Subject(s)
Critical Care , Outcome Assessment, Health Care , Child , Humans , Morbidity , Severity of Illness IndexABSTRACT
Adoption is one of a range of options that can provide children in out-of-home care with permanency when they are unable to be reunified with their birth parents. This paper reports on how the adoption of children from out-of-home care is understood by professionals involved in making decisions about the permanent placement of children in out-of-home care in Victoria, Australia, where adoption is rarely used. Data were collected through a single, face-to-face semi-structured interview with 21 professionals; eight child welfare specialists, eight adoption and permanent care specialists and five judicial officers. The adoption of children from out-of-home care was primarily understood as a child-centered practice that can afford children stability and a sense of belonging. Adoption was largely viewed as a voluntary process dependent upon the consent of a child's birth parents. Adoption and permanent care specialists were the only group to refer to the dispensation of parental consent as a means of obtaining an adoption order. Most decision makers understood that contact between children and their birth parents is possible following adoption, but this was not understood by all judicial officers or all child welfare specialists. Children's connection to their cultural heritage was viewed as important to the consideration of adoption for children in out-of-home care. This research provides insight into the foundations upon which decision makers may appraise adoption, within a hierarchy of options, as a potential outcome for children in need of permanency.
Subject(s)
Adoption/legislation & jurisprudence , Child Welfare/legislation & jurisprudence , Decision Making, Organizational , Foster Home Care/legislation & jurisprudence , Child , Child Custody/legislation & jurisprudence , Decision Making , Female , Humans , Male , Parental Consent/legislation & jurisprudence , Qualitative Research , VictoriaABSTRACT
OBJECTIVE: To describe the characteristics, pattern of injury and outcome of children admitted to a paediatric intensive care unit (PICU) following an inflicted injury. DESIGN, SETTING AND PARTICIPANTS: A retrospective review of hospital records from a 30-bed PICU in a university teaching hospital, examining data for children admitted to the PICU after an inflicted injury from 1 January 2005 to 31 December 2013. MAIN OUTCOME MEASURES: The hospital records of 46 children with an inflicted injury were reviewed. Outcome was categorised using the Pediatric Overall Performance Category score. RESULTS: Sixty-one percent of children admitted to the PICU after an inflicted injury were aged under 12 months. Eighty-three percent of children required admission for a head injury. Radiological findings suggestive of pre-existing inflicted injury were evident in 50% of children. Follow-up information was available for 41 children; 76% were alive at follow-up while 24% had died. Among survivors, outcome was evaluated at a median of 11.3 months after admission to the PICU; 74% had a favourable outcome, despite 61% of these children having a disability. The remaining 26% of children had an unfavourable outcome and were likely to live dependent on care. CONCLUSIONS: The majority of children admitted to intensive care following an inflicted injury are aged under 12 months. Children most commonly require intensive care for management of a head injury. Many children have radiological findings suggestive of pre-existing inflicted injury. Despite high mortality, the majority of children survive. While most are likely to be independent, many children will have residual disabilities.
