Parenting Services provided at Maternal & Child Health Centres

1. Parenting Services provided at Maternal & Child Health Centres Dr. Shirley Leung FRCP(Glasg), FHKAM(Paed) Principal Medical Officer, Family Health Service Department of Health

2. The Family Health Service (DH)衞生署家庭健康服務部 • Our business: To provide a comprehensive range of health promotion and disease prevention services • for children from birth to 5 years, & • womenbelow 65 years of age. through a network of • Maternal & Child Health Centres (MCHCs), & • Woman Health Centres (WHCs)

3. Integrated Child Health and Development Programme幼兒健康及發展綜合計劃

4. Features of the Integrated Child Health & Development Programme • Accessible through a network of 31 MCHCs • Acceptable: >90% of newborns covered • Holistic health • Empowerment of parents • Partnership with parents and community • Evidence-based approach

5. Integrated Child Health & Development Programme -Birth to 5 years-

6. Integrated Child Health and Development Programme (0 – 5 years) (2007) 年齡(月)Age in Months    ()   () ()  ()   Keys註解: Immunization 免疫注射 Physical Examination身體檢查 Growth Monitoring生長監察 Developmental Surveillance Scheme發展監察 AOAE Hearing Screening聽力普查 Vision Screening視力普查 Parenting Programme親職教育計劃 If indicated如有需要 Antenatal產前    ( ) AN

7. Parenting: Levels of intervention

8. Universal Parenting Programme 普及親職教育計劃

9. Universal Parenting Programme • Parenting: Fulfilling the roles of a parent in meeting the individual needs of the child, and nurturing the child’s physical, cognitive & socio-emotional development. • Aim: Equipping parents with the necessary knowledge and skills & supporting them to fulfill their parenting roles, to bring up healthy and well-adjusted children

10. Universal Parenting Programme • For expectant parents and parents of allchildren attending MCHCs • Provide anticipatory guidance to parents to increase their confidence in the parenting role • Address a range of parenting issues, including physical, cognitive, social and emotional issues.

11. Universal Parenting Programme Means: • Health educational resources • Staged developmental leaflets: Child Development 兒童發展 • Specific parenting issue leaflets : Childcare & Parenting 育兒及親職系列 • Video on child development 0-3: The Budding Years 寳寳成長路 • Video on parenting: Parenting Do Re Mi 親子三點式 • Series of interactive workshops共享育兒樂 • Individual counselling

12. Intensive Parenting Programme Positive Parenting Programme加強課程 -- 3P親子「正」策課程

13. Positive Parenting Programme (Triple P) Target: Families / Parents • of children with early/mild behaviour problems • with parenting difficulties

14. Positive Parenting Programme (Triple P) • Developed by a group of clinical psychologists in the University of Queensland, Australia over a period of 20 years • A form of behavioural family intervention (BFI) based on social learning principles

15. Triple P: The Evidence • Documented Efficacy of BFI in treatment & prevention of child behavioural problems, using RCT • Evidence of Effectiveness of different levels of intervention, and with a range of family types

16. 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)

17. Changes in Different Child Behavior Problems Pre- & Post-intervention

18. Changes in Different Parenting and Marital Relationship Scales Pre- & Post-intervention

19. Triple P: Structured group training • 4 two-hour weekly group sessions, followed by 4 telephone sessions • Lecture, video demonstrations, role plays, group discussion, homework assignments

20. Implementation of TP in MCHCs • Since 2002, over 300 MCHC doctors and nurses trained and accredited to deliver Triple P • From September 2002 to October 2005: conducted 419 TP groups, with 3,777 participants

21. 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

22. Pre and post intervention scores

23. Maintenance of gains

24. Triple P – Continuous Evaluation • Factors associated with clinical outcome (ECBI – intensity 子女問題行為): • Residential status 居留身分 • Mother education level 母親教育程度 • Session attendance 上課節數 • Pre-intervention parenting stress scores 課前親職壓力指標

25. Change by Parent Residential Status

26. Change by Mother Education Level

27. Change by Attendance

28. Change by Pre-intervention PSI Scores

29. Completion Rate

30. Completion Rate by Residential Status

31. Completion Rate by Family Type

32. Completion Rate by Family Type

33. Factors Influencing Programme Completion (Reasons) Convenience sample, n=199 • Work hours affecting participation • Family facing other problems • Difficulty in getting childcare while attending programme • Difference with partners

34. Way Forward • Increase accessibility of the programme Universal programme • Resource materials to be uploaded on FHS web site • Publication of a parenting book (0-3 years) • Production of more materials in audio-visual form

35. Way Forward Triple P • For working parents – Increase the no. of after-hours groups • 2002 to 2004 – 6 groups • 2005 – 12 groups • For new immigrant parents – flexible attendance arrangement • For single parents – give them the option of single parent groups • For parents with difficulties arranging childcare – provide information on occasional childcare and mutual help childcare centres

36. Way Forward • Expanding the scope of the programme Universal programme • Teaching values to young children • Supporting children’s learning • Facilitating communication between parents & grandparents Targeted programme • For new immigrant parents • For parents of low socio-economic status

37. The Bio-socio-ecological Framework (Bronfenbrenner, 1979)

38. Thank you