Family Centre in the Nordic Countries – a Meeting Point for Children and Families

Ved Stranden 18 DK-1061 Copenhagen K www.norden.org Family centre in the Nordic countries – a meeting point for children and families

ISBN 978-92-893-2303-1 ANP 2012:701

Family centre in the Nordic countries – a meeting point for children and families

Marjatta Kekkonen, Mia Montonen and Riitta Viitala (ed.) Family centre in the Nordic countries – a meeting point for children and families.

ANP 2012:701 © Nordic Council of Ministers, Copenhagen 2012 ISBN 978-92-893-2303-1 Print: Oy Fram Ab Layout: Erling Lynder Cover photo: Kuvatoimisto Rodeo Oy Copies: 500

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www.norden.org Contents

7 Foreword 9 Introduction

14 Family centre and Family policy in the Nordic countries 15 Historical development of family centres in Sweden and the Nordic countries Vibeke Bing

21 Family centres in Finland – a new approach within services for children and families Riitta Viitala, Marjatta Kekkonen and Nina Halme

29 The Family’s House in Norway – an interdisciplinary, municipal/community healthcare service for children, adolescents and their families Anette M. Thyrhaug, Gørill W. Vedeler, Monica Martinussen and Frode Adolfsen,

34 Danish family policy and Child Reform Anna Jin Rolfgaard

36 Child and family services in the Icelandic welfare system Sigrun Juliusdottir and Elisabet Karlsdottir

40 Promotion of the well-being of parents and children 41 The Swedish strategy for developed parental support and the family centre as an arena for the provision of municipal parental support services Johanna Ahnquist

48 The importance of social support and reflective functioning for parenthood Mirjam Kalland

56 Child’s right to an uppbringing – Family centre as a promoter of a rearing culture which respects the child Maria Kaisa Aula 62 Family centre is based on preventive work and collaboration 63 Preventive services – a guarantee for the well-being of children and families Sirkka Rousu, Aila Puustinen-Korhonen and Marju Keltanen

69 The Swedish Leksand model – family preparation as a starting point for the family centre Thomas Johansson

75 Mother and father – for the first time Henriette Weberg

79 The non-governmental organisation as a player within the family centre – a vision of collaboration Milla Kalliomaa

86 Is preventive work cost-effective? 87 Effectiveness and costs of preventive services for children and families Ismo Linnosmaa, Antti Väisänen, Eero Siljander and Jukka Mäkelä

98 Family centre entails changes in professional skills and knowledge 99 Knowledge advancement concerning family centres Vibeke Bing

102 Collaboration in the Family’s House Anette M. Thyrhaug, Gørill W. Vedeler, Monica Martinussen and Frode Adolfsen

105 Good practice dialogues as a tool for sharing expertise Jukka Pyhäjoki and Mimosa Koskimies

109 A picture of future competence needs in family centres Heidi Backman and Alexandra Nordström

112 Future challenges

113 Developing the family centre in the Nordic countries Marjatta Kekkonen, Mia Montonen and Riitta Viitala

115 The Authors 119 Steering group and editiorial team Foreword

Within the field of child and family Nordic partnership. One goal is to of children and the whole family and policy, the Nordic countries have raise the level of interest in the Nordic for combating social exclusion by much in common and a long tradition collaboration over family centres. The supporting positive parenting. Family of working together. The challenges two Nordic family centre conferences centres are also a universal arena that the Nordic countries will face in the – the first held in Sweden in 2005 and enable children and families to partici- future are also similar. A variety of the second in Finland in 2010 – dem- pate and have a say themselves, thus initiatives are implemented in the onstrated that exchanging knowledge reinforcing solidarity within society. Nordic countries in order to support and networking are worth the invest- The important factor as regards family parenthood. The foundations are laid ment. Under Finland’s chairmanship, centres is that the work is cross-bor- by the health promotion and early pre- themes such as a healthy lifestyle der and builds on the co-operation of vention initiatives that are carried out for families with children, the project all stakeholders. with families with children. Problem concerning families with children who This publication represents a prevention and supporting families are at risk of social exclusion and the curtain-raiser in the discussion through the provision of services with Nordic collaboration relating to the surrounding family centres in the a low threshold is an important aspect mental health of children and young Nordic region. The publication brings of Nordic welfare policy. In the Nordic people will be taken further. Another together experiences and knowledge countries, collaboration with civil important theme is the campaign from the Nordic countries. Family cen- society and voluntary organisations against the corporal punishment of tres are being developed not only in is highly valued. Broad participation children, which will kick off with a the Nordic countries, but also across and multifaceted commitment from seminar in December 2011. Europe and elsewhere. Through this the third sector in order to achieve the The discussion surrounding current publication, we wish to take part in shared goals are vital. structural reforms and the develop- the international debate. Families with children are of enor- ment of welfare services for children, mous importance for our future wel- young people and families is impor- fare. During its chairmanship, Finland tant. Similar discussions are also is promoting the work that is already underway in an international con- Kari Välimäki underway within the field and placing text. Family centres are a model for Permanent Secretary an emphasis on continuity within the improving the health and well-being Ministry of Social Affairs and Health

Introduction

This publication represents a com- by changes that take place in society What is a family centre? pilation of experiences and current and living conditions. Immigration, A family centre is a service model knowledge concerning family centre internal migration, urbanisation, which brings together the services services in the Nordic countries. The greater distances between relatives that promote the well-being and aim of the publication is to clarify and networks of friends and family, health of children and families on the the approach of family centres, the difficulties in reconciling work and basis of a promotive and preventive desired service structure and the family life, the increase in divorce approach. Sweden has been a pioneer roles of professionals, families and and varied family structures, supply in the development of family centres. children in family centre services. problems and poverty all dictate the The first family centres were set up The child and family welfare policies living conditions of families with in Sweden back in the 1970s, but the of the Nordic countries have many children in the 21st century. On the boom in such centres did not really common themes. Efforts are being other hand, social media and the occur until the early 21st century. In made to steer the services more internet are increasingly being seen Finland and Norway, the development towards universal health-promoting by parents as a source of informa- process for family centres began and preventive services, to pro- tion and ideas concerning a good in the early 2000s, and Denmark, mote the psychosocial health and life, good parenting and a good Iceland and the other Nordic coun- well-being of parents and children, childhood. The general changes that tries also showed an interest in the and to safeguard the families’ own are taking place in living conditions initiative at the time. Various terms resources. Collaboration and a affect all families with children in are used in the Nordic countries to multi-professional approach are some way or other, but the con- refer to family centres. In Sweden, valued, and openness and trust sequences for the well-being of “familjecentral” (family centre) is a are promoted. There is a desire to children and parents vary. The goal well-established term, whilst in Fin- strengthen the collaboration with of the family centre is to meet the land “familjecenter” is the recognised the third sector and civil society. needs of families with children as term. In Norway, the term “Familiens These themes also permeate this regards services in modern society hus” (Family’s House) is used. publication. and to even out consequences of Regardless of the different terms The needs of children and fami- changes in living conditions for fami- used, family centres are governed by lies as regards services are defined lies with children. the same principles. The fundamen-

9 tal basis for the family centre is that processes which reinforce and safe- • to develop multi-professional, the well-being of children is strongly guard health. The multifaceted family cross-sector collaboration between linked to that of their parents. centre service network enables the the services Well-being of parents is connected early identification of problems being • to build up partnerships with the to the resources to respond to their experienced by children and families, third sector children’s needs. By reinforcing the as well as fast and flexible support • to act as a centre for information parenting skills of mums and dads and help initiatives. Thirdly, the family and competence and supporting the marital relation- centre promotes social integration and • to disseminate knowledge that is ship, it is possible to improve the solidarity by offering an easily acces- based on scientific research and child’s chances of a secure and happy sible meeting place for all families and evidence childhood. The aims are to raise the children, regardless of any differences parents’ level of knowledge, to rein- in their social or ethnic background. The Swedish National Institute of force their community and to encour- In parent groups, parents get to know Public Health has defined the fam- age them to have their say in society. other people who are in the same life ily centre as a complete range of Secondly, the family centre acts as situation, thereby providing support services which are fully co-located, a service with a low threshold with for equality, friendship and daily covering maternal healthcare, child universal service provision aimed at social interaction. The basis for well- healthcare, open early childhood all families with children. The family being can be found in the everyday education and care and the preven- centre is based on services that are networks and surroundings of children tive work carried out by the social based on health promotion and early and families. services. The definition assumes that prevention. Promotion is charac- The family centres offer a new way the four basic services operate from terised by the promotion of healthy of supporting the everyday lives of the same premises. In Norway, family families with children. Family centres centres have been defined as a com- provide services in a multi-profession- plete range of services based in the al, cross-sector way in collaboration same premises with a health centre with the third sector. In accordance that provides antenatal care, preven- with the basis for the family centres, tive child welfare services, education- the following goals have been estab- al-psychological services and open lished for the family centres: daycare for children. In Finland, three models for family centres can be iden- • to support and strengthen parents tified: a model with the provision of in their role as carers and child- maternal and child healthcare advice, rearers a model with open early childhood • to develop the social networks of education and care, and a regional children and parents model. The fourth model consists of • to act as a local meeting point for family centres that are run by organi- children, families and local resi- sations. There are many different dents types of family centre in each of the • to develop working models which Nordic countries. In Norway, the ser- engage children and parents vices that are often co-located in Fam- • to identify physical, mental and ily’s Houses are a health centre that social risk factors at an early stage offers healthcare service for children • to offer children and parents support including pregnancy care, preventive and services with a low threshold child welfare services, pedagogical-

10 psychological services and an open subdivided into three phases. The children and families follow the same kindergarten. A similar trend can also discussion in Finland stemmed trends as the family centre concept. be discerned in Finland in the form of from concern over the resources of the development of a network of fam- parents, and has now resulted in the In the second part of the publication ily services. In the Nordic countries establishment of the family centre as Promotion of the well-being of there are strong and ground-breaking an arena for health promotion, early parents and children, parenting developments in progress, which prevention and a dialogue-engaging is interpreted and considered as a are resulting in the reorganisation of working practice. national resource. Parenting needs child and family services and creation support from society, a consistent of service models which cut across In the article from Norway entitled service strategy and service struc- sector boundaries. The Family’s House in Norway – an tures like that of the family centres interdisciplinary, municipal/com- where the processes for the support The publication in a nutshell munity healthcare service for chil- can be realised. The chapter also The first part of the publication Fam- dren, adolescents and their families, describes how the ability of parents ily centre and family policy in Thyrhaug, Vedeler, Martinussen and to interpret and meet the needs of the Nordic countries describes Adolfsen describe the Norwegian their children in an emotionally sensi- the historical development of the model. The article’s authors describe tive and reflective way contributes to family centre, the service models and the family centre as a venue for a the the child and the parents’ mutual- working practice as well as future complete range of services, which can ly positive experiences of each other. challenges in Sweden, Norway and offer families health promotive and This reinforces parenting. Bonding in Finland. The chapter also presents universal interventions and services, the child-parent relationship gives Denmark and Iceland’s family policy selected interventions and indi- the child a sense of security and a guidelines and service mechanisms cated interventions and services. In for children and families, which Norway, family centres have a health provide a stable basis for the family centre on the same premises which centre service models. offers antenatal care, preventive child welfare services, educational-psy- In her article entitled Historical devel- chological services and open daycare opment of family centres in Sweden provision for children. and the Nordic countries, Vibeke Bing describes the long develop- Rolfgaard from Denmark discusses ment process that began with the Danish family policy and Child need to prevent child abuse and has Reform, while Juliusdottir and Karls- now resulted in public health work dottir from Iceland describe Child and in which the family centres play a family services in the Icelandic welfare central role as well as in child public system. These two articles present an health. overview of the respective countries’ preventive family policy and child In their article Family centres in and family service systems. Although Finland – a new approach within there is not as much talk about family services for children and families, centres in Denmark and Iceland as Viitala, Kekkonen and Halme describe yet, these articles show that the fam- the development of family centre ily policy guidelines of the two coun- services in Finland, which can be tries and the service mechanisms for

11 fundamental confidence in life. In the explains how family centre services chapter, parenting is also approached can help parents to be good parents In the article entitled The Swedish through the child’s hopes and experi- to their children. Leksand model – family prepara- ences. tion as a starting point for the family The third part of the publication centre, Johansson describes the basis In her article entitled The Swed- The family centre is based and success factors for the family ish strategy for developed parental on preventive work and col- preparation process and presents a support and the family centre as an laboration focuses on preventive number of suggestions for the further arena for the provision of municipal services and their links with the development of the model. In the arti- parental support services, Ahnquist family centre initiative. This chapter cle entitled Mother and father – for describes the way in which Sweden gives a general account of the role of the first time Weberg describes how has adopted the approach of sup- the family centre with the municipal the Swedish Leksand model has been porting and helping parents in their authority’s preventive services. The applied in the municipality of Greve in parenting through a strategy entitled chapter describes Leksand’s family Denmark. “A benefit for all”, as well as the way centre concept and the Danish family in which family centres are seen as preparation model, which has been Kalliomaa’s article entitled The an important element in this work. developed from this concept. The non-governmental organisation as The government’s strategy is based chapter also presents a vision of the a player within the family centre – a around the view that it is the parents role of the non-governmental organi- vision of collaboration highlights the themselves who are the experts on sation at the family centre and the collaboration between the public their children. way in which the fourth sector – civil sector and the fourth sector, i.e. society – can work in partnership NGOs and civil society. The third sec- In her article entitled The impor- with the public sector. tor, i.e. voluntary organisations and tance of social support and reflective associations, act as an important link functioning for parenthood, Kalland In their article entitled Preven- between professionals and voluntary discusses the importance of reflective services – a guarantee for the parties. tive skills, the sense of solidarity well-being of children and families, By way of conclusion, Kalliomaa and the way in which family centres Rousu, Puustinen-Korhonen and discusses how the collaboration can support parents in a down-to- Keltanen emphasise the importance between the family centre services earth way. The article describes how of preventive work in the promo- that are run by the public sector and the natural prerequisites that most tion of the well-being of children the working forms that are based on parents possess can be reinforced in and young people and the child voluntary work under the direction of a respectful way through exploring policy of municipal authorities. The NGOs can be facilitated. reality together in a group. well-being of children is a common issue for the entire municipality. The The fourth part of the publication In her article The child’s right to authors describe the family centre concerns the question: Is preven- an upbringing – Family centre as a as a way of organising preventive tive work cost-effective? Linnos- promoter of the rearing culture which child welfare work so that it does not maa, Väisänen, Siljander and Mäkelä respects the child, Aula highlights the involve the exercising of authority. discuss preventive work from the child’s view of their parents and par- The family centre has concretised perspective of cost-effectiveness. enting. She discusses what the child the objective of preventive child In their article Preventive child and would want from its parents, as well welfare in Finland and given struc- family services, effects and costs, as aspects of the adults’ behaviour tures for collaboration across sector the authors describe the objectives which give rise to anxiety. Aula also boundaries. of the child and family services and

12 illustrate, through the use of exam- between that of expert and adviser, of staff. The authors outline future ples of preventive child welfare, the that of a good host for parents’ meet- scenarios for child and family services consequences of unsuccessful early ings and that of circle leader. from a perspective which shows what intervention, as well as the costs would happen if the services were to that the child welfare measures In Collaboration in the Family’s be developed in line with the fam- would give rise to in two alterna- House, Thyraug, Vedeler, Martinussen ily centre model. They also discuss a tive service strategies. By way of and Adolfsen describe how compe- vision of the future as regards what conclusion, the authors discuss tence, commitment and a desire to would happen if the service concept why the preventive approach has collaborate have a decisive effect were not to be actively developed or not been adopted and what sort of on how high-quality family centre if the services did not take account of evidence can be obtained concerning services must be produced for chil- the changes that occur in the living the effectiveness of the preventive dren, young people and families. The conditions of families and in society in approach. According to the authors, authors state that multi-professional general. it is also a question of whether the collaboration includes both ele- decision-makers believe in the return ments that facilitate and elements The publication is concluded with the on investment in preventive work. that burden the work. In the Family’s chapter entitled Future challenges. house, it is shown that most of those In the article entitled Delelopin the The fifth part of the publication employed have positive experiences family centres in the Nordic countries, Family centre entails changes of working with other professional Kekkonen, Montonen and Viitala high- in professional skills and groups. light the views that apply to the com- knowledge concerns knowledge, mon further development of the family collaboration and interaction. The In their article entitled Good practise centre initiative in the Nordic countries. focus is placed on the staff’s know- dialogues as a tool for sharing exper- how and the new professional roles. tise, Pyhäjoki and Koskimies describe Professionals at family centres are the importance of tacit knowledge in being compelled to adopt new work- the development of society. Children, ing methods and be flexible in their parents and employees need prem- work and professional roles. Col- ises and forums where they can make laboration and interaction between themselves heard and talk to each different professional groups also other about their competence, their facilitates a new form of knowledge fears and their everyday experiences advancement. in order to ease their concerns. The method “Dialogues for good practice’ In the article entitled Knowledge can be applied in the development advancement concerning family of family centres, where there is a centres, Bing describes the family desire to improve collaboration, par- centre as an organisational form that ticipation or management relating to is filled with learning. For the staff, family centre service provision. this means not only that their professional role is altered, but also that In their article entitled A picture of their role can change even during the future competence needs at family course of a single working day. Bing centres, Backman and Nordström believes that the roles performed by describe what the future could hold professionals at family centres vary with regard to the competence needs

13 Family centre and family policy in the Nordic countries

14 Historial development of family centres in Sweden and the Nordic countries

Vibeke Bing

This article describes 30 years of development leading up to today’s starting points. The first is the time. family centres, which form part of the welfare and public health service The aim of the family centres is to give children a healthy start by being and can be understood not only in terms of Child Public Health, support- there from the beginning and by ing environment and equality, but also on the basis of increased knowl- targeting their services at both as yet edge concerning pregnancy, infants, cohabitation and the mental health unborn and newborn children, and their parents. Secondly, the family of children. The article also describes how our knowledge has developed centres represent a low-risk strategy, since the first Nordic family centre conference in 2005 and the interest in as they are aimed at all future and family centres in the Nordic countries. new parents and their children aged 0-5 years, not just at the most vulnerable. In exactly the same way as with Introduction the prenatal and well baby clinics, all public health services, the family Family centres rest upon a con- co-located with an open nursery. centres also build on the interaction ception that there is a strong link Access to social guidance is also between different authorities and dif- between well-being of children and available under the same roof. ferent professional groups. They are their parents. That is why preventive Social advice also forms part of the both preventive and health-promot- work regarding children must also social services’ prevention work and ing. This means that they target their be aimed at the parents. Sweden is provided without any exercising of services in order to not only reduce currently has over a hundred com- authority (National Board of Health risk factors but also to increase plete family centres spread across and Welfare, 2008). health and protection factors. Finally, the country. In terms of definition, Swedish family centres have the family centres act as an everyday a complete family centre offers all what are, in terms of public health meeting place for parents and chil- the healthcare services relating to services, a number of strategic dren in a local area.

15 Preventing children from working parents, particularly single was one of the first. Back in 1976, suffering parents. councillors there reached a decision The first steps in the development of The 1970s turned out to be a good concerning the provision of “par- the family centres were taken back decade for children, during which ent information” and subsequently in the 1970s. This decade saw the interest in and research into children decided that open nurseries and pre- introduction of a series of family and childhood came into focus and ventive social workers would be made policy reforms aimed at safeguard- began to be reflected in social policy. available to all parents of young chil- ing the upbringing of children. These An advancement of knowledge began dren. Social workers abandoned the reforms stemmed from the Swedish and, together with Sweden’s ratifica- desks of their social services offices Paediatric Society highlighting child tion of the Convention on the Rights to devote their attention to children abuse and its causes at one of its of the Child in 1990, helped establish and the parents of young children at annual meetings back in the 1960s. the stable foundations in terms of open nurseries and prenatal and well A lack of care which led to the death knowledge and values behind family baby clinics. This form of collabora- of a young girl subsequently fuelled centres today. tion has been called “the Gothenburg an already intense debate within Parliament’s resolution from 1979 Model” and became the predecessor society. The frightening truth was concerning a parenting course result- to today’s family centres (Bing, 1997). out: parents who are normally their ed in an offer to all future and new children’s fiercest protectors can parents in the first instance. This ini- Family centres also hurt their children the most. tiative saw the beginning of the trend The financial crisis in the early The public debate covered child towards what 20 years later would 1990s resulted in cutbacks in the abuse, children with special needs, come to be called family centres. The public sector, which had a severe a lack of childcare provision and aim of the family centres has many effect on preventive work. Local the need for preventive work. It was similarities with the three objectives authorities had to save money. Out clear that, if children were to be of the parenting course, which were of several thousand open nurseries, protected from harm, parents would to increase parents’ knowledge, suddenly only a couple of hundred have to have a reasonable standard reinforce their community and encour- remained,and preventive social of living and the tools they needed age them to influence circumstances workers were recalled to their offices. to help them cope with parenthood. within society. The crisis coincided with high levels This was followed at a national As the isolation of families was of immigration, high unemployment level by a political response in the seen as a serious threat to the health and rising sick leave statistics. Public form of government-initiated stud- of children, a new meeting place and sector employees were seeing a rise ies and subsequent legislation and nursery provision emerged – open in demand amongst the population reforms. One was the parliamentary nurseries (Gustafson, 1983). The aim as the resources available to them resolution concerning parenting was the same as for the parenting dwindled. courses in 1979. The same year saw course. Open nurseries immediately In this difficult situation, various the introduction of the ban on corpo- became popular amongst parents professional groups began to work ral punishment of children and leg- and an important partner for the together in the hope that by doing islation concerning parental leave in children’s healthcare service, which so they could make their resources connection with the birth of a child. strengthened its expertise in child go further. Midwives and paediatric All this was aimed at facilitating psychology at the same time. On the nurses outside Gothenburg now also parenting and protecting children. whole, professional groups gradu- gained good experience of work- A major expansion of childcare pro- ally began to work together when it ing with social workers and nursery vision made life more secure both came to their common target group of teachers on a daily basis. In many for children themselves and for their future and new parents. Gothenburg parts of the country, collaboration

16 had become a habit and there was invited to an initial network meet- centre network formed the Förenin- a readiness to take the next step of ing in Gothenburg in 1995. This was gen för familjecentralers Främjande moving in together under one roof. followed by other meetings, and (the Swedish Association for the The people on the ground therefore a major workshop in Leksand the Promotion of Family Centres) (www. contacted managers and decision- following year was attended by 180 familjecentraler.org), which, with its makers in order to put their ideas people from 14 different municipali- annual conferences, has since acted forward. In Sweden, where maternal ties. At this workshop, the delegates as a hub and a driving national and children’s healthcare services concluded that municipal authori- force. The association’s board are provided by the county council, ties and county councils should represents all the many professional whilst open nurseries and social get together and create a meeting groups who work at family centres. services are run by the municipal place for parents, where parents It is an inter-professional vocational authority, the decision-making pro- could meet and play with their own association whose thousands of cess had to take place in a number children, as well as those of other members have in common the fact of stages. This complicated the parents; where children could enjoy that they are committed to children, political process and at the time the spending time together; and where preventive work and collaboration. coffers were empty. various professional groups could With the exception of one part- In this situation, projects were work together in order to make time clerk, all work is carried out seen as a solution. The recently parenting easier. This meeting place on a non-profit basis. The fruitful established Swedish National was giving the working name “fam- collaboration between the Nordic Institute of Public Health began ily centre”. The aims were to: countries has come about as a result to receive applications for project of the association’s initiative. funding. A remarkable number • offer a local meeting place of applications concerned inter- • reinforce the social network The new public health work professional collaboration relating around children and their parents Swedish family centres are therefore to pregnancy and the very youngest • identify working methods in which the result of a protracted process, children. Midwives within the mater- children and their parents can which has largely been driven nal healthcare sector stressed that take part forward by the professional groups the time leading up to the birth of a • offer easily accessible support involved themselves. However, dur- child represented a golden oppor- • act as a centre for knowledge and ing the 2000s, family centres, which tunity to exert an influence over the information grew from a “bottom-up movement”, health of an unborn child. In order to • develop a good service came to be included in local and deal with depression, cohabitation regional public health plans. This problems, abuse and stress, they The National Institute of Public accelerated their development and, needed help from other professions Health’s task was to finance and during the period 1997 to 2010, the such as social workers, family advi- coordinate the network in order to number of family centres increased sors and psychologists. consider, in collaboration with the from 35 to 130. This orientation corresponded delegates, what the work relating to In Sweden and other Nordic well with the WHO’s “Health for All family centres should involve. At the countries, public health has held a 2000” policy, where the principal turn of the millennium, the National strong position in policy, research, goals of the European regions were Institute of Public Health underwent education and practice in recent “Equity in life” and “Healthy start in restructuring and was assigned decades. This has benefited the life”. Behind the applications were what were to some extent new family centres, as the new public politicians and officials which the tasks. Support for the family centre health work places an emphasis on National Institute of Public Health network ceased. Instead, the family cross-sector and promotional work.

17 This work encompasses both more health perspective, it is obvious that the professions who work at family traditional preventive work and family centres fit in extremely well centres. health promotion, which has gained with the “new public health work”. a stronger foothold. Promotion is The Nordic countries characterised by the promotion of Child health science and If the development of Swedish fam- healthy processes which reinforce education ily centres was a bottom-up event, and protect health. In the new public In recent decades, a separate field their Norwegian equivalents experi- health work, the responsibility is of public health science for children enced top-down development. In the moved closer to decision-makers has developed, known as “child mid-1990s, Norway adopted a major and organisations. Living conditions public health” (CPH) or “child health multi-annual national programme, are given greater emphasis and sup- science”. This is an intersectorial, the Escalation Plan for Mental Health porting environments are seen as a multi-scientific and multi-profes- 1999-2006 [Opptrappingsplanen key strategy (Bing, 2005). sional initiative, which studies for psykisk helse 1999-2006]*. The A supportive environment aban- the health and well-being of the plan was strongly influenced by the dons the illness-based approach in population from a social, economic, Ottawa Charter, which was drawn up favour of a health-based approach cultural and political perspective. in connection with an international and switches from prevention based Child public health is based on the WHO conference in 1986. The Ottawa on risk factors to opportunities knowledge and experiences of vari- Charter focuses on social inequality for health promotion in everyday ous professions and extends across as an important determining factor, arenas. From concentrating on the social sectors. It is an appropriate on multi-sectoral strategies and on individual, a holistic view is adopted approach for studying complex rela- power mobilisation. This reflected a instead, in which other factors tionships which govern the health new approach towards public sector that affect the individual are also and development of children. Child services, which had inspired the considered. The health promotion public health is a counterweight to Norwegian authorities (Haugland et work involves many players and super-specialisation and fragmen- al, 2006). collaboration partners. The work is tation (Köhler, 2008). The teams The Swedish family centre model transferred to various everyday are- working at family centres find their was presented at a Nordic public nas that are appropriate for health common anchoring within child pub- health conference in Kristiansand promotion work. lic health, which develops the public in 1997 and attracted considerable Whilst public health science health work within three areas: attention. Norwegian public sector introduced the new strategies of employees considered family centres health promotion and health-pro- • education and career develop- to be a workable arena in which to moting arenas (Petersen & Lupton, ment of everyone who will work promote the mental health of chil- 2000), traditional mother and child with children, young people and dren. Later on, an annual budget of care provision had already begun their health NOK 3 million was allocated via the to adapt. Behind this development • research Escalation Plan for the development was a realisation that the traditional • service and practice of family centres in six municipalities. approach was not enough to resolve Special funding was also allocated children’s health problems. The rela- Using child public health as a start- for evaluation and research. During tively poor health of people today is ing point, Kristianstad University the trial period, Norway adopted more psychosocial than medical in held a distance learning course in the name “Familiens hus” [Family’s origin and the solutions will require 2010. The course, entitled “Working House]. This form of organisation input from many organisations and at a family centre”, is so far the only is considered to be appropriate for professional groups. From a public course of its kind and is aimed at all * Subsequently extended to 2008

18 providing paediatric mental health children and families. The develop- family centres, as well as relevant services, as it is a low-threshold ment of family centre provision in experience and knowledge. Repre- service which guarantees fast and around 100 municipalities received sentatives of ministries and authori- holistic help. Norwegian municipali- state financial support. ties in Sweden, Norway and Finland ties are recommended to organise also participated. The Nordic Council their health-promoting and preventive Knowledge concerning family of Ministers also financed a Nordic services aimed at children and young centres meeting of researchers in 2007 at the people according to the Family’s The Swedish Association for the Pro- Nordic School of Public Health (NHV) House model. The Regional Centre motion of Family Centres celebrated in Gothenburg (Stiftelsen Allmänna for Child and Adolescent Mental its tenth anniversary by inviting barnhuset, 2008). Health at the University of Tromsø delegates to a Nordic family centre After both of these conferences, is responsible at a national level for conference in Stenungsund in 2005. the Swedish family centres attracted promoting and developing the model. With the help of contributions from the attention of their own authorities For 14 years, there has been close the Nordic Council of Ministers and and ministries. The Swedish National interaction between Norway and others, over 600 delegates from the Agency for Education and the National Sweden concerning the development Nordic countries had the opportu- Board of Health and Welfare conduct- of family centres within both research nity to attend four days of lectures, ed a review of family centres. The lat- and practice. courses, seminars and workshops ter identified a need for an unambigu- The Finnish family centres have a (Föreningen för Familjecentralers ous definition of what is meant by a slightly different history. The national Främjande, 2005). Conference del- “family centre”. The National Board FAMILY project developed the social egates were given an account of the of Health and Welfare’s Institute for services and health work relating to Nordic countries’ views concerning the Development of Methods in Social Work (IMS) also prepared a summary of the current state of knowledge in 2007 (National Board of Health and Welfare, 2008). The investigators concluded that there was a lack of knowledge con- “The National Board of cerning the work and effects of family centres. They wanted to see a Nordic Public Health and Welfare proposes that evaluation of the effects of family there should be fully co-located family cen- centres and a more precise clarification of the needs that the family tres offering healthcare services for moth- centres were intended to meet. No pan-Nordic studies have yet ers and their children, open nurseries and been published, but when Finland the preventive work of the social services, organised the second Nordic family centre conference in Espoo (Esbo) in which in future should be referred to using 2010, the development of knowledge in Sweden had taken a big stride the term ‘family centre’.” forward in just a few years. (National Board of Health and In addition to a large number of local evaluations, three Swedish Welfare, 2007) dissertations on family centres have

19 been presented. All three of these 2010). A comprehensive evalua- committee with assistance from Kris- dissertations were published within tion of 16 family centres in Västra tianstad University and the University the field of social work (Hjortsjö, Götaland was also carried out on of Borås (Abrahamsson et al, 2009). 2005; Perdahl, 2009 & Lindskov, behalf of the regional public health

References

Abrahamsson A, Bing V, Löfström M (2009) Lundström Mattsson Å (2004) Socialt Familjecentraler i Västra Götaland – en förebyggande arbete – med familje- utvärdering. Västra Götaland Public Health centralen som arena. FoU Södertörns Committee. Skriftserie nr 41/04, Sollentuna.

Bing V (1997) Morötter och maskrosor om Nordiskt ljus över omtyckt hus, doku- uppväxtvillkor och förebyggande sociala mentation av den nordiska familje- tjänster. Borlänge Public Health Institute. centralskonferensen i Stenungsund 2005. Träffpunkt June 2005. Bing V (2003) Små, få och fattiga – om barn och folkhälsa. Lund Studentlitteratur. Nordisk forskarträff – kunskap om familjecentraler. Föreningen för Bing V (2005) Föräldrastöd och samverkan, familjecentralers främjande, 2007. familjecentralen i ett folkhälsoperspektiv. Gothia, Stockholm. Perdahl, A-L (2009) Verksamhetsut- veckling i socialt arbete – konstruk- Familjecentraler kartläggning och kun- tion av en interaktiv modell. Disserta- skapsöversikt, National Institute of Public tion 2009. School of Social Work, Health and the Institute for the Develop- Umeå University. ment of Methods in Social Work: Västerås. National Board of Health and Welfare 2008. Petersen A & Lupton D (2000) The new public health – health and self Gustafson M (1983) Öppen förskola. Liber, in the age of risk. Sage Publications, Stockholm. London.

Haugland R, Rønning J, Lenschow K (2006) Research seminar on family centres, Evaluering av forsøk med familiesentere 10-12 March 2008. Stiftelsen Allmän- i Norge Regionsenter for barn og unges na Barnhuset. Västerås 2008. psykiske helse. Department of Clinical Medicine, University of Tromsø. Vandenbroucke JP (2008) Observa- tional Research, Randomised trials, Hjortsjö M (2005) Med samarbete i sikte om and two Views of Medical Science. samordnade insatser och samlokaliserade PLos Medicine March 2008 Volume familjecentraler. Dissertation, School of 5 Issue 3. Social Work, Lund University.

Köhler L (2008) Dagens Medicin 13.02.2008.

Lindskov C (2010) Family Centre Practice and Modernity a qualitative study from Sweden. Doctoral Thesis, Kristianstad Academic Press 1:2010.

20 Family centres in Finland – a new approach within services for children and families

Riitta Viitala, Marjatta Kekkonen and Nina Halme

In recent years, child, youth and family policy has become a topical relationship problems, and control of difficult feelings such as anger in con- theme in Finnish political discussion. The promotion of children’s and flict situations (Janhunen & Oulasmaa families’ welfare, by means of co-operation between different admin- 2008). At the same time, parenthood istrative and operational sectors, has grown stronger during the new began to be respected in a new way. The idea of promoting educational millennium. The basis of well-being has been broadening and it is now partnerships between parents and perceived as being fundamentally connected to social relationships professionals grew stronger. The and experiences of inclusion. Mutual co-operation and partnership discussion of parenthood broadened into an “it takes a village to raise a between municipal services and congregations, NGOs and private child” conversation. Some also asked players is also deemed important. The starting point for organising how parents should be approached services is the client’s participation and the possibility of having more and how they could be involved in services. Are parents able to make influence. their voices heard, do they communicate their needs, ask questions, and The service structure of a family centre combines a meeting place for are they able to have an influence? families with the family service network. In addition to municipal basic What meanings do we give to mother- and specialised services, the family centre network can also include hood, fatherhood and parenthood in services for children and families? congregations, NGOs, volunteers and the private sector. The services Another discussion topic was of a family centre can be either located apart or centralised in the same workers’ professional knowledge premises. Operations are based on an agreed co-operation structure. and skills. Workers felt that families’ problems have become more complex, more serious and harder to solve. The traditional reply would be Family centre discussions in ever-changing everyday life. These to increase specialised services, but Finland began in the early challenges can easily put the resourc- this was considered unsustainable. A 2000s es of many families to the test. During better starting point was to strength- When Finland emerged from the the new millennium, the following en the competence for preventive recession, the sufficiency of parents’ issues have become factors which work in order to provide families with resources and their ability to cope strain parents’ resources: stress, the support at an early stage in terms were seen as central concerns. Some uncertainty as a parent, combining of basic services. Close co-operation even said that parenthood was lost. the role of a parent with everyday between different players became Families with children lead a busy and life, combining work and family life, the key method in preventive work.

