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The Health Needs of Vulnerable Children: Challenges and Solutions

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 May 2018) | Viewed by 72674

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Dr. Eunice Rodriguez

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Department of Pediatrics, Stanford University, Stanford, CA 94305, USA
Interests: health disparities; health impact of social programs and policies; school health; health education; disease prevention
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on the “Health Needs of Vulnerable Children: Challenges and Solutions” in the International Journal of Environmental Research and Public Health. The venue is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph.

Improving public health is an important objective for policy makers, and the health of children could have long-lasting consequences over the life course. We use the term vulnerable children in a broad sense to include many types of vulnerabilities. Children who are in extreme crisis situations, such as displacement due to climate disaster, civic unrest and violence or economic crisis, as well as those who suffer abuse, are victims of trafficking, or have complex health needs would be among the most vulnerable. However, many other children are also at risk of experiencing health problems due to a variety of persisting challenges, such as poverty and lack of social protection policies. In the more affluent communities, children might be especially vulnerable to stressors that precipitate mental health conditions including self-inflicted harm and suicide.

There is extensive research documenting children vulnerabilities and health challenges during those critical developmental years. Yet, this Special Issue aims to go one step further and focus on programs and policies that have proved to have a positive impact among diverse groups of vulnerable children. With a diverse collection of papers concentrating on different aspects of children’s health and vulnerabilities we intend to offer a critical guide for policy efforts and planning for public health.

This Special Issue is open to any subject area related to the health needs of vulnerable children, and most importantly to interventions and policies that have proved to have a positive impact on improving children’s health. The listed keywords suggest just a few of the many possibilities.

Dr. Eunice Rodriguez
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Children’s health
Social programs and health
Health policy and children
Quality of life

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Related Special Issue

Health Needs of Vulnerable Children: Challenges and Solutions: Second Edition in International Journal of Environmental Research and Public Health (7 articles)

Published Papers (12 papers)

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14 pages, 1273 KiB

Open AccessArticle

Short-Term Medical Relief Trips to Help Vulnerable Populations in Latin America. Bringing Clarity to the Scene

by Melodyanne Y. Cheng and Eunice Rodriguez

Int. J. Environ. Res. Public Health 2019, 16(5), 745; https://doi.org/10.3390/ijerph16050745 - 1 Mar 2019

Cited by 4 | Viewed by 3374

Abstract

Non-profit organizations provide international medical relief trips to low/middle-income countries (LMIC) in order to provide healthcare to medically underserved areas. Short-term medical relief trips (STMRT) take a large amount of time and resources, and arouse concerns about their actual effectiveness. Here we develop a novel tool for consistently assessing how U.S. organizations provide primary care to Latin America through short-term medical relief trips. First, in Part 1, we create a “Best Practice” (BP) framework focused on the efficacy, sustainability, and long-term impact of the organizations based on a review of the last 27 years of available literature published in peer-reviewed journals. Second, in Part 2, out of 581 total medical relief organizations in the US, we identify the 19 organizations currently providing short-term primary care services to Spanish-speaking countries in Latin America. We use the BP framework to analyze the website content and secondary sources of these 19 organizations. We find that only three of the 19 organizations met 80% or more of the criteria defining BP according to the framework and four out of the 19 did not perform well in any of the framework’s three aspects of efficacy, sustainability, and long-term impact. Because there exists no current standardized way of assessing the methods implemented and services offered by STMRT, we provide suggestions about using this novel framework as a self-assessment tool for STMRT organizations. Full article

(This article belongs to the Special Issue The Health Needs of Vulnerable Children: Challenges and Solutions)

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10 pages, 497 KiB

Open AccessFeature PaperArticle

Increasing Screening Follow-Up for Vulnerable Children: A Partnership with School Nurses

by Eunice Rodriguez, Ashini Srivastava and Melinda Landau

Int. J. Environ. Res. Public Health 2018, 15(8), 1572; https://doi.org/10.3390/ijerph15081572 - 25 Jul 2018

