Child Health Services Provided at Maternal & Child Health Centres

1. Child Health Services Provided at Maternal & Child Health Centres Family Health Service Department of Health

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

3. 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

4. Levels of intervention

5. The Positive Parenting Programme (Triple P)

6. Triple P Target: Parents with children aged 2 to 5 years • early/mild behaviour problems • with parenting difficulties

7. 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

8. Triple P: Principles & Strategies Principle: To encourage self-regulation & self efficacy of parents • Setting goals for change in parent’s own and child’s behaviours • Keeping track of child’s behaviour • Behaviour diary • Behaviour graph

9. 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

10. 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

11. 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

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

13. 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)

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

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

16. 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

17. Pre and post intervention scores

18. Maintenance of gains

19. 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

20. The Comprehensive Child Development Service

21. 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

22. 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

23. The Sham Shui Po Experience

24. Identification &Management of High-risk Pregnant Women

25. 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

26. Identification & Management of Mothers with Postnatal Depression

27. Changes due to Implementation of CCDS • Procedural changes • more systematic identification procedures: EPDS • Structural changes • psychiatric nurse on site • Changes in working relationship

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

29. 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

30. Early Identification & Referral of Social Services Needs

31. 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

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

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

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

35. Identification & Referral of Preschool Children

36. Changes due to Implementation of CCDS • Procedural change • Formal referral mechanism established between preschools and MCHCs • Changes in working relationship

37. Routine Service Statistics • July 2005 to January 2006 • Reasons for Referral • Learning problems • Behaviour/emotional problems • Health problems • Parenting issues • Others

38. 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

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

40. Roll Out Plan to the Other 3 Communities

41. Roll Out Schedule • Extended to Tuen Mun, Tin Shui Wai and Tseung Kwan O in January 2006

42. Achievements & Challenges

43. 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

44. Achievements • Increased client accessibility to services • Psychiatric service • Social services • Child assessment & some support service

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