Pediatric Hospital Admissions with Concern for Neglect: Correlations Between Neglect Types and Other Clinical and Environmental Risk Factors.

OBJECTIVE: Child neglect is a public health concern with negative consequences that impact children, families, and society. While neglect is involved with many pediatric hospitalizations, few studies explore characteristics associated with neglect types, social needs, and post-discharge care. METHODS: Data on neglect type, sociodemographics, social needs, inpatient consultations, and post-discharge care were collected from the electronic medical record for children aged 0-5 years who were hospitalized with concern for neglect during 2016-2020. Frequencies and percentages were calculated to determine sample characteristics. The Chi-square Test for Independence was used to evaluate associations between neglect type and other variables. RESULTS: The most common neglect types were inadequate nutrition (40%), inability to provide basic care (37%), intrauterine substance exposure (25%), combined types (23%), and inadequate medical care (10%). Common characteristics among neglect types included age less than 1 year, male sex, Hispanic ethnicity, public insurance, past involvement with Child Protective Services, and inpatient consultation services (social work, physical therapy, and occupational therapy), and post-discharge recommendations (primary care, physical therapy, and regional center). Neglect type groups varied by child medical history, social needs, and discharge recommendations. Statistically significant associations supported differences per neglect type. CONCLUSIONS: Our findings highlight five specific types of neglect seen in an impoverished and ethnically diverse geographic region. Post-discharge care needs should focus on removing social barriers and optimizing resources, in particular mental health, to mitigate the risk of continued neglect. Future studies should focus on prevention strategies, tailored interventions, and improved resource allocations per neglect type and discharge location.

Facilitators and barriers to Children's Advocacy Center-based multidisciplinary teamwork.

BACKGROUND: Children's Advocacy Centers (CACs) use a multidisciplinary team (MDT) approach to initiate, coordinate, and provide essential multisector services for children and families who experience child abuse. Despite rapid dissemination of the CAC model across the world, little is known about characteristics associated with CAC-based teamwork. OBJECTIVE: Given that teamwork characteristics may impact the outcomes of child and families who interact with CACs, the purpose of this qualitative study was to explore experiences, facilitators, and barriers to CAC-based multidisciplinary teamwork. PARTICIPANTS, SETTING, & METHODS: We conducted semi-structured interviews with members of a MDT at a Midwestern CAC. RESULTS: Findings suggest that MDT teamwork was fostered by clear communication, responsiveness, commitment, openness, and appropriate resources whereas MDT teamwork was hindered by role confusion, conflicting perspectives, poor communication, low staffing, complex politics, and structural barriers. CONCLUSIONS: Characteristics of CAC-based teamwork may vary from the teamwork of other types of child protection teams. Interventions that enhance CAC-based teamwork may optimize the function of CAC MDTs and improve outcomes for children and families who engage with CACs.

Examining child flourishing, family resilience, and adversity in the 2016 National Survey of Children's Health.

PURPOSE: Explore factors associated with flourishing and family resilience among children aged 6 months to 5 years old in the 2016 National Survey of Children's Health (NSCH). DESIGN AND METHODS: Cross-sectional analysis of the 2016 NSCH was conducted using Kleinman and Norton's Regression Risk Analysis method to derive adjusted risk measures for logistic regression models to assess factors contributing to (1) child flourishing and (2) child flourishing stratified between resilient and non-resilient families. RESULTS: In multivariable models, resilient families less often reported a child with two or more lifetime ACE exposures (ARD -0.11, 95% CI -0.15, -0.08), more likely to live in a supportive neighborhood (ARD 0.08, 95% CI 0.05,0.11), and more likely to report emotional support in raising children (ARD 0.07, 95% CI 0.12, 0.40). Accounting for ACE exposures, within resilient families, child flourishing was more likely when the child lived in a supportive neighborhood (ARD 0.09, 95% CI 0.03, 0.15), received care in a patient centered medical home (ARD 0.09, 95% CI 0.02,0.15), and when parents reported having emotional support in raising children (ARD 0.10, 95% CI 0.05, 0.17) Within non-resilient families, child flourishing was more likely when parents had emotional support in raising children (ARD 0.15, 95% CI 0.04,0.27). CONCLUSION: Promoting emotional support for parents may bolster family resilience and help young children to flourish despite adversity. PRACTICE IMPLICATIONS: Further research and innovative models of care are needed to optimize the role of pediatric primary care in promoting safe, stable, nurturing relationships and environments for children and families.

Examining the Relationship of Family Social Capital and Use of Pediatric Primary Health Care Services in the 2016-19 National Survey of Children's Health.

INTRODUCTION: This study examined the relationship of family social capital (FSC) and pediatric primary health care services (PHCU) among young children aged 0-5 years in the United States. FSC involves the interrelated contexts of child health and family characteristics. Understanding how this impacts PHCU may reveal important considerations for supporting access and use of essential health care services. METHOD: Using data from the 2016-19 National Survey of Children's Health (weighted N = 21,496,634), we conducted descriptive statistics and logistic regression to ascertain the relationship between FSC and PHCU. RESULTS: Statistically significant contributions included FSC (odds ratio [OR] = 1.2; confidence interval [CI] = 1.08-1.40), high school (OR = 0.49; CI = 2.65-5.39), and some college (OR = 0.72; CI = 0.62-0.85) DISCUSSION: Findings support that FSC and parent academic achievement impact PHCU. Interventions that foster family connection and parent adult health literacy may enhance PHCU.

