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Parental Sensitivity and Nurturance 父母的敏感和养育
4区 法学 Q1 Social Sciences Pub Date : 2020-09-01 DOI: 10.1353/foc.2020.a807761
Carrie E. DePasquale, M. Gunnar
Summary:Parental sensitivity and nurturance are important mechanisms for establishing biological, emotional, and social functioning in childhood. Sensitive, nurturing care is most critical during the first three years of life, when attachment relationships form and parental care shapes foundational neural and physiological systems, with lifelong consequences. Sensitive, nurturing care also buffers children from the negative effects of growing up in difficult circumstances such as poverty.In this article, Carrie DePasquale and Megan Gunnar examine several interventions that directly or indirectly target parental sensitivity and nurturance, and demonstrate the causal role that this type of care plays in children’s development, especially during the first three years of life. They note that even though sensitive, nurturing care is still helpful after infancy and early childhood, it doesn’t completely mitigate the effects of not receiving this type of care early in life. And because sensitive care involves knowing when to respond and when to let the child manage more independently, excessive responsiveness, overinvolvement, and intrusiveness are also forms of insensitive care.Sensitive and nurturing parent behaviors vary across cultures, and numerous other factors influence parental sensitivity as well. For example, children’s temperament and emotional reactivity may affect parents’ behavior and/or alter the effects of parenting behavior on children’s development. Physiological, cognitive, and emotional self-regulatory capabilities, as well as socioeconomic and environmental factors, can also affect a parent’s ability to provide sensitive, nurturing care. Based on the expansive research related to parental sensitivity and nurturance, the authors recommend that policy makers should aim to increase family and community access to programs that enhance sensitive, nurturing care and support parents so they can provide high-quality care to their children.
总结:父母的敏感性和养育是在儿童时期建立生物、情感和社会功能的重要机制。在生命的前三年,当依恋关系形成,父母的照顾塑造了基础的神经和生理系统,并产生终身影响时,敏感的养育照顾是最关键的。敏感的养育照顾也可以缓冲儿童在贫困等困难环境中成长的负面影响。在这篇文章中,Carrie DePasquale和Megan Gunnar研究了几种直接或间接针对父母敏感度和养育的干预措施,并证明了这种护理在儿童发展中发挥的因果作用,尤其是在生命的前三年。他们指出,尽管敏感的养育护理在婴儿期和儿童早期仍然有帮助,但它并不能完全减轻在生命早期没有接受这种护理的影响。由于敏感护理涉及到知道何时做出反应,何时让孩子更独立地管理,过度反应、过度投入和侵扰也是不敏感护理的形式。父母的敏感和养育行为因文化而异,许多其他因素也会影响父母的敏感。例如,孩子的气质和情绪反应可能会影响父母的行为和/或改变父母行为对孩子发展的影响。生理、认知和情绪自我调节能力,以及社会经济和环境因素,也会影响父母提供敏感、养育护理的能力。基于与父母敏感度和养育能力相关的广泛研究,作者建议政策制定者应致力于增加家庭和社区获得增强敏感度、养育能力的护理和支持父母的项目的机会,以便他们能够为孩子提供高质量的护理。
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引用次数: 19
Time On with Baby and Time Off from Work 带孩子的时间和下班的时间
4区 法学 Q1 Social Sciences Pub Date : 2020-09-01 DOI: 10.1353/foc.2020.a807760
Maya Rossin-Slater, Jenna Stearns
Summary:Compared to unpaid leave, paid family leave may better help working parents balance the competing needs of job and family early in a child’s life, among other advantages. Yet the United States remains one of only two countries in the world without a statutory national paid maternity leave policy, and one of the only high-income countries that doesn’t provide access to paid paternity leave for new fathers at the federal level.In theory, Maya Rossin-Slater and Jenna Stearns write, paid leave can benefit families in two ways: by changing the amount of income available in the household (and the amount of resources available for the child), and by increasing the amount of time parents spend with their children. Despite the lack of paid leave at the federal level, several US states have their own paid family leave programs, all of which provide partial wage replacement during leave to care for a newborn or newly adopted child, and aim to cover a broad segment of the workforce through minimal eligibility requirements. Rossin-Slater and Stearns review research about the effects of these state-level programs, as well as paid leave programs in other countries.The authors find that paid family leave has a number of benefits. For one, compared to unpaid leave, paid family leave increases leave-taking rates and leave duration, especially among disadvantaged parents. Paid leave programs that range from a few months to up to a year in length also appear to improve both infants’ health and mothers’ outcomes in the job market. At the same time, the research finds that existing paid leave programs have minimal impacts on businesses, suggesting that these programs confer benefits to workers and their families at little to no cost to their employers.Finally, because rising economic inequality in the United States is in part driven by disparities in early childhood, the authors argue that paid family leave may be one way to level the playing field for children from all backgrounds and help improve intergenerational mobility.
