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

Child Health Services Provided at

Maternal & Child Health Centres

Child Health Services Provided at

Maternal & Child Health Centres Family Health ServiceDepartment of Health

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

Parenting Programme • Preparation for parenthood

• Building positive relationship

• Breastfeeding

• Nutrition

• Home safety

• Oral health

• Other newborn & childcare issues

• Promoting child development

• Managing child behaviour

Immunization programme • Vaccination against 9 infectious diseases

Health & Developmental Surveillance Programme

• Physical examination

• Growth monitoring

• Developmental surveillance

• Hearing and vision screening

Integrated Child Health and Development Programme (0 – 5 Integrated Child Health and Development Programme (0 – 5 years)years)

AN 0 1 2 3 4 6 9 12 18 24 30 36 42 48 54 60

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

() () () ()

(2007)

Levels of interventionLevels of intervention

Target clients Service provider

Resources / Methods of

delivery

Universal programme

•All •MCHCs •Leaflets/videos

•Workshop

•Counselling

Intensive programme

•Mild behaviour problems

•Difficulties in parenting

•MCHCs

•CACs

•Triple P (Primary care)

•Triple P (Group)

Specialist referral

•Severe behavioural and other psychosocial problems

•CACs•HA•SWD/NGOs

•Psychotherapy/ family support/ family therapy/ drug treatment

The Positive Parenting Programme (Triple P)

The Positive Parenting Programme (Triple P)

Triple PTriple P

Target: Parents with children aged 2 to 5 years

• early/mild behaviour problems

• with parenting difficulties

Triple P 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

Triple P: Principles & StrategiesTriple P: Principles & StrategiesTriple P: Principles & StrategiesTriple P: Principles & Strategies

Principle: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


10 Positive parenting strategies10 Positive parenting strategiesHow to develop a positive relationship with

your child1. Spend quality time with your child2. Talk with your child3. Show affectionHow to encourage desirable behaviour4. Praise your child5. Give your child attention6. Provide engaging activities


How to teach your child new skills or behaviours

7. Set a good example

8. Use incidental teaching

9. Use Ask, Say, Do

10.Use behaviour charts


7 Strategies to managing misbehaviour7 Strategies to managing misbehaviour1. Establish clear ground rules2. Use directed discussion to deal with rule

breaking3. Use planned ignoring to deal with minor

problem behaviour4. Give clear, calm instructions5. Back up your instructions with logical

consequences6. Use quiet time to deal with misbehaviour7. Use timeout to deal with serious

misbehaviour

Triple PTriple P

• 4 two-hour weekly group sessions, followed by 4 telephone sessions

• Lecture, video demonstrations, role plays, group discussion, homework assignments

Triple P: Local EvidenceTriple 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)

Changes in Different Child Behavior Problems

Pre- & Post-intervention

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

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

Triple P – Continuous EvaluationTriple 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

Pre and post intervention scoresPre and post intervention scores

0

50

100

150

ECBI-intensity

ECBI-problem

PSI PSOC

Scor

es

pre-intervention

post-intervention

Maintenance of gainsMaintenance of gains

0

50

100

150

ECBI-intensity

ECBI-problem

PSI PSOC

Scor

es

Pre Post 6 months follow-up

Service figures (Sept 2002 to Jan 2006)

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

The Comprehensive The Comprehensive Child Development Child Development

ServiceService

The Comprehensive The Comprehensive Child Development Child Development

ServiceService

The Four ComponentsThe Four Components

1. Identification and management of high-risk pregnant women

2. Identification and management of mothers with postnatal depression

3. Identification and referral of children & families in need of social service intervention

4. Identification and referral of pre-school children with physical, developmental, behavioural & family problems

MethodsMethods

• 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

The Sham Shui Po The Sham Shui Po ExperienceExperience

The Sham Shui Po The Sham Shui Po ExperienceExperience

Identification & Identification & Management of High-risk Management of High-risk

Pregnant WomenPregnant Women

Identification & Identification & Management of High-risk Management of High-risk

Pregnant WomenPregnant Women

Implementation progressImplementation 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

Identification & Identification & Management of Mothers Management of Mothers

with with Postnatal DepressionPostnatal Depression

Identification & Identification & Management of Mothers Management of Mothers

with with Postnatal DepressionPostnatal Depression

Changes due to Implementation of CCDS

Changes due to Implementation of CCDS

• Procedural changes – more systematic identification

procedures: EPDS

• Structural changes – psychiatric nurse on site

• Changes in working relationship

Service FlowService Flow

Services recommended

Psychiatric services

Social services MCHC services

Counselling

Parenting

Breastfeeding

Others

ObservationsObservations

• 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

Early Identification Early Identification & Referral of & Referral of

Social Services NeedsSocial Services Needs

Early Identification Early Identification & Referral of & Referral of

Social Services NeedsSocial Services Needs

Changes due to Implementation of CCDSChanges 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


Service FlowService Flow

Interviewed using SSIG

New cases

Recommended for support service

Recommended for MCHC service

Recommended for IFSC referral

Reasons for referralReasons for referral

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


• More clients accessing social services earlier

• Initial period – most clients referred for casework

• Recent months – more clients referred for supportive programmes

Identification & Referral Identification & Referral

of of Preschool ChildrenPreschool Children

Identification & Referral Identification & Referral

of of Preschool ChildrenPreschool Children

Changes due to Implementation of CCDS Changes due to Implementation of CCDS

• Procedural change – Formal referral mechanism established

between preschools and MCHCs


Routine Service Statistics Routine Service Statistics

• July 2005 to January 2006– Reasons for Referral

• Learning problems• Behaviour/emotional problems • Health problems• Parenting issues• Others

Qualitative Study: Interview with Head-teachersQualitative 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


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

Roll Out Plan to the Roll Out Plan to the Other 3 Other 3

CommunitiesCommunities

Roll Out Plan to the Roll Out Plan to the Other 3 Other 3

CommunitiesCommunities

Roll Out ScheduleRoll Out Schedule

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

Achievements & Achievements & ChallengesChallenges

Achievements & Achievements & ChallengesChallenges

AchievementsAchievements

1. 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

AchievementsAchievements

2. Increased client accessibility to services

– Psychiatric service– Social services– Child assessment & some support

service

ChallengesChallenges

1. Ensuring the effectiveness & efficiency of services delivered (all service providers)

2. Structural Issues in MCHC

Documents

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