Cited by 11 | Viewed by 5171

Abstract

Approximately 20% of school-age children have a vision problem. Screening is an effective way to detect visual impairments, although only if adequate follow-up is available. Here, we evaluate the impact of hiring full-time nurses in four underserved schools on the likelihood of increasing follow-up for treatment after vision screening. First, we compared descriptive screening follow-up data from the intervention schools with that of five matched schools with part-time nurses in San Jose, California, from 2008 to 2012. The intervention schools had around 2800 low-income, minority children each year, and the five comparison schools had around 3445. Secondly, we conducted a qualitative analysis of open-ended survey responses from 129 teachers in the nine participating schools. In the final year, 96% of the students screened and referred for possible vision problems in schools with full-time nurses were followed up and examined by a health care provider. Yet, only 67% of students screened in comparison schools were examined. Teachers in schools with full-time nurses reported that follow-up of vision problems and getting glasses for students was the most beneficial activity performed by the nurses. School nurses can effectively increase medical care coordination and follow-up of vision screening in low-income communities. Full article

(This article belongs to the Special Issue The Health Needs of Vulnerable Children: Challenges and Solutions)

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9 pages, 283 KiB

Open AccessArticle

In-Person Interpreter Use and Hospital Length of Stay among Infants with Low Birth Weight

by Monica Eneriz-Wiemer, Lee M. Sanders, Mary McIntyre, Fernando S. Mendoza, D. Phuong Do and C. Jason Wang

Int. J. Environ. Res. Public Health 2018, 15(8), 1570; https://doi.org/10.3390/ijerph15081570 - 25 Jul 2018

Cited by 9 | Viewed by 4058

Abstract

To ensure timely appropriate care for low-birth-weight (LBW) infants, healthcare providers must communicate effectively with parents, even when language barriers exist. We sought to evaluate whether non-English primary language (NEPL) and professional in-person interpreter use were associated with differential hospital length of stay for LBW infants, who may incur high healthcare costs. We analyzed data for 2047 infants born between 1 January 2008 and 30 April 2013 with weight <2500 g at one hospital with high NEPL prevalence. We evaluated relationships of NEPL and in-person interpreter use on length of stay, adjusting for medical severity. Overall, 396 (19%) had NEPL parents. Fifty-three percent of NEPL parents had documented interpreter use. Length of stay ranged from 1 to 195 days (median 11). Infants of NEPL parents with no interpreter use had a 49% shorter length of stay (adjusted incidence rate ratio (IRR) 0.51, 95% confidence interval (CI) 0.43–0.61) compared to English-speakers. Infants of parents with NEPL and low interpreter use (<25% of hospital days) had a 26% longer length of stay (adjusted IRR 1.26, 95% CI 1.06–1.51). NEPL and high interpreter use (>25% of hospital days) showed a trend for an even longer length of stay. Unmeasured clinical and social/cultural factors may contribute to differences in length of stay. Full article

(This article belongs to the Special Issue The Health Needs of Vulnerable Children: Challenges and Solutions)

27 pages, 3528 KiB

Open AccessArticle

Nonadult Supervision of Children in Low- and Middle-Income Countries: Results from 61 National Population-Based Surveys

by Mónica Ruiz-Casares, José Ignacio Nazif-Muñoz, René Iwo and Youssef Oulhote

Int. J. Environ. Res. Public Health 2018, 15(8), 1564; https://doi.org/10.3390/ijerph15081564 - 24 Jul 2018

Cited by 26 | Viewed by 5296

Abstract

Despite scarce empirical research in most countries, evidence has shown that young children are unsupervised or under the supervision of another young child while their adult caregivers attend work or engage in other activities outside the home. Lack of quality supervision has been linked to unintentional childhood injuries and other negative outcomes. Nationally representative, population-based data from rounds four and five of the Multiple Indicator Cluster Surveys (MICS) and four to eight of the Demographic and Health Surveys (DHS) from 61 low- and middle-income countries were used to estimate prevalence and socio-economic factors associated with leaving children under five years old home alone or under the care of another child younger than 10 years of age. Socio-economic factors included age and sex of the child, rurality, wealth, maternal education, and household composition. Large variations in the prevalence rates (0.1–35.3% for children home alone and 0.2–50.6% for children supervised by another child) and associated factors have been recorded within and across regions and countries. Understanding why and under what conditions children are home alone or under the supervision of another child is crucial to the development of suitable policies and interventions to protect young children, promote healthy growth, and support caregivers. Full article

(This article belongs to the Special Issue The Health Needs of Vulnerable Children: Challenges and Solutions)

