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In this webinar, Family for Every Child Members Juconi (Mexico) and Partnership for Every Child (Russia) shared their experiences and learnings around monitoring the reintegration of children into family-based care. RISE Learning Network also joined the panel, contributing experience based on their Monitoring & Evaluation Toolkit, which has been used across many organisations and regions.
Family for Every Child influences national, regional and global decision-makers to implement positive change to child welfare policies and services, with a specific focus on children being cared for in a safe family environment. This is possible, in part, through advocacy efforts led by Family members.
Background Chile Crece Más ("Chile Grows More", CCM) is a comprehensive, multisector, equity-focussed health and social development program which provides essential support to Chilean children and families. Since its rollout in 2007 it has become the centerpiece of Chile's child development policy, but has faced challenges in its design, delivery, and functionality. Reform content This Health Reform Monitor paper identifies four key policy opportunities to improve CCM. To augment the program's impact, the Chilean government could universalize the program to cover all children, not just those insured publicly; adopt a risk-based, family-centered approach to care; modernize record-keeping practices and electronic medical record use in primary care centers; and create (over time) a nationwide, centralized medical record database for all Chilean children. Expected results These reforms will improve access, efficiency, and quality of the program. Together, they are likely to improve child development and health outcomes, and will likely be popular among program users. They are also in line with broader reforms underway in Chile, enhancing political feasibility and salience. Conclusions By improving CCM, the Chilean government has an opportunity to improve child health in the country. Other countries seeking to develop or refine similar programs could utilize these principles when reforming their own policies.
Walker P, Solano S, Medel G et al.
Background Outdoor play supports children's physical, social, and cognitive development; yet, opportunities are declining as indoor, screen-based childhoods become the norm. Early Learning and Child Care (ELCC) centers are key settings for promoting outdoor play, but limited evidence exists on the health and developmental outcomes of licensed nature-based ELCC programs, particularly for children with and those without disabilities. Objective The Sending Preschoolers Outside (SPROUT) and SPROUT-able studies aim to examine the impact of one of Canada's first purposely designed and built licensed outdoor-focused ELCC programs. The primary objective is to examine the health and developmental outcomes of children aged 10-59 months, with and those without disabilities, attending an outdoor-focused, full-day licensed ELCC program compared to those in conventional (eg, not outdoor-focused) ELCC settings. Secondary objectives are to (1) examine educator job satisfaction, health, well-being, and attitudes toward teaching outdoors for children with and those without disabilities; (2) examine caregiver beliefs and attitudes toward children's participation in outdoor play and learning; and (3) identify barriers and facilitators to outdoor play and learning for children with and those without disabilities (ie, the SPROUT-able substudy) in an outdoor-focused ELCC program. Methods This prospective longitudinal open cohort study follows children, caregivers, and educators over 3 years. Participants are recruited from 1 outdoor-focused (experimental) and 3 conventional (usual care) ELCC centers in Ontario, Canada; all sites are licensed. Assessments occur every 6 months and include direct measures of children (eg, anthropometry, motor skills, and accelerometry) and caregiver and educator questionnaires. Mixed-effects modeling will examine changes over time and between groups (experimental vs usual care). Results As of August 2025, 86 caregiver-child dyads are enrolled in the study (67 experimental and 43 control). Of these, 70 children who enrolled at study initiation have completed baseline and T1 and T2 assessments (43 experimental and 27 usual care), while 18 children enrolled at the 6-month time point (T1; 13 experimental and 5 usual care) have completed T1 and T2 (with a missing baseline assessment). A total of 19 children from the experimental group were identified as having a disability meeting criteria for the SPROUT-able substudy: 4 with a formal diagnosis, 3 with caregiver-reported functional difficulties, and 12 receiving additional support from an inclusion support worker. Conclusions By combining a holistic and comparative approach with a focus on children with and those without disabilities, the SPROUT and SPROUT-able studies will generate comprehensive evidence to inform ELCC practice and policy in Canada and internationally. This model within Canada provides timely evidence on outdoor-focused ELCC delivery, integrating disability inclusive outdoor play into ELCC settings, and has the potential to guide meaningful improvements in child development, educator well-being, and community health.