21 Indeed, in the birth of the family cen- had increased families’ loneliness. the very beginning. The seeds of tre model, the key aspect lay in work- Strengthening inclusion and promot- family centre work also began to ers’ feeling that multi-professional ing a sense of community became a grow through family work, open early co-operation increased their resourc- means of preventing loneliness and childhood education, NGO peer group es, competence and opportunities to social marginalisation. Today, the activity projects and in projects support families. Co-operation began recently published strategy for social promoting partnership co-operation to develop into doing things together and health policy, Socially Sustain- between municipalities and the third in a structured, planned manner. able Finland 2020 (Publications sector. Development projects of fam- A third factor, still taking shape 2011:6), identifies solidifying inclu- ily centres during the first wave were at the beginning of the new millen- sion and a sense of community as a started upon the initiative of and nium, was a new way of perceiving strategic issue. as co-operation between individual well-being. Public, social and health municipalities, the Association of services as such were not felt to guar- Development of family centres Finnish Local and Regional Authori- antee well-being. A human being is a in Finland ties, NGOs and universities of applied sum of physical, psychological and For the time being, no precise infor- sciences (Paavola 2004). At an early social factors, and his or her well- mation is available on the number stage, the development work yielded being is generated through inclusion. of family centres in Finland.1 It has single projects and there was no The realisation emerged that public been estimated that about one-fifth nationwide, shared development services for children and families of municipalities have organised vision or development network to could empower and create com- services for children and families as support service renewal. A major munities and integrate people into family centres or in a similar way. shift in viewpoint, however, occurred society. Crumbling social networks Services similar to family centres are when the problem-oriented practice chiefly planned through co-operation was replaced by addressing issues between municipalities. (Perälä et in a proactive and resource-oriented al. 2011). Slightly over ten years ago, way. The results of the first wave were at the beginning of the 21st century, encouraging and interest was kin- there were only few family centres dled in disseminating family centre in Finland. Family centre work has work. (Paavola 2004; Pietilä-Hella & developed in phases. Viinikka 2005).

The first wave – family centres The second wave – family centres’ arrive in Finland operating models formed at a local The development of family centres level in Finland has taken place in three The second wave of family centre stages. Family centres first came activities began in 2005 when the to Finland in 2002 when the city of Ministry of Social Affairs and Health Espoo, together with Diaconia Uni- established the national FAMILY versity of Applied Sciences, renewed Project (2005–2007) to support family training at child health clinics, the development of family centres. following the example of the Swedish Led by the National Research and Leksand model . They began to carry Development Centre for Welfare and 1 The National Institute for Health and Welfare is conducting a survey on the overall situa- out family training in parent groups, Health STAKES (currently the National tion concerning family centres in Finland. This which met before and after the child Institute of Health and Welfare), survey will be completed in autumn 2011. was born. Fathers participated from the project became a partnership

22 project. The FAMILY Project was 1. Promotion of children’s welfare: parents in their child’s life. based on the Government Resolu- Strengthening parenthood Peer activities promote the tion to Secure the Future of Social is the best way of promoting emergence of parents’ social Welfare (2003), in which family children’s health and welfare. networks, sense of community centres were defined as an operat- Supporting parenthood may and the attachment of parents ing model based on families’ needs also prevent “ill-being” among to their residential area and strengthening contacts between children and adolescents families. 4. Creating a culture of co-opera- During the second wave, set in 2. Development of basic services tion and partnership: motion by the FAMILY Project, devel- for children and families: Family centres operate on the opment was steered at a national Support for parenthood is basis of co-operation between level. Such steering comprised inter- at its most effective in ser- services for families with chil- active co-operation based on strong vices intended for all families dren, professional groups and dialogue, networking between with children. The focus is on families themselves. Family projects and players, sharing strengthening basic services for centre work is co-operative and know-how and exchanging experi- children and families, namely cross-sectoral. Co-operation ences. Families’ participation in prenatal and child health clin- is agreed on in partnership such development was supported. ics, early childhood education contracts between municipali- Almost 100 municipalities partici- and care and preventive work in ties, congregations, NGOs and pated in the FAMILY Project, through social services and schools voluntary organisations a total of thirty sets of projects. In 2003–2007, the Ministry of Social 3. Promoting peer activities and 5. Renewing the service structure: Affairs and Health allocated 36 mil- sense of community: Family centres are developed lion euros of government subsidy Family centres take advantage with the aim of permanently to social welfare development, of parents’ and children’s renewing service structures of which 7.6 million euros were own resources, inclusion and and creating networks between allocated to family centre work. In expertise. Parent group activi- services. Municipal welfare addition, the provinces allocated a ties support both mothers’ and strategies and child and family total of 54 million euros to develop- fathers’ growth into parenthood welfare policy programmes ment in the same period, 8.8 million as well as partnership between serve as municipality’s strate- euros of which was set aside for parents and professionals while gic steering instruments in the supporting services for children and strengthening the value of both operation of family centres families (Oosi et al. 2009, 28–29). Municipalities which participated in the FAMILY Project created a shared vision of the operating concept for family centres. The operating concept was crystallised in five principles which guided the development of local operating models in municipalities and municipal regions. These principles were as follows:

23 Based on these principles, the operat- In the second stage of the develop- by the consolidation of municipali- ing concept of family centres has been ment wave, family centres were ties which took place during the summarised as follows: developed into service models whose project period and in which several operations are based on the local smaller municipalities joined a service needs and service struc- central municipality. In the region “A family centre is a tures. During the FAMILY Project, of Kainuu, family centres operate locally developing service three kinds of family centre models through a regional operating model emerged in municipalities (Oosi et in which local services for families model whose services include al. 2009, 57–58; Viitala et al. 2008, with children have been collected prenatal and child health clin- 41–42). into sub-regional family centres ics, open early childhood educa- and family stations whose opera- 1. Family centre model based on child tions are slightly more limited. tion, primary school services, health clinics Furthermore, web-based family early support and family work Characteristic of the child health centre work has been developed, services. Family centres include clinic based model was imple- for example in Ostrobothnia mentation of group-based family meeting places for parents, in training in prenatal and well baby During the second wave of family cen- which they can participate in clinics, which was based on the tre development, group-type services unstructured or guided parent Swedish Leksand model. Further- for children and parents were rein- more a stronger co-operation was forced as part of services for families group activities. Family-oriented built between prenatal and child with children. Peer support between practices promote child welfare, health clinics, child day care and families and the significance of support parenthood and the preventive social work (family child-parent groups were increased. work) Attention was paid to strengthening couple’s relationship, and their parents’ relationships. The work of nature is preventive. A fam- 2. Family centre model based on open child health clinics and child day care ily centre’s working method is early childhood education was also developed. Functioning co- The open early childhood educa- operation models also grew between partnership co-operation with tion service was developed in a child day care and school, at the NGOs congregations, volunteers way which offered meeting places school-entry stage. Multi-sectorial and families themselves. Family for families with small children. co-operation between open early Meeting points operated on a childhood education, congregations centres are part of the municipal low-threshold basis, and organ- and NGOs was intensive, supporting structure of services for children ised peer group activities, offered the establishment of families in their and families. Case management steered and targeted parent groups residential area. In a family centre, it and pedagogically steered activi- is essential that children and families services ensures that special- ties for children and parents. These themselves participate in planning ised services reach the families activities were organised by NGOs and implementing activities. who need them.” (Viitala, Kek- and congregations, as well as by The focus on the development of municipalities family centres was on basic ser- konen & Paavola 2008, 23.) vices, inclusion and multi-actor 3. Sub-regional family centre model co-operation. Partnerships aimed to Many FAMILY Projects were sub- introduce the family centre working regional. This was partly influenced method as a co-operation method in

24 partners’ (organisations, congrega- receive the support they need at an For implementation of the pro- tions, resident associations, etc) earlier stage than now, in their own gramme, the first cross-sectoral own activities. The steering group everyday lives and development national and regional development of the FAMILY Project consisted of environments at home, in day care, structure was established, including representatives from the Ministry of at school or in leisure environments. representatives from non-govern- Social Affairs and Health, the National So far, the government subsidy mental organisations. The country Research and Development Centre allocated to the development of was divided into five KASTE regions. for Welfare and Health STAKES (cur- cross-sectoral services for children, Instead of single development pro- rently the National Institute of Health adolescents and families totals 33.5 jects, sets of projects, broad in both and Welfare), the National Board of million. operational and geographical terms, Education, the Association of Finn- The KASTE programme emphasises were conducted. Development projects ish Local and Regional Authorities, client-orientedness, the promotion of of services for children, adolescents the Central Union for Child Welfare, health and welfare, preventive work and families are currently in progress the Mannerheim League for Child and inclusion. The starting point as distinct projects in all KASTE Welfare, the Finnish Parents’ Associa- is the notion that sector-specific regions. The development and broad- tion, the Family Federation and the reforms are no longer sufficient. Sup- ening of family centre work is included Evangelical Lutheran Church Council. porting the development of children in each of these. Furthermore, imple- In municipalities, the group of players and adolescents at home, in day care mentation of the KASTE programme was even wider. A partnership-based and at school, and the prevention of included novel, interactive and active working method was implemented at emotional, behavioural and learning co-operation with numerous players both national and local level. problems, provision of early sup- such as universities, universities of port and the appropriate treatment applied sciences and Centres of Excel- The third wave – family centre as a of disorders form a whole. When the lence on Social Welfare. Educational, supporter of child and adolescent various elements of this task work cultural, sports and youth services development environments well together, a good childhood is became central co-operation partners The third wave began when the devel- ensured, preventing social marginali- in child and adolescent services. opment of family centres was includ- sation in young people and psycho- The KASTE programme has seen ed in the government programme social problems in adulthood. the launch of a significant change in 2007. Development has been Supporting children and adolescents process in the operating cultures of taken further with the support of the in their own development environ- child and family services. This has government’s Policy Programme for ments entails simultaneous sup- reinforced the preventive role of basic the Well-being of Children, Youth and port for those adults – parents and services and early support expertise. Families, steered by the Ministry of professionals – who are responsible Co-operation between basic and Education and Culture. The National for children and adolescents (the specialised services has diversified, Development Plan for Social and Kaste programme 2008, 20; Risikko and intensive rapid action consultation Health Care Services 2008–2011, i.e. 2010, 5; Mäkelä 2010, 7). It could be and co-operation structures have been the KASTE programme, became the said that family centres’ operating created as part of these services. The actual development engine. Based concept, with respect to cross-sec- first programme period is about to end on the statutory KASTE programme, toral co-operation and partnership and preparations have begun for the a thorough, nationwide renewal of between players supporting children KASTE II 2012–2015 programme. services for children, adolescents and and families, was also chosen as the Under the KASTE programmes, basic families with children was launched. leading development principle for services for children, adolescents and The aim of renewal of services was the national renewal of services for families have been brought together, that children and adolescents could children, adolescents and families. both operationally and structurally,

25 into municipal preventive services, family services network. In addition structures, operating models and best i.e. family centres. However, combin- to municipal basic and specialised practices and to spread them through- ing services into family centres has service professionals, the family ser- out the nation. In spite of numerous meant different things in different vices network may include workers positive accomplishments, there are municipalities, such as wide-ranging from associations, NGO volunteers still challenges in the development of organisation of services in line with and private-sector services. Family the family centre model. life-cycle thinking, family centres, centres combine the expertise and welfare child health clinics, family know-how of parents, professionals Strengthening parenthood and stations, shared physical premises, and other players in a way which supporting the child’s growth open early childhood education, etc. benefits all parties. Parents not The basic task of a family centre is More detailed information is needed only need information and parent- to promote child welfare and health on the preventive services offered ing support, but also the chance to by supporting parenthood. This is by family services and how they are exchange experiences with others in based on continuously increasing and organised and managed. Research a similar life situation. For this rea- diversifying knowledge of the fact data is also needed on the effective- son, the prerequisites of peer activi- that child health and welfare are built ness of family centres’ health and ties have been reinforced. The family during interaction between parent and welfare promoting work, and on centres are universal and intended child. The Finnish family centre model preventive activities. In Finland, fam- for all families with children. faces the challenge of developing ily centre work faces the challenge The services of a family centre personnel’s shared know-how on the of defining criteria and drawing up a may be located on the same prem- parent–child attachment, and on early guide for family centre work. ises, “under one roof’, or in their interaction and encouraging upbring- In the third stage of family cen- own locations, in which case the ing practices which support the child’s tre development – in which KASTE family centre operates as a net- development. In other Nordic Coun- development work has included all work. Operations are based on an tries, structured parenting support services for children and families, agreed co-operation structure and programmes are widely used. Finnish, from universal basic services to child- a partnership agreement drawn nationally2 developed, cross-occupa- and family-specific specialised ser- up with NGOs, congregations or tional training programmes include vices, including child welfare, child other players. Family centre work is Supporting early interaction (VAVU), psychiatry and adolescent psychiatry organised by municipalities, NGOs Theraplay, Taking up one’s worries, – family centres have been empha- or both as multi-actor co-operation. Educational partnership and Let’s Talk sised as a structure which promotes Family centres can also act as cen- about Children. The family centre of the health and welfare of children and tres of expertise, creating networks Western Turunmaa supports its know- entire families, while offering early between professionals in the field how with the ICDP programme3, origi- support. Family centres are becoming and family centre professionals, and nally developed in Norway and known a service structure which consists developing services, family centre in Sweden as Vägledande samspel. of meeting places for families and a work and working methods which The international and widely dissemi- support welfare and health. nated International Child Development Programme (ICDP) encourages positive 2 In Finland, parenting support programmes The development challenges of interaction with the child. This pro- have been developed by the National Research the family centre model and Development Centre for Welfare and Health, STAKES, and currently by the National Institute The goal of the next KASTE pro- 3 The International Child Development Pro- for Health and Welfare, THL. The National Public gramme period is to continue the gramme (ICDP) is a parenting support programme developed by Norwegian professors Karsten Health Institute and STAKES merged in 2009, to reform which has already begun, form THL. Hundeide and Henning Rye at the University of to regionally entrench new service Oslo. It is applied in more than 20 countries.

26 gramme is based on the UN Conven- ily centres’ pedagogic groundwork ties have not made agreements on tion on the Rights of the Child and is means combining support for the common goals and operational approved by the WHO. child’s learning with support for practices, nor on common follow-up Family centres offer a place where parenting. and assessment of work (Perälä et al. parenting, normally part of the 2011, Joensuu et al. 2011). In many private home environment, can be Reconciling preventive services and municipalities, family centres have communally shared. Support for developing management already evolved from development everyday life and strengthening of The municipal and service reform work into practice, but family centre families’ own resources and exper- (2005–2012) has reduced the num- players also feel unclear about what tise are needed for parenting, child ber of Finnish municipalities and a family centre means as a method upbringing, the relationship between reshaped the structures of social and of organising services, how multi- the parents and other everyday healthcare services. With the service professional co-operation can be challenges. By investing in motiva- field in transition, family centres offer supported and how partnership with tional and preventive services which an operating model which combines the third sector should be organised. are easily accessible for families, local services for children and fami- A pivotal challenge is to make multi- it is possible to reduce the number lies into a whole whose functions are sectorial co-operation and agree- of child welfare customers and, in based on families’ needs. A family ing on common practices genuinely the long run, save on corrective centre consists of multiple services. attached to preventive work and the service costs. In preventive work, it At its best, a family centre can act as management of child, adolescent and is of great importance to have the the foundation of services for families family services. opportunity to share the joys and with children, reshaping the entire sorrows, bafflements and feelings service structure into a whole which Family centre into legislation of helplessness, as well as experi- is child and family-oriented, consists A thorough reform of social welfare ences of being capable and coping, of basic services and relies on the life and health-care legislation is cur- and to have premises available for cycle model. To achieve this, services rently underway in Finland. The new shared activities which strengthen must be reconciled and cross-sectoral Health Care Act entered into force parenting. In preventive group-form management must be developed. in May 2011, the Social Welfare Act parent work, capabilities and skills Multi-sectorial co-operation is is currently being reformed, while pertaining to parenthood, shared by based on the expertise of each part- preparations are being made to renew all parents, can be reinforced. This, ner, clearly defined needs, and goals legislation on the organisation and in turn, reinforces social integration. in which resources, risks and benefits development of social welfare and Open early childhood education are shared. Partnership reinforces healthcare. services have been a significant part the mutual trust and commitment Sector-specific legislation on of the family centre model since its of service providers, increasing the services for children, adolescents beginning. One of family centres’ likelihood of attaining these goals. and families with children has been development challenges lies in the To achieve this, management needs renewed to support a working method need to strengthen their pedagogic to be developed in such a way as to which is family-oriented, promotes groundwork. Pedagogic activities form child and family services into welfare and health, and is multi-sec- support children’s individual devel- unities which are coherent and func- toral and network-oriented. In child opment and social activity within tional from the viewpoint of families. health clinic work, the emphasis is on child groups. Pedagogically planned Multi-sectorial co-operation does not directing support towards the whole activities reinforce parenthood as a appear spontaneously, but requires family. In addition to child welfare, promoter of a child’s comprehensive plenty of co-operative thinking and the welfare of both parents and their learning. Reinforcement of fam- planning. One third of municipali- relationship form the focus. Access to

27 family training, parent group activities work. The Act on Children’s Day Care The family centres has been pro- and home visits for families expecting will probably be transformed into moted by means of sector-specific their first child has been amended in an Early Childhood Education Act. legislation, but there is no legislation particular. The Child Welfare Act lays Several sector-specific Acts lay down concerning family centres as such. In down provisions on preventive child provisions concerning multi-sectoral addition to national and local devel- welfare, confirming child health clin- co-operation working groups. Peer opment efforts, steering by way of ics, child day care, school and youth group activities also hold a stronger legislation is needed to establish the work as co-operators in child welfare legislative position than before. family centre model.

References

Janhunen Kristiina & Oulasmaa Minna Pietilä-Hella Riitta, Viinikka Anne (2006) Sosiaalisesti kestävä Suomi 2020. Sosiaali- (toim) (2008). Äidin kielletyt tunteet. Kumppanuus kannattaa. Verkostot voima- ja terveyspolitiikan strategia. STM Julkaisuja Väestöliitto. Nykypaino Oy, Helsinki. varana uudessa perhevalmennuksessa. 2011:1. Raportti Espoon kaupungin ja Diakonia- Joensuu Johanna, Halme Nina, Nummi Tapio ammattikorkeakoulun kumppanuushank- Viitala Riitta, Kekkonen Marjatta, Paavola & Perälä Marja-Leena (2011). Lasten ja keesta. Suomen Kuntaliitto. Helsinki. Auli (2008) Perhekeskustoiminnan kehit- perheiden palvelujen yhteensovittamista täminen. PERHE -hankkeen loppuraportti. kuvaavan rakenneyhtälömallin kehittämin- Pietilä-Hella, Riitta (2010) Tuntemattomista Sosiaali- ja terveysministeriön selvityksiä en ja arviointi. (unpublished manusckript) vertaistuttaviksi. Esikoisäitien ja –isien 2008:12. Sosiaali- ja terveysministeriö. perhevalmennusprosessi Espoon uuden- Helsinki. National Development Plan for Social and tyyppisessä perhevalmennuskokeilussa. Healthcare Services Kaste Programme Diakonia-ammattikorkeakoulun Julkaisuja A 2008–2011. Publications of the Ministry of Tutkimuksia 29. social Affairs and Health 2011:1 Raatikainen, Tuija (2010) Perheiden parissa. Oosi, Olli, Wennberg, Mikko, Alavuotunki Perhekeskukset hyvinvointia edistämässä. Kaisa, Juutinen Sirpa, Pekkala Henrik, Humanistinen ammattikorkeakoulu. Opin- PricewaterhouseCoopers Oy (2009) näytetyö. Kansalaistoiminnan ja nuorisotyön Sosiaalialan kehittämishankkeen arviointi. koulutusohjelma 11/2010. Loppuraportti: tulosten ja vaikutusten arviointi. Sosiaali- ja terveysministeriön Risikko, Paula (2010) Kaste jalkautuvan kehit- selvityksiä 2009:12. Helsinki. tämistyön airueena. Teoksessa: Siltala, Elina , Paananen, Maiju (toim.) Paavola, Auli (toim.) (2004) Perhe kes- (2010) Mitä Kasteesta on kasvamassa? kiössä. Ideoita yhteistyöhön perheiden Lasten Kaste-seminaari 5.10.2010. Avauksia parhaaksi: kokemuksia Ruotsin Leksand- 23/2010. Terveyden ja hyvinvoinnin laitos. ista ja useista Suomen kunnista. Lasten- Helsinki. suojelun Keskusliitto. Helsinki. Gummerus Kirjapaino Oy. Siltala, Elina , Paananen, Maiju (toim.) (2010) Mitä Kasteesta on kasvamassa? Perälä Marja-Leena, Halme Nina & Hammar Lasten Kaste-seminaari 5.10.2010. Avauksia Teija & Nykänen, Sirpa (2011). Hajanaisia 23/2010. Terveyden ja hyvinvoinnin laitos. palveluja vai toimiva palvelukokonaisuus? Socially sustainable Finland 2020. Strategy Lasten ja perheiden palvelut toimialajohta- for social and health policy. Publications jien näkökulmasta. Institute for Health and of the Ministry of Social Affairs and Health Welfare. Reports 29/2011. Helsinki. 2011:6

28 The Family’s House in Norway – an emphasise that the model is in line with the intentions of the Co-ordina- interdisciplinary, municipal/community tion Reform currently being implemented (Ministry of Health and Care healthcare service for children, adoles- Services, 2009). The model is also cents and their families highlighted by the National Institute of Public Health, which in a new report on health-promoting and preventive recommendations recommends that Anette M. Thyrhaug, Gørill W. Vedeler, Monica Martinussen the model be further tested as a coor- and Frode Adolfsen dinating initiative and that it should be systematically assessed together with other models (National Institute of Public Health, 2011). Many different services and depart- This chapter presents a description of the Family’s House/ Family Centre ments are collectively responsible for Model, as it is applied in Norway following a national pilot study of Fam- the health, development and well- being of children and adolescents ily Centres during 2002–2004. An overview is also given of the number in Norway. These are financed in of municipalities that have organised their services in the form of a different ways, have a specialist sup- Family’s House, based on a survey carried out in 2008. One new study port function in different departments and directorates, and have different associated with the model which focuses on how an open kindergarten legal frameworks to adhere to. The can act as a parental support initiative, is also described. fragmentation of responsibility for different areas which are nevertheless closely associated with each other can represent a significant challenge The Family’s House provides inter- a national pilot study involving fam- for children, adolescents and families disciplinary services in the munici- ily centres (now Family’s Houses) with complex needs. In an official palities which addresses mental and on behalf of the Norwegian Health report on the co-ordination of services physical health of children, adoles- Authorities. The pilot study was for vulnerable children and adolescents and their families. The munici- based on the Swedish family centre cents, the Family’s House is promoted pality’s primary health and social model, but was adapted to Norwegian as a suitable model for the organiza- care services aimed at children, conditions (Haugland, Rønning, and tion of the collaboration covering this adolescents and their families are Lenschow, 2006). At that time, the target group (Ministry of Children, coordinated, co-located and anchored project was anchored in the National Equality and Social Inclusion, 2009). locally through this service. The aim Plan for Advancing Mental Health is for families to receive both well Care that was implemented between The Family’s House coordinated and family supported 1999 and 2008 (Ministry of Health co-ordination model services within the same building. and Care Services, 1998). The services that are often co-located During the period 2002-2004, the The Norwegian authorities recom- in Family’s Houses are a health centre Regional Centre for Child and Youth mend that municipalities should that offers healthcare service for Mental Health and Child Welfare at organize their services according children including pregnancy care, the University of Tromsø conducted to the Family’s House model, and preventive child welfare services, ped-

29 agogical-psychological services and How many Family’s Houses are to establish such a centre. The 19 an open kindergarten. Professionals there in Norway? County Governor offices were also from the various services make up a A national survey of Family’s Houses contacted in order to find out what flexible interdisciplinary team that conducted in the autumn of 2008 they knew about municipalities with delegates the work according to the indicated that many different forms such organizations. This resulted in wishes and needs of the users. The of interdisciplinary collaboration had a total of 59 organizations spread goal for the work is to promote well- developed within Norwegian munici- across 40 municipalities. Many of the being and good health amongst chil- palities (Thyrhaug and Martinussen, 59 organizations that responded to dren, adolescents and their families, 2009). All Norwegian municipalities the survey were designated as family and to improve conditions for children were contacted and asked to give centres, Family’s Houses or similar. and young people (RKBU Nord, 2008). feedback as to whether they had These were in turn sorted into four Amongst other means, this goal can an organization corresponding to categories (see Figure 2). Upon closer be achieved by: that of a family centre or planned inspection, it was apparent that 14 of

• Identifying the physical, mental and social challenges faced by the child and the family at an early stage Figure 1 • Providing readily accessible sup- Levels of initiative and interventions port and initiatives within a Family’s House • Supporting and reinforcing parents in their role as caregivers Third floor – Indicated • Enabling children, adolescents and interventions their families to strengthen their Children, adolescents social networks and families with par- • Developing communication and ticular needs working methods with the involve- Second floor/level – ment of children and parents Selected interventions • Developing appropriate, coordi- Children, adolescents nated and interdisciplinary services and families with indi- for users vidual needs • Being available as a meeting place in the areas where people live First floor/level – • Disseminating relevant information Health promotive and universal interventions The goal is to develop a good dynam- All children and ic and ensure that assistance is well- adolescents with their coordinated, whether at a universal, families targeted or indicated level (see Figure 1). The model is intended to ensure Foundations that services that are co-located work Professional infra- together to develop an integrated structure and compe- service that includes initiatives at all tence levels.

30 the participating organizations con- and preventive initiative in order to manent place. Parents are given the sisted of all the same services that provide users with readily accessible opportunity to use the kindergarten were included in the model formu- parental support by serving as a ped- service at times that suit them during lated in the trial project, and there- agogical, open and inclusive meeting opening hours. Other people caring for fore qualified as a Family’s House. 16 place for the parents of young chil- children within the target group are of the organisations were given the dren. The goals of the initiative are to also welcome. name Resource Health Clinic. These stimulate the development and health Users are invited to actively contrib- were developed on the basis of a of children, to support and reinforce ute to the formulation of the kindergar- health centre, but had only integrated parents in their role as caregivers, ten’s programme and to the perfor- certain individual elements from the to promote a good level of interac- mance of daily activities. Pedagogical Family’s House model. tion between parents and children staff are responsible for ensuring that Two groups of organizations were and to strengthen the social network such participation takes place. constructed in an entirely different of parents. Open kindergartens are Open kindergartens supplement manner. We found 10 organiza- open to everyone with children up to Family’s House services in several tions that we decided to refer to as the age of six, and the service is free ways. First and foremost, they add specialist referral teams. These had with no one being allocated a per- a new dimension to the range of established an interdisciplinary team consisting of various types of personnel with expertise within mental health work. Amongst the participat- Figure 2 ing organizations, we also found nine Proportion of different types of organisation more independent open kindergartens with additional resources. The link for collaboration with health centres was unclear for the latter two The Family’s House, categories. It was our understanding 16 % n=14 that it was the parents themselves 24 % Resource health who contacted the centres, or other clinics, n=16 child-oriented services referred fami- Specialised referral lies there, in cases where the prob- 16 % teams, n=10 lems facing the child and the family were so great that extended assis- Open kindergarten with extra resources, tance was needed. During the survey, n=9 contact was established with nine 17 % 27 % organisations who informed us that Organizations under they were in the process of establish- establishment, n=9 ing a Family’s House. However, we are unaware of the direction in which these Family’s Houses developed.

Open kindergarten– a parental supportive effort Open kindergarten in the the Fam- ily’s house are a health-promoting

31 municipal services on offer by being was a mother aged around 31, who munity initiatives corresponding to available to users without the need attended with a child of around 1.6 open kindergartens. for prior appointments or referrals. years of age, and that they visited During opening hours, users are the kindergarten on a weekly basis Summary given access to a social meeting (70%) (Vedeler, 2009). Compared The Norwegian authorities recom- place and a secure and stimulating with figures from Statistics Norway, mend the establishment of Family’s environment in which their children the survey suggested that the level Houses in Norwegian municipalities. can meet other children. They can of education of users was somewhat A national survey indicates that there also receive support and guidance lower than the national average, are also a number of other organiza- there. The kindergarten strengthens which could indicate that kindergar- tional forms. The characteristic fea- the Family’s House’s interdisciplinary tens with parental support initiatives tures of the Family’s House model are team through low-threshold peda- also recruit users from a somewhat the fact that a number of services are gogic skills, and the kindergartens’ lower socio-economic background co-located and coordinated in order premises locations may be used for than those with a somewhat higher to provide users with a holistic range other Family’s House services outside threshold, e.g. where parents have of services, and the fact that open its opening hours. The functionality to register for courses (Reedtz, Mar- kindergartens are included in this of the locations provides space for a tinussen, Wang Jørgensen, Mørch model, in addition to the traditional diverse range of activities. The value and Handegård, 2009). Other stud- municipal services such as healthcare of the kindergarten, as an interdisci- ies have shown that parents with a services, child welfare services and plinary arena, is apparent when pro- lower socio-economic background pedagogical-psychological services. fessionals from the Family’s House’s seek out informal services to a great- Assessments indicate that parents other services are present and make er extent, rather than use formal using open kindergartens are very themselves available to users during bodies or course services requiring pleased with the service. the kindergartens’s opening hours. prior appointments or referrals. Open kindergartens recruit users One of the main goals of open via the healthcare service, the local kindergartens is to create an arena area around the Family’s House or where parents can strengthen their from the surrounding geographical social networks. Of those who areas. Almost all parents in Norway responded to the survey, 75% stated use the healthcare service, and that they got to know other parents information concerning the kinder- through visits to the kindergarten gartens’ services has often already either to a great extent or a very been disseminated via the antenatal great extent. Even though most care service before the child has of the users were stay-at-home even been born. The nurse from the parents, the 2009 survey indicated healthcare service can be helpful that around 30% of parents were in establishing personal contact working or in education. It is notable between the user and pedagogical that 68% of the users stated that staff, and thereby contribute to the they had moved during the past five further lowering of the threshold. A years, of which 40% had moved user survey conducted in five open two or more times during the same kindergartens in 2009, to which 185 period. This could indicate that the people responded, indicated that the user group was relatively mobile and average user of open kindergartens therefore required integrating com-

32 References

Haugland, R., Rønning, J. and Lenschow, K. National Institute of Public Health (2011). Bedre Contact information: Gørill Warvik Vedeler (2006). Evaluering av forsøk med fami- føre var – Psykisk helse: Helsefremmende og ([email protected]), Monica Martinus- liesentre i Norge. Tromsø: Regionsenter for forebyggende tiltak og anbefalinger (Report sen ([email protected]), Frode barn og unges psykiske helse, region Nord 2011:1). Oslo: National Institute of Public Adolfsen ([email protected]) and (Regional Centre for Child and Adolescent Health. Anette Moltu Thyrhaug (anette.thyrhaug@ Mental Health – North), University of uit.no). Regional Centre for Child and Youth Tromsø. Reedtz, C., Martinussen, M., Wang Jørgensen, Mental Health and Child Welfare, Univer- Mørch, W.-T. and Handegård, B.-H. (in press). sity of Tromsø, NO-9037 Tromsø, Norway. Ministry of Children, Equality and Social Parents seeking help in child rearing: Are they Inclusion. (2009). Det du gjør, gjør det in need of intervention? Journal of Children’s helt. Bedre samordning av tjenester for Services. utsatte barn og unge (NOU 2009:22). Downloaded from http://www.regjer- RKBU Nord. (2008). Brochure: Familiens hus. ingen.no/pages/2272040/PDFS/ Et tverrfaglig lavterskeltilbud. RKBU-Nord, NOU200920090022000DDDPDFS.pdf University of Tromsø.

Ministry of Health and Care Services. (1998). Thyrhaug, A. M. and Martinussen, M. (2009). Om opptrappingsplanen for psykisk helse, Familiens hus. Nasjonal kartleggingsunder 1999–2006 (Storting Bill no. 63). Oslo: søkelse 2008 (Report no. 3). RKBU Nord, Ministry of Health and Care Services. University of Tromsø.

Ministry of Health and Care Services. (2009). Vedeler, G. (2009). Åpen barnehage i Familiens Samhandlingsreformen. Rett behandling – hus – en brukerundersøkelse blant foreldre. på rett sted – til rett tid (Storting Report No. Master’s thesis. Institute for Pedagogics and 47 2008–2009). Oslo: Ministry of Health and Teacher Training, University of Tromsø. Care Services.

