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Comprehensive Child Development Service (CCDS) – Early Identification and Timely Intervention

Comprehensive Child Development Service (CCDS) – Early Identification and Timely Intervention Department of Health Hospital Authority Social Welfare Department. 10 March 2017. Content.

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Comprehensive Child Development Service (CCDS) – Early Identification and Timely Intervention

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  1. Comprehensive Child Development Service (CCDS) – Early Identification and Timely Intervention Department of Health Hospital Authority Social Welfare Department 10 March 2017

  2. Content (1) CCDS Collaborative Model(2) CCDS in Kowloon East Cluster & pregnant psychotropic substance abusers family supporting scheme(3) Development of Parenting Capacity Assessment Framework

  3. (1) CCDS Collaborative Model

  4. To address the various developmental needs of young children (0 to 5 years) CCDS: Background A 2005 Policy Address Initiative • An integrated community-based child and family service model

  5. The Critical early years • The early years of a child’s life are critical in affecting the outcomes through the life course • Genes set the blueprint for brain development early before birth. • The environment experienced by a young child literally sculpts the developing brain and establishes the trajectory for long term cognitive and social-emotional outcomes • If we want to improve outcomes in adult life we have to focus on the early years • Investing in early childhood is a sound economic investment. Centre for Community Child Health, Royal Children Hospital, Melbourne

  6. CCDS: Aim • To identify and meet, at an early stage, various health and social needs of children (aged 0 to 5) and their families. • Needy children and families identified will be referred to the appropriate health and/or social services for management.

  7. CCDS: Partners • Labour and Welfare Bureau (LWB) • Department of Health (DH) Maternal and Child Health Centres (MCHCs) • Hospital Authority (HA) Obstetrics, Paediatrics and Psychiatric Services • Social Welfare Department (SWD) & Non-governmental organisations (NGOs) Integrated Family Service Centres (IFSCs), Integrated Services Centres (ISCs), and other service units • Education Bureau (EDB) Pre-primary institutions

  8. CCDS: PartnersMaternal and Child Health Centres (MCHCs) • A network of MCHCs • Antenatal and Postnatal care • A shared care programme for pregnant and postnatal women with public hospitals • Child health service • Integrated child health and development programme • Over 90% of local newborns registered with MCHCs

  9. Maternal Health Service

  10. CCDS: PartnersChild Care Centres and Kindergartens Percentage of 3 to 5-year-olds attending pre-school • 2011 Census: 91.3% • 2016 By-census: 92.5%

  11. CCDS: PartnersHospital Authority Hospitals & Clinics • Provision of various specialist out-patient and in-patient services • Obstetrics, Paediatrics and Psychiatric Services for CCDS

  12. CCDS: PartnersIntegrated Family Service Centre (IFSC) / Integrated Services Centre (ISC) • Currently, there are a total of 65 IFSCs and 2 ISCs covering the whole territory. • Each IFSC serves a well-defined geographical service boundary to facilitate the accessibility of services for service users.

  13. CCDS: PartnersIFSC / ISC Three major components: Intensive counselling, therapeutic groups & crisis intervention Family Counselling Unit Support services to vulnerable or at-risk individuals & families Family Support Unit Family Resource Unit Developmental & preventive services

  14. CCDS: PartnersIFSC / ISC A continuum of preventive, supportive and remedial family services: • Enquiry service • Resource corner • Family life education /Parent-child activities • Groups and programmes • Volunteer training and service • Outreaching service • Counselling service • Referral service • Statutory cases including DSW Ward / Care or Protection / Guardianship Order cases (by SWD IFSCs only)

  15. CCDS: TARGET SERVICE COMPONENTS Early identification and management of: • At-risk pregnant women (teenage, substance abuse, mental illness) • Pregnant ladies and mothers with depression • Children and families with psychosocial needs • Pre-primary children with physical, developmental and behavioural problems

  16. Inter-sectoral / Inter-disciplinary Collaboration Interdepartmental Coordinating Committee HA Specialist Departments DH MCHCs SWD IFSCs Labour and Welfare Bureau Task Group - Developing PCAF

  17. Inter-sectoral / Inter-disciplinary Collaboration • Referral and reply mechanism • Out reaching service • Unified protocol / assessment framework • Communication to facilitate client management • Regular / ad hoc case conference (MCHC staff / psychiatric team / paediatricians / social workers) to discuss the management of difficult clients • If child abuse / neglect are identified, the mechanism of Multi-disciplinary Case Conference on Suspected Child Abuse Cases will be activated

  18. Identification and Management of High-risk Pregnant Women NGOs (Drug addicts) HA OBS AN clinics MCHCs HA Paed NGOs (teenagers) HA Psych (mental health) IFSCs / ISCs

  19. Identification and Management of Pregnant Women & Mothers with Depression MCHC To screen and assess clients with depression/ psychological distress HA Psych team On-site service IFSC / ISC

