Family centre in the Nordic countries – a meeting point for ... - Expoo

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

Family centre in the Nordic countries – a meeting pointfor children and families.ANP 2012:701© Nordic Council of Ministers, Copenhagen 2012ISBN 978-92-893-2303-1Print: Oy Fram AbLayout: Erling LynderCover photo: Kuvatoimisto Rodeo OyCopies: 500Printed on environmentally friendly paperThis publication can be ordered on www.norden.org/order. OtherNordic publications are available at www.norden.org/publicationsPrinted in FinlandTryckeriNordic co-operationNordic co-operation is one of the world’s most extensive formsof regional collaboration, involving Denmark, Finland, Iceland,Norway, Sweden, the Faeroe Islands, Greenland and the ÅlandIslands.Nordic co-operation has firm traditions in politics, the economyand culture. It plays an important role in European and internationalcollaboration, and aims at creating a strong Nordic communityin a strong Europe.Nordic co-operation seeks to safeguard Nordic and regional interestsand principles in the global community. Common Nordicvalues help the region solidify its position as one of the world’smost innovative and competitive.Nordic Council of MinistersNordic CouncilVed Stranden 18 Ved Stranden 18DK-1061 Copenhagen KDK-1061 Copenhagen KPhone (+45) 3396 0200 Phone (+45) 3396 0400Fax (+45) 3396 0202 Fax (+45) 3311 1870www.norden.org

Contents7 Foreword9 Introduction14 Family centre and Family policy in the Nordic countries15 Historical development of family centres in Sweden and the Nordic countriesVibeke Bing21 Family centres in Finland – a new approach within services for children and familiesRiitta Viitala, Marjatta Kekkonen and Nina Halme29 The Family’s House in Norway – an interdisciplinary, municipal/community healthcareservice for children, adolescents and their familiesAnette M. Thyrhaug, Gørill W. Vedeler, Monica Martinussen and Frode Adolfsen,34 Danish family policy and Child ReformAnna Jin Rolfgaard36 Child and family services in the Icelandic welfare systemSigrun Juliusdottir and Elisabet Karlsdottir40 Promotion of the well-being of parents and children41 The Swedish strategy for developed parental support and the family centre as an arena forthe provision of municipal parental support servicesJohanna Ahnquist48 The importance of social support and reflective functioning for parenthoodMirjam Kalland56 Child’s right to an uppbringing – Family centre as a promoter of a rearing culture whichrespects the childMaria Kaisa Aula

62 Family centre is based on preventive work and collaboration63 Preventive services – a guarantee for the well-being of children and familiesSirkka Rousu, Aila Puustinen-Korhonen and Marju Keltanen69 The Swedish Leksand model – family preparation as a starting point for the family centreThomas Johansson75 Mother and father – for the first timeHenriette Weberg79 The non-governmental organisation as a player within the family centre– a vision of collaborationMilla Kalliomaa86 Is preventive work cost-effective?87 Effectiveness and costs of preventive services for children and familiesIsmo Linnosmaa, Antti Väisänen, Eero Siljander and Jukka Mäkelä98 Family centre entails changes in professional skills and knowledge99 Knowledge advancement concerning family centresVibeke Bing102 Collaboration in the Family’s HouseAnette M. Thyrhaug, Gørill W. Vedeler, Monica Martinussen and Frode Adolfsen105 Good practice dialogues as a tool for sharing expertiseJukka Pyhäjoki and Mimosa Koskimies109 A picture of future competence needs in family centresHeidi Backman and Alexandra Nordström112 Future challenges113 Developing the family centre in the Nordic countriesMarjatta Kekkonen, Mia Montonen and Riitta Viitala115 The Authors119 Steering group and editiorial team

