Mental health services for youths in foster care and disabled youths.
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OBJECTIVES: This study assessed whether mental health services for youths differ with respect to medical assistance aid category. METHODS: Computerized claims for 15,507 youths with Medicaid insurance in a populous county of a mid-Atlantic state were used to establish population-based prevalence estimates of mental disorders and psychotherapeutic treatments during 1996. RESULTS: An analysis of service claims revealed that the prevalence of mental disorders among youths enrolled in foster care (57%) was twice that of youths receiving Supplemental Security Income (SSI; 26%) and nearly 15 times that of other youths receiving other types of aid (4%). Rates of mental health service use were pronounced among foster care youths aged 6 to 14 years. Attention deficit/hyperactivity disorder, depression, and developmental disorders were the most prevalent disorders. Stimulants, antidepressants, and anticonvulsants were the most prevalent medications. CONCLUSIONS: Youths enrolled in foster care and youths receiving SSI use far more mental health services than do youths in other aid categories. Additional research should evaluate the complexity and outcomes of mental health services for youths in foster care. (+info)
Assistance to States for the Education of Children with Disabilities. Office of Special Education and Rehabilitative Services, Department of Education. Final regulations.
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The Secretary amends the regulations for the Assistance to States for the Education of Children with Disabilities program under Part B of the Individuals with Disabilities Education Act (IDEA; Part B). This amendment is needed to implement the statutory provision that for any fiscal year in which the appropriation for section 611 of the IDEA exceeds $4.1 billion, a local educational agency (LEA) may treat as local funds up to 20 percent of the amount it receives that exceeds the amount it received during the prior fiscal year. The amendment is intended to ensure effective implementation of the 20 percent rule by clarifying which funds under Part B of IDEA can be included in the 20 percent calculation, and, as a result, to reduce the potential for audit exceptions. (+info)
The clinical meaning of functional outcome scores in children with juvenile arthritis.
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OBJECTIVE: The Childhood Health Assessment Questionnaire (CHAQ) is the most widely used measure of function in childhood arthritis and yields a score of 0 (no disability) to 3 (very severe disability). This study ascertained the cutoff levels for CHAQ scores that represent no, mild, moderate, and severe disability, to determine the minimal clinically important change in scores and to determine whether the minimal important change in scores is similar for parent-reported assessments and the self-assessments provided by their older children. METHODS: One hundred thirty-six parents of children with arthritis were interviewed. They were asked to complete the CHAQ by assessing their child's functional status under 3 categories: current health, a hypothetical small improvement, and a hypothetical small worsening. They also completed a categorical scale of subjective disability. Those children who were > or = 10 years old also completed the CHAQ interview separately. RESULTS: The pediatric patients had mostly no, mild, or moderate disability. For those children rated as having no disability, the median CHAQ score was 0. The median CHAQ scores corresponding to mild, mild-to-moderate, and moderate disability were 0.13, 0.63, and 1.75, respectively. The minimal clinically important improvement was a reduction in score of 0.13. The minimal clinically important deterioration was a median change in score of 0.75. This discrepancy may be due to the ceiling effect seen with the CHAQ. There were no significant differences when the children assessed themselves. CONCLUSION: Clinicians, as well as researchers setting protocols, should aim for a mimimum improvement of 0.13 in the CHAQ score when treating pediatric patients with arthritis. (+info)
Treatment of functional impairment in severe somatoform pain disorder: a case example.
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OBJECTIVE: To describe the assessment and treatment of severe functional impairment in a young female adolescent with somatoform pain disorder. METHODS: Treatment included an inpatient hospital admission using a rehabilitation approach and behavior modification program. Standardized assessment of functional impairment and health-related quality of life was performed at baseline and follow-up. Diagnostic evaluation and treatment costs were computed using insurance and hospital billing data. RESULTS: Pre-/postintervention measures of functional disability indicated significant improvement in physical and psychosocial functioning in everyday activities. Although costly, the inpatient admission decreased frequent health care use over the short term. CONCLUSIONS: Delay in diagnosis of somatoform disorders may seriously extend children's disability and require more intensive treatment. Functional disability is a critical measure of treatment outcome in children with severe somatoform disorder. Future research concerning interventions for children with a broad range of recurrent and chronic pain symptoms can be strengthened through a focus on reducing functional disability. (+info)
Review of group interventions for pediatric chronic conditions.
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OBJECTIVE: To identify treatment studies on group interventions for pediatric conditions and to review their efficacy using standardized criteria. METHODS: Through a systematic literature review, we identified 125 studies describing group treatments for pediatric populations. Group interventions were classified into one of four types of groups distinguished by their primary goals and intended outcomes: emotional support, psychoeducation, adaptation/skill development, or symptom reduction. A fifth category, summer camps, contained elements of the other categories, but due to their unique setting, we considered them separately. Treatments were evaluated and designated as "promising," "probably efficacious," or "well-established," based on the Chambless/Society for Pediatric Psychology criteria. RESULTS: Group interventions for children and adolescents have been developed to increase knowledge of illness, to increase psychological adaptation, and to decrease physical symptoms and side effects. This literature falls on a broad continuum, ranging from descriptive articles with no empirical assessment of outcome to treatment outcome studies employing randomized control conditions and standardized outcome measures. CONCLUSIONS: Although well-established group interventions do exist, much work is required to establish the efficacy of most group treatments for children and adolescents with chronic illness. Recommendations for improving the status of research are offered. (+info)
Training support staff to embed teaching within natural routines of young children with disabilities in an inclusive preschool.
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We evaluated a program for training 4 support staff to embed instruction within the existing activities of 5 children with disabilities in an inclusive preschool. The program involved classroom-based instruction, role playing, and feedback regarding how to effectively prompt, correct, and reinforce child behavior. Descriptions of naturally occurring teaching opportunities in which to use the teaching skills were also provided. Following classroom training, brief on-the-job training was provided to each staff member, followed by on-the-job feedback. Results indicated that each staff member increased her use of correct teaching procedures when training was implemented. Improvements in child performance accompanied each application of the staff training program. Results are discussed in terms of using effective staff training as one means of increasing the use of recommended intervention procedures in inclusive settings. Areas for future research could focus on training staff to embed other types of recommended practices within typical preschool routines involving children with disabilities. (+info)
Birth weight and school-age disabilities: a population-based study.
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Mortality rates have declined for low birth weight and extremely low birth weight infants. Yet, the consequences of survival for these children may be adverse developmental outcomes. Few studies to date have examined school-age outcomes for these children. The participants in this study represented a population-based cohort of Florida children who were born between 1982 and 1984 and who were receiving a public school education in 1996-1997. Linkage methodology was used to establish a cohort of 267,213 children aged 12-15 years with both birth certificate and school records. Birth weights were stratified into 500-g increments beginning with +info)
Prevention of disability on grounds of suffering.
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This paper examines one particular justification for the screening and termination of embryos/fetuses which possess genetic features known to cause disability. The particular case is that put forward in several places by John Harris. He argues that the obligation to prevent needless suffering justifies the prevention of the births of disabled neonates. The paper begins by rehearsing Harris's case. Then, drawing upon claims advanced in a recent paper in the Journal of Medical Ethics, it is subjected to critical scrutiny, focusing on Harris's "suffering claim" (the claim that a life with disability inevitably involves suffering on a significant scale).(1) It is argued that the suffering claim must be false if understood as an empirical claim. And, even if understood as a conceptual truth, it mistakenly assimilates the concepts of harm and suffering. Finally, again focusing on Harris's recent work in this area, his characterisation of disability as a "harmed condition" is shown not to apply in the case of at least some moderate forms of intellectual disability. (+info)