总结:与无薪假期相比,带薪家庭假可能更好地帮助在职父母在孩子生命早期平衡工作和家庭的竞争需求,以及其他优势。然而,美国仍然是世界上仅有的两个没有法定国家带薪产假政策的国家之一,也是仅有的几个没有在联邦层面为新父亲提供带薪陪产假的高收入国家之一。Maya Rossin Slater和Jenna Stearns写道,理论上,带薪休假可以通过两种方式使家庭受益:改变家庭的可用收入(以及孩子的可用资源),以及增加父母与孩子相处的时间。尽管联邦层面缺乏带薪休假,但美国几个州都有自己的带薪家庭假计划,所有这些计划都在照顾新生儿或新收养儿童的假期中提供部分工资替代,并旨在通过最低资格要求覆盖广大劳动力。Rossin Slater和Stearns回顾了关于这些州级计划以及其他国家带薪休假计划影响的研究。作者发现,带薪家庭假有许多好处。首先,与无薪休假相比,带薪家庭假增加了休假率和休假时间,尤其是在处境不利的父母中。带薪休假计划从几个月到一年不等,似乎也能改善婴儿的健康和母亲在就业市场上的表现。与此同时,研究发现,现有的带薪休假计划对企业的影响很小,这表明这些计划向工人及其家人提供福利,而雇主几乎没有成本。最后,由于美国日益加剧的经济不平等在一定程度上是由幼儿时期的差异驱动的,作者认为,带薪家庭假可能是为各种背景的儿童创造公平竞争环境的一种方式,有助于改善代际流动性。
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引用次数: 4
Parental Language and Learning Directed to the Young Child 针对幼儿的父母语言和学习
4区 法学 Q1 Social Sciences Pub Date : 2020-09-01 DOI: 10.1353/foc.2020.a807752
Dina Kapengut, Kimberly G Noble
Summary:The early home language environment, and parents in particular, form the foundation of children’s language development. In this article, Dina Kapengut and Kimberly Noble explore the intersection of neuroscience and developmental psychology to explain how language experiences in the home, and the home learning environment more broadly, shape young children’s brains and, ultimately, their developmental and academic outcomes.Brain plasticity during childhood makes the brain particularly sensitive to environmental influence. Because socioeconomic inequality is associated with variation in environmental exposures and experiences that are particularly powerful in predicting children’s outcomes, the authors write, children from socially and economically disadvantaged backgrounds are at a profoundly increased risk for negative physical, socioemotional, cognitive, and academic outcomes. This harmful pattern emerges early, compounds over time, and persists into adulthood.Fortunately, a number of interventions show promise for helping parents improve the home learning environment. Kapengut and Noble highlight several evidence-based programs, most of which focus on the concept of language nutrition—a term created by pediatricians to explain to caregivers that exposure to language that’s rich in quality and quantity and delivered in the context of social interactions is crucial for children’s development and health. They also note the limitations of existing programs and of the research behind them, and they suggest where policy makers, practitioners, and researchers could look to narrow socioeconomic-related differences in home learning environments.