33 Danish family policy and the Child Reform

Anna Jin Rolfgaard

Danish family policy for themselves and those closest to The vast majority of children in Strong, self-supporting families are them. The task of society is to pro- Denmark grow up in appropriate and essential for a secure and strong soci- vide services which secure families’ secure surroundings with parents ety experiencing growth. Families are freedom of choice and uninhibited who support them throughout their the focal point for people throughout development and provide a safety net childhood. However, this is not true their lives. It is first and foremost for those who find it difficult to cope for all children. Some children do not within the family that individuals on their own. Society must provide an have a secure framework or receive acquire their basic values, attitudes appropriate framework, but the fami- the support they need at home. It is a and perspective on life, and the lies themselves also have a responsi- key task of society to support these family is the unit that performs a bility to create a good family life. children and their families, in order wide variety of basic and particularly to ensure that the children have the important functions. This applies There are five underlying principles in same opportunities as their peers when it comes to both having children Danish family policy: for personal self-realisation, devel- and providing them with key social opment and health in spite of their skills which equip the individual for • The family policy must give fami- difficulties and challenging circum- life and enable them to understand lies the flexibility and freedom to stances. and function as a citizen in society. organise their family life as they Achieving this goal will require the Furthermore, families are an abso- wish framework behind the initiative to be lutely essential prerequisite for the • The family policy must help to pro- optimal. This framework was con- existence of society, simply because mote a balance between family and siderably strengthened through the it is within families that the popula- working life child welfare reform of 2006, which tion reproduces. • The family policy must ensure good amongst other things focused on Family policy is not just about framework conditions for families the importance of a comprehensive maternity rules and day care provi- across initiative areas review of the child’s problems and an sion; it is also about health policy, • The family policy is based on the action plan for the initiative. Through social policy, environmental policy, necessity of utilising the resources the agreement – the Child’s Reform etc. The circumstances and well-being that are available within civil soci- of 2009 – the political parties behind of families are therefore key parame- ety the rate adjustment pool agreement ters in the formulation and implemen- • Family policy and social policy are brought focus to the following three tation of new political initiatives. interlinked. Vulnerable families themes: The Danish government sees a must receive the help and sup- successful family policy as a family port that will enable them to take 1. Closeness and care (Strengthening policy as one that gives families the advantage of society’s opportuni- of foster family programmes) freedom to organise their own lives. ties and create a secure framework 2. Children’s rights and the previous The initial assumption is that families for their children’s upbringing and initiative (The legal position of vul- can and want to take responsibility the family’s well-being nerable children must be strength-

34 ened, so that the child’s interests wherever possible, both so that the If you have any questions regarding are always the most important con- time which the child and the parents Danish family policy, please contact sideration, and prevention and an spend together can be as positive as Head of Section Anna Jin Rolfgaard early response are of vital impor- possible and in order to ensure that ([email protected]) or Special Consultant tance in order to secure vulnerable the child can return to their parents Anne Katrine Bertelsen ([email protected]) children a good childhood) wherever possible. at the Danish Ministry of Social 3. Quality in the initiative (Many areas Affairs. must be considered if it is to be “Family centre provision” in ensured that the initiative will make Denmark a positive difference to vulnerable As part of the Child’s Reform, funding children and in the long term help was allocated to the development of to ensure that they get the same the “Mødrenes Hus” (The Mothers’ opportunities as other children, House) model. The Mothers’ House including the elimination of red has the characteristics of a model tape, knowledge production and that local authorities, in partnership dissemination, etc.) with a voluntary association, will implement and test. The model was The parents of vulnerable children developed by drawing on inspiration play a major role in their children’s from practice, including “Familie- lives, regardless of any failure or defi- huse” (Family’s Houses) in the Nordic ciencies on their part. It is therefore countries and the Netherlands, and important to be aware of the parents’ the “I gang” (Underway) project, needs for special support if they which is being carried out under are to contribute to their children’s the direction of the Danish NGO well-being and development. In some “Mødrehjælpen” (Mothers’ Help). cases, placement in foster care is The model is based on our current essential, but this does not alter best knowledge of how an initiative the fact that a placement outside aimed at vulnerable young mothers the home is always an unhappy should be organised so that the goals situation which must be prevented for education, employment, parent- wherever possible. At the same time, ing skills, networks and housing are the parents still have a major role to achieved. The model’s starting point play for the children during a foster is a holistic and non-stigmatising placement. It is therefore vital that approach to the target group of vul- efforts are made to resolve the fam- nerable young mothers, their chil- ily’s problems during the placement dren, networks, etc.

35 Child and family services in the needs, particularly children and young people. Services and resources Icelandic welfare system are provided by both the state and the municipal authorities. The range of services provided for children Sigrun Juliusdottir and Elisabet Karlsdottir and families in the Icelandic welfare society varies from municipality to municipality. Framework legislation provides scope for differing interpretations of the laws and the range of The aim of this chapter is to present a picture of the range of services services offered by municipal authori- available to children and families in the Icelandic welfare system ties under family policy. A further based on three perspectives: the public, state and municipal sector, factor that plays a part in this respect is the fact that the 76 municipalities the voluntary sector and the private sector. The principal focus has in Iceland vary greatly in terms of therefore been placed on the general and preventive, rather than on size and therefore also their needs in vulnerable families or marginalised groups. terms of services and support. Rey- kjavik is the largest municipality, with Welfare services in Iceland for children and families are in many approximately 119,000 inhabitants, respects similar to the Nordic welfare system, particularly when compared with the smallest munici- it comes to public sector childcare. Various general services are pality which has 52 inhabitants. A total of 33 municipalities have fewer described, along with social initiatives for various types of family than 1,000 inhabitants. Over 60% of based on their varying needs. Finally, the presentation is linked to the Icelandic population live in the results from Icelandic family research, amongst other things on the Reykjavik area (203,000 out of the entire population of 318,452) (Hag- basis of family policy aspects and the role of social work in postmod- stofa Íslands, 2011). A recent survey ern family development. of municipal services for children and families in Iceland (in municipalities with more than 1,000 inhabitants) showed that, of 58 different services The public, state and municipal municipal authorities are required available, Reykjavik provided 50, sector to ensure the financial and social compared with one of the smallest Care and services for children, fami- security and welfare of the popula- which only offered 20 of the services lies and young people represent an tion. This must take place through (Félags- og tryggingamálaráðuneytið, important part of the welfare society. improvements in the living conditions 2010). Formal, public sector family ser- of vulnerable groups and through The range of services offered to vices are enshrined in Icelandic laws ensuring the development of general- children and families can be divided concerning social support for families ly favourable upbringings for children into six areas: welfare and social and children in the form of social and young people (Act No. 40/1991). services, educational initiatives, lei- services and maternal and children’s The purpose of this is welfare with sure, cultural issues, communication, healthcare, as well as geriatric care. social and financial support for all third sector and non-governmental According to Icelandic legislation (universal). There are also special- organisations (Félags- og tryg- covering welfare and social services, ist services for those with special gingamálaráðuneytið, 2010). The

36 range of services offered to children prioritisation or special treatment mainly in the Reykjavik area, have and families from a preventive as regards admission to nursery study advisors and/or school welfare perspective covers the provision of for disabled children. In addition, officers, usually the same person. both preventive advice and sup- certain municipalities offer allow- port for parents, as well as varying ances for the care of children in the Services for families, children levels of financial support for single home. Eydal and Rostgaard (2010 and young people provided by parents, the unemployed, those on in Gíslason and Eydal (ed.)) have the third sector sick leave, parents living below the discussed the concept of “börnepas- Voluntary work has traditionally poverty threshold, etc. Financial ning” (childcare) with regard to played a role within social and non- support includes for example a the integration of care and learn- profit organisations in Iceland and sibling discount at nurseries, dis- ing. One of their findings is that represents what is known as “the counts for childcare in the home and all Nordic countries except Iceland third sector” (Juliusdottir, 1999: discounts for single parents, as well offer daycare centre allowances as Juliusdottir & Sigurdardottir, 1997). as financial support for participa- a direct continuation of parental This activity falls between the public tion in leisure activities for children, leave. Some of the family services and private sectors and is aimed at totalling 23 different benefits. This concern leisure activity provision. non-profit services for the benefit of preventive service is offered to This area includes social club activi- the general public (Hrafnsdóttir & 47% of the population (Félags- og ties for children aged 13–16, sports Kristmundsson, 2010). It is common tryggingamálaráðuneytið, 2010). centres for the whole family, and for various interest groups in Iceland Another resource concerns state the provision of employment and to do voluntary work and, according contributions to families with leisure activities during the sum- to Hrafnsdóttir (2006), around 40% children in the form of, for exam- mer for children of school age. It of people now participate in various ple, parental leave, child benefit, also includes free entry for children types of voluntary work. This mostly children’s pensions for disabled to swimming pools, entertainment concerns sports and parents’ associa- parents and parental allowances for for children at libraries and free tions, as well as various charitable single parents (Hagstofa Íslands, bus travel for children. Healthcare organisations. One unexpected 2009). Parental leave in Iceland can centres in the larger municipalities finding was that it is the age group be taken by both the mother and the provide not only maternal care but which is most likely to have their father. A total of nine months’ leave also access to certain family support own children that contributes most is given: three months for mothers services, particularly for families to voluntary work. Activities that only, three months for fathers only with very young children, but the are specifically aimed at families, and three months which the parents focus is primarily on the physical children and young people are the can allocate between themselves health and development of children. most comprehensive, both now and (Eydal & Gíslason, 2008). Child Some healthcare centres provide in the past, and these activities are benefit is paid via taxes and varies targeted parental care with teaching often supported by the public sector according to the income of the fam- and advice. (Steinunn Hrafnsdóttir, 2008). ily, except that the same amount is Very little family work is carried Parents often participate with their paid to everyone with children under out through schools, but the ordi- own children in various sports and the age of seven (Arnaldur Sölvi nary parents’ associations cooper- youth organisations on a voluntary Kristjánsson, 2011). ate in various “home and school” basis. A major voluntary contribution There are opportunities to take programmes and the schools them- is the involvement of parents with part in educational initiatives for selves are to some extent involved various service programmes and the children of non-Icelandic origin in collaboration with social and provision of advice to children and (mother tongue lessons), and for childcare services. A few schools, young people with various types of

37 disability or long-term illness, such the University of Iceland’s institute Welfare has implemented compre- as Sjónarhóll (http://www.sjonarholl. for continuing education. All five were hensive measures to deal with this net) and Þroskahjálp (http://www. full-time public sector employees, new situation, including initiatives to throskahjalp.is). two of whom still run a private clinic counteract the financial difficulties Another organisation that works in for couples, parents and children. faced by families and the threat of the interests of children and families Kyrkans familjerådgivning provides bankruptcy and wherever possible to and for attitude change concerning access to family advisors, three protect the public sector welfare ser- their affairs is Barnaheill (Save the social workers and a psychologist. vice that had previously been built up Children), which works both national- Some clergymen have specialised in (Félags- og tryggingmálaráðuneytið, ly and internationally. There are also bereavement counselling for families, 2009a). organisations such as Kyrkans välgör- whilst a few lawyers work with social Greater acknowledgement of the enhet (Charity work of the Church), workers and psychologists provid- importance of evidence-based knowl- the Red Cross and Mödrahjälpen ing mediation to divorcing couples edge within the social arena has con- (The Aid of Mothers), which have in conflict over child custody and tributed to social services for children specifically dealt with parents and access issues. The limited provision and families now being increasingly children living below the poverty of family services due to a failure to based on research and evaluations threshold since the economic crisis in acknowledge the need for specialist of various service programmes and 2008. Voluntary work has long been expertise relating to families (Félags- methods. This has resulted in greater important in family welfare issues in og tryggingamálaráðuneytið, 2009; ambitions amongst social workers Iceland (Steinunn Hrafnsdóttir, 2006). Nososco, 2009) has contributed to a and other professionals within social growing number of social workers and care for participation in development Family services in the private psychologists opening private clinics projects and the evaluation of ser- sector for families with special needs, e.g. vices, and thus helping to raise the Private sector services covering fam- associated with Alzheimer’s disease, level of quality of post-modern social ily issues are not particularly exten- ageing, relationships, etc. Research work. The result is a better developed sive in Icelandic society. It is primar- has shown that the need and demand range of services for users of social ily social workers and psychologists for family advice and support, par- services (Guðmundsson, Jónsdóttir who have clinical expertise or who ticularly in connection with divorce & Júlíusdóttir, 2010). An example of are authorised psychotherapists. issues and step-child relationships, a service that is based on evidence- This service is primarily available in has increased in line with the post- based practice within the state and the Reykjavik area. The first recep- modern development of families municipal sector (Reykjavik) is Kven- tion clinic, Föräldrarådgivningen, was (Juliusdottir, 2009 a & b). nasmiðjan, which is a collaborative started by two female psychologists project between the City of Reykjavik in 1979 and reorganised to form Welfare services and evidence- and the Social Insurance Administra- Psykologcentrum in 1983, an organi- based knowledge tion (Guðmundsson, Jónsdóttir and sation which is still active and offers Icelandic society has changed Júlíusdóttir, 2010; Hrafnsdóttir & both individual and family therapy. since the banking crisis in 2008 Karlsdóttir, 2009). In 1982, a team of family therapists, with (almost previously unheard of) three social workers and two psy- unemployment and reduced spend- chologists founded Familjemottagnin- ing power as a result. This has had a gen Tengsl, which also offered family marked negative effect, particularly courses and management, as well as in terms of the ability of families with longer family therapy education pro- children to provide for and maintain grammes, e.g. in collaboration with their quality of life. The Ministry of

38 References

Arnaldur Sölvi Kristjánsson (2011). Fjölsky- Hagstofa Íslands (2009). Heilbrigðis-, félags- Nordic conference: Frivilligt arbete, forskning ldubætur á Íslandi. Fjárstuðningur vegna og dómsmál. 19 October 2009. och förmedling. NOPUS report 1999:13 framfærslu barna árið 2010. Greining og samanburður við önnur lönd,ásamt útfærs- Hagstofa Íslands (2011:1). Mannfjöldi. Juliusdottir S (2009 a). Icelandic families lu á nýju kerfi barnatrygginga. Reykjavik: 29 March 2011. and intergenerational relationships: Young Þjóðmálastofnun Háskóla Íslands. people’s experiences, views and values. Hrafnsdóttir S & Kristmundsson O(2010). REASSESSING THE NORDIC WELFARE MODEL. Eydal G B and Gíslason I., (2008). Paid Challenges in the Icelandic Non-Profit Sector. Conference 18-20 May, 2009. Soria Moria parental leave in Iceland – history and ISTR Volume VII . Conference Working Paper Hotel. Oslo context. In Eydal and Gíslason (ed.). Equal Series – 9th International Conference, Istan- rights to earn and care – Parental leave in bul, Turkey. Juliusdottir S (2009 b). Félagsleg skilyrði Iceland. Reykjavik: Félagsvísindastofnun og lífsgæði. Rannsókn á högum einstæðra Háskóla Íslands. Hrafnsdóttir S (2006). The Icelandic voluntary forelda á Ásbrú/Keili í Reykjanesbæ. Rey- sector. Development of research. In Aila-Leena kjavík: RBF. Eydal G B and Rostgaard T (2010). Dag- Matthies (ed.) Nordic civic society organisa- pasningsordininger og tilskud tilpasning tions and the future of welfare services. A Lög um félagslega þjónustu (40/1994). af börn i hjemmet. Í Gíslason and Eydal model for Europe? pp. 194-211. TemaNord:517. (ed.) Föräldraledighet, omsorgspolitík och Copenhagen: Nordic Council of Ministers. NOSOSKO 2007-9. (2009). Social Protection jämställdhet i Norden. pp. 62–104. Copen- in the Nordic Countries 2007-2008. Scope, hagen: Thema-Nord 2010:595. Hrafnsdóttir S (2008). Frjáls félagasamtök expenditure and financing. Copenhagen: og sjálfboðaliðastörf á Ísland. Ómar H. Nordic Social Statistical Committee. Félags- og tryggingamálaráðuneytið Kristmundsson and Steinunn Hrafnsdóttir (2009). Skýrsla nefndar um stöðu barna í (ed.) Stjórnun og rekstur félagasamtaka, (pp. mismunandi fjölskyldugerðum. Reykjavík: 21-41). Reykjavík: Háskólaútgáfan Félags- og tryggingamálaráðuneytið. Hrafnsdóttir S & Karlsdóttir, E (2009). Com- munity work in Iceland in Hutchinson (ed.). Félags- og tryggingamálaráðuneytið Community work in the Nordic Countries – New (2009a). Greinargerð um grunnþjónustu Trends. Oslo: Universitetsforlaget. og aðferðir við hagræðingu í efnahag- sþrengingum Reykjavík: Félags- og tryg- Juliusdottir S & Sigurðardottir S (1997). Hvers gingamálaráðuneytið. vegna sjálfboðastörf? Reykjavik: Háskólaut- gáfan. Félags- og tryggingamálaráðuneytið (2010). Þjónusta sveitarfélaga við börn og Juliusdottir S (1999). Humanism – voluntarism barnafjölskyldur. Reykjavik: Höfundur. – professionalism. Om frivilligt arbete i Island.

39 Promotion of the well-being of parents and children

40 The Swedish strategy for developed Parents are important Parents are the most important peo- parental support and the family centre ple in every child’s life and are best placed to influence their children’s as an arena for the provision of munici- health. Whilst a good and trusting pal parental support services relationship between a child and his or her parents acts as a safety Johanna Ahnquist factor for a child, deficiencies in the home environment can also have a negative impact on the child. Inad- equate supervision, parents who In order to support the country’s parents, the Swedish government has have a positive attitude towards formulated a national strategy for developed parental support – A benefit norm-breaking behaviour and serious conflicts between children and for all (Nationell strategi för ett utvecklat föräldrastöd -En vinst för alla). their parents are known risk factors. The aim of the strategy is to promote local collaboration surrounding the Poor relationships within a family provision of support and assistance to parents in their parenting. The can for example increase the risk of mental ill-health as well as high-risk strategy places an emphasis on the family centre as an example of both a behaviour such as alcohol and drug form of collaboration and a health-promoting arena for parents and their abuse, smoking, obesity, etc. in chil- children. During 2010–2012, some 10 pilot projects are being carried out dren (Resnick et al, 1997; Rhoades, 2008; Stewart-Brown, 2008; Weich, in various locations across the country with the common aim of develop- Patterson, Shaw & Stewart-Brown, ing and evaluating municipal strategies for parental support in accordance 2009). with the national strategy. Some interesting development work is under- When children themselves are asked, they consider that the most way in many of these projects using the family centre as a starting point. important factor for feeling good is The aim of this article is to give an account of the Swedish strategy for to have parents who get involved, developed parental support and to present a number of specific examples i.e. who set aside time, who care about and who listen to their chil- of the way in which family centres can play a key role in building up new dren (Backett-Milburn, Cunningham- structures and forms of collaboration for parental support provision. Burley & Davis, 2003).

41 Support for parents to be at home with their children for strategy is therefore aimed at promot- The preamble to the Convention of around a year, good access to care, ing local collaboration concerning the the Rights of the Child states “Con- school and nursery provision, leisure provision of support and assistance vinced that the family, as the fun- activities, etc. to parents in their parenting. The damental group of society and the The health of Swedish children strategy is one of universal parental natural environment for the growth stands up well in a historical and support, i.e. all parents are offered and well-being of all its members international perspective. However, the same opportunities for support and particularly children, should be despite a well-developed safety net, and assistance. The strategy offers afforded the necessary protection and there are still a number of disturbing a definition of parental support and assistance so that it can fully assume trends. One of these trends is the one overarching objective and three its responsibilities within the com- increase in mental and psychoso- secondary objectives. munity” (Ministry of Foreign Affairs, matic disorders amongst adolescents The overarching objective of the 1990). A fundamental concept of that has become apparent in recent strategy is to offer parental support Swedish welfare policy has been to years (Danielson & National Institute to all parents until their child reaches offer parents good living conditions, of Public Health, 2006; National the age of 18. The Swedish national which are one of the preconditions Board of Health and Welfare, 2009). strategy for developed parental for good parenting. Sweden therefore Developing social support for par- support highlights the view that has a well-developed safety net that ents is therefore an important piece the support must build on existing provides families with fundamental of the jigsaw associated with revers- structures, promote collaboration and support and protection in the form of, ing this negative trend. provide the right circumstances to for example, child allowance, a par- enable parents to meet. ents’ allowance that enables parents The government’s initiative Parental support is defined in the concerning support for parents strategy as an activity that “teaches – “A benefit for all” parents about their child’s health, From a social perspective, it is vital emotional, cognitive and social devel- to provide parents with support and opment and/or strengthens the social assistance that strengthens them network of parents”. in their parental role and helps to reinforce the safety factors within Forms of parental support the family. In order to better enable There are many occasions during a Swedish parents to give their children child’s upbringing when support in a secure and good upbringing, the some form may be needed. The report Swedish government has established entitled “Föräldrastöd – en vinst för the “National Strategy for Parental alla. Nationell strategi för samhällets Support – a benefit for all” (Ministry stöd och hjälp till föräldrar i deras of Health and Social Affairs, 2009). föräldraskap” (Parental support – a The Swedish national strategy for benefit for all. National strategy for parental support forms part of the social support and assistance for par- government’s long-term initiative to ents in their parenting) (Föräldrastöd- promote health and prevent ill-health sutredningen, 2008), which forms the amongst children and adolescents. basis for the Swedish government’s The strategy is based around the view national strategy, states that there is that the responsibility for the child’s a void when it comes to support for best interests is a joint one and the parents. Studies have, for example,

42 shown that many Swedish parents places. The third and final means of In its review and overview of family say that they need support in their achieving the overarching objec- centres, the National Board of Health role as parents (Lagerberg, Magnus- tive is to ensure that the parental and Welfare stated that no evalua- son, & Sundelin, 2008) and that they support offered is based on science tions have been published concern- would be interested in becoming and tried and tested experience by ing the effects of family centres. The involved in various parental support increasing the number of parental reports and evaluations that do exist activities. This is particularly true of support players with training in are limited to processes and collabo- parents with young children (Brem- health-promoting methods and ration at family centres and the way in berg, 2004; Bremberg & Eriksson, universal evidence-based parental which staff and visitors perceive the 2008). support programmes. service (National Board of Health and The government’s strategy empha- The strategy also emphasises the Welfare, 2008). However, according sises that it is the parents themselves view that no one can do everything, to the National Board of Health and who are experts on their children and but each initiative is a piece of the Welfare’s overview, the reports and that it is therefore the needs of par- jigsaw which, when combined, can evaluations that examined what the ents and children that will determine form an entirety. visiting families thought of the family the content of the support that is centres showed great appreciation offered. According to the strategy, it The family centre – a well- amongst the parents. The children must also be voluntary to participate established health-promoting can meet and play with other chil- and take advantage of the opportuni- arena for parents dren, whilst the parents can interact ties that are available. The family centre (Familjecentralen) with other parents and combine visits If all needs are to be met, a broad is an example of both a form of co- to a number of services. The criticism range of types of support will be operation and a health-promoting that is put forward often concerns needed. In Swedish society today, arena for parents and their chil- many different players provide dren, a view that is given particular services which, if they were to be emphasis in both the report and the developed, could provide parents strategy. At family centres, the pro- with better help and support in their motion and prevention work relating parenting. One of the secondary to children aged 0-18 is coordinated objectives of the strategy is there- and co-located. There is no official fore to increase co-operation over interpretation of the term, hence parental support between players the meaning can vary. The centres whose services are aimed at parents. normally provide an open nursery, Examples of such organisations as well as maternal healthcare, are local authorities, county coun- children’s healthcare and social ser- cils, religious communities, parent vices. Many professional categories, associations, sports clubs and other such as midwives, nurses, nursery non-profit organisations and adult teachers, social workers, family advi- education associations. Another sors, recreational leaders, psycholo- means of achieving the overarching gists, etc., work together around the objective is to create the right condi- family with children. According to an tions to enable parents to meet and inventory drawn up in autumn 2007, exchange experiences and knowledge there were 131 family centres across by promoting a greater number of Sweden in 2007 (National Board of health-promoting arenas and meeting Health and Welfare, 2008).

43 short opening hours, an insufficient municipalities, will develop municipal in close co-operation with the family number of waiting rooms and a lack strategies for parental support. With- centres. of activities (National Board of Health in the framework of the project, many and Welfare, 2008). projects have been initiated to devel- Parental support partnership op municipal strategies for parental within the Umeå region – the Development of municipal support. The work carried out within Familjepeppen project strategies for parental support the framework of the project has “Familjepeppen” is a collaborative During the period 2010–2012, a primarily involved the development of project that is aimed at all parents number of government projects are structures for the local co-ordination with children aged 0–17 in the Umeå underway within the framework of of parental support bodies, partly region. The principal aim of the the national strategy with the aim of through the appointment of project project is to help ensure that children developing and evaluating municipal leaders/project coordinators, work on have a secure and good environment strategies for parental support in cross-sectorial co-operation, consti- in which to grow up. The starting accordance with the national strat- tuted steering groups, reviews, etc. point for the project is that all parents egy. Structures have also been built up need meeting places in order to have On behalf of the government, the for the dissemination of information, the opportunity to reflect on their National Institute of Public Health e.g. websites and the preparation of role as parents and to learn positive (FHI) has, for example, distributed information and training material. The approaches in order to handle future SEK 70 million in stimulation grants supply and demand of parental sup- conflicts in the best possible way. to a total of 10 principal municipali- port methods has also been reviewed Within the framework of the project, ties which, together with research- and among other things courses have a broad range of activities is there- ers and in co-operation with other been held for leaders within existing fore offered in the form of talks parental support methods. Most pro- and eight general parental sup- jects are also aimed at expanding the port programmes around the Umeå range of parental support activities region. The idea is that the range of by developing new forms of parental programmes and methods should support that can attract new groups be suitable for as many parents as of parents, e.g. single parents, young possible. A special website has also parents, parents with several children been developed where parents can and parents with an immigrant back- find easily accessible information on ground, who do not normally attend the parenting courses that are avail- parental support groups. able in their municipality within the Many of the projects are also aimed Umeå region. The parental support at developing the family centre into is offered to all parents in the region an important part of the municipal that have children under 18. family support services as well as a Co-operation with family centres meeting place and health-promoting is an important aspect of the project arena for parents and their children. and there is co-operation with all the Examples are given below of two family centres in the Umeå region, projects that have been allocated including the “family centre-like ser- funding within the framework of the vices” that are available. parental support initiative, where The project is being carried out in the work to develop the provision of close collaboration with research- parental support is being carried out ers from the Department of Clinical

44 Sciences at Umeå University, which own auspices or in collaboration with well as Linköping University (Tema is evaluating the results. No results an adult education association. All Barn), which is evaluating the results have yet been published. However, the staff at the family centres have of the project. The aim is to create experience from the project so far completed Stage 1 training in the a parental support network which indicates that the family centres have parental support method entitled reaches all parents. The network will acted as an enabler for both Familje- “Guiding interaction” (Vägledande work to raise awareness of children’s peppen and the parental support samspel). One person from each fam- circumstances amongst parents and work as a whole. This has resulted ily centre will also undergo Stage 2. professionals who work with children in the family centres becoming the This initiative is expected to result in and parental support. The guiding arena for the most comprehensive an improvement in the quality of the words for the project are: “universal, parental group services within the groups at MVCs (maternal healthcare complementary, long-term”. The pro- framework of the project. centres) and BVCs (childcare centres). ject involves activities that concern, It has also proven easier to attract It is also believed that the fact that among other things, parental support parents of children aged 0–4 to all staff at the family centres have at school parents’ evenings, parental participate in parental groups via the undergone training will also result support in connection with SFI (Swed- family centres. It is believed that this in greater uniformity in interaction ish For Immigrants), parent forums (a is primarily because parents trust in and the views concerning children at shorter alternative to traditional par- the staff at the family centres and the the family centres. Follow-up of staff enting courses), a network for COPE parents listen to what they recom- who completed the course this spring leaders and group leader training. mend. The reason why the family cen- shows that they have found that they Within the framework of the pro- tres have succeeded in recruiting the now have a common language and ject, the family centres are an impor- parents of young children in particu- common values as a basis for talking tant arena for developing the work lar is believed to partly be because about children and parenthood. These relating to coherent parent groups. new parents are more open to new issues have been put on the agenda Activities that directly involve family networks and information concerning through the “Guiding interaction” centres are aimed at creating a coun- their children than parents who have course. tywide network for family centres as a few years of parenthood behind well as greater cultural expertise at them. They have finished the groups Interacting parental support family centres (“bridge-builders”). at the BVCs (the childcare centres) – a network for research and Within the sub-project “Countywide and many people find that they still development in Östergötland network for family centres” (Länsnät- have a need to meet up with other Linköping, together with nine verk för familjecentraler), a network parents in order to discuss issues. other municipalities in the county is being established for the county’s Younger children are also involved in of Östergötland, are collaborating family centre staff as well as other fewer activities, which provides scope on the project entitled “Interacting staff who carry out similar work, i.e. for the parents of young children to parental support – a network for maternal healthcare nurses, chil- participate in groups. research and development” (Sam- dren’s healthcare nurses, education- Another experience from the verkande föräldrastöd – nätverk för alists and social workers. The family project is that the family centres forskning och utveckling), which has centre network is a forum where staff themselves have been given a boost the aim of creating a network for can meet and share good ideas and by the project in terms of their work those in the county who are involved challenges that they face in their introducing and running parental sup- in the provision of parental sup- (fairly special) profession. There are port groups. Today, six out of a total port: municipal authorities, county regular meetings (once a term) with of eight family centres run parental councils, non-profit associations various relevant themes and talks support groups, either under their and adult education associations, as and with relevant research. The aim is

45 to provide an opportunity for discus- evaluated by Tema Barn at Linköping. their arguments on the concepts: pro- sion and the exchange of experience University, which is also evaluating fessional, personal and private. Some between the county’s family centres other sub-projects. parents are identified as being in and thereby promote method devel- Researchers from Tema Barn at need of more support from the staff in opment and interaction. Linköping University are also carry- the network-building work than oth- The aim of the sub-project “bridge- ing out a qualitative research study ers. As an individual member of staff, builders” is to increase the linguistic of family centres with the aim of it is about observing and supporting, and cultural expertise available at describing and analysing the experi- sitting next to people with a cup of family centres in multicultural areas ences of staff and parents concerning coffee and trying to involve people using “bridge-builders”, who can various types of initiatives at the in conversation. One member of staff act as a cultural and linguistic link family centres. The research study said something along the lines of: between parents and profession- is being conducted at three family “no one should have to go home and als. The project utilises staff within centres in three municipalities in feel that there was no one for them municipal authorities and county areas with different characteristics. to talk to today.” Another theme is councils who have a mother tongue Interviews with staff members have the relationship between the differ- other than Swedish and who possess been concluded and interviews of ent areas of expertise. In relation to cultural expertise that is important parents are currently underway. The parents, social services are the least in order to inform people of and results so far indicate that externally clear area of expertise. People who promote parental support initiatives. the family centres differ through the work within social services approach An example of such a staff category differing characteristics of the areas, their work in slightly different ways. is mother tongue instructors/teach- the length of time that the family One approach is to become a “name” ers, who normally possess cultural centre has been in existence, actual rather than a professional role, even expertise in two cultures. Another co-location or “visiting”, the layout though you are working as a profes- example is teaching assistants. The of the rooms and premises, opening sional of course. The research study bridge-builders work to motivate hours and accessibility, the degree will be concluded and the results pub- people with an immigrant background of structure in activities (“we decide lished during the latter part of 2012. into visiting the family centre and what to do as we go along” or “at 10 taking part in the family programmes o’clock, we sing songs”) and the way that are offered. The demand arose in which the staff relate to targeted when staff at the family centres said groups. The similarities between the that they did not feel they were able family centres are also striking. There to communicate with all visitors is pride in the initiative amongst the because of language barriers and staff and a belief that the family cen- that they were therefore unable to tres are appreciated by the parents. offer the same support and provide The analyses present certain themes, the same information to all visitors. e.g. the family centre as a meeting The “bridge-builders” concept has place and the network-building that is previously been successfully devel- being carried out, something that is oped at the family centre at Skägge- considered to be the main task of the torp in Linköping Experience to date family centre. It is also clear that the indicates that the “bridge-builders” staff place an emphasis on a profes- initiative has been a success and sional approach – it is important for achieves its purpose in the areas con- the staff not to be “a close friend”. cerned. The method is currently being Many members of staff have based

46 References

Backett-Milburn K, Cunningham-Burley föräldrar i deras föräldraskap : betänkande. National Board of Health and Welfare S & Davis J (2003) Contrasting lives, con- SOU 2008:131, Stockholm: Fritze. (2009). Folkhälsorapport 2009. Stockholm: trasting views? Understandings of health National Board of Health and Welfare. inequalities from children in differing Lagerberg D, Magnusson M & Sundelin C social circumstances. Soc Sci Med, 57(4), (2008). Barnhälsovård i förändring: resultat av Stewart-Brown S (2008). Improving parent- 613-623. ett interventionsförsök (1st edition). Stockholm: ing: the why and the how. Arch Dis Child, Gothia. 93(2), 102-104. Bremberg S (2004) Nya verktyg för föräl- drar: förslag till nya former av föräldrastöd. Resnick M D, Bearman P S, Blum R W, Bauman Ministry of Foreign Affairs (1990). Konven- Stockholm: Swedish National Institute of K E, Harris K M, Jones J et al (1997). Protect- tionen om barnets rättigheter: Convention Public Health. ing adolescents from harm. Findings from the on the Rights of the Child. [Stockholm]: National Longitudinal Study on Adolescent [Ministry of Foreign Affairs]. Bremberg S & Eriksson L (2008) Kartläggn- Health. JAMA, 278(10), 823-832. ing av föräldrars erfarenhet och intresse av Weich, S, Patterson J, Shaw R & Stewart- föräldrastöd. Swedish National Institute of Rhoades K A (2008) Children’s responses to Brown S (2009). Family relationships Public Health. interparental conflict: a meta-analysis of their in childhood and common psychiatric associations with child adjustment. Child Dev, disorders in later life: systematic review of Danielson M & Swedish National Institute 79(6), 1942-1956. prospective studies. Br J Psychiatry, 194(5), of Public Health (2006). Svenska skolbarns 392-398. hälsovanor 2005/06 grundrapport. Stock- Ministry of Health and Social Affairs (2009). holm: Swedish National Institute of Public Nationell strategi för ett utvecklat föräldrastöd: Health. en vinst för alla. Stockholm: Ministry of Health and Social Affairs. Föräldrastödsutredningen (2008). Föräldrastöd – en vinst för alla: nationell National Board of Health and Welfare (2008). strategi för samhällets stöd och hjälp till Familjecentraler: kartläggning och kunskapsö- versikt. Stockholm: National Board of Health and Welfare: Institute for the development of methods in social work.

