Parenting-Education-The-Public-Health-Approach.pptx

Parenting Education:The Public Health ApproachDr.Shirley Leung Dr.Shirley Leung FRCP(Glasg),FHKAM(Paed),MPH(Auckland)FRCP(Glasg),FHKAM(Paed),MPH(Auckland)Family Health ServiceFamily Health ServiceDepartment of HealthOutline1.1.The Parenting Programme in the Family Health Service2.2.Public health concepts&principles3.3.The public health approach to the development of the Parenting ProgrammeThe Family Health Service(DH)l lOur business:Our business:To provide a comprehensive range of health promotion and disease prevention services l lfor for childrenchildren from from birth to 5 years,birth to 5 years,and and l lwomenwomen below 65 yearsbelow 65 years of age.of age.through a network of l lMaternal&Child Health Centres(MCHCs),&Maternal&Child Health Centres(MCHCs),&l lWoman Health Centres(WHCs).Woman Health Centres(WHCs).The“Integrated Child Health&Development Programme”“Parenting”as a major componentWhat is“parenting”?l lParenting means fulfilling the roles of a parent in meeting the individual needs of the child,and nurturing the childs physical,cognitive,social-emotional,moral&personality development.Integrated Child Health&Development Programme -Content-Parenting ProgrammeParenting Programmel l Breastfeeding Breastfeedingl l NutritionNutritionl l Home safety Home safetyl l Oral health Oral healthl l Other newborn&childcare issues Other newborn&childcare issues l l Preparation for parenthood Preparation for parenthoodl l Building positive relationship Building positive relationshipl l Promoting child development Promoting child developmentl l Managing child behaviour Managing child behaviourImmunization Immunization programmeprogrammel l Vaccination against 9 infectious diseases Vaccination against 9 infectious diseasesChild Health&Child Health&Developmental Developmental Surveillance ProgrammeSurveillance Programmel l Physical examination Physical examination l l Growth monitoring Growth monitoringl l Developmental surveillance Developmental surveillancel l Hearing and vision screening Hearing and vision screeningParenting ProgrammelAim:Equipping parents with the necessary knowledge and skills&supporting them to fulfill their parenting roles,to bring up healthy and well-adjusted childrenParenting ProgrammeUniversalUniversalProgrammeProgrammeIntensive Intensive ProgrammeProgrammeSpecialist Specialist ReferralReferralTarget Target clientclientAllAlll lAt risk groupAt risk groupl lMild/Early Mild/Early problemsproblemsSignificant Significant behavioural&behavioural&other psycho-other psycho-social problemssocial problemsServiceServiceProviderProviderMCHCsMCHCsl lMCHCsMCHCsl lCACsCACsl lCACsCACsl lHAHAl lSWDSWDResourcesResourcesl lLeafletsLeafletsl lWorkshopsWorkshopsl lCounsellingCounsellingl lPrimary carePrimary care Triple P Triple P l lGroup Triple PGroup Triple PPsychotherapy/Psychotherapy/family support/family support/family therapy/family therapy/drug treatmentdrug treatmentUniversal ProgrammevvFor expectant parents and parents of all children For expectant parents and parents of all children attending MCHCs attending MCHCs(90%newborn babies register with MCHCs)(90%newborn babies register with MCHCs)vvAddress a range of parenting issues,including Address a range of parenting issues,including physical,cognitive,social and emotional issues.physical,cognitive,social and emotional issues.vvProvide anticipatory guidance to parents to Provide anticipatory guidance to parents to increase their confidence in parenting activitiesincrease their confidence in parenting activitiesvvGiven in staged formatGiven in staged formatIntegrated Child Health&Development Programme -Schedule-ANAN0 01 12 23 34 46 6121218182424363648486060Age in Months Keys:Immunization Physical Examination Growth Monitoring Comprehensive Observation Service OAE Hearing Screening Parenting Programme Antenatal AN Integrated Child Health and Development Programme(0 5 years)ANAN0 01 12 23 34 46 69 9121218182424303036364242484854546060年齡年齡(月月)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 Programme 發展綜合觀察服務 OAE 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 ()()()()(2006)Formatl lSeries of interactive workshopsSeries of interactive workshops共享育兒樂共享育兒樂共享育兒樂共享育兒樂l lIndividual counsellingIndividual counsellingl lHealth educational resourcesHealth educational resourcesl lStaged developmental leaflets:Staged developmental leaflets:Child Development Child Development 兒童發展兒童發展兒童發展兒童發展l lSpecific parenting issue leaflets:Specific parenting issue leaflets:Childcare&Parenting Childcare&Parenting 育兒及親職系列育兒及親職系列育兒及親職系列育兒及親職系列l lVideo on child development 0-3:Video on child development 0-3:The Budding Years The Budding Years 寳寳成長路寳寳成長路寳寳成長路寳寳成長路l lVideo on parenting:Video on parenting:Parenting Do Re Mi Parenting Do Re Mi 親子三點式親子三點式親子三點式親子三點式Intensive Programme:Positive Parenting Programme(Triple P)Target:Families/Parentslat risklof children with early/mild behaviour problems