In considering health information systems, great hope is attached to the use of child health records as a data source for research and community planning. In order to test the completeness of child health records data and their agreement with other sources, information about living conditions, use of medical services and health problems in preschool children were studied in 707 child health centres' records. The results show a considerable number of deficiencies in the system which could, to a certain extent, be remedied by improved instructions to the staff. Health problems in the area of child care also need to be fully defined.
AIMS: To analyse mothers' self-assessed quality of interaction with their children and their opinions about child difficulty with respect to socio-economic status and subjective factors: postnatal depression, social isolation, sense of coherence and locus of control. METHODS AND MATERIAL: A comprehensive questionnaire was completed by 1039 mothers of 18-mo-old children participating in the baseline measurements of a Swedish multicentre study developing and testing a new psychosocial model for the child health services. RESULTS: All subjective factors, including the number of factors, showed significant associations with perceived interaction and difficultness. Effect sizes of subjective factors ranged from about 0.3 to 1 SD for interaction, and from about 0.2 to 0.8 SD for difficultness. As for difficultness, effect sizes were larger for boys. There were no associations between high socio-economic status and high-quality interaction or low child difficultness: the few significant differences in fact favoured low-status children. CONCLUSION: The results provided some contradictory findings to the well-known association between high socio-economic status and favourable outcome. This result is of practical relevance for interventions: supportive programmes cannot be limited to areas and families of low socio-economic status. Positive effects may ensue if subjective factors like those studied here can be promoted among parents and children through the child health services.
AIM: To describe an evidence-based model for preventive child health care and present some findings from baseline measurements. METHODS: The model includes: parent education; methods for interaction and language training; follow-up of low birthweight children; identification and treatment of postnatal depression, interaction difficulties, motor problems, parenthood stress, and psychosocial problems. After baseline measurements at 18 mo (cohort I), the intervention was tested on children from 0 to 18 mo at 18 child health centres in Uppsala County (cohort II). Eighteen centres in other counties served as controls. Two centres from a privileged area were included in the baseline measurements as a "contrasting" sample. Data are derived from health records and questionnaires to nurses and mothers. RESULTS: Baseline experiment (n = 457) and control mothers (n = 510) were largely comparable in a number of respects. Experiment parents were of higher educational and occupational status, and were more frequently of non-Nordic ethnicity. Mothers in the privileged area (n = 72) differed from other mothers in several respects. Experiment nurses devoted considerably fewer hours per week to child health services and to child patients than did control nurses. CONCLUSIONS: Despite certain differences, experiment and control samples appeared comparable enough to permit, in a second step, conclusions about the effectiveness of the intervention.
This paper describes experiences from a three-year research project concerning questions of child abuse and neglect. The emphasis is placed on an attempt to define the real difficulties that have arisen during the course of this work, e.g. group pressure, breaks in continuity, goal heterogeneity, role conflicts and differences in frames of reference. Collaboration problems must be taken seriously and deserve systematic investigation. Multidisciplinary collaboration in different connections within medical, health and social care is of particular importance at this time when the care resources are limited. At the same time it is of decisive importance that the members of the team clarify their attitudes towards certain fundamental questions.
OBJECTIVE: The objectives were to assess: (1) child health nurses' identification of abuse/neglect of children of preschool age in their districts; (2) overall prevalence of abuse/neglect according to the nurses; (3) determinants of nurse identification; (4) determinants of nurse-reported district prevalences; and (5) determinants of reporting to the child protection services (CPS). METHOD: Questionnaires were mailed to about 3,000 child health centers. RESULTS: Fifty-five percent responded. Of these, 22% identified no case and 33% at least one (mostly five or fewer). The overall prevalence was 1.4%. Identification correlated with general participation rate in the county. Other determinants of identification were acquaintance with the district, large district populations, and three variables assumed to reflect a personal interest. Determinants of prevalences were small district populations, regular contacts with the social services, and two personal interest variables. With large district populations, identification increased, whereas prevalences decreased. Only 30.3% had made a report to the CPS. Regular contacts with the social services correlated with reporting. Personal interest was a determinant of the decision to report, and acquaintance with the district a determinant of reporting rate. CONCLUSIONS: Abuse and neglect did not appear as priorities for the Child Health Services. The method probably led to an underestimation of the true prevalence. Personal interest and social services contacts emerged as important determinants. However, the assumed criteria of "interest" were not validated. For effective identification, no nurse should be responsible for more than 400 to 500 children. Implications for practice and research are discussed.
