Telerehabilitation: An Adjunct Service Delivery Model for Early Intervention Services

Early Intervention (EI) services for children birth through two years of age are mandated by Part C of the Individuals with Disabilities Education Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telerehabilitation has the potential to build capacity among caregivers and local providers as well as promote family-centered services through remote consultation.  This article provides an overview of research related to telerehabilitation and early intervention services; discusses the feasibility of telerehabilitation within traditional EI service delivery models; examines telecommunications technology associated with telerehabilitation; and provides hypothetical case examples designed to illustrate potential applications of telerehabilitation in early intervention

Preemie Care: A Co-designed Digital Tool to Improve Communication Between Health Personnel and Parents of Preterm Infants

Communication between parents and health providers is essential in the Neonatal Intensive Care Unit (NICU) settings to ensure both parties collaborate in infant care. However, in most NICUs, the interaction between parents and NICU staff is strained, thus hindering communication. These communication challenges are due to language, medical vocabulary and cultural barriers between NICU staff and mothers. These challenges create communication gaps, which disempower parents and frustrate health staff. To bridge NICU communication gaps, several researchers have deployed digital health interventions. However, although the existing NICU technologies have effectively improved NICU communication, most parents struggle to interact with these interventions because they do not fit parents' technical and literacy capabilities. These design gaps arise because parents were not fully included in the design process of the existing NICU digital interventions. In this research, we sought to address the communication gaps within the NICU environment by employing a co-design approach to develop a digital intervention that supports infant care journey in a low-resource NICU setting. The co-design process included six research phases that spanned over 32 months. We engaged mothers of premature infants and NICU staff throughout this process while focusing on identifying how best to involve NICU stakeholders in a codesign process to ensure that the final intervention was usable and useful. The co-design process led to the development of MoM connect workflow which was disqualified by mothers and NICU staff because it did not meet mothers' needs. We further engaged NICU stakeholders in the co-design process and agreed on developing Preemie Care (PMC) system, an educational resource tool that disseminated digital health videos in multiple languages and through multiple technologies to empower parents and NICU staff to work together and advocate for their preterm infants. PMC system was deployed at Groote Schuur NICU for eight months where we interacted with users and monitored it usage logs to evaluate its efficacy. Our empirical evidence revealed that access to health information improved parents and their social networks medical vocabulary, thus empowering them to engage with their peers and NICU staff. We also learned that sharing health information in multiple languages does not resolve the language barriers among multilingual NICU parents. Instead, our results show that bilingual parents prefer accessing health information in multiple languages to improve their medical vocabulary and understandability, thus empowering them to engage in their infants' health care and decision-making. Hence, this research provides the design mechanisms for a NICU intervention to bridge communication gaps between bilingual parents and NICU staff. This work contributes to the field of Human-Computer Interaction(HCI) by highlighting the ethical and methodological considerations to engage NICU stakeholders interacting in a sensitive NICU setting in a collaborative co-design process. We also contribute to HCI knowledge by providing design mechanisms for a NICU intervention meant to bridge communication gaps between bilingual parents and NICU staff in a low-resource setting and design features of a digital NICU intervention that enhance family-centred care in the NICU setting

Preparing America's Children for Success in the 21st Century: Too Small to Fail

A joint initiative of Next generation and the Bill, Hillary & Chelsea Clinton Foundation, Too Small to Fail aims to help parents, caregivers, educators, communities and businesses take specific, meaningful and evidence-based actions to improve the health and well-being of america's youngest children, ages zero to five, and prepare them to succeed in the 21st century.Improving the health and well-being of america's youngest children isn't just the right thing to do -- it's the economically smart thing to do. Our nation's future, and our ability to compete in an increasingly globalized economy, depends on it. Research conducted over the past few decades and across multiple disciplines has shown that early health and learning directly impacts an individual's long-term productivity and success, and our country's economic well-being. Other countries, including emerging economies like India and China, are making substantial investments in the learning, health and care of their youngest children. Yet, in the United States, many children don't receive the basic nutrition they need in the earliest years of life. Many start kindergarten unprepared, lagging in critical skills from vocabulary acquisition and early numeracy to attention span and self-control. more and more grow up with chronic health conditions ranging from obesity to asthma to autism.This is no way to train the leaders, entrepreneurs and workers of tomorrow. What's worse, many parents don't realize that they can take specific actions in the first months and years of their child's life to insure their child's long-term success.That's the bad news. But there is good news, too. right now, more than at any moment in our history, we have the knowledge and tools to meet these challenges head-on. First, we know more than ever before about how early interactions and nutrition shape lifelong brain development, and we have proof that investments in health and well-being during a child's earliest years yield high social and economic returns. Second, new technologies and expanded access to existing tools make it easier to connect with parents and caregivers, provide them with useful information, and motivate them to act. Finally, there is a growing commitment and interest from government, business leaders, communities and parents to prioritize and support early childhood development.Too Small to Fail is founded on the principle that it will take all of us together to prepare our youngest Americans for success in the 21st century. government investment and policy changes are part of that equation, but not the whole solution. We believe that small acts can have a big impact on our kids.this moment in time presents a tremendous opportunity to communicate to all americans what child development experts have known for a long time: what we do for our kids matters -- not just to them, but to all of us