ForewordWithin the field of child and familypolicy, the Nordic countries havemuch in common and a long traditionof working together. The challengesthe Nordic countries will face in thefuture are also similar. A variety ofinitiatives are implemented in theNordic countries in order to supportparenthood. The foundations are laidby the health promotion and early preventioninitiatives that are carried outwith families with children. Problemprevention and supporting familiesthrough the provision of services witha low threshold is an important aspectof Nordic welfare policy. In the Nordiccountries, collaboration with civilsociety and voluntary organisationsis highly valued. Broad participationand multifaceted commitment fromthe third sector in order to achieve theshared goals are vital.Families with children are of enormousimportance for our future welfare.During its chairmanship, Finlandis promoting the work that is alreadyunderway within the field and placingan emphasis on continuity within theNordic partnership. One goal is toraise the level of interest in the Nordiccollaboration over family centres. Thetwo Nordic family centre conferences– the first held in Sweden in 2005 andthe second in Finland in 2010 – demonstratedthat exchanging knowledgeand networking are worth the investment.Under Finland’s chairmanship,themes such as a healthy lifestylefor families with children, the projectconcerning families with children whoare at risk of social exclusion and theNordic collaboration relating to themental health of children and youngpeople will be taken further. Anotherimportant theme is the campaignagainst the corporal punishment ofchildren, which will kick off with aseminar in December 2011.The discussion surrounding currentstructural reforms and the developmentof welfare services for children,young people and families is important.Similar discussions are alsounderway in an international context.Family centres are a model forimproving the health and well-beingof children and the whole family andfor combating social exclusion bysupporting positive parenting. Familycentres are also a universal arena thatenable children and families to participateand have a say themselves, thusreinforcing solidarity within society.The important factor as regards familycentres is that the work is cross-borderand builds on the co-operation ofall stakeholders.This publication represents acurtain-raiser in the discussionsurrounding family centres in theNordic region. The publication bringstogether experiences and knowledgefrom the Nordic countries. Family centresare being developed not only inthe Nordic countries, but also acrossEurope and elsewhere. Through thispublication, we wish to take part inthe international debate.Kari VälimäkiPermanent SecretaryMinistry of Social Affairs and Health7

illustrate, through the use of examplesof preventive child welfare, theconsequences of unsuccessful earlyintervention, as well as the coststhat the child welfare measureswould give rise to in two alternativeservice strategies. By way ofconclusion, the authors discusswhy the preventive approach hasnot been adopted and what sort ofevidence can be obtained concerningthe effectiveness of the preventiveapproach. According to the authors,it is also a question of whether thedecision-makers believe in the returnon investment in preventive work.The fifth part of the publicationFamily centre entails changesin professional skills andknowledge concerns knowledge,collaboration and interaction. Thefocus is placed on the staff’s knowhowand the new professional roles.Professionals at family centres arebeing compelled to adopt new workingmethods and be flexible in theirwork and professional roles. Collaborationand interaction betweendifferent professional groups alsofacilitates a new form of knowledgeadvancement.In the article entitled Knowledgeadvancement concerning familycentres, Bing describes the familycentre as an organisational form thatis filled with learning. For the staff,this means not only that their professionalrole is altered, but also thattheir role can change even during thecourse of a single working day. Bingbelieves that the roles performed byprofessionals at family centres varybetween that of expert and adviser,that of a good host for parents’ meetingsand that of circle leader.In Collaboration in the Family’sHouse, Thyraug, Vedeler, Martinussenand Adolfsen describe how competence,commitment and a desire tocollaborate have a decisive effecton how high-quality family centreservices must be produced for children,young people and families. Theauthors state that multi-professionalcollaboration includes both elementsthat facilitate and elementsthat burden the work. In the Family’shouse, it is shown that most of thoseemployed have positive experiencesof working with other professionalgroups.In their article entitled Good practisedialogues as a tool for sharing expertise,Pyhäjoki and Koskimies describethe importance of tacit knowledge inthe development of society. Children,parents and employees need premisesand forums where they can makethemselves heard and talk to eachother about their competence, theirfears and their everyday experiencesin order to ease their concerns. Themethod “Dialogues for good practice’can be applied in the developmentof family centres, where there is adesire to improve collaboration, participationor management relating tofamily centre service provision.In their article entitled A picture offuture competence needs at familycentres, Backman and Nordströmdescribe what the future could holdwith regard to the competence needsof staff. The authors outline futurescenarios for child and family servicesfrom a perspective which shows whatwould happen if the services were tobe developed in line with the familycentre model. They also discuss avision of the future as regards whatwould happen if the service conceptwere not to be actively developed orif the services did not take account ofthe changes that occur in the livingconditions of families and in society ingeneral.The publication is concluded with thechapter entitled Future challenges.In the article entitled Delelopin thefamily centres in the Nordic countries,Kekkonen, Montonen and Viitala highlightthe views that apply to the commonfurther development of the familycentre initiative in the Nordic countries.13

