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Biomedical subjects

M D Simms

Publications and source records attributed to M D Simms.

At least 19 recordsLinked to original sources
PubMed2001

Foster care placement improves children's functioning.

OBJECTIVE: To examine changes in reported functioning over a 12-month follow-up period and predictors of those changes for a cohort of young children enrolled in foster care. DESIGN: Data came from a longitudinal follow-up of a cohort of young children entering foster care in one Connecticut region. These data were originally assembled to evaluate the effectiveness of a specialized set of services designed to provide a baseline multidisciplinary assessment and ongoing monitoring for young children entering foster care. SETTING AND PARTICIPANTS: From February 1, 1992, through July 31, 1993, all young children (N = 120) entering foster care in one Connecticut region were enrolled in this study. Children were assessed at entry into care and at 6 and 12 months after entry. Participation rates exceeded 90% at each follow-up period. MAIN OUTCOME MEASURES: The principal outcome of interest for these analyses is 12-month functioning as measured by the Vineland Adaptive Behavior Scale (VABS) scores completed by their foster mothers. RESULTS: At entry into foster care, children ranged in age from 11 to 76 months, were evenly divided by sex, and had a mean VABS score of 79.5 signifying functioning below the average range. At 6 months children gained an average of 7.87 points on their VABS score. By 12 months children showed an average change of 9.65 points, for a mean VABS score of 94.5, well within the nationally normed average range. The multivariate linear model predicting the 12-month VABS score showed that, controlling for the baseline VABS score, when children who were abused, older at placement, female, of African American ethnicity, spent more time in foster care, and had fewer recommended services while in care, they were more likely to show improvement on the foster mother-reported VABS evaluation. CONCLUSIONS: These results demonstrate that children's reported functioning improves over the course of placement in foster care and that sociodemographic characteristics, reason for placement, length of time in foster care, and fewer recommended services at entry into foster care identified children who were more likely to improve. These results argue for a careful examination of the foster care environment to better understand which aspects of the environment contribute to improved foster mother reported functioning. Such understanding will be critical for the care and development of maltreated children.

Child↗
PubMed2000

Specialized assessments for children in foster care.

OBJECTIVE: To investigate the differences in health problems identified and health services received by children newly entering foster care who participated in a comprehensive multidisciplinary program, compared with children newly entering foster care who received customary community-based services. METHODS: Using a 2-group quasiexperimental design, 120 young children entering foster care were enrolled in a multidisciplinary intervention program (n = 62) or were followed by customary care providers (n = 58). An interview with the foster parent; a complete medical examination; and a battery of developmental, psychological, speech/language, and motor assessments were completed for each child at baseline. Children in both groups participated in follow-up assessments at 6 and 12 months. RESULTS: No significant differences between the 2 groups existed in medical, educational, developmental, or mental health problems identified by foster mothers. However, children in the intervention group were more likely to be identified with developmental (56.5% vs 8.6%) and mental health problems (37.1% vs 13.8%) by providers than children in the comparison group. Children in the intervention group were also more likely to be referred for health services at baseline (71.0% vs 43.1%) and receive follow-up care at 6 and 12 months of age than children in the comparison group. CONCLUSIONS: Findings indicate that community providers identify medical and educational needs but do not recognize developmental and mental health needs of young children newly entering foster care. The discrepancies in the number of recommended services and follow-up care between the 2 groups make a case for the establishment of specialized services for children entering out-of-home care.

Child↗
PubMed2000

Health care needs of children in the foster care system.

Nearly 750 000 children are currently in foster care in the United States. Recent trends in foster care include reliance on extended family members to care for children in kinship care placements, increased efforts to reduce the length of placement, acceleration of termination of parental rights proceedings, and emphasis on adoption. It is not clear what impact welfare reform may have on the number of children who may require foster care placement. Although most children enter foster care with medical, mental health, or developmental problems, many do not receive adequate or appropriate care while in placement. Psychological and emotional problems, in particular, may worsen rather than improve. Multiple barriers to adequate health care for this population exist. Health care practitioners can help to improve the health and well-being of children in foster care by performing timely and thorough admission evaluations, providing continuity of care, and playing an active advocacy role. Potential areas for health services research include study of the impact of different models of health care delivery, the role of a medical home in providing continuity of care, the perception of the foster care experience by the child, children's adjustment to foster care, and foster parent education on health outcomes.

