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This article discusses the origin of the concept of primary health care (PHC) and compares and contrasts it with the concept of selective primary health care (SPHC) as it relates to programs devoted to improving child health. PHC came to encapsulate a health policy that emphasized basic health services particulary for the poor and focused attention on the relationship of health improvements to socioeconomic factors, which incorporated such things as education, nutrition, employment, and overall standards of living. SPHC narrowed the focus of health to a limited number of cost-effective medical/technological interventions that were believed to improve health rapidly and dramatically. Health planners developing child survival strategies must choose which approach to follow. Those who emphasize the importance of process do not reject the value of specific medical interventions, just as those who follow specific programs recognize the importance of considering the broader processes that determine health. However, entry points, work methods, and goals of the 2 approaches are very different. Whether the choice is conscious or unconscious, the one which is taken will have wide implications for the allocation of money, material, and manpower. 相似文献
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Stuart Copans Helen Krell John Gundy Frances Field Janet Rogan 《Child abuse & neglect》1979,3(1):123-130
A wide range of health workers in the community provide care for families that abuse or have a potential for abusing their children. Frequently these workers are unable to work effectively because of difficulty dealing with feelings aroused by contact with such families.An experimental child abuse training program for community health workers was designed by a pediatrician, a social worker, a public health nurse and two child psychiatrists. This program included a six-month study group which met weekly to focus on feelings and conflcts aroused during the course of work with abusing or potentially abusing families.Through analysis of the group experience, the leaders identified eleven sets of feelings or conflicts which seemed to interfere consistently with effective delivery of care: 1)anxieties about a) being physically harmed by angry parents and b) about the effects of a decision; 2) denial and inhibition of anger; 3) need for emotional gratification from clients; 4) lack of professional support; 5) feelings of incompetence; 6) denial and projection of responsbility; 7) feeling total responsibility for assigned families; 8) difficulty separating personal from professional responsibility; 9) feelings of being a victim; 10) ambivalent feelings a) toward clients and b) about one's professional role; 11) need to be in control.This type of group experience seems to be an effective method for exploration and resolution of feelings and conflicts. 相似文献
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《Early childhood research quarterly》2000,15(1):5-39
A randomized experiment was conducted to test the effects of the Comprehensive Child Development Program (CCDP), a two-generation program that employed case management and home visiting to ensure multi-risk, low-income children and their parents a range of education, health, and social services to meet the complex needs of disadvantaged families. The evaluation of 21 CCDP projects, which followed 4,410 families for five years, found no statistically significant impact on CCDP families when they were compared with control families in either child outcomes (cognitive and socio-emotional development, and health) on parent outcomes (parenting, family economic self-sufficiency, or maternal life course). Since the intervention failed to change parenting behavior or family economic status, the two hypothesized pathways to affecting the well-being of the children, not unexpectedly there were no significant impacts of CCDP on children. The study suggests that the combination of case management and parenting education, delivered through home visits, is not an effective means of improving developmental outcomes for low-income children. 相似文献
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《Early childhood research quarterly》2000,15(1):41-59
The Comprehensive Child Development Program (CCDP) was a demonstration project designed to test a specific model of service delivery for young children and families in poverty. Following the evaluation’s failure to show strong impacts, early intervention has come under fire from opponents in the popular literature and in Congress. We conclude that shortcomings in both implementation and evaluation contributed to the failure to demonstrate effectiveness. Lessons learned from the CCDP are articulated, addressing the roles of demonstration projects and their evaluations, the problems associated with evaluating programs early in their implementation, the importance of assuring appropriate treatment quantity and quality, and the judicious use and interpretation of large-scale randomized evaluations. 相似文献
