Browsing by Subject "child"

Now showing 1 - 7 of 7
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    Open Access
    Exploring the perspectives of health service providers on mental health policy and interventions for school children in the Western Cape, South Africa
    (2021) Mgoqi, Khusela; Shung-King, Maylene
    Background: Mental health is recognised as a critical public health challenge globally, yet child and adolescent mental health receive low priority, particularly in low- and middle-income countries. Children and adolescents spend a significant proportion of their lives in school, suggesting that educational settings are potentially important environments where child and adolescent mental health (CAMH) can be strengthened to improve early identification and treatment. This study explored the perspectives of key service providers on needs, barriers and facilitators of child and adolescent mental health services (CAMHS) in schools in the Western Cape province of South Africa. Methods: This study employed an exploratory qualitative approach. In-depth individual interviews were conducted by one of the authors (SM), and the first author (KM) conducted a thematic analysis on the interview data. Results: There were nine interviewees selected who were diverse health service providers involved in child and adolescent health which included school doctors, school nurses, psychiatrists, occupational therapist, clinical nurse and mental health nurse. Thematic findings were grouped under: a) perceived needs, b) barriers and c) facilitators. The need to improve intersectoral collaboration, following a referral pathway, a strong multidisciplinary team (MDT) and integration of services were all identified important in the delivery of CAMHS. The neglect of CAMHS in both education and health sectors and limited resources were identified as barriers. Facilitators included intersectoral collaboration, task shifting from nurses and doctors to community health workers, and committed health workers. Conclusion: CAMHS receives very low priority in comparison to other health issues such as HIV/TB in South Africa. There is an urgent need to address CAMHS in South Africa, and the school setting is an important site of intervention. Intersectoral collaboration, task-shifting, continuous training of teachers and health professionals are potential strategies that could be used to strengthen access to CAMHS in education sector and have integrated services in the Western Cape Province.
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    How does the EQ-5D-Y Proxy version 1 perform in 3, 4 and 5-year-old children?
    (2020-05-24) Verstraete, Janine; Lloyd, Andrew; Scott, Des; Jelsma, Jennifer
    Background The EQ-5D-Y Proxy is currently recommended for Health Related Quality of Life (HRQoL) measurement in children aged 4–8 years of age. However, it has only been validated in children over six years of age. The aim of this study was to investigate the performance of the EQ-5D-Y proxy version 1 in children between the ages of 3–6 years. Methods A sample of 328 children between 3 and 6 years of age were recruited which included children who were either acutely-ill (AI), chronically-ill (CI) or from the general school going population (GP). The EQ-5D-Y Proxy Version 1 and the PedsQL questionnaires were administered at baseline. The EQ-5D-Y Proxy was administered telephonically 24 h later to children with chronic illnesses to establish test-retest reliability. The distribution of dimensions and summary scores, Cohen’s kappa, the intraclass correlation coefficient, Pearson’s correlation and Analysis of variance were used to explore the reliability, and validity of the EQ-5D-Y for each age group. A single index score was estimated using Latent scores and Adult EQ-5D-3 L values (Dolan). Results The groups included 3-year olds (n = 105), 4-year olds (n = 98) and 5-years olds (n = 118). The dimension Looking after Myself had the greatest variability between age groups and had the highest rate of problems reported. Worried, Sad or Unhappy and Pain or Discomfort were not stable across time in test-retest analysis. The Visual Analogue Scale (VAS), and single index scores estimated using the latent values and Dolan tariff had good test retest (except for the latent value scores in a small number of 4-year olds). EQ-5D-Y scores for all ages had small to moderate correlations with PedsQL total score. The EQ-5D-Y discriminated well between children with a health condition and the general population for all age groups. Caregivers reported difficulty completing the Looking after Myself dimension due to age-related difficulties with washing and dressing. Conclusion The dimension of Looking after Myself is problematic for these young children but most notably so in the 3 year old group. If one considers the summary scores of the EQ-5D-Y Proxy version 1 it appears to work well. Known group validity was demonstrated. Concurrent validity was demonstrated on a composite level but not for individual dimensions of Usual Activities or Worried, Sad or Unhappy.. The observable dimensions demonstrated stability over time, with the inferred dimensions (Pain or Discomfort and Worried, Sad or Unhappy) less so, which is to be expected. Further work is needed in exploring either the adaptation of the dimensions in the younger age groups.