Family centre and family policyin the Nordic countries14

Historial development of family centres in Sweden and theNordic countriesVibeke BingThis article describes 30 years of development leading up to today’sfamily centres, which form part of the welfare and public health serviceand can be understood not only in terms of Child Public Health, supportingenvironment and equality, but also on the basis of increased knowledgeconcerning pregnancy, infants, cohabitation and the mental healthof children. The article also describes how our knowledge has developedsince the first Nordic family centre conference in 2005 and the interest infamily centres in the Nordic countries.IntroductionFamily centres rest upon a conceptionthat there is a strong linkbetween well-being of children andtheir parents. That is why preventivework regarding children must alsobe aimed at the parents. Swedencurrently has over a hundred completefamily centres spread acrossthe country. In terms of definition,a complete family centre offers allthe healthcare services relating tothe prenatal and well baby clinics,co-located with an open nursery.Access to social guidance is alsoavailable under the same roof.Social advice also forms part of thesocial services’ prevention work andis provided without any exercising ofauthority (National Board of Healthand Welfare, 2008).Swedish family centres havewhat are, in terms of public healthservices, a number of strategicstarting points. The first is the time.The aim of the family centres is togive children a healthy start by beingthere from the beginning and bytargeting their services at both as yetunborn and newborn children, andtheir parents. Secondly, the familycentres represent a low-risk strategy,as they are aimed at all future andnew parents and their children aged0-5 years, not just at the most vulnerable.In exactly the same way as withall public health services, the familycentres also build on the interactionbetween different authorities and differentprofessional groups. They areboth preventive and health-promoting.This means that they target theirservices in order to not only reducerisk factors but also to increasehealth and protection factors. Finally,the family centres act as an everydaymeeting place for parents and childrenin a local area.15

Preventing children fromsufferingThe first steps in the development ofthe family centres were taken backin the 1970s. This decade saw theintroduction of a series of familypolicy reforms aimed at safeguardingthe upbringing of children. Thesereforms stemmed from the SwedishPaediatric Society highlighting childabuse and its causes at one of itsannual meetings back in the 1960s.A lack of care which led to the deathof a young girl subsequently fuelledan already intense debate withinsociety. The frightening truth wasout: parents who are normally theirchildren’s fiercest protectors canalso hurt their children the most.The public debate covered childabuse, children with special needs,a lack of childcare provision andthe need for preventive work. It wasclear that, if children were to beprotected from harm, parents wouldhave to have a reasonable standardof living and the tools they neededto help them cope with parenthood.This was followed at a nationallevel by a political response in theform of government-initiated studiesand subsequent legislation andreforms. One was the parliamentaryresolution concerning parentingcourses in 1979. The same year sawthe introduction of the ban on corporalpunishment of children and legislationconcerning parental leave inconnection with the birth of a child.All this was aimed at facilitatingparenting and protecting children.A major expansion of childcare provisionmade life more secure bothfor children themselves and for their16working parents, particularly singleparents.The 1970s turned out to be a gooddecade for children, during whichinterest in and research into childrenand childhood came into focus andbegan to be reflected in social policy.An advancement of knowledge beganand, together with Sweden’s ratificationof the Convention on the Rightsof the Child in 1990, helped establishthe stable foundations in terms ofknowledge and values behind familycentres today.Parliament’s resolution from 1979concerning a parenting course resultedin an offer to all future and newparents in the first instance. This initiativesaw the beginning of the trendtowards what 20 years later wouldcome to be called family centres. Theaim of the family centres has manysimilarities with the three objectivesof the parenting course, which wereto increase parents’ knowledge,reinforce their community and encouragethem to influence circumstanceswithin society.As the isolation of families wasseen as a serious threat to the healthof children, a new meeting place andnursery provision emerged – opennurseries (Gustafson, 1983). The aimwas the same as for the parentingcourse. Open nurseries immediatelybecame popular amongst parentsand an important partner for thechildren’s healthcare service, whichstrengthened its expertise in childpsychology at the same time. On thewhole, professional groups graduallybegan to work together when itcame to their common target group offuture and new parents. Gothenburgwas one of the first. Back in 1976,councillors there reached a decisionconcerning the provision of “parentinformation” and subsequentlydecided that open nurseries and preventivesocial workers would be madeavailable to all parents of young children.Social workers abandoned thedesks of their social services officesto devote their attention to childrenand the parents of young children atopen nurseries and prenatal and wellbaby clinics. This form of collaborationhas been called “the GothenburgModel” and became the predecessorto today’s family centres (Bing, 1997).Family centresThe financial crisis in the early1990s resulted in cutbacks in thepublic sector, which had a severeeffect on preventive work. Localauthorities had to save money. Outof several thousand open nurseries,suddenly only a couple of hundredremained,and preventive socialworkers were recalled to their offices.The crisis coincided with high levelsof immigration, high unemploymentand rising sick leave statistics. Publicsector employees were seeing a risein demand amongst the populationas the resources available to themdwindled.In this difficult situation, variousprofessional groups began to worktogether in the hope that by doingso they could make their resourcesgo further. Midwives and paediatricnurses outside Gothenburg now alsogained good experience of workingwith social workers and nurseryteachers on a daily basis. In manyparts of the country, collaboration