47 The importance of social support and has been studying the links between an insecure upbringing and mental and reflective functioning for parenthood physical ill-health as an adult. They found strong links with both subsequent Mirjam Kalland misuse and mental ill-health and our most commonly occurring widespread diseases such as cardio-vascular disease (see for example Felliti et al, 1998). A Finnish study also demonstrated that Family centre provision is based on the basic idea that the best thing the most important psychosocial factor we can do to support public health as a whole in the long term is to for contracting cardio-vascular disease work for a secure childhood. This basic idea is underpinned by exten- later in life was the emotional distance between the mother and her child and a sive research into how our childhood circumstances, starting during lack of support and appreciation (Kelti- pregnancy, influence our physical and mental health later in life. kangas-Järvinen, 2001). More recently, the significance of stress during childhood as regards the brain’s development, the immunological system as a whole and the link between traumatic In Finland, most of our children and which divorce affects children has events during childhood and depression families are happy and healthy. long been debated, but a comprehen- has also been highlighted. In sum- However, there is a growing pro- sive study published in The Lancet mary, it can be said that stress during portion of children who are at risk. in 2003 shows that children who live childhood can result in a reduction in The proportion of children living in with single parents run a greater risk the volume of the brain, adversely affect families with low incomes or below of suffering mental illness than other the child’s ability to learn, increase the the poverty threshold has risen from children. The study covered 65,085 risk of diseases relating to the immu- less than 5% to 13% over the past children with single parents (primarily nological system and affect the child’s 15 years. We have received reports single mothers) and compared their capacity to handle stress in the future of increasing alcohol abuse at a development with that of 921,257 (Middlebrooks & Audage, 2008). level which poses a risk in families children from families with two par- In turn, epigenetic research has with young children (Halme, 2008), ents (Ringbäck et al, 2003). begun to explore the way in which trau- and we are seeing a steady rise The care that children receive dur- matic events experienced by parents in the number of children who are ing their early years has far-reaching can leave their mark on their children’s covered by the child welfare open consequences for their develop- genetic make-up and thus affect the care system (5.4%) or who are ment and factors such as abuse and characteristics of future generations. growing up outside the home (1.2%, domestic violence pose a serious Traumatic experiences do not affect equivalent to over 16,000 children). risk for subsequent marginalisation DNA, but they do affect the way in which Children are also increasingly being and drop-out from society (Kalland et DNA is read. A group of methyls which affected by their parents divorcing. al. 2001; Kalland et al, 2006). If the can be connected to or disconnected Divorce has consequences for the mother experiences stress during her from the genes seems to be of decisive health and life expectancy of adults pregnancy, this will have an adverse importance. The important factor in this (it increases both mortality and effect on the unborn child (Mulder et context is that the interaction between morbidity amongst both genders, al, 2002). During the past decade, inheritance and the environment is (Köhler et al, 1986)). The way in a group of researchers in the USA more complicated than was previ-

48 ously believed, and this points to In Aaron Antonovsky’s theory on tion” about how they should act the importance for future health of a Sense of Coherence, the individual’s (Antonovsky, 1979). An example of secure environment in which to grow perception of life as meaningful, com- such an environment is a home where up (Franklin et al, 2010; Yehuda R & prehensible and manageable is high- the parents have an addiction or suf- Bierer L, 2009). lighted as fundamental. Antonovsky fer from mental problems, with the assumes that this perception of the result that they are neither physically Parenthood, a sense of world arises at an early age, when the nor mentally available to meet their coherence and the importance infant experiences emotionally and child’s needs in a predictable way of social support cognitively correct responses to his or and the parents’ actions are dictated When people become parents, their her needs. He refers to examples from by their own mental condition rather identity undergoes a change, as they Seligman, who assumes that learned than the child’s needs. have to make room in their inner helplessness has its origins in However, Antonovsky notes that self not just for the child, but also to experiences of a lack of synchronicity the sense of coherence is not about become a mother or father to their between response and outcome or, having absolute internal control. If child. This change is fundamental seen from the child’s perspective, a one wants to experience absolute and irreversible – Daniel Stern has lack of synchronicity between activity control, it is a question of an inner described it as a gate which you pass and response. If the child finds that rigidity, where the tolerance of uncer- through and which then closes behind nothing it does makes any difference, tainty is low and the capacity for flex- you. However, becoming a parent is it will decide that it is unable to influ- ibility prior to changes can be limited. not just a psychological change; it ence its surroundings and give up. If the need for control is too strong, it must also be anchored in a cultural Children grow up in an environment can lead to a spasmodic orientation and sociological context. with “a lot of noise, but no informa- towards the outside world, where the existence of the uncontrollable is not tolerated. At the same time, he also points out that his theory has a One must therefore ask oneself: what does parent- sociological anchoring and that what hood mean in the post-modern society? In simpli- defines stress factors and the way in which they are handled is anchored in fied terms, it can be said that well-being in post-modern macrocultural and cultural contexts. society could mean a perception that anything is possible, Compared with post-modern soci- on-line, at any time. The sense of freedom and infinite ety, people in industrial and agrarian society were tied to their workplace possibilities can be total amongst young, well-educated or home in a different way than is and resourceful parents-to-be. However, the child can the case today. The days and weeks be described as anti post-modern, as the child demands revolved around routines. One can imagine that the transition to parent- continuity, stability and recurring routines. It could even be hood was a lower stress factor than it said that post-modern life ends with the birth of the child. is in today’s society. On the contrary, This can have consequences for the parents which can be being tied to the home because of a child could give life more meaning, perceived as both positive and negative. whilst today it can be seen as an interruption in the lifestyle that one has grown accustomed to leading.

49 It can therefore be assumed that are single at the time of the birth of groups, particularly for couples who the sense of coherence can be very their child show significantly more are expecting their first child. The stable in a stable life situation, but it parental stress than mothers who advantage of a universal approach is can also be disturbed when that life have a partner (Copeland & Harbaug, that one can reach parents in the risk situation changes. A number of stud- 2005). Research furthermore shows zone who have not yet been identified ies have shown that Antonovsky’s that social support has a damping and who would not seek out a service original assumption, that the sense effect on parental stress – more where they risk being categorised. of coherence (as expressed with the support means less stress. Finally, One can also reach parents with a aid of the formula) should express a recent research indicates a link suboptimal parenting capacity who lasting feeling that is independent between type 1 diabetes in infants would never become involved in tar- of the life situation one finds one- and parental stress (Sepa, 2005), geted or indicated programmes, but self in, cannot be verified (Eriksson indicating that the stress that parents who would still benefit greatly from & Lindström, 2006). The question experience can affect the health of support. Stress research also shows then arises as to whether the sense the whole family. that social support is of fundamental of coherence is something that is The link between inadequate social importance for all parents, regardless re-established more quickly in some networks and parental stress is a of their initial circumstances, and for individuals after a life crisis than in factor worth noting, as an increasing the health of the family as a whole. others, and what significance it has number of parents have moved from As virtually all parents in Finland as regards well-being and health. the environment in which they grew (99%) visit a mother and child advisor When life takes a new direction up in order to study or find work and within the public healthcare system, and new demands are placed on the therefore have no natural network. there is enormous potential here for individual, the general level of stress preventive work which is only partly will often increase. It is natural to The importance of parent being exploited. There is also a need take one’s new tasks as a parent groups to further develop the universal seriously and this often also leads Long-term research indicates that service and the service aimed at to feelings of inadequacy. Some early home visit-based support, particularly vulnerable groups. One parents experience a strong sense preferably during the first pregnancy, popular form of support has been that they do not have the resources has beneficial effects on the well- the open nurseries and family cafés, that are needed for parenthood. This being and development of children as well as other open groups. Most feeling is called “parental stress” and families, and is also economically studies show that these services (Östberg, 1999). It is worth noting profitable (Olds, 2002). Of particular are appreciated by parents and that that everyday worries and concerns, importance is home-based support the parents themselves believe that such as food and sleeping problems, for parents in the risk zone. In recent they have enabled them to make often seem to weigh down parents decades, interest in group-based new friends and reduced their need more than major, life-defining events support for parenting has increased. to seek professional help. It is often (Crnic & Grenberg, 1990; Krech & Parent groups can be set up as believed that parent groups can reach Johnston, 1992). A number of stud- universal, targeted (e.g. for single resourceful parents more easily, but ies show that mothers who have no parents) or indicated support (the this view is not supported by the social support become significantly risk has already been identified). Finnish study that is presented by more stressed over their parenthood Groups can also be open or closed. Kalliomaa (see page 80–85 of this (Sepa et al, 2004) and that stress There is evidence to suggest that publication). On the other hand, it and depression are strongly linked indicated group-based support is can be difficult to compare different (Milgrom & MacCloud, 1996). It has cost-effective. However, there are countries with each other, as open also been shown that mothers who also strong arguments for universal parent groups in Finland are primarily

50 organised within the third sector • the effect becomes clearer, the sonal. During the past decade, a (non-governmental organisations), younger the child group of researchers from London whilst closed (and often targeted) • the best effect is achieved when and Yale has created a theory con- groups are also organised within the child is younger than 6 months cerning the way in which this reflec- the primary healthcare sector, • the effect becomes markedly tive functioning affects our ability to under the child welfare service and weaker if the group meets more form relationships with other people within the framework of the fam- than 16 times, i.e. relatively short (Fonagy et al, 2002). According to ily advice service. However, both and focused initiatives seem to Peter Fonagy, reflective functioning reports and practical experience work best protects the individual’s develop- indicate that a special effort should ment, as it gives us the opportunity be made to include parents with an The report also states that open to understand and predict the feel- immigrant background. groups (at family centres/family ings and actions of other individuals. Few ambitious comparative cafés/open nurseries) are difficult to With the aid of this reflective func- studies have been carried out evaluate, but they are appreciated by tion, we create a “theory of mind”, a into the effects of open universal parents. Parents are generally very consciousness theory. An individual parent groups, and those that do satisfied, but many would like to see with a high reflective functioning can exist do not give strong support a clearer structure. It can also be dif- thus distinguish between internal to the view that they have any ficult to include fathers and parents and external reality, separate his demonstrable effect. Carrying out with an immigrant background. or her own feelings and needs from research in this form is problem- More theoretically anchored inter- those of others, and understand his atic, as both the activity and the ventions and ambitious experimen- or her own feelings and needs in dif- intensity of participation can vary tal research are needed in order to ferent ways (Fonagy, 1996). greatly. However, there is evidence improve our knowledge within this According to Peter Fonagy, the to suggest that closed and struc- area. individual’s reflective functioning tured groups can have a positive can also represent a modifying fac- effect (Thomas & Zimmer-Gembeck, Mentalising capacity and tor between one’s early experiences 2008). One study (Cox & Docherty, reflective functioning in and the way in which one practises 2008) shows that perceived health parenthood parenting. Of particular importance is improved amongst parents who An individual’s reflective functioning is the observation that individuals received group support after the concerns the (metacognitive) capac- with difficult experiences but a high birth of their first child, but more ity to think about how one thinks reflective level have the capacity to studies are needed in order to show and feels, and the links between create secure relationships with their the possible long-term effects. these inner thoughts and feelings own children. Fonagy’s colleagues, An excellent summary of what we and how one acts. The basis for Professor Linda C. Mayes and Dr know about structured groups was this process is mentalising capac- Arietta Slade, of Yale University and prepared by the Swedish National ity, which in turn embraces a sort of City College of New York, have devel- Institute of Public Health (Brem- obvious basic assumption that peo- oped a research tool and interven- berg, 2004), but our knowledge in ple have an actively processing mind tion models based on these theories this area needs to be updated. The or consciousness. The mentalising which are applicable to both the report states that structured group- process is initiated when an individ- normative population and to parents based support (closed groups) ual attempts to understand how he in various high risk situations. has positive effects on the mental himself or someone else thinks and In parenthood, reflective function- health and attachment of children, feels, and the reflective functioning ing is particularly important. This and that: is characterised by being interper- capacity is both commonplace and

51 A parent with a high important to observe one’s child and information for other forms of support its reactions, to consider and wonder, which are available and which may reflective functioning can to take an interest in the feelings and be needed, e.g. family advice, family observe, receive and process needs of one’s child and to see one’s work, etc. In Finland, the Parents their child’s feelings and needs child at all times as a unique person First groups (Föräldraskapet Främst with a unique way of perceiving the in Swedish and Vahvuutta vanhem- without being affected by anxi- outside world and a unique way of muuteen in Finnish) are intended for ety or frustration. The child is expressing their feelings and needs. both parents who come to the group seen as a separate individual Relatively little empirical research together with their child. After the has so far been carried out concern- conclusion of a parent group, the par- and the parent is able to link the ing this capacity, but research into ents can hire parent cafés and other child’s feelings to the child’s parenting in high risk situations services linked to family centres or behaviour. shows that it is possible to influence non-governmental organisations. the reflective functioning of parents Folkhälsans förbund has adapted in interventions and that this is linked and developed the manual for to their capacity for parenthood Parents First groups through four (Schechter et al, 2002 and 2003; pilot groups: two in Helsinki (one Slade et al, 2005; Pajulo & Kalland, organised by Folkhälsan and another sophisticated: a mother who realises 2006). organised by the City of Helsinki), that her baby is crying because he is The Parents First programme is the one in Uusimaa (Nyland) and one hungry needs to have the capacity to first support service for parenthood in Ostrobothnia (Österbotten). The respond to both the child’s physi- to be explicitly developed to support manual was completed in January cal needs and the child’s emotional the reflective function in parent- 2010 and has been translated into needs for affection and security – hood (Goyette-Ewing et al, 2002). Finnish. From 2010 onwards, the only meeting the physical needs of The parent groups are organised Mannerheim League for Child Welfare the child is not enough to ensure the into 12-week periods and have been has, in collaboration with Folkhäl- development of the child. The mother developed and tested by Yale Child san, developed the method further then understands that the child is Study Center, Yale University, New and intends to implement the model crying in order to express both a need Haven. The aim of the groups is to across the entire country in collabora- and a feeling, and she understands meet other parents to consider what tion with the municipal authorities. (intuitively) that the way in which feelings and needs (newborn) infants Parents who are expecting their first she responds to the child’s needs express through their behaviour. The child are recruited to the groups by will affect the child. If she is irritated groups do not focus on strategies or the antenatal groups and are given and heavy-handed or indifferent and solutions, but on giving meaning and the chance to continue attending mechanical when she feeds the child, significance to the infant’s or child’s meetings after the birth when the this will have an adverse effect on the signals. The Parents First groups child is around four months old. The child, but if she is calm and playful, therefore offer a forum for parents project is linked to research accord- she will affect the child in a favour- to discuss parenting and family life, ing to a “case-control design” with able way. to understand their child better and follow-up until the child reaches the Reflective functioning in parent- support their development, and to age of two. The principal research hood is therefore less about having work for changes in family life where issue is whether it is possible, via ability and knowledge, and more necessary. They also act as a source these theoretically anchored, closed about being open and receptive to of social support for parents. The and structured groups intended for the child’s signals. As parents, it is parent groups are also a source of both parents together with their

52 child, to improve family health and learn together. This process cannot to bounce back after experiencing the marital relationship after the birth be learned through an “ABC book hardship, about picking yourself up of the child. with tricks and tips”, but the parents and dusting yourself off, and so on. have natural preconditions which can In international literature, resilience Why support reflectivity in be supported in a respectful manner is defined as an individual’s positive parenthood? by exploring the reality together. development in spite of the presence The National Institute of Public Through the groups, parents also of harmful factors during their child- Health’s report states that all involve- discover the value of not knowing hood. Harmful factors are defined as ment in parenthood is a sensitive and of not being able – as opportuni- factors that have statistically been issue, as it can violate the family’s ties for discovery arise when uncer- shown to be linked to an increased right to self-determination. On the tainty is endured. By not knowing risk of physical, mental and social other hand, here in Finland we have too much and giving good advice, problems, such as a childhood envi- perhaps been unnecessarily sensi- one also paves the way for parents to ronment characterised by violence, tive towards the right of the family to learn about their child themselves. abuse or poverty. Positive develop- independence and individual solu- This reinforces the parents’ self- ment, on the other hand, is about tions. One could even claim that we confidence and increases the positive coping with the task of developing have developed a “non-intervention experience of being a good parent. which the development stage presup- ethic”, where in the worst case Reflectivity is shielding, as through poses without any major difficulties. scenario we sacrifice the well-being the development of our reflectivity we Research into resilience is consid- and health of the child and family in can protect our child from any harm ered to have potential for finding the name of humanism and respect. or traumatic experiences that we opportunities for the prevention of As a result of this initial exaggerated might have been through ourselves. diseases and for promoting individual respect, we can be forced to intervene Reflectivity is also liberating, as it competence and adaptation in spite more dramatically later, e.g. by taking helps us to understand that there of perceived difficulties, and could custody of the child. are various ways of being here in the therefore form the basis for a social, However, it is also clear that what world. Reflectivity releases us from health and education policy that can we offer parents on a universal basis the shackles of childhood and helps support human resources in the best should be voluntary, and that what us to distinguish between the way in possible way and reduce the “ero- we do should be based on tried and which we have been treated and who sion” of aptitude and potential that is tested evidence that we really can we are (“he was unloving, but I am brought about by mental illness and support the well-being of families and not unlovable”). Reflective think- marginalisation (Luthar & Cicchetti, children in this way. There is also a ing is also dynamic: nothing is ever 2000). risk that parents will become lost in finally achieved; we have our whole It was originally believed that there a jungle of contradictory advice and life ahead of us at every stage of our were, or could be, a number of special that their parenting could actually lives. The dynamic aspect is also protective factors that contribute to be adversely affected by increasing restorative by nature – we can return resilience which are of importance confusion. The theoretical starting to what was wrong, we can repair for those who are not vulnerable. point for parent groups based on damaged relationships and we can Today, we work more to a cumulative reinforcing the reflective functioning give and receive new chances. or compensatory model. The cumula- of parents is based on the simple Finally, I would go so far as to claim tive model is based on the assump- assumption that meeting the emo- that supporting reflectivity increases tion that the more supporting factors tional needs of the infant/child is a the resilience of individuals and an individual has, the less risk there unique process which each individual families. Resilience is about a sort of will be of problems in the future. The parent and each individual child must mental elasticity, about being able compensatory model is based on

53 the assumption that the factors that support children in general References (such as good self-esteem, good Antonovsky A (1979) Health, stress and coping. Fonagy P & Target M (1996) Playing with reality: relationships with parents, good Jossey Bass. San Fransisco. Theory of mind and the normal development of relationships with friends) also psychic reality. International Journal of Psycho- Bremberg S ed. ( 2004) Nya verktyg för föräl- Analysis, 77. 217-233. support children with regard to drar – förslag till nya reformer av föräldrastöd. risk factors in their surroundings Swedish National Institute of Public Health. Fonagy P, Gergely G, Jurist E L, Target M (2002) (Fergusson & Horwood, 2003), Stockholm. Affect Regulation, Mentalization and the Develop- ment of the Self. Other Press. New York. and that we can support the Brockington I (1996) A portfolio of postpartum health of individual children and disorders. In “Motherhood and mental illness”, Franklin TB, Russig H, Weiss IC, Gräff J, Linder N, families with very ordinary things, pp. 134–198. Oxford University Press Inc., New Michalon A, Vizi S, Mansuy IM (2010) Epigenetic York. with the “magic of the ordinary”. transmission of the impact of early stress across generations. Biol Psychiatry 2010 Sep 1; 68:408. This approach can be reflected Cox J L, Holden J M & Sagovsky R (1987) Detec- against the fact that what weighs tion of postnatal depression. Development of Goyette-Ewing M, Slade A, Knoebber K, Gilliam the 10-item Edinburgh Postnatal Depression down parents more than anything W, Truman S & Mayes L (2002) Parents first: a Scale. Br J Psychiatry 150, 782-786. developmental parenting program. Manual. Yale else are these very everyday Child Study Center. concerns. Cox P & Docherty K (2008) Assessing the impact of a first-time parenting group. Nursing Times; Perhaps this is precisely the Halme N (2009) Isän ja leikki-ikäisen lapsen 104: 21, 32-33. yhdessäolo. Yhdessäoloa, isänä toimimiseen liit- magic of the family centres, the tyvä stressi ja isän tyytyväisyyttä parisuhteessa family cafés and other open meet- Copeland D & Harbaug BL (2005) Differences in kuvaavan rakenneyhtälömallin kehittäminen ja Parenting Stress between Married and Single ing places? That we support very arviointi. Akateeminen väitöskirja. Tampereen First Time Mothers at Six to Eight Weeks After yliopisto. ordinary families with ordinary Birth. Issues in Comprehensive Pediatric Nurs- problems in a way that is down- ing Vol. 28, No. 3, Pages 139-152. Kalland M, Pensola T, Meriläinen J, Sinkkonen to-earth and mundane? And that J (2001) Mortality in children registered in the Crnic KA & Greenberg MT (1990) Minor parent- Finnish child welfare registry: population based all this is so mundane that it even ing stress with young children. Child Develop- study. BMJ no 7306, pp 207–208. evades strictly scientific investiga- ment 61, 1628-1637. tion, so that we just have to trust Kalland M, Sinkkonen J, Gissler M, Meriläinen J, Eriksson M & Lindström B (2005) Validity of Siimes MA (2006) Maternal smoking behavior, the mundane words of ordinary Antonovsky’s sense of coherence scale: a background and neonatal health in Finnish chil- families – they make me feel systematic review. Journal of Epidemiology and dren subsequently placed in foster care. s, Child Community Health 59: 460-466. better, they help me get through Abuse & Neglect 2006. the day and I now have some new Felliti Vj, Anda RF, Nordenberg D, Williamson Keltikangas-Järvinen L (2001) Sydän ja verisuo- friends? DF, Spitz AM, Edwards V, Koss MP et al (1998) nitautien psykososiaaliset riskitekijät lapsilla. The relationship of adult health status to Duodecim 117(13):1389-94. childhood abuse and household dysfunction. American Journal of Preventive Medicine 14: Krech KH & Johnston C (1992) The relationship 245-258. of depressed mood and life stress to maternal perceptions of child behavior. Journal of Clinical Fergusson, DM, & Horwood, LJ (2003) Resil- Child Psychology 21, 115-122. ience to childhood adversity. In S. Luthar (ed) Resilience and vulnerability (pp. 130–155). Köhler L, Lindström B, Barnard K, Itani H (1986) Cambridge University Press. Cambridge. Health implication of family breakdown. Families with children in divorce. NHV report 1986:3. Fonagy P (1996) The significance of the development of metacognitive control over mental Lundahl B, Risser HJ, Lovejoy MC. 2006 A meta- representations in parenting and infant devel- analysis of parent training: moderators and opment. J Clin Psychoanalysis 1996;5:67-86. follow-up effects. Clin Psychol Rev 26 (1): 86-104.

54 Luthar S & Cicchetti D (2000) The construct of Schechter D S, Kaminer T, Grienenberger J F, & Stewart-Brown S (1998) Public health impli- resilience: Implications for interventions and Amat J (2003) Fits and starts: a mother-infant cations of childhood behaviour problems social policies. Development and Psychopathol- case-study involving intergenerational violent and parenting programmes. In: Parenting, ogy 12, 857-885. trauma and pseudoseizures across three gen- Schooling & Children’s Behaviour: Interdisci- erations. Infant Mental Health Journal, 24(5), plinary approaches. Middlebrooks JS, Audage NC. (2008) The Effects 510-528. of Childhood Stress on Health Across the Buchanan A, Hudson BL, editor. Ashgate Lifespan. National Center for Injury Prevention Schechter D S, Zeanah C & Myers M M (2002) Publishing. Aldershot. and Control. Negative and distorted maternal attributions among violence-exposed mothers of very young Spoth RL, Kavangh KA, Dishion TJ. (2002) Milgrom J & McCloud PI (1996) Parenting Stress children before and after single-session feed- Family Centred Preventive Intervention Sci- and Postnatal Depression: Stress Medicine, 12, back: are maternal psychopathology and reflec- ence: toward benefits to larger populations (3), 177-186. tive functioning predictive? Paper presented at of children, youth and families. Prevention the meetings of the World Association of Infant Science 2002;3: 145-152. Mulder JH, Robles de Medina PG, Huizink AC, Mental Health, Amsterdam, The Netherlands. Van der Bergh BRH, Buitelaar, JK, Visser GHA Yehuda R & Bierer L (2009) The Relevance (2002) Prenatal maternal stress: effect on Slade A (2005) Parental Reflective Function- of Epigenetics to PTSD: Implications for the pregnancy and the (unborn) child. Early Human ing: An introduction. Attachment and Human DSM-V. Journal of Trauma and Stress 22 (5), Development 70 3-14. development, 7, 269-281. 427-434.

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55 Child’s right to an upbringing – Family centre as a promoter of a rearing culture which respects the child

Maria Kaisa Aula

This article examines upbringing from the point of view of Finnish chil- “Because they have always been dren. What constitutes a good upbringing from a child’s perspective? around, asking me about things” How can family services promote an upbringing culture which respects (secondary school pupil). the child? The information used in this text has been collected from Finnish school children, but the same questions are topical throughout In addition to parents, important child rearers often include grandparents, the Nordic Countries. The UN Convention on the Rights of the Child who are associated with providing a emphasises the mother’s and the father’s primary and shared respon- role model and experience of life. sibility for a child’s upbringing. A child has the right to parental care, nurture and guidance. Public services should support parents, acting “Let’s also mention my late as educational partners both at schools and in daycare. At its best, grandma, because she was always a family centre can promote a culture in child-rearing which respects encouraging, tolerant and proud of children, helping the parents to recognise their value as guardians. each of her children and grandchil- dren” (secondary school pupil)

Other relatives are also considered For children, the most important and separately, were mentioned important to upbringing. As close upbringing is provided by most often when, in the spring of family members, siblings, espe- parents 2010, the office of the Ombudsman cially older sisters and brothers, are Based on children’s own opinions, for Children in Finland asked over mentioned as child-rearers. Persons it is clear who the most important two hundred school children about named from outside the family include childrearer is. One of the principles of the most important person involved godparents in particular, as well as family centre activities is to support in their upbringing (Nivala 2010). aunts and uncles in general. Children parenthood and, by doing so, increase The position of parents was justi- also name “professional child-rearers” children’s well-being. The parents, i.e. fied by their closeness, care and such as teachers and hobby instruc- the mother and father, both together support: tors as important childrearers, but

56 their status is not as clear as that of those bringing them up to demon- advice and guidance on the important parents. Hobby instructors become strate suitable, situation-specific matters in life. He or she does not important childrearers if they support flexibility. concentrate solely on a single aspect the child in ways other than teaching A good child-rearer is non- of the child, but views the child or the hobby. violent, while offering affection and adolescent as a whole. A good child- Children see upbringing as an tenderness. Children and adoles- rearer also grows with the task, not important activity which affects them. cents also wish that those bringing treating an adolescent like a child. It partly overlaps with teaching, but them up show patience and listen is not entirely the same. Upbringing and encourage more, rather than Shared time, good food and includes teaching, but also something shouting. Violence does not make harmony more. Support, help, care, teaching to for a more effective, but a more Upbringing cannot be distance work. distinguish right from wrong, listen- damaging, upbringing. It is living and being together. In ing, understanding, caring, spending surveys conducted by the office of time together and being present are “Some people believe that a the Ombudsman for Children, school components of this. children wished for a greater adult child learns through punish- presence in their lives and for less “It’s like teaching, but you also ment, but that’s not true. He loneliness. In addition, they wished or she only feels terrible or for more harmony and fewer quarrels. take care of the child you’re bring- A tense atmosphere and tetchiness ing up” (girl, 10 years) becomes angry with the parent.” in the home are often connected to (primary school pupil)”More hurry and stress. (Tuononen 2008) “Upbringing is supporting some- affection, no bossing around, one, teaching them the difference etc.” (primary school pupil) “(I’d like to persuade) Mum and between right and wrong, spend- Dad to stop arguing, but I’ve ing time together with that person, “The ability to listen, and not noticed that it’s no use trying (pri- etc (girl, 12 years) being pointlessly judgemental” mary school pupil) (secondary school pupil) A good child-rearer is present, cares Common mealtimes are the kind of and wants to listen to and understand Children want their child-rearers shared family time which Finnish today’s children and adolescents. He and parents to be actively at their families seem to lack: according to or she is also interested in the child disposal. This includes caring, ask- surveys, in Finland, children and as an individual and wants to get to ing questions and offering support, parents eat together less frequently know him or her better. even when the child does not ask than in other European countries. The for these things: meaning of good food and mealtimes “He always helps me and takes to children’s experience of care at “That they take care of the child home should not be underestimated. an interest in my life” (secondary Not all children are beset by par- school pupil). and ask how the child is really ents who lack time, or by loneliness. doing” (secondary school pupil) Naturally, most children have a lot of A good child-rearer is encouraging good and positive things to say about and can be trusted. Limits are impor- A good child-rearer is useful in a their families. tant for children, but they also want concrete way, being able to give

57 “I’m safe, I have food, a loving parents] were rich and unemployed” provide their children with a positive family and a roof over my head,” (boy, 12 years). upbringing and to set limits. They From children’s point of view, are burdened by relationship prob- summarises a primary school family services need to encourage lems, mental illness and substance pupil. parents to remember their value, abuse, for which support is too to maintain a family-work balance, slow to arrive. Changing relation- In another survey recently con- to cherish their relationship, and to ships may see the child cast aside. ducted for the Council of Europe, avoid over-programming free time Adolescents in particular experience Finnish children felt that home was and putting pressure on their children difficulties in finding one’s place in the very place where they were best to achieve. a blended family. Work and career- heard, taken seriously and where orientedness can be all-consuming, they could influence their life. They Value for children – time for resulting in the child’s needs being compared their homes to school upbringing neglected or going unnoticed. and hobbies, among other things. How have parents’ status and the However, when there is room for challenges of parenthood developed “They could keep a closer eye improvement, children’s wishes usu- in recent decades? Many things have ally concentrate on common time, changed for the better. More parents on their alcohol consumption. doing things together and interact- now support their children’s school- Another thing is the amount of ing in harmony: ing and hobbies, and are present in work. They are under terrible their children’s lives than, for exam- stress at work -- and they take it “Everything is fine in my family, ple, in the 1960s or 1970s. Levels of mild violence (pulling the child’s out on me” but my sister and I often need hair, spanking) used for upbringing to spend almost the whole day purposes are around half of what “I don’t like my stepfather, alone, as the grown-ups are they were 20 years ago. Progress also includes understanding the sig- because he sometimes shouts at working late or running important nificance of mutual respect between me for nothing” (primary school errands” (primary school pupil, parents and children, and the wish to child) the “It concerns adults!” report). listen to their children.

“Everybody gets along well, and Parenting involves more tasks According to Leena Valkonen’s than before. Media and advertising doctoral dissertation (2006), 5th everyone’s opinions are taken into penetrate a child’s world at a wholly and 6th grade pupils mention giving account. Everyone has a good time different level than they did, for time as one of the characteristics of together. Our family is big but example, during my own childhood a good parent. A good parent gives in the 1970s. Parents are needed his/her time, thinks that the child is everyone gets the same amount more than before, to filter messages important, is easy to get along with, of attention” (secondary school from the media and advertising, and sets limits, provides the child with pupil) to define the limits of moderation. an appropriate upbringing and has On the other hand, parents often a suitable way of life. In addition, take care of upbringing alone. Migra- the children surveyed by Valkonen However, growing inequality between tion can mean that relatives live sometimes viewed work as a rival for children poses a problem. A small far away. Friends and relatives also their parents’ time: “I wish they [my portion of parents lack the means to have their own work and priorities.

58 In the adult world, success is established in the early years. The Children and adolescents expect measured based on working life. The foundation for a good life, stretching schools to do more. School provides rhythm of working life has acceler- far into the future, is created during children with a familiar forum and ated, resulting in greater stress. The the child’s infancy. Parents may also could provide better support for shift to a so-called 24/7 society, the find fragmented family services dif- their well-being. Within the school day-and-night availability of various ficult to grasp. Professionals tend to environment, various forms of sup- services, is visible in children’s lives. use unfamiliar terms to denote such port could be offered to both children Working life requires flexibility and services. and, through them, to parents via an readiness to work evenings, nights Children and adolescents are upbringing partnership. By this, I also and weekends. Single parents, in unaware of special services. Neither mean affordable hobbies and the sup- particular, are forced to make difficult are they sufficiently informed about port provided by friendships. Many choices between work and subsist- such services in a suitable manner young people would like to see youth ence on the one hand, and parental for their age level. Furthermore, workers at school. School could also responsibilities on the other. In Fin- children do not always trust ser- provide more information on munici- land, even the parents of very young vices, because they do not under- pal services and the kind of support children often work full-time. stand their proceedings or know the children commonly have the right to professionals involved. Services do expect from parents. To children and adolescents, not always involve asking children The better that parents support services mean people and about how they are treated at home, their children’s education and hob- human relationships in which case problems pertaining bies, care for them and set limits, are From children’s and adolescents’ to violence or alcohol abuse are not present in their everyday lives and perspective, the relevant issue is hav- revealed. Seeking the services of a have the appropriate lifestyle, the ing people who are easy to contact school psychologist or school social less of a need there is for other spe- in order to discuss their lives – both worker can be hindered if the person cial services (see Valkonen 2008). For joys and sorrows – rather than ser- in question is not present or well- children without major worries, the vices and professions in themselves. known in the school community, or most familiar services include their Most problems faced by children if adolescents have not been told school, sports and leisure services, and adolescents in their everyday what his/her tasks include. (see e.g. libraries and health services. lives result from a lack of timely sup- Ministry of Social Affairs and Health port for parents in facing their own 2010) Family centres and a child- problems. Such problems include respecting rearing culture relationship issues, alcohol con- “People often talk about violence At their best, family centres bring sumption, excessive work or lack of but do not provide children with together the full range of services parenting skills. Most low-threshold which support children, adolescents services which provide child-rearing sufficient information on what and families. Such services aim to and peer support after the maternity to do, or how the matter should support children’s and families’ clinic phase are rarely available to be handled, if they fall victim to everyday lives, which do not cor- parents. In practice, however, such respond to the boundaries of admin- services and support would be highly violence. Being removed from istrative sectors. In family centres, significant to the everyday lives of home and the thought of stran- services have been developed as children and adolescents. Support gers scare children to the extent units with common objectives. They for families with a baby is impor- also aim to include children’s and tant, because the interactional basis that they dare not inform anyone adolescents’ practical expertise between parents and children is about the issue” in improving service quality. In

59 Finland, family services are chal- ily centres would have greater pos- to the attention of their parents. The lenged by uncoordinated manage- sibilities if the basic and continuing better the connections family services ment of preventive work, as well as education of professionals working have with the school, the better sector-specific administration. Pupil with children and young people were low-threshold support for upbring- care, services for children in need renewed in light of such issues. Such ing and the provision of early assist of special support, relationship themes should be covered in the edu- for parents experiencing problems support and services for divorced cation of different professionals, as is enabled. Challenges in Finland families particularly suffer from this. studies common to all students. also include developing educational The family centre concept offers an In addition to professional help, partnership between teachers and opportunity for positive change. an emphasis is placed on supporting parents and support children and The various professionals who the dialogue between peer groups families by means of family work. meet children and adolescents and parents. Such support can also In Finland, in particular parents of need sound basic knowledge of be organised by family organisations. children of secondary school age are child development and children’s It would also be necessary to speak not engaged with schools. rights, adequate social skills with openly about a violence-free upbring- Children must not be left to grow respect to children and adolescents, ing and to give advice, particularly up alone. Neither should their parents and good general knowledge of to the parents of small children and be left to raise children on their own. municipal services. They should children in need of special support, In turn, each adult teaches through also respect children’s and their as well as immigrant families. his or her own example. At its best, parents’ opinions as a source of sup- In addition, it is important to help an educational partnership between port in their own work. Each should the parents of secondary school-aged teachers and parents together with be capable of conducting case children recognise their own value as the support from family services, can management and providing basic child-rearers. The services may help create a new community spirit and information on services to children, to bring children’s and adolescents’ responsible adulthood.This ensures adolescents and their parents. Fam- hopes and opinions about upbringing all children’s right to a good life.