总结:早期的家庭语言环境,尤其是父母,构成了孩子语言发展的基础。在这篇文章中,Dina Kapengut和Kimberly Noble探讨了神经科学和发展心理学的交叉点,以解释家庭中的语言体验以及更广泛的家庭学习环境如何影响幼儿的大脑,并最终影响他们的发展和学术成果。儿童时期的大脑可塑性使大脑对环境影响特别敏感。作者写道,由于社会经济不平等与环境暴露和经历的变化有关,这些变化在预测儿童的结果方面尤其重要,因此来自社会和经济弱势背景的儿童在身体、社会情感、认知和学业方面产生负面结果的风险大大增加。这种有害的模式出现得很早,随着时间的推移而复合,并一直持续到成年。幸运的是,许多干预措施有望帮助家长改善家庭学习环境。Kapengut和Noble重点介绍了几个循证项目,其中大多数侧重于语言营养的概念,这是儿科医生创造的一个术语,旨在向护理人员解释,接触质量和数量丰富的语言,并在社交互动中提供语言,对儿童的发展和健康至关重要。他们还注意到现有项目及其背后研究的局限性,并建议政策制定者、从业者和研究人员可以在家庭学习环境中缩小与社会经济相关的差异。
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引用次数: 1
Supporting Development through Child Nutrition 通过儿童营养支持发展
4区 法学 Q1 Social Sciences Pub Date : 2020-09-01 DOI: 10.1353/foc.2020.a807754
D. Schanzenbach, Betsy Thorn
Summary:Nutrition is vitally important both during pregnancy and during a child’s early years. Inadequate nutrition during this critical period can harm children’s health and developmental outcomes throughout childhood and into adulthood. Thus, write Diane Whitmore Schanzenbach and Betsy Thorn, it’s particularly important that young children have adequate nutrition and resources.Yet many young children in the United States lack adequate nutrition. In this article, Schanzenbach and Thorn lay out the extent of the problem and review what the research tells us about inadequate nutrition’s detrimental effects on young children’s development. They report on the effectiveness of policies and programs that aim to improve nutrition among young children—especially the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)—as well as supplementation of nutrients (both mandatory and voluntary) by the manufacturers of food products, primarily grains. Finally, they suggest how policy makers and others could help more young children, especially the most vulnerable, get the nutrition they need.
摘要:营养在怀孕期间和孩子的早期都至关重要。在这一关键时期营养不足可能会损害儿童的健康和发育结果,包括整个童年和成年期。因此,Diane Whitmore Schanzenbach和Betsy Thorn写道,幼儿有足够的营养和资源尤为重要。然而,美国的许多幼儿缺乏足够的营养。在这篇文章中,Schanzenbach和Thorn阐述了问题的严重性,并回顾了研究告诉我们营养不足对幼儿发育的有害影响。他们报告了旨在改善幼儿营养的政策和计划的有效性,特别是补充营养援助计划(SNAP)和妇女、婴儿和儿童特别补充营养计划(WIC),以及食品制造商(主要是谷物)补充营养(强制性和自愿性)。最后,他们建议政策制定者和其他人如何帮助更多的幼儿,尤其是最脆弱的儿童,获得他们需要的营养。
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引用次数: 2
Family Income and Young Children’s Development 家庭收入与幼儿发展
4区 法学 Q1 Social Sciences Pub Date : 2020-09-01 DOI: 10.1353/foc.2020.a807757
Christopher Wimer, S. Wolf
Summary:Is income during children’s earliest years a key determinant of long-term child and adult success in the longer run? The research to date, Christopher Wimer and Sharon Wolf write, suggests that it is.Wimer and Wolf review substantial descriptive evidence that income can enhance child development and later adult outcomes, and that it does so most strongly during children’s earliest years. Next they wrestle with the question of whether this relationship is causal. After outlining the challenges in identifying such causal relationships, they describe a number of studies that purport to overcome these challenges through quasi- or natural experiments.Among other topics, the authors examine how family income affects the outcomes of young children compared to those of older children, and how its effects vary among poor, low-income, and higher-income families. They also look at the evidence around other dimensions of income, including nonlinear relationships between income and key outcomes, instability in income versus the absolute level of income, and various forms of income, and they review the evidence for impacts of in-kind or near-cash income supports.Finally, Wimer and Wolf highlight some recently launched studies that will shed further light on the relationship between income and development in children’s earliest years, and they suggest how policy might better provide income support to low-income families and their children.