had become a habit and there wasa readiness to take the next step ofmoving in together under one roof.The people on the ground thereforecontacted managers and decisionmakersin order to put their ideasforward. In Sweden, where maternaland children’s healthcare servicesare provided by the county council,whilst open nurseries and socialservices are run by the municipalauthority, the decision-making processhad to take place in a numberof stages. This complicated thepolitical process and at the time thecoffers were empty.In this situation, projects wereseen as a solution. The recentlyestablished Swedish NationalInstitute of Public Health beganto receive applications for projectfunding. A remarkable numberof applications concerned interprofessionalcollaboration relatingto pregnancy and the very youngestchildren. Midwives within the maternalhealthcare sector stressed thatthe time leading up to the birth of achild represented a golden opportunityto exert an influence over thehealth of an unborn child. In order todeal with depression, cohabitationproblems, abuse and stress, theyneeded help from other professionssuch as social workers, family advisorsand psychologists.This orientation correspondedwell with the WHO’s “Health for All2000” policy, where the principalgoals of the European regions were“Equity in life” and “Healthy start inlife”. Behind the applications werepoliticians and officials which theNational Institute of Public Healthinvited to an initial network meetingin Gothenburg in 1995. This wasfollowed by other meetings, anda major workshop in Leksand thefollowing year was attended by 180people from 14 different municipalities.At this workshop, the delegatesconcluded that municipal authoritiesand county councils shouldget together and create a meetingplace for parents, where parentscould meet and play with their ownchildren, as well as those of otherparents; where children could enjoyspending time together; and wherevarious professional groups couldwork together in order to makeparenting easier. This meeting placewas giving the working name “familycentre”. The aims were to:• offer a local meeting place• reinforce the social networkaround children and their parents• identify working methods in whichchildren and their parents cantake part• offer easily accessible support• act as a centre for knowledge andinformation• develop a good serviceThe National Institute of PublicHealth’s task was to finance andcoordinate the network in order toconsider, in collaboration with thedelegates, what the work relating tofamily centres should involve. At theturn of the millennium, the NationalInstitute of Public Health underwentrestructuring and was assignedwhat were to some extent newtasks. Support for the family centrenetwork ceased. Instead, the familycentre network formed the Föreningenför familjecentralers Främjande(the Swedish Association for thePromotion of Family Centres) (www.familjecentraler.org), which, with itsannual conferences, has since actedas a hub and a driving nationalforce. The association’s boardrepresents all the many professionalgroups who work at family centres.It is an inter-professional vocationalassociation whose thousands ofmembers have in common the factthat they are committed to children,preventive work and collaboration.With the exception of one parttimeclerk, all work is carried outon a non-profit basis. The fruitfulcollaboration between the Nordiccountries has come about as a resultof the association’s initiative.The new public health workSwedish family centres are thereforethe result of a protracted process,which has largely been drivenforward by the professional groupsinvolved themselves. However, duringthe 2000s, family centres, whichgrew from a “bottom-up movement”,came to be included in local andregional public health plans. Thisaccelerated their development and,during the period 1997 to 2010, thenumber of family centres increasedfrom 35 to 130.In Sweden and other Nordiccountries, public health has held astrong position in policy, research,education and practice in recentdecades. This has benefited thefamily centres, as the new publichealth work places an emphasis oncross-sector and promotional work.17