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OBJECTIVE: Previous research suggests that training workshops on investigative interviewing conducted with front-line workers, such as police officers or child protective service (CPS) workers, may result in improved knowledge about appropriate strategies to use. Limited research has addressed whether such training programs result in improvements in actual interviewing skills. The present investigation assessed the impact of a training workshop on CPS workers' knowledge about conducting and behavior during investigative interviews. METHOD: Twelve CPS workers participated. To evaluate the impact of the training, a quasi-experimental design was used. Participants completed outcome measures prior to, immediately following, and 3 months following the training. Outcome measures included (a) a questionnaire to assess knowledge about interviewing practices, (b) simulated interviews with a confederate to assess participant behavior during an investigative interview, and (c) questionnaires to gather information related to the simulated interviews (e.g., materials requested for use during interview, abuse status of confederate). All participants completed 6 hours of training during 3 weekly 2-hour sessions. RESULTS: Participants' knowledge on the topic, as well as several interviewing skills during simulated interviews, improved following the training. However, the training failed to impact several key interviewing skills such as the types of questions asked or the length of the interview. CONCLUSIONS: Knowledge-based workshop training programs may not adequately prepare CPS workers to conduct appropriate investigative interviews with children who were allegedly abused. Further, knowledge about how to conduct such interviews may not be the best indicator of whether someone is prepared for this aspect of the job. 相似文献
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Henry Giarretto 《Child abuse & neglect》1982,6(3):263-278
The number of families troubled by parent-child incest in the typical community is much larger than suspected by professional helpers. If left unattended, the victim(s) and the family as a whole will be critically traumatized. Parental incest in the nuclear family can be likened to terminal cancer in the individual. The community must encourage the incestuous families to seek treatment and must provide comprehensive in-depth therapy to all members of the family. The etiology and dynamics of parental incest and the treatment method developed by the Directors of the Child Sexual Abuse Treatment Program of Santa Clara County (CSATP), California, are discussed. Over the past ten years the CSATP has provided therapy to over 4,000 children and their families (about 14,000 individuals), by far the largest number so treated by any single organization. About 90% of the children have been returned to their families; and the recidivism rate in the families who have completed the treatment program remains at less than 1%. 相似文献
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Teachers have a significant role in preventing, detecting and reporting child abuse and neglect. They are hindered in fulfilling this role by a serious lack of knowledge of the law, of school board policies, and of maltreatment. A comprehensive professional development workshop was developed and presented to elementary school teachers. The package was evaluated by means of a randomized controlled trial. The workshop proved to be effective in increasing and maintaining knowledge. 相似文献
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Richard Volpe Ph.D. 《Child abuse & neglect》1984,8(4):511-517
This paper reports the outcome of an attempt to teach children in grades 5 and 6 about child abuse and neglect. The Child Abuse Component of the Human Relations Program described and evaluated here is a unique effort to provide children with an opportunity to discuss and learn about this aspect of family violence. An impact assessment was conducted by documenting possible changes in student knowledge and attitudes regarding child abuse as a result of exposure to the Child Abuse Component of the Human Relations Program. The test group of children consisted of 315 boys and girls in grades 5 and 6. A comparison group of 298 children was closely matched with the test group on the basis of age and sex. These groups were formed by randomly selecting 12 teachers from all teachers agreeing to use the Component and 10 teachers choosing not to employ the Component. The students in the classrooms of these teachers received the same curriculum for their grade level with the exception of the field-test group additionally receiving the Component. Selected child abuse knowledge, attitude, and personality (security) measures were given all subjects in a post-test with comparison group research design. Teacher knowledge and attitude were also assessed. The results of the data analysis, teacher, and special observer reports suggest that the Component was effective in meeting its objectives and was not disturbing to test subjects. Apparently, the test children profited by experiencing the Component mainly because of the opportunity it provided for class discussion. Moreover, the knowledge levels and interest of the children in both groups was seriously underestimated. 相似文献
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This paper focuses on evaluations of programs to prevent child abuse and neglect. It discusses the quality of the evaluations and offers suggestions for improvement to evaluators, program planners, and funders. Thirteen evaluations recommended by experts and published from 1978 through 1988 were reviewed. Using the true experiment as the standard of quality, we found evaluations frequently characterized by careful attention to methodologic detail. Evaluators describe eligibility criteria; half of the studies had control groups or followed progress. However, to learn more about prevention of abuse and neglect the caliber of evaluation research must improve. Evaluators do not define abuse or neglect; they accept reports of abuse. This has the effect of shifting the responsibility to others whose concerns and reporting standards differ. Lack of definition is reflected in a paucity of valid measurements; we could not assess the characteristics of families who benefit most from programs. Evaluators also omit important topics. Although seven evaluations studied health-related variables, no comprehensive analysis of the consequences and costs of medical neglect could be found; very little information on costs and benefits of any kind was available. 相似文献