总结:从长远来看,儿童早年的收入是儿童和成人长期成功的关键决定因素吗?Christopher Wimer和Sharon Wolf写道,迄今为止的研究表明确实如此。Wimer和Wolf回顾了大量描述性证据,证明收入可以促进儿童的发展和日后的成人结果,而且在儿童的早期,收入的作用最为强烈。接下来,他们纠结于这种关系是否是因果关系的问题。在概述了识别这种因果关系的挑战后,他们描述了一些旨在通过准或自然实验克服这些挑战的研究。在其他主题中,作者研究了与年龄较大的儿童相比,家庭收入如何影响幼儿的结果,以及其影响在贫困、低收入和高收入家庭中的差异。他们还研究了收入其他方面的证据,包括收入和关键结果之间的非线性关系、收入相对于绝对收入水平的不稳定性以及各种形式的收入,并审查了实物或近现金收入支持影响的证据。最后,Wimer和Wolf强调了最近启动的一些研究,这些研究将进一步阐明儿童早年收入与发展之间的关系,并提出了政策如何更好地为低收入家庭及其子女提供收入支持。
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引用次数: 8
Child Care and Early Education for Infants and Toddlers 儿童保育与婴幼儿早期教育
4区 法学 Q1 Social Sciences Pub Date : 2020-09-01 DOI: 10.1353/foc.2020.a807756
A. Chaudry, H. Sandstrom
Summary:In this article, Ajay Chaudry and Heather Sandstrom review research on child care and early education for children under age three. They describe the array of early care and education arrangements families use for infants and toddlers; how these patterns have changed in recent decades; and differences by family socioeconomic status, race, and ethnicity.Chaudry and Sandstrom note that families face many challenges both in getting access to child care and in finding care of more than mediocre quality. These challenges include limited supply and limited affordability relative to the needs of working parents and those pursuing education. Other challenges are based on families’ and children’s circumstances; for example, parents may work nontraditional or variable hours, or children may have special developmental needs.Although experts agree that the quality of children’s care is important for their learning and development, the authors write, there is no consensus on how to best measure quality and what factors are most important. They review what we know about the quality of infant and toddler child care in the United States, why child care quality matters for children’s learning and development, and how the federal government as well as the states are trying to improve child care quality.Chaudry and Sandstrom also examine the major public programs that support early care and education, primarily for children in low-income families—child care subsidies, tax credits, and the Early Head Start program. Overall, they note, the United States’ public investment in quality child care and early education is relatively minimal, though bold proposals to bolster that investment are now on the table.
综述:在这篇文章中,Ajay Chaudry和Heather Sandstrom回顾了关于三岁以下儿童保育和早期教育的研究。它们描述了家庭为婴幼儿使用的一系列早期护理和教育安排;近几十年来,这些模式发生了怎样的变化;以及家庭社会经济地位、种族和民族的差异。Chaudry和Sandstrom指出,家庭在获得儿童保育和寻找质量平平的护理方面都面临着许多挑战。这些挑战包括相对于在职父母和追求教育的人的需求,供应有限,负担能力有限。其他挑战是基于家庭和儿童的情况;例如,父母可能非传统或可变的工作时间,或者孩子可能有特殊的发展需求。作者写道,尽管专家们一致认为,儿童的护理质量对他们的学习和发展很重要,但对于如何最好地衡量质量以及哪些因素最重要,还没有达成共识。他们回顾了我们对美国婴幼儿保育质量的了解,为什么儿童保育质量对儿童的学习和发展至关重要,以及联邦政府和各州如何努力提高儿童保育质量。Chaudry和Sandstrom还研究了支持早期护理和教育的主要公共项目,主要针对低收入家庭的儿童——儿童保育补贴、税收抵免和早期启动计划。他们指出,总体而言,美国在优质儿童保育和早期教育方面的公共投资相对较少,尽管目前正在讨论加强这一投资的大胆建议。
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引用次数: 2
Maternal and Environmental Influences on Perinatal and Infant Development 母亲和环境对围产期和婴儿发育的影响
4区 法学 Q1 Social Sciences Pub Date : 2020-09-01 DOI: 10.1353/foc.2020.a807759
A. O'sullivan, C. Monk
Summary:Mother and child wellbeing are intimately connected during pregnancy and the first 12 months of the infant’s life. The fetus and child directly experience the mother’s life and are shaped by it. A mother’s environmental experiences, physical health, and psychological distress affect her interactions with her infant, which in turn have physiological, neurological, and psychological consequences that extend far into the future.In this article, Alexandra O’Sullivan and Catherine Monk explore the biological and behavioral pathways through which the physical and psychological toll of environmental experiences such as poverty, trauma, pollution, lack of access to good nutrition, and systemic disadvantage is transmitted from mother to child, thus impairing fetal and infant neurobiological and emotional development.Fortunately, there are ways to buffer these risks and reorient both the child and the mother-child pair toward a strong developmental trajectory. The authors examine promising avenues for policy makers to pursue. Chief among these are policies that increase access to health care, including mental health care, and those that reduce family stress during pregnancy and the postpartum period, for example, by boosting family income or allowing parents to take paid leave to care for their newborn children.