Usability and acceptability of a mobile app for behavior change and to improve immunization coverage among children in Pakistan: A mixed-methods study

Background: Pakistan\u27s immunization uptake rates are still significantly lower than anticipated despite several initiatives. Lack of awareness, forgetting about vaccination schedule, and vaccine misconception/misinformation are a few of the major drivers that mitigate the rates of immunization. The current COVID-19 pandemic emphasizes the importance of immunization. The significant reductions in regular childhood vaccination during pandemic have increased the risk of outbreaks of vaccine-preventable diseases. Concerns among parents over possibly exposing their children to COVID-19 during child visits may have contributed to the reported declines. Innovative and cost-effective mHealth interventions must be implemented in order to address the problem of inadequate immunization rates. In addition, it is also critical to understand the end user needs in order to reflect on the highly relevant essence of the customized healthcare experience.Objective: The aim of this study was to learn about caregivers\u27 attitudes toward the usability and acceptability of behavior-change smartphone applications (mobile phones) for improving immunization coverage in Pakistan.Methods: A mixed-method design was employed for this study. The study was conducted at Aga Khan University, Hospital. Parents visiting the Community Health Center for 6-week vaccination of their children were recruited. The study was conducted in two stages. Stage 1 consisted of qualitative interviews that grasped the parent\u27s attitudes and challenges to immunization, as well as their acceptability and accessibility of the smartphone-based behavior-change application to increase vaccine uptake. Stage 1 was followed by stage 2, in which data were collected through a questionnaire designed by using data from qualitative interviews.Results: The majority of participants agreed that immunization serves an important role in protecting their child from illnesses that cause morbidity and mortality. Almost all of them emphasized the importance of using a pre-appointment method at vaccination center in order to reduce the waiting time. Furthermore, participants were also interested in AI-based behavior modification applications related to immunization. They also wanted to have applications in their native language for better understanding and communication of related information. In our study, approximately 95.2 percent of participants agreed to accept SMS immunization updates, which was also reasonably high. Lastly, the majority of them identified forgetfulness as a significant contributor to regular immunization.Conclusion: To enhance the uptake of childhood vaccines, overall vaccination rates, and overcome barriers related to vaccination coverage, cost-effective and user-friendly mHealth AI-based smart phone applications are required to raise awareness regarding the continuation of vaccination service and the importance of timely vaccination. Parents\u27 experiences and attitudes must be considered while designing and evaluating the efficacy of mHealth-based interventions

Projeto de um aplicativo móvel para monitoramento domiciliar de bebês com cardiopatias congênitas complexas