James M, de Lannoy L, Arbour-Nicitopoulos KP et al.
Refugee children's school adjustment is often associated with host country language proficiency, peer victimization, and school belonging, but longitudinal associations among these constructs may reflect both stable child differences and time-varying school-experience processes. This three-wave longitudinal study examined English language proficiency, bullying victimization, and school belonging in 68 Syrian refugee children in Canada. We estimated a cross-lagged panel model (CLPM) and a random intercept cross-lagged panel model (RI-CLPM), both with family-clustered robust inference and controlling for child's age and gender, to distinguish stable child effects from time-varying school-experience processes. The former addresses correlation (e.g., children show trait stability in the three constructs and their associations over time) while the latter addresses whether time-varying school experiences precede later change (e.g., bullying is followed by lower host country language proficiency). In the CLPM, significant cross-lag paths showed that higher Wave 1 bullying victimization predicted lower Wave 2 English language proficiency, higher Wave 1 English language proficiency predicted higher Wave 2 school belonging, higher Wave 1 school belonging predicted higher Wave 2 bullying victimization and higher Wave 2 school belonging predicted higher Wave 3 English language proficiency. In the RI-CLPM with the stable child effect removed, only two significant cross-lags were seen: higher Wave 1 bullying victimization predicted lower Wave 2 English language proficiency (expected), and higher Wave 1 school belonging predicted higher Wave 2 bullying victimization (unexpected). The difference in the findings from the two models suggests that observed longitudinal associations between English language proficiency, bullying victimization, and school belonging are primarily stable between-child differences, whereas early bullying was associated with lower later English language proficiency.
Vitoroulis I, Wang S, Al-Janaideh R et al.
Background Parents of children with Developmental Coordination Disorder (DCD) face barriers in accessing school-based services and supports for their children despite challenges in academic attainment related to motor coordination difficulties and secondary consequences associated with DCD. Changes to service delivery are vital for student success but need to be rooted in parent- and child-identified needs and priorities. Purpose To explore parent perspectives of children (5-18 years) with DCD on the barriers and facilitators in accessing clinical and curriculum-based services and supports across Canada. Method We circulated an online cross-sectional survey using a multi-pronged recruitment strategy to parents of children with suspected or confirmed DCD across Canada from November 2021 to June 2022. Quantitative data were analysed using descriptive statistics and chi-square tests. Exploratory content analysis was completed for qualitative data. Findings Parents across Canada responded, with 488 included surveys. There is inconsistent availability and access to school-based therapies, creating an inequitable service delivery. There are long waitlists, limited frequency of visits and often children are ineligible for services. Despite classroom accommodations and resource support, parents report a lack of educator awareness and understanding with variable adherence to needed curriculum adaptations. Canadian school supports and services are failing to meet the needs of children with DCD, resulting in negative trajectories in physical, social, emotional and academic pursuits. Conclusion Transformative changes are required for provision of school-based clinical and curriculum services and supports. Evidence-informed approaches, such as a tiered service delivery model, can provide effective and financially viable processes, ensuring positive outcomes for students with DCD.
Klein ES, Pereira N, Gill A et al.
Background Although school-based physical activity (PA) is associated with improvements in multiple health and learning indicators, significant gaps persist regarding its systematic implementation at the preschool level. This protocol presents the rationale and methodological design of a curriculum-integrated active break program aimed at evaluating its impact in 5- to 6-year-old preschoolers. Methods A three-arm, non-randomized cluster-controlled trial employing a sequential explanatory mixed-methods design (QUAN → qual) will be conducted in 12 urban public schools in the province of Biobío, Chile, involving 200 kindergarten preschoolers. Primary outcomes-motor competence and health-related physical fitness-and secondary outcomes-learning outcomes and healthy habits (sleep, eating behavior, nutritional status)-will be assessed at baseline and post-intervention. Over 16 weeks, children in the Total Experimental Group (TEG; 4 schools, n = 67) will complete 10 active breaks per week; the Partial Experimental Group (PEG; 3 schools, n = 66) will complete 3-5 active breaks per week; and the Control Group (CG; 5 schools, n = 67) will continue regular daily routines. Discussion To the best of our knowledge, this is the first controlled trial to simultaneously examine the efficacy of a curriculum-integrated active break program on motor competence, physical fitness, learning outcomes, and healthy habits in preschool-aged children. The inclusive design, digital platform support, and mixed-methods approach position this trial as a novel contribution to the evidence base for early childhood PA interventions and educational public policy. Study protocol registration Open Science Framework (OSF). Unique identifier: cu6za. Public URL: https://osf.io/cu6za/overview.