From Arksey and O'Malley and Beyond: Customizations to enhance a team-based, mixed approach to scoping review methodology.

This article presents a method of conducting a scoping review that synthesizes recommendations from previous literature while contributing additional customizations to enhance a team-based, mixed method approach. A form of knowledge synthesis, scoping reviews aim to describe the breadth of an existent knowledge base and inform future research, practice, and policy. Scoping review methodology has continued to evolve since the inception of the Arksey and O'Malley Framework in 2005. After examining recommendations from the body of literature on scoping review methodology and scoping reviews about scoping reviews, we found that teamwork and mixed method approaches were rarely addressed. Following the Arksey and O'Malley Framework, we discuss current recommendations within the literature, rationale for our customizations to enhance the method, and present an application of these customizations as illustrated in our companion article, "Outcomes and outputs affiliated with children's advocacy centers in the United States: A scoping review."In sum, our enhancements to the Arksey and O'Malley Framework:•Explicitly integrate qualitative and quantitative assessment of the literature following best practices in mixed methods research, and,•Integrate a team-based approach throughout all stages of the scoping review process.

Outcomes and outputs affiliated with Children's Advocacy Centers in the United States: A scoping review.

BACKGROUND: The Children's Advocacy Center (CAC) model is the predominant multidisciplinary model that responds to child sexual abuse (CSA) in the United States (US). While the CAC model has made important contributions in case coordination and referrals for specialty services, little is known about child- or family-oriented outcomes. OBJECTIVE: Explore the trends and gaps involving outcome and output measures affiliated with CACs in the US. PARTICIPANTS & SETTING: A scoping review of the literature was conducted on English language articles published between 1985-2019 that involved CACs and children less than 18 years of age. METHODS: An electronic database search using the terms "Children's Advocacy Center(s)," "Child Advocacy Center(s)," and "CAC(s)" identified titles and abstracts. Data from articles selected for full text review were evaluated by a multidisciplinary team using a mixed methods approach. RESULTS: Measures of CAC impact frequently focus on service and programmatic outputs with person-centered outcomes left often reported. The most prevalent output measures related to case prosecution and forensic interviews. Person-centered outcomes most commonly emphasized child mental health and caregiver satisfaction. The majority of articles were limited by weak or unspecified study designs. CONCLUSION: The current literature on CACs suggests that while they are successful in coordinating services and facilitating referrals, little is known about how engagement with CACs impacts short- and long-term outcomes for children and families. Further research beyond cross sectional or quasi-experimental designs is necessary to better understand how variability in CAC structure, function, and resources can be optimized to meet the needs of the diverse communities that they serve. This is especially salient given the national dissemination of the CAC model. Without such additional studies, knowledge will remain limited regarding the enduring impacts of CACs on the lives of those impacted by CSA.

Performance of the Person Centered Primary Care Measure in Pediatric Continuity Clinic.

OBJECTIVE: Improvement efforts in pediatric primary care would benefit from measures that capture families' holistic experience of the practice. We sought to assess the reliability and validity of the new Person-Centered Primary Care Measure (PCPCM) in a pediatric resident continuity clinic serving low-income families. METHODS: We incorporated the 11-item PCPCM, stems adapted to reflect a parent responding about their child's visit, into a telephone survey of 194 parents presenting for care in October 2019 at a pediatric resident continuity clinic in Cleveland Ohio (64% response rate). We evaluated PCPCM items using factor analysis and Rasch modeling, and assessed associations of the PCPCM with parents' demographics and perceptions of specific elements of their child's care. RESULTS: In this sample of low-income families, the PCPCM had good reliability (Cronbach's alpha 0.85). All items loaded onto a single factor in principal axes factor analysis. Of the 11 aspects of primary care represented in the scale, "shared experience" was most difficult for parents to endorse in Rasch modeling. All 11 items contributed significantly to the total scale score with corrected item-total correlations >0.4. The PCPCM score was independent of socio demographics and was associated with parent's report that their child's clinician spends enough time with them. CONCLUSIONS: The PCPCM performs well in a pediatric continuity clinic setting, warranting consideration for its use as a parsimonious parent-reported measure of what patients and clinicians say matters most in pediatric primary care.

Advancing Social Mission in Nursing Education: Recommendations From an Expert Advisory Board.

BACKGROUND: Social mission refers to a set of concepts and perspectives that promote health equity in health care delivery and within health professions. Little is known about social mission within the context of nursing education. This article clarifies the role of social mission in nursing education, offers current applications, and identifies future opportunities to maximize social mission within nursing to foster a more just culture of health. METHOD: A multidisciplinary advisory board of experts in nursing education convened to review pertinent literature, current case exemplars, and craft a conceptual framework of social mission in nursing education. RESULTS: The resulting framework consisted of three action-oriented domains to implement social mission into nursing education: board accreditation, curriculum building and faculty training, and developing institutional culture. CONCLUSION: Successful implementation of social mission into nursing education, and subsequently the nursing workforce, offers the opportunity to further embed equity into health care. [J Nurs Educ. 2020;59(8):433-438.].

Social Capital: A Concept Analysis.

The concept of social capital appears in the literature of multiple disciplines as a social determinant of health, an important aspect of human interaction, and a means to support population health capacity. Little is known about the use of social capital within the context of nursing. This article's aim provides insight into the concept of social capital and nursing. Avant and Walker methodology was used to analyze a sample of 78 articles. Along with a variety of articles and content themes, findings from this concept analysis include critical attributes, an operational definition, and reflections regarding future use.