总结:在怀孕期间和婴儿生命的前12个月,母亲和孩子的健康状况密切相关。胎儿和孩子直接体验母亲的生活,并受其影响。母亲的环境经历、身体健康和心理困扰会影响她与婴儿的互动,而这些互动又会产生生理、神经和心理后果,影响深远。在这篇文章中,Alexandra O'Sullivan和Catherine Monk探讨了环境经历(如贫困、创伤、污染、缺乏良好营养和系统性劣势)造成的身体和心理损失通过生物学和行为途径从母亲传递给孩子,从而损害胎儿和婴儿的神经生物学和情感发展。幸运的是,有一些方法可以缓冲这些风险,并使孩子和母子二人都朝着强大的发展轨迹重新定位。作者研究了政策制定者寻求的有希望的途径。其中最主要的是增加获得包括心理健康护理在内的医疗保健的机会的政策,以及减少怀孕和产后家庭压力的政策,例如通过增加家庭收入或允许父母带薪休假照顾新生儿。
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引用次数: 4
Social Capital, Networks, and Economic Wellbeing 社会资本、网络与经济福祉
4区 法学 Q1 Social Sciences Pub Date : 2020-03-22 DOI: 10.1353/foc.2020.0002
J. Hellerstein, D. Neumark
Summary:Scholars and policy makers alike are increasingly interested in understanding how social capital shapes people’s economic lives. But the idea of social capital is an amorphous one. In this article, economists Judy Hellerstein and David Neumark define social capital as networks of relationships among people who are connected by where they live or work. Thus social capital, in contrast to human capital, resides in the connections among people rather than their individual characteristics.The authors draw on survey evidence, case studies, and administrative data to document that social capital networks play an important role in improving wellbeing, especially in terms of better labor market outcomes. Labor market networks, they write, provide informal insurance or risk sharing, and they facilitate the transfer of information (about job opportunities for individuals, and about potential employees for businesses). Moreover, networked individuals’ choices and outcomes affect others in the network, a phenomenon known as peer effects.The evidence suggests that when it comes to getting a job, networks are especially important to low-skilled workers and immigrants. Hellerstein and Neumark also report some limited evidence on how neighborhood networks may shape children’s health and educational outcomes. Throughout, they discuss how policy might strengthen (or inadvertently weaken) the beneficial effects of networks.
摘要:学者和政策制定者对了解社会资本如何塑造人们的经济生活越来越感兴趣。但社会资本的概念是无定形的。在这篇文章中,经济学家Judy Hellerstein和David Neumark将社会资本定义为人们之间的关系网络,这些人通过生活或工作地点联系在一起。因此,与人力资本相比,社会资本存在于人与人之间的联系,而不是人的个人特征。作者利用调查证据、案例研究和行政数据证明,社会资本网络在改善福祉方面发挥着重要作用,尤其是在改善劳动力市场结果方面。他们写道,劳动力市场网络提供非正式的保险或风险分担,并促进信息的传递(关于个人的工作机会和企业的潜在员工)。此外,网络个人的选择和结果会影响网络中的其他人,这种现象被称为同伴效应。有证据表明,在找工作时,人际网络对低技能工人和移民尤为重要。Hellerstein和Neumark还报告了一些关于社区网络如何影响儿童健康和教育结果的有限证据。在整个过程中,他们讨论了政策如何加强(或无意中削弱)网络的有益影响。
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引用次数: 6
Parenting Practices and Socioeconomic Gaps in Childhood Outcomes 育儿实践和儿童结果的社会经济差距
4区 法学 Q1 Social Sciences Pub Date : 2020-03-22 DOI: 10.1353/foc.2020.0004
A. Kalil, R. Ryan
Summary:In this article, developmental psychologists Ariel Kalil and Rebecca Ryan examine the relation between parenting practices and socioeconomic gaps in child outcomes. They document substantial differences between richer and poorer families, including growing gaps in parental engagement and time use. These gaps matter: the fact that children born to lower-income, less-educated parents are less likely to spend quality time with their parents only compounds their relative economic disadvantage.Evidence suggests that disadvantaged parents want to do many of the same things that higher-income parents do, such as reading to their children and engaging them in educational experiences like trips to parks and museums. But they’re nonetheless less likely to do those things. The authors consider a number of explanations for this discrepancy. One important contributing factor, Kalil and Ryan write, appears to be financial strain and family stress, both of which can impede parents’ emotional and cognitive functioning in ways that make it harder for them to interact with young children in intellectually stimulating and emotionally nurturing ways.The authors conclude with a discussion of the types of policies and programs that might narrow income-based parenting gaps. They find encouraging evidence that relatively low-cost, light-touch behavioral interventions could help parents overcome the cognitive biases that may prevent them from using certain beneficial parenting practices.