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13 pages, 2070 KiB

Open AccessArticle

Exploring Harms Experienced by Children Aged 7 to 11 Using Ambulance Attendance Data: A 6-Year Comparison with Adolescents Aged 12–17

by Debbie Scott, Rose Crossin, Rowan Ogeil, Karen Smith and Dan I. Lubman

Int. J. Environ. Res. Public Health 2018, 15(7), 1385; https://doi.org/10.3390/ijerph15071385 - 2 Jul 2018

Cited by 8 | Viewed by 4725

Abstract

Many population data sources do not routinely collect data of children under 12, despite research showing that mental health, self-injurious behaviour, and substance ingestion can have severe consequences in this age group. We used 6 years (January 2012 to December 2017) of ambulance attendance data from the Australian state of Victoria to characterise mental health, self-injurious behaviour, and substance ingestion in children aged 7–11. We compared this group to older children aged 12–17. We found that in comparison to those aged 12–17 (n = 26,778), a smaller number of children aged 7–11 years (n = 1558) were experiencing serious harms, with mental health symptomology the most common harmful outcome. Self-injurious behaviour significantly increased in both age groups throughout the study period. For mental health, self-injurious behaviour and substance ingestion in the 7–11 age group, males were significantly over-represented. These aged 7–11 were more likely to ingest pharmaceuticals, rather than alcohol or illicit substances, and suicidal ideation was the most common self-injurious behaviour in this age group. Our study suggests that data collection needs to occur specifically in the 7–11 age group, and importantly, services and interventions to improve mental health and wellbeing will need to be specifically designed and targeted at this age group. Full article

(This article belongs to the Special Issue The Health Needs of Vulnerable Children: Challenges and Solutions)

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10 pages, 302 KiB

Open AccessArticle

The Influence of Maternal and Household Resources, and Parental Psychosocial Child Stimulation on Early Childhood Development: A Cross-Sectional Study of Children 36–59 Months in Honduras

by Helga Bjørnøy Urke, Mariela Contreras and Dennis Juma Matanda

Int. J. Environ. Res. Public Health 2018, 15(5), 926; https://doi.org/10.3390/ijerph15050926 - 7 May 2018

Cited by 21 | Viewed by 5920

Abstract

Optimal early childhood development (ECD) is currently jeopardized for more than 250 million children under five in low- and middle-income countries. The Sustainable Development Goals has called for a renewed emphasis on children’s wellbeing, encompassing a holistic approach that ensures nurturing care to facilitate optimal child development. In vulnerable contexts, the extent of a family’s available resources can influence a child’s potential of reaching its optimal development. Few studies have examined these relationships in low- and middle-income countries using nationally representative samples. The present paper explored the relationships between maternal and paternal psychosocial stimulation of the child as well as maternal and household resources and ECD among 2729 children 36–59 months old in Honduras. Data from the Demographic and Health Surveys conducted in 2011–2012 was used. Adjusted logistic regression analyses showed that maternal psychosocial stimulation was positively and significantly associated with ECD in the full, rural, and lowest wealth quintile samples. These findings underscore the importance of maternal engagement in facilitating ECD but also highlight the role of context when designing tailored interventions to improve ECD. Full article

(This article belongs to the Special Issue The Health Needs of Vulnerable Children: Challenges and Solutions)

9 pages, 456 KiB

Open AccessFeature PaperArticle

Parental Attitudes, Behaviors, and Barriers to School Readiness among Parents of Low-Income Latino Children

by Jaime Peterson, Janine Bruce, Neel Patel and Lisa J. Chamberlain

Int. J. Environ. Res. Public Health 2018, 15(2), 188; https://doi.org/10.3390/ijerph15020188 - 24 Jan 2018

Cited by 29 | Viewed by 8808

Abstract

We sought to explore parental attitudes, behaviors, and barriers regarding school readiness in a county clinic serving low income, Latino children. Between December 2013–September 2014, we conducted a cross sectional survey of parents during 3–6 years well-child appointments about school readiness (SR) across: (1) attitudes/behaviors; (2) barriers; and (3) awareness; and (4) use of local resources. Most parents (n = 210, response rate 95.6%) find it very important/important for their child to know specific skills prior to school: take turns and share (98.5%), use a pencil and count (97.6%), know letters (99.1%), colors (97.1%), and shapes (96.1%). Over 80% of parents find education important and engage in positive SR behaviors: singing, practicing letters, or reading. Major barriers to SR were lack of knowledge for kindergarten readiness, language barriers, access to books at home, constraints on nightly reading, difficulty completing school forms, and limited free time with child. Awareness of local resources such as preschool programs was higher than actual utilization. These low-income, Latino parents value SR but lack knowledge to prepare their child for school and underutilize community resources such as free preschool programs. Pediatricians are uniquely positioned to address these needs, but more evidence-based interventions are needed. Full article