providing paediatric mental healthservices, as it is a low-thresholdservice which guarantees fast andholistic help. Norwegian municipalitiesare recommended to organisetheir health-promoting and preventiveservices aimed at children and youngpeople according to the Family’sHouse model. The Regional Centrefor Child and Adolescent MentalHealth at the University of Tromsøis responsible at a national level forpromoting and developing the model.For 14 years, there has been closeinteraction between Norway andSweden concerning the developmentof family centres within both researchand practice.The Finnish family centres have aslightly different history. The nationalFAMILY project developed the socialservices and health work relating to“The National Board ofchildren and families. The developmentof family centre provision inaround 100 municipalities receivedstate financial support.Knowledge concerning familycentresThe Swedish Association for the Promotionof Family Centres celebratedits tenth anniversary by invitingdelegates to a Nordic family centreconference in Stenungsund in 2005.With the help of contributions fromthe Nordic Council of Ministers andothers, over 600 delegates from theNordic countries had the opportunityto attend four days of lectures,courses, seminars and workshops(Föreningen för FamiljecentralersFrämjande, 2005). Conference delegateswere given an account of theNordic countries’ views concerningPublic Health and Welfare proposes thatthere should be fully co-located family centresoffering healthcare services for mothersand their children, open nurseries andthe preventive work of the social services,which in future should be referred to usingthe term ‘family centre’.”(National Board of Health andWelfare, 2007)family centres, as well as relevantexperience and knowledge. Representativesof ministries and authoritiesin Sweden, Norway and Finlandalso participated. The Nordic Councilof Ministers also financed a Nordicmeeting of researchers in 2007 at theNordic School of Public Health (NHV)in Gothenburg (Stiftelsen Allmännabarnhuset, 2008).After both of these conferences,the Swedish family centres attractedthe attention of their own authoritiesand ministries. The Swedish NationalAgency for Education and the NationalBoard of Health and Welfare conducteda review of family centres. The latteridentified a need for an unambiguousdefinition of what is meant by a“family centre”. The National Boardof Health and Welfare’s Institute forthe Development of Methods in SocialWork (IMS) also prepared a summaryof the current state of knowledge in2007 (National Board of Health andWelfare, 2008).The investigators concluded thatthere was a lack of knowledge concerningthe work and effects of familycentres. They wanted to see a Nordicevaluation of the effects of familycentres and a more precise clarificationof the needs that the familycentres were intended to meet.No pan-Nordic studies have yetbeen published, but when Finlandorganised the second Nordic familycentre conference in Espoo (Esbo) in2010, the development of knowledgein Sweden had taken a big strideforward in just a few years.In addition to a large number oflocal evaluations, three Swedishdissertations on family centres have19

