Management of extremely complex constipation patients in a nurse-led clinic with health play specialist involvement

IntroductionChildren with idiopathic chronic constipation are extremely challenging to manage. Before review by tertiary specialist teams, Children have suffered for years with constipation, which leads to significant behaviour related issues around toileting, despite adequate medical treatment. The involvement of the health play specialist (HPS) in the nurse-led constipation clinic is to address behaviours around toileting.AimsTo demonstrate involvement of HPS in the clinic led to improved outcomes for children and families. This will be identified through the use of parental satisfaction questionnaires and four case studies.Case StudiesWe demonstrate four extremely complex constipation cases referred to clinic and successfully managed by HPS with unique individualised approach with support and plans for parents and school.9-year-old boy with history of sexual abuse, with soiling and wetting accidents.5 sessions with the HPS, focusing on toileting behaviours. Sessions involved desensitizing play around the body, use of toilet related games/activities, videos and mobile apps. All issues resolved.5-year-old boy: Stool with-holding, will only pass stools in a nappy and soiling.8 sessions with HPS - Intense toilet training for 2–4 days with hourly sits. Reward charts to compliment interests, targets adjusted when goal reached, prizes given. Desensitization play around toileting behaviours. Using analogies to improve behaviour, he loved dustbin lorries – body empties the waste (poo) just like the bin men collecting the rubbish to get rid of it from home. No more accidents, independent toileting achieved5-year-old girl Issues with constipation, soiling and toilet refusal. All bowel movements in knickers.Complete HPS treatment virtually, secondary to COVID restrictions. 6 Video call sessions- individualised plan of regular sits to relax, with no pressure to perform. To do an activity whilst on the toilet. Visual pictures/videos explaining how the body works and the plan was adjusted on the video. Rewards when child reached the target, and prize sent in post. Outcome -no fear of the toilet, bowels open on the toilet, no accidents.8 year old boy premature 33 + 5 weeks. Constipation with overflow since birth. Referred to surgeons for rectal biopsies and botox injections at the age of 3 but no improvement. Age 4 admitted to the ward for 1 week for observation, transit marker study and toilet training was unsuccessful. Referred to another unit for second opinion at parental request. Started to refuse medications. ACE surgery discussed. Diagnosed with Autism at 7 years.Invited for a week of intense toileting with HPS, hourly sits and desensitization activities on medication taking, toileting, with-holding, signs and signals of body. Reward system in place, when reached expectations, reward given by hospital. Outcome bowels open daily in the toilet, wears pants all the time.Satisfaction questionnaires were given to parents and feedback was extremely positive.ConclusionThe health play specialist involvement in the nurse led constipation clinic allows for individualised intervention guided by the child’s needs. Pharmacological interventions alone may be unsuccessful without addressing behavioural needs.

Intergenerational programming during the pandemic: Transformation during (constantly) changing times.

Intergenerational programs have long been employed to reduce ageism and optimize youth and older adult development. Most involve in-person meetings, which COVID-19 arrested. ​​Needs for safety and social contact were amplified during COVID-19, leading to modified programming that engaged generations remotely rather than eliminating it. Our collective case study incorporates four intergenerational programs in five US states prior to and during COVID-19. Each aims to reduce ageism, incorporating nutrition education, technology skills, or photography programming. Authors present case goals, participants, implementation methods, including responses to COVID-19, outcomes, and lessons learned. Technology afforded opportunities for intergenerational connections; non-technological methods also were employed. Across cases, programmatic foci were maintained through adaptive programming. Community partners' awareness of immediate needs facilitated responsive programming with universities, who leveraged unique resources. While new methods and partnerships will continue post-pandemic, authors concurred that virtual contact cannot fully substitute for in-person relationship-building. Remote programming maintained ties between groups ready to resume shared in-person programming as soon as possible; they now have tested means for responding to routine or novel cancellations of in-person programming. Able to implement in-person and remote intergenerational programming, communities can fight ageism and pursue diverse goals regardless of health, transportation, weather, or other restrictions.

Keeping Intergenerational Programming Alive During the Pandemic Through Collaboration and Technology

The University of Rhode Island Cyber-Seniors’ in-person intergenerational programming was quickly shut down during the Spring 2020 semester due to the pandemic. Since then, we have worked diligently and collaboratively with partners to offer creative intergenerational options for university students and older adults living in the community. We partnered with Age-Friendly RI and the Census Outreach to provide phone-based wellness checks to 11,500 older adults, and this evolved into a statewide weekly call with partners (n=34 calls) focused on reducing social isolation for older adults. Our students moved to offering phone or Zoom-based appointments with 21 community organizations across Rhode Island and became mentors for the new Cyber-Seniors ® organization digital offerings (n=90 students). In this presentation, we will share our experiences with the pivot from in-person to mostly technology-based interactions. We will discuss challenges and lessons learned, some of which will be retained regardless of the pandemic situation.

Priorities for the child public health response to the COVID-19 pandemic recovery in England.

Child health is at risk from the unintended consequences of the COVID-19 response and will suffer further unless it is given proper consideration. The pandemic can be conceived as a systemic shock to the wider determinants of child health, with impacts on family functioning and income, access to healthcare and education. This article outlines COVID-19 impacts on children in England. Key priorities relate to the diversion of healthcare during lockdown; interruption and return to schooling; increased health risks and long-term impacts on child poverty and social inequalities. We provide an overview of mitigation strategies and policy recommendations aimed to assist both national and local professionals across child health, education, social care and related fields to inform the policy response.