Children and Adolescents with Disabilities and Exposure to Disasters, Terrorism, and the COVID-19 Pandemic: a Scoping Review

Complex Health Needs in Hurricane-Affected Youth and Their Families: Barriers, Vulnerabilities, and Mental Health Outcomes

Youth with complex health needs (CHNs; e.g., requiring daily assistance or equipment for care) and their parents face heightened vulnerabilities during natural disasters, potentially leading to poorer mental health outcomes compared to those without CHNs. However, limited research has focused on this group's disaster-related experiences and their impact on mental health outcomes. This study aimed to investigate the disaster experiences, perceptions, and mental health outcomes of youth with CHNs and their parents' post-hurricane and to evaluate the unique influence of CHN- and disaster-related factors on their psychological functioning. Parents (N = 142) of youth with CHNs (n = 48) and without CHNs (n = 94) who experienced a hurricane reported on their youth's and their own psychological functioning, disaster perceptions, experiences, and CHN-related information. Youth with CHNs exhibited greater perceived life threat compared to youth without CHNs. Families of youth with CHNs were more likely to evacuate and faced greater evacuation barriers. They also exhibited greater PTS, depressive, and anxiety symptom severity compared to those without CHNs. Financial healthcare concerns were not associated with youth with CHNs or their parents' mental health symptomatology. Hurricane-impeded access to healthcare necessities was associated with youth and parent PTS and depressive symptom severity and youth anxiety symptom severity. These findings underscore the vulnerabilities of youth with CHNs and their parents' post-hurricane, emphasizing the need for tailored mental health services and improved disaster planning resources to support this population effectively.

An exploratory cross-cultural study of community-based health literacy interventions to promote the mental well-being of disadvantaged and disabled young Africans: a multi-method approach

Background

This study explores the impact of community-based health literacy interventions on the health and mental well-being of disadvantaged young Africans in Zambia, Sierra Leone, Rwanda, and South Africa. The pandemic has exacerbated mental health problems amongst children and young people, underscoring the urgent need for equitable access to mental healthcare resources. Emphasizing the importance of equitable access to mental healthcare resources, the research addresses educational and income disparities in low- and middle-income countries (LMICs), particularly amongst young Africans with disabilities or vulnerabilities.

Methods

The study comprised 1,624 young Africans, of whom 1,592 were surveyed, while 191 later participated in in-depth interviews and focus groups. Additionally, 32 participants exclusively joined focus groups. Participants were recruited to complete the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS), WHO-5 Well-being Index, Pandemic Anxiety Scale (PAS), and Self-rating of Happiness, as well as semi-structured interviews or focus groups.

Results

The findings highlight the significance of tailored health literacy interventions in addressing mental health challenges and promoting well-being in marginalized African communities. In the sample, 43.1% (686) reported to have at least a physical disability or serious health condition and 51.4% (818) had special educational needs (SENs). Mental health scores were significantly lower in participants with two or more physical disabilities and pre-existing mental health problems. Factors significantly associated with poor mental health included poor health literacy, physical disabilities, and pre-existing mental health problems. Four main themes were generated from the thematic analysis: early childhood trajectories and mental illness experiences; positionality, open communication, and mental illness experience; mental illness experience, emotional honesty, and social stratification; and spirituality, cultural beliefs, and mental illness experience.

Conclusion

The study emphasizes the need for context-specific, culturally appropriate health literacy interventions to support the mental health and well-being of young Africans in LMICs. By focusing on the lived experiences of disadvantaged groups, the research contributes to a better understanding of effective strategies for promoting health literacy and addressing health inequalities in African communities during and after health emergencies.

A Virtual Home Preparedness Intervention Centered on Children and Youth With Special Health Care Needs

OBJECTIVE

Children and youth with special health care needs (CYSHCN) require additional considerations for staying safe in emergencies. Our team of clinicians and preparedness professionals developed and tested a virtual home preparedness intervention (VHPI) in families with CYSHCN receiving care in a statewide medical home network.

METHODS

The VHPI comprised 1) a pre/post interview covering fire safety, emergency evacuation, sheltering in place, and informing emergency responders of the child/youth's care needs; 2) a resource packet containing emergency planning templates and information on local supports; and 3) individualized referrals coordinated through the medical home/community partners. Eligible CYSHCN had medical technology reliance, physical/mobility needs, communication/intellectual challenges, and/or vision/hearing loss. Preparedness was measured as pre/post affirmed rates of 19 items from the interview and as mean composite scores of these items; associations were evaluated using generalized estimating equations-based regression for repeated measures.

