Aspects of health surveillance at child welfare centres

Abstract: Objective: To evaluate aspects of the health surveillance at Child Welfare Centres (CWC) particularly the promotion of mental development and health. Method, Subjects: In the main study, which this thesis is a part of, a cohort of children from the general population was studied with regards to their health and development during the preschool years. This part of the study was designed to compare measures of the children's health and development using standard Child Welfare Centre (CWC) methods with prospectively collected information from the longitudinal project. Results: Study I. The first home visit to the newborn baby by the nurse at the CWC was evaluated. Her assessments seemed valid in identifying families with stressful psychosocial conditions. When the general home situation was judged as 'poor' or 'dubious' the boys hadan increased risk to have a delayed mental development at 4-5 years of age. Study II. The four-year check-up at CWC was studied by means of a score. The score was useful in identifying children at risk of delayed mental and behavioural development on a group level. Study III. A model combining the methods used in I and II together with other information at CWC was presented. The results indicate the usefulness of the concept of developmental surveillance. The results indicated that it was possible to identify children at risk of development delay on an individual level. Study IV. Screening at CWC for Minimal Brain Dysfunction at 6 years of age showed that children with an positive screening result at school-start may have exhibited signs of delayed psychoneurological development and symptoms of psychopathology already at 4 years of age. Study V. Children experiencing psychosocial stress and exhiting psychopathological symptoms were found to run a higher risk of having accidents than other children. This information could be useful in the accident prevention work at CWC. Study VI. Behavioural problems and psychopathology in preschool children were evaluated with both a categorical classification in the DSM-III, and a dimensional approach. High rates of certain diagnoses, especially 'oppositional defiant disorder' and 'undersocialised conduct disorder' was found. In future studies, the results will be used in order to develop a CWC-questionnaire with the objective of identifying behavioural problems. Conclusions: The health surveillance programme at CWC, with regards to developmental delay and behavioural problems, has components that seem to be valid in identifying current, and to some extent future, health problems. However, the programme may need revision, e.g. adding tools to identify behavioural problems, and more clear cut advice to the staff on when and how to intervene in a family where the child needs support and stimulation. The significance of the observations in this thesis for the children's health during the school age will be the object for future studies.