Adolescent↗
PubMed1998

Medical care of children who are homeless or in foster care.

The number of children who are homeless or in foster care has risen dramatically during the past two decades. Poverty, substance abuse, lack of education and employment, and the failure of the social "safety net" to catch all those in need of support and financial assistance are root causes of this increase. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, popularly know as the "welfare reform" act, will likely have a powerful impact on levels of child poverty in the future and place even greater numbers of children at risk for becoming homeless or entering foster care over the next decade. Recent studies provide increased understanding of the health care and educational needs of children who are homeless or in foster care.

Child↗
PubMed1997

Widespread growth retardation and variable growth recovery in foster children in the first year after initial placement.

OBJECTIVES: To determine children's growth patterns in the first year of foster care placement and to compare catch-up growth with initial height percentile as indicators of prior growth retardation. DESIGN: Inception cohort. SUBJECTS: Forty-five children aged 1 1/2 to 6.0 years in their first year of foster care. SETTING: Urban, community-based primary care center. MAIN OUTCOME MEASURES: Height, weight, weight-for-height, and annual growth velocity z scores 1 year after placement. RESULTS: The group entered foster care with an overall height deficit (height z = -0.21), grew at an above-average rate (velocity z = +0.33), and eliminated the height deficit by the end of the year (height z = -0.02; P < .05). Weight increased (baseline weight z = -0.16; year-end weight z = +0.35) and correlated with height z change (r = 0.385, P = .009). Weight for expected weight-for-height-age was above average and did not change (baseline weight for expected weight-for-height-age z = +0.30; year-end weight for expected weight-for-height-age z = +0.40). Baseline age correlated with velocity z (r = .413, P = .005) but not with change in height z. Baseline height z did not correlate with either velocity z or change in height z. Three patterns of growth were seen: 21 (47%) showed catch-up growth (height velocity z = 1.34; gain in height z = +0.61); 16 (36%) showed stable growth; and 8 (18%) showed poor growth (height velocity z = -1.49; decrease in height z = -0.49). CONCLUSIONS: Almost half of the children showed significant catch-up growth in the first year after foster care placement, indicating probable prior growth failure. Initial height was not predictive of future growth, and simple screening (such as height less than the fifth percentile) would have missed the majority of children who showed catch-up growth. A substantial minority (18%) continued to decline across height percentiles after placement. The initial and subsequent growth failure and catch-up growth in this population did not appear to be related to nutritional changes.

Body Height↗
PubMed1997

Foster care: an update.

OBJECTIVE: To inform child and adolescent psychiatrists about the almost 500,000 children now residing in the American foster care system. This overview surveys the pediatric, developmental, and psychiatric needs of these children. METHOD: Child and adolescent psychiatrists, pediatricians, a child welfare researcher, a social worker, and a psychologist developed a consensus paper from their experience with child welfare and a review of the literature in their respective fields. RESULTS: Being in foster care is a defining experience in these children's lives. They are at risk in myriad ways: for instance, being poor, having chronic health deficits, experiencing the trauma of abuse and neglect, and suffering from a gamut of emotional challenges. Evolutionary developments in foster care such as therapeutic foster homes, kinship care, and changes in Medicaid funding will continue to alter the system. CONCLUSIONS: Foster children are a huge reservoir of unmet pediatric and psychiatric needs; research on them is spotty at best. It is hoped that child and adolescent psychiatrists will meet the challenges these youngsters present and will advocate for them.

Adolescent↗
PubMed1996

Foster home environments: a preliminary report.

