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Housing mobility programs and housing choice vouchers provide low-income families with a potentially-transformative opportunity to move to low-poverty neighborhoods. However, families often face barriers to attaining upward residential mobility; poor health may be one important barrier, although few studies have examined this hypothesis. We used the experimental Moving to Opportunity (MTO) Study, constructed residential trajectories, and linked neighborhood opportunity measures to over 14,000 addresses of 3526 families across 7 years. We used latent growth curve longitudinal models to test how baseline health modified effects of MTO housing voucher treatment on neighborhood opportunity trajectories. Results show that poor baseline health adversely influenced how the voucher induced upward mobility. Voucher receipt strongly promoted residential mobility if families were healthy; moreover the low-poverty neighborhood voucher plus counseling treatment promoted higher opportunity neighborhood attainment compared to controls, regardless of the baseline health of the family. However families with health vulnerabilities did not retain the same initial neighborhood gains conferred by the housing choice voucher treatment, as families without health vulnerabilities. These results suggest that housing counseling may be one necessary element to expand neighborhood choice into higher opportunity neighborhoods for families with health challenges. Providing housing vouchers alone are insufficient to promote low-income family high opportunity moves, for families who have disabilities or special needs. The implications of these results point to scaling up housing mobility programs, to provide tailored support for low-income families to use housing choice vouchers to make high opportunity moves, which is particularly necessary for families with health challenges.

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AIM: Comparison of care burden and resilience levels in parents of children with special needs and chronic diseases. METHODS: This study, designed with a cross-sectional and relationship-seeking design, was conducted in a Training and Research Hospital in Turkey. Data was obtained from parents of children with special needs (n = 102) and chronic diseases (n = 102) who presented to the outpatient clinic for routine follow-up between October 2022 and February 2023. The consecutive sampling method was used while choosing the sample. The "Descriptive Characteristics Questionnaire," "Zarit Caregiver Burden Scale (ZCB)," and "Resilience Scale for Adults (RSA)" were used to collect data. Data were evaluated using the SPSS 22.0 statistical program. RESULTS: The burden of care in parents differed significantly between the two groups (p < 0.001), the majority of parents of children with chronic diseases (PCCD) had a mild/moderate care burden, and the majority of parents of children with special needs (PCSN) had a moderate/severe level of care. The care burden scores and total resilience scores were found to be higher in the PCSN group, and the care burden scores and total resilience scores were found to be lower in the PCCD group (p < 0.001). CONCLUSION: This research determined that PCSN showed more care burden and less resilience than PCCD. In this context, it is recommended to regularly monitor the resilience, caregiver burden, and quality of life of caregivers of children with special needs and conduct preventive and strengthening programs.

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Home confinement during the COVID-19 outbreak had psychological effects that continue to be explored by researchers. This study investigated factors influencing the mental health of mothers caring for special needs children in Italy's first lockdown. Specifically, we investigated the relationships between emotional states of depression, anxiety, stress, perceived distress related to home confinement, coping strategies, and other contextual variables (such as opportunities for distance learning and remote working) in a group of 68 mothers of children with special needs and 68 matched mothers of typically developing children. Data from an online survey showed no significant difference between the two groups. However, the research revealed that being a remote worker was a significant predictor of reduced stress in mothers of children with special needs, while distance learning was a significant predictor of reduced stress in mothers of typically developing children. In addition, the study found that hyperarousal symptoms were predictive of stress in mothers of children with special needs, while intrusive thoughts and avoidance coping were predictive of stress in mothers of typically developing children. In conclusion, further research is needed to develop effective support and intervention strategies for families with children with special needs and to deeply investigate the impact of flexible work arrangements and social aid on the mental health of mothers in non-emergency settings.

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This meta-analysis aimed to analyze the oral health inequalities among special needs children during 2004-2019 in Asia to reveal the importance and the needs of establishing integrated and equitable special needs dentistry care system in Indonesia. PubMed, Scopus, Cochrane Library, Web of Science, and Wiley Online Library were systematically searched for full-text observational studies published from 1 January 2004 to 15 January 2020, in English in Asia. Studies that included children under 18 years of age with special needs and compared them to healthy controls were selected. Study quality was assessed using the Joanna Briggs Institute 2017 Critical Appraisal Checklist. Risk of bias was assessed using the ROBINS-E tool. The decayed, missing, and filled permanent teeth (DMFT) index indicated that special needs children who suffer from intellectual disability or autism spectrum disorder had significantly more caries than normal children (p < 0.001). The special needs children who had more caries than normal children lived in countries that had a high average DMFT value among 12 years old children (p < 0.001), and these two variables showed a positive correlation in meta-regression analysis (p < 0.001). Having an integrated and equitable care system and elevating children's oral health are important to maintain special needs children's oral health.

