Child health clinics in support of families with children. Guidelines for local authorities on arranging the work of the clinics. Helsinki 2004. 111p. (Publications of the Ministry of Social Affairs and Health, ISSN 1236-2050; 2004:13) ISBN 952-00-1535-3

The publication is meant primarily for the municipal decision-makers responsible for the operational prerequisites of the child health clinics. The publication presents guidelines for the local authorities on how to develop the services of the clinics as a part of the municipal primary services. The guidelines include overall objectives and operational principles as well as proposals for organising and directing the work. A guide meant for clinic staff, which is published separately, has otherwise the same content as the publication but deals, in addition, with other contents and methods of work.

A family- and resource-oriented approach and considerably more extensive peer support are proposed to support efficiently families and parenting and to prevent ill-health in children. It is also proposed that special support and sometimes even frequent home visits should be arranged for families in need. Matters that should be tackled in the first place are the staffing of public health nurses and physicians working at child health clinics as well as their inadequate further education. For carrying out the work described in the guide, an adequate number of public health nurses (max. 340 children under 7/public health nurse when there is no substitute) are needed taking account of the local population and its special characteristics. It is proposed that persons skilled in family-oriented work should be added to the staff to carry out home visits to families in need of special support. A sufficient number of physicians with appropriate education that are motivated in this kind of work (max. 2,400 children/ full-time physician when there is no substitute) are also needed. Physicians must be actively involved in the planning and developing of the child health clinic work.

It is proposed with a view to intensifying the clinic work that a family service network should be established and that there should be close co-operation with the day care system, family guidance and child counselling clinics, psychologists, speech therapists, physiotherapists, nutritional therapists and occupational therapists, social workers and, as necessary, other professionals. It is worthwhile linking the intensification of the co-operation to the municipality’s childhood policy programme. Furthermore, a broad-based working group should be set up to boost the health promotion for families with children and to target and monitor services; the group should report of its work to the municipal decision-makers. In the best of cases the promotion of inclusion in community and civic activities started besides parents’ groups can constitute a part of the balanced development of children and young people and of a secure growth basis and social capital supporting families.

An issue that is particularly important is the joint desire to develop both the own work and ways of co-operation for the benefit of children, families and the population. The proposals can be applied in different ways in different municipalities and regions, but appropriately for each locality. Increased social and mental health problems make it necessary to seriously consider an early prevention of them and tackling them at an early stage. There are means to address both, and their introduction only demands reasonable or – in relation to the problems and their treatment – modest additional resources. It is known that the costs of corrective services can be reduced by intensifying preventive action.

Improving the efficiency of the child health clinic work requires not only enhancing the resources and co-operation but also a more efficient management and appointment of persons responsible for the management. It is necessary to enhance the quality assessment, compilation of statistics and local development work regarding the service. The new statutes and recommendations on further education provide a good basis for the updating and maintaining of staff skills. The main responsibility for the enforcement of the proposals put forward in the guide is vested in the local authorities. Extensive regional co-operation by educational institutions, NGOs and the social and health care system is needed, in addition. Some of the proposals require measures at the national level, including development of statistics, information systems and evidence-based activities. The recommendations in the end of the publication provide an overall picture of the guidelines presented in the whole guide.

Key words: child health clinics, children, co-operation, health, health promotion, management, physicians, public health nurses, wellbeing