This study evaluated the quality of developmental and emotional stimulation available to young children in their first foster home placement. Visits were made to 28 of 34 (82%) homes of children ages 2 to 6 years who were enrolled in a prospective study of foster care. Based on the results of the Home Observation for Measurement of the Environment (HOME) scale, 18% of homes were found to be understimulating. Multivariate analysis revealed that low HOME scores were related only to income level and not to other foster parent characteristics. Subscale scores showed that low HOME scores were due largely to lack of adequate play materials and limited interaction between the foster parents and the children. These results demonstrate great variability in the quality of foster home environments. Adjusting foster care subsidies according to foster parents' income levels, providing age-appropriate books and play materials, and additional training of foster parents should increase the developmental and emotional stimulation available to foster children.

Adult↗
PubMed1995

Comparative analysis of catalases: spectral evidence against heme-bound water for the solution enzymes.

A recent X-ray structural analysis of M. luteus catalase indicates heme-bound H2O trans to the proximal tyrosinate ligand, a finding in contrast to previous X-ray data reporting a 5-coordinate heme for bovine liver catalase. The presence of heme-bound H2O, requiring displacement prior to substrate-binding, is likely to be catalytically significant for catalases. We have used magnetic circular dichroism (MCD) spectroscopy, a highly accurate method for assignment of heme spin- and coordination-states, to study native, solution forms of bovine liver, M. luteus, and A. niger catalases. All three enzymes display similar spectral features with the weak (approximately 5 delta epsilon M [moles.cm.Tesla]-1) intensity typical of a 5-coordinate high-spin ferric heme. No evidence for H2O-ligation, inducing a 6-coordinate heme, occurred upon variation of pH or buffer composition. Therefore, we suggest that the catalytically significant structure of catalases has an unoccupied heme binding site trans to the proximal tyrosinate heme ligand.

Animals↗
PubMed1994

Impact of developmental problems on young children's exits from foster care.

Children entering foster care are often described as having multiple problems, although there are surprisingly few comprehensive baseline descriptions of children as they enter care. Further, few studies have examined the interactions among baseline characteristics, physical and mental health problems, and their joint influence on the likelihood that a child will remain in care. The purpose of this study was to investigate the relationship of physical and developmental problems identified shortly after the children entered substitute care to the likelihood of their remaining in care. Data for these analyses came from 272 children (ages 1 month to 7 years) seen at the Foster Care Clinic in Waterbury, Connecticut, between November 1985 and December 1989. All children received a complete physical health assessment and developmental screening upon entry into care. The outcome variable, children's placement status as of September 1990, was confirmed through the Social Services Agency's records. Results indicate that children in foster care commonly showed developmental delays (53%). Further, those who were older at entry into care and nonwhite and who had developmental problems identified were 1.93 times more likely to remain in foster care. Given these findings, early comprehensive assessment for children entering foster care is strongly recommended.

Adoption↗
PubMed1991

Foster children and the foster care system, Part II: Impact on the child.

These three programs represent efforts to solve some of the common clinical problems encountered in the care of foster children. Building on existing community resources, they create new services tailored to the specific needs of the individuals. Together, they form a continuum of services for foster and natural families; as children are identified in the Foster Care Clinic, they are referred for help to community service providers. Supporting visitation through the FRP can smooth the child's adjustment to placement and facilitate eventual return home or another permanent plan. The information from each program complements the other, and a rich and very valuable picture of the children which emerges can assist the agency and the court to make decisions based on assessments of the individual strengths and needs of the children and their families. The medical passport provides a critical link between the agency and physicians to ensure that the children receive the highest standard of health care possible.

Adolescent↗
PubMed1989

The foster care clinic: a community program to identify treatment needs of children in foster care.

A community-based multiagency and multidisciplinary clinic was developed to perform comprehensive evaluations of preschool children in foster care. One hundred thirteen children, ages 1 month to 6 years old, were seen during the first 2 years. Forty-seven percent of the children were known to the social service agency from birth; however, the mean age at placement was 19 months. Fifty-seven percent of the children were in their first foster home at the time of their initial evaluation, but 17% has already been placed in three or more homes. Behavioral problems were found in 39% of the children, and chronic medical problems in 35%. Sixty-one percent of the children were delayed in one or more portions of the developmental assessment. Developmental delay was associated with older age. Sixty percent of the children with developmental delays were not involved in any community educational or therapeutic program, although they had been in foster care for a mean of 6 months. Because of the high mobility of this population, continuity of care by social workers, foster parents, and physicians is hard to achieve. The evaluation model developed by the clinic appears to facilitate the identification of children in need of additional services, enhances cooperation between various community agencies, and provides a constant site for monitoring the status and progress of children in foster care.

