Parental and Practitioner Views of Telepractice for Pediatric Auditory Verbal Habilitation at a Time of Global Pandemic

Purpose: The aim of this study was to explore parents' and therapists' views of the benefits and challenges of telepractice for early intervention for children who are deaf or hard of hearing during the COVID-19 pandemic. Method: Surveys probed the views of (a) parents and (b) Listening and Spoken Language Specialist (LSLS) Certified Auditory Verbal Therapists (AVTs) in using telepractice to deliver auditory verbal (AV) sessions. The survey for parents covered technology, coaching, communication, learnings for the parent, learnings for the child, and parental preference. The survey for the therapists examined therapy style, technology, relationships with families, and coaching style. Using a convenience sample of 65 families and nine LSLS Certified AVTs, data were collected using Google Forms. Results: A response rate of 42% was achieved for the parents' survey. Families were overwhelmingly confident in the subjective effectiveness of AV sessions delivered by telepractice with modal ratings of 8 and 9 on a 10-point rating scale for telepractice sessions and in-person sessions, respectively. On average, however, parents rated in-person sessions at a significantly higher level. Eighty-five percent opted to continue with either AV delivered solely via telepractice or a blend of telepractice and in-person sessions. Changes in therapists' style included (a) increased interactions with the parent rather than the child and (b) an improvement in coaching techniques. Eight of nine therapists (89%) felt that sessions delivered via telepractice were equally effective as or more effective than in-person sessions. Discussion: The necessary transfer of all AV sessions to telepractice from in-person sessions during the global pandemic of COVID-19 was enacted successfully for the majority of families. Both parents and therapists described benefits and challenges of telepractice for AV intervention. Going forward, the high proportion of families requested either a blended service delivery of telepractice and in-person sessions or therapy via telepractice alone, demonstrating the families' satisfaction with this approach.

Emergency Pediatric Vascular Access

Vascular access is often needed for pediatric patients being treated in the emergency department. Access is often required to evaluate for acute metabolic emergencies, assess for infectious emergencies, to provide fluid resuscitation, blood product and medication administration. Obtaining vascular access can be a challenge, particularly in young children with small vessels and in critical conditions with dehydration or poor perfusion. The method, site, and size of device used to obtain vascular access primarily depend on the patient’s clinical status, the agent to be administered as well as parental preference. Anatomical differences considering the smaller vessels in pediatric patients and patient discomforts and fear of needle sticks afford challenges that are unique to this population. In addition, it is imperative that the emergency physician is cognizant and has strategies to treat both the child’s and the parent’s anxiety associated with the procedure. The emergency physician should have a level of comfort and knowledge of the various techniques and sites of access that are used for pediatric emergencies.

Screen time as an index of family distress

The increase in children's screen time over the last few decades has concerned parents, educators, and policymakers alike, due to its association with negative developmental outcomes. Interventions have focused on educating parents about the apparent dangers and coaching them on how to limit screen time. Such interventions are unlikely to be effective if screen time is driven less by parental preference than by parental necessity, supplementing insufficient adult caretaker availability. We show that during the COVID crisis, screen time increased dramatically as a direct result of sudden decrease in adult caretaker availability. This indicates that lower screen time rates prior to the pandemic were not (merely) a function of well-informed parenting but of well-resourced parenting. We discuss implications for policy, as well as for the ongoing scientific debate about whether screen time is actually problematic for development.

Child Custody and Parental Competencies

Chapter 12 contains only two cases, Painter v. Bannister and Santosky v. Kramer, but these cases are extremely important in having established the important principles of “best interest of the child” for determining child custody arrangements and terminating parental rights based on “clear and convincing evidence.” The former overturned the idea that parental preference should drive custody decisions and the latter recognized the serious and potentially traumatic effects of removing a child from his/her parents.

Which Child Is Parents’ Preferred Caregiver/Listener in China?

Adult children are an important source of care providers for parents in a rapidly aging Chinese society, but we know little of which particular child is preferred by parents in time of need. Using the China Longitudinal Aging Social Survey, we investigate the factors associated with parental preference of caregivers and listeners among all his or her children. With children nested within each parent, we fit the conditional (family) fixed-effect fractional logit model. The main results for both caregivers and listeners suggest a preference for the unmarried, the oldest or the youngest, and children who have provided them with support before. Coresident children are favored in rural but not urban China. We did not find preference for sons over daughters. Neither did we find any effect of prior transfers from parents to children. Our findings shed light on the changing norms of eldercare provision in a transitioning society.