(This article belongs to the Special Issue The Health Needs of Vulnerable Children: Challenges and Solutions)

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21 pages, 1396 KiB

Open AccessArticle

Seeing Context through Metaphor: Using Communications Research to Bring a Social Determinants Perspective to Public Thinking about Child Abuse and Neglect

by Nathaniel Kendall-Taylor and Kate Stanley

Int. J. Environ. Res. Public Health 2018, 15(1), 152; https://doi.org/10.3390/ijerph15010152 - 19 Jan 2018

Cited by 5 | Viewed by 9238

Abstract

Human beings think in metaphor and reason through analogy. The metaphors through which we think influence how we understand and feel about social issues as well as the actions that we see as appropriate and important. Metaphors can be used to increase understanding of how issues work and increase the salience of a given issue, build support for programs and policies necessary to address the issue, and instigate demand for change and civic action. In this paper, we use a mixed methods research design, including brief qualitative interviews, experimental surveys, and focus groups, to test the ability of different metaphors to influence public understanding of the social determinants of child abuse and neglect in the UK. We find one metaphor in particular that improves people’s understanding of the social causes of child maltreatment and increases support for structural solutions. This metaphor can be used to build support for preventative public health solutions. Full article

(This article belongs to the Special Issue The Health Needs of Vulnerable Children: Challenges and Solutions)

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887 KiB

Open AccessArticle

Maternal Depressive Symptoms and Child Behavior among Mexican Women and Their Children

by Emily P. Flynn, Esther O. Chung, Emily J. Ozer and Lia C. H. Fernald

Int. J. Environ. Res. Public Health 2017, 14(12), 1566; https://doi.org/10.3390/ijerph14121566 - 18 Dec 2017

Cited by 8 | Viewed by 5676

Abstract

Over 50% of mothers in rural Mexico have high depressive symptoms, and their children’s health and development are likely to be negatively affected. A critical question is whether children vary in their vulnerability to the effects of high maternal depressive symptoms according to their indigenous ethnicity, maternal education, or household wealth. Our sample included 4442 mothers and 5503 children from an evaluation of Mexico’s social welfare program. Maternal depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) Scale, and child behavior was measured using an adapted version of the Behavior Problems Index (BPI). Multiple linear regression models were used to explore the associations between maternal depressive symptoms and child behavior problems, and the heterogeneity of associations by indigenous ethnicity, maternal education, and household assets. We found that having greater maternal depressive symptoms was significantly associated with having a child with more behavior problems (β = 0.114, p < 0.0001, [95% CI 0.101, 0.127]), in adjusted models. In tests of heterogeneity, the association between maternal depressive symptoms and child behavior problems was strongest in households with indigenous ethnicity, low maternal education, or in households with fewer assets. These results strengthen the case for effective mental health interventions in low- and middle-income countries, particularly among the most vulnerable families where mothers and children appear to be at the greatest risk. Full article

(This article belongs to the Special Issue The Health Needs of Vulnerable Children: Challenges and Solutions)

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9 pages, 465 KiB

Open AccessProject Report

Implementation of Motivational Interviewing Training in an Undergraduate Nursing Curriculum: Identifying Adolescents at Risk for Substance Use

by Denise Seigart, Max Veltman, Janet Willhaus and Colene Letterle

Int. J. Environ. Res. Public Health 2018, 15(8), 1623; https://doi.org/10.3390/ijerph15081623 - 1 Aug 2018

Cited by 8 | Viewed by 5293

Abstract

Motivational interviewing (MI) has been increasingly utilized by health care practitioners for many years. MI has been practiced by social workers, nurses, physicians, psychologists, substance use counselors, and many other health care practitioners. Unfortunately, many health care practitioners do not have adequate training in motivational interviewing, and therefore feel ill equipped to utilize this approach when faced with clients who are in need of assessment and coaching. This paper discusses our experiences with a pilot project to implement MI training within an Adolescent SBIRT (Screening, Brief Intervention, Referral to Treatment) content addition to the undergraduate nursing curriculum. It includes discussion of the evaluation, which measured student attitudes towards substance users with the Substance Use Attitudinal Survey (SAAS), student satisfaction with the newly implemented curriculum, and implications for sustainable inclusion of this content and simulation experiences at the undergraduate level to promote MI use by future health care practitioners. Pre- and post-tests (SAAS) were conducted with 51 nursing students, and 56 students completed the satisfaction survey. Overall, students were very satisfied with the implementation of the curriculum, however, we did not see significant changes in SAAS test scores. This may, however, be a positive indicator of a balanced attitude toward substance users. Continuing evaluation of the curriculum change is needed. Full article