60 References

Nivala Elina: Lasten ja nuorten omia rights. Reports of the Office of the Ombudsman vanhemmuuskäsitykset. Jyväskylä Studies näkökulmia kasvatukseen. Address at the for Children 4:2008. Jyväskylä: Office of the in Education, Psychology and Social Ombudsman for Children’s 5th anniversary Ombudsman for Children. Research. Jyväskylä: University of Jyväskylä. celebration on 1 September 2010. http:// www.lapsiasia.fi/nyt/puheenvuorot/ Ministry of Social Affairs and Health, puheet/puhe/view/1530920 Publications 2010:7. Don’t hit the child! National action plan to reduce corporal Tuononen, Päivi 2008. It concerns adults! punishment of children 2010–2015. The opinion of children and young people in Finland on the realization of their Valkonen, Leena 2006. Millainen on hyvä äiti tai isä? Viides- ja kuudesluokkalaisten

61 Family centre is based on preventive work and collaboration

62 Preventive services – a guarantee for the This article describes the development of child and family policy in well-being of children and families Finnish municipalities. It describes preventive work promoting health and welfare, the steering and preparation Sirkka Rousu, Aila Puustinen-Korhonen and Marju Keltanen of welfare programmes for children and adolescents, and the status of family centre activities in municipalities. The article utilises the results of a survey of municipalities conducted “Today’s decisions will define future child policy. Creating a bal- by the Association of Finnish Local anced growth and development conditions for children is the most and Regional Authorities in 2010. important investment society can make – nothing surpasses a Finland’s approximately 1.1 million children live with some 590,000 child in importance. The welfare of children is much discussed and families. Children account for around acted upon by adults, but do value choices that respect the child one-fifth of the entire population, and childhood steer decision-making in society, or are childhood but child and adolescent age groups are shrinking. While well-being of the and the child population dwarfed by “big” issues and market- most Finnish children and adoles- oriented values? Our globalising world strives for efficiency. cents has been good over the last This is characterised by selfishness and short-sighted pursuit of fifteen years the number of children and adolescents requiring special individual gain. Protection of a child’s – a human being’s – life services has increased. from exploitation and neglect requires a policy of assuming joint Many factors underlying this trend responsibility, based on sustainable underlying values.” can be identified, such as Finland’s deep economic recession of the early 1990s, which saw reductions Child Policy Programme “Long live the children” 2000–2015, by in many basic municipal services for the Association of Finnish Local and Regional Authorities children and families, among guidance and counselling centres, day care, schools, youth work, etc. For instance, the availability of home-

63 help services for families with chil- child. Child protection is a com- comprehensive development of child dren plummeted. High unemployment mon concern. (Protection) and adolescent welfare. among families with children, thin- • Childhood is a social investment In these programmes, the key ning out of basic services supporting that benefits all. A long-term was to develop a child and family children and families, and a drastic social and child policy that pre- oriented working method in order to reduction in preventive service activi- vents problems is the lowest-cost strengthen parenthood. The intent ties resulted in an increase in the use strategy. (Provision) was to provide a natural provider of specialised services for children • Social skills do not appear of of services for families during each and adolescents. their own accord, but via inclu- phase of childhood, which would be sion and being heard. Appreciat- responsible for supporting parent- Change of direction in municipal ing a child’s views fosters healthy hood. At child welfare and prenatal child and family policy self-esteem in the child and pre- clinics, staff skills in supporting early Several national development pro- vents insecurity. (Participation) interaction between child and parent grammes and legislative initiatives were improved and co-operation are indicating the increasing malaise The aim of the Association of Finn- models developed between the clin- among children and adolescents, ish Local and Regional Authorities’ ics and day care, and day care and as well as problems in the service child policy document was to trigger pre-primary education. Renewal of system. In Finland, municipalities a broad-based discussion of the child and family policy, and co-oper- are largely responsible for providing status of children and services for ation between actors in municipali- basic and specialised services for families with children. In munici- ties, were also promoted via other children and families. Service system palities, the need arose to develop programmes. The most significant reform in the municipalities has basic services and preventive work, of these was the Harava project therefore been considered essential. in order to halt the growth of spe- implemented in 2000–2004. Harava Together with municipalities, the cialised services. The Association of was a national joint project between Association of Finnish Local and Finnish Local and Regional Authori- the public and various NGOs aimed at Regional Authorities launched a child ties recommended that municipali- producing collaboration and service policy reform process in the late ties, too, draw up a municipal or models for children and adolescents’ 1990s. This was based on the idea regional child policy programme psycho-social services. The project that child welfare is a common con- in support of decision-making on also generated numerous new tools cern throughout the whole municipali- children and adolescents’ welfare for practical work. ty. The Child Policy Programme “Long policy, the management and devel- Inspired by the project, a family live the children’, which steers the opment of activities, and practical centre called “Pihapiiri” was estab- activities of the Association of Finnish work with children, adolescents and lished in the city of Raisio in south- Local and Regional Authorities, was families. In addition, local actors west Finland in 2002. This family approved in 2000. Programme objec- were encouraged to engage in an centre, operating on a low threshold tives are anchored in the Conven- extensive preparation and learning principle, is one of Finland’s first. It tion on the Rights of the Child. The process involving various parties was established in co-operation with programme will continue to guide the and actors. the City of Raisio, the local parish and Association’s activities until 2015. Its The 2005 follow-up survey on various NGOs which jointly developed key theses are as follows: child policy programmes by the a strategic partnership for service Association of Finnish Local and provision. Pihapiiri provides open, • A child is prepared for life and finds Regional Authorities revealed that alternative activities to standard day basic security from the home, but the majority of municipalities had care services for those families and it takes a “whole village” to raise a prepared municipal programmes for parents, who are looking after their

64 children at home. The objective was right of all children to a safe growth various municipal sectors. Govern- to develop forms of child welfare environment, balanced and diverse ment decree (380/2009), issued support for non-institutional care development, and special protection. on the basis of the Primary Health and healthcare, to provide diversified Parents are responsible for bringing Care Act and adopted in 2009, also support for parenthood, to intro- up children and ensuring their well- strives to support families. Accord- duce peer support and early support being, but society is responsible for ing to the decree, some of a child’s models and to develop co-operation supporting parents and child welfare regular check-ups at prenatal and between the authorities, NGOs and professionals in this task. child health clinics, and in school volunteer organisations (records of The amended Child Welfare Act healthcare, concern the entire family. the Raisio Social Welfare Board 27 (417/2007) entered into force on The role of preventive healthcare, and February 2002). According to cus- 1 January 2008. In particular, the co-operation with other operators, tomer surveys conducted in Pihapiiri, purpose of the Act was to enhance have been confirmed by decree. parents bring their children to the the inclusion and legal protection of Correspondingly, municipalities’ centre for the chance to meet other children and families, to ensure that responsibilities for developing the children, and in order for the parents the authorities co-operate in sup- living conditions of adolescents to meet other childrearers in a similar porting families and to specify local were strengthened by the Youth Act situation. Parents also feel that they authority obligations with respect (72/2006), amended in 2006. Valid receive support in their personal to child welfare. Key issues in terms since 1 January 2011, an obliga- parenthood, raising children and in of family centre activities included tion on municipalities to establish a coping. In 2005, Pihapiiri’s opera- the incorporation of the concept of multi-sectoral co-operation group for tions were rendered permanent. The preventive child welfare in the Act, developing the living conditions and centre centre continues to operate as well as imposing an obligation on services of adolescents was added to (http://lapsitieto.fi). municipalities to draw up a four- the Youth Act. A provision was also In developing Finland’s municipal yearly comprehensive welfare plan added which obliged municipalities services in the 2000s, the key con- for children and adolescents. The Act to perform outreach youth work. cept posits that the best way to help thereby also obliges municipalities Through this, all adolescents must be a child is to offer support to child’s to manage preventive work on a more provided with the possibility of early own everyday environments at home, comprehensive basis, and to develop support. For instance, early support school and day care. Opportunities to services for families with children in must be offered in situations where a receive support for the healthy devel- support of upbringing activities. young person encounters trouble in opment of children and adolescents, The new Child Welfare Act clarified finding a study place or employment. and parenting activities, should be the extent to which promoting and made available for all families and securing the welfare of children and Child and adolescent welfare plan children. adolescents is a matter for municipal The Child Welfare Act obliges child welfare authorities in particular. municipalities to prepare, either on Emphasis on preventive child It also defined the extent to which their own, or together with other welfare this should be carried out by other municipalities, a child and adolescent Child welfare is currently viewed municipal authorities or other actors welfare plan that must be revised as a broad process protecting the and through co-operation. Being the at least once every four years. This welfare of children. This involves not responsibility of the municipality, child and adolescent welfare plan only the social welfare authorities, tasks concerning the development must also be taken into account when but also other public authorities of growth conditions and support preparing the municipal budget. As and all citizens. The primary objec- for parenthood, and those involv- a consequence of the amended Child tive of child welfare is to secure the ing preventive child welfare, involve Welfare Act, municipalities’ child

65 policy programmes have been largely Preventive child welfare services Resourcing, goal-setting and merged in line with the statutory are also provided by other munici- management of preventive work child and adolescent welfare plan. pal services, such as prenatal Resourcing of preventive child Initiated by the Association of Finn- and child health clinics and other welfare, goal-setting for work, and ish Local and Regional Authorities healthcare providers, home-help management of preventive work together with the municipalities, child services, day care, primary edu- within municipalities is vital. Of the policy development work helped pave cation/school or youth work as municipalities that responded to the the way for enshrining the child wel- specialised support, even when survey by the Association of Finn- fare plan more extensively in legisla- the child or family is not a client ish Local and Regional Authorities, tion. The child and adolescent welfare of child welfare services. Organi- 94 per cent (192 municipalities) plan must also include objectives and sations, associations and other reported that the statutory child and measures of preventive child welfare. civic activity may offer valuable adolescent welfare plan had been This plan is prepared in co-operation support to the child and family, completed, or was underway. Nine with various administrative sectors without defining any particular out of ten municipalities prepared the and actors. In many cases, repre- problems (Taskinen, S. lastensuoje- welfare plans under the guidance of sentatives of NGOs, parishes or other lulaki (417/2007), Soveltamisopas. a multi-sectoral co-operation group corresponding parties also contrib- Stakes, Oppaita 65). comprising several service sectors. ute to its preparation. The views of Welfare plans had been prepared by clients, i.e. children and adolescents, The family centre as a multi-sectoral co-operation groups must also be consulted. preventive child welfare in more than one half of the munici- Among other issues, strategic structure palities responding to the survey. A objectives and measures facilitat- When adopting the child policy pro- multi-sectoral preparation process ing the implementation of support gramme, the Association of Finnish was viewed as a factor that enhanced for parents and parenthood, as part Local and Regional Authorities also a more comprehensive review of child of preventive child welfare services decided to monitor the programme. and adolescent welfare and services. within primary social and healthcare The 2010 follow-up survey handled Implementation of the plans, and services, must be recorded in the the implementation and enforce- monitoring of development, was also child and adolescent welfare plan. ment of the new Child Welfare implemented by a multi-sectoral Children and parents must be provid- Act on an extensive basis. Within co-operation group in almost all ed with the support they need at the municipalities, the survey analysed respondent municipalities. earliest possible stage, in their famil- the status of child and adolescent In general, the municipalities had iar, ordinary environments. Activities welfare plans and services for taken careful account of service sys- supporting the health and welfare of children and families. A total of 252 tem development needs included in children include physical activities municipalities, out of 326 in con- the plan, and the set goals had been and cultural and artistic activities of tinental Finland, responded to the met. However, less than one-third of various types. In addition, in terms of survey, conducted in co-operation respondents were of the view that the the well-being of children and parents with the Ministry of Social Affairs plan took good account of children alike, it is vital for them to experience and Health, the National Institute and adolescents’ possibilities to a sense of togetherness and to see for Health and Welfare and the participate and influence matters, themselves as part of a community Ministry of Education and Culture’s and of developing such a possibility. they view as significant. Today’s fami- policy programme for children, ado- Objectives involving appropriations lies need a new sense of community. lescents and families. The research and human resources were fulfilled Family centre activities, among other report on the follow-up survey was well in only every fourth municipality. factors, can create this. completed in June 2011. The municipality’s financial situation

66 was regarded as the main reason for child, the need for child and family ties expressed most concern about the this shortcoming. specific child welfare services was mental well-being of children between According to the survey results, assessed as best prevented with the the ages of 13 and 20. multi-sectoral management and help of support services by fam- political decision-making were still ily workers. More than 80 per cent Number of family centres increasing evolving in the municipalities. Man- of respondents found that support The key aim of family centres is to sup- agement of preventive child welfare is services by family workers prevented port parenthood. Such activities are being implemented in more than fifty the need for child welfare fairly or characterised by family-oriented, com- per cent of respondent municipali- extremely well. These support servic- munity-oriented and multiprofessional ties in such a way that multi-sectoral es were fairly or fully available in half co-operation, family work based on expert groups can integrate and of the municipalities that responded. early support and groups for children develop their activities during client The situation has improved consider- and parents. In 2005–2007, the focus work. On the basis of the results, it ably from the recession years in the of family centre development was on can be concluded that, pursuant to 1990s. preventive work through basic services the Child Welfare Act, the joint long- As regards children in primary and creating supportive co-operation term preparation process for child school, early support family work was networks involving child and family and adolescent welfare plans will pro- assessed as the best method for pre- services. In 2008–2011, the operat- mote the emergence of multi-sectoral venting the need for child welfare (80 ing method and model was developed management and decision-making per cent of respondents). Only some further, based on a municipality-driven structures in municipalities. Such 40 per cent of respondents, however, approach in projects receiving state structures can promote responsibility regarded family work as rather easily aid, under the National Development within the entire municipality for the or easily available. Early family work Programme for Social Welfare and well-being of children and adoles- refers to support that can be offered Health Care (Kaste). cents, and families. to families on the initiative of child The survey by the Association of health clinics, day care or school Finnish Local and Regional Authorities Availability of preventive services healthcare services. In some munici- indicated that the number of family The results of the survey reveal palities, families can apply for family centres was increasing, with 45 munici- that the services assessed by the work services on their own initiative, palities, i.e. approximately a quarter respondents as at least moderately without a referral. of the municipalities that responded, successful in preventing the need For lower secondary level students, reporting that they provided fam- for child welfare measures are still the most efficient method of prevent- ily centre services. More than half of quite poorly or not at all available to ing the need for child welfare was municipalities providing family centre children and families. In the munici- evaluated as having a safe adult services produce them as one of the palities’ view, basic services, and the close by, with preventive social work municipality’s own activities. On the individual, group and community- services being available (68 per cent basis of free-form responses, family level support measures available of respondents) from school. How- centre activity seems to be intended through them, could well prevent the ever, preventive school-based social for children under school age. However, need for child welfare measures from work services are easily or fairly information on the number of family arising. The survey indicates that, easily available in only 47 per cent of centres, and implementation methods to at least a moderate extent, family the municipalities that responded. It and practices, varies between studies1. centre activities could prevent the is noteworthy that a safe adult close need for child welfare. by is at least fairly easily available For families with children under in only 11 per cent of municipalities. 1 The National Institute for Health and Welfare is conducting a survey into the overall status of school age, and those expecting a However, responses by municipali- family centres in Finland.

67 The development of family cen- of every municipality. Family centre peer support by other parents, and tres has concretised the goals of activities create preventive co-opera- early support for families and children preventive child welfare in a number tion structures for services aimed at and adolescents of different ages. of ways, while bringing structure to families with children and for those Family centres could also form a child the preventive child welfare. Family co-operating within such services. At and family-oriented approach that centres should therefore develop in various stages of life, family centre steers all implementation of child and the direction of providing a basis for activities promote the partnership family policy within municipalities. preventive child welfare in every part between professionals and parents,

References

http:// www.lapsitieto.fi > Harava-aineistot Rousu, Keltanen (tulossa 2011). Puska, Pekka (2010). Hyvinvointia ja > Strategista kumppanuutta perhekeskus Kuntien lakisääteinen lasten ja nuorten terveyttä edistävä perhekeskus. Diasarja. Pihapiirissä -raportti. hyvinvointisuunnitelma sekä hyvinvoinnin ja Terveyden ja hyvinvoinninlaitos. palveluiden tila 2010. Kuntaliitto, Helsinki. Kuoppala Tuula, Säkkinen Salla (2010): Lastensuojelu 2009. Tilastoraportti Mannerheimin Lastensuojeluliitto (2011). 29/2010. Terveyden ja hyvinvoinnin laitos. “Kun riittävästi lahjoittajia on koossa, minä lupaan…”. Tiedotteet ja uutiset. Saatavilla Neuvolatoiminta, koulu- ja http://www.mll.fi/ajankohtaista/tiedotteet_ja_ opiskeluterveydenhuolto sekä ehkäisevä uutiset/?x41088=13383110 (viitattu 29.3.2011 suun terveydenhuolto. Asetuksen (380/2009) perustelut ja soveltamisohjeet. Kasvun kumppanit (2011). Perhekeskus. Sosiaali- ja terveysministeriö. Julkaisuja Saatavilla http://www.thl.fi/fi_FI/web/ 2009:20. kasvunkumppanit-fi/palvelut/perheita/ perhekeskus (viitattu 30.3.2011) THL (2009): Lasten asema ja palvelut 1990-luvun lamasta tähän päivään. Riitta Viitala, Marjatta Kekkonen, Auli Paavola Diasarja. Valmistettu Lasten ja (2008). Perhekeskustoiminnan kehittäminen. nuorten terveyden ja hyvinvoinnin PERHE-hankkeen loppuraportti. Sosiaali- ja neuvottelukunnan aloitteesta. terveysministeriön selvityksiä 2008:12. Sosiaali- ja terveysministeriö: Helsinki.

68 The Swedish Leksand model – family remit, the sense of social togetherness in the groups and the level of preparation as a starting point for knowledge and awareness of the child’s needs are increased. the family centre Parental support starts with the first antenatal appointment with the Thomas Johansson midwife. Both mum and dad attend this appointment. Both must feel welcome “Support for parents makes for happy and secure children who can grow up after the appointment and have no into sociable and responsible adults.” doubts about joining a parent group Introduction: The Swedish Leksand model has become widespread across some weeks later. In the group, the par- many countries, particularly within the Nordic region. The reason for the suc- ents get advice, support and education. Initially, the parents meet in their cess of the model is probably the simplicity of the concept. groups around eight or nine times This article summarises 15 years of work experience related to the Lek- before the birth and an equal number sand model. of times afterwards, right up until the The article presents a number of results and factors that have played child’s first birthday. Three out of four a major role in the development of the Leksand model, factors which are groups choose to continue meeting in their groups. Some groups have been repeatedly referred to in the various evaluations. The article describes the meeting for 10 years. The responsibil- original Leksand model in brief and the way in which various staff groups ity for activities after the child’s first and voluntary organisations cooperate with regard to the support. The arti- birthday rests with the group itself, the cle also describes the additional initiatives relating to fathers, the topics that adult education association and the are usually covered and the methods for parental support that are usually open nursery. When a problem arises within a fam- used. A brief overview is also presented of the results produced by various ily, it is easy to obtain advice, support evaluations over the 15-year period concerned and the success factors that and treatment, as the parents already we were able to identify through the evaluations. Finally, a number of pro- know many of the relevant profession- posals are presented ahead of the future work relating to parental support in als through their visits and talks to the Leksand. parent group. The service is provided in partnership between Dalarna County I hope the article will inspire the creation of appropriate and comprehen- Council, the Municipality of Leksand, sive parenting support provision and that between the Nordic countries we religious communities, adult education can develop our knowledge exchange and experience associated with paren- associations and voluntary organisa- tal support. tions. The aim is to equip parents with the tools they need in order to handle their family situation, whilst at the The original Swedish Leksand provided through a structure that is same time reinforcing social interaction model in brief based on extended and reinforced and networks between parents and Since 1996, Leksand has offered parental education in groups, where other adults surrounding children and parents various forms of support in the groups learn skills and establish young people. Special support either order to improve the circumstances contacts with various functions in in groups or individually is offered to of children and make life easier for society. As the staff have shared parents who find their children difficult parents. This support is primarily goals and cooperate around a clear to manage.

69 Before the birth istrators from the Swedish Social as to how often he will be needed. A Provision of the support begins when Insurance Agency. The midwives are dads’ mentor is a completely normal, the midwife meets the future parents responsible for the meetings before slightly more experienced dad with two at their first antenatal appointment. the birth. Dads’ mentors and couples or more children. He will attend a short The midwife greets the parents and who have recently had children also course/introduction before participat- welcomes them to the parent group, take part. ing in the groups and receive a small which starts at around pregnancy fee from the county council. The role of week 25. If the marketing of the group After the birth the dads’ mentor is to support the dads is successful, virtually all of the 12-20 When all the children in the group and answer their questions. He can parents who are invited will attend. have been born, all the parents will be also tell them about his own experienc- Each parent is given the opportunity invited to a postnatal meeting which es. Evaluations indicate that the dads’ to be seen and heard. The number reinforces the sense of solidarity with- mentor is appreciated by the dads in of parents in a group varies with the in the group. Nurses from the child general and the mums in particular. number of pregnancies. Children who healthcare (paediatric healthcare) unit are due at around the same time will are responsible for the meetings right The role of volunteers end up in the same group. People up until the child’s first birthday. In An important role is played by the adult remain with their original group when addition to the professional groups education associations1, especially dur- siblings are born. At this initial meet- referred to above, other professionals ing the early years. (The Swedish Study ing, the aim is for the parents to feel will also participate, including family Promotion Association (Studiefrämjan- secure and to want to continue in the law experts, nursery head teachers det) is extremely important. When the group. One way of creating identity and dental hygienists. The parents child is older, other adult education and a good atmosphere is for the par- also make visits to a library, where associations will also take part.e.g. BF, ents to choose a name for their group, the children’s librarian will tell the NBV, Studieförbundet Vuxenskolan and e.g. Potty 98, the Millennium Group, parents about children’s literature. Bilda.) Voluntary organisations give the Rising Stars, the Spring Flowers, Through to the child’s first birthday, guest lectures and talk to the parent End-game and The Untouchables. the parents will have plenty of time to groups, or alternatively the parents can A meeting often starts with a short get to know each other and the vari- make study visits to see the work of talk or presentation by an invited ous professional groups in the team, the association in practice. Examples guest, either professional or volun- as well as take part in other activities of participating voluntary organisa- tary. After perhaps a half-hour talk, within the community. Representa- tions include the various municipal the day’s topic is discussed, with tives of local authorities, adult educa- bodies, the Civil Defence Association, mums and dads in separate groups. tion and other associations, religious the Red Cross, the parents’ associa- A dads’ mentor usually leads the communities and businesses can visit tions Lek i Leksand and Kids & Dads dads’ discussion. The meeting is the group. and the local hockey team Leksands closed with the mums and dads dis- cussing the day’s topic together over Dads’ mentors 1 Adult education associations are organisa- a cup of coffee. Dads’ mentors have been a natural tions that promote popular education through The professional groups involved part of the Leksand model ever since study circles, meeting programmes, projects and arrangements/events with the aim of giving prior to the birth are midwives from the very beginning in 1996. Dads’ the participants knowledge. The study circle, a the maternal healthcare unit, nurses mentors normally take part in two to small group that learns together, is the core of from the child healthcare (paediatric four meetings before and two to four popular education and an educational concept that has been around in Sweden for over a hun- healthcare) unit, psychologists, nurs- meetings after the birth, right up until dred years. The adult education associations ery teachers, family advisors, family the child’s first birthday. The group are collectively the largest cultural organiser in therapists, social workers and admin- will then agree with the dads’ mentor Sweden. (Source: sv.wikipedia.org)

70 IF (Idrottsförening). Companies can with children aged 2-12 years), Familje- 70%. The control groups were given also be invited to the parent group, or verkstan (for parents with children a traditional programme with fewer alternatively the group can be invited aged 3-12 years), COPE – Community meetings. This resulted in much lower to visit the company on a study visit. Parent Education Programme (for attendance, particularly amongst dads. Examples of such companies are parents with children aged 3-12 years), Attendance prior to the birth is cur- insurance companies and banks. After ÖPP – Örebro Prevention Programme rently almost 100%. the child’s first birthday, the impor- (for parents with children aged 13-16) tance of the voluntary organisations and LUT – Leksand Utbildar Tonårs- Some more results from the for the parent group increases, as the föräldrar (for parents with children same evaluations activities are customised to meet the aged 12-18). On average, seven new parent groups needs and wishes of the parents and started each year in Leksand (15,500 the children. Results and evaluations of the inhabitants with 120 births/year). Swedish Leksand model • Each parent group had around 12-18 Themes parents and siblings were included in Themes prior to the birth and during Attendance the original group the first year of parental education The proportion of parents who attend • Participation was very high in a include emotional ups and downs; the groups is high. The average national comparison safe and secure bonding; the loving attendance amongst mums at the eight • Two questionnaire surveys showed relationship; task delegation and new to nine meetings prior to the birth that parents had a lot of confidence roles; the child’s needs and develop- was around 95%, whilst attendance in the staff ment; male-female language; breast- amongst the dads for the same period • The parents appreciated the gender- feeding; children’s food; accident was around 90%. During the subse- separated discussions, as this risks; fairy tales; songs, music and quent eight to nine meetings through approach often led to a more open visits to libraries; dental health; fam- to the child’s first birthday, attendance discussion ily law; parental leave; household amongst mums was just under 90%, • The dads’ mentors were appreciated finances and insurance; child safety; whilst that for dads was just under by both the mums and the dads maturity and self-esteem; balanc- ing family and work; information on medicines, alcohol and other drugs; and siblings and step-siblings. Attendance in 17 parent group meetings, pregnancy – one year old children 100 Women – pregnancy Methods 90 2 Men – pregnancy Examples of methods that are used 80 within the framework of the Leksand 70 Women – child one model include PREP – Prevention year old 60 Relationship Enhancement Pro- Men – child one 50 year old gramme (a programme for couples), 40 ICDP – International Child Develop- 30 Evaluation of ment Programme/Guiding interaction Kertin Hopstadius, 20 (for parents with infants/nursery age Research Council children), Active Parenting (for parents 10 of Dalarna (Dalar- 0 nas Forskingsråd) Project group Control group 1998 och 2000 2 all methods are universal, i.e. they are The attendance above concerns the period up to 2000. intended for everyone

71 • Parents in control groups who 2. Early start support amongst both parents and received traditional parental sup- The Leksand model starts “early” staff. A lot of time and care has been port were dissatisfied with this with the first antenatal appointment put into creating well-being and a support and parent groups with a high level of sense of solidarity, with the result • The taking of leave amongst the attendance. This enables early discov- that networks have subsequently dads increased during the period by eries and initiatives. When a parent been formed and further developed 3.3% feels secure in their environment and in various forms, as the child grows surroundings, he or she will be more older. Parents meet over a common Continuity likely to seek help for a problem. Help and important goal – the good of the Up until 2006, an average of three out that is given at this stage will often be child of every four parent groups continued more effective and far less expen- to meet after the child’s first birthday. sive from every perspective than if it 5. Own strength Around half have continued to meet had been provided a few years later. Gradually increasing the parents’ over a period of five years. After the Economist Ingvar Nilsson has calcu- own involvement in a group rein- child’s first birthday, the parents meet lated the profitability of the Leksand forces the group spirit and increases between six to eight times per year model from a social and individual the parents’ own strength and on average during the first four years. perspective. Source: “Det är bättre att insight into their own abilities as a Attendance amongst mums during this stämma i bäcken än i ån” www.seeab. parent and role model. Parents have period averaged around 60%, whilst se also had representatives on devel- that for the dads was around 30%. opment groups, enabling them to 3. Support for the dad be involved and influence develop- The success factors for the a. Dads are welcomed to the first ante- ments Swedish Leksand model natal appointment and receive their 1. Continuity – the same parent groups own invitation to join the parent 6. Co-operation continue to meet over time, and the group Despite many setbacks and financial staff have a holistic perspective. b. Dads have their own dads’ men- difficulties, the staff still believed in The continuity stems from having tor at most meetings of the parent the working method and have con- the same leaders for the various group tinued to perform their role as group meetings before and after the c. Dads’ mentors are given brief train- leader. The Leksand model is the birth right up until the child’s first ing and receive some remuneration result of (a) collaboration between birthday. It also stems from not d. There is open provision for dads on the county council and municipal breaking up the original group, i.e. Saturdays, with a special “Kids & authority. Decisions are taken by the same parents continue to meet Dads” club for all dads with children both of these bodies individually. after the birth of the child. Also of The collaborative body is the politi- importance for continuity is the fact These dads’ initiatives have resulted cal collaboration committee (Politisk that the staff encourage the parents in more paternity leave and parental Samverkans-beredning) (POLSAM). to continue to meet and through leave being taken, as well as more dads There have always been groups for their attendance “overlap” the participating in nurseries and spending collaboration between different various stages through which the more time with their children. professional groups, whilst groups group passes. Another important between civil servants and politi- factor is that political decisions and 4. “We feeling” cians have fluctuated over the years. organisational changes interact over Networks, a “we feeling” and identity Voluntary organisations have been time and facilitate and support the are probably the decisive reasons invited to meetings. It is important collaborative structure why the Leksand initiative has won for the survival and success of the

72 initiative that the collaboration the age and culture-integrating work. works not only between decision- Economist Ingvar Nilsson One aim is for the family centre to also makers, but also between profes- on the Leksand model: offer education, advice and support to sional groups “I find it inexplicable that the Lek- parents with teenage children. sand model could have survived It is proposed that family centres 7. Feedback should house an open nursery, the and achieved such good results The staff have been good at pick- social services’ family team, social ser- over all these years with the ing up on the need for change and vices for advice and support, maternal this has resulted in the service minimal budget that has been healthcare, children’s healthcare, school being renewed. One instrument available.” healthcare, leisure activities, activities for follow-up and action has been for the elderly and an arena for cultural and remains the “diary sheets”. programmes such as dance, theatre, During the early years, these were The future films, talks, conferences, etc. distributed after each meeting to From 2011, the Municipality of Lek- The following is still only at the pro- each parent and member of staff. sand has abolished the traditional posal stage and may be trialled either in Today, they are given out more committees and administrations, and full or in part. sparingly. The sheet asks what the all work relating to children, young person thought was good, what people and their parents is now Parent groups at nursery they thought was bad and how it concentrated within a single organi- A proposal has been put forward accord- can be changed. The sheets are sation. This organisation will now ing to whom responsibility for ongoing collated and form the basis for pos- build up the new, developed support group-linked parental support after the sible changes and improvements. in Leksand in collaboration with the child’s first birthday should be trans- It is important that the changes are county council and voluntary organi- ferred to the preschool nursery, i.e. that also implemented in reality sations. Of the following initiatives, each preschool nursery department the family centre is the one that is should become a parent group – an edu- Difficulties over the years most established and a decision will cational unit for parents. The advantage • A reduced budget has resulted in be taken shortly. Other proposals of this structure is that the municipal fewer temporary and permanent will be considered over the next 12 authority takes a clear responsibility staff, fewer meetings and fewer months. for the activity when the county council occasions on which support is “hands over” at the time of the child’s provided Family centre for all ages first birthday. It is proposed that par- • A lack of coordinators has adverse- A decision will soon be made con- ents who do not take advantage of the ly affected management and com- cerning the establishment of a family nursery’s service should still belong to munication between members of centre in the town centre, probably a group. The preschool nursery prin- staff adjacent to an existing activity centre cipal (head teacher) is responsible for • Certain political decisions have for all ages. The aim is for the family convening the parent group. The activity adversely affected the collabora- centre to provide support for all chil- can be carried out in collaboration with tion and contact between profes- dren, young people and their parents. an adult education association, which sionals It is proposed that the current age- can provide a leader and materials. It • Important meeting forums have based provision at the activity centre, must be largely free of charge for the been withdrawn and this has as well as the open and group-based parents. The principal (head teacher) adversely affected the dialogue activity relating to children and young is given more responsibility, but on the between groups of staff and people, be continued. This presents other hand benefits through having between staff and decision-makers an excellent opportunity to develop more committed parents and through a

73 proposed parental support unit within ers. The proposal is based on children be followed by the Role-play described the municipality. and young people themselves identify- above. An employee could, for example, ing the conflicts that occur most fre- then give a brief talk, which in turn is Parent groups at schools quently at home and the consequences then followed by group discussions. Children join a preschool (nursery) that such conflicts usually have. This The meeting can be concluded with a class at the age of six. Under the could for example be done through a cup of coffee, a summary and perhaps proposal that has been put forward, questionnaire survey, combined with more singing and music. The meeting it is proposed that each school class personal visits to schools. The ongo- would take up to 90 minutes in total. An should become a parent group – an ing idea can then also be presented adult education association can also be educational unit for parents. With this – creating small scenes/Role-plays in involved as a collaboration partner here. arrangement, the municipal authority’s about five minutes, which reflect the There are many benefits to this method clear responsibility to provide educa- conflict. The actors will be the young of working. The young people become tion, advice and support for parents people themselves. The audience will more aware of how their parents can can therefore continue. The principal consist of parents and professionals. perceive different situations and of (head teacher) takes responsibility The scenes will be used as ice-breakers their own responsibilities. The parents for the activity at the school and the at parent meetings/parent cafés. The become more aware of how their children class teacher convenes the parent primary target groups will be the can perceive different situations as well group. The activity can be carried out parent groups at the schools. as more secure in their own role as a in collaboration with an adult educa- The meetings will be interesting and parent. The aim is to equip the parents tion association, which can provide a good-humoured. A meeting could be not only with more and better tools for leader and materials. It must be largely opened with young people singing and handling different situations, but also free of charge for the parents. The playing instruments. This would then with sustainable networks for the future. expanded responsibility for the school can again be offset through more committed, active parents and through a proposed parental support unit within Source references for the Leksand model 1996–2011 the municipality. Some evaluations have no source reference. Please contact the author of the article for more information. The term “parental support” and Methods for parental support Parents of teenagers http://www.fhi.se/Handbocker/Uppslagsverk-barn-och-unga/Foraldrastod/ Existing courses for parents of teenag- 1998 – Evaluation 1 by Dalarna Research Council (Kerstin Hopstadius) ers have primarily been based on COPE 2000 – Evaluation 2 by Dalarna Research Council (Kerstin Hopstadius) http://www.dfr.se/ or LUT (Leksand Utbildar Tonårsföräl- drar). Interest has been strong and 2001 – Midwives in the team distribute their own questionnaire to all parents (Ingegerd Jons) 2002 – Summary diary sheet (Thomas Johansson) attendance high. In the case of LUT, 2002 – “Föräldragrupper i praktiken”, handbook by Thomas Johansson & Ingegerd Jons, attendance by mothers during the Gothia Forlag eight meetings of the programme was 2004 – Pilot study for FHI “New tools” (Nya verktyg) (Sven Bremberg, FHI) around 90%, whilst the corresponding http://www.fhi.se/Publikationer/Alla-publikationer/Nya-verktyg-for-foraldrar/ figure for fathers was 80%. 2006 – Social anthropological study in parent group (Sköndal Institute) 2007 – National economic study (Ingvar Nilsson) “Det är bättre att stämma i bäcken än i ån” http://www.seeab.se/ Role-play for parents – created by 2007 – Quality assurance ahead of change work (Marianne Sellner and Thomas Johansson) their children… Thomas Johansson, A proposal has been put forward for a Public health planner, Municipality of Leksand way of increasing the level of involve- [email protected] +46 247 80137 ment amongst the parents of teenag-

