Serious and fatal injuries to infants with discrepant parental explanations: some assessment and case management issues

The objective of this study was to examine the challenges faced by child protection systems in assessment and case management where babies and infants have received serious and fatal physical injuries in the context of discrepant parent/carer explanations. Thirty‐eight case files or review records of children under the age of 2 with serious or fatal physical injuries were examined. Qualitative methods were employed to identify issues relating to types of parent/carer explanations, factors of concern in addition to the injuries and child protection system responses to the families. Findings indicate that the initial safety response by child protection systems to babies with serious injuries with discrepant explanations can be inadequate. Assessment of further risks could be inconsistent, especially in cases where there are few other factors of concern apart from the injury. There is a need for the development in the UK of more systematic decision‐making processes to achieve more consistent standards of assessment and case management of high‐risk infants and to minimize false‐negative and false‐positive predictions of further risk. Copyright © 2002 John Wiley & Sons, Ltd.     

The Myth of Bodily Perfection

The paper identifies the myth of bodily perfection as one that permeates the dominant culture of late 20th century Western civilization, and points to ways in which the myth supports the creation of an illusory category of people called 'the disabled'. Grounded in an understanding of disability as socially constructed, and drawing on the experiences of women with disabilities, the paper further points to important differences in social expectations depending on whether one has disabilities that are visible or invisible. In discussions of disability, however, disabilities that are not visible are often ignored. It is concluded that this contributes to the widespread denial of disability and is oppressive.     

Toward ethical approaches to the inclusion of peers with disabilities

What would it mean for program leaders and caregivers to shape the thinking of typically developing youth toward their peers with disabilities in a way that we could regard as ethically sound? The author weaves examples from his research in settings such as Girl Scout troops and Boys and Girls Clubs as well as his own parenting experiences to answer this question. He has found that it is commonplace for program leaders, coaches, and others to avoid direct discussion or acknowledgment of the disabilities of children in their groups, in the mistaken belief that this is the best way to demonstrate that all children are equal and to avoid the perception of discrimination. His interpretation is that this is not a product of thoughtlessness but of caring staff and volunteers who believe they are doing the right thing--the ethical thing--by avoiding acknowledgment of individual differences. Disabilities--even when they are readily apparent--are treated as if they were invisible. Rather than giving disabilities the "silent treatment," the author challenges us to go beyond the prevailing ethos and find ways to build on naturally occurring opportunities to learn more about individual needs and supports.     

A HEURISTIC TECHNIQUE FOR TESTING FOR THE PRESENCE OF INTERACTION IN NONREPLICATED FACTORIAL EXPERIMENTS

Abstract  This paper suggests univariate and multivariate techniques for investigating interaction in nonreplicated factorial experiments. The tests can detect certain types of interaction, but they are not powerful against all possible alternative hypotheses. The two-way factorial experiment is discussed in some detail and an example is used to demonstrate the procedure. The procedure is compared to other tests for interaction. These comparisons show that the procedure can detect some types of interaction which other tests cannot. Likewise other tests can detect interaction this procedure cannot.     

A culturally responsive practice model for urban Indian child welfare services

This article describes collaboration among a university, a state child welfare agency, and a Native American community organization to develop a culturally driven practice model for urban, Native American child welfare. The approach includes a strategy to build resources to serve Native American clients, a training program for child welfare and court personnel using a culturally responsive curriculum, and an advocacy program that monitors for Indian Child Welfare Act compliance and provides assistance to child welfare workers and the court. The discussion identifies challenges and opportunities in addressing the needs of urban Native American communities. The article concludes with principles for culturally responsive practice for urban Native American child welfare practice.     

Differences in Pharmacokinetics Between Children and Adults—II. Children''s Variability in Drug Elimination Half-Lives and in Some Parameters Needed for Physiologically-Based Pharmacokinetic Modeling

In earlier work we assembled a database of classical pharmacokinetic parameters (e.g., elimination half-lives; volumes of distribution) in children and adults. These data were then analyzed to define mean differences between adults and children of various age groups. In this article, we first analyze the variability in half-life observations where individual data exist. The major findings are as follows. The age groups defined in the earlier analysis of arithmetic mean data (0-1 week premature; 0-1 week full term; 1 week to 2 months; 2-6 months; 6 months to 2 years; 2-12 years; and 12-18 years) are reasonable for depicting child/adult pharmacokinetic differences, but data for some of the earliest age groups are highly variable. The fraction of individual children's half-lives observed to exceed the adult mean half-life by more than the 3.2-fold uncertainty factor commonly attributed to interindividual pharmacokinetic variability is 27% (16/59) for the 0-1 week age group, and 19% (5/26) in the 1 week to 2 month age group, compared to 0/87 for all the other age groups combined between 2 months and 18 years. Children within specific age groups appear to differ from adults with respect to the amount of variability and the form of the distribution of half-lives across the population. The data indicate departure from simple unimodal distributions, particularly in the 1 week to 2 month age group, suggesting that key developmental steps affecting drug removal tend to occur in that period. Finally, in preparation for age-dependent physiologically-based pharmacokinetic modeling, nationally representative NHANES III data are analyzed for distributions of body size and fat content. The data from about age 3 to age 10 reveal important departures from simple unimodal distributional forms-in the direction suggesting a subpopulation of children that are markedly heavier than those in the major mode. For risk assessment modeling, this means that analysts will need to consider "mixed" distributions (e.g., two or more normal or log-normal modes) in which the proportions of children falling within the major versus highweight/fat modes in the mixture changes as a function of age. Biologically, the most natural interpretation of this is that these subpopulations represent children who have or have not yet received particular signals for change in growth pattern. These apparently distinct subpopulations would be expected to exhibit different disposition of xenobiotics, particularly those that are highly lipophilic and poorly metabolized.