On this page

1. Policy framework

2. Stakeholders

3. Guidance to stakeholders

4. Target groups

5. Funding

The healthy psychological development of children and youth is based on biological prerequisites, but also on relationships with family and the environment. Negative events during childhood are a common basis for developing mental health issues. These issues can manifest either during childhood or in adulthood and may lead to suicidal tendencies as a consequence. An inappropriate relationship with parents or other educational figures, often characterised by a low level of care and a high level of control, can increase the risk of developing depression by two or three times. Child abuse increases the risk of developing depression by four times. However, a wide array of child abuse prevention activities is already being implemented as part of the National Strategy of Protection against Family Violence 2017-2022, along with different measures and activities resulting from the strategy. Promoting healthy lifestyles for children and youth, as well as improving their socioeconomic circumstances, is addressed by the National Plan for Children's Rights in the Republic of Croatia 2022-2026 and the corresponding Action Plan for the Rights of Children in the Republic of Croatia 2022-2024. In addition, various programmes are implemented by local communities. Various programmes aimed at developing parenting and communication skills have also been initiated. They propose the harmonisation and further stimulation of the development of parenting and communication skills, along with monitoring early parent-child interaction. The emphasis is placed on ensuring the availability of all possible methods of mental health protection for children and youth in the local community. 

Policy framework

Croatia has a legal framework defining the concept of early intervention, mainly focused on supporting parents and children to reach their full health and social potential as they grow. There is no dedicated strategic framework specifically focused on youth and their particular health risks, apart from the broader frameworks mentioned earlier. The policy framework that defines and prescribes mechanisms for early detection and intervention in Croatia will be discussed below. Within these legislative and strategic frameworks, the term ‘children’ also pertains to young people aged 15-18.

The Social Welfare Act defines early intervention as a social service in situations involving identified development risks or development difficulties. This service offers professional assistance to children and provides guidance to parents, other family members, or foster parents. The early intervention service is provided for children and their parents or foster parents within a family setting. Its goal is to ensure the child’s inclusion in the wider social network, except when the service is provided within the healthcare framework. This service is provided for children who exhibit signs of developmental deviation, developmental risk, or developmental difficulty at an early age – typically before the child reaches three years old and never after turning seven. Following a professional assessment by a neonatal or pediatric specialist, or exceptionally, a physician from another specialisation, the social welfare centre requests the service provider to assess the duration and frequency of the early intervention service and issues an order granting the right to the service.

Regarding social welfare, one proposed measure is the development of risk assessment criteria and procedures to standardise the implementation of early intervention measures and other support services in the social welfare system.

The Republic of Croatia is one of the signatories of the United Nations Convention on the Rights of Persons with Disabilities. Croatia signed the convention on 1 June 2007, and came into effect in May 2008, being signed by 24 countries. This document will serve as the foundation for comprehensive legislation concerning people with disabilities, including children with disabilities. Recognising the need for international cooperation in this field was one of the incentives for creating this document. Identifying the importance of active participation and self-representation for persons with disabilities was another motivating factor. Article 7 of the document, pertaining to children with disabilities, prescribes the State’s responsibility to ensure that children with disabilities fully enjoy all human rights and fundamental freedoms on an equal basis with other children. 

The Health Care Act provides that within the primary health care framework exists specific preventative health care aimed at children and the health rehabilitation of children with physical or mental disabilities (Article 30). The health care of children falls under the responsibility of a pediatrician specialist. The implementation of individual primary health care measures for children may involve professionals such as psychologists, speech specialists, social workers, and others (Article 31). The planning, coordination, and monitoring of specific child-oriented health care are the responsibility of the Croatian Institute of Public Health (CIPH). The specific care and improvement of children’s mental health is the responsibility of the Mental Health Service.