74 Children and parents belong Mother and father – for the first time together: The work is based on the view that children and parents should be Henriette Weberg together. When there is a need to work with the family, the approach must therefore be based on the provision of This article describes the experiences gained through the project entit- extensive support and assistance and led “Mother and father – for the first time.” The project was previously the least possible intervention with regard to the child. carried out in Greve Municipality as an attempt to test the Leksand model in practice in a Danish context. At a time when resources are Prevention and health promotion are scarce, it is unfortunately not yet possible to adopt the method on a accorded a high priority: Children and adolescents are offered permanent basis, but there are now signs of political interest in the assistance within this area at an early project once again. stage in order to reduce the need for more comprehensive measures later on in the child’s life. Being a child or adolescent in widely varying circumstances, Greve Municipality needs and interests can develop A targeted service is offered to people Greve Municipality is situated just and realise themselves. Similarly, who are in need of assistance: south of Copenhagen. There are it is also an aim that childhood The family is a very real and active approximately 48,000 inhabitants and adolescence will provide the collaboration partner and is always and around 500 births a year. In the foundations for a meaningful adult involved in the objectives of the initia- work with families, there is a long tra- existence. Greve Municipality is of tive, regardless of whether assistance, dition of interdisciplinary initiatives. course unable to guarantee this on support or supervision is required. Within Greve Municipality, this its own. The vital factors for all chil- It must be ensured that a broad work is carried out on the basis of dren and adolescents are always range of services is provided at all an overarching Child and Adolescent their parents and their close net- times in order to meet the individual Policy, which states amongst other work. Greve Municipality therefore needs of families for support and things that children and adolescents aims to help parents and families development insofar as this is pos- should thrive in Greve Municipality. achieve the best for their children sible. They should be happy in themselves and adolescents, even when they and they should be part of communi- find life difficult. We also want to An interdisciplinary approach shall ties. They should be looked after, so ensure that all our institutions, be ensured: that they are safe. Yet they must also schools, clubs and other places The family services that are provided be challenged, so that they grow up involved with children are perme- are based on an interdisciplinary col- believing in themselves and their own ated by our ambition on behalf of laboration, bringing together a broad abilities. Greve Municipality wants to our youngest citizens, i.e. that they range of knowledge concerning the create the best possible framework can lead a good and happy life. family’s resources and ensuring an and opportunities to enable both individual and holistic approach. childhood and adolescence to become More specifically, this results in a a valuable period in itself during series of overarching objectives for Professional, methodical which children and adolescents with the work with families: development shall be ensured:

75 Professional development shall be first-time parents starting before the through universal preventive parent ensured at all times, so that relevant birth has a good preventive effect on support work,2 which involves offer- support can be given to families at family stability, parent well-being, ing initiatives to new parents based any one time. and the well-being and development on the relationship between the of the child. Starting up a preven- child and its parents, as well as the Why a parents’ course? – a tive group project aimed at couples parents’ resources. brief history expecting their first child and starting The parent support work must In line with developments within before the birth of the child can give therefore help parents to promote society and changes in the structure parents an opportunity to improve their child’s positive and healthy of the family, there is an ongoing their parenting skills and enjoy development as well as developing need to adapt the healthcare services the role of parent more, as well as the parents’ ability to act in relation that are provided to future first-time preventing family problems which in to both their own health and that of parents in the municipality. Future the longer term can be both resource- their child. parents are part of the hypercomplex intensive and difficult to repair. It can In Greve Municipality, we in the society. As there is an enormous be difficult to predict and assess in Healthcare Service have worked on amount of information, advice and which families parents are likely to the provision of support for parents guidance available in connection with experience difficulties with their role through the project “Mother and becoming a parent, it can be difficult and therefore be in need of additional Father – for the first time”. to decide what to listen to and what support in order to safeguard the The goal of this project is to sup- to ignore. child’s development and well-being port and develop the parents’ capac- Many future parents have a well- when adopting an individual-oriented ity to care and act with the aim of developed network, yet no idea let perspective. There are both ethical establishing a strong bond between alone experience of what challenges, and professional problems associated parent and child and developing and joys and worries the parental role will with identifying and thereby stigma- maintaining healthy habits for the bring. Even if they do have a good tising a particular group of parents in whole family. The aims of the project network of friends and family, most advance, and it is difficult to recruit are therefore: people today lead very busy lives; the parents to initiatives that are aimed grandparents are still working and at special groups. • To give first-time parents the prioritise their own interests in their opportunity to participate in a spare time. Many people have never Parent support work group programme; held a newborn baby in their arms Support initiatives aimed at parents • To establish networks within the until they hold their own for the very as early as the pregnancy stage have groups; first time. There is therefore a lot to a decisively positive effect on the • To provide the parents with the take on board and a lot to learn, and child’s weight at birth and the number tools needed to deal with critical there are few if any role models to of complications, and thus also on the situations at an early stage; follow. There is considerable inter- child’s health at birth1. By target- • To provide professional support est and motivation amongst future ing the initiatives at the factors that and guidance at an early stage, parents when it comes to creating the lie behind inappropriate behaviour, thereby preventing dissatisfaction best possible circumstances for both instead of at individual risk factors, it and inappropriate development in themselves and their future children. is possible to promote the child’s gen- the individual child; Evaluations from both international eral health and well-being to a greater • To support and guide the fam- and Danish studies have shown that degree. This process is supported ily, so that they are able to make a preventive approach in the form 1 L. Lier, M. Gammeltoft, IJ Knudsen: “Early of the creation of parent groups for mother-child relationship” 2 The Leksand model. http://www.leksand.se

76 healthy choices for both the chil- Recruiting the families who will which they can develop and exchange dren and the adults participate experiences and thoughts, enabling A pivotal aspect of the method is them to acquire new skills. This helps The unique aspect of this model is linked to the meetings before the child to enable the participants to sup- that the work is aimed at both the is born, so it is vital that the group is port their child’s healthy and positive future father and the future mother. established as early as possible dur- development. The couple participate in the project ing the pregnancy. In addition to being from every tier together and attend the same meet- Here, the midwives are key collabo- of society, the participants in the ings. ration partners, as they are in contact group can also be of many different When the child has become a little with the couples at an early stage and nationalities. older – about a year – good experi- able to invite the couples to take part Danes with a non-Danish ethnic ence will have been gained concern- in the project. origin can participate if they are able ing the provision of supplementary It is vital that the midwives are to speak enough Danish to get some- services for fathers and their chil- motivated into setting aside time to thing out of the programme whilst dren. tell couples about the opportunity and at the same time not restricting the that they distribute material about group process and the discussions Overall organisation the group to the couples in the form that take place. “Mother and Father – for the first of a leaflet which gives the couples a The method is an obvious oppor- time” is a working method that is chance to find out more about what tunity to reinforce integration, as strongly based on interdisciplinary is on offer and decide whether or not throughout the programme there will collaboration. they wish to take part. be a focus on how people as parents One of the fundamental ideas is When the couple has been offered can support their child’s development that both internal and external, as the chance to take part in the pro- as much as possible. Throughout well as public and private, profession- ject, it is the project leader who the programme, there will therefore als provide the professional basis in takes responsibility for the further be opportunities to discuss val- the work relating to the method. organisation regarding group start- ues, upbringing, attitudes towards When the project was carried out up, information on the meeting place, children, family life, couple relation- in Greve Municipality, there was a dates, etc. ships and so on. In this way, all the health visitor who acted as anchor for participants gain a greater insight the group. This decision was made in Composition of the group into the thoughts and attitudes of view of the fact that the healthcare The families that take part in the other people, as well as an excellent visitor would in all circumstances groups come from all walks of life. opportunity to sweep away prejudices have contact with the family when the This means that families from every and misunderstandings. child was born. social class participate. The health visitor has a broad inter- It is actually one of the fundamental Topics for the meetings disciplinary internal network within ideas behind the model that the group Participants in “Mother and Father the municipality, as well as knowl- will use the resources that are avail- – for the first time” take part in 12 edge and experience of communica- able and that the participants all have meetings, split between three meet- tion paths and collaborative relations. something to learn from each other. ings before the birth and nine after Links with external collaboration A learning community thus develops the birth. A wide variety of topics are partners will also be established within the group. touched upon at these meetings. in the primary sector, e.g. with the The idea is that the group will pro- There will be many different ways in GP, and with collaboration partners vide each other with a network in both which to combine the topics, as well within the region. the short and the long term, through as many ways of tackling the meet-

77 ings. This will depend on both the between the child and its parents Making a special effort participants and the professionals. and the role of a parent. “Mother and Father – for the first time” Some examples are given below of was carried out in Greve Municipality, topics which were brought up during The child in the family: but at a time when resources are scarce, the “Mother and Father – for the first The child’s development and well- it has not yet been possible to launch time” meetings. being. How can parents “talk” with the method as a permanent initiative. their child? How can parents read However, there are signs of political Before the birth, there are topics the signals that a new-born baby interest in “Mother and Father – for the that concern the impending birth, as gives out? And how should parents first time” once again and the Child and well as things that relate to the birth react to these signals? Here, it is Adolescent Committee has asked for a itself. Examples of topics which were important to draw the participants’ brief overview of what it would cost to brought up are: experiences into the discussion. run a number of groups a year for this When are people (un)sure about programme in Greve Municipality. Expectations of parenthood & what they are experiencing? There are currently many other ser- preparation for the birth: vices available for parents who are in The preparations that the couples can The early days as a parent: need of support and guidance. These make for the birth are discussed at Parent dynamics and the roles are services which are both preventive this meeting. of parents. What kind of mother/ and, for some people, more therapeutic. Mutual expectations are also dis- father do the participants want In all cases, the focus is on the provi- cussed, with an emphasis on the roles to be? What has surprised the sion of assistance at as early a stage of the father and mother. participants? – Here, we can talk as possible and on drawing on as many Here, the meetings can touch upon both about what “new” aspects of interdisciplinary resources as neces- topics that are practically-oriented, themselves the participants have sary. but more emotional topics such as become aware of since they became The healthcare service in Greve sexuality can also be considered. parents and what aspects of their Municipality is working on special initia- partner they have been surprised tives aimed at vulnerable young moth- Law – finance and/or insurance: by. ers, families with children who were parental authority and its importance, It will also be relevant to discuss born prematurely, families with twins as well as the key legal issues con- the participants’ views as regards and also families of non-Danish ethnic cerning parenthood, are discussed at what is good for the child, what can origin. Work is also carried out to seek this meeting. help to support its development, out post-birth reactions without using The family’s financial prospects and and what personality traits of the additional resources. challenges can be discussed, and the child should be encouraged. insurance policies that you should At some of the meetings, it may take out when you become a family be appropriate to follow up what References may also be considered. was discussed at the last meeting L. Lier, M. Gammeltoft, IJ Knudsen: “Early Once the child has been born, and also to expand on the discus- mother-child relationship” the topics that have already been sions with new angles and aspects. http://www.leksand.se discussed are followed up and new It can be a good idea for the Interdisciplinary knowledge gathering for the rate pool. The Healthcare Service and topics are also brought up. These participants to give examples from other early interdiscplinary initiatives. topics particularly relate to the child’s their everyday lives and to create Danish National Board of Health, 2008 development – how parents can sup- a forum where there is scope to air port the development of their child prejudices and discuss values and in a positive way, the relationship norms.

78 The Non-governmental organisation has been on developing peer support groups and open activities for as a player within the family centre families with children. Family cafes in particular have gained favour with – a vision of collaboration families. There are currently hundreds of family cafes throughout Finland, operated by Folkhälsan, the Manner- Milla Kalliomaa heim League for Child Welfare, and other players. MLL’s current family centre operation is mainly based on volunteering. This article describes the special role which organisations and vol- Nationwide and regional development is financed by Finland’s Slot Machine unteering play in the operation of family centres. The special role of Association (RAY). Municipalities organisations is based on the voluntary work they organise. Organisa- also provide financial support for the tions, or the third sector, integrate with the fourth sector, which consists regional direction of family centres. Nationwide operation includes of families and social networks between people. Partnership-based various peer support groups, family co-operation between municipalities and NGOs faces the challenge of cafes, children’s clubs and support moving from parallel, partly overlapping production of services towards persons for families with children. In addition, MLL’s district organisations co-operative planning and implementation of family centre operations. offer temporary child care help to The Mannerheim League for Child Welfare is a nationwide organisation families with children. Family centres which, in the context of family centres, concentrates on developing peer are operated by MLL’s local associations and their volunteers. District group activities and family cafes. organisations, whose personnel have the task of supporting co-operation between local associations and the municipality, are responsible for The Finnish family centre model is The idea of family centres was directing the operations of family based on co-operation between many introduced in Finland nearly thirty centres. contributing players, aimed at enhanc- years ago, when the first family Municipalities hold the main ing child and family welfare. Family centre was founded by the Man- responsibility for family centre ser- centre work by organisations, munici- nerheim League for Child Welfare vices and develop their operations in palities and other partners have the in Rovaniemi in 1987. Following a co-operation with organisations, con- joint goal of providing support for model set in the United Kingdom, the gregations and other local players. parenting and children’s growth and aim was to bring together municipal Indeed, the role which organisations development at the earliest possible child health clinic services, MLL’s play in the co-operation between fam- stage. In organisations, such as the temporary childcare services and ily centre partners is characterised Mannerheim League for Child Welfare parent groups. Due to the economic by creating and strengthening mutual (MLL) and Folkhälsan, development recession in the 1990s, this kind support between families, through of family centre work has focused on of family centre was never realised volunteering and offering an easily different forms of peer support, parent (Kalliomaa, 2004). Thereafter, the approachable, low-threshold environ- groups and open activities. focus of MLL’s family centre work ment. To achieve this, an organisation

79 requires structures and resources narrow down their task and volun- ised by the organisation. Voluntary for supporting volunteers, and must teering hours as they see fit. They peer group leaders describe their guide their work and forge co-oper- commit to ethical principles, such as motivation in the following manner: ation within the multifaceted family respecting other people, appreciating centre network. children and childhood, and depend- ability, confidentiality and equality. In Volunteering and the fourth return, they have the right to support “Without the sup- sector and guidance. port of peer discussions, Due to the voluntary work which they Support structures for volun- organise, organisations play a central tary work consist of basic training I don’t think I would lead role in family centre operations. It provided for each task, continuing another group” could be said that the third sector education, peer meetings for vol- “Finding a collaborator enfolds the fourth, which consists of unteers, and guidance offered by a families and social networks between worker at the organisation. They also to run the peer group and people. Volunteers rarely engage comprise adherence to consistent become a second group in direct participation in municipal practices in various activities (e.g. in leader was truly motivation- services or the activities of municipal family cafes). Organisations’ pivotal professional working communities. partners in volunteer training include al” (Halonen, Sourander & The reason for this is understand- state-supported study centres offer- Viinikka 2010) able. Voluntary work is directed by a ing liberal adult education, such as different operating logic to paid work. the OK Study Centre and the Svenska Several co-operative projects have studiecentralen operating in Swedish. shown that, when seeking the participation of volunteers, a community Volunteers is required which volunteers can join MLL volunteers, such as group lead- In addition to mutual feedback on the basis of their own terms and ers, family cafe volunteers or support between volunteers, it is important values, and through which they can persons, are not required to have a that they receive support and feed- receive help from the organisations’ vocational education and are not paid back from the organisation’s work- workers. for their work. Volunteering is con- ers. Peer meetings organised by the For many people, voluntary work sidered valuable, as the additional organisation’s workers are indispen- is a path which begins with par- education and experience gained in sable to keeping voluntary work alive. ticipation in peer support activities such activities complement volun- and that continues with meaningful teers’ professional skills. Indeed, Families volunteer work, suited to the volun- one-third of peer group leaders report Families usually find their way to teer’s current life situation, within that the benefit to their professional MLL’s family activities after hearing an organisation. A volunteer is often lives is a motivating factor. However, about them at their child health clinic motivated by the experience of hav- even more important motivators for (32%). In almost as many cases, a ing being helped and consoled by becoming a peer group leader include friend or acquaintance has told them others. This is something they would willingness to help others (48.7%) about MLL’s family work and the like to pass on. and to share one’s own experiences participation possibilities offered. It is important to create an environ- (42.3%). Nearly every parent participating ment in which volunteers can both In voluntary work, motivation is in peer groups refers to the need to learn and obtain support in their supported by volunteer peer meet- talk to other parents facing the same work. Volunteers have the right to ings, training and feedback, organ- situation as the reason for partici-

80 pating. Six out of ten participants tional background can be divided “For many, family join a group in the hope of finding fairly evenly into three groups. new friends. These hopes are often A lower academic degree is the cafes offer indispen- fulfilled, with nearly 70% of par- most common educational back- sable settings for making ticipants reporting that their social ground, while vocational school is friends, sharing parenting network has grown stronger and the second most common, almost that they have made new friends. matched by the number of higher experiences and receiving The second most important effect academic degrees. Approximately peer support. If it wasn’t for of group participation was that half of all visitors visitors feel that them, many things would participants felt better when they their subsistence is secured and had the opportunity to talk to other their social networks are function- be worse. Not everyone is parents. Participants felt that the ing. Many worry about subsistence surrounded by relatives, group contributed to their well- and the scarcity of social networks. and relationships formed being (35.8%). Over a third felt that Over one-third of family cafe visitors this helped them to settle into the often feel weary or fear that the fam- at the family cafe make up area (Halonen, Sourander & Viinikka ily’s income is insufficient to cover for these. Being a parent is 2010). its needs. not an easy or carefree task; Participants in groups led by Two-fifths of those who have volunteers feel that the most signifi- taken the survey report that the without peer support and cant parenting support is provided family cafe helped them to settle friends you can’t get through by friends, spouses and relatives. down in a new location. They also it!!!” (Halonen, Sourander & Child health clinics are first on the referred to the cafe as the place at list of professional help, occupying which they heard about services for Viinikka 2011) fourth position on families’ help families with children. The survey networks after the persons men- currently being conducted suggests tioned above. It is therefore worth- that family cafes offer help and while investing in early support, support to families whose socio- associations, which are independent, bolstering families’ own resources. economic statuses may differ but registered associations. These asso- Families know how to benefit from who have a certain life situation in ciations plan their activities as they mutual support and openly report common. Open responses from visi- see fit and according to the needs of that participating has provided tors provide encouraging feedback participating families. There is not them with new strength (Halonen, to local associations and the entire always even time to co-operate with Sourander & Viinikka 2010). organisation. the municipality. Such co-operation is According to the preliminary also beset by volunteers’ perception results of the family cafe survey NGOs support for and of an imbalance in their relationship currently underway, parents think management of family centre with the municipality’s professionals that children finding company is the work (Carpelan 2007). most important element in attend- NGOs co-operate closely with munic- Concrete co-operation requires ing a family cafe. Strengthening ipal family centres. Such co-opera- co-operative planning; municipal of the parents’ social network is tion is hampered by the fact that the organisations do not have a tradition viewed as the second most common volunteer-based family centre work of planning their services together effect. of local associations is insufficiently with families. Co-operation with the A family cafe reaches a very wide integrated with the rest of the broad field of organisations also variety of families, whose educa- service network. MLL has 566 local takes time. In a report on partner-

81 ships, municipal players viewed they have the task of assisting local Vision for family centre their co-operation with organisa- associations. Each worker oper- co-operation tions as highly important, but also ates at the junction of the public, In Finland, the family centre model is felt that no working time had been third and fourth sectors. Municipal still taking shape. In some municipali- allocated for this (Carpelan 2007). workers can reach a worker during ties, this model is based on network This is the key development chal- office hours, in order to negotiate on co-operation between services in lenge in managing organisations’ issues or plan meetings. The worker different locations and mainly focuses family centre activities. meets families in open meeting on family training. Some munici- In 2009, MLL began a devel- places and events, and visits family palities assemble various municipal opment project with the goal of cafes organised by volunteers. He services and open activities, provided renewing professional guidance of or she also assumes responsibil- by organisations under a single roof. voluntary work and responding to ity for directing demanding vol- Sometimes, family centres run by the challenges posed to co-oper- untary work, which includes e.g. municipalities and organisations ation between municipalities and support person work for families operate side by side and may even organisations. This project aims to with children, for which training offer similar services for families with implement a regional control model and a longer-term commitment are children. for family centre work throughout required of volunteers. Regardless of the model, since Finland by the beginning of 2014. The organisation’s worker helps around the turn of the millennium, Instructors hired for the project by its volunteers to recognise situa- municipalities and organisations fam- the organisation are social services, tions where a parent, who is a mem- ily centre thinking has directed the health and education profession- ber of a parents’ group or visits a development of services for families als. Together with municipalities, family cafe, needs to be referred for with small children. A set of services professional help. Lengthy periods has been under development, based of dejection, relationships in crisis on multi-professional co-operation or exhaustion require professional and a multiple player model, with all help. In such cases, the family in players sharing the goal of support- question is referred by the group or ing families at the earliest possible family cafe for further help. stage. The forerunners of the fam- The organisation’s worker ily centre model have referred to a ensures that families are familiar paradigm shift, which has brought with the entire service path and that families to the centre of services. municipalities are aware of what Families are viewed as proactive organisations offer to families. Fam- experts in their own welfare, capable ilies need support from organisa- of creating and receiving help through tions and municipal services ranged their peer relationships. In the family side by side. This service path centre model, volunteers and families model is illustrated in the figure (1) themselves are recognised as play- attached to the end of this article. ers, as well as municipal profession- The figure reveals that, in addition als and organisation workers. to voluntary work, organisations In practical everyday life, much offer professional services. In most remains to be done in order to cases, such services are based on achieve the goals mentioned above. outsourcing service contracts with Co-operation between municipalities municipalities. and organisations continues to be

82 mainly based on purchased services, centres are being developed in the the project’s first year, co-operation a model in which the municipality area in co-operation with the munici- has already begun in 55 municipali- purchases while the organisation palities. ties. sells. A partnership model, based on Organisations need to invest more The vision underlying the proposed collective service planning and reali- in the professional management of changes is based on genuine co- sation, is seen less often. Especially family centre operations and co- operation and planning and working rare is a situation where families’ operation with the municipalities. together. Municipal resources are mutual networks, family cafes and They also need to improve their also needed to support the organisa- groups, all organised by the organi- follow-up and assessment – system- tions’ voluntary family activities. Each sations, actually form one of the atic information should be generated euro invested by a municipality in municipality’s set of services. The on families’ needs and experiences of an organisation is highly productive. parties usually operate side by side the support they receive. Organisa- According to a recent economic sur- but not together. This is partly due to tions may rely too much on the idea vey, every euro invested in support- the fact that the organisations have that their services are more human, ing voluntary work yields six euros in not publicised open activities run value-based and intimate. Continuous return (Ruralia Institute, University of by volunteers. Another explanation assessment should be harnessed to Helsinki, 2011). The most important can be found in the municipalities investigate whether people actually yield, however, takes the form of themselves. Within municipalities’ feel this way. human welfare, experienced by fami- own development projects, municipal Co-operative development and lies as they offer and receive help. open services may have been estab- political commitment would be Municipalities have no need to lished next door to an organisation’s made easier if the family centre were reinvent the wheel. The family cafes family centre. Development projects defined more clearly. Families do of MLL (439) and Folkhälsan (38) are therefore face the danger of taking a not perceive the service network as a resource which should be brought suffocating, over-organised approach a low-threshold family centre. The into closer co-operation with child to families’ own activities. A volun- network model should be developed health clinics and family centres. Par- tary leader may be crowded out by a into a set of operations which is ents visiting family cafes emphasise professional. easier to grasp. Shared locations and the significance their participation There are also some exemplary environments should be created, of holds for the children in particular. local models in which a municipal the kind which families perceive as The connection between family cafes family centre combines an open family centres. Multi-professional and open daycare centres should be municipal child daycare centre, the co-operation ought to be concretised, reinforced. This would ensure that organisation’s family cafe, stand-in and further professional education the environment better meets the grandparent activities, events organ- is needed to create a new breed of needs of children of various ages. ised by volunteers and municipal service thinking. MLL and Folkhälsan An open child daycare centre could child health clinic and family services have especially good experiences of provide a natural environment for in the same building. Working in shared training for organisational and both a volunteer-run family cafe and the same place brings the organisa- municipal workers. Such training has children’s play and interaction in a tion’s and municipal workers closer been provided in MLL and Folkhäl- pedagogically planned and guided together and makes cooperative plan- san’s co-operative project entitled environment. This would also give ning more natural. In the Vauvaperhe Vahvuutta vanhemmuuteen (‘Strength children in home care access to early (‘Family with a baby’) project of MLL’s to parenting’), which seeks to lay a childhood education and care. Southwest Finland District, a model path from municipal family training, Local solutions vary considerably, was created for a service chain. through guided family groups, to the due to the strong autonomy of munici- Based on this model, new family organisations’ open activities. During palities in Finland. For this reason,

83 it would probably not be worthwhile changes. Co-operative planning vision outlines a new, shared working to even plan a single, shared family ensures that the open services of the culture and a flexible path for fami- centre model. It is essential that the municipality do not overlap with the lies, from peer support to services organisations, other local players organisations’ operations, and that and vice versa. and municipalities engage in joint families in different life situations planning as the nature of their work find the right kind of support. This

The Mannerheim League for Child Welfare is a nationwide non-governmental organisation which promotes the welfare and inclusion of children, adolescents and families with children, by developing different forms of support and by influencing decision-making. The organisation has over 92,000 members and its operations are based on active volunteering within its 566 local associations, and on a nationwide network of 13 districts. Its associations and districts are independent associations which organise various family-supporting activities. They are also responsible for their own finances and operating. Activities are guided by the organisation’s common strategy and national programmes. About NGOs 8,500 people throughout Finland volunteer for work are an essential part which strengthens families with children. In open of the Finnish welfare state. They activities, over 900,000 contacts are made develop services, produce information each year with children, adolescents on people’s needs, and create environments in and parents. which people can participate and help each other. In comparison to other Nordic Countries, NGOs operate exceptionally widely in Finland. The Register of Associa- tions holds about 120,000 associations, and the number of social and health associations alone is 13,000. Volun- teer hours across the entire field of organisations are not annually surveyed in Finland, but in 1996 their number totalled 123 million hours. Among the Member states of the European Union, Finland is in the second highest category in terms of volunteer activity (Volunteering in the European Union, 2010).

Folkhälsan is a non-profit social and healthcare organisation founded in 1921. The organisation employs about 1,800 people in health services, research, education and health-promotion. 100 local associations and a total of around 17,500 members operate throughout Swedish-speaking Finland. Hundreds of volunteers support children and families, for example by assisting in schools, and acting as family cafe leaders, support for women in labour (dou- las), or by participating in or organising swimming schools and other events. Folkhälsan seeks to encourage people to care about their and other people’s health, by both offering practical activities and influencing societal development. Its health-promoting activities are divided into four fields: volunteering, families and relationships, lifestyle questions (physical activities, food, rest, youth work, sexual health), and language development and communication.

References

Carpelan Christa, 2007. Kumppanuus Kalliomaa Milla, artikkeli julkaisussa Perhe vertaistukea järjestettäessä -kunnan ja keskiössä, toim. Auli Paavola, Lastensuojelun kolmannen sektorin yhteinen haaste. Opin- Keskusliitto, 2004. näytetyö. Kymenlaakson AMK, sosiaali- ja terveysala, ylempi ammattikorkeakoulutut- Study on Volunteering in the European Union, kinto. Terveyden edistämisen koulutu- Country Report Finland, 2010. Final Report sohjelma. submitted by GHK. 17 February 2010

Halonen Elisa, Sourander Johanna and Ruralia Institute, University of Helsinki, 2011. Viinikka Anne: MLL’s peer group work Vapaaehtoistoiminnan kansantaloudelliset assessment survey 2010, The Mannerheim vaikutukset, Helsingin yliopiston Ruralia- League for Child Welfare. instituutin raportti 70/2011.

85 Is preventive work cost-effective?

86 Effectiveness and costs of preventive services for children and families

Ismo Linnosmaa, Antti Väisänen, Eero Siljander and Jukka Mäkelä1

Introduction: This article discusses issues related to the economic Starting point: securing the evaluation of preventive services for children and families. A concrete welfare of children and families with children example is presented in the form of child welfare and its financial Although the majority of Finnish evaluation, chosen because child welfare costs have sharply increased people are better off than before, part throughout the new millennium. The number of children placed outside of the population is becoming socially marginalised. There is a danger of the home increased until 2009. Especially rapid growth has been seen social marginalisation, poverty and in the number of 16–17-year-olds outside the home. social deprivation continuing down We begin the article by describing the aims of services for children the generations. Many services for children and families aim to secure and families. We discuss the concept of preventive measures and, the most equal starting points pos- with the help of two examples, demonstrate the possible result if early sible for children. Early intervention intervention fails, alongside the costs of such an outcome. In terms of in problems and support for the everyday life of families with children effectiveness, we take a closer look at services for children and families enhances family life and the safe which might reduce the risk of a child being placed outside the home. development of children. Sometimes, We then examine the concept of cost-effectiveness and current research situations become so grave that they endanger the provision of a safe envi- data on the effects and costs of prevention. In conclusion, we discuss ronment and balanced development the possibilities and problems involved in preventive measures. for the child, in which case it may be necessary to resort to child welfare. 1 We thank Aija Puustinen-Korhonen and Marjatta Kekkonen for their constructive comments on our manuscript. 87 Placing a child outside the home in the growth environment. This existing resources, knowledge and is a child welfare measure of the last preventive role can be viewed as a skills of children and families, in resort. It can have long-term effects counterbalance to heavy child welfare order to promote physical, mental on his/her life, affecting, for example, measures. Family centre activities are and social health, and welfare. his/her education and career (Heino universally available to all families These definitions are also applica- and Johnson, 2010). Placing a child with small children, but services are ble to services for children and fami- outside the home is also expensive also targeted to those who are being lies, especially child welfare. Primary for society. given help and specialised support. prevention covers everything which Among other things, the Child Through family centres, it is also supports the functioning of families Welfare Act 417/2007 lays down pro- possible to offer families non-insti- and thus reduces the likelihood of the visions on preventive child welfare, tutional child welfare services and, child becoming a client of child and support for parenthood, support if necessary, to refer clients onwards family-specific child welfare. Mean- interventions in community care, and (THL, Kasvun kumppanit). while, secondary prevention denotes placing children and adolescents all work aimed at positively affecting outside the home. The Act deter- Cost-effectiveness of preventive the child’s welfare during commu- mines the circumstances in which the measures nity based care. Tertiary prevention threshold for child welfare support includes those measures which are measures is considered to have been Concept of preventive measures used to secure a child’s welfare after crossed. Child welfare measures as The concept of prevention has been a decision has been made to take such cannot be eliminated, without defined by the literature on primary him/her into care. In other words, changing the unfavourable develop- healthcare and health economics (see prevention includes a wide variety of ment conditions which make such Kenkel, 2000). Primary prevention measures before and during the time measures necessary. Rather, demand covers measures which reduce the the child is a child welfare client, as for child welfare can be affected risk of falling ill. For example, regular well as before and after a decision by means of preventive measures exercise and a healthy diet may has been made to place the child and child welfare community-based reduce the risk of illness. Second- outside the home or take him/her into services. Since placement outside ary prevention denotes measures care. the home is a drastic measure from whose aim is to improve the patient’s Family centre work is a new way of the viewpoints of child and adoles- condition after he/she has fallen organising preventive measures. It cent welfare and municipal finances, ill. For example, cancer screening increases families’ opportunities to means of preventing such placements programmes may help to discover receive both peer and professional are required. the illness in time, in which case it is support at an early stage, when their Family centre work is a new method possible to significantly improve the own resources still are reasonably of organising services which support cancer patient’s condition. Tertiary sufficient. This is an ideal stage at children and families with children. It prevention refers to measures taken which to increase the child’s possi- combines easy accessibility, low- to reduce detriments/disabilities bilities of faring well, since a change threshold activities and family inclu- caused by permanent illness. As an of direction at an early stage signifi- sion. The idea is that families find it example, Kenkel (2000) mentions the cantly affects the situation later in easy to approach service providers, appropriate podiatric treatment of life. The origins of a possible need for and that problems related to family diabetes patients, which can prevent child welfare at a later stage begin welfare and health can be solved as certain serious complications caused to develop long before the actual comprehensively as possible. The by the disease. Preventive work is concern has emerged. task of family centres is to promote preceded by a promotive approach, Family centre work is an example of family welfare and prevent problems which refers to strengthening the a universal social policy service. An

88 activity is termed universal when it are particularly reflected in the explained by increased use of ser- is targeted at all members of a given growing number of municipal child vices and higher unit costs, but also, group, such as families with children, welfare clients. Cuts in services first and foremost, by the institution- while the aim of targeted measures is during the recession of the 1990s alisation of all services. (Kuoppala to improve the life situation and wel- also affected services for families and Säkkinen, 2010). An increasing fare of a selected group, for example with children, such as domestic aid. portion of children placed outside a certain high-risk group. Primary Poverty among families with children the home are placed in child welfare prevention is universal and all chil- had been decreasing over a long institutions, a trend clearly reflected dren and adolescents in Finland are period, but began to increase in 1995 in growing costs. The daily cost of subject to it. Meanwhile, secondary and continued to do so until 2005 institutional care is four times that and tertiary preventive measures are (Salmi et al., 2009). These factors of foster family care (Väisänen and targeted at a certain child or fam- were expressed in a growing need for Hujanen, 2010). Municipalities are ily, whose problem or risk has been child welfare. The number of children being faced with difficult decisions recognised. placed outside the home grew stead- due to high costs. Indeed, children A significant element of preven- ily from 1991 all the way to 2009. are in danger of inequitable treat- tion consists of recognising high-risk During this period, the figure almost ment between municipalities due to groups and allocating resources doubled to more than 16,600 children the municipalities’ varying financial to the most vulnerable population and adolescents. With respect to situations. All in all, the economic groups. Child welfare can be used teenagers in particular, the number incentives to reduce the out-of-home as an example, since there appears of children placed outside the home placement are great. to be a clear connection between has been growing steadily throughout family poverty and the need for child the 2000s. This is probably explained Early intervention and the costs welfare. Consequently, it can be seen by growing ill-being among young of antisocial behaviour and social that financial subsidies allocated to people (Kuoppala and Säkkinen, marginalisation in young people the poorest families have preventive 2009). The same trend can also be Early intervention is a working meth- effects. explained by the increasing mental od based on which the child’s school, health problems faced by young social services and families co-oper- Failure to take preventive measures people and insufficient availability of ate to prevent antisocial behaviour leads to the culmination of problems mental health services for children and social marginalisation, through and major costs and adolescents (Child Welfare Act timely recognition of problems in Services for children and adolescents 417/2007). young people’s lives and in their can also be seen to have a broad In 2009, almost a billion euros was educational progress (Työministeriö, role in supporting lives and develop- spent on child welfare services. Of 2004). It is possible to intervene at an ment, as well as preventing problems. this sum, almost 600 million euros early stage in such problems, steer- Below are two examples of the possi- were spent on out-of-home care ing the young person’s development ble consequences of failed prevention services (Sotkanet), which entailed in a positive direction before more or insufficient early intervention, and yearly costs of about 40,000 euros serious and expensive action is initi- the resulting costs to society. per each child placed outside the ated by the authorities. home (Kumpulainen, 2010). Child Antisocial behaviour and social Trends in child welfare use and welfare costs are clearly increasing at marginalisation in young people costs a faster pace than in other social and may incur expenses for society. A In Finland, problems experienced health services, excluding the costs follow-up study conducted in the by families experiencing ill-being of services for older and disabled United Kingdom (Scott et al., 2001), amongst children and adolescents people. Such growth in expenses is surveyed the costs of antisocial

89 behaviour in young people and adults international study (Healey et al., employer’s additional expenses added. aged 10 to 28. The study noted that 2004) noted that workforce participa- The impact on the public economy con- a young person with behavioural tion, the employment rate and the sists of lost tax revenue and increased problems costs society three times income of young people exhibiting service expenditure. However, Kajano- as much as a young person belong- antisocial behaviour are lower than ja (2000) points out that these calcula- ing to the average population, when those of the whole population at both tions are likely to underestimate the costs are assessed in terms of public 18 and 32 years of age, i.e. long after total costs of social marginalisation. expenditure on public services. Most the period of youth. Young people The need for child welfare, and costs caused by antisocial young peo- in whom antisocial tendencies are social marginalisation amongst young ple are incurred in the form of police observed at an early age tend to people, are extreme examples of the and judicial services (about 60% spend longer periods unemployed possible consequences of allowing of total costs), while the education and have a criminal record. Culmina- young people’s problems to accumu- sector (about 20%) accounts for the tion of such antisocial behaviour can late. Although the situation is nowhere second greatest cost levels and child lead to social marginalisation from near as grave for most children and welfare comes third (about 10%). education and working life. young people, appropriate and timely Health service costs were significant- The National Audit Office of Finland prevention and early intervention may ly smaller. When the costs of public has estimated that a young person in also improve the lives of “ordinary” services are taken into account, at a state of permanent social marginali- children. Clearly, some problems are its highest the total cost can amount sation from the labour market costs only noticed at a later age and cannot to almost 70,000 pounds at 1998 society around one million euros (Val- always be solved, but this does not prices (Scott et al., 2001), or around tiontalouden tarkastusvirasto, 2007). eliminate the clear need for preventive 100,000 euros at current prices. One This figure corresponds to the cost of measures. Family centre work can be youth unemployment to the national used to combine professionals from economy. According to Nilsson and multiple sectors to co-operate for the Wadeskog (2008), this million-euro benefit of children. Family centres also price tag measures only around half support families and parents, while of the actual costs of social marginali- encouraging parents to participate in sation. This is because, in addition to various activities. This makes it easy production losses, the socially mar- to approach problems and enables ginalised are associated with greater early-stage intervention. Although, in than average use of services such as its current form, family centre work the police and the judicial system, focuses on early childhood, services employment authorities, social wel- available in the centres include social fare and social security. and family work services, home-help Kajanoja (2000) has also estimated services, child welfare services and the costs of social marginalisation. non-institutional adolescent psychiatry According to his calculations, perma- services (THL, Kasvun kumppanit). nent social marginalisation causes Family centre work represents a a loss to national income of around new method of organising preventive 700,000 euros and an increase of services for children and families. 450,000 euros to the public economy, However, no direct research evidence 2 The base figures from the year 1996 2 were 3 million marks in losses to national at current values. Loss of national exists on the effectiveness and costs income and a 2 million mark increase in income has been calculated according of this, although indirect evidence is public expenditure. to the lowest wage group, with the available on its effectiveness.