Introducción: Las cardiopatías congénitas están relacionadas con defectos cardíacos que se desarrollan durante el embarazo y están presentes al nacer. El éxito de las intervenciones depende en gran medida de la educación de los padres/cuidadores sobre los signos y síntomas de alerta. Los cuidadores necesitan tener herramientas para hacer frente a las barreras del sistema de salud. Objetivo: crear un sistema como herramienta de seguimiento para los bebés con cardiopatías congénitas complejas que ayude a los padres/cuidadores y a los profesionales médicos a observar las variables fisiológicas del paciente y a brindar una retroalimentación oportuna y profesional a los padres/cuidadores desde la atención domiciliaria. Materiales y métodos:se presenta un sistema que proporciona apoyo a los pacientes que necesitan seguimiento de cardiopatías congénitas complejas mediante un programa de monitoreo en casa. El sistema consiste en una aplicación móvil que permite a los padres/cuidadores controlar las variables fisiológicas del paciente (peso, ingesta de alimento y oximetría). La información registrada en la aplicación se envía para ser evaluada en tiempo real por el equipo médico. Resultados: la aplicación proporciona un medio eficaz para enviar datos y comunicarse con el centro de control médico, además de ofrecer material educativo e informativo. De este modo, los padres/cuidadores reciben constantemente ayuda e información acerca del estado de su bebé. Conclusiones: la aplicación móvil podría ayudar a minimizar los costos de la atención médica y superar las limitaciones del seguimiento domiciliario, dando a los médicos la posibilidad de ver la evolución del paciente y dar recomendaciones oportunas. Como citar este artículo: Castro David, Pérez-Rivero Paula, Quintero-Lesmes Doris Cristina, Castro Javier. Design of a mobile application for home monitoring of babies with complex congenital heart disease. Revista Cuidarte. 2022;13(3):e2335. http://dx.doi.org/10.15649/cuidarte.2335       Introduction: Congenital heart diseases are related to heart defects that develop during pregnancy and are present at birth. Children must regularly attend specialized clinical centers for treatment, which includes medical check-ups, hemodynamic procedures, and surgery. Nevertheless, the success of interventions largely depends on the education of parents and caregivers about the symptoms and warning signs that babies with complex congenital heart disease may present during the period between stages. Likewise, it is necessary for caregivers to have tools to face the barriers of the health system, such as, obstacles or delays in obtaining healthcare services. This facilitates timely health care for patients and avoids fatal outcomes or deterioration in quality of life. Materials and Methods: This document presents a system that provides support to patients with complex congenital heart disease in follow-up by a home monitoring program. The system consists of a mobile application that allows parents/caregivers to monitor physiological variables of the patients (weight, intake, and oximetry). The information registered in the application is sent for real-time evaluation by the medical team. Results:The application provides an effective means for sending data and communicating with the medical control center, in addition to offering educational and informative material. In this way, parents/caregivers get constant help and feedback about their baby's condition. Conclusions: The mobile application could help mitigate the costs of medical care and overcome the limitations of follow-up at home, giving doctors the possibility to see the patient's evolution and give timely recommendations. How to cite this article: Castro David, Pérez-Rivero Paula, Quintero-Lesmes Doris Cristina, Castro Javier. Design of a mobile application for home monitoring of babies with complex congenital heart disease. Revista Cuidarte. 2022;13(3):e2335. http://dx.doi.org/10.15649/cuidarte.2335       Introdução: as doenças cardíacas congênitas estão relacionadas a defeitos cardíacos que se desenvolvem durante a gravidez e estão presentes no nascimento. O sucesso das intervenções depende em grande parte da educação dos pais/responsáveis sobre os sinais e sintomas de alerta. Os cuidadores precisam ter ferramentas para lidar com as barreiras do sistema de saúde. Objetivo: Criar uma ferramenta de sistema de monitoramento para bebês com doenças cardíacas congênitas complexas, que ajude pais/cuidadores e profissionais médicos a observar as variáveis fisiológicas do paciente e manter um feedback profissional e oportuno para os pais/cuidadores dos cuidados domiciliares. Materiais e Métodos: é apresentado um sistema que fornece suporte aos pacientes com cardiopatias congênitas complexas em acompanhamento através de um programa de monitoramento domiciliar. O sistema consiste em uma aplicação móvel que permite aos pais/responsáveis pelo acompanhamento das variáveis fisiológicas do paciente (peso, ingestão e oximetria). As informações registradas no aplicativo são enviadas para serem avaliadas em tempo real pela equipe médica. Resultados: a aplicação fornece um meio eficiente para enviar dados e se comunicar com o centro de controle médico, além de oferecer material educativo e informativo. Desta forma, os pais/responsáveis recebem ajuda constante e feedback sobre a condição de seu bebê. Conclusões: a aplicação móvel pode ajudar a minimizar os custos do atendimento médico e superar as limitações do acompanhamento domiciliar, dando aos médicos a possibilidade de ver a evolução do paciente e dar recomendações oportunas. Como citar este artigo: Castro David, Pérez-Rivero Paula, Quintero-Lesmes Doris Cristina, Castro Javier. Design of a mobile application for home monitoring of babies with complex congenital heart disease. Revista Cuidarte. 2022;13(3):e2335. http://dx.doi.org/10.15649/cuidarte.2335      &nbsp