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AIM: In the context of global changes in the epidemiology of internationally adopted children (IACs), the prevalence of infectious diseases and nutritional impairment has not been recently reviewed. Moreover, in France, these characteristics of the children according to their continents of origin and preadoption special needs (SN) status have been incompletely explored. METHODS: Demographic, infectious data and anthropometric of all the newly arrived IACs seen in a specialised clinic for international adoptees in Paris, France, between 2013 and 2016 were retrospectively reviewed. RESULTS: Three hundred and fifty IACs [mean age: 3.4 years (±2.7), 204 male] from 39 countries were included; 55% had SN. Ninety-nine patients had at least one infection, 42% being classified as 'serious' (chronic viral infection, tuberculosis or malaria). Chronic viral infection was diagnosed in 26 (7%) patients (HIV: 16 cases, HBV: 5, HCV: 4) and affected especially Asian children (P < .001). The prevalence of stunting, underweight, wasting and microcephaly was, respectively, 25%, 22%, 15% and 8%. Stunting was more frequent in children from Eastern Europe (P = .02), while SN children were more often microcephalic or underweight (respectively P = .03 and .02). CONCLUSION: The prevalence of serious infections and nutritional impairment remains high in IACs and requires early detection and careful follow-up.

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We assessed the mental health of parents (N = 1450, Mage = 40.76) of special needs children during the COVID-19 pandemic. We conducted an online survey comprising items on demographic data; two self-designed questionnaires (children's behavioral problems/psychological demand of parents during COVID-19); and four standardized questionnaires, including the General Health Questionnaire, Perceived Social Support, Parenting Stress Index, and Neuroticism Extraversion Openness Five Factor Inventory. The results showed that there were significant differences among parents of children with different challenges. Parents of children with autism spectrum disorder were more likely to have mental health problems compared to parents whose children had an intellectual disability or a visual or hearing impairment. Behavioral problems of children and psychological demands of parents were common factors predicting the mental health of all parents. Parent-child dysfunctional interactions and parenting distress were associated with parents of children with autism spectrum disorder. Family support, having a difficult child, and parenting distress were associated with having children with an intellectual disability. It is necessary to pay attention to the parents' mental health, provide more social and family support, and reduce parenting pressures.

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OBJECTIVES: The study aims to investigate the state anxiety of parents of special needs children during the 2019 coronavirus disease (COVID-19) epidemic and the influence of parental stress, social support, and other related variables on the anxiety of parents. METHODS: Bespoke questionnaires of children's and parent's mental and behavioral problems during the epidemic were used in the study. We also used the State Anxiety Inventory (S-AI), the Parenting Stress Index-Short Form-15 (PSI-SF-15), the NEO Five-Factor Inventory (NEO-FFI), and the Multidimensional Scale of Perceived Social Support (MSPSS). The data used in the study were pooled from an online survey of parents of special needs children and analyzed by one-way analysis of variance (ANOVA) and multiple linear regression. RESULTS: Overall, 1,451 individuals were included, of which 402 were fathers (27.71%) and 1,049 were mothers (72.29%). ANOVA results showed that educational background, family monthly income, and type of their child's disability made parents' state anxiety significantly different. The results of multiple linear regression showed that during the epidemic, social support negatively predicted parents' state anxiety (B = -0.15, p < 0.001), whereas parenting stress (B = 0.07, p = 0.001) and parental mental and behavioral problems (B = 0.37, p < 0.001) positively predicted parents' state anxiety. CONCLUSIONS: During the outbreak of COVID-19, parents of special needs children suffered mental and behavioral problems, together with parenting stress and social support, which influenced their state anxiety. These findings can be used to develop relevant psychological interventions to improve the mental health of vulnerable groups during a pandemic like COVID-19.