90 Cost-effectiveness Figure 1 Basic concepts in the evaluation of From input to effectiveness cost-effectiveness The concept of cost-effectiveness Inputs Output Effectiveness can be defined with the help of (e.g. person- (e.g. inpatient (changes in the concepts of inputs, output and nel, premises) days) welfare) effectiveness (see Fig. 1).

Input denotes the resources used in service production, such as work Source: Sintonen and Pekurinen (2006) force, equipment, machines and production materials. In municipal child welfare services, a focal production factor can be found in the input of a social worker and, for example, family worker, but service achieving positive effects in terms be noted that service use does not production also requires physical of clients’ welfare. always result in the desired outcome capital such as premises. If social Sintonen and Pekurinen (2006) – service effectiveness can remain workers decide to place a child in define effectiveness as a change in small or even negative in value. a professional family home instead final output which is in accordance of a foster family home, production with the goal of the action taken. To The cost-effectiveness of preventive factors include input and the neces- define the effectiveness of services, measures sary premises, as well as factors information is needed on both the Evaluating the cost-effectiveness of needed to maintain the premises, length and quality of life (Williams, preventive measures is difficult due such as energy. Input use is often 1985). In the case of child welfare, to the fact that the benefits of such measured based on production the child’s well-being is a natural measures are usually realised only in costs. candidate as the life quality vari- the future. Chronologically, a preven- Combining different kinds of able (see e.g. Knapp, 1984). tive measure precedes any positive inputs creates an output compris- Fig. 2 depicts the effectiveness of effects it may have. In such a case, ing the amount of services and a child welfare service. For exam- variations in effectiveness are usually goods produced. For example, child ple, this service may involve placing also explained by other factors influ- welfare services include social work the child outside the home or taking encing the child’s welfare, such as his case management and guidance, the child into care. In the example, or her education. A research-related support interventions in child the child care service is effective challenge in evaluating the effective- welfare community care (e.g. family because the welfare of a child who ness of preventive measures lies in work and family rehabilitation) and is provided with the service is distinguishing the measure’s effec- substitute care services which can greater than that of a child who is tiveness from changes in the child’s be realised as institutional care, left without. The effectiveness of welfare which are due to other factors professional foster care or foster the service can be measured with (see Fig. 3). This is probably the family care. Nonetheless, services the help of area E. Effectiveness main reason for the scarcity of direct as such are not the actual out- takes into account both the change research evidence on the effective- come. Instead, the use of services in welfare at any given moment, and ness of preventive measures. can hopefully contribute towards the duration of the effect. It should

91 depicted as shown in Fig. 5, in which Figure 2 the costs and effectiveness of commu- The effectiveness of child welfare services nity care are compared to those of care in a foster family. In the figure shown Welfare above, the effectiveness and costs of community care are positioned in the middle. If the costs and effectiveness of placing a child in a foster family are in area I, the placement costs more than community care and it is less effective than child welfare community care. In Welfare with services; such a case, for the decision-maker observed welfare community care is a better alternative than foster family care. Whereas, if the costs and effectiveness of placing the child in a foster family are located in E area IV, foster family care is a better alternative than community care, since the costs of placing the child in a foster Welfare without services family are smaller and the effectiveness greater than in the case of child welfare Start of service Time community care. Areas II and III are more challenging from the viewpoint of decision-making than areas I and IV. Let us begin by Decision-making in the evaluation of decided to implement two, mutually examining a situation in which the cost-effectiveness exclusive alternatives in organising costs and effectiveness of foster family When cost-effectiveness is assessed, a child’s care. In alternative A, the care land in area II. In this case, foster two or several alternative measures decision-maker chooses enhanced family care costs more than community of services are compared to each oth- community care, whose expected care, but is also more effective. Now er. In child welfare, these can include, effectiveness is EA and costs CA. the decision-maker needs to evaluate say, enhanced community care ser- Under alternative B, the decision- how much extra he/she is willing to vices and the child’s placement in a maker chooses to place the child in a pay for additional effectiveness EB – EA foster family. Different measures are foster family. Care in a foster family generated through foster family care. If 3 often used to pursue the same goal, is expected to yield efficiency EB and the additional cost calculated for each which is usually that of securing or costs CB. For the sake of simplicity, let improving child welfare. Alternative us assume that the costs and benefits measures all have a certain effective- of the two alternatives are known to 3 In economic evaluation literature, additional ness and scant financial resources the decision-maker. effectiveness BE – EA and additional costs CB – CA are required in order to put them into Which of these two alternatives are termed incremental effectiveness and costs. practice. should the decision-maker choose? On the other hand, the cost calculated for an effectiveness unit is termed the incremental Fig. 4 depicts a situation in which In economic evaluation literature, a cost-effectiveness ratio and calculated using the a social welfare decision-maker has similar decision-making situation is formula ICER = (CB-CA)/(EB-EA).

effectiveness unit (CB – CA )/(EB – EA) is Figure 3 lower than the decision-maker’s will- Effectiveness of preventive measures ingness to pay, placing the child in a foster family is a better alternative Welfare Welfare with education and preventive than community care. If the additional measures; observed welfare cost surpasses the decision-maker’s willingness to pay, community care would be a better alternative. (See e.g. Sintonen and Pekurinen, 2006) If the costs and effectiveness of Welfare with education placing the child outside the home are located in area III, community Welfare without prevention care will yield greater effectiveness or education but it will also cost more than placing the child in a foster family. The same decision-making rules as in case II apply to this situation. Education d What is known about preventive Preventive measure Time work? Can family centre work reduce the subsequent need for child welfare or other specialised services, that is to say, is it an effective form of primary prevention? No direct answer to this Figure 4 can be found based on research. Comparing the alternatives However, the theoretical basis of fam- (EA,CA ) ily centre work can be demonstrated through research. A child’s survival A: community care through the various challenges of B: foster family care life, without developing serious symptoms, is a process involving A multiple factors. Some of these factors arise from the child’s own profile of abilities or special difficulties, and his or her temperament. Most factors, however, are related to how the adults close to the child respond to B the child’s needs and support his or her development. Parenthood is an important varia- ble, any lack of which in the child’s or adolescent’s current situation leads (EB,CB) to a growing need for child welfare:

93 primary prevention relates to home visits made during pregnancy and Figure 5 C Decision-making the child’s early years. According to a longitudinal study of international significance conducted in Finland, I II supervised home visits by nurses

(EB,CB) during the child’s early years significantly reduced mental disorders and CB – CA outwardly visible behavioural disorders in young people (Aronen and E - E Arajärvi, 2000). Although the study (EA,CA) B A E did not directly evaluate child welfare measures, outwardly visible symptoms in young people were usually III IV among the factors creating a need to take the child into care. Consequent- ly, as home visits reduce the number of symptoms, the need to take children into care is likely to decrease among this population. In a Swedish study evaluating the economic effects of interventions, it was concluded in child welfare, society assumes under a notable burden, the need for that, purely on the basis that they part of the parent’s primary respon- wider resources is obvious. The more reduce depression, the cost-benefit sibility for the child’s development. naturally support is available, the ratio of home visits is twofold com- Nonetheless, insufficient parenting easier it is to receive. Consequently, pared to ordinary cost-effectiveness is not only connected to parents but child health clinics and the related limits used in healthcare (one DALY, also to the broader context in which home-help services, home visits and or a disability-adjusted life year, was the community provides parents with family work as well as parent groups obtained with 25,000 euros, while the the support they need. This basic are all forms of work which can be acceptable cost-effectiveness limit assumption of a communally-borne assumed to help parents when there is considered to be 50,000 euros in burden of parenthood is characteris- is a need, but not too great a need, Sweden) (Bremberg, 2007). Similarly, tic of the way human beings care for for support. In a family centre, sup- in the US, the Nurse-Family Partner- children. It is also indispensable in port services can be organised in a ship programme (Eckenrode et al., light of human maturation, which is way which allows the maximum num- 2010) has been deemed an effective exceptionally long and wearing on the ber of players working with families way of reducing social marginalisa- parents’ resources. with children to offer their services tion in socially high-risk families. Although children are a huge and forms of support, all within the These home visit studies have been blessing, even an ordinary childhood same environment. Such an organi- conducted in child health clinics cat- demands an immense amount of time sational approach may increase the egorised as universal. The effective- and mental and emotional resources usability of services and the effectiveness of home visit work has also been from parents. In a situation in which ness of early prevention. studied amongst a group of young the child faces developmental chal- The greatest existing source people, namely the group in which lenges or the parents are otherwise of evidence on different forms of the number of children taken into care

94 has grown most in Finland. In the US, evaluated programmes (Incredible the ratio of municipal social work- the most heavily researched intensive Years, ICDP/Vägledande samspel, ers to the number of children within home visit work method is multi- COPE, etc.), the more directly this will the municipality placed outside the systemic therapy, MST. In Finland, prevent developments which result in home during the following year. for example the Nopsa family work a need for child welfare. According to the results, employing a conducted by the Social Services Family group conferences are an social worker reduces the number of Department of the City of Helsinki example of effective secondary pre- children placed outside the home in has been piloted based on the same vention, because they usually lead to the following year. Hiring one social principles. Nopsa family work inten- a solution other than taking the child worker in the previous year (in 2001 sively addressed families through into care. In family group confer- and 2003) reduced the number of home visits, in a situation in which ences, parents can aim at a solution children placed outside the home by a young person is under an immedi- alongside their own close family and an average of 0.37 children in 2002 ate risk of being taken into care. In associates, which is then approved and an average of 0.38 in 2004. 2009, Nopsa work involved 110 young or rejected by a social worker (Heino, persons, of which only 19 were later 2003). This form of work requires a Why no investment in placed outside the home. Earlier on, change in professionals’ attitudes prevention? a social worker evaluated all of the rather than their work input, since Many factors influence decision-mak- young people involved as being in responsibility for the actual confer- ers’ commitment to preventive work. immediate need of entry into care, ence lies with the family and their The most important of these is uncer- but this was the eventual fate of only close acquaintances. Family group tainty about what is viable. Many 17% (Hovi and Mansikkasalo 2010). conferences have proven able to solve measures and programmes which are Consequently, within only two years, various, dead-end situations, such as said to prevent a later need for more Nopsa work has proven an effective the threat of the child’s being immedi- expensive investments, but no direct way of preventing young people from ately taken into care. evidence is available on their effec- being taken into care. Investments in the service network tiveness. Collecting direct evidence is Another form of preventive work may also prevent children from being genuinely difficult. As in this article, closely associated with family centres placed outside the home. Väisänen it is therefore necessary to rely partly is peer support. Peer support is usu- and Linnosmaa (2011) ask whether on indirect evidence. For example, ally understood to take place between the number of municipal social work- this has been done in Imatra, where people in a certain type of situation, ers affects the number of children the total costs of specialised services such as the parents of small children placed outside the home. This study in various sectors had risen steeply meeting in a family centre’s family began from the hypothesis that if throughout the 2000s. There, home cafe. Peer group activities can also the number of social workers in a visits by child health clinics were incorporate professional guidance municipality is large, it is possible to supported by a new team. In just one for supportive parenthood, a form monitor the welfare of children and year, a downward turn in the costs of of work comparable to many effec- families in an effective manner and expensive specialised services was tive international programmes with to take measures at a sufficiently seen at macro level (Imatra, 2011). a proven track record of cost-effec- early stage to prevent children being This highlights another problem tiveness, such as the Incredible Years placed outside the home. Early related to investing in preventive programme (O’Neill et al., 2010). The detection of family problems may work, namely sectoral thinking. Since more systematically parent groups lead to increased use of community sectors hold budget responsibil- are used to support the parenthood of based services and decreased the ity, preventive work ought to create parents whose children have behav- number of placements outside the savings in the sector in question. ioural disorders, as in structured and home. The researchers observed However, the situation may be such

95 that an investment in healthcare before the results of the investment adolescent welfare can be supported reduces costs in the social sector, show. The savings in the Imatra and in a way which reduces the need for or that supporting the group forma- Helsinki Nopsa cases were seen cumbersome and expensive activi- tion of school classes with education quickly, in the following budget year, ties. This problem, too, is best over- sector resources prevents costs in but in practice this still involves come by means of research and pro- specialised healthcare. It is difficult a transition period during which viding decision-makers with research to envisage a solution to this problem expenditure exceeds savings. Since data. For example, it is important to without multisectoral management of future savings can be significant, sur- be familiar with developments which preventive work. It is equally difficult mounting this problem should be an can lead to a need for child welfare to resolve the issue of thinking and important topic in economic research. and which could be transformed into decision-making being closely con- The key question is whether greater ability to cope at an earlier nected to budget, council or election decision-makers believe that preven- stage. This is the only way to plan periods. When investments are made tive work is possible and useful. Do sensible, universal and specialised in child and family welfare, a wait of they believe that, even in difficult preventive measures which are also several years is often unavoidable situations, development of child and cost-effective.

96 References

Aronen, E.T., Arajärvi, T., 2000, Effects of Kajanoja, J., 2000, Syrjäytymisen hinta, Center for Health and Social Economics, early intervention psychiatric symptoms of teoksessa Heikkilä M., Karjalainen, J. (toim.), National Institute for Health and Welfare young adults in low-risk and high-risk fami- 2000, Köyhyys ja hyvinvointivaltion murros, lies, American Journal of Orthopsychiatry Gaudeamus, Helsinki Willams, A., 1985, Economics of coronary 70(2), pp. 223-232 artery bypass grafting, British Medical Knapp, M., 1984, The economics of social care, Journal, 291(3), pp. 326-329 Bremberg, S., 2007, Hälsoekonomi for Studies in social policy, MacMillan Education kommunala satsingar på barn och ungdom, Ltd, London Acts and provisions: En method for att uppskatta nyttan I förhål- Finlex, Child Welfare Act 417/2007. lande till konstnaden för olika insatser, Kuoppala, T., Säkkinen, S., 2010, Lastensuojelu statens Folkhälsoinstitut 2009, THL, Tilastoraportti 29/2010. Online publications: Kumpulainen, A., 2010, Kuuden suurimman Eckenrode, J., Campa, M., Luckey, D.W., Nilsson, I., Wadeskog, A., 2008, Det är bättre kaupungin lastensuojelu vuonna 2009, Henderson, C.R., Cole, R., Kitzman, H., att stamma i backen an i ån, Institute of Socio- Lastensuojelun työryhmä, http://www. Anson, E., Sidora-Arcoleo, K., Powers, Ecological Economics kuusikkokunnat.fi/ J., Olds, D., 2010, Long-term effects of prenatal and infancy nurse home visitation O’Neill, D., McGilloway, Donelly, M., Bywater, THL, Kasvun Kumppanit: on the life course of youths, Arch Pediatr T., Kelly, P., 2010, A cost-benefit analysis of http://kasvunkumppanit.thl.fi/fi_FI/web/ Adolesc Med., 164(1), pp. 9-15 early childhood prevention: Evidence from an kasvunkumppanit-fi experimental evaluation of the incredible years Healey, A., Knapp, M., Farrington, D.A., parenting program, Department of Economics, Sotkanet: http://uusi.sotkanet.fi/portal/ 2004, Adult labour market implications NUI Maynooth. page/portal/etusivu of antisocial behaviour in childhood and Scott S., Knapp M., Henderson J., Maughan B., Työministeriö, 2004, Early Intervention adolescence: findings from a UK longitu- 2001, Financial cost of social exclusion: follow as an Employment Policy Method – The dinal study, Applied Economics, 36(2), pp. up study of antisocial children into adulthood, Objective: A Good Work Career, EU project/ 93-105 British Medical Journal, 323, pp. 191-194. VS/2003/0678s, Ministry of Labour, Helsinki: http://www.esr.fi/mol/en/99_pdf/ Heino, T., 2003, Kokemuksia läheisneuvon- Salmi, M., Sauli, H., Lammi-Taskula, J., 2009, en/90_publications/earlyintervention_final- pidoista. Päiväkirja-aineiston raportointi. Lapsiperheiden toimeentulo, teoksessa report.pdf Stakes. Aiheita 4/2003. Lammi-Taskula, J., Karvonen, S., Ahström, S., 2009, Lapsiperheiden hyvinvointi, Terveyden ja Heino, T., Johnson, M., 2010, Huostassa hyvinvoinnin laitos, Helsinki olleet nuorina aikuisina, teoksessa Hämäläinen, U., Kangas, O., 2010, Perhepi- Sintonen, H., Pekurinen, M., 2006, Tervey- irissä, KELA, Helsinki staloustiede, WSOY Oppimateriaalit Oy, Helsinki. Hovi, A., Mansikkasalo, K. 2010. Nopean puuttumisen perhetyö – Nopsa. Info- Valtiontalouden tarkastusvirasto, 2007, tilaisuus 18.03.2010. Dia-esitys Nuorten syrjäytymisen ehkäisy, Toimintaker- tomus 146/2007, Valtiontalouden tarkastus- Imatran, Sosiaali- ja terveystoimi. 3/3 virasto osavuosikatsaus 1.1.-31.12.2010. Sosiaali- ja terveyslautakunta 24.2.2011 Väisänen, A., Hujanen, T., 2010, Sosiaalihuol- lon yksikkökustannukset Suomessa vuonna Kenkel, D., 2000, Prevention in Culyer A. 2007, THL, Avauksia 1/2010 and Newhouse J. (eds.), 2000, Handbook of Health Economics, Elsevier Science, Väisänen, A., Linnosmaa, I., 2011, Exploring Amsterdam the demand for child welfare services: Do social workers have a preventive role? Working paper,

97 Family centre entails changes in professional skills and knowledge

98 Knowledge advancement ents’ daily life, captures each other’s knowledge and is influenced by it concerning family centres and changes its working method. The dynamic means that the work can be revised and the level of knowledge Vibeke Bing and the quality of the work are gradually raised. The working method used by the family centres is not static. Over the years, new research observations have been added to the Knowledge advancement are available, nor are they appropri- work. The initiative has benefited concerning a new practice ate for such a relatively new initiative. from knowledge concerning the way The composition and completeness Controlled effect studies are intend- in which the foundations for health of family centres is a new practice ed to assess whether previously are laid during pregnancy, the devel- that was formulated in a partner- researched and proposed methods opment of the brain and attachment, ship between various professional actually achieve the effect they are relationships and infant research. Val- groups and thanks to interaction expected to give. In the case of family ues and political messages today are with parents and children. If we centres, knowledge which contributes not the same as they were yesterday. consider what knowledge favours a to observations and clarification from The Convention on the Rights of the development towards a new practice, an internal perspective has advan- Child and equal treatment are require- Vanderbroucke (2008) believes that tages compared with studies which ments that leave their mark on prac- the ranking of the suitability and can demonstrate the effects of the tice. If the aim was once to prevent strength of study designs within the family centres. The best knowledge the failure of care, the aim today is to known evidence pyramid must be that is currently available concerning provide more scope for self-esteem turned upside down. In these cases, family centres is based largely on and good relationships. case studies and qualitative data are observational studies, case studies the most suitable design, whilst ran- and qualitative data whose aim is to The context of the family domised controlled studies (RCT) are provide new knowledge through find- centres considered to be the least suitable. ings and explanations. As part of strategic public health Despite this, evidence of the effects Family centres are an organisa- work, family centres are expected of family centres is still sought. tional form that is filled with learning. to contribute to the reduction of dif- However, no studies of these effects A working group learns about the par- ferences in health. In all the Nordic

99 countries, both child poverty and the family centre more accessible. oneself to physical and psychologi- relative poverty have increased in Parents say that when they are there, cal distance and depth. At a univer- recent decades. The gap between rich they learn about children and parent- sal level, easy-going contacts are and poor has increased. With differing. They expand their social contact established which lead to individu- ences in income come differences in network and get a chance to relax ally adapted initiatives. Interviewed health, and a recurring question is in a secure environment where they parents testify that they received the whether the family centres, with their know that social support is in reach. right help at the right time thanks expanded resources, reach out to The staff is important, as profession- to this availability and the fact that the socio-economically vulnerable or als create structure and a friendly they got to know the staff at an early whether they are only visited by the atmosphere, so that parents feel stage. For the staff, the collabora- well-heeled. welcome. They get support to enjoy tion clarifies the professional roles, A family’s general quality of life and bond with their children. When and knowledge is increased through is after all the factor that has the Lindskov (2010) interprets family the proximity to other professional biggest influence on the health of centres in relation to modernity, she groups. The everyday contact with young children. The family centres describes the parents’ perception of all the ever-present young children form part of a context, and their the initiative. At family centres, par- reinforces the child perspective importance must be interpreted with ents receive professional advice from (Abrahamsson, 2009). regard to the way in which children experts. They also say that they can So, are all social groups reached and families live their lives (Bing, share experiences with other parents by the family centre’s resources? 2003). Nordic children tend to live and thereby learn about child-rearing The answer is yes. A study of all the their lives between home and school. and parenthood. According to the parents who visited the open nurs- From a fairly young age, they spend parents, the task of the staff is there- eries at 16 family centres in Västra a lot of their time at nursery and fore to facilitate the meetings. Family Götaland shows this to be the case. school amongst other children and centres are also used as play centres, The visitors accurately reflected the professionals. Mothers and fathers where children can socialise, play and socio-economic structure of the popu- are well-educated and both are in sing with adults and other children. lation in the area where their family paid employment. The family mem- The staff prepares and organises centre was located. Information from bers therefore spend their time each everything. Finally, the family centres the 437 parent visitors also showed day in different arenas. Fathers, like act as a living room for socialising that the family centres are of particu- mothers, are becoming increasingly and social interaction. According to lar importance for immigrants. There involved in their children’s lives and parents, the role of the staff is there- is therefore an argument that family have to make an effort to balance fore to be a good host with the task of centres have the potential to contrib- their working life and family life. The inviting guests and making sure that ute to social inclusion and greater statutory parental leave has there- everyone is happy. equality in terms of health. fore become an exclusive period for In other words, the professional parents and children, time that they role is changing. Staff are expected own together. to perform a broad spectrum of The way in which the link with an roles. The professional role will vary open nursery at a family centre bene- depending on whether one is acting fits the parents of young children has as an expert, hostess, play leader or been evaluated in a qualitative study circle leader. As a member of staff, of six family centres (Abrahamsson you must continually switch between et al, 2009). The study shows that all these roles. The new professional- it is the open nursery which makes ism involves consciously adapting

100 References

Abrahamsson A, Bing V, Löfström M (2009) Haugland R, Rønning J, Lenschow K (2006) Nordisk forskarträff – kunskap om familje- Familjecentraler i Västra Götaland – en Evaluering av forsøk med familiesentere i Norge centraler. Föreningen för familjecentralers utvärdering. Västra Götaland Public Health Regionsenter for barn og unges psykiske helse. främjande, 2007. Committee. Department of Clinical Medicine, University of Perdahl, A-L (2009) Verksamhetsutveckling Tromsø. i socialt arbete – konstruktion av en inter- Bing V (1997) Morötter och maskrosor om aktiv modell. Dissertation 2009. School of uppväxtvillkor och förebyggande sociala Hjortsjö M (2005) Med samarbete i sikte om Social Work, Umeå University. tjänster. Borlänge Public Health Institute. samordnade insatser och samlokaliserade Petersen A & Lupton D (2000) The new pub- familjecentraler. Dissertation, School of Social lic health – health and self in the age of risk. Bing V (2003) Små, få och fattiga – om Work, Lund University. Sage Publications, London. barn och folkhälsa. Lund Studentlitteratur. Vandenbroucke JP (2008) Observational Bing V (2005) Föräldrastöd och samverkan, Köhler L (2008) Dagens Medicin 13.02.2008. Research, Randomised trials, and two Views familjecentralen i ett folkhälsoperspektiv. of Medical Science. PLos Medicine March Gothia, Stockholm. Lindskov C (2010) Family Centre Practice and 2008 Volume 5 Issue 3. Familjecentraler kartläggning och kun- Modernity a qualitative study from Sweden. skapsöversikt, National Institute of Public Doctoral Thesis, Kristianstad Academic Press Health and the Institute for the Develop- 1:2010. ment of Methods in Social Work: Västerås. National Board of Health and Welfare 2008. Lundström Mattsson Å (2004) Socialt förebyg- Research seminar on family centres, 10-12 gande arbete – med familjecentralen som March 2008. Stiftelsen Allmänna Barn- arena. FoU Södertörns Skriftserie nr 41/04, huset. Västerås 2008. Sollentuna.

Gustafson M (1983) Öppen förskola. Liber, Nordiskt ljus över omtyckt hus, dokumentation Stockholm. av den nordiska familjecentralskonferensen i Stenungsund 2005. Träffpunkt June 2005.

101 Collaboration in the Family’s House

Anette M. Thyrhaug, Gørill W. Vedeler, Monica Martinussen and Frode Adolfsen,

The competence, commitment and Research Council of Norway, 2010; Study participants co-operation of employees are of Sitter, 2008). Other studies from the All the employees of the six original crucial significance for the quality of health sector indicated that the lack Family’s Houses in the pilot project the services that are provided for chil- of collaboration could have serious were invited to participate in a ques- dren, adolescents and their families. health consequences for patients, in tionnaire survey. A total of 71 people It has long been a requirement within addition to reduced levels of satisfac- (91% of which were women) responded the healthcare sector that profes- tion with services (Fewster-Thuente to the survey. This represents a sionals should work together not and Velsor-Friedrich, 2008). The response rate of 51%. The majority of only in order to make services more collaboration between professions participants were married/living with efficient, but also because children and services is thus viewed as an partners (90%), and a large proportion and parents with problems have many important resource within mental had children under the age of 18 living needs and different competence are health work by those who will receive at home (66%). required in order to help them. It is the services, personnel within the therefore vital that the various profes- healthcare and care services and the Results sionals are able to work together with Norwegian authorities. The questionnaire presented various regard to solutions, so that those in Working with other people is both statements regarding what it is like to need of help receive the best pos- rewarding and stressful. Several stud- work at a Family’s House. Responses sible service in a timely manner and ies have suggested an increased risk to the questions were given using a have the opportunity to participate. of burn-out amongst health and peda- five-point scale, ranging from “to a A number of evaluations have been gogical personnel (Maslach, Schaufeli very little extent” through to “to a very carried out of the Plan for Advancing and Leiter, 2001). On the other hand, great extent”. Table 1 presents the Mental Health Care (Research Council such jobs also provide opportunities proportion that were in agreement with of Norway, 2010). Amongst other to help others and to have a valuable the statements to a great or very great things, these evaluations indicated and meaningful job with opportuni- extent. that a number of improvements have ties to work with other colleagues. been made, such as the provision of We have therefore decided to look in Participants were also asked to more municipal health personnel. more detail at employees who work describe what was positive or benefi- However, in the opinion of both users at Family’s Houses in Norway and the cial about the Family’s House organiza- and health personnel, there is room way in which they assess their work tion and what was challenging. Several for improvement with regard to col- situation and the collaboration that participants mentioned that readily laboration between professions and takes place within Family’s Houses accessible low-threshold services were services (Andersson and Ose, 2007; (Adolfsen and Martinussen, 2010). beneficial for users and that the model

102 had led to increased user partici- found that maintaining professional gested alternatives, training/courses pation. As regards challenges and secrecy was challenging. A consider- and guidance were mentioned as disadvantages, the use of time and able number (50%) considered it to being either important or extremely the considerable number of meet- be easy to obtain assistance from important (around 73%), whilst better ings were mentioned, along with the other departments, and that there collaboration was considered to be fact that this meant less time spent was mutual respect between the either important or extremely impor- with users. Other challenges were departments (60%). The employees tant by 66%. that the collaboration did not work were also asked what was needed in Burnout and engagement were as expected, and that the employees order to do a good job. Of the sug- also surveyed amongst the employ-

Tabell 1 Professionals’ views of working in the Family’s House To a great/ very great extent Family’s House has helped to improve the opportunities for informal collaboration 85% between the different services.

I am satisfied with the way the work is organised at the Family’s House. 83%

I have developed a more extensive professional network by working in the Family’s House. 83%

Family’s House has helped to improve the opportunities for informal collaboration bet- 82% ween the various services.

There has been a stronger focus on the mental health of children and adolescents since 71% the establishment of the Family’s House.

I have become aware of how other services work in my municipality through working at a 65% Family’s House.

The courses in which I have participated in during the establishment of the Family’s House 64% have been useful for my job with children and adolescents.

I feel that my service has gained added competence as a result of the establishment of the 58% Family’s House.

The Family’s House has led to changes in the way in which my service works in relation to 53% children and adolescents.