Child Abuse↗
PubMed1986

Response of broiler chickens to addition of zinc bacitracin to diets containing salinomycin and roxarsone.

Five trials were conducted at various locations to determine the response of broiler chickens to the addition of zinc bacitracin to diets containing both salinomycin and roxarsone. Results indicate that when a combination of salinomycin and roxarsone is used as an anticoccidial, the addition of zinc bacitracin at 33 or 55 mg/kg diet will improve growth rate and feed utilization by broiler chickens. Regression of body weight and feed utilization on dietary levels of zinc bacitracin indicated that each milligram of zinc bacitracin in the diet increased the 49-day weight of broiler chickens by .92 g and reduced the feed required per gram of gain by .0012 g.

Animals↗
PubMedDate not supplied

Factors associated with toilet training in the 1990s.

CONTEXT: Few studies have systematically evaluated the factors influencing toilet training in children with normal development. OBJECTIVES: To determine those child, parent, and environmental factors associated with toilet training completion, focusing on the influence of the child's temperament and development. DESIGN AND SETTING: Cross-sectional descriptive study of normal children, ages 15-42 months, attending 1 of 4 pediatric clinics in Milwaukee in 1995 and 1996. METHODS: Demographics for child, parents, and household were surveyed. Temperament was assessed using the Toddler Temperament Scale and the Behavioral Style Questionnaire. Child development was measured using the Bayley Scales of Infant Development II. MAIN OUTCOME MEASURE: Toilet training status was by parental report and was categorized as not trained, not currently training, in training, or training complete. RESULTS: The study population included 496 children, comprising 219 that had not started training, 70 that were not currently training, 148 that were in training, and 59 that were completely trained. The ages at which 50% of the children were predicted to be toilet trained were 35 and 39 months for girls and boys, respectively. In the multivariate regression model, statistically significant factors best predicting toilet training completion were older age, non-Caucasian race, female gender, and single parenthood. Temperament, development, maternal employment, or use of day care were not statistically significant factors. CONCLUSION: Innate factors such as older age, non-Caucasian race, and female gender are the best predictors of completing toilet training (rather than a child's temperament and developmental stage). Day care and maternal employment appear to be unimportant variables. Parents should not be discouraged, because children are completing toilet training at older ages. Research is needed to discover why single parents are more successful at toilet training.

Age Factors↗
PubMedDate not supplied

Pediatricians and foster children.

The poor state of health and health care of foster children is well documented. The cure lies in the hands of the agencies that administer the foster care system and pay for medical services, and in those of the physicians who provide that care. This study suggests that much of the problem may be solvable. Adequate numbers of pediatricians in Connecticut seem to be committed to caring for foster children, but major impediments remain, including inadequate reimbursement for both primary and specialty health services. The institution of a medical passport can make needed information available and help to establish and promote standards of care. Pediatricians appear willing to take a leadership role in assisting other agencies in developing programs to improve the care of these children; despite the problems in providing medical care to foster children, most pediatricians view it as part of their responsibility to the community and to all children.

Attitude of Health Personnel↗
PubMedDate not supplied

The health care needs of children in foster care: a research agenda.

The health and mental health problems of the children in out-of-home care present many challenges to child welfare agencies and demand closer collaborative relationships among a variety of professional groups. Despite generally well-accepted guidelines for action and strong evidence suggesting that appropriate care may result in significant benefit to the children, many questions remain as to the most effective and efficient methods of providing these services at the individual, system, and policy levels. At the present time, a small number of programs are attempting to implement various parts of the CWLA and AAP recommendations for health and mental health services for children in out-of-home care. It is not certain, however, how efforts to reform the health care system may affect the delivery of services to this population. Research efforts should concentrate on collecting and evaluating data from existing programs at all three levels (individual, system, policy) to aid in refining and directing future policy and practice in the field of child welfare.

Child↗