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This paper aims to provide a critical review of the studies dealing with Educational Robotics for children with Neurodevelopmental Disorders. We aimed to investigate whether in the literature there is a sound evidence that activities with robots improve the abilities and performances of children with special needs. This paper explores the methodological aspects as well as the outcomes of the selected studies to provide a clear picture of the state-of-the-art on this topic. After a systematic search in the online database via keyword searches, 15 scientific papers were included in this review. We applied strict selection criteria limiting our review only to papers reporting educational robotics activities with children (from 3 up to 19 years old) with a diagnosis of neurodevelopmental disorders, in which the children had the opportunity to somehow program the behaviours of real robots. The majority of experiences showed improvements in the participants' performance or abilities, their engagement and involvement, communication/interaction with peers, during robotics sessions. Some studies reported mixed results, calling for the need to carefully design the objective and the related activities of each experience.

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Children with autistic spectrum disorder (ASD) often exhibit uncontrollable disruptive behaviour during transfer to the operating room and operating table and at the induction of anaesthesia (sleep). This process often involves the physical restraining of children. These children are then lifted onto the operating table by healthcare staff after being anaesthetized. This predisposes children to fall risk and hospital staff to musculoskeletal injuries. We developed two concept mobility devices, IMOVE-I and -II, based on robotics systems comprising of restraint modules and multi-positional modality (sitting, supine, Trendelenburg). The aim was to intuitively secure children to facilitate the safe induction of sleep and ease of transfer onto operating tables upon sleep. IMOVE-I loads the child in standing position using a dual arm restraint module that is activated by trained healthcare staff. IMOVE-II loads the child in the sitting position by motivating the self-application of restraints. Opinions were obtained from 21 operating theatre healthcare staff with experience in the care of ASD children and parents with ASD children. The mean satisfaction rating of IMOVE-I was 5.62 (95% CI 5.00, 6.27) versus 8.10 (95% CI 7.64, 8.55) in IMOVE-II, p < 0.001. IMOVE-II is favoured over IMOVE-I in system operation and safety, ease of use and module functionality.

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Objectives: To develop an in-depth understanding of the perceptions and experiences of senior dental students before and after fieldwork visits to a centre for children with special needs. Methods: A qualitative study utilised open-ended questions and involved 39 fifth-year dental students. A thematic analysis of the collected responses was undertaken, and a hierarchy of themes and subthemes were developed. Results: Analysis of the pre-visit responses revealed three main themes and a number of subthemes: 'negative expectations', 'positive expectations', and 'pain expectations'. Similarly, four main themes with a number of subthemes emerged from the post-visit responses: 'positive perceptions', 'negative perceptions', 'oral problems observed', and 'recommendations'. Conclusions: Within the study limits, different perspectives were extracted. Prior to the fieldwork visit, students expressed their lack of self-confidence and inadequate preparation. Following the situated learning visit experience, students' perceptions of managing special needs children was positively influenced. Students were happy to be exposed to such an experience, but hoped for better organisation and specialised supervision in the future.

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There is concern that mothers of special needs children in developing countries like Pakistan are neglected populations facing hidden health challenges. The aim of this study was to investigate the kinds of health challenges mothers experience and to highlight the role of health social workers in supporting the needs of mothers. Twenty-one mothers were sampled across three cities and findings were analyzed through a thematic content analysis approach. Findings revealed that mothers faced significant and salient challenges under eight sub-categories of mental health and six sub-categories of physical health. We recommend that health social workers collaborate with healthcare practitioners to improve health services for mothers and also coordinate with other social workers, community members, and policymakers for improving both social and structural support for special needs families.

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RESUMEN Fundamento: La mirada inclusiva sobre las escuelas debe ser de cambios y amplitud para establecer en el sistema educacional la comprensión del ser humano, considerando sus historias, concepciones, percepciones, creencias, experiencias y trayectorias personales de forma interdisciplinar, especialmente de los niños con deficiencia. Objetivo: Analizar las experiencias de los niños con deficiencias, vivenciadas en una escuela de un municipio brasileño, a partir de los relatos maternos. Metodología: Estudio transversal, exploratorio con abordaje cualitativo. Se aplicó una encuesta a 20 madres de niños con deficiencias que estaban en seguimiento en un Centro de Salud, ubicado en una ciudad del estado de Minas Gerais, Brasil. Fue adoptado el referencial teórico-metodológico de la perspectiva hermenéutica dialéctica, buscando comprender la realidad situada en su contexto, atada a la confrontación y análisis crítico de las categorías empíricas. Resultados: Emergieron puntos problemáticos relativos a la inclusión escolar, inequidades de los derechos, escasez de profesionales de educación y de salud capacitados para el cuidado de los niños con deficiencias, así como las inadecuaciones arquitectónicas, selección y adaptación de mobiliarios para los niños. Conclusiones: La inclusión escolar se presenta como un reto multidimensional, una vez que aún son necesarias condiciones estructurales y contextuales adecuadas en correspondencia con un enfoque de desarrollo sostenible, de modo que la educación inclusiva en las escuelas se efectúe de manera concreta y real, ultrapasando el idealismo referido en las propuestas de políticas públicas.