(This article belongs to the Special Issue The Health Needs of Vulnerable Children: Challenges and Solutions)

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8 pages, 301 KiB

Open AccessBrief Report

The At Risk Child Clinic (ARCC): 3 Years of Health Activities in Support of the Most Vulnerable Children in Beira, Mozambique

by Claudia Marotta, Francesco Di Gennaro, Damiano Pizzol, Geoffrey Madeira, Laura Monno, Annalisa Saracino, Giovanni Putoto, Alessandra Casuccio and Walter Mazzucco

Int. J. Environ. Res. Public Health 2018, 15(7), 1350; https://doi.org/10.3390/ijerph15071350 - 27 Jun 2018

Cited by 30 | Viewed by 4445

Abstract

The concept of “children at risk” changes worldwide according to each specific context. Africa has a large burden of overall risk factors related to childhood health and development, most of which are of an infective or social origin. The aim of this study was to report and analyze the volumes of activities of fifteen At Risk Child Clinics (ARCCs) within the Beira District (Mozambique) over a 3 year-period in order to define the health profile of children accessing such health services. We retrospectively analyzed the data from all of the children accessing one of the 15 Beira ARCCs from January 2015 to December 2017. From this, 17,657 first consultations were registered. The motivations for accessing the services were in order of relevance: HIV exposure (n. 12,300; 69.7%), other risk conditions (n. 2542; 14.4%), Moderate Acute Malnutrition (MAM) (n. 1664; 9.4%), Severe Acute Malnutrition (SAM) (n. 772; 4.4%), and TB exposure (n. 542; 3.1%). During the first consultations, 16,865 children were screened for HIV (95.5%), and 7.89% tested HIV-positive. In our three years of experience, HIV exposure was the main indication for children to access the ARCCs in Mozambique. ARCCs could represent a strategic point to better understand health demands and to monitor the quality of care provided to this vulnerable population group, however significant effort is needed to improve the quality of the data collection. Full article

(This article belongs to the Special Issue The Health Needs of Vulnerable Children: Challenges and Solutions)

17 pages, 904 KiB

Open AccessCase Report

Addressing the Mental Health Needs of Black American Youth and Families: A Case Study from the EMBRace Intervention

by Riana E. Anderson, Shawn C. T. Jones, Crystal C. Navarro, Monique C. McKenny, Tulsi J. Mehta and Howard C. Stevenson

Int. J. Environ. Res. Public Health 2018, 15(5), 898; https://doi.org/10.3390/ijerph15050898 - 2 May 2018

Cited by 26 | Viewed by 9176

Abstract

Black American youth are vulnerable to the consequences of repeated exposure to racial discrimination, particularly through hampered coping abilities and greater internalizing and externalizing problems. One way in which Black American parents have protected their children from these deleterious consequences is through racial socialization, or communication regarding aspects of racialized experiences and contexts. Less is known, however, about the potential therapeutic benefits of racial socialization via clinical intervention. The five-week Engaging, Managing, and Bonding through Race (EMBRace) racial socialization intervention was developed to enhance coping strategies for parents and adolescents and reduce adolescent internalizing and externalizing problems. The purpose of this study is to describe a case study of one family through a mixed methods approach. Variables of interest included racial discrimination, racial socialization, coping, and psychological well-being. Quantitative and qualitative assessments were performed two weeks prior to and one week after the implementation of EMBRace, with qualitative data collected throughout the intervention. Results indicate a developing sense of coping for the adolescent and parent and reduced adolescent psychosocial problems despite increased racialized stress. Results will be used to further investigate the hypotheses proposed in the pilot with a powered sample, and future studies will explore how sociodemographic and biopsychosocial variables relate to policy recommendations, program implementation, and psychosocial outcomes. Full article

(This article belongs to the Special Issue The Health Needs of Vulnerable Children: Challenges and Solutions)

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