  20. Identification and Management ofPregnant Women & Mothers with Depression Antenatal period: Nurses and Doctors in MCHC • Identify pregnant women with mood problem or past history of psychiatric illness • Offer supportive counselling service • Refer to the CCDS midwives at the obstetric clinics of HA or the visiting psychiatric team for assessment and follow up

  21. Identification and Management ofPregnant Women & Mothers with Depression Postnatal period: Nurses and Doctors in MCHC • Identify mothers with probable postnatal depression (PND) using the Edinburgh Postnatal Depression Scale (EPDS) • Perform systematic assessment of the condition and the associated psychosocial factors • Those with symptoms suggestive of PND or psychosocial distress are referred to the visiting HA psychiatric nurses at MCHCs for further assessment and counselling. • Depending on the severity of the condition and needs of the mothers and babies, referral are made to: - the HA visiting Psychiatric teams or paediatricians, - regular Psychiatric service of HA - IFSC / ISC

  22. Identification and Management of Pre-primary Children with Health & Developmental Problems • Aims to enhance the identification (by Preschool teachers) and referral (to MCHCs) of pre-school children with physical, developmental & behavioural problems • Formal referral mechanism established between preschools and MCHCs • Briefing cum training for preschool teachers • Development of a training kit on child development and behavioural management for pre-primary teachers • Regular training provided to existing KG teachers and teachers-to-be

  23. Identification and Management of Children & Families with Social Service Needs MCHCs To screen and assess families with high risk factors for their psychosocial needs IFSCs / ISCs

  24. Identification and Management of Children & Families with Social Service Needs In MCHCs • To assess the psychosocial needs of high risk families • Single parents • Teenage parents • Mother / father having substance misuse • Other notorious risk categories e.g. History of domestic violence, family history of drug abuse • Parents observed to have parenting inadequacy • To link families in need with appropriate social services in the community • Supportive on-site services at MCHC, introduce / refer to IFSC / ISC / other supportive community services

  25. Identification and Management of Children & Families with Social Service Needs By IFSCs / ISCs District Support to Needy Cases • Assessment of parenting capacity • Casework and counseling support • Educational / support / mutual-help / therapeutic groups and programmes Support for MCHCs • Briefing on family services and community resources • Setting up information booth to introduce welfare services and deliver service leaflets to service users

  26. (3) Development of Parenting Capacity Assessment Framework

  27. Suboptimal child care and parenting capacity • It is always one of the main problems found in high risk families. • At times, discrepancy among different professionals on assessment of child care adequacy, and • lack of a common language for sharing their respective assessment and proposed management plans for the at-risk families.

  28. Development • Alignment of assessment/intervention among different professions • Enhancement of inter-disciplinary communication and collaboration • Mutually agreed care plans in the best interest of children could be formulated Lack of common language Standardised framework for child care and parenting assessment capacity is thus critical among different professionals Discrepancy in respective assessment and proposed management plans

  29. Parenting Capacity Assessment Framework (PCAF) Overview • Designed for the use by various disciplines of social and health sectors • Developed and implemented by phases for children aged between 0 to 3 years • First PCAF is targeted for children aged between 0 to 12 months for use by social workers • 6 domains including nutrition and growth, sleep pattern, development and parenting, personal hygiene, safety and health care Remarks • It is NOT a checklist or a psychometric scoring test pointing to any specific diagnosis. • The PCAF provided reference in assessing the capacity of the parents/carers when social worker conduct the social assessment.

  30. Pilot

  31. Training, sharing and focus group • Seminars and Workshops • Case Sharing Sessions • Focus groups

  32. Feedbacks Positive feedback - • a useful reference tool to facilitate social workers to conduct a comprehensive assessment on parents with new born babies • for formulating intervention • for facilitating inter-disciplinary collaboration • for engaging clients

  33. Feedbacks (cont’d) Sharing of difficulties • unmotivated parents • clients live in partitioned cubicle / rooms Comments on • training design / needs • Manual and Record Forms • collaboration with other professionals

  34. Refinement after pilot - manual • Elaboration on the part related to assessment on parents with drug / substance abuse habit • Matrix table • highlight key words • Record forms • format • adding bullet points

  35. Manual

  36. Elaboration on the part related to assessment on parents with drug / substance abuse habit

  37. Matrix Tables and Record Forms Framework “Usual” condition/practice as well as “Alerting” and “Serious” conditions for further follow up and intervention in the following aspects

  38. Refinement after pilot - training • videos for illustrating the application • having small group discussion • providing two cases for discussion each group for practice • experienced social worker to share practical tips

  39. 3-Phase Roll-out

  40. Encourage to use Social workers of IFSCs and the related settings are encouraged to use the framework on any at-risk families

  41. Way forward • Assessment framework for social worker for children aged 13 to 36 months and another version for health sector.

  42. Experience Sharing

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