ABSTRACT: The inclusive view on schools must be of changes and breadth to establish in the educational system the understanding of the human being, considering their histories, conceptions, perceptions, beliefs, experiences and personal trajectories in an interdisciplinary way, especially from disabled children. Objective: To analyze the experiences of disabled children, experienced in a school from a Brazilian municipality, based on the maternal stories. Methodology: Cross-sectional, exploratory study with qualitative approach. A survey was applied to 20 mothers of disabled children being followed up in a health center, located in a city in the state of Minas Gerais, Brazil. The theoretical-methodological reference of the dialectical hermeneutical perspective was adopted, seeking to understand the reality located in its context, tied to the confrontation and critical analysis of the empirical categories. Results: Problematic points emerged regarding school inclusion, rights inequities, scarcity of education and health professionals trained for the care of disabled children, as well as architectural inadequacies, selection and adaptation of furniture for children. Conclusions: School inclusion is presented as a multidimensional challenge, since adequate structural and contextual conditions are still necessary in correspondence with a sustainable development approach, so that inclusive education in schools is carried out in a concrete and real way, exceeding the idealism referred to in public policy proposals.

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RESUMEN Fundamento: La mirada inclusiva sobre las escuelas debe ser de cambios y amplitud para establecer en el sistema educacional la comprensión del ser humano, considerando sus historias, concepciones, percepciones, creencias, experiencias y trayectorias personales de forma interdisciplinar, especialmente de los niños con deficiencia. Objetivo: Analizar las experiencias de los niños con deficiencias, vivenciadas en una escuela de un municipio brasileño, a partir de los relatos maternos. Metodología: Estudio transversal, exploratorio con abordaje cualitativo. Se aplicó una encuesta a 20 madres de niños con deficiencias que estaban en seguimiento en un Centro de Salud, ubicado en una ciudad del estado de Minas Gerais, Brasil. Fue adoptado el referencial teórico-metodológico de la perspectiva hermenéutica dialéctica, buscando comprender la realidad situada en su contexto, atada a la confrontación y análisis crítico de las categorías empíricas. Resultados: Emergieron puntos problemáticos relativos a la inclusión escolar, inequidades de los derechos, escasez de profesionales de educación y de salud capacitados para el cuidado de los niños con deficiencias, así como las inadecuaciones arquitectónicas, selección y adaptación de mobiliarios para los niños. Conclusiones: La inclusión escolar se presenta como un reto multidimensional, una vez que aún son necesarias condiciones estructurales y contextuales adecuadas en correspondencia con un enfoque de desarrollo sostenible, de modo que la educación inclusiva en las escuelas se efectúe de manera concreta y real, ultrapasando el idealismo referido en las propuestas de políticas públicas.

ABSTRACT: The inclusive view on schools must be of changes and breadth to establish in the educational system the understanding of the human being, considering their histories, conceptions, perceptions, beliefs, experiences and personal trajectories in an interdisciplinary way, especially from disabled children. Objective: To analyze the experiences of disabled children, experienced in a school from a Brazilian municipality, based on the maternal stories. Methodology: Cross-sectional, exploratory study with qualitative approach. A survey was applied to 20 mothers of disabled children being followed up in a health center, located in a city in the state of Minas Gerais, Brazil. The theoretical-methodological reference of the dialectical hermeneutical perspective was adopted, seeking to understand the reality located in its context, tied to the confrontation and critical analysis of the empirical categories. Results: Problematic points emerged regarding school inclusion, rights inequities, scarcity of education and health professionals trained for the care of disabled children, as well as architectural inadequacies, selection and adaptation of furniture for children. Conclusions: School inclusion is presented as a multidimensional challenge, since adequate structural and contextual conditions are still necessary in correspondence with a sustainable development approach, so that inclusive education in schools is carried out in a concrete and real way, exceeding the idealism referred to in public policy proposals.

