Child Health Services Provided at Maternal

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Child Health Services Provided at Maternal
Child Health Centres

• Family Health Service
• Department of Health

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Integrated Child Health Development Programme
-Birth to 5 years-
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Integrated Child Health and Development Programme
(0 5 years)
(2007)
??(?) Age in Months
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Keys??
Immunization ???? Physical Examination ????
Growth Monitoring ???? Developmental
Surveillance Scheme ???? AOAE Hearing Screening
???? Vision Screening ???? Parenting Programme
?????? If indicated ???? Antenatal ??
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AN
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Levels of intervention
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The Positive Parenting Programme (Triple P)
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Triple P

• Target Parents with children aged 2 to 5 years
• early/mild behaviour problems
• with parenting difficulties

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Triple P

• Aims
• Increase parental competence and confidence in
  raising children
• Increase positive parent-child communication
• Improve parents skills in managing behaviour
  problems with the use of non-coercive and
  non-punitive methods
• Reduce emotional and behaviour problems in
  children

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Triple P Principles Strategies

• Principle To encourage self-regulation self
  efficacy of parents
• Setting goals for change in parents own and
  childs behaviours
• Keeping track of childs behaviour
• Behaviour diary
• Behaviour graph

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Triple P Principles Strategies

• 10 Positive parenting strategies
• How to develop a positive relationship with your
  child
• Spend quality time with your child
• Talk with your child
• Show affection
• How to encourage desirable behaviour
• Praise your child
• Give your child attention
• Provide engaging activities

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Triple P Principles Strategies

• How to teach your child new skills or behaviours
• Set a good example
• Use incidental teaching
• Use Ask, Say, Do
• Use behaviour charts

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Triple P Principles Strategies

• 7 Strategies to managing misbehaviour
• Establish clear ground rules
• Use directed discussion to deal with rule
  breaking
• Use planned ignoring to deal with minor problem
  behaviour
• Give clear, calm instructions
• Back up your instructions with logical
  consequences
• Use quiet time to deal with misbehaviour
• Use timeout to deal with serious misbehaviour

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Triple P

• 4 two-hour weekly group sessions, followed by 4
  telephone sessions
• Lecture, video demonstrations, role plays, group
  discussion, homework assignments

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Triple P Local Evidence

• A randomized controlled trial with Hong Kong
  parents
• 69 parents with children between 3 and 7 years
• Results
• Decrease in child behaviour problems
• Decrease in dysfunctional parenting practices
• Increase in parenting sense of competence
• Increase in marital relationship satisfaction
• (Leung, Sanders, Leung, Mak Lau, 2003)

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Changes in Different Child Behavior Problems Pre-
Post-intervention
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Changes in Different Parenting and Marital
Relationship Scales Pre- Post-intervention
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Triple P Continuous Evaluation

• Database on pre- and post- Triple P group
  measures of child behaviour and parenting
• Effectiveness of the programme on the whole
• Effectiveness of individual groups / facilitators

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Pre and post intervention scores
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Maintenance of gains
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Service figures (Sept 2002 to Jan 2006)

• Triple P
• 477 groups
• Number of families served 3672
• Universal parenting programme
• 8499 sessions
• Number of families served 56856

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The Comprehensive Child Development Service
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The Four Components

• Identification and management of high-risk
  pregnant women
• Identification and management of mothers with
  postnatal depression
• Identification and referral of children
  families in need of social service intervention
• Identification and referral of pre-school
  children with physical, developmental,
  behavioural family problems

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Methods

• Routine Service Statistics
• Qualitative Study
• Interview / Focus group discussion with clients
  frontline workers
• Case studies
• A Randomized Controlled Trial
• Effectiveness of PND screening programme using
  the Edinburgh Postnatal Depression Scale

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The Sham Shui Po Experience
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Identification Management of High-risk Pregnant
Women
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Implementation progress

• Target clients Pregnant women attending
  Methadone clinic
• Partnership between HA (Obs / Paed / Psych),
  SARDA, DH (Methadone Clinic, MCHC), IFSC other
  social services
• Comprehensive management plan

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Identification Management of Mothers with
Postnatal Depression
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Changes due to Implementation of CCDS

• Procedural changes
• more systematic identification procedures EPDS
• Structural changes
• psychiatric nurse on site
• Changes in working relationship

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Service Flow
Services recommended
Psychiatric services
Social services
MCHC services
Counselling
Parenting
Breastfeeding
Others
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Observations

• Increased number of clients identified as
  probable PND cases
• Increased accessibility to psychiatric services
• Increased accessibility to other support
  services, e.g. IFSC general and specific
  counselling services in MCHC

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Early Identification Referral of Social
Services Needs
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Changes due to Implementation of CCDS

• Procedural changes
• Use of Semi Structured Interview Guide
• Formal referral feedback mechanism
• Structural changes
• Flexible arrangement to facilitate clients
  direct contact with social workers
• Changes in working relationship

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Service Flow
New cases
Interviewed using SSIG
Recommended for support service
Recommended for MCHC service
Recommended for IFSC referral
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Reasons for referral

• Marital problem
• Family relationship
• Interpersonal relationship
• Emotional problems
• Childcare
• Financial assistance
• Accommodation
• Employment
• Premarital pregnancy
• Drug/alcoholic/gambling
• Others

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Observations

• More clients accessing social services earlier
• Initial period most clients referred for
  casework
• Recent months more clients referred for
  supportive programmes

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Identification Referral of Preschool Children
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Changes due to Implementation of CCDS

• Procedural change
• Formal referral mechanism established between
  preschools and MCHCs
• Changes in working relationship

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Routine Service Statistics

• July 2005 to January 2006
• Reasons for Referral
• Learning problems
• Behaviour/emotional problems
• Health problems
• Parenting issues
• Others

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Qualitative Study Interview with Head-teachers

• Positive about the service
• Referral forms easy to complete
• Quick MCHC assessment and feedback
• Uncertain about the outcome of further referral /
  follow-up services

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Observations

• Increased accessibility of children in need to
  assessment and some support services (For
  participating preschools)

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Roll Out Plan to the Other 3 Communities
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Roll Out Schedule

• Extended to Tuen Mun, Tin Shui Wai and Tseung
  Kwan O in January 2006

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Achievements Challenges
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Achievements

• Change in intra- and inter- organizational and
  professional practices
• More proactive and systematic approach to
  identifying clients in need
• Decreased structural barrier
• Established inter-organization communication
  system

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Achievements

• Increased client accessibility to services
• Psychiatric service
• Social services
• Child assessment some support service

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Challenges

• Ensuring the effectiveness efficiency of
  services delivered (all service providers)
• Structural Issues in MCHC