RESULTS

The pre and post-VHPI interviews were completed by 170 and 148 participants, respectively. Significant individual-item gains included having a current Emergency Information Form for the child/youth (31% [pre] to 47% [post] affirmed) and assembling an evacuation kit (50% to 68%). The mean preparedness score was 13.33/19 items affirmed at baseline and increased to 14.96 post-VHPI (P < .01). In the adjusted regression model, the post-intervention preparedness score remained significantly higher than pre-VHPI, with mean increases of 1.22 preparedness steps affirmed for homeowners and 1.85 for renters.

CONCLUSIONS

Preparedness scores improved post-VHPI in families with CYSHCN. Future work should address incorporating the VHPI into care visits in the medical home.

From Survival to Growth - The Coping Experience of Mothers of Children with Disabilities During a Global Crisis: The Case of COVID-19

This study explored the coping experiences of mothers of children with disabilities during the COVID-19 pandemic in Israel. Semi-structured in-depth interviews were conducted with 14 mothers. The data were thematically analyzed to gain in-depth understanding of their coping experiences. The findings indicated that COVID-related restrictions disrupted the family routine and added a significant burden for the mothers as primary caregivers, and for the family system as a whole. Three distinct types of coping experiences arose from the analysis: surviving the crisis, controlling the crisis, and growing out of the crisis. Three key elements differentiated these three types: the perceptions of the meaning of the pandemic for parental roles and of the response of the education and welfare systems to the children's needs - in routine and during COVID-19; coping with the different pandemic challenges; and the implications of both COVID-19 and the mothers' coping strategies for the functional and emotional status of their children, themselves, and family relations. The results are discussed in light of models of family stress and coping, focusing on the tension between the mothers' caregiving role and maternal roles as warranting particular attention by professionals and policymakers.

Beyond Barriers: Addressing Challenges and Opportunities of People with Disability During the Pandemic

People with disabilities often experience worse health outcomes than ordinary people because of multiple barriers to accessing healthcare. These inequalities are particularly exposed during the pandemic, indicating an urgent need to strengthen health systems, so that they are inclusive and responsive to the needs of these people during crises. These people are particularly affected by changes in routine services because of diversion of healthcare staff and facilities to respond to the pandemic, e.g., rehabilitation and medications. The combination of these factors substantially imparts negative impacts on their functioning and well-being. Health services research can help address the challenges of maintaining continuity of care during crises as well as addressing systematic inequalities in the health sector that marginalize people with disabilities even during noncrisis times. Therefore, research is needed to understand the health service design and to identify strategies to maximize active participation from this population.

Caregiver Knowledge, Attitude, and Behavior toward Care of Children with Cerebral Palsy: A Saudi Arabian Perspective

The care of children with cerebral palsy (CP) requires a complex system of care that is not only dependent on health care resources, but is also strongly influenced by social and cultural attributes. Hence, it is important to explore the understanding and practices of caregivers within a regional perspective. This study was conducted to investigate the knowledge, attitude, and behavior (KAB) of parents with children diagnosed with CP in Saudi Arabia. A cross sectional survey was conducted on the caregivers of children with CP admitted for inpatient rehabilitation between October 2023 to January 2024. A total of 216 caregivers participated in this survey. About 82.9% of caregivers were the mothers of CP children, half (50.5%) were ≤36 years old, 53.7% were highly educated, and 89.2% lived in urban areas. More than half of the participants (57.7%) owned their homes. Regarding children, spastic quadriplegia was the most common type (46.3% of cases). Overall, the participants recorded good values for all variables for KAB. The mean value for attitude was higher (2.67 ± 0.20) when compared to behavior (2.49 ± 0.36) and knowledge (2.46 ± 0.25). Participants who had children with spastic quadriplegia CP reported lower behavior scores than their peers. Strategies with a special emphasis on improving the behaviors of caregivers for children with quadriplegia need to be adapted. Similarly, the living situations of families need to be taken into consideration given its significant association with the attitude of caregivers. A considerable lack of knowledge in handling emergency situations by caregivers signifies a gap in care, which could have potentially life-threatening consequences.

Receipt of and Satisfaction with School-based and Virtual Special Education Supports and Therapeutic Services During the COVID-19 Pandemic

The COVID-19 pandemic impacted school-based delivery of special educational supports and therapeutic services. This study describes student receipt of school-based supports/services and parent satisfaction by instruction modalities during the 2020-2021 academic year in the United States. Data were collected through the COVID Experiences Survey from parents of children ages 5-12 years, administered using NORC's AmeriSpeak panel. Most parents reported satisfaction with supports (88.4%) and services (93.2%). Dissatisfaction with special education supports and therapeutic services was more common among parents whose children received supports/services virtually than in person (special educational supports: aOR=12.00, 95% CI [1.49-96.89], p=0.020; therapeutic services: aOR=15.76, 95% CI [1.01-245.40], p=0.049). These findings suggest opportunities to improve design and delivery of online special education supports and therapeutic services as well as emergency preparedness by considering the needs of students with disabilities and their families.