The impact of use of technology in early childhood development

https://www.ester.ee/record=b5366757*es

The Role of Online Social Support in Supporting and Educating Parents of Young Children With Special Health Care Needs in the United States: A Scoping Review

Background: When parents of young children with special health care needs (CSHCN) receive their child’s diagnosis, they encounter information they may not understand, emotions they may not know how to cope with, and questions about their child’s immediate and long-term future that frequently lack answers. The challenge of health care providers is how to prepare parents for caring for their CSHCN, for coping with any resulting challenges, and for accessing the systems and services that can assist them. Objective: The purpose of this work was to review evidence of the information and support needs of parents of young CSHCN and to determine whether online social support can serve as an avenue for learning and empowerment for these parents. Methods: A scoping review identified the challenges, coping mechanisms, and support needs among parents of CSHCN, and the reach and effectiveness of digital technologies with these families and health care providers. We also conducted interviews with professionals serving parents of CSHCN. Results: The literature review and interviews suggested that parents best learn the information they need, and cope with the emotional challenges of raising a CSHCN, with support from other parents of CSHCN, and that young parents in recent years have most often been finding this parent-to-parent support through digital media, particularly social media, consistent with the theory of online social support. Evidence also shows that social media, particularly Facebook, is used by nearly all women aged 18-29 years across racial and socioeconomic lines in the United States. Conclusions: Parents of young CSHCN experience significant stress but gain understanding, receive support, and develop the ability to care for and be advocates for their child through parent-to-parent emotional and informational social support. Online social support is most effective with young adults of childbearing age, with social media and apps being the most useful within the theoretical framework of social support. This opens new opportunities to effectively educate and support parents of young CSHCN. Providers seeking to inform, educate, and support families of CSHCN should develop strategies to help parents find and use social support through digital resources to facilitate their emotional adjustment and practical abilities to care for and access services for their child. [J Med Internet Res 2016;18(12):e333

The Negative Impact of Excessive Screen Time on Language Development in Children Under 6-Years-Old: An Integrative Review with Screen Time Reduction Toolkit and Presentation for Outpatient Pediatric and Family Health Providers

Background. Increased amounts of recreational screen time, defined as time watching television and DVDs, playing videogames, and using computers, tablets, and cellular phones without academic purpose, and the lack of effective media use assessment and patient education being done by primary care providers is associated with increased risk of language developmental delays for young children under 6-years-old. Purpose. The purpose of this integrative review is to develop a toolkit that provides education for providers and families on the adverse effects of excessive screen time on language development in children younger than 6-years-old and evidence-based screen time reduction strategies that can be implemented in outpatient primary care clinics at all wellness visits. Toolkit and Presentation. An integrative review was conducted to describe the effects of excessive screen time on language development for children under age 6 and analyze interventions to decrease screen time. From these results, the Screen Time Reduction Toolkit was created. The toolkit includes the 2-Question Assessment for Screen Time (2-QAST), screen time reduction algorithm, provider and patient education on health risks associated with excessive screen time, screen time recommendations published by the American Academy of Pediatrics (AAP), and evidence-based screen time reduction strategies, provider resources, and patient education handouts. The integrative review findings and toolkit were presented to a group of local pediatric providers, nurses, and medical technicians for education and implementation. Outcomes/Discussion. The pre-presentation survey was created after the Health Belief Model (HBM), which served as the framework for this educational intervention. Staff members had high perceived seriousness (83%), perceived susceptibility (83%), and perceived benefit (100%), demonstrating that staff members’ attitudes and beliefs about screen time for young children were in agreement with the principles of this project. Barriers identified included lack of knowledge about health risks from excessive screen time, potential for parental resistance to screen time reduction advice, and time constraints during wellness visits. Regarding cues to action, staff members requested visual aids, handouts, and more education about screen time. The toolkit and patient education resources reduce barriers and address cues to action identified by the staff members. The post-presentation evaluation revealed that 100% of staff members found the toolkit presentation informative and said it increased their knowledge and understanding of the topic. Conclusion. The toolkit provides the education that providers need to be knowledgeable as well as confident in their ability to discuss screen time with families. Being consistent about providing a few minutes of screen time education at every wellness visit from 2-months-old to 5-years-old sets a solid foundation for parents and children to create healthier screen time habits at home