© 2008 – bzga, dji 1 bridging the gap between healthcare system and youth welfare services –...

© 2008 – BZgA, DJI 1

Bridging the Gap between Healthcare System and Youth Welfare Services

– the National Centre on Early Prevention

Reducing Health Inequalities

Workshop I: Public Health Strategies for Families of Low Socioeconomic Status

Berlin, Friday, 8th May 2009

© 2008 – BZgA, DJI 2

Summary

Introduction Data on Prevalance of Child Neglect and Abuse in Germany Federal Action Plan on Early Prevention Starting Points for Early Prevention in Different Domains Need for Interdisziplinary Cooperation The National Centre on Early Prevention First results from evaluation

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Introduction

Starting Points for Enhancement of Early Prevention in Germany

An unsufficient data base on prevalance of neglect and abuse

Two strictly separated systems of support

An increasing number of tasks and expectancies regarding the Youth Welfare Services, but stagnation of funding and staff

A substantial decrease of number and funding of public health agencies in local communities

No common sense about criteria for good quality in early prevention

No proven screening instruments, diagnosis tools, methods or programms of intervention

An increasing public awareness and discussion of child protection issues triggered by some severe cases of child maltreatment

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German Politics on Early Childhood in Recent Years

Improvement of early childhood education in institutions and in families: curricula for early childhood education in Kindergarten, initiative for new compulsative training for professionals on academic level training programs for parents (especially for parents with migration background and low education level)

Expansion of early childhood care for under 3 years oldd daycare centers and daycare mothers

Better health promotion for young children through obligatory visits to pediatricians

„Re-Discovery“ of early childhood

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Data

Statistics on the cause of death: In the period from 1998 – 2006, between 10 and 20 children (below the age of 10) lost their lives each year due to “neglect and abandonment” as well as “other types of abuse”. Babies and toddlers were mainly affected.

Police Criminal Statistics

(Abuse of Children, below the age of 14):

1990: 1,213 2007: 3,373 cases were brought to light

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Data

Increasing numbers of children were taken into care by the Youth Welfare Service:

In total 2005: 25,442 2006: 25,847

0 - 6 years of age 2005: 3,105 2006: 3,693

Since the beginning of the 1990s there has been a definite increase in the need for help with regard to family support and supplementary family support.

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Data II

Results of a survey of 16 youth welfare services (n=318)

(Münder et al., 2000)

< 3 years of age: 71 %

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Initial situation

Resolution of the Federal Government (2005)

Objective:

The improvement of child protection through the development of early warning systems and early prevention for social protection

Integration of healthcare-related services and youth welfare services as well as involvement in the realm of civil society

Strengthening of the State Protection Order

Strengthening of parental responsibility

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Initial Situation

Federal state actions

There are already many examples of good practices in the federal states (however these are often limited locally!)

Mutual decisions made by the Youth and Family Ministry Conference as well as the Health Ministry Conference of the federal states:

“Child and Health”

Discussion regarding (obligatory) early detection examinations with a registration system/invitational system for children

© 2008 – BZgA, DJI 11

Initial Situation

Action Programme of the Federal Ministry for Family, Senior Citizens, Women and Youth (2006)

Focus on the prevention of the neglect and abuse of babies and toddlers,

beginning during pregnancy and continuing until the end of child’s third year (0 – 3 )

Early identification of strain in families and risks for the wellbeing of the child.

Early support of parents in order to strengthen their parental competence (primary and secondary prevention), thereby enhancing child developement.

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Quality Dimensions of Early Prevention

According to the federal action plan

Gaining systematically access to families

Early identification of strain and risks

Motivating families to accept help

Providing support that meets families needs

Sustainable monitoring of the development of families and children

Implementation of early prevention systems into local social services as a regular offer

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Target Groups for Early Prevention

Expectant mothers and young mothers and fathers in stressful situations:

Own experience of violence, violence in the current relationship

Psychological problems of the parents (e.g. drug addiction, depression)

Parents with afflicted life histories (own history of neglect, breakdown in relationships, negative experiences of attachment)

Child’s characteristics: handicap, difficult disposition

Motherhood at a young age, single parents with no support system

No knowledge about how to raise children, unrealistic expectations of the child’s intentions and behaviour

Poverty, unemployment and poor education

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Starting Points for Early Prevention (selection)