Valencia-Pacheco MA, Vallejos Garcías V, Kracht-Suazo K et al.
Background Vision impairment affects approximately 1 in 4 school-aged children in the United States, and yet challenges in connecting to care exist. Poor vision has been linked to diminished academic performance, social development challenges, and poor mental health. School-based vision programs (SBVPs), which typically provide vision screenings, eye exams, and eyeglasses directly in schools, are one promising avenue to improve access to care, especially in underserved communities. Contributions to theory Vision is a foundational component of both health and educational equity, and SBVPs are interventions that address gaps in access to care for disadvantaged populations. Implications for school health policy, practice, and equity SBVPs would benefit from better integration with school health services and more robust systems to coordinate referrals to eye care providers. States should monitor the impact of SBVPs on access to care. Implementation and expansion of SBVPs should prioritize under-resourced schools and students who face the greatest access barriers. Conclusion Evidence for the impact of SBVPs in addressing unmet eye care needs among our most vulnerable students is robust. Evidence-based policy, financing, data infrastructure, and community partnerships are needed to embed vision care in school health to advance both health and educational equity.
Xu Y, Guo X, Collins M
AbstractWhether and how patients should participate in clinical ethics discussions is an important contemporary debate. Murdoch recently reported clinicians' and ethics service members' views from England and the United States on patient participation in ethics consultation. In response to the call for further understanding, we report parents' and clinicians' experiences of active parental and child involvement in ethics case reviews (ECRs), including the then-novel use of videoconference ECRs during the pandemic in a UK tertiary children's hospital. Between January 2018 and May 2023, parents attended 59 of 85 hospital ECRs and provided positive anecdotal feedback. To better understand their perspectives, we interviewed three families (two couples and one single parent) and four clinicians involved in ECRs, conducted via videoconference because of pandemic restrictions, between March and December 2020. All reviews concerned proposals for innovative COVID-19 therapies. Reflexive thematic analysis identified six themes: (1) parental presence at ECRs is essential; (2) preparation is vital; (3) ECRs support complex decision-making; (4) videoconferencing worked well, although choice of format is important; (5) ECRs offer wider benefits; (6) the ECR process was generally smooth but could still be improved. Although this evaluation focused on videoconference ECRs during the pandemic, the findings remain relevant to current debates. Unlike Murdoch, we found that both parents and clinicians highly valued ECR and supported active participation by parents and, where possible, children and young people. However, we agree that clear guidance is needed to support patients' involvement in ethics processes, including preparation and support that promote inclusive, effective reviews.
Dittborn M, Aylett S, Brierley J
Background Young adults aging out of foster care face a higher risk for negative adult outcomes, including homelessness, substance abuse, mental health issues, lower levels of education and employment, and financial instability, all of which affect their transition to adulthood. Extended foster care provides ongoing support to these young adults, yet participation remains low. Objective This study explores associated factors, both demographic and foster care-related, of extended foster care participation. Participants and setting The study sample included 45,292 young adults in the United States who aged out of foster care between 2011 and 2020. Methods A secondary analysis of merged data from the National Youth in Transition and the Adoption and Foster Care Analysis and Reporting System databases from 2011 to 2024 was conducted. A multivariable binomial logistic regression analysis examined whether demographic or foster care factors, including total time in foster care, age at first removal, placement setting type, and removal reasons, were associated with participation in extended foster care. Results Results indicate that total time in foster care, placement setting at age 17, and rural-urban context are most strongly associated with participation. Race and ethnicity, prior adoption, and the removal reasons of relinquishment, neglect, caretaker's inability to cope, and a child's disability, also show significant associations, though with smaller effect sizes. Conclusions Implications for future research include the need for geographically focused studies that examine structural influences alongside individual factors and include the voices of those with lived experience.
Kim SQ, Leichtle AC, Rocha CC