in childrenlwith parenting difficultiesSummary(1)l lThe Parenting Programme(as a major component of the Integrated Child Health&Development Programme)in MCHCs aims to equip and support parents to fulfill their roles in bringing up healthy and happy childrenPublic Health Concepts&PrinciplesPublic Healthl lThe science and art of preventing disease,prolonging life,and promoting health through organized efforts of society(Acheson Report:Public Health in England,1988)(Acheson Report:Public Health in England,1988)l lAddress health at the population levell lMulti-disciplinaryEpidemiologyl lThe study of the distribution and determinants of health-related states or events in specified populations,and the application of this study to control of health problems.HealthHealth is a state of complete physical,mental and is a state of complete physical,mental and social well-being and not merely the absence of social well-being and not merely the absence of disease or infirmity(1948)disease or infirmity(1948)Health is the extent to which an individual or group is the extent to which an individual or group is able to realise aspirations and satisfy needs,and is able to realise aspirations and satisfy needs,and to change or cope with the environment to change or cope with the environment Health is a resource for everyday life,not an is a resource for everyday life,not an objective of living;it is a positive concept,objective of living;it is a positive concept,emphasising social and personal resources,as well emphasising social and personal resources,as well as physical capabilities(1984)as physical capabilities(1984)EnvironmentalSocietalSocialEmotionalPhysicalMentalSpiritualSexualDimensions of Health(Aggleton et al,1987&Ewles et al,1999)The Main Determinants of Health(Dahlgren&Whitehead 1991)General Socio-Economic,Cultural and Environmental ConditionsLiving and Working ConditionsSocial and Community Networks WorkenvironmentUnemploymentEducationWater and sanitationAgricultureAnd foodproductionHealthCareservicesHousingAge,Sex&Hereditary FactorsIndividual Lifestyle FactorLife-course approachl lEarly life experiences are related to later life outcomes(child health adult health)l lBiological programmingBiological programmingl lSocial deprivationSocial deprivationl lEarly care&nurtureEarly care&nurtureLevels of preventionl lPrimordial prevention Establishment&maintenance of conditions(social,economic,environmental,cultural&behavioural)that minimize hazard to health(public health policy&health promotion)(public health policy&health promotion)l lPrimary prevention Protection of health by personal&communal efforts,such as enhancing nutritional status,immunization,and elimination of environmental risksLevels of preventionl lSecondary prevention Secondary prevention a set of measures a set of measures available to individuals&communities for early available to individuals&communities for early detection&prompt intervention to control detection&prompt intervention to control disease&minimize disabilities,disease&minimize disabilities,e.g.by use of screening e.g.by use of screening programmeprogrammel lTertiary prevention Tertiary prevention Measures aimed at Measures aimed at softening the impact of long-term disease by softening the impact of long-term disease by eliminating and reducing disability&handicap;eliminating and reducing disability&handicap;minimizing suffering&maximizing potential minimizing suffering&maximizing potential years of useful life years of useful life(medical treatment&rehabilitation)(medical treatment&rehabilitation)(Last,2001)(Last,2001)Disease PreventionEnvironmental Risk FactorsEnvironmental Risk FactorsGeneticGenetic Disease Clinical Disease Clinical Onset Presentation Onset Presentation Primary Primary SecondarySecondary Prevention Prevention Prevention PreventionPrimary Prevention:High-risk vs Population-based ApproachPrimary Prevention:High-risk vs Population-based Approachl lHigh-risk approachl lMore efficient;More efficient;BUTBUTl l“RiskRisk”are imprecisely defined are imprecisely definedl lProblem of developing a Problem of developing a“screeningscreening”tool to tool to identify the high risk groupidentify the high risk groupl lLabeling effectLabeling effectl lMiss the cases generated by a large number Miss the cases generated by a large number of people at lower riskof people at lower riskPrimary Prevention:High-risk vs Population-based Approachl lPopulation-based intervention aims to:l lShift the risk distribution curve towards the Shift the risk distribution curve towards the favourable directionfavourable directionl leveryone enjoys a lower risk;everyone enjoys a lower risk;l lhigh-risk individuals are shifted out of the high-risk individuals are shifted out of the“dangerdanger”zonezonel lReverse the Reverse the“risk paradoxrisk paradox”l lA large number of people exposed to a small risk A large number of people exposed to a small risk may generate more cases than a small number