Early Childhood Intervention for

handicaped children

Early prevention

Youth Welfare Service(Public) Healthcare System

Counselling during Pregnancy

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Starting Points in the Healthcare System

Almost complete access to all families through:

Gynaecology (in prenatal care)

Obstetric Clinic

(Family) midwives

Children’s Hospitals

Social Pediatric Centres

Registered Pediatricians

Public Health Services

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Starting Points in the Youth Welfare Services

Different offers to children and parents according to their needs:

Parenting training

Daycare: in institutions and in families

Counselling in case of family problems (center based)

Support in education (home based)

Mother-child institutions (living together under surveillance)

Therapeutical daycare

Foster care, home for orphans / children at risk

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Need for Cooperation in Early Prevention

The Healthcare System gets access to almost every parent and child at the time of pregnancy and birth through providing medical care. Assessment of both medical and psychosocial strains and risks in this context is possible and less discriminating. Parents are particularly receptive to advice and offers of support in the period of birth and early childhood (especially with their first child).

The expertise of the Youth Welfare Services is predominantly the clarification of psychosocial risks and need for support. The professionals in this field are trained to work with families with high psychosocial burdens and can motivate them to accept support by methods of co-investigation of problems and co-construction of solutions.

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Need for Cooperation in Early Prevention

Bridging the gap between Healthcare System and Youth Welfare Services is the great challenge for providing better preventive services in early childhood.

Practitioners need:

Knowledge about (local) structure and main tasks of different systems

Interdisziplinary networking and cooperation for a better communication

Interdisziplinary training on early childhood and risk assessment

Effective (empirical proofed) methods of joining and supporting parents

© 2008 – BZgA, DJI

National Centre on Early Prevention

Knowledge platform:

Knowledge production:

Monitoring of the development in the practical field of early prevention in Germany (survey)

Coordination of 10 pilot projects in the federal states (funding is part of the Action Plan)

Development of criteria for systematisation and quality management in the practical field of early prevention

Gathering and dissemination of knowledge:

Findings from international research regarding early prevention (data base)

Summary of findings from the national research (pilot projects, survey)

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Central topics of the pilot projects:

Suitable access and increase in motivation of families to accept early prevention support offers in local communities

Reliable screening and diagnosis tools for risk assessment

Evaluation of special intervention approaches, e.g. family midwives or attachement based counselling

Processing reliable, obligatory network structures (e.g. clearing procedures and coordination)

Transitions between the systems whilst maintaining data protection

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First results from the pilot projects (2008)

Good accessibility to families via the Public Healthcare System.

All of the projects promoted reach a significant section of the target group in practice, but only half of the planned number of families participated in the evaluation projects.

The success of local “early prevention” networks strongly depends on the general conditions (funding, ressources for coordination) and on individual local engagement.

There is also good access through pregnancy advice centres, early prevention institutes for handicaped children, schools and work agencies, if they participate in the networking activities. Daycare centres could be more involved

Family midwives working in early prevention networks are sometimes better integrated with the Youth Welfare Service than before

“Early prevention” is most successful in women who are under severe strain.

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Transfer:

Supporting governmental and NGO participants in their attempts of developing early prevention support systems (counselling)

Supporting practioners and researchers by providing opportunities for exchange of experiences (conferences, workshops)

Supporting interdisciplinary networking between different disciplines and between practise and academia (publications, internet platform)

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First findings from the national survey (2008)

Study included all local authorities both from Youth Welfare Services and Public Health Agencies, 60 % sent back the forms

89% of the local authorities report activities in the field of early prevention

Only 40 % of the local authorities have specialised staff for early prevention activities (mostly 0,5 to 1,0 person for coordination)

Intensifying cooperation between the both systems (72%), implemetation of new support offers for families in need (56%) and initiiating interdisziplinary networks (55%) are the main activities

Networking enhances knowledge about structure and offers of the different cooperation partners (89%), supports communication (81%) and facilitates the cooperation in cases of child protection (78%)

© 2008 – BZgA, DJI


Communication / public relations:

Emphasising the importance of early prevention

Creating a climate for interdisciplinary collaboration and cooperation

Improving parental knowledge regarding raising a child in the first years of life

Strengthening of parental competences

Creating a climate to motivate parents to accept support

© 2008 – bzga, dji 1 bridging the gap between healthcare system and youth welfare services –...

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