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BACKGROUND: Children with complex chronic medical conditions benefit from early introduction of palliative care services and advanced care planning for symptom management and to support quality of life and medical decision-making. This study evaluated whether introducing palliative care during primary care appointments (1) was feasible; (2) increased access and improved knowledge of palliative care; and (3) facilitated advanced care planning. METHODS: Pilot study of a multi-modal intervention including targeted education for primary care providers (PCPs), an informational packet for families and presence of a palliative care team member in the outpatient clinic. PCPs completed pre- and post-surveys assessing experience, knowledge and comfort with palliative care. Enrolled families received an information packet; a subset also met a palliative care team member. All families were encouraged to make an appointment with the palliative care team, during which the team assessed palliative care needs and goals of care. Upon study completion, the investigators assessed family and PCP satisfaction and collected feedback on project feasibility. RESULTS: Twenty families were enrolled and received the information packet; 15 met a palliative care team member. Of the 17 participating families who were reached and completed a post-study survey, 11 families had never heard of palliative care and 13 were unaware that the palliative care team existed. Most families perceived palliative care information as 'very helpful' and 'very important'. All would recommend palliative care team services to others. Nine families followed up with the palliative care team, but none was prepared to complete an advanced care plan. PCPs reported lack of training in communicating bad news and conducting goals of care discussions. However, they felt increasingly comfortable introducing palliative care to families and supported program continuation. CONCLUSIONS: Initiating palliative care services in the outpatient primary care setting is logistically challenging but increases access to palliative care for children with complex chronic medical conditions and improves palliative care knowledge and comfort for PCPs.

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OBJECTIVES: Families, clinicians and policymakers desire improved delivery of health and related services for children with special health care needs (CSHCN). We analyzed factors associated with ease of use in obtaining such services. We also explored what were specific difficulties or delays in receiving services. By examining data from the National Survey of Children with Special Health Care Needs (NS-CSHCN 2009-2010) and using the revised criteria for "ease of use," we were able to assess the percentage of parents who reported that their experiences seeking services for their children met those criteria. METHODS: We performed Chi square tests to examine associations between the independent variables and their relationship to the difficulties or delays assessed in the survey; including: eligibility, availability of services, waiting lists, cost, and access to information. We used logistic regression to determine the association of meeting the "ease of use" criteria with socio-demographic, complexity of need, and access variables. RESULTS: Overall, a third of families of CSHCN (35.3 %) encounter difficulties, delays, or frustrations in obtaining health and related services. The lack of access to health and community services in this study fell most heavily on children from racial/ethnic minority backgrounds, those in poverty, and those with complex emotional/behavioral or developmental needs and functional limitations. CONCLUSIONS: for Practice CSHCN require services from a broad array of providers across multiple systems. Unfortunately, there are certain difficulties that hamper the accessibility of these systems. These findings underscore the need for both practice-level response and systems-level reform to ensure equitable distribution of health and community resources.

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A successful partnership model between an academic health sciences library and a K-12 school district to provide librarians, nurses, and special education staff with access to health information to support special needs children and their parents is presented. Train-the-trainer staff sessions and a parent session were collaboratively developed. Funding support was used to purchase iPads for librarians and nurses to deliver mobile support. The results indicate the resources taught are being used to find health information and the school librarians and nurses are being sought after to assist in finding health information. Positive feedback from the school district indicates this model could be replicated in similar settings.

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Oral health literacy (OHL) is important in empowering people to improve their general and oral health.Carers’ OHL may be associated with their ability to deliver good oral healthcare to their children. The aimof this pilot study was to assess the OHL among carers of special needs children. This is a descriptivecross-sectional study of carers in four Community-Based Rehabilitation Centre. Data were collectedthrough a structured face-to-face interview of 40 carers. Oral Health Literacy Malay Version (OHLI-M)was measured using text passages and prompts with a total of 57 items. These items were used toassess comprehension and numerical ability of carers based on domains namely, accessing dental care,understand appointment and following medication instructions. The results showed that majority of theparticipants had ‘marginal’ and ‘adequate’ OHL level of 32.5% and 52.5%, respectively. Only four (10%)participants had ‘inadequate’ OHL level. The ‘reading comprehension’ and ‘numeracy’ sections’ meanscores were 37.54 (95% CI 35.7-39.4) and 38.17 (95% CI 34.8-41.6). The total OHL mean score was75.7 (95% CI 71.2-80.2). In conclusion, majority of the carers of special needs children in this sample hadmoderate OHL. Such information is important to develop more appropriate intervention programmes forcarers to match their OHL.

