The present study examined the relationship between stigma and parental help-seeking after controlling for demographics, child behavior, and barriers to treatment. One hundred fifteen parents of children ages 4 to 8 years were surveyed during well-child visits in a rural pediatric primary care practice. Parental perceptions of stigma toward parents and children were both assessed. Parents believe that children are more likely to be stigmatized by the public and personally impacted by stigma. In linear regression analyses, parents rated themselves as more likely to attend parenting classes with lower levels of self-stigma and greater levels of personal impact of stigma. Stigma toward the child was not associated with help-seeking. Child behavior moderated the relationship between stigma and parental help-seeking. When referring parents to treatment, providers should address potential stigma concerns. Future research should assess both the impact of the stigma of attending treatment and the stigma of having a child with behavior problems.

Significant numbers of children have diagnosable mental health problems, but only a small proportion of them receive appropriate services. Stigma has been associated with help-seeking for adult mental health problems and for Caucasian parents. The current study aims to understand factors, including stigma, associated with African American parents' help-seeking behavior related to perceived child behavior problems. Participants were a community sample of African American parents and/or legal guardians of children ages 3-8 years recruited from an urban primary care setting (N = 101). Variables included child behavior, stigma (self, friends/family, and public), object of stigma (parent or child), obstacles for engagement, intention to attend parenting classes, and demographics. Self-stigma was the strongest predictor of help-seeking among African American parents. The impact of self-stigma on parents' ratings of the likelihood of attending parenting classes increased when parents considered a situation in which their child's behavior was concerning to them. Findings support the need to consider parent stigma in the design of care models to ensure that children receive needed preventative and treatment services for behavioral/mental health problems in African American families.

Background and aims The implementation of European working time directive and shift patterns of working has highlighted the importance of good handovers in Paediatrics. Current guidance from RCPCH and GMC stress the importance of good handovers. We present a closed loop audit cycle of handover practice, process mapping, the organisational strategies which resulted in use of standardised handover proformas, reducing potential for clinical errors and improved handovers in a district general hospital (~4000 paediatric inpatients a year). Methods Data was collected assessing the handover process using 19 parameters, which included -timing, duration, structure, documentation, facilities and facets of clinical care, over a 2 week period. Changes were introduced following the audit and a re-audit was carried out with same parameters. Results 604 patients were handed over in 2 weeks (32 handovers) during the initial audit. 69% of handovers were delayed greater than 5 min and finished beyond the designated time on 50% occasions. Average duration was 25 mins with 17 interruptions during 2 week period.Changes were implemented following the audit, which involved organisational strategies:Safety briefing Handover proceedings sheet Structured handover sheet Training sessions SBAR handover tool Bleep free period for handover (except emergencies) The re-audit showed significant improvement in all parameters monitored and resulted in improved patient safety and quality of care. Conclusions The use of structured handover format and the above organisational strategies has resulted in improvement in the efficacy and efficiency of data transfer during patient handover and good clinical documentation, resulting in improved patient safety and quality of care.