Parenting Services provided at Maternal & Child Health Centres

Parenting Services provided at

Maternal & Child Health Centres

Parenting Services provided at

Maternal & Child Health Centres Dr. Shirley Leung

FRCP(Glasg), FHKAM(Paed) Principal Medical Officer, Family Health Service

Department of Health

The Family Health Service (DH)衞生署家庭健康服務部

The Family Health Service (DH)衞生署家庭健康服務部

• Our business: To provide a comprehensive range of health promotionhealth promotion and and disease preventidisease preventionon services services – for children from birth to 5 yearschildren from birth to 5 years, & – women below 65 years of age.

through a network of – Maternal & Child Health Centres (MCHCs), &– Woman Health Centres (WHCs)

Integrated Child Health and Development Pr

ogramme

幼兒健康及發展綜合計劃

Integrated Child Health and Development Pr

ogramme

幼兒健康及發展綜合計劃

Features of the Integrated Child Health & Development Programme

Features of the Integrated Child Health & Development Programme

• Accessible through a network of 31 MCHCs31 MCHCs• Acceptable: >90% of newborns covered>90% of newborns covered• Holistic health• Empowerment of parents• Partnership with parents and community• Evidence-basedEvidence-based approach

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

Parenting ProgrammeParenting Programme • Preparation for parenthood

• Building positive relationship

• Breastfeeding

• Nutrition

• Home safety

• Oral health

• Other newborn & childcare issues

• Promoting child development

• Managing child behaviour

Immunization programmeImmunization programme • Vaccination against 9 infectious diseases

Health & Developmental Health & Developmental Surveillance ProgrammeSurveillance 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)

Parenting: Levels of interventionParenting: Levels of intervention

Target clients Service provider

Resources / Methods of

delivery

Universal Universal programmeprogramme

•All •MCHCsMCHCs •Leaflets/videos

•Workshop

•Counselling

Intensive Intensive programmeprogramme

•Mild behaviour problems

•Difficulties in parenting

•MCHCsMCHCs

•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

Universal Parenting Programme


普及親職教育計劃普及親職教育計劃



• 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



For expectant parents and parents of allall children attending MCHCs

Provide anticipatory guidanceanticipatory guidance to parents to increase their confidence in the parenting role

Address a a range of parenting issuesrange of parenting issues, including physical, cognitive, social and emotional issues.

Universal Parenting ProgrammeUniversal Parenting Programme

Means:• Health educational resourcesHealth 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 workshopsSeries of interactive workshops 共享育兒樂• Individual counsellingIndividual counselling

Intensive Parenting Programme

Positive Parenting Programme

加強課程加強課程 -- 3P-- 3P 親子「正」策課程親子「正」策課程

Intensive Parenting Programme

Positive Parenting Programme

加強課程加強課程 -- 3P-- 3P 親子「正」策課程親子「正」策課程

Positive Parenting Programme (Triple P)


Target: Families / Parents

• of children with early/mild behaviour problems

• with parenting difficulties



• 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

Triple P: The EvidenceTriple 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

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: Structured group trainingTriple P: Structured group training

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

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

Implementation of TP in MCHCsImplementation 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

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

Triple P – Continuous EvaluationTriple 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

Change by Parent Residential StatusChange by Parent Residential Status

0

5

10

15

20

25

PMR Local

Chan

ges

in E

CBI-

inte

nsity

scor

es

Change by Mother Education LevelChange by Mother Education Level

15.8

1616.2

16.4

16.6

Form 3 or below Form 4 or aboveChange

s in EC

BI-inte

nsity scores

Change by AttendanceChange by Attendance

0

5

10

15

20

Chang

es in

ECBI

-inten

sity

scores

Change by Pre-intervention PSI Scores

Change by Pre-intervention PSI Scores

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

45.00

50.00

50.01-60 60.01-70 70.01-80 80.01-90 90.01-100 100.01-110

110.01-120

120.01-130

130.01-140

140.01-150

150.01-160

Pre-intervention PSI total scores

Cha

nge

in p

re a

nd p

ost

EC

BI

inte

nsit

y sc

ores

Completion Rate Completion Rate

135, 10%

1218,90%

DefaultersNon-defaulters

Completion Rate by Residential StatusCompletion Rate by Residential Status

Non-new immigrants

105, 9%

1088, 91% Defaulters

Non-defaulters

New immigrants

172, 80%

42, 20%

Defaulters

Non-defaulters

Completion Rate by Family TypeCompletion Rate by Family Type

Nuclear families

103, 9%

1033, 91%

Defaulters

Non-defaulters

Non-nuclear families

288, 82%

64, 18%

Defaulters

Non-defaulters

Completion Rate by Family TypeCompletion Rate by Family Type

Lone parent families

8, 24%

25, 76%Defaulters

Non-defaulters

Extended families

52, 17%

246, 83%Defaulters

Non-defaulters

Factors Influencing Programme Completion (Reasons)

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

Way ForwardWay Forward

1. 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


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


2. 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

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

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

Macrosystem – Larger society

Exosystem – Work and friends

Microsystem - Family

Documents

Parenting Services provided at Maternal & Child Health Centres