摘要:在这篇文章中,发展心理学家Ariel Kalil和Rebecca Ryan研究了育儿实践与儿童结果中的社会经济差距之间的关系。他们记录了富裕家庭和贫穷家庭之间的巨大差异,包括父母参与度和时间使用方面的差距越来越大。这些差距很重要:低收入、受教育程度较低的父母所生的孩子不太可能与父母共度美好时光,这只会加剧他们相对的经济劣势。有证据表明,处境不利的父母希望做许多与高收入父母相同的事情,比如给孩子读书,让他们参与教育体验,比如去公园和博物馆。但他们还是不太可能做这些事情。作者考虑了对这种差异的多种解释。Kalil和Ryan写道,一个重要的促成因素似乎是经济压力和家庭压力,这两个因素都会阻碍父母的情绪和认知功能,使他们更难以智力刺激和情感培养的方式与年幼的孩子互动。作者最后讨论了可能缩小基于收入的育儿差距的政策和计划类型。他们发现了令人鼓舞的证据,证明相对低成本、轻松的行为干预可以帮助父母克服认知偏见,这些偏见可能会阻止他们使用某些有益的育儿方法。
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引用次数: 43
Evolving Roles for Health Care in Supporting Healthy Child Development. 医疗保健在支持儿童健康成长方面不断演变的角色。
4区 法学 Q1 Social Sciences Pub Date : 2020-01-01
Adam Schickedanz, Neal Halfon

Health care reaches more children under age three in the United States than any other family-facing system and represents the most common entry point for developmental assessment of and services for children. In this article, Adam Schickedanz and Neal Halfon examine how well the child health care system promotes healthy child development early in life. They also review children's access to health care through insurance coverage, the health care system's evolution in response to scientific and technical advances, and the shifting epidemiology of health and developmental risk. The authors find that the health care system is significantly underperforming because it is constrained by antiquated conventions, insufficient resources, and outmoded incentive structures inherent in the traditional medical model that still dominates pediatric care. These structural barriers, organization challenges, and financial constraints limit the system's ability to adequately recognize, respond to, and, most importantly, prevent adverse developmental outcomes at the population level. To achieve population-level progress in healthy child development, Schickedanz and Halfon argue that pediatric care will need to transform itself and go beyond simply instituting incremental clinical process improvement. This will require taking advantage of opportunities to deliver coordinated services that bridge sectors and focusing not only on reducing developmental risk and responding to established developmental disability but also on optimizing healthy child development before developmental vulnerabilities arise. New imperatives for improved population health, along with the growing recognition among policy makers and practitioners of the social and developmental determinants of health, have driven recent innovations in care models, service coordination, and coverage designs. Yet the available resources and infrastructure are static or shrinking, crowded out by rising overall health care costs and other policy priorities. The authors conclude that child health systems are at a crossroads of conflicting priorities and incentives, and they explore how the health system might successfully respond to this impasse.

在美国,三岁以下儿童接受医疗保健服务的人数比其他任何面向家庭的系统都要多,医疗保健系统也是儿童发展评估和服务最常见的切入点。在本文中,亚当-施基丹兹(Adam Schickedanz)和尼尔-哈芬(Neal Halfon)研究了儿童医疗保健系统在促进儿童生命早期健康发展方面的作用。他们还回顾了儿童通过保险获得医疗保健的情况、医疗保健系统随着科技进步而发生的演变,以及健康和发育风险流行病学的变化。作者发现,医疗保健系统之所以表现不佳,是因为它受到传统医疗模式固有的陈规陋习、资源不足、激励结构过时等因素的制约,而传统医疗模式仍然主导着儿科医疗保健。这些结构性障碍、组织上的挑战和财政上的制约,限制了该系统充分识别、应对,最重要的是在人群层面预防不良发育结果的能力。施克丹兹和哈丰认为,要想在儿童健康成长方面取得全民层面的进步,儿科医疗就必须进行自我变革,而不仅仅是逐步改进临床流程。这就需要利用各种机会,提供跨部门的协调服务,不仅要关注降低发育风险和应对已确立的发育障碍,还要关注在发育脆弱性出现之前优化儿童的健康发育。改善人口健康的新要求,以及政策制定者和从业人员对健康的社会和发展决定因素的日益认识,推动了最近在护理模式、服务协调和覆盖设计方面的创新。然而,可用的资源和基础设施却处于静止或萎缩状态,被不断上涨的总体医疗成本和其他政策优先事项所挤占。作者得出结论,儿童保健系统正处于优先事项和激励机制相互冲突的十字路口,他们探讨了保健系统如何才能成功应对这一僵局。
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引用次数: 0
期刊
Future of Children
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