Emergency and disaster preparedness among children and youth with disabilities and chronic conditions, their caregivers and service providers: a scoping review

PURPOSE

People with disabilities, especially children and youth, are often not considered in emergency and disaster preparedness planning, which leaves them vulnerable and at a higher risk of the negative effects of natural and human caused disasters. The purpose of this study was to understand the extent of emergency and disaster preparedness and factors influencing preparedness among children and youth with disabilities and chronic conditions, their caregivers and service providers.

METHODS

Our scoping review involved searching six international databases that identified 1146 studies of which 27 met our inclusion criteria.

RESULTS

The studies in this review involved 2613 participants (i.e., children, parents, educators and clinicians) across nine countries over a 20-year period. Our results highlighted the following trends: (1) the extent of emergency preparedness; (2) factors affecting emergency preparedness; and (3) interventions to enhance preparedness.

CONCLUSIONS

Our findings underscore the critical need for more attention to emergency preparedness for children and youth with disabilities, their families and service providers and their inclusion in planning.

Current Situation of Disaster Preparedness for Effective Response in Japanese Special Needs Schools

OBJECTIVE

Schools may serve as shelters in the event of a disaster, but little is known about the requirements of children with disabilities in such situations. This study, therefore, aimed to investigate disaster preparedness in Japanese special needs schools depending on the designation of welfare shelters.

METHODS

A questionnaire was distributed to schools nationwide. The respondents (authorities from 531 schools) answered questions about their jobs, disaster experiences, the school type, its students' disabilities, its designation as a welfare shelter, its evacuation readiness, and the items of a disaster prevention awareness scale. Differences in preparedness among schools and the relationship between preparedness and designation as a welfare shelter were determined.

RESULTS

Most respondents had never experienced a natural disaster. Schools had insufficient resources to cope with disasters. While the majority (68.2%) had resources for children to stay overnight, a substantial minority of schools (31.8%) did not. No differences were found in preparedness among schools with different types of children with disabilities. Schools designated as welfare shelters were significantly better prepared than others.

CONCLUSIONS

Special needs schools in Japan have limited disaster preparedness. The designation of schools as welfare shelters may increase their preparedness for disasters.

Home-Based Emergency Preparedness for Families of Children and Youth With Special Healthcare Needs: A Scoping Review

Children and youth with special healthcare needs (CYSHCN) are at disproportionate risk of harm from widespread disasters and from life-safety emergencies. These risks may be mitigated by providing preparedness training and support to family caregivers. We conducted a scoping review to identify and map the scholarly literature on home-focused preparedness of families with CYSHCN. Our search strategy yielded 22 relevant articles; 13 pertained to life-safety emergencies, 5 centered on widespread disasters, and 4 addressed preparedness on multiple scales. Approaches to measure or attempt to improve emergency preparedness levels in CYSHCN and their families were diverse and included interviews and focus groups; didactic, video-based, or side-by-side instruction; simulated medical crises; and provisioning of emergency kits. For the studies that involved an intervention (n=15, 68%), several proxy indicators of preparedness were used, including caregiver knowledge, skill, or comfort level with managing emergencies that could affect their CYSHCN; completion of preparedness tasks; and reduction in adverse clinical outcomes. Despite the varied methodologies, prevailing themes in the studies were that family caregivers of CYSHCN felt underprepared for emergencies and disasters, desired training to improve their preparedness at home, and benefited from such trainings, at least in the short term, across domains of self-efficacy, skill, and health outcomes of their CYSHCN. Although more research is needed to compare preparedness interventions and evaluate the durability of these interventions in larger, more diverse samples of CYSHCN and their families, our findings support incorporating preparedness training into preventive care encounters and the hospital-to-home transition.

Creating a better post-pandemic future for adolescents with disabilities

Adolescents with disabilities must have their needs prioritised in recovery and future pandemic responses to improve health, educational, and social outcomes, argue Sarah Baird and colleagues

Kinder- und Jugendgesundheit in der Klimakrise

Kinder und Jugendliche sind aufgrund ihrer Physiologie und längerer Expositionszeiten besonders von den gesundheitlichen Folgen der Klimakrise betroffen. Darüber hinaus wird die Klimakrise ohne Gegenmaßnahmen vorbestehende gesundheitliche Ungleichheiten verschärfen, da Kinder und Jugendliche aus Familien mit niedrigem sozioökonomischen Status und schlechterem Gesundheitszustand besonders stark von den gesundheitlichen Folgen der Klimakrise betroffen sind.

