7.6 Mechanisms of early detection and signposting of young people facing health risks
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The healthy psychological development of children and youth is based on biological prerequisites, but also on relationships with family and environment. Childhood negative events are a common basis for developing mental health issues which can manifest in childhood, or in adult age, and have suicidal tendencies as a consequence. Inappropriate relationship of parents or other educational figures, mostly in the form of low level of care and high level of control, increases the risk of developing depression by two or three times. Child abuse increases the risk of developing depression by four times, but a wide array of child abuse prevention activities is already being implemented as a part of the National Strategy of Protection against Family Violence for the period 2017 – 2022, as well as different measures and activities resulting from the strategy. Promoting healthy lifestyles of children and youth as well as improving their socioeconomic circumstances is covered by the National Strategy for the Rights of Children in Republic of Croatia for the period 2014-2020 and different programmes being implemented by local communities. Different programmes for developing parenting and communication skills have also been started. They propose the harmonisation and further stimulation of the development of parenting and communication skills and monitoring early parent-child interaction, with the emphasis on the availability of all possible methods of mental health protection for children and youth in the local community.
Croatia has a legal framework defining the concept of early intervention, mostly aimed at parents and children so that they might achieve their full health and social potential as they grow up. There is no strategic framework specifically focused on youth in the sense of different health risks, except the abovementioned wider frameworks. We will now discuss the policy framework defining and prescribing mechanisms of early detection and early intervention in Croatia, noting that in these legislative and strategic frameworks, the term children also pertains to young people aged 15-18.
The Social Welfare Actdefines early intervention as a social service in the case of a determined development risk or development difficulty, providing children with professional help in the form of encouragement, and taking the form of counsel for their parents, as well as other family members or foster parents. The early intervention service is provided for children and parents, or foster parents, in a family setting to ensure the child’s inclusion in the wider social network, unless such a service is provided in the healthcare framework. Such a service is provided for children who have, at an early age, shown signs of development deviation, development risk or development difficulty, typically prior to the child turning 3, and never after they turned 7 years of age. Following a professional assessment by a neonatal or paediatrician specialist, or exceptionally a physician of a different specialisation, the social welfare centre asks the service provider for an assessment of the length and frequency of the service from the first paragraph of this article and adopts an order granting the right to the service.
Speaking of social welfare, one of the proposed measures is the development of risk assessment criteria and procedure with the goal of standardising the implementation of early intervention measures and other socially protective measures and services from the social welfare system.
The Republic of Croatia is one of the signatories of the UN Convention on the Rights of Persons with Disabilities. Croatia signed the convention on 1 June 2007, and the convention came into effect in May 2008, signed by 24 countries. The reason for particularly mentioning this document is that it will become the foundation for the complete legislation in the field of persons with disabilities and children with disabilities. Recognising the need for international cooperation in this field was one of the incentives for creating this document. Recognising the need for persons with disabilities to actively participate in self-representation was another incentive. The document’s article 7, relating to children with disabilities, prescribes the State’s duty to ensure the full enjoyment by children with disabilities of all human rights and fundamental freedoms on an equal basis with other children.
The Health Care Act provides that within the framework of primary health care exists a specific preventative health care aimed at children, health rehabilitation of children with physical or mental disabilities (article 25). The health care of children is the responsibility of a paediatrician specialist, while the implementation of individual primary health care measures for children can involve a psychologist, speech specialist, social worker and other professionals (article 26). Article 69 prescribes the obligation of community health centres to provide care for infants and preschool children. Furthermore, article 70 prescribes that some of the health care obligations from the previous article can take place in private practices. The planning, coordination, and monitoring of specific child-oriented health care are the responsibility of the Croatian Public Health Institute. The specific care and improvement of children’s mental health is the responsibility of the Mental Health Service.
Beside the stakeholders in the health care and social welfare systems, the early intervention process also includes the Office of the Ombudsman for children, the Office of the Ombudsman for persons with disabilities, the Office of the Ombudsman for gender equality, the Office of the Croatian People's Ombudsman, the UNICEF Croatia Office (the lifelong learning programme of health care professionals for supporting families and the well-being of children), the WHO Country Office Croatia, the EU and EP institutions in Croatia, the Government and Ministries of Croatia, the Croatian Parliament, the Office of the Croatian President, the Croatian Health Insurance Fund (monitoring the finances and rights of parents and children with special health needs to accommodation in special hospitals for medical rehabilitation, and recompenses the transport costs for the child and parent), the Croatian Public Health Institute (the registry of disabled persons, the Public health service – Department for research and monitoring of mothers’ and preschool children’s health care) and county public health institutes, county social welfare offices and others (professional associations: the Croatian Medical Chamber, Croatian Physicians Association professional societies (the evaluation of neurodevelopmental rehabilitation procedures in regard with proposed standardisation and implementation of new therapeutic procedures with additional education of health care professionals preforming them), the Croatian Nursing Council, Our Children Society (The Child Friendly City initiative, the Child Friendly Maternity Hospitals, “A child's smile in the hospital”) etc.).
Visiting nurses in the community health care centres and current programmes (maternity courses, visiting pregnant women, visiting new mothers and infants, breastfeeding support groups, diet/breastfeeding counselling, cooperation with primary care physicians and nurses, cooperation with other community services, educating parents during pregnancy – complementing maternity courses with mini-workshops – proper baby handling etc. Local counselling service for the support of children, parents and entire families within the Healthy city project, but also in other organisational frameworks are a significant resource aimed at supporting the family and early child development. Psychological counselling services staffed with professionals in the near vicinity are a strong community protective factor. By offering support to the family and children after the identification of early risk signs conditioned by different factors, it is possible to achieve a greater functionality of the child and family, stimulate the child’s positive growth and development and provide the family with support in sensitive periods of the family cycle. By following scientific knowledge and evidence on the significant influence of early development on a person’s health for the rest of their life, support centres like these can function as preventative community centres. However, psychological counselling services for the support of families and early child development are not the standard of family and child care in Croatia, but rather they represent the super-standard of communities standing out by their readiness for strategic thought and health planning in their own environment. The social welfare act provides for the possibility of founding social welfare institutions analogous to community service centres where different forms of psychological and psychosocial activities could take place, and which could be founded by the unit of local self-administration. With the insufficiency of state organised psychological and psychosocial protection of family and children at early development risk, this legal regulation offers units of local self-administration the possibility of founding and financing institutions/centres for counselling and psychosocial support of families. This gives units of local self-administration with a legal and operational solution for providing a super-standard of service which could influence the health of entire generations, provided that they possess the necessary information on the significance of investing in children’s’ early development and are ready to responsibly manage with health in mind.
In Croatia, besides the preventative mechanisms of early disease detection in the health care system and the mechanisms for improving and promoting health, most of the early intervention mechanisms are focused on parents and children, in order to provide them with the opportunity to realise their full health and social potential when they grow up. The stated mechanisms apply also to young people up to 18 years of age.
Funding is provided through previously mentioned strategic frameworks and programmes, as well as through the existing system of financing the health care and social welfare in Croatia.