Category Archives: Child welfare
Cindy A. Crusto, PhD, is a Robert Wood Johnson Foundation (RWJF) New Connections grantee, an associate professor of psychology in psychiatry, Yale University School of Medicine, and a Public Voices Fellow with The OpEd Project.
Were the findings really a surprise? The recent release of the report The Burden of Stress in America commissioned by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health, highlights the major role that stress plays in the health and well-being of American adults. As a researcher who studies the impact of emotional or psychological trauma on children’s health, I immediately thought about the findings in the context of trauma and the associated stress in the lives of children. That trauma can include violence in the home, school, and community.
Two decades of research has produced clear findings on this significant public health problem: Psychological trauma can have a powerful influence in the lives of children, and if not detected and addressed early, it can (and often does) have long-lasting physical and mental health effects into adulthood. Despite this strong evidence, I have encountered the sheer resistance of some advocates who work with or on behalf of vulnerable children to fully engage in this topic. Perhaps it’s because of the belief that this talk about trauma is a fad—a hot topic that will fade as soon as something “sexier” comes along.
There is also a concern that an emphasis on trauma further stigmatizes children and the cultural groups to which they belong, reinforcing existing negative stereotypes. You can understand their caution that children’s trauma histories could be used against them, that children might automatically be diagnosed with a mental health disorder, or that they would be seen as a danger to society and in need of the highest, most restrictive level of care. That care often takes children away from their families to secure facilities outside of their communities and even outside of their states.
This is part of the July 2014 issue of Sharing Nursing’s Knowledge.
Short Rest Between Nurses’ Shifts Linked with Fatigue
New research from Norway suggests that nurses with less than 11 hours between shifts could develop sleep problems and suffer fatigue on the job, with long-term implications for nurses’ health.
Psychologist Elisabeth Flo, PhD, of the University of Bergen in Norway, led a team of researchers that analyzed survey data from more than 1,200 Norwegian nurses, focusing on questions about how much time nurses had between shifts, their level of fatigue at work and elsewhere, and whether they experienced anxiety or depression.
Analyzing the data, they found that nurses, on average, had 33 instances of “quick returns” in the previous year—that is, shifts that began 11 hours or less after another shift ended. Nurses with more quick returns were more likely to have pathological fatigue or suffer from difficulty sleeping and excessive sleepiness while awake—both common problems for night workers.
Adam L. Sharp, MD, MS is an emergency physician and recent University of Michigan Robert Wood Johnson Foundation Clinical Scholar (2011-2013). He works for Kaiser Permanente Southern California in the Research and Evaluation Department performing acute care health services and implementation research.
Violence is a leading cause of death and injury in adolescents. Recent studies show effective interventions can prevent violent behavior in youth seen in the Emergency Department (ED). Adoption of this type of preventive care has not been broadly implemented in EDs, however, and cost concerns frequently create barriers to utilization of these types of best practices. Understanding the costs associated with preventive services will allow for wise stewardship over limited health care resources. In a recent publication in Pediatrics, "Cost Analysis of Youth Violence Prevention," colleagues and I predict that it costs just $17.06 to prevent an incident of youth violence.
The violence prevention intervention is a computer-assisted program using motivational interviewing techniques delivered by a trained social worker. The intervention takes about 30 minutes to perform and was evaluated within an urban ED for youth who screened positive for past year violence and alcohol abuse. The outcomes assessed were violence consequences (i.e., trouble at school because of fighting, family/friends suggested you stop fighting, arguments with family/friends because of fighting, felt cannot control fighting, trouble getting along with family/friends because of your fighting), peer victimization (i.e., hit or punched by someone, had a knife/gun used against them), and severe peer aggression (i.e., hit or punched someone, used a knife/gun against someone).
Quick thinking and a lucky coincidence saved a toddler’s life, and the incident is serving as a powerful reminder about the need to train parents and other caregivers about what to do when children choke.
Maja Djukic, PhD, RN, a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar and assistant professor at the New York University College of Nursing, was rollerblading near her home in Connecticut this fall when she heard screaming. Djukic raced to the scene to find a one-year-old boy limp and turning blue. The boy’s father was calling 9-1-1 while him mother tried, unsuccessfully, to clear his air passages. Djukic was able to do so; she had the child breathing by the time an ambulance arrived. He has fully recovered.
In “Keeping Little Breaths Flowing,” Jane E. Brody of the New York Times wrote about the incident, noting that “few parents of newborns are taught how to prevent choking and what to do if it occurs.” Brody’s two-part piece on cardiopulmonary resuscitation (CPR) concludes with “How CPR Can Save a Life,” in which she focuses on resuscitating adult victims of cardiac arrest.
David Olds, PhD, is founder of the Nurse-Family Partnership, a Robert Wood Johnson Foundation 40th Anniversary Force Multiplier that provides maternal and early childhood health programs for at-risk, first-time mothers. He is a professor of pediatrics at the University of Colorado School of Medicine, where he directs the Prevention Research Center for Family and Child Health.
When I finished my undergraduate degree in Baltimore in 1970, I went to work at an inner-city day care center, hoping that I might help poor preschoolers get off to a great start and have a better chance of succeeding in school and becoming productive, healthy citizens. But I soon realized that for many children in my classroom, it was already too little, too late. One little boy had been exposed to alcohol during pregnancy and was pretty profoundly developmentally compromised—he couldn’t communicate with words. Other children were being abused or neglected, so it was clear to me that parents’ prenatal health and parenting behaviors were part of the solution for low-income children.
I would have been out of touch, however, to think that all that was needed was for parents to do a better job of caring for their children. Our center was in a poor, inner-city neighborhood, where poverty, crime and a lack of adequate housing were undeniable influences for families. It was clear that parents wanted the best for their children, but their own personal histories and the social and material stressors weighing on them often made it really hard for them to protect themselves and their children. And this was happening in countless communities across the country.
On April 27, 2011, Robert Wood Johnson Foundation Ladder to Leadership: Developing the Next Generation of Community Health Leaders program graduate (2009-10) Beth Albright Johns, M.P.H., assistant vice president for Early Childhood Initiatives and Education and the Success by 6 program at the United Way of Central Alabama, watched as much of her hometown was destroyed by tornadoes. While helping her friends, neighbors and colleagues in any way that she could, Johns also focused on her primary role, finding ways to protect the emotional health of the children affected by the tornado.
On April 27, 2011, the largest outbreak of tornadoes in the history of our country hit the southeastern United States and my home state of Alabama. Living in my part of Alabama, I am used to severe weather, but the 27th felt different. The day started with a sense of foreboding, but given our weather history, worrying about it was out of character. In our community, a warning of severe weather generally means watching experienced meteorologist, James Spann, roll up his sleeves and get down to business to help us prepare. So that April day, we tuned in only to watch Spann struggle to maintain his composure as the tornado destroyed Tuscaloosa. I became more and more alarmed as I watched it devastate the communities of friends, colleagues and other neighborhoods where I work and tear through my hometown of Birmingham. Numbing disbelief set in as Spann said, “Oh my God, take cover…it’s out of control.”
The next day, April 28th, the community sprung into action. Our boardroom became the statewide 2-1-1 help line headquarters. Calls poured in from people asking for assistance or asking: “What can I do to help out?” Over 13,000 citizens registered through Hands On Birmingham and 2-1-1 to assist with the clean up and recovery. Pallets of clothes, water, generators and people from all over the country arrived to help. While trying to help others, my co-workers were also searching for loved ones and focusing on our job—protecting the mental health of children affected by the storms.
We immediately went to work with local agencies to advocate for mental health assessments for post-traumatic stress disorder among the kids.