een presented. All three of thesedissertations were published withinthe field of social work (Hjortsjö,2005; Perdahl, 2009 & Lindskov,2010). A comprehensive evaluationof 16 family centres in VästraGötaland was also carried out onbehalf of the regional public healthcommittee with assistance from KristianstadUniversity and the Universityof Borås (Abrahamsson et al, 2009).ReferencesAbrahamsson A, Bing V, Löfström M (2009)Familjecentraler i Västra Götaland – enutvärdering. Västra Götaland Public HealthCommittee.Bing V (1997) Morötter och maskrosor omuppväxtvillkor och förebyggande socialatjänster. Borlänge Public Health Institute.Bing V (2003) Små, få och fattiga – om barnoch folkhälsa. Lund Studentlitteratur.Bing V (2005) Föräldrastöd och samverkan,familjecentralen i ett folkhälsoperspektiv.Gothia, Stockholm.Familjecentraler kartläggning och kunskapsöversikt,National Institute of PublicHealth and the Institute for the Developmentof Methods in Social Work: Västerås.National Board of Health and Welfare 2008.Gustafson M (1983) Öppen förskola. Liber,Stockholm.Haugland R, Rønning J, Lenschow K (2006)Evaluering av forsøk med familiesenterei Norge Regionsenter for barn og ungespsykiske helse. Department of ClinicalMedicine, University of Tromsø.Hjortsjö M (2005) Med samarbete i sikte omsamordnade insatser och samlokaliseradefamiljecentraler. Dissertation, School ofSocial Work, Lund University.Köhler L (2008) Dagens Medicin13.02.2008.Lundström Mattsson Å (2004) Socialtförebyggande arbete – med familjecentralensom arena. FoU SödertörnsSkriftserie nr 41/04, Sollentuna.Nordiskt ljus över omtyckt hus, dokumentationav den nordiska familjecentralskonferenseni Stenungsund2005. Träffpunkt June 2005.Nordisk forskarträff – kunskap omfamiljecentraler. Föreningen förfamiljecentralers främjande, 2007.Perdahl, A-L (2009) Verksamhetsutvecklingi socialt arbete – konstruktionav en interaktiv modell. Dissertation2009. School of Social Work,Umeå University.Petersen A & Lupton D (2000) Thenew public health – health and selfin the age of risk. Sage Publications,London.Research seminar on family centres,10-12 March 2008. Stiftelsen AllmännaBarnhuset. Västerås 2008.Vandenbroucke JP (2008) ObservationalResearch, Randomised trials,and two Views of Medical Science.PLos Medicine March 2008 Volume5 Issue 3.Lindskov C (2010) Family Centre Practiceand Modernity a qualitative study fromSweden. Doctoral Thesis, KristianstadAcademic Press 1:2010.20

Indeed, in the birth of the family centremodel, the key aspect lay in workers’feeling that multi-professionalco-operation increased their resources,competence and opportunities tosupport families. Co-operation beganto develop into doing things togetherin a structured, planned manner.A third factor, still taking shapeat the beginning of the new millennium,was a new way of perceivingwell-being. Public, social and healthservices as such were not felt to guaranteewell-being. A human being is asum of physical, psychological andsocial factors, and his or her wellbeingis generated through inclusion.The realisation emerged that publicservices for children and familiescould empower and create communitiesand integrate people intosociety. Crumbling social networks1 The National Institute for Health and Welfareis conducting a survey on the overall situationconcerning family centres in Finland. Thissurvey will be completed in autumn 2011.22had increased families’ loneliness.Strengthening inclusion and promotinga sense of community became ameans of preventing loneliness andsocial marginalisation. Today, therecently published strategy for socialand health policy, Socially SustainableFinland 2020 (Publications2011:6), identifies solidifying inclusionand a sense of community as astrategic issue.Development of family centresin FinlandFor the time being, no precise informationis available on the numberof family centres in Finland. 1 It hasbeen estimated that about one-fifthof municipalities have organisedservices for children and families asfamily centres or in a similar way.Services similar to family centres arechiefly planned through co-operationbetween municipalities. (Perälä etal. 2011). Slightly over ten years ago,at the beginning of the 21st century,there were only few family centresin Finland. Family centre work hasdeveloped in phases.The first wave – family centresarrive in FinlandThe development of family centresin Finland has taken place in threestages. Family centres first cameto Finland in 2002 when the city ofEspoo, together with Diaconia Universityof Applied Sciences, renewedfamily training at child health clinics,following the example of the SwedishLeksand model . They began to carryout family training in parent groups,which met before and after the childwas born. Fathers participated fromthe very beginning. The seeds offamily centre work also began togrow through family work, open earlychildhood education, NGO peer groupactivity projects and in projectspromoting partnership co-operationbetween municipalities and the thirdsector. Development projects of familycentres during the first wave werestarted upon the initiative of andas co-operation between individualmunicipalities, the Association ofFinnish Local and Regional Authorities,NGOs and universities of appliedsciences (Paavola 2004). At an earlystage, the development work yieldedsingle projects and there was nonationwide, shared developmentvision or development network tosupport service renewal. A majorshift in viewpoint, however, occurredwhen the problem-oriented practicewas replaced by addressing issuesin a proactive and resource-orientedway. The results of the first wave wereencouraging and interest was kindledin disseminating family centrework. (Paavola 2004; Pietilä-Hella &Viinikka 2005).The second wave – family centres’operating models formed at a locallevelThe second wave of family centreactivities began in 2005 when theMinistry of Social Affairs and Healthestablished the national FAMILYProject (2005–2007) to supportthe development of family centres.Led by the National Research andDevelopment Centre for Welfare andHealth STAKES (currently the NationalInstitute of Health and Welfare),the project became a partnership

