—low-resolution LiDARs, mmWave radars, and environmental sensors—we evaluate their suitability based on technical feasibility, spatial integration, operationalized privacy metrics, and ethical alignment. Supported by preliminary technical observations from lab-based sensor tests, low-resolution LiDAR emerges as the most balanced option for its ability to offer sufficient behavioral insight while enabling edge-based local processing, robustly protecting privacy, and maintaining compatibility with compact residential settings. Based on this, we present a working three-layered system architecture emphasizing edge processing and minimal-intrusion feedback mechanisms. While this paper primarily focuses on the framework and design aspects, we also outline a concrete pilot implementation plan tailored for small-scale home environments, detailing future empirical validation steps for system effectiveness and user acceptance. This structured design logic and pilot framework lays a crucial foundation for future applications in diverse residential and care contexts, facilitating longitudinal observation of behavioral patterns and iterative refinement through lived feedback. Ultimately, this work contributes to the broader discourse on how technology can ethically and developmentally support children’s autonomy and well-being, moving beyond surveillance to enable subtle, ambient, and socially responsible spatial interactions attuned to children’s everyday lives. Full article

This study investigated how county- and state-level socioeconomic factors influence racial differences in placement stability outcomes for children in foster care. Using a sample drawn from the Adoption and Foster Care Analysis and Reporting System (AFCARS) covering 2012–2020, we employed linear mixed modeling (LMMs) to nest individual- and case-level data within counties and states. Our analysis focused on Black and White children, examining how variables such as poverty, unemployment, public welfare expenditures, residential mobility, and family structure affect the number of placement moves experienced by children. The findings indicated that Black children experience higher rates of placement instability compared to White children, although the gap narrows over time. Key factors associated with improved stability included county-administered child welfare systems and higher rates of multigenerational households and owner-occupied housing, particularly benefiting Black children. In contrast, higher levels of Supplemental Nutrition Assistance Program (SNAP) participation and increased residential mobility were linked to greater instability. The implementation of program improvement plans (PIPs) during the third round of the Child and Family Services Reviews (CFSR-3) produced mixed outcomes, with PIPs contributing to a reduction in the racial gap primarily by increasing placement moves for White children. These findings underscore the importance of analyzing data by race and incorporating broader socioeconomic contexts into child welfare improvement strategies, while also emphasizing the need for localized, context-sensitive approaches to improve placement stability. Full article

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

Background: Family caregivers of individuals with intellectual disabilities (ID) face numerous challenges in long-term planning, which have been exacerbated amidst the COVID-19 pandemic. Specific triggers raise awareness of future planning needs, but barriers like painful emotions and exhaustion often impede the process. This study aimed to explore Hong Kong (HK) caregivers’ perspectives on long-term planning for family members with ID at the later period of the pandemic. Methods: A qualitative phenomenological approach was utilized. In-depth interviews regarding experiences with long-term care preparation during COVID-19 were conducted with 12 purposively sampled HK caregivers of adults with ID. Data were analyzed using Colaizzi’s method. Results: Four key themes emerged: planning a loved one’s future alone, the burden of arranging care for disabled loved ones, planning a child’s future care amid family tensions, and the pandemic worsening future caregiving worries. Conclusion: Caregivers urgently require encouragement and support from policymakers and professionals to build confidence in long-term strategy and access robust assistance. Implications include identifying caregiver concerns, aiding gradual planning implementation, increasing respite options, and facilitating discussions regarding future residential care homes. This study provides initial valuable insights into an overlooked population during an unprecedented crisis. Full article

Adults with a history of living in residential youth care (RYC) face elevated risks across various life domains. In this cohort profile paper, we outline the design of a comprehensive follow-up study—the VINGO study—targeting young adults (22–30 years) with a history of living in RYC (T2). We describe the recruitment strategy and present sample characteristics. Data were collected in the baseline study (T1) from 2011 to 2014. At T1, the 400 adolescent participants showed a high prevalence of mental disorders, maltreatment experiences, substance use, and self-reported suicide attempts. Data collection at T2 10 years later (2021–2023) included self-reported sociodemographic information, physical health, childhood maltreatment, dissociation, quality of life, social support, and self-esteem using standardized and validated instruments. A diagnostic psychiatric assessment and subjective evaluation of service utilization were conducted by telephone interviews. Additionally, a qualitative sub-study involved in-depth interviews of fourteen participants. We reached a 52% response rate at T2. Comparing participants (n = 157, 107 females) to non-participants (n = 243, 123 females) based on T1 data revealed that T2 participants had a higher prevalence of depression, anxiety, and conduct disorder and a lower prevalence of ADHD at T1. Furthermore, T2 participants reported more suicide attempts, experiences of maltreatment, and problematic substance use at T1. Our results show that we reached a burdened population, positioning the VINGO study as a unique opportunity to examine a vulnerable population of emerging adults. 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

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