103 ees. The employees generally scored in a Family’s House and thought model concerned the use of the lower than a comparative group on that this had led to a more extensive professional secrecy, and the fact two of the three aspects of becoming professional network and better that a considerable amount of time burnout (exhaustion and cynicism) opportunities for both formal and was wasted on meetings, which and higher on engagement (Adolfsen informal collaboration between the resulted in less time being spent with and Martinussen, 2010). services. The Family’s House model the users. was reported as being favourable Conclusion due to the ease of access for users The majority of employees were and greater user participation. The therefore very positive about working challenges associated with the

References

Adolfsen, F. and Martinussen, M. (2010). Psychology, 52, 397-422. doi: 10.1146/annurev. rhaug ([email protected]), Regional Samhandling i familiens hus i Norge. Pre- psych.52.1.397 Centre for Child and Youth Mental Health sentation at the Nordisk familiecenterkon- and Child Welfare, University of Tromsø, ferens (Nordic Family Centre Conference). Research Council of Norway. (2010). Evalu- NO-9037 Tromsø, Norway. Helsinki, Finland, 6-7 May 2010. ering av opptrappingsplanen for psykisk helse (2001-2009). Sluttrapport – syntese og analyse Andersson, W. W., and Ose, S. O. (2007). av evalueringens delprosjekter. Oslo: Research Unmet mental health service needs among Council of Norway. Norwegian children and adolescents. Child and Adolescent Mental Health, 12, 115-120. Sitter, M. (2008). Brukerbasert evaluering av doi: 10.1111/j.1475-3588.2006.00423.x det kommunale tjenestetilbudet for barn og unge med psykiske vansker 2004-2008. Trond- Fewster-Thuente, L. and Velsor- heim: SINTEF Report A5204. Friedrich, B. (2008). Interdisciplinary collaboration for healthcare profes- Contact information: Gørill Warvik Vedeler sionals. Nursing Administration Quar- ([email protected]), Monica Martinussen terly, 32, 40-48. doi:10.1097/01. ([email protected]), Frode Adolfsen NAQ.0000305946.31193.61 ([email protected]) and Anette Moltu Thy-

Maslach, C., Schaufeli, W., and Leiter, M. P. (2001). Job burnout. Annual Review of

104 Good practice dialogues as a tool for For instance, good practice dialogues can be arranged for supervi- sharing expertise sors, work communities, between work communities and between work communities and key partners, such Jukka Pyhäjoki and Mimosa Koskimies as children, adolescents, parents, and employees in other sectors. Reflecting on good practices, and sharing and developing them together in dialogue and dialogically, is also good practice in itself. Implementa- tion of good practice dialogues, as Everyday skills and ways of acting work and functioning practices take part of the functioning of a com- are often termed tacit knowledge, a time, requires a location and space as munity, promotes a service culture term coined by philosopher Michael well as special methods. Moreover, that supports inclusion and fruitful Polanyi (1940). According to Polanyi structures are required that support encounters. we always know more than we are dialogicality and dialogical manageable to tell. The better one knows ment of processes. Tacit knowledge highlighted something, the less one is able to Communities can use good practice and shared – implementation of explain such knowledge. Traditional- dialogues (Gp-dialogues) to pinpoint dialogues ly, proficiency in a certain skill or pro- and share good practices and work- Good practice dialogues constitute an fession – and the related knowledge ing methods that relieve worries and opportunity for the dialogical devel- – has been transferred from master keep them at bay. The objective is for opment of work or other communi- to apprentice. Today, systematic shar- people to become more aware of their ties. Dialogues pinpoint situations, ing of skills and knowledge between own and the community’s tacit knowl- related to everyday work, or, where one generation and an individual and edge, and those aspects of their children and adolescents are con- another, or between communities, is practices and operating methods cerned, connected to life in general rare in working life. Various pressures that work well. Together, they should or school attendance, that involve at work often overwhelm common also share and develop practices and no worry. They also identify situa- opportunities for reflection and shar- the operational culture. The aim is to tions that involve various degrees of ing. Tacit knowledge, everyday skills create new ways of developing work worry. In addition, personal skills and and good practices remain “inside” and well-being at work, of enhancing those of the community are shared: people. This either leaves no time to participation by children and parents, what already works for me/us, what exploit them, or people are unable strengthening open co-operation and am I/are we good at, what should we to do so. However, tacit knowledge promoting a dialogical, networked enhance, in what areas do we want to involves huge potential for develop- operating culture. Benchmarks for develop further? In such dialogue, it ing the working methods of a commu- reviewing one’s own activities and is essential that while one develops nity and interaction between people. developing services in Gp-dialogues one’s own work and interaction, for As part of the target-oriented always include openness, inclusion instance with customers, one also development of a community, utilisa- and early co-operation. The goal is for develops the ways in which communi- tion and sharing of tacit knowledge these to feature in work and in every- ty members work together as a com- is based on the desired state and one’s ways of acting and interacting munity. In Gp-dialogues, people inter- needs of the community in question. with others. act with others, listen to and meet Joint reflection upon and analysis of community members, colleagues,

105 children and adolescents, and other adolescents and families too can use cooperative learning tools, includ- parents. They also form a multivocal such zones to assess their personal ing the learning café and open space reality together, while strengthening degree of worry and need for support. methods, and other variants. In the sense of community. The zones are not intended as a tool the development process for Gp- The core of the good practices enabling employees to interpret situa- dialogues, it has proven essential to dialogue process comprises two tions in a similar way. Rather, the aim form a functioning basic model, on interactive dialogue forums. A first is to promote the possibilities of peo- whose basis leaders can tailor and meeting identifies well-functioning ple and various actors to develop an modify different variations, as neces- and worrying situations related to interest in mutual differences. Neither sary. Tailoring and modification are the activity. The second shares good, are the zones intended for the clas- both the Gp-dialogue’s strength, and everyday practices and ways of acting sification or registration of children, the prerequisite for its functionality. A that keep worry at bay, arising from adolescents or families (Pyhäjoki & guide will be completed by the end of themes based on these situations. In Koskimies 2009). 2011 on the purpose and use of good addition, face-to-face advance plan- Gp-dialogues constantly function practices dialogue processes, and ning with management and person- at the interfaces of private and public leadership of dialogues (Koskimies & nel is important to good practices knowledge. How might we manage Pyhäjoki & Arnkil 2011). dialogue processes. Aspirations and the public sharing of individuals’ tacit So far, good practice dialogues objectives for the dialogue process knowledge so that it is sufficiently have been arranged and developed are negotiated in planning sessions. detailed, but not too general? And in intensive co-operation with staff At the end of the process, agreement vice versa, how can we put general and managers of services for chil- is reached on how the community and knowledge into a form, and convey dren, adolescents and families in the management intend to continue pro- it in a way, which touches individu- cities of Nurmijärvi and Rovaniemi. In cessing good practices and develop- als and gains traction with them? Rovaniemi, good practice dialogues ment themes in the future. Such bridges have been constructed have been employed in activities Zones of subjective worry (see illus- through good practice dialogues, such as the Napero project, which tration) provide support in reflecting by combining and applying various developed a family services centre, on situations. A method developed by the National Institute for Health and Welfare, “zones of subjective worry” is a tool for developing co-operation Figure 1 between children, adolescents and The zones of subjective worry families, and employees working with Considerable them. “Zones of subjective worry” No worry Minor worry worry Major worry is a figure of speech, a metaphor 1 2 3 4 describing the degree of worry and No worries at all Feelings of worry The worry is Worry is extreme- working conditions. The phrase also or wonder considerable ly great represents an attempt to form a High confidence Running out of Unable to resolve language facilitating discussion of in own possibili- own resources situation using comprehensive experiences. With the ties own resources help of these zones, an employee can Thoughts of need Need for Immediate analyse the degree of worry he or she for additional additional change in situa- feels, the sufficiency of his or her per- resources resources and tion required sonal scope for action, and the need greater control for additional resources. Children, Arnkil Tom & Eriksson Esa 1998

106 and in developing co-operation with show confidence and proceed in a in facing these concerns. After the organisations. Within municipali- process-based manner. parents’ meeting, the results, plans, ties, the National Institute for Health feedback and messages to the chil- and Welfare is training leaders of Dialogue process for practices dren from parents and class teachers good practice dialogues as part of that ease the worries of were reviewed with the children. the development of early open co- children, parents and class Later in the autumn, a parents’ operation. teachers meeting themed “Good practices for Written feedback is collected for all The following is a description of how alleviating the worries of children” rounds of good practices dialogue. the good practices dialogue process was arranged for the parents. In Giving, receiving, joint handling and was utilised in developing the school the invitation, parents were asked utilisation of feedback are integral operational culture together with chil- in advance to record worry-free and to dialogicality and the creation dren, parents and teachers. Children’s worrisome situations in the zones of and development of a dialogical worries and good practices for allevi- subjective worry. The parents and operational culture. Several hundred ating such worries, and the issue of class teachers began by familiaris- instances of feedback have been col- how adults at home and school can ing themselves with the summary of lected from Gp-dialogues arranged combine to support and contribute to worries and good practices created so far. Such feedback is extremely children’s growth and development, in connection with the children’s Gp- positive and enthusiastic. Employees lie at the core of the process. dialogue. In small groups, they then have an intense need and willingness Seventh-grade students at Isoniittu reflected on the worries identified by to discuss and perform their work, School in Nurmijärvi considered the children and what kind of support coupled with a desire to share and their worries, and good practices for they might give to help the child act develop their competence together. alleviating them, by class, led by their in such a way that could alleviate the According to the experiences of par- teachers. Work began with reflec- child’s worries and make him/her ticipants, Gp-dialogues are practical tion on their worries, with the help of feel better. Small groups of parents and make everyday work easier. They the zones of subjective worry. Using and class teachers considered and are regarded as a safe way of rais- these zones, the children recorded exchanged experiences of good ing ideas and concerns, while being the kinds of issues related to school “everyday” “small” acts and activi- found to enhance a sense of commu- attendance, teachers, friends, hob- ties which might ease children’s fears nity, motivation, well-being at work, bies, home, family, etc. that made and comfort them. Themes included and dialogicality. Such dialogues are them happy and feel good, as well as friendships of children and adoles- also viewed as a light, fast way of those which caused small, consider- cents, coping, sufficient rest and bringing out tacit community knowl- able and/or major worries. A summa- good nutrition, preparing for exams edge and the operational culture of ry of these anxieties was prepared. and doing homework, use of comput- the community. According to super- Next, in small groups the children ers/the internet, spending money and visors themselves, they are able to considered good practices relevant family relationships. Group discus- make direct use of the results of Gp- to the situations they selected within sions were reviewed and debriefings dialogues in the preparation of devel- each zone of worry. Finally, situa- conducted together. Finally, the par- opment plans. People often have fun tions and practices were reviewed ents presented their own impressions in good practice dialogues, even if in mutual discussions. The children of teachers’ discussions, focussing dialogicality is no easy, comfortable were told in advance that parents and on what particularly pleased and con- option. A dialogical encounter always class teachers would also examine cerned them about the discussions. requires participants to pause, com- their worries and practices at a future As a concrete next step, it was agreed mit themselves, tolerate uncertainty, parents’ meeting, and consider how that an event would be arranged for they might best support the children the parents at which various methods

107 of providing learning support would with other parents and class teachers creating new collective and organisa- be presented. Secondly, it was decid- was considered interesting and valu- tional knowledge lies in individuals, ed that a joint discussion would be able. According to parents, fruitful and their interaction within a group arranged, on buying and consuming discussions and getting to know and the working community. sweets and soft drinks during school other parents were the best aspects The first steps in creating new hours. In addition, a message on the of the evening. They mentioned the knowledge involve bringing out tacit evening’s discussions was agreed, for exchange of everyday practices, knowledge, sharing competence and communication to the children. experiences, ideas, tips, viewpoints creating new understanding (Von The teacher leading the Gp- and peer support as particularly use- Krogh 1998). It is the task of manage- dialogues with children mentioned ful. Parents found it extremely impor- ment to provide the time, place and that the students greatly appreci- tant and relieving to find out that space for learning by the community. ated separate enquiries being made others, too, had similar worries. They Good practice dialogues are spaces about their concerns. This made it hoped that these practices would and processes for learning that create easier for them to open up about their continue and that parental meetings new knowledge, skills, meanings and worries. The children pointed out of this kind, in which even children interpretations. These spaces support that while reflection on worries and could participate, would form part of the professional growth of partici- good practices was enjoyable and the school’s working culture. pants and strengthen the competence easy, implementing such practices of individuals. A successful dialogue in one’s personal life was not always Conclusion requires a context where people can so straightforward. For instance, a The creation of new, communal speak safely about their competence, number of sound exam preparation knowledge requires the transforma- worries and development needs in a methods had been collected (begin tion of tacit individual knowledge into positive atmosphere. Developing such preparing in time, go to bed early, understandable shared knowledge. spaces, or dialogue forums, for shar- spend only limited time during the day Personal knowledge and experience ing competence is essential. There, surfing the Web) but pupils did not must be shared in a reciprocal pro- people can be and are heard, and can always comply with these. According cess with others. The foundation for share everyday best practices. to the teacher, children were eager to participate in consideration of good practices, concentrated well on listen- ing to proposals by classmates, and discussed them in earnest. Feedback from parents and teach- References ers indicated that gathering children’s Arnkil, Tom Erik and Eriksson, Esa (ed.) Pyhäjoki Jukka & Koskimies Mimosa 2009. worries and practices was considered (1998) Huolen harmaa vyöhyke. Dialogi Varhainen puuttuminen ja dialogisuuden a wonderful, useful and important 7/1998. edistäminen huolen vyöhykkeillä. Teoksessa exercise. The opportunity to hear their Lammi-Taskula J., Karvonen S. & Ahlström Melkas Helinä & Uotila Tuomo 2008. Tieto S. (toim.) Lapsiperheiden hyvinvointi 2009. children’s ideas was rewarding, inter- ja tietämys alueellisissa innovaatioverkos- Helsinki: Terveyden ja hyvinvoinnin laitos esting and thrilling. It was considered toissa; teoreettista pohdintaa. Teoksessa extremely positive that children were Harmakorpi V. & Melkas H. (toim.) Innovaa- Von Krogh, Georg 1998. Care in Knowledge tiopolitiikkaa järjestelmien välimaastossa. Creation. California Management Review. the genuine starting point, with eve- Lappeenrannan teknillinen yliopisto. Spring; 40; 3.133–153. ryone given the chance to participate Suomen kuntaliitto. Helsinki. and share their worries. The parents meeting was deemed extremely useful. Exchanging ideas and experiences

108 A picture of future competence needs creative learning environments for the children. This has helped to make it in family centres fashionable (amongst both men and women) to work with children, and Heidi Backman and Alexandra Nordström the status of the sector has risen. Family centres are multi-professional centres where healthcare providers, What does the future hold within the field of children’s and family services? social workers, kindergarten teachers, What competencies will be needed under various possible future scenarios? special needs kindergarten teachers, What would happen if we did not actively develop the provision of services and nutrition therapists, family counsel- what would a social disaster mean for the services that are aimed at children lors, cultural officers and co-educators and families? What consequences would the digitalisation of society have and work together. This multi-professional what consequences would there be if a family centre were to be provided in approach has made the centres more every municipality? health-promoting and preventive. This article is based on a project carried out by the Finnish National Board Special needs are identified at an early of Education during the period 2009–2011. The project working group con- stage and essential initiatives, such sisted of representatives from the fields of day care, healthcare, social work as psychiatric care and special needs education, are implemented. Health- and culture. The group developed four scenarios that describe the provision of promoting initiatives for exercise and children’s and family services looking 10–15 years into the future. The first sce- diet are integrated into the activities. nario that was prepared was a “business as usual” scenario, where the current The advice service makes preventive trends within the day care sector continue even if the outside world changes; home visits and social workers seek the second scenario is a disaster scenario where the welfare and care systems out clients with the aim of identifying are dismantled. The following text presents a description of the third scenario and rectifying problems as quickly as in particular, multi-professionalism and smorgasbord, a scenario in which the possible. children’s and family centres are developed. Society is increasingly becoming service-focused and all sectors are becoming more service-oriented, Multi-professionalism and in demand for various forms of ser- although day care provision is increas- smorgasbord – children’s and vices for children and families. ingly becoming customer-oriented. family centres are developed Local authorities have set up chil- People are expecting better and In Finland, the economy is steady and dren’s and family centres or networks improved services, as well as more the employment situation is good. with co-located services for families, customised services. They want to This has led to an increase in immi- based on a lifecycle approach with choose the services they need from gration and the proportion of people the child in focus. A single centre a smorgasbord of services. There are in paid employment, as well as an offers day care or early childhood also profiled day care centres and, at increase in the demand for day care education, health services, schools, least in larger municipalities, parents provision. Society can afford to invest child welfare services and various can choose between these different in public sector care provision. The forms of special needs support, profiles for their child, such as lan- ageing population is leading to an such as speech therapy. The family guage, art and culture, gender issues, increase in demand for care services, centres are being developed into both natural science or sustainable develop- but the birth rate is not declining; it attractive and flexible workplaces in ment. There is also an increasing need is instead rising in line with immigra- terms of working hours and organi- for customer segmentation in order to tion, which is resulting in an increase sation, as well as into appropriate productively and efficiently develop

109 different types of service, both The multi-faceted knowledge of knowledge of the national languages digital services and face-to-face the personnel and an awareness of the importance services. Families do not always The importance of pedagogic knowl- of language to the development and want to visit a health centre when edge is a key feature in the provision identity of the child is therefore impor- their child is ill; they would rather of all children’s and family services, tant, as is knowledge of bilingualism obtain information via the internet but it is of particular importance when or multilingualism, home language and have an opportunity to obtain it comes to early childhood education. support and a knowledge of “language advice and guidance from experts at However, knowledge of children with showers” and “language baths”. A a distance or through peer support special needs, gender issues, inter- part of the personnel has an immigrant groups. Children’s and family cen- cultural issues and media and art are background and need further training tres are customer-oriented and they important supplementary competen- in the national languages. Knowledge are serving increasingly heteroge- cies. Emphasis is placed on supporting of foreign languages, particularly neous families and family struc- the development of the child’s identity English and Russian, is also necessary. tures. Parents are offered a variety and taking an individual and respectful Interpreters are in increasing demand of flexible day care solutions, such approach to children and families. The within the day care, child welfare and as open day care, overnight and personnel should also have knowledge child advice sectors. Different cultural weekend care, as well as services of the learning process, of children backgrounds are taken into considera- that are charged at an hourly rate. in groups, of creativity and of family tion and the personnel receive support Some families are moving to eco- dynamics. The ability to communicate from a cultural interpreter if and when towns or communes in apartment and cooperate is important with regard necessary. It is becoming increasingly buildings and working from home to contact with parents, officials and important to understand different cul- or living on a citizen’s wage. A large decision-makers within the municipal- tures, including one’s own culture and group of parents are demanding ity. The personnel should have the its subcultures, in order to be able to locally produced food without addi- competence to counter, guide and communicate with people with differ- tives, are sceptical about vaccina- support families and to cooperate ent backgrounds. The personnel need tion and want to work from home with other professional groups as well to have knowledge of multi-cultural- and care for their children at home. as the parents, to create and work in ism, intercultural competence and the There is an ever-increasing need networks and to establish learning ability to educate about internationali- for professional groups that can environments. The effects of digitalisation. Due to the increase in immigra- guide and mentor families with sation in society must be taken into tion and globalisation, the personnel regard to various issues concerning consideration and it is important that must also have knowledge of what are life management, such as health, the personnel is able to learn how to for us exotic and previously unusual well-being and exercise, sleep and use information and communication illnesses. dietary issues, as well as financial technology and new media in a way The personnel should have a profes- issues or advice concerning the which supports and does not harm the sionalism that enables them to work in choice of day care or educational development of children. multi-professional networks. Knowl- services or leisure activities for The personnel at children’s and edge of professional ethics, confi- children. Many of these services are family centres are an important dentiality and secrecy obligations, as provided by the private sector. This linguistic role model for the children, well as knowledge of law, is becoming could involve services that combine particularly for bilingual children and increasingly important. Professional child day care and household ser- immigrant children. The personnel identity and pride, as well as an ability vices, such as cooking or gardening, must be able to support the develop- to market one’s own knowledge and or healthcare services which can be ment of language skills in different the sector, is becoming important in all provided in the home. linguistic environments. An excellent professions within the sector, as well

110 as an ability to act as a role model for at a distance over the internet. There issues, particularly issues concern- others . The ever-changing nature of is a need for consulting kindergarten ing leadership or teamwork, and to society and working conditions means teachers, special needs kindergarten be able to lead, guide, cooperate, that the personnel should be develop- teachers and various types of educa- develop, change, evaluate and contrib- ment-oriented and flexible, possess tors and pedagogues, such as gender ute to occupational well-being in the an inner enterprising spirit and have pedagogues who can act as a mobile workplace. the ability to reflect and to work in resource and as a consultant. In the projects. It is important that the per- future, some of these services will be This article is based on the results of sonnel is able to plan and evaluate the provided at a distance, e.g. through the Finnish National Board of Educa- operation, identify needs and develop information technology. The need for tion’s ESF-financed VOSE project, a new productive and efficient working IT support is increasing in line with project which is aimed at developing methods, even in demanding situa- the broader utilisation of information a national model for the forecasting tions. The role of the staff member as and communication technology within of future competence needs within all a tutor, coach or mentor is becoming operations. The general areas of com- sectors. The results will support the increasingly important both in relation petence are as follows: development of vocational educa- to children and families and in relation tion and training, polytechnic and to colleagues. Communication and customer orienta- university education, including adult Leadership is a skill which, although tion: to be able to counter and support education and training in both the highlighted in this scenario, is not different types of families, to work with short and the long term. A pilot group a distinct part of current training. colleagues and parents in an edu- within the provision of day care and Knowledge of leadership as regards cational co-operation, as well as the other children’s and family services multi-professional work and work in ability to communicate digitally. has been working on the forecasting change is needed, as is a positive atti- model in Swedish since autumn 2009. tude towards life-long leadership and Problem-solving and the ability to be The educators and pedagogues who visionary leadership. Factors that con- innovative: to be able to develop one’s participated in the group intend to tribute to the popularity of the sector skills and working methods in different take the results into consideration in in the scenario are initiatives aimed at situations according to the changing their own work with curriculums and the well-being of the personnel, e.g. demands of society and customers. study programmes. The VOSE project the development of a work community will conclude its work on the forecast- and the collaboration that takes place, Cultural aspects and language: to take ing model in spring 2012. the tutoring of personnel, support for into consideration in one’s work a occupational well-being and mental child’s monolingualism, bilingualism health at the workplace, as well as or multilingualism, as well as families References methods for stress management. Busi- with different cultural backgrounds, Heidi Backman, Kristel Englund and ness knowledge and financial know- including subcultures. Alexandra Nordström. Barnen är how, as well as other administrative framtiden – framtidsscenarier och skills, are becoming increasingly Education: to possess fundamental kompetensbehov inom dagvård och annan barn- och familjeverksamhet, published important as public sector finances pedagogical skills, including skills in Swedish and Finnish in June 2011 on become ever-more limited. within, for example, special needs the Finnish National Board of Education’s In order to provide sufficient com- teaching, gender issues, intercultural website. (http://www.oph.fi/utvardering_ och_statistik/prognostisering/ petent staff for all regions and areas, issues and media and art. kompetensbehov/vose_projektet) there is an increasing need for social workers and healthcare workers who Professional role and work culture: are mobile or who can provide services to be able to handle administrative

111 Future challenges

112 these positive results, we currently Developing family centres in the Nordic do not know enough about the effects countries of the family centre initiative and the cost-effectiveness of the prevention work. With regard to future developments, evaluation and research should Marjatta Kekkonen, Mia Montonen and Riitta Viitala be intensified with regard to the effectiveness of family centres. We need both cross-sectional information and long-term monitoring when it comes Nordic collaboration is essential in and organisational culture of child to family centre initiatives within the order to develop family centres. In and family services are changing. The municipal service system and the this publication, we have attempted client and family orientation is being economic and human consequences of to present a complete picture of the emphasised and this is changing ser- the effectiveness of mother and child development of family centres in the vice structures and service provision. advice, family preparations, open day Nordic countries, describe the key The preventive work needs multi- care provision and the preventive fam- themes for family centres and outline professional partnership structures ily and social work within the family future development needs and visions not only in the client work and in the centre services. In this context, it is of the family centres. The Nordic cross-border collaboration between vital to formulate and realise common countries have a long tradition of the service sectors, but also between Nordic family centre research. collaboration with regard to children non-governmental organisations. In In the Nordic countries, family and family policy. The development of the future, Nordic collaboration will centres have generated a lot of very family centres and the working meth- be needed within the development practical knowledge, a wealth of good ods of the family centre are evidence of the complete range of services practice and tacit knowledge over the of a good Nordic collaboration that offered by the family centres in order years, which governs the activities in has given rise to major benefits in the to establish a common Nordic thread family centres. In addition to research, form of expertise and knowledge. for strategies for parental support there is also a need to compile this The living conditions of families and early prevention. experience-based knowledge and and the prerequisites for parenting The results of the evaluations of good practice. Within the work relat- are in the same state of change in family centre projects that have been ing to family centres, a diversified all the Nordic countries. The work carried out of family centre projects range of education programmes has routines, organisational approach have generally been positive. Despite been implemented diversified range

113 of education programmes that could goals established by the staff and the of health promotion and early preven- be of great benefit for all the Nordic service structures and activities that tion. The large number of delegates countries. The Nordic countries could have been implemented. The views, at the conferences also reflects the also benefit from common threads responses, experiences and sugges- level of interest in and the desire to in a family centre manual. The key tions for improvements of parents exchange information and become contents of this manual should con- and children are of pivotal importance involved in health-promoting and cern the competence development of in the development of the family preventive collaboration. professionals and other players, new centres. It is therefore important to We hope that these joint Nordic family-oriented working methods, compile information concerning the conferences, which have already greater involvement of children and experiences and values of mums, become something of a tradition, will parents, and the management of the dads and children as regards family continue to be held at regular inter- family centres. centres in the Nordic countries. vals in our respective countries in The ultimate aim of family cen- Finland hosted the Nordic family turn. Family centre stakeholders need tres is to promote a good childhood centre conference in 2010, five years a forum where they can meet their through reinforcing parenting skills. after the first conference, which was colleagues and others interested in The way in which family centres held in Sweden. The first Nordic developing the family centres in their should be developed and the effec- family centre conference was held in home country and across the Nordic tiveness of the family centre services Sweden five years previously. These region. We hope that this publica- should be analysed with greater conferences showed that there is a lot tion will initiate a dialogue and an clarity and evaluated in relation to of Nordic know-how surrounding the exchange concerning family centres the views of parents and children, the theme of family centres and the issue at both Nordic and international level.

114 The Authors

FINLAND

Maria Kaisa Aula Mirjam Kalland Marju Keltanen Licenciate of Political Sciences Doctorate in Education Master of Education Ombudsman for Children Adjunct Professor in Social Work and Family Research Assistant Office of the Ombudsman for Children Research at University of Helsinki , The Association of Finnish Local and Regional Finland Adjunct Professor in Music Education at the Authorities, [email protected] Sibelius Academy [email protected] +358-50-530 9697 Secretary General The Ombudsman for Children promotes the Mannerheim League for Child Welfare Mimosa Koskimies realisation of children’s rights in Finland. The Finland Master of Social Sciences Ombudsman acts as a sounding board for the Mirjam’s main research interest has been risk Special Planning Officer voice of children and a bridge builder for child and protective factors for children’s develop- National Institute for Heath and Welfare policy. The Ombudsman raises the awareness ment and is currently working actively on [email protected] of decision-makers and influences social policy developing support for parenthood within by speaking out on behalf of children. The maternal and children’s advisory activities Ismo Linnosmaa intention is also to promote the development of within primary healthcare in Finland. The Man- PhD services that support the welfare of children, nerheim League for Child Welfare introduced Research professor young people and families. the family welfare centre activities in Finland Centre for Health and Social Economics and currently has over 400 open meeting places National Institute for Health and Welfare Heidi Backman for parents. Finland Master of Politics [email protected] Director of Education Milla Kalliomaa Ismo is responsible for the cost-effectiveness Finnish National Board of Education Director, Organisational and Volunteer Work analysis of child welfare services. Finland Mannerheim League for Child Welfare [email protected] Finland Mia Montonen Throughout the period 2009-2011, Heidi has [email protected] Nurse, Master of Politics been involved in developing a national model Milla has been involved in developing and Development Manager for how to create future skills in different voca- expanding MLL’s family centre activities in AB Det Finlandsvenska Kompetenscentret inom tions and industries. She has tested the model Finland. det sociala området – FSKC (The centre of excel- within the daycare industry, as well as other lence of social welfare) child and family activities. Marjatta Kekkonen Finland [email protected] Master of Politics, PhD, Group Supervisor Nina Halme Mia has worked on developing the Swedish Senior Planning Officer Doctor of Health Sciences family centre in Helsinki. She has worked in Child, Adolescent and Family Services Senior Researcher different positions of trust in the Swedish National Institute for Heath and Welfare Child, Adolescent and Family -services speaking Finnish association Familjeparasol- Finland National Institute for Heath and Welfare let as well as being involved in the founding of [email protected] Finland the Finnish Suomen perhekeskusyhdistys. In Marjatta worked on the PERHE project between [email protected] addition to that, she was one of the people in 2005 and 2007. She has worked as an instruc- charge of arranging the Nordic family centre tor for the in- service training model of edu- conference that took place in Finland 2010. cational partnership for the ECEC- and family service personnel. She worked as an instructor for the in-service training model of educational partnerships for the ECEC and family service personnel. She participated in the organisation of the Nordic family centre conference in Finland 2010, as well as being involved in the development of the family centres within the national KASTE programme from 2008 to 2011.

115 Jukka Mäkelä Sirkka Rousu Riitta Viitala MD, Child Psychiatrist,Trainer-level Child Doctor of Administrative Science, Social Worker Psychologist Psychotherapist and Theraplay-therapist, Principal Lecturer, Helsinki Metropolia Univer- Development Manager Development Manager for Promotive and sity of Applied Sciences, www.metropolia.fi Ministry of Social Affairs and Health Preventive Child Mental Health Services Project manager (on leave), The Association Finland National Institute for Health and Welfare of Finnish Local and Regional Authorities, [email protected] Finland www.localFinland.fi Riitta has been involved in the development [email protected] Finland of the family centres in Finland from the very Jukka has a long experience in preventative [email protected] beginning. First in the control group as a rep- work in the grey area between child protection Since the beginning of 2000, Sirkka has been resentative of the Ministry of Social Affairs and and child mental health. involved in developing the family centre activi- Health for Espoo’s family centre project 2003- ties in the Harava project of The Association of 2005, then as a project manager within the Alexandra Nordström Finnish Local and Regional Authorities. During National PERHE project 2005–2007. She subse- Bachelor of Social Sciences the period 2004–2007, Sirkka participated in quently developed the family centres within the Planning Specialist the PERHE project, which is a family service national KASTE programme 2008-2011. Finnish National Board of Education programme within the national development Finland programme for the social area. She has also [email protected] been responsible for a research project that Alexandra wrote her bachelor’s thesis on child- the Association of Finnish Local and Regional hood research and on the questions that are Authorities carried out between 2010 and 2011 linked to daycare in Finland. She has worked together with its co-operation partners. The with the Finnish National Board of Education’s project investigates services and co-operation project on forecasting future skills needs within that apply to children, young people and daycare and other child and family activities. families as well as how the statutory municipal welfare plans have been met and how the Finn- Aila Puustinen-Korhonen ish Child Welfare Act is observed. Master of Social Sciences Senior Adviser Eero Siljander The Association of Finnish Local and Regional Licenciate Political Science (Economics) Authorities Senior Researcher [email protected] National Institute for Health and Welfare, www.kommunerna.net Centre for Health and Social Economics Finland Jukka Pyhäjoki [email protected] Family Therapist, Educational Science, Vocational Education, 333 ECTS credits Antti Väisänen Senior planning officer Master of Political Science (economics) National Institute for Health and Welfare (THL) Researcher Finland Centre for Health and Social Economics [email protected] (CHESS), National Institute for Health and Welfare, Finland [email protected] Antti is a researcher and is currently investigat- ing cost efficiency in social services.

116 NORWAY SWEDEN

Anette Moltu Thyrhaug Frode Adolfsen Johanna Ahnquist Public Health Nurse. Qualifying as a Master of Master of Education, Research Fellow BSc, MPH and PhD Public Health Adviser Public Health Planning Officer Adviser University of Tromsø Swedish National Institute of Public Health. University of Tromsø Norway Sweden Norway RKBU Nord (RKBU North), Faculty of Health [email protected], tel. +4670199691 RKBU Nord (RBUP North), Faculty of Health Sciences, University of Tromsø, Norway E-mail: Johanna works at the Swedish National Institute of Sciences, University of Tromsø, Norway E-mail: [email protected] Public Health, gathering and disseminating informa- [email protected] Frode has carried out questionnaires among tion on methods and strategies for promoting children Anette has been a member of the project group employees in six Norwegian family centres and young people’s health. The family centre consti- for the Family’s House at RKUP North since (Adolfsen & Martinussen, 2010). Member of the tutes an important promotional and preventative arena 2007. project group for the Family’s House at RKBU in this context. North. Gørill Warvik Vedeler Vibeke Bing Master of Education, PhD candidate Social Worker and Nursery Teacher Adviser Public Health Education via the Nordic School of Public University of Tromsø Health (NHV) as well as journalism training. Norway Development and quality coordinator in Backa Läkar- RKBU Nord (RBUP North), Faculty of Health husgruppen. Sciences, University of Tromsø, Norway E-mail: [email protected] ; vibeke.bing@backalakarhus- [email protected] gruppen.se Gørill is currently project manager for the Phone +46766451147 Family’s House project at RKUP North. She is As an administrative Officer at the National Institute of developing a doctoral study on early parent Public Health Vibeke established a national network support anchored in open daycare in the Fam- of family centres in Sweden and took the initiative ily’s House. Member of the project group for to create the Association of Family Centres and was The Family’s House at RKBU North. its chairman for many years. She was appointed as a consultant by different municipal authorities and Monica Martinussen municipalities to help start family centres and in 2004 Master of Psychol. (1989) and Ph.D. (1997) received the Allmänna Barnhuset’s Stora Prize for this Professor work. She has also contributed to several books about University of Tromsø Child Public Health and reports and evaluations of Norway the family centres. She completed a course in 2010 at Regional Centre for Child and Youth Mental Kristianstad University entitledy “Working at a family Health and Child Welfare, University of Tromsø, centre”. In recent years, Vibeke has been engaged in a Norway E-mail: [email protected] European context regarding children’s health “parent- Monica is leader of the research group for ing support” and child poverty. preventive and health promoting interventions Thomas Johansson at the centre. The research group is responsible Community Public Health Coordinator for supporting Norwegian municipalities in Academic education: sociology, psychology, psychol- establishing the Family’s House commissioned ogy of religion and astronomy. by the Norwegian Directorate of Health. This Municipality of Leksand includes information activities and teaching as Sweden well as research linked to the Family’s House [email protected] in Norway. +46 247 801 37 Thomas was involved in initiating and developing the Leksand model from 1996. One of the cornerstones of the model is early and continuous parental support through different ages. Another is inter-disciplinary co-operation and co- operation between professional and voluntary players. The model has received great acclaim in Sweden, Finland, Russia and recently in Denmark. School recreational leader/education as well as sociology, psychology, psychology of religion and astronomy.

117 ICELAND DENMARK

Sigrún Júlíusdóttir Anna Jin Rolfgaard Social worker, Family therapist, Social Worker, Batchelor of Administrative Sciences Authorised Psychotherapist, PhD Head of Section Professor of Social Work; Family Therapist Danish Ministry of Social Affairs Faculty of Social Work. University of Iceland. Denmark Private clinic (part-time) +4541851101 Iceland [email protected] [email protected] Anna’s area of responsibility is young and Sigrún initiated one of the first family therapy vulnerable people. centres in Iceland in the early 1980s and started the Center for Children and family Research, Henriette Weberg University of Iceland, 2006. She is involved in Health Visitor family politics and social debate surrounding Leading Health Visitor family issues, contributing to the family therapy Center for Børn & Familie, Greve Municipality field through therapeutic educational and train- Denmark ing activity and conducts family research. [email protected] Greve Municipality was the first municipality in Elísabet Karlsdóttir Denmark to follow a method in which first-time MA, Diploma in Services to the Elderly parents received an offer that was strongly Social Worker, Project Manager inspired by the Leksand model. Henriette was Centre for Children and Family Research, involved in testing the method and acted as Faculty for Social Work, University of Iceland. facilitator for the first group of parents. She Iceland subsequently devised a timetable for the [email protected] method, which can be used by other municipali- Elísabet has worked as a social worker provid- ties in Denmark. ing social support and advice to families, children and young adults in Reykjavik municipality in relation to social problems in the family such as drugs, financial problems, care and more. She has worked as a lecturer in the social worker programme at the University of Iceland. Her job as leader of the research centre includes family research, particularly in relation to violence against women, co-operation and presentation of research in different contexts.

118 Steering group and editorial team

Chair Members Editorial team Riitta Viitala, Development Manager, Milla Kalliomaa, Director, Manner- Marjatta Kekkonen, Senior Officer, Ministry of Social Affairs and Health heim League for Child Welfare National Institute for Heath and Wel- fare Project Manager Mia Montonen, Development Manag- Marjatta Kekkonen, Senior Planning er, The Centre of excellence of Social Mia Montonen, Development Manager, Officer, National Institute for Health Welfare – FSKC the Centre of Excellence in Social Wel- and Welfare fare – FSKC Sirkka Rousu, Project Manager, as from 21.2.2011 Riitta Viitala, Development Manager, Aila Puustinen-Korhonen, Senior Ministry of Social Affairs and Health Adviser, the Association of Finnish Local and Regional Authorities Elina Suontama (previously Siltala), Communications Officer, National Elina Suontama (previously Siltala), Institute for Health and Welfare Communications Officer, National Institute for Health and Welfare

Torbjörn Stoor, Managing Director, the Centre of Excellence in Social Welfare – FSKC

George Henrik Wrede, Programme Director, Department for Cultural, Sports and Youth Policy, Ministry of Education and Culture

119 120 Ved Stranden 18 DK-1061 Copenhagen K www.norden.org Family centre in the Nordic countries – a meeting point for children and families

ISBN 978-92-893-2303-1 ANP 2012:701