Stakeholders  

Community health care centres provide services through visiting nurses, offering various programs such as maternity courses (e.g., complementing maternity courses with mini-workshops on proper baby handling and related topics), visits to pregnant women, support for new mothers and infants, breastfeeding support groups, diet/breastfeeding counselling, collaboration with primary care physicians and nurses, cooperation with other community services, and education for parents during pregnancy. Local counselling services, available within the Healthy City project and other organisational frameworks, serve as a significant resource dedicated to supporting children, parents, and entire families. The focus is on promoting family well-being and early child development. Psychological counselling services staffed with nearby professionals serve as a strong community protective factor. Supporting families and children following the identification of early risk signs influenced by various factors can enhance the overall functioning of both the child and the family. This approach aims to foster the growth and development of the child while supporting the family during sensitive periods of the family cycle. By adhering to scientific knowledge and evidence regarding the substantial impact of early development on a person’s lifelong health, support centres like these can operate as preventive community hubs. However, psychological counselling services for supporting families and early child development are not the standard for family and child care in Croatia; instead, they represent an elevated standard in communities that stand out for their readiness in strategic thinking and health planning within their environment. The Social Welfare Act allows for the establishment of social welfare institutions analogous to community service centres, where various psychological and psychosocial activities can be implemented. These institutions can be founded by the unit of local self-administration. Due to the insufficient state-organised psychological and psychosocial protection for families and children at early development risk, this legal regulation provides units of local self-administration the opportunity to establish and fund institutions/centres for counselling and psychosocial support to families. This gives units of local self-administration a legal and operational solution for offering an elevated standard of service that could positively impact the health of entire generations, contingent upon their awareness about the importance of investing in children’s early development and readiness to manage responsibilities with a focus on health.

Guidance to stakeholders 

The CIPH implements various preventive programmes targeting the general population (such as colon cancer and breast cancer prevention programmes) as well as children and young people.

One of the programmes aimed at children is the National Preventive Programme for Early Detection of Visual Impairment. As part of the programme, children at the age of four receive a notification to their home address specifying the exact date, time, and place of the examination. Screening by testing the visual acuity of four-year-olds is highly reliable for detecting low vision, as this simple test can detect up to 97% of all eye anomalies.

The Division for School Medicine, Mental Health and Addiction Prevention operates within the CIPH. The tasks of the Service include:

• coordination, professional guidance, and supervision of school medicine activities

• enhancing the health care for school children and students

• monitoring and enhancing the health of school children and young people

• monitoring of health indicators of school children and young people

• coordination, professional guidance, and supervision of mental health and addiction prevention activities

• prevention of mental illnesses and disorders

• administering the Registry of Persons Treated for Psychoactive Drug Abuse

• administering the Special Registry of Deaths from Psychoactive Drug Abuse

The CIPH implements national vaccination programmes. Vaccination programmes cover children and young people and are carried out in the pre-school period, during primary and secondary school. One of the programmes is Programme of Vaccination Against Human Papilloma Virus (HPV). Voluntary and free vaccination is available to all eighth-grade elementary school students throughout the Republic of Croatia. 

The Service for Mental Health and Addiction Prevention operates within the Teaching Institute of Public Health ‘Dr. Andrija Štampar’. Mental health protection includes measures and activities across several key areas: promotion and enhancement of mental health, prevention, early recognition, treatment, and rehabilitation of behavioural disorders and mental health conditions. Activities are directed towards the entire population, as well as being tailored to specific population groups, including those at risk and vulnerable. The service carries out counselling and educational activities with the teaching staff of preschool and school institutions in the areas of:

• counselling aimed at protecting the mental health of children and adolescents
• Work on preserving the mental health of children and adolescents with risky behaviour
• Early detection, diagnosis, and therapy of children and adolescents with behavioural disorders and mental health problems

The Education and Teacher Training Agency (ETTA) is responsible for the professional development of teachers and school staff (e.g., pedagogues, psychologists, etc). Each year, the Agency prepares a Catalogue of national professional meetings where teaching and school professional staff acquire new knowledge and skills. These cover not only individual school subjects but also areas such as human rights, prevention of violence, prevention of various addictions, and the civic competencies of students.

Civil society plays a significant role in the education of teachers and school professional staff. Civil society organisations frequently conduct educations, often evaluated and verified by the ETTA, aimed at enhancing the knowledge and skills of teaching and school professional staff.

The Forum for Freedom of Education educates teaching and school professional staff through the following programmes: Improvement of Teaching, Democratisation of Schools, and Development of Personal and Social Competences. The Women's Room implements preventive programmes targeting violence against and among children and young people, with an emphasis on the prevention of sexual violence. The programme Sexual Violence - Education and Prevention (SNEP, SNEP 2, and SNEP Online Tool) is intended for the education of teaching and professional school staff in primary and secondary schools. The goal is to prevent sexual violence against and among children and young people. This is currently the first and only programme of its kind in the Republic of Croatia.

Target groups

In Croatia, aside from the preventative mechanisms for early disease detection in the healthcare system and mechanisms for improving and promoting health, the majority of early intervention mechanisms are focused on parents and children. The goal is to provide them with the opportunity to realise their full health and social potential as they grow up. The mentioned mechanisms also apply to young people up to 18 years of age.

Funding

Funding is provided through previously mentioned strategic frameworks and programmes, as well as through the existing system of financing healthcare and social welfare in Croatia.