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M J Van Meter 《Child abuse & neglect》1986,10(1):79-84
Two central forces dominated the conception and development of the Parents and Children Together (PACT) project: the need for provision of an in-home alternative to foster care for abuse and/or neglect families and the prevention of further abuse and/or neglect in the family. Wayne State University in Detroit is the site for Parents and Children Together (PACT) project, a contractual service of the Michigan Department of Social Services (DSS). Graduate students provide in-home services to referred families who, due to child abuse or neglect, would otherwise have their child(ren) removed from the home. This family-based work is a one-year cooperative education experience for students interested in professions in the human services. This report discusses the PACT project as a grant operated through the university, the specification of course work associated, and the attraction of students to graduate study with "hands-on" experience. All of these program attributes, as well as the resource of the project for research, make it an important effort for the university. Further, the university has an additional meaningful role with community residents. Beyond university and student opportunities, the DSS and its clients benefit by having broad-based expertise brought into homes on a weekly basis. Annual success rates of keeping children out of foster care are cited along with cost effectiveness. The university's role in levels of prevention in a highly coordinated community effort is indicated. 相似文献
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This article describes a therapeutic program for child abusive parents that is psychoeducationally based and is conducted through home visits by trained behavioral interventionists. The immediate goals of the intervention are to teach abusive parents effective child management procedures based on social learning therapy and to modify faulty or excessive expectations these parents have toward the behavior of their children. The general model is discussed as well as criteria for selection of parents for home intervention services, the differences between home intervention with abusive and non-abusive parents and the procedures used in home intervention services. A general discussion is also provided of the various goals and stages through which parents progress. 相似文献
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OBJECTIVES: This study evaluated client-level outcomes among an entire statewide group of Family Preservation and Family Support (FPFS) programs funded under PL 103-66. METHOD: A total of 1,601 clients (primarily low income, moderate to high risk with no current involvement in the child protection system) were assessed and followed over time for future child maltreatment events reported to Child Protective Services. The study compared program completers with program dropouts, compared recipients of more lengthy full-service programs with recipients of one-time services, and examined the effects of program duration, intensity, service site (center-based vs. home based) and service model/content. Effects were modeled using survival analysis and variable-exposure Poisson hierarchical models, controlling for initial client risk levels and removing failure events because of surveillance bias. Changes in lifestyle, economic and risk factors were also examined. RESULTS: A total of 198 (12.2%) participants had at least one defined failure event over a median follow-up period of 1.6 years. Controlling for risk and receipt of outside services, program completers did not differ from program dropouts or from recipients of one-time services, and there was no relationship between program intensity or duration and outcomes. Program types designed to help families meet basic concrete needs and programs using mentoring approaches were found to be more effective than parenting and child development oriented programming, and center-based services were found to be more effective than home-based services, especially among higher risk parents. CONCLUSIONS: The findings did not support the effectiveness of these services in preventing future maltreatment cases, and raised questions about a number of common family support assumptions regarding the superiority of home-visiting based and parent training services. A number of possible reasons for this are explored. 相似文献
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Infants respond differentially, and at times with fearlike behavior, to unfamiliar persons. This study was designed to see how infants discriminate among strangers. Since it has been shown that infants respond differently to children and adults, the physical characteristics of persons used to make such differentiations were of interest. Facial configuration and height were systematically varied as 4 different strangers--a male and female child, a female adults, and a small female adult the same height as the children (midget)--each approached 40 different infants. The infants responded as if there were 3 classes of persons--adult, child, and small adult, suggesting that both size and facial configuration cues were used. Infants as young as 7 months of age reacted to the size-facial configuration discrepancy of the small-adult condition. 相似文献