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OBJECTIVES: To explore parents' and caregivers' experience, knowledge, and preferences regarding advance directives (ADs) for children who have chronic illness. METHODS: We conducted a prospective, cross-sectional survey of parents and caregivers of children who have chronic illness. During ambulatory medical visits, participants were asked about previous AD experience and knowledge, future preferences regarding AD discussions, their child's past and current health status, and family demographics. RESULTS: Among 307 participants surveyed, previous AD experience was low, with 117 (38.1%) having heard of an AD, 54 (17.6%) having discussed one, and 77 (25.1%) having known someone who had an AD. Furthermore, 27 (8.8%) participants had an AD or living will of their own, and 8 (2.6%) reported that their chronically ill child had an AD. Previous AD knowledge was significantly more likely among parents and caregivers who had a college degree than those who did not have a high school diploma, yet significantly less likely among primarily Spanish-speaking parents and caregivers than those primarily English-speaking. Interest in creating an AD for the child was reported by 151 (49.2%) participants, and was significantly more likely among families who had more frequent emergency department visits over the previous year. CONCLUSIONS: The limited AD experience and knowledge of parents and caregivers of children who have chronic illness and their interest in creating an AD suggest an unmet need among families of children who have chronic illness, and an opportunity to enhance communication between families and medical teams regarding ADs and end-of-life care.

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BACKGROUND: The management of children with special needs can be very challenging and expensive. OBJECTIVE: To examine direct and indirect cost drivers of home care expenditures for this vulnerable and expensive population. METHODS: We retrospectively assessed secondary data on children, ages 4-20, receiving Medicaid Personal Care Services (PCS) (n = 2760). A structural equation model assessed direct and indirect effects of several child characteristics, clinical conditions and functional measures on Medicaid home care payments. RESULTS: The mean age of children was 12.1 years and approximately 60% were female. Almost half of all subjects reported mild, moderate or severe ID diagnosis. The mean ADL score was 5.27 and about 60% of subjects received some type of rehabilitation services. Caseworkers authorized an average of 25.5 h of PCS support per week. The SEM revealed three groups of costs drivers: indirect, direct and direct + indirect. Cognitive problems, health impairments, and age affect expenditures, but they operate completely through other variables. Other elements accumulate effects (externalizing behaviors, PCS hours, and rehabilitation) and send them on a single path to the dependent variable. A few elements exhibit a relatively complex position in the model by having both significant direct and indirect effects on home care expenditures - medical conditions, intellectual disability, region, and ADL function. CONCLUSIONS: The most important drivers of home care expenditures are variables that have both meaningful direct and indirect effects. The only one of these factors that may be within the sphere of policy change is the difference among costs in different regions.

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In this article we discuss the steps taken by the United States (US) and the European Union (EU) to meet the health care needs of children with rare diseases and suggest possible directions for future endeavors for further improvement. We reviewed 23 reports and nine legislative documents related to pediatric rare diseases and public policy. We assessed the outcome measures of access and satisfaction with medical services by utilizing the surveys done by the European Organization for Rare Diseases -Eurordis (n = 5,963). Comparable surveys were not available in the US. Our analyses of the existing policies and surveys indicate multiple differences between the US and EU. While the US policies seem to be aimed at disease diagnosis and neonatal screening, EU legislators appear to be focusing on access to existing specialized care. However, both systems have struggled with effectively promoting new treatments. Also, while Eurordis surveys have evaluated areas such as the access to medical services, access to social services and satisfaction with the services received in Europe, there are no comparable surveys in the United States. We conclude that better tools are needed to measure the quality of care, needs-assessment and outcome of pediatric rare diseases in both the EU and US. We suggest a better assessment of areas such as access to primary and specialty care, legal advocacy, comfort-care, end-of-life care, social and financial services, psychological support and quality outcome-measures.