may generate more cases than a small number exposed to a high riskexposed to a high riskPrimary Prevention:High-risk vs Population-based ApproachAddressing a range of Health Issues&Risk Factors:Health Promotionl lHealth Promotion is the process of enabling people to increase control over(the determinants of health)and(thereby)improve their health(WHO 1986;Nutbeam,1985)(WHO 1986;Nutbeam,1985)The Ottawa Charter for Health Promotion(WHO 1986)nBuild healthy Public PolicynCreate Supportive EnvironmentnStrengthen Community ActionsnDevelop Personal SkillsnReorient Health ServicesnAdvocatenEnablenMediateThe Jakarta Declaration(WHO,1997)(WHO,1997)There is clear evidence thatThere is clear evidence that.l lComprehensive approaches(using combinations Comprehensive approaches(using combinations of 5 strategies)are the most effectiveof 5 strategies)are the most effectivel lParticular settings offer practical opportunities Particular settings offer practical opportunities for implementation of comprehensive strategies for implementation of comprehensive strategies(e.g.schools,workplaces,local communities)(e.g.schools,workplaces,local communities)l lParticipation from people is essential to sustain Participation from people is essential to sustain effortseffortsl lHealth learning(access to education&Health learning(access to education&information)fosters participation&information)fosters participation&empowerment of people&communitiesempowerment of people&communitiesSummary(2)l lHealth Health multi-dimensional multi-dimensional l lDeterminants of health Determinants of health l lBio-genetic/Bio-genetic/Life-style/Eco-system Life-style/Eco-systeml lLife-course approachLife-course approach l lPrevention Prevention l lPrimordial/Primary/Secondary/TertiaryPrimordial/Primary/Secondary/Tertiaryl lPrimary(Population vs high-risk approach)Primary(Population vs high-risk approach)l lHealth PromotionHealth Promotionl lEmpowerment(individual/community)Empowerment(individual/community)l lMultiple strategiesMultiple strategiesl lInter-disciplinary&inter-sectoral collaborationInter-disciplinary&inter-sectoral collaborationThe Development&Diffusion of the Parenting Programme-The Public Health Approach-Community Diagnosisl lNeeds assessment:3 approachesl lEpidemiological Epidemiological l lComparative Comparative l lCorporateCorporateEpidemiological Needs AssessmentEffectiveness of interventionsPopulations health statusAvailability of servicesThe problem:Childhood behaviour problemsl lChildhood behaviour problems likely to develop Childhood behaviour problems likely to develop into adolescent emotional&behaviour disorders into adolescent emotional&behaviour disorders l lLinks between adolescent emotional&behaviour Links between adolescent emotional&behaviour disorders to depression,anti-social behaviour and disorders to depression,anti-social behaviour and major physical illness in adulthood major physical illness in adulthood l lInter-generational links Inter-generational links psychologically troubled psychologically troubled children will become psychologically troubled children will become psychologically troubled parentsparents The Determinantsl lThe Bio-socio-ecological Framework(Bronfenbrenner,1979)(Bronfenbrenner,1979)-4 interacting domains4 interacting domains-The biological childThe biological child-The family*The family*-The school/communityThe school/community-The wider worldThe wider worldChildFamilySchoolCommunityWider worldChild behaviour problem and Parenting difficultyChild Behaviour problemParenting DifficultyA Viscous CycleLocal situation(1)Prevalence of behaviour problems Prevalence of behaviour problems l l Preschoolers Preschoolersl lMild=17.9%,Moderate=4.6%,Severe=0.8%Mild=17.9%,Moderate=4.6%,Severe=0.8%(Luk et al,1991)(Luk et al,1991)l l Children under 18yrs Children under 18yrs l lInternalizing behaviour=10.3%,Internalizing behaviour=10.3%,l lExternalizing behaviour=18.9%Externalizing behaviour=18.9%(Tang et al,SWD 1999)(Tang et al,SWD 1999)Local situation(2)Parenting difficultyParenting difficultyl l55.2%indicated great or extremely great difficulties in 55.2%indicated great or extremely great difficulties in parenting(preschoolers)parenting(preschoolers)(Hong Kong Council of Social Services,1999)(Hong Kong Council of Social Services,1999)l lParenting stress in relation to:(children under age 15)Parenting stress in relation to:(children under age 15)l lChildrenChildren s academic performance s academic performance 51.7%51.7%l lChildrenChildren s discipline s discipline 49.5%49.5%l lBeing a good parent Being a good parent 47.4%47.4%(HK Boys(HK Boys and Girls and Girls Clubs Association,2000)Clubs Association,2000)l l18%fulfilled research criteria defined for child abuse18%fulfilled research criteria defined for child abuse(Tang et al,SWD 1999)(Tang et al,SWD 1999)Local Situation(3)Family adversity:Family adversity:l lIncreasing number of families with children under 5 Increasing number of fa