Needs, rights, and the human family: the practicality of the Convention on the Rights of the Child

The United Nations Convention on the Rights of the Child (CRC) is an important document that has both policy and practice implications. Its practicality as a working document hinges on its implementation. This article proposes that the CRC be viewed from a child rights perspective that has five building blocks. These building blocks relate to specific articles in the CRC. They also each allow for the CRC to be realistically interpreted and to be actively promoted.

The mental and physical health difficulties of children held within a British immigration detention center: a pilot study

OBJECTIVE

The present study aimed to assess the mental and physical health of children held within a British immigration detention center.

METHOD

A total of 24 detained children (aged 3 months to 17 years) were assessed with their parents or carer after being referred by a registered legal charity. Thirteen were seen by a pediatrician alone, 4 by a psychologist alone, and 7 by both professions using semi-structured clinical interviews. The psychologist also used standardized self-report questionnaires to measure psychopathology.

RESULTS

During the psychological assessment of 11 children, 8 met criteria for psychiatric "caseness" on the Strengths and Difficulties Questionnaire. All 11 reported symptoms of depression and anxiety. Sleep problems, somatic complaints, poor appetite, emotional symptoms, and behavioral difficulties were common. Symptoms of global distress were also reported by all 9 parents. According to pediatric assessment 8 out of 20 children had lost weight. Six had missed health appointments and 2 were taken to hospital. Nutritional, developmental, educational, and child protection concerns were raised.

CONCLUSIONS

Detained children were found to be experiencing mental and physical health difficulties of recent onset, which appeared to be related to the detention experience. These findings support previous Australian studies demonstrating that detention is not in the best interest of the child. It suggests that current UK policies regarding the detention of children for purposes of immigration control should be re-examined. Further research in the area is required.

PRACTICE IMPLICATIONS

Although high levels of mental and physical health problems, as well as child protection concerns were detected, detained families had very limited access to appropriate assessment, support or treatment. The traumatic experience of detention itself also has implications for the sizeable proportion of psychologically distressed children who are eventually released from detention and expected to successfully reintegrate into British society; while those children who are deported are returned with increased vulnerability to future stressors.

The development of certificate of need legislation

This article examines the development of Certificate of Need (CON) legislation in the United States. Over time, CON legislation developed into efforts to contain rising health care costs, while maintaining quality of care. In recent years, numerous states have begun to reevaluate the current impact of CON regulations, and ask whether the programs should be discontinued. State regulators as well as academic researchers must address the costs vs. benefits of such legislation. Specific measures within such regulations must be addressed in order for health policy makers, administrators, and researchers to help meet the escalating demand for health services.

Preventive home visits to older people in Denmark--why, how, by whom, and when?

In Denmark, political decisions improved the implementation of 'preventative thinking' into every-day clinical work. The potential benefits of preventive efforts have been supported by legislative and administrative incentives, and an ongoing effort to remain focused on the benefits of these initiatives towards older people is politically formulated and underlined as part of the new structured municipality reform. Evidence of beneficial effects of health promotion and prevention of disease in old age is well documented. In-home visits with individualised assessments make it possible to reach older persons not normally seen in the health care system. In-home assessment is not just a health check, but also an opportunity to meet individual needs that may be of importance for older people to stay independent. Preventive home visits may be part of an overall culture and strategy to avoid or prevent functional decline. There is an urgent need of an interdisciplinary teamwork and management for such programmes, incorporating flexible cooperation between the primary and secondary health care sector. The value and importance of geriatric and gerontological education is evidence based.

[Diagnostic judgement and evaluation]

The present article provides an overview of principles and standards for diagnostic decisions and evaluation. Assessment aims to answer concrete questions. Clinical and statistical judgements represent two strategies for the integration of diagnostic information. It is illustrated that the hit-rate is closely linked to validity, base-rate, and selection-rate. Depending on the psychological question it might be necessary to either detect many "appropriate" or reject many "inappropriate" persons (sensitivity-specificity). In the case of multiple criteria three strategies are available, for which adequate practical applications are proposed. As far as the assessment process is concerned, recommendations are available for hypothesis-guided data collection and integration. As a special assessment problem simulation/aggravation is discussed. A listing of quality aspects shows how to identify good evaluations. Finally, procedures to maintain a high quality are recommended.

