Balancing the differences in social health
In Sweden, the child health services (CHS) is a service offered free of charge to all children aged 0-6 years, and the participation rate is estimated to be almost 100 percent . The CHS aims to contribute to children’s physical, psychological, and social health, by promoting health and development, preventing illness, detecting emerging problems early, and intervening when needed to optimise development.
The Swedish Association of Local Authorities and Regions , which reports on the health of children and adolescents in Sweden, describes that health among children in general is good, particularly in international comparisons. However, the association also reports that there are increasing levels of psychological health problems and unequally distributed health. Through universal and targeted interventions, the CHS plays an important role by balancing the differences in social health and promoting good and sustainable health development .
In 2014, the National Board of Health and Welfare (NBHW) published new guidance for the CHS with the aim of contributing to homogeneity of the CHS and evidence- based practice. In the guidance, experience and current knowledge were combined with CHS regulations to support the development of a national CHS programme . Based on this guidance, literature reviews, and consensus discussions, a new national CHC programme was developed and agreed upon by the Swedish counties/regions’ central child health services units [CCHSU] as guidelines for the CHS in Sweden.
The national CHS programme
Current knowledge about the determinants affecting children’s health and development permeates the national CHS programme . This is shown in person-centered care, adapting the content of each health visit to the specific family’s situation and needs, which may change over time. The CHS programme embraces universal interventions, an important cornerstone of the CHS, as well as targeted interventions that enable equitable provision of services.
The CHS offers activities at CHS centers and via home visits, health guidance, health examinations, vaccinations, and parental support . A strength of the CHS is that the professionals have regular contact with children and families over time .
The CHS programme consists of three tiers based on the needs of the child and the family, but is not divided into three separate programmes with clear boundaries; rather, it is one programme with integrated parts that forms a triad including interventions to be used to varying degrees during shorter or longer periods as needed .
The three tiers of the programme are described below:
- The universal tier (I) includes interventions that are offered to all children and are intended to promote health and development and prevent diseases, injuries, and physical, psychological, and social problems. These interventions include engaging in a dialogue with the child and his or her parents, being responsive to the child’s health and development and the family’s observations and concerns, identifying and evaluating the protective health determinants as well as those that put the child at risk, asking questions about the child’s health and development, conducting observations and targeted investigations, monitoring the child’s health and development over time and providing health-related guidance that is relevant to the child’s age and the family’s needs .
- The first targeted tier (II) includes additional interventions provided to children and families on a need basis and is intended to strengthen the determinants that promote health, to do so early, and to prevent negative development of the child’s physical, psychological, and social health. These interventions include additional assessments that aim to increase knowledge and understanding of the child’s situation and to tailor interventions. These may include additional health guidance, follow-up visits, parental support, counseling, and home visits.
- The second targeted tier [III] includes additional needs-based interventions from or in collaboration with other health care services, the social services, or other supportive resources in the community.
The team at the CHS centre consists of CHS nurses and physicians. CHC nurses are specialists in either primary health care or paediatric care. They organise and lead the work as the primary CHS providers for the child and his or her family. Referrals to other experts such as psychologists, speech therapists and dietitians are made when needed .
Each county or region has at least one CCHSU, made up of a chief medical officer and one or more CHS coordinators, and many units also employ a psychologist. By mandate from the county council/regional management, the CCHSU is responsible for quality assurance for the local CHS through education and support, data collection to monitor children’s health, follow up of interventions, and evaluation of CHS results and service provision . Managers at each respective CHS center are responsible for ensuring that CHC targets are met.