Purpose: Rates of childhood disability are estimated to be high in African settings; however, services to provide information and support are limited. This study aims to explore perspectives and experiences of caregivers of children with disabilities (CWD) from acquired brain injury to inform the development of training packages for health-workers (HW) in hospital settings. Methods: The study was conducted in a tertiary hospital using qualitative methods. Fourteen in-depth interviews (IDIs) were conducted with parents/carers (PC), and 10 IDIs and 4 focus-group discussions (FGDs) with HW. Data were audio-recorded, transcribed, translated and analysed using thematic approaches. Results: HWs and PCs held varying perspectives on aetiology and prognosis for CWD. HWs raised concerns about impact on families, risks of neglect and abuse. Barriers to care and support included prioritisation of acute illness, lack of HW knowledge and confidence, stigma, poor communication, focus on physical disability, and poor availability of services. Among ideas for improvement, good communication and counselling was seen as a priority but not often achieved. Conclusion: A range of family, health service and wider contextual factors affect care for CWD. Training for HW should emphasise disability rights, access to services, a range of disabilities and specific training on counselling.Implications for RehabilitationTo create good training programmes for workers who manage children with neurodisability, workers’ views on their training needs, as well parents’ views of what feel they need to know most, must be taken into account.The need for training regarding communication skills is a priority for health-workers (HW), who manage children with neurodisability in Malawi and confidence in this area is likely to be vital in providing support for these families.Disability rights and inclusion should be imperative in any training programme for managing children with neurodisability in hospital settings.Even in low-resource settings such as Malawi, it is vital that the links between hospital management and the limited resources in the community are updated and maintained.
Exclusion from school was associated with child, family and school-related factors identifiable at, or prior to, primary school age. Child health professionals have an important role in the holistic, multidisciplinary assessment of children who are at risk of exclusion from school. Mental health and neurodevelopmental difficulties should be recognized and supported, to improve the health and educational outcomes among this vulnerable group.
Background: As the prevalence of childhood mental health conditions varies by age and gender, we explored whether there were similar variations in the relationship between psychopathology and exclusion from school in a prospective UK population-based birth cohort. Method: The Avon Longitudinal Study of Parents and Children collected reports of exclusion at 8 years and 16 years. Mental health was assessed at repeated time points using the Strengths and Difficulties Questionnaire (SDQ). Results: Using adjusted linear mixed effects models, we detected a nonlinear interaction between exclusion and age related to poor mental health for boys [adjusted coefficient 1.13 (95% confidence interval 0.55-1.71)] excluded by age 8, but not for girls. The SDQ scores of boys who were excluded in primary school were higher than their peers from age 3, and increasingly diverged over time. As teenagers, these interactions appeared for both genders [boys' adjusted coefficient 0.18 (0.10-0.27); girls 0.29 (0.17-0.40)]. For teenage girls, exclusion by 16 was followed by deteriorating mental health. Family adversity predicted exclusion in all analyses. Conclusion: Prompt access to effective intervention for children in poor mental health may improve both mental health and access to education. Key Practitioner Message • Children who were subsequently excluded from school often faced family adversity and had poor mental health, which suggests the need for an interdisciplinary response and a multiagency approach. • Poor mental health may contribute to and result from exclusion from school, so both mental health and education practitioners have a key role to play. • Boys who enter school with poor mental health are at high risk of exclusion in primary school, which prompt assessment and intervention may prevent. • Both boys and girls who are excluded between the ages of 15 and 16 years may have poor, and in the case of girls, deteriorating, mental health.
The version presented here may differ from the published version. If citing, you are advised to consult the published version for pagination, volume/issue and date of publication '...he was excluded for the kind of behaviour that we thought he needed support with…' A qualitative analysis of the experiences and perspectives of parents whose children have been excluded from school Abstract Exclusion from school is associated with adverse outcomes for young people. There is limited research that explores parents' perspectives, particularly in relation to the exclusion of primary school aged children. The present study used semi-structured interviews with 35 parents of 37 children aged 5-12 years from the Southwest of England. Parent's experiences were captured in a conceptual model through three main themes. Exclusion was described as part of a complex journey of difficulties reflected by a continuum of coping. The child's place on the continuum was determined by an interaction between the child, family, and school with communication a key determinant. The study also highlighted the wider implications of exclusion, including emotional and functional impacts on the child and parent and highlighted the importance of the parent's voice in the identification and support of their child's needs. It also presents the many complexities surrounding exclusion from school and the limited support parents felt their child was offered.
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