[Rehabilitation need in sociomedical assessment--development and evaluation of an algorithm of decision-making]

For sociomedical assessment on application for medical rehabilitation by the German Statutory Pension Insurance no valid diagnostic assessment tools exist. In the present study two expert surveys and current guidelines were used to develop an algorithm of decision-making which is based on 13 criteria for rehabilitation need. The algorithm was evaluated in a prospective, longitudinal survey in the sociomedical services of five Bavarian Statutory Pension Insurance agencies on a sample of applicants with primary musculoskeletal disease (n=243). The medical experts rated the criteria after they had made their decision on the applications. To examine validity of the algorithm, concordance with the medical expert decisions and individual need for rehabilitation was analyzed. Respectively results of the algorithm were compared with data in course of the measure (rating by the clinician, patient questionnaire). Analyzing data, there is evidence for problems in rating the criteria by assessment on medical records; on average 9.2 (s=2.4) of 13 criteria could be rated. There is statistically significant concordance between decisions by the algorithm and sociomedical decisions based on assessment of medical records (kappa=0.37, p<0.001) or examination (kappa=0.71, p<0.001). Applications with positive recommendation by the algorithm have a significantly higher degree of subjective rehabilitation need (d=0.38). The results illustrate the need for measures to improve the basis of information by medical records. By reason of heterogeneity in practical application of criteria for rehabilitation need, operationalisation and explicit diagnostic algorithms are necessary to improve objectivity of making decisions.

Bedarf an rehabilitativen Leistungen: Zur Theorie von Bedarfsermittlungen („needs assessment”)

Several projects of the North German Association for Rehabilitation Research had focused on needs assessment in the field of medical rehabilitation to be provided by statutory pension funds. Their results prompted a more differentiated understanding of the concepts of rehabilitation-neediness, -ability and -prognosis and lead to the development of the "Lübecker algorithm". It is based on (a) assessing the present health disorder and its consequences in terms of activity limitations and participation restrictions, (b) defining rehabilitation goals, and (c) selecting a rehabilitative intervention. The three components form the corners of a triangle. Its connecting sides can be described in terms of norms and expectations (disorder-goals), theoretical considerations (disorder-intervention), and empirical evidence from systematic research (intervention-goals). Needs assessment can thus be--partly--objectified, and "need" can be safely distinguished from related concepts such as "burden of illness", "wish", "demand", "supply", and "provision".

Selbstausfüllbogen zur Unterstützung der Begutachtung von Rehabedarf: Probleme und Lösungen

Rehabilitation in Germany is an important sector of the medical system. Rehabilitation need of insurees who claim rehabilitation benefits is assessed by the financially responsible agency (mostly pension funds). Legal regulations allow little time for this decision so insurers aim at making decisions from the records only. Information on the specific case often is however insufficient. Self-administered questionnaires have been employed in the past to remedy that problem. In this article typical problems are illustrated which arise when administering additional questionnaires to assist the assessment, and solutions for these problems are shown. Important questions concern the instruments that should be used, technical problems of computer-aided assessment and processing of the data, and possible legal objections. Also, general problems and limitations of the approach are discussed.

Legal aspects of continence

This article considers the law which applies to the supply of incontinence equipment. It considers the liability of the employee and the primary care trust and possible defences to an action for negligence and the right to acquire records relating to an incident which has arisen. It also looks at the health and safety laws which apply to the provision of safe equipment, and considers the patient's right to access health services and the issues which arise when resources are limited.

"Medical necessity" determinations--a continuing healthcare policy problem

To promote an understanding of the implications of current structures and processes for medical necessity determinations that affect everyone, directly or indirectly, the American Health Lawyers Association will devote its biannual Public Interest Colloquium (to be held in February 2005) to the topic. In preparation for the colloquium, the author summarizes the history and current importance of the topic, identifies stakeholders in the system and their interests, and sets forth a preliminary list of issues to be considered by the colloquium participants, focusing on potential elements of an ideal system for making medical necessity determinations.

Finance issue brief: medical necessity: year end report-2003

The information in this issue brief is based on a 50--state survey and a recent literature review. The Health Policy Tracking Service recognizes the complexity of this issue and discourages the use of this document as a sole resource on the issue.

Funktionale Kompetenz und Pflegebedürftigkeit nach SGB XI bei Hundertjährigen

The maintenance of autonomy and independence in the oldest old population is at high risk due to the inevitable aging process, which primarily affects functional and cognitive capacities. In this study, we investigate centenarians to assess the extent in which they have lost their ability to live independently. This is done with a classification system for dependency that considers both functional and cognitive limitations and determines the level of functional competence in this population. Based on this system, we evaluate the necessity for nursing care and investigate to which extent their actual needs are covered by the German Long-term Care Insurance. An important and relevant question is whether this system even addresses the evaluation of cognitive impairment. For this reason, 85 centenarians and their proxies were assessed with standardized instruments and the results show a severe loss of independence. The necessity for at least daily contact with nursing care was identified in 91 percent of the centenarians due to their dramatically limited capacities. Forty-four percent of the centenarians need more support than they actually receive from the German Long-term Care Insurance. Therefore, considering cognitive impairment is a crucial component in the evaluation, which would lead to more support by the official system in 20 percent of the centenarians. The considerable differences between the granted and the necessary nursing care demonstrate that co-operation from family members must be heavily relied upon.