project. The FAMILY Project wasbased on the Government Resolutionto Secure the Future of SocialWelfare (2003), in which familycentres were defined as an operatingmodel based on families’ needsand strengthening contacts betweenfamilies.During the second wave, set inmotion by the FAMILY Project, developmentwas steered at a nationallevel. Such steering comprised interactiveco-operation based on strongdialogue, networking betweenprojects and players, sharingknow-how and exchanging experiences.Families’ participation insuch development was supported.Almost 100 municipalities participatedin the FAMILY Project, througha total of thirty sets of projects. In2003–2007, the Ministry of SocialAffairs and Health allocated 36 millioneuros of government subsidyto social welfare development,of which 7.6 million euros wereallocated to family centre work. Inaddition, the provinces allocated atotal of 54 million euros to developmentin the same period, 8.8 millioneuros of which was set aside forsupporting services for children andfamilies (Oosi et al. 2009, 28–29).Municipalities which participatedin the FAMILY Project createda shared vision of the operatingconcept for family centres. Theoperating concept was crystallisedin five principles which guided thedevelopment of local operatingmodels in municipalities and municipalregions. These principles wereas follows:1. Promotion of children’s welfare:Strengthening parenthoodis the best way of promotingchildren’s health and welfare.Supporting parenthood mayalso prevent “ill-being” amongchildren and adolescents2. Development of basic servicesfor children and families:Support for parenthood isat its most effective in servicesintended for all familieswith children. The focus is onstrengthening basic services forchildren and families, namelyprenatal and child health clinics,early childhood educationand care and preventive work insocial services and schools3. Promoting peer activities andsense of community:Family centres take advantageof parents’ and children’sown resources, inclusion andexpertise. Parent group activitiessupport both mothers’ andfathers’ growth into parenthoodas well as partnership betweenparents and professionals whilestrengthening the value of bothparents in their child’s life.Peer activities promote theemergence of parents’ socialnetworks, sense of communityand the attachment of parentsto their residential area4. Creating a culture of co-operationand partnership:Family centres operate on thebasis of co-operation betweenservices for families with children,professional groups andfamilies themselves. Familycentre work is co-operative andcross-sectoral. Co-operationis agreed on in partnershipcontracts between municipalities,congregations, NGOs andvoluntary organisations5. Renewing the service structure:Family centres are developedwith the aim of permanentlyrenewing service structuresand creating networks betweenservices. Municipal welfarestrategies and child and familywelfare policy programmesserve as municipality’s strategicsteering instruments in theoperation of family centres23