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    Investigating strategies for addressing child and adolescent mental health following exposure to extreme weather events in low- and middle-income countries: A scoping review
    (2022) Kadota, Molly Kaelin; Rother, Hanna-Andrea; Jagarnath, Meryl
    The inevitability of an increase in extreme weather events (EWE) due to climate change will likely influence every determinant of human health and wellbeing. Children and adolescents, defined as anyone under the age of 19, are among the most susceptible because of their unique vulnerabilities (i.e. physiologically, developmentally, biologically, and behaviourally) and lifespans. The effects on physical health are generally well documented, and many climate change adaptation strategies have begun to include them in their considerations. However, the implications of EWE exposure on mental health are less understood, particularly within low- and middle-income countries (LMICs). Populations residing in LMICs are especially vulnerable because of pre-existing conditions like already extreme weather, lack of resources, poor economic conditions, weak health systems, high burden of disease, and poor governance. Therefore, children and adolescents in LMICs maintain a heightened vulnerability to experiencing adverse effects. In Part A, a preliminary literature review determined the breadth of information documenting child and adolescent mental health outcomes following exposure to EWE. Research, mainly from high-income countries (HICs) or international organisations, demonstrating an association between mental health impacts and climate change, focused primarily on adult populations, has increased substantially over the last few years. Experiencing an EWE in childhood or adolescence likely leads to direct (e.g. anxiety, post-traumatic stress disorder, depression, behavioural disorders, and suicidal ideations), indirect (e.g. displacement, loss of sense of place, violence, malnutrition, developmental delays, and disruption of education), and overarching (e.g. general climate anxiety about impending threats) mental health impacts, presenting in both the short- and long-term. The goals of adaptation and mitigation strategies were also presented in the protocol to determine the potential for specific mental health strategies. In Part B, then, a scoping review was conducted to provide a narrative of where adaptation, resilience, and mitigation strategies in LMICs address, and where they do not, child and adolescent mental health impacts following exposures to EWE. A search conducted in June-August 2021 of 12 online databases from the Pubmed, EBSCOhost, and Scopus platforms and grey literature sites like Google Scholar, Microsoft Academic, and NGO pages identified 5,073 relevant records. Search results were limited to documents written in English and filtered by a 2000-2021 date range. In the current LMICs climate change strategies, the review highlighted a general lack of consideration for child and adolescent mental health and resilience. Therefore, eight main themes recurring in the literature were identified as integral components for including child and adolescent mental health in future national strategies and policymaking discussions. The themes provide general guidance, but their addition necessitates country-specific conceptualisation to determine technical considerations (e.g. funding and responsibility) and relevance. This review, therefore, emphasised the necessity for LMICs to begin including child and adolescent mental health in climate change strategies, highlighted key recommendations that were applicable in the LMICs context, and illuminated still existing gaps in the literature and potential areas for future research.
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    Outcomes of preadolescent children after inpatient psychiatric admission: a scoping review and qualitative study
    (2022) Swart, Tania; de Vries, Petrus J; Davids, Eugene Lee
    Background: Approximately twenty percent (20%) of children and adolescents have mental health disorders and between 50–75% of all adult mental illness has its onset before the age of 18. Few under 18-year-olds with mental health disorders are, however, admitted for psychiatric inpatient care. The majority of those are adolescents who present with emerging serious mental health disorders. Very little is known about inpatient admission of preadolescent children (under 13 years) with mental health disorders. A review in 2000 showed mixed results about outcomes from admissions and highlighted a number of challenges with outcome studies. Objectives: The purpose of this study was to investigate the outcomes of preadolescents (hereafter referred to as ‘children') after inpatient admission, both locally and internationally. Methods: To meet the first aim, we performed a scoping review. Two reviewers independently searched EBSCOhost and Scopus (January 2000 – February 2017), using keywords ‘inpatient'; ‘psychiatry'; ‘psychiatric unit'; ‘mental health'; ‘children'; ‘treatment outcome/s'; ‘follow-up'; ‘secondary care'; to identify studies examining child (0–12 years) psychiatric inpatient outcomes. To meet the second aim, perspectives of convenience sampled parent-child dyads, who were previously patients at an inpatient psychiatric unit for under 13-year-olds in Cape Town, South Africa, were gathered using in-depth individual interviews. Data generated from the interviews were transcribed and analysed using thematic analysis. Results: Seventeen studies were identified by the PRISMA-guided search strategy in the scoping review. Measurements used differed widely. Significant improvements were reported at discharge and was maintained in short-term follow-up (1–4 months) studies. However, medium-term (5–11 months) and long-term (1 year or more) follow-up studies showed mixed results, with marked deterioration in very long-term studies. The qualitative study showed that most families found inpatient admission helpful, and indicated positive outcomes, but with ongoing difficulties over time. Two main themes related to outcomes emerged from the 10 parent-child dyads included in the study. The first theme (“A turn in the road”) highlighted inpatient admission as the catalyst of positive outcomes. Diagnostic certainty; newly acquired cognitive and behavioural skills; improved parent-child relationships; appropriate school placements; development of peer relationships; as well as follow-up psychiatric care and medication, were seen as contributing to positive outcomes. Conversely, the second theme (“Still a rough journey”) described ongoing difficulties including lingering problems despite improvement; minimal improvement when lacking a diagnosis; regression with transition to mainstream secondary school; and negative outcomes associated with lack of peer relationships and discontinuation of psychiatric care and medication. Conclusion: Taking together findings from our work, inpatient stay for child psychiatric patients was found to result in substantial short-term improvement. Medium-term outcomes were less clear, while long-term outcomes appeared mixed, with potential deterioration in the very long-term. However, the relatively few and diverse studies found in the scoping review made interpretation of the findings difficult. One striking finding from the research, was the absence of internationally agreed outcome measures to inform such research. In this study, qualitative data from families and children who had received inpatient treatment provided several functional outcomes that may be important, both for outcomes research and for post-discharge clinical practice.