AIM: To determine whether children considered by child health nurses to be at risk of abuse or neglect differed from the general population in gender, age and health status, and whether such child characteristics were related to nurses' perceptions of case seriousness, or to reporting to the child protection services (CPS). METHODS: Questionnaires were sent to nurses in the preventive Child Health Services, 951 of whom identified a total of 6044 children aged 0 to 6 y as suspected of risk of maltreatment. RESULTS: Boys and older children were over-represented among the identified children, possibly because the attention of the nurses was attracted by salient symptoms in older boys. Children with health problems and boys exposed to disturbed parenting/neglect were perceived as more serious cases than other children. Children aged 4-6 y were more likely to be reported to the CPS than children under 3 y of age. CONCLUSION: The findings raise the question whether possibly maltreated children who are very young, female or in good health run a particularly high risk of non-detection, of being considered non-serious cases and of not being reported to the CPS. The risk of going unnoticed may be higher for some children at risk of maltreatment than for others.
The study comprised all 1805 children, most born in 1967, who were in grade 9 of the compulsory school in Uppsala in the spring of 1983 (cross-sectional population) and all 1723 children born in 1967 and resident in Uppsala at ages 10 and 15 years (longitudinal population). The aims were (1) to describe and analyse a normal population of 9th graders in social, medical, educational and psychological respects, (2) to assess relationships between risk level at 10 years, school-identified difficulties at 15 years and psychosocial problems up to age 18, (3) to assess relationships between intervention in school at 15 years and psychosocial problems up to 18 years. Ten-year data had been collected through teacher interviews and analysis of school health records in grade 3. Fifteen-year data were collected through interviews with school health staff and analysis of school health records in grade 9. School marks were gathered at the end of grade 9. Psychosocial problems up to 18 years were assessed on the basis of all registered contacts with official institutions outside school (authorities for care of the handicapped, Department of Child Psychiatry, social agencies, legal authorities). CROSS-SECTIONAL POPULATION. Children older than the grade norm and children of lower social class manifested a more problematic school adjustment and had lower mean marks than younger children and those of higher social classes. Twenty-five per cent of the population had entries in official registers up to age 18, indicating psychosocial problems. Social conditions were related both to the learning process and to psychological health. Educational and psychological problems were mutually correlated. Social problems increased the risk of a number of medical conditions. There were certain relationships between medical and educational problems as well as between medical and psychological problems. LONGITUDINAL POPULATION. Both 10- and 15-year data, particularly the latter, contributed independently to the prediction of psychosocial problems up to age 18. There was a considerably increased risk of psychosocial problems if there had been numerous school difficulties at age 15. Children who had been offered intervention in school at 15 years did not escape psychosocial problems up to 18 years more frequently than children without interventions. In fact, the contrary was the case: with more interventions, the frequencies of psychosocial problems up to age 18 increased.
This article describes some of the results of a study of services to families and children in a suburban district, Sweden. Services included in the study were: maternal and child health care, child psychiatry, services for handicapped children, school health care, day care services, community social services and family counselling services. The baseline studies comprised analyses of official goals expressed in legislation and recommendations, interviews with local politicians and administrators, record studies, studies of working time distribution and questionnaires to field professionals and families. The results indicate that services with traditional goals and well-defined tasks (e.g. health supervision) were more satisfied with their goal attainment, less inclined to collaborate with other services, and more occupied with direct client work than services with non-traditional goals and vaguely defined tasks (e.g. strengthening democracy).