Improving resident self-efficacy in pediatric palliative care through clinical simulation.

CONTEXT: Pediatric residents have limited training and practice experience with palliative care. This study examined whether clinical simulation improved resident self-efficacy in pediatric palliative care. METHODS: Residents were surveyed on their self-efficacy and how they perceived the importance of pediatric palliative care; they were then randomized into either a control group or an intervention group. The intervention group participated in two simulated pediatric palliative care scenarios. The residents' responses before and after the intervention were analyzed to determine whether simulation training had influenced their responses. RESULTS: Although there were no differences in responses on the importance of pediatric palliative care, respondents were more comfortable with suggesting that conferences are needed with families of children who have life-limiting conditions in order to explain do-not-resuscitate orders. CONCLUSION: Simulation improved pediatric residents' self-efficacy with end-of-life discussions.

Maltreated infants and toddlers: predictors of developmental delay.

OBJECTIVE: The aim of this study was to examine the relationship of child, caregiver, and maltreatment characteristics at the time of the investigation with low scores on developmental measures obtained 18 and 36 months after substantiation in a nationally representative sample of maltreated infants and toddlers. METHOD: A proxy for developmental delay was constructed based on a criterion of 2 or more scores > or = 1 SD below the mean in the domains of adaptive behavior, cognition or communication at each assessment time point. Twenty-three percent of children were classified as having developmental delay, 26% with inconsistent low scores, and 51% with no low scores. An ordered logistic regression was conducted to determine factors associated with low scores. RESULTS: Case worker report of special needs at the time of the investigation, living in continuous poverty, and with caregiver characteristics of cognitive impairment and not having a high school education were associated with low scores. Failure to provide and "other" types of maltreatment, which included sexual abuse and abandonment, were more highly associated with low scores 18- and 36-month postinvestigation. A notable finding was that 15% of children were <6% height/weight. Parameter estimates from an ordered logistic regression are presented to explain the increased likelihood of low scores. CONCLUSION: Characteristics associated with low scores and the developmental delay proxy are identifiable at the time of investigation of maltreatment of infants and toddlers, emphasizing the urgency of providing early intervention developmental services to avoid developmental delay and to maximize outcomes in this highly vulnerable population.

Child welfare worker characteristics and job satisfaction: a national study.

The education, recruitment, training, and retention of a quality child welfare workforce is critical to the successful implementation of public policy and programs for the nation's most vulnerable children. Yet, national information about child welfare workers has never been collected. The National Survey of Child and Adolescent Well-Being is a study of children who are investigated for child maltreatment that also offers information about the child welfare workers (unweighted N = 1,729) who serve them in 36 states and 92 counties. These cases represent the national population of child welfare workers, estimated at more than 50,000, serving children approximately 12 months after a case was opened. Child welfare workers having any graduate or social work degree in a nonurban setting were more satisfied than their peers. Regression results indicate that worker satisfaction is associated with quality of supervision and urban setting but does not have a clearly independent relationship with having a degree in social work. Practice implications are discussed.