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    Philosophical enquiry and autism: story/ing/ied bags of unexpected human and more-than-human encounters in speech-language therapy and classroom spaces
    (2025) Babamia, Sumaya; Murris, Karin
    This study is located within early childhood education, early childhood intervention and childhood dis/ability studies. The aim of the thesis is to explore the concept of ontoepistemic injustice for autistic children with/in educational and therapeutic settings. Current pedagogies and interventions are embedded in human-centric ontologies that position autistic child as lacking, immature, and often incapacitated epistemologically. Drawing on critical posthumanism, notably Karen Barad's Agential Realism, the study asks: how might the community of philosophical enquiry be put to work with children who present with significant challenges to enquiry-based learning? How can subjectivity for autistic children be re-configured outside of humanist narratives of mastery, skill and performance? The research questions were explored through postqualitative storying practices where communities of autistic learners participated in a teaching and learning approach known as Philosophy for/with Children. The philosophical enquiries took place at two learning centres in Johannesburg, South Africa. These centres were ‘outlier' educational facilities that accommodated the learning differences of children who were deemed to be intellectually in/eligible for mainstream or remedial schooling. Despite learning, language and communication dis/abilities, the enquiries produced philosophical thinking that emerged in unexpected spaces and times. Often, the thinking that emerged worked outside of language and voice yet were weighty and imbued with intensity as well as affect. The postqualitative analysis in the thesis disrupts the nature/culture binary which has historically positioned autistic child as being of dis/ordered mind. Diffractive engagement with the co-created data of videotapes, photographs, drawings, and fieldnotes troubled normative theories of child development in early childhood education and early intervention that still rely heavily on language and cognition. Of significance in this study is the re-configuration of child subjectivity ‘outside' of the adult human-centred privileges of language, power and agency. Postqualitative research methods highlighted the agency of the material-discursive and troubled the ontoepistemic status of autistic child as ‘lacking' and ‘less-than'. The study shows how Philosophy for/with Children, when theorised as a posthumanist transdisciplinary theorypractice of deep, attentive listening to children's questions and ideas, contributes to and innovates within the fields of autism studies, early childhood education and early intervention.
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    The development of an English Health-Related Quality of Life (HRQoL) measure for very young children, to be completed by proxy
    (2018) Verstraete, Janine; Jelsma, Jennifer; Ramma, Lebogang
    Background and Aims: There is an increasing awareness that, in order to monitor health outcomes both mortality and morbidity need to be assessed. A common metric used to measure morbidity and functional limitation is the quality adjusted life year or QALY, which incorporates time spent in a health condition and Health-Related Quality of Life (HRQoL) into the measure. This is of increasing importance in Low Income Countries (LIC) where programmes have been adopted and implemented to address the high burden of child mortality. The ‘first 1000 days’ is one such initiative which has been adopted by the WHO to improve nutritional support, health care and social support for both the mother and child. One of the aims is to improve quality of life during this vulnerable period. As there is currently no appropriate measure of HRQoL in this age group, we set out to develop a valid and reliable, HRQoL instrument for children from 1 month to 3 years old, amenable to the elicitation of preference weights. Methods: The new HRQoL instrument, HRQoL-6D-IT, was based firstly on a mapping review of HRQoL measures for children. The next stage involved eliciting options through cognitive review from caregivers of very young children regarding HRQoL dimensions included in the EQ-5D-Y an existing validated HRQoL measure for older children. The care-givers were requested to identify items to be considered for inclusion, the wording and layout of the new measure. The item pool generated from the literature reviews and cognitive interviews were then assessed through a Delphi study with experts in the field. These items were further reduced through subsequent testing of items and retesting of a preliminary measure. The final items on the HRQoL-6D-IT included: movement, play, pain, relationships, communication and eating and, apart from pain, the descriptors referenced the behaviour of the child to age appropriate behaviour. The HRQoL-6D-IT was then tested for validity and reliability in a group of acutely-ill (AI), chronically-ill (CI) and typically developing (TD) children in two provinces in South Africa: Western and Eastern Cape. Results: The methodology used to identify candidate items was rigorous and yielded items which were developed to be observable with dimension descriptors referring to ‘age appropriate behaviour’. Caregivers were able to reliably report on HRQoL of their very young children from age 1-36 months. The content validity had been established during the development of the instrument. Concurrent validity of the different items (dimensions) was tested between the HRQoL-6D-IT and relevant items from the ASQ, FLACC and NIPS pain scale and Diet History.
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    The National Food Consumption Survey (NFCS): South Africa, 1999
    (2005) Labadarios, D; Steyn, NP; Maunder, E; MacIntryre, U; Gericke, G; Swart, R; Huskisson, J; Dannhauser, A; Vorster, HH; Nesmvuni, AE; Nel, J H
    Bournemouth University Website, Bournemouth, England, UK