Die Klimakrise wirkt sich über zahlreiche Mechanismen auf die Gesundheit von Kindern und Jugendlichen aus, wobei jedes Organsystem betroffen sein kann. Extremwetterereignisse gehen u. a. mit einem erhöhten Risiko für Hitzschläge, Elektrolytstörungen, Verletzungen und psychische Erkrankungen einher. Der Temperaturanstieg führt zu veränderten Ausbreitungsgebieten von Krankheitsvektoren, die u. a. die Erreger der Borreliose oder des West-Nil-Fiebers übertragen. Im Bereich der psychischen Gesundheit stehen Klimaangst und die psychischen Auswirkungen von Extremwetterereignissen im Vordergrund.

Zahlreiche Maßnahmen in den Bereichen Klimaschutz und Klimafolgenanpassung haben zugleich positive Effekte auf die Gesundheit und werden daher als Win-Win-Lösungen bezeichnet (z. B. aktiver Transport, Ausweitung urbaner Grünflächen). Kinder- und Jugendärzt:innen können einen wichtigen Beitrag zu Prävention und adäquater Behandlung von klimawandelassoziierten Erkrankungen leisten, indem sie u. a. in U‑Untersuchungen Win-Win-Lösungen adressieren und klimawandelbedingte Belastungsfaktoren in der Anamnese berücksichtigen. Darüber hinaus können sie durch ihr Engagement in Organen der ärztlichen Selbstverwaltung (z. B. Etablierung nachhaltiger Anlagestrategien in ärztlichen Versorgungswerken) oder durch die Umsetzung von Maßnahmen in Gesundheitseinrichtungen aktiv zum Klimaschutz beitragen.

Describing adolescents with disabilities' experiences of COVID-19 and other humanitarian emergencies in low- and middle-income countries: a scoping review

BACKGROUND

The COVID-19 pandemic and other humanitarian emergencies exacerbate pre-existing inequalities faced by people with disabilities. They experience worse access to health, education, and social services, and increased violence in comparison with people without disabilities. Adolescents with disabilities are amongst those most severely affected in these situations. Using participatory research methods with adolescents can be more effective than other methods but may be challenging in such emergency contexts.

OBJECTIVES

We conducted a scoping review to: 1) describe the literature and methods used in peer-reviewed and grey literature on adolescents (aged ten to nineteen) with disabilities' experience of COVID-19 and other humanitarian emergencies in low- and middle-income countries, and 2) identify research gaps and make recommendations for future research.

METHODS

The review followed a protocol developed using PRISMA guidelines and the Arksey and O'Malley framework. We searched grey and peer-reviewed literature between 2011 and 2021.

RESULTS

Thirty studies were included. Twelve were peer-reviewed, and of those seven used participatory methods. Humanitarian emergencies had adverse effects on adolescents with disabilities across health, education, livelihoods, social protection, and community participation domains. Surprisingly few studies collected data directly with adolescents with disabilities. Twenty-three studies combined data from non-disabled children, caregivers, and disabled adults which made it challenging to understand adolescents with disabilities' unique experience.

CONCLUSIONS

Our review highlights both the scarcity of literature and the importance of conducting research with adolescents with disabilities in humanitarian contexts. Despite challenges, our review shows that it has been possible to conduct research with adolescents with disabilities to explore their experiences of humanitarian emergencies, and that these experiences were different from those of non-disabled adolescents. There is a need to disaggregate findings and support the implementation and reporting of rigorous research methods. Capacity development through partnerships between non-governmental organisations and researchers may improve reporting of methods.

Relationship between Teachers’ Awareness of Disaster Prevention and Concerns about Disaster Preparedness

Disaster preparedness in schools is critical for the health and well-being of students and staff. To enhance disaster preparedness, awareness of disaster prevention should be raised among teachers. The aim of the current study was to assess disaster prevention awareness among teachers and to clarify the relationship between disaster prevention awareness and concern regarding disaster preparedness. Teachers from special needs schools, for which disaster preparedness is particularly important, were selected. Study questionnaires were sent to 1310 schools for children with special health care needs across 47 Japanese prefectures. Five-hundred-and-thirty-one complete responses were obtained. The disaster preparedness in the schools was insufficient. Teachers were concerned about child management, life saving, life maintenance, evacuation shelter management, and school management. There was a positive correlation between disaster prevention awareness and concern about disaster (r = 0.217, p-value = 0.000). The disaster awareness scale items “A sense of crisis about disaster” and “Anxiety” were positively correlated with concern about disaster, whereas “Imagining the disaster situation” was negatively correlated with concern about disaster. The current study analyzed the relationship between disaster prevention awareness and concern regarding disaster preparedness, which is relevant for the practice and indicates the importance of imagination strengthening.