Child Health Service in Hong Kong
The Parenting Programme in Maternal and Child Health Centres
This paper describes the Parenting Programme, implemented in all Maternal and Child Health Centres, as a public health initiative to promote positive and effective parenting to expectant parents and parents of children 0 to 5. The universal programme aims to provide anticipatory guidance to all parents in both the physical and psychosocial aspects of child health that is specific to the ages and stages of development of the child. The intensive programme, intended for parents who encounter difficulties in parenting, adopts the structured Positive Parenting Program (Triple P) to equip them with positive skills and strategies to manage their children's behaviours. The effectiveness of the Programme has been established by overseas and local studies. Challenges ahead for meeting the different needs of parents and wider dissemination of the programme are discussed.
Keyword : Child, Preschool; Child behaviour; Parenting; Parenting education; Public health
A child's development is influenced by his/her genetic and physiological make-up, as well as his/her environment. Parents are the primary influencing agent on the child's development. Research has shown that the way parents interact with and bring up their children will influence the development of children in all domains. Ineffective parenting may impede children's development and lead to child behaviour problems, resulting in adolescent conduct and mental health problems, which are associated with high social and economic costs.1 Thus supporting parents to bring up well-adjusted and healthy children is a public health imperative.
The Family Health Service (FHS) of the Department of Health launched the Parenting Programme in 2002. The objective of the programme is to promote positive and effective parenting by: 1) providing necessary knowledge and skills to parents and caregivers; and 2) rendering support to parents to bring up healthy and well-adjusted children. The programme consists of two levels: the universal and the intensive.
The Universal Programme
The universal programme aims to provide anticipatory guidance to all expectant parents and parents/caregivers of infants and preschool children. Anticipatory guidance has been considered as the 'cornerstone of child health supervision visits' and there is evidence of its effectiveness on the functional outcome of children and their families.2 Through the programme, parents are equipped with the necessary knowledge and skills for promoting children's development and handling possible parenting difficulties specific to the ages and stages of development of their children. Both the physical and psycho-social aspects of child development and parenting are covered.
The 'Happy Parenting!' workshop series consists of an antenatal workshop and 7 workshops for parents with children from newborn to 3 years. The content covers both physical (e.g. newborn care, breastfeeding, nutrition, home safety and oral health) and psychosocial aspects (e.g. preparation for parenthood, bonding, promoting child development, parenting skills and behaviour management). The content of each workshop addresses the developmental needs of children of a specific age range. For instance, the topic of home safety focuses on cot and pram safety for newborn to 4 months of age and toy safety is introduced in the 4- to 6-month-old workshop, while behaviour management strategies are introduced from 12 months onwards. The workshops adopt an interactive approach with small group discussion, sharing, role play, and live or video demonstration in addition to mini-lectures. An unpublished service evaluation on the Happy Parenting workshops indicated that participants could benefit from the workshops by showing knowledge gain and change in attitude towards parenting after attending the workshops. Individual guidance on specific issues of concern is also given to parents upon their request during interview by nurses in Maternal and Child Health Centres (MCHCs). Apart from these, information is presented in the form of leaflets, videos, which are accessible on the FHS website,3 or as telephone hotline messages.
The Intensive Programme
For parents of children with early signs of behaviour problems or those who encounter difficulties in parenting, the Positive Parenting Program (Triple P) is adopted. The Triple P is a multi-level, parenting and family support strategy developed in Australia aiming to improve parent-child relationship, enhance parenting efficacy, and reduce child behaviour problems and parenting stress. The design is based on social learning models, behaviour approaches, developmental psychopathology research and public health perspective. The model of self-regulation is also a built-in feature of the programme.4 With the aid of video demonstration, discussion, role play and homework, the participants are guided in self-management through understanding the causes of their children's problems, setting goals for themselves and for their children, choosing the positive strategies and practice tasks that suit their situations, evaluating their strengths and weaknesses and monitoring progress.
All the facilitators who conduct the Triple P in MCHCs are trained and accredited by the programme developer from Australia. The group and individual formats of the well-structured programme are adopted for clients with different needs. The group programme targets parents who may need intensive training on general behaviour management strategies or those who have children with multiple behaviour problems. It consists of 4 two-hour weekly sessions and 4 individual phone follow-up sessions. The individual format focuses on giving active training to parents of children with a discrete behaviour problem. It is made up of 2 to 4 sessions. In both formats, participants learn the skills to observe behaviour of their children and themselves, and to enhance parent-child relationship, as well as the strategies and skills to encourage desirable behaviours, establish new behaviours and manage misbehaviours. Participants also learn how to prevent problems in high risk situations and maintain progress.
The effectiveness of the Triple P programme is supported by research evidence.4-6 Furthermore, the efficacy of Triple P in local Chinese families was demonstrated by a randomised controlled trial which indicated that Triple P was effective in reducing perceived problem behaviours and dysfunctional discipline styles. There was also an improvement in the parenting sense of competence as well as marital relationship.7 Another local study was conducted to identify variables that might predict programme outcomes. The predictors of the magnitude of behaviour change were lower levels of family income, new immigrant status and higher pre-intervention level of parenting stress, suggesting a profile of parents who are most likely to benefit from the Triple P parent training programme.8
Although the drop-out rate from the Triple P group programme is only about 10%, non-nuclear families (extended families and single parents) and new immigrant families were more likely to drop out.8 The main reasons for non-completion as reported by participants were conflicting work hours, existing family problems, lack of childcare and personal stress.9 To address these issues, the number of groups conducted outside office hours has been increased and for parents in need, childcare services are introduced and referral to integrated family service centres is arranged. More flexible programme attendance arrangements are also made for new immigrant parents who might still need to return to mainland China frequently.
Social marketing has increasingly been recognised as a valuable strategy in the practice of public health and can be adopted to promote parenting education in the community.10 Publicity campaigns on positive parenting such as roving exhibitions, television documentary series and the publication of a book "Happy Parenting!" 《共享育兒樂》 11 have been launched. Besides the MCHCs, paediatricians, family physicians and general practitioners are the potential "distributor" of good parenting practices to parents they encounter in their practices. The FHS has been conducting training for our community partners on the objectives, principles, strategies, contents and access means of our parenting programmes, enabling them to use the approaches of positive parenting in advising and guiding parents, or refer them to access the parenting programme. Through collaborating with these community partners, the FHS hopes to more widely disseminate positive parenting as an evidence-based strategy to reduce parenting stress and prevent child behaviour problems, thereby promoting the mental health of parents and children.
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