Based on these principles, the operatingconcept of family centres has beensummarised as follows:24“A family centre is alocally developing servicemodel whose services includeprenatal and child health clinics,open early childhood education,primary school services,early support and family workservices. Family centres includemeeting places for parents, inwhich they can participate inunstructured or guided parentgroup activities. Family-orientedpractices promote child welfare,support parenthood and thecouple’s relationship, and theirnature is preventive. A familycentre’s working method ispartnership co-operation withNGOs congregations, volunteersand families themselves. Familycentres are part of the municipalstructure of services for childrenand families. Case managementservices ensures that specialisedservices reach the familieswho need them.” (Viitala, Kekkonen& Paavola 2008, 23.)In the second stage of the developmentwave, family centres weredeveloped into service models whoseoperations are based on the localservice needs and service structures.During the FAMILY Project,three kinds of family centre modelsemerged in municipalities (Oosi etal. 2009, 57–58; Viitala et al. 2008,41–42).1. Family centre model based on childhealth clinicsCharacteristic of the child healthclinic based model was implementationof group-based familytraining in prenatal and well babyclinics, which was based on theSwedish Leksand model. Furthermorea stronger co-operation wasbuilt between prenatal and childhealth clinics, child day care andpreventive social work (familywork)2. Family centre model based on openearly childhood educationThe open early childhood educationservice was developed in away which offered meeting placesfor families with small children.Meeting points operated on alow-threshold basis, and organisedpeer group activities, offeredsteered and targeted parent groupsand pedagogically steered activitiesfor children and parents. Theseactivities were organised by NGOsand congregations, as well as bymunicipalities3. Sub-regional family centre modelMany FAMILY Projects were subregional.This was partly influencedby the consolidation of municipalitieswhich took place during theproject period and in which severalsmaller municipalities joined acentral municipality. In the regionof Kainuu, family centres operatethrough a regional operating modelin which local services for familieswith children have been collectedinto sub-regional family centresand family stations whose operationsare slightly more limited.Furthermore, web-based familycentre work has been developed,for example in OstrobothniaDuring the second wave of family centredevelopment, group-type servicesfor children and parents were reinforcedas part of services for familieswith children. Peer support betweenfamilies and the significance ofchild-parent groups were increased.Attention was paid to strengtheningparents’ relationships. The work ofchild health clinics and child day carewas also developed. Functioning cooperationmodels also grew betweenchild day care and school, at theschool-entry stage. Multi-sectorialco-operation between open earlychildhood education, congregationsand NGOs was intensive, supportingthe establishment of families in theirresidential area. In a family centre, itis essential that children and familiesthemselves participate in planningand implementing activities.The focus on the development offamily centres was on basic services,inclusion and multi-actorco-operation. Partnerships aimed tointroduce the family centre workingmethod as a co-operation method in

into municipal preventive services,i.e. family centres. However, combiningservices into family centres hasmeant different things in differentmunicipalities, such as wide-rangingorganisation of services in line withlife-cycle thinking, family centres,welfare child health clinics, familystations, shared physical premises,open early childhood education, etc.More detailed information is neededon the preventive services offeredby family services and how they areorganised and managed. Researchdata is also needed on the effectivenessof family centres’ health andwelfare promoting work, and onpreventive activities. In Finland, familycentre work faces the challengeof defining criteria and drawing up aguide for family centre work.In the third stage of family centredevelopment – in which KASTEdevelopment work has included allservices for children and families,from universal basic services to childandfamily-specific specialised services,including child welfare, childpsychiatry and adolescent psychiatry– family centres have been emphasisedas a structure which promotesthe health and welfare of children andentire families, while offering earlysupport. Family centres are becominga service structure which consistsof meeting places for families and a2 In Finland, parenting support programmeshave been developed by the National Researchand Development Centre for Welfare and Health,STAKES, and currently by the National Institutefor Health and Welfare, THL. The National PublicHealth Institute and STAKES merged in 2009, toform THL.26family services network. In additionto municipal basic and specialisedservice professionals, the family servicesnetwork may include workersfrom associations, NGO volunteersand private-sector services. Familycentres combine the expertise andknow-how of parents, professionalsand other players in a way whichbenefits all parties. Parents notonly need information and parentingsupport, but also the chance toexchange experiences with others ina similar life situation. For this reason,the prerequisites of peer activitieshave been reinforced. The familycentres are universal and intendedfor all families with children.The services of a family centremay be located on the same premises,“under one roof’, or in theirown locations, in which case thefamily centre operates as a network.Operations are based on anagreed co-operation structure anda partnership agreement drawnup with NGOs, congregations orother players. Family centre work isorganised by municipalities, NGOsor both as multi-actor co-operation.Family centres can also act as centresof expertise, creating networksbetween professionals in the fieldand family centre professionals, anddeveloping services, family centrework and working methods whichsupport welfare and health.The development challenges ofthe family centre modelThe goal of the next KASTE programmeperiod is to continue thereform which has already begun,to regionally entrench new servicestructures, operating models and bestpractices and to spread them throughoutthe nation. In spite of numerouspositive accomplishments, there arestill challenges in the development ofthe family centre model.Strengthening parenthood andsupporting the child’s growthThe basic task of a family centre isto promote child welfare and healthby supporting parenthood. This isbased on continuously increasing anddiversifying knowledge of the factthat child health and welfare are builtduring interaction between parent andchild. The Finnish family centre modelfaces the challenge of developingpersonnel’s shared know-how on theparent–child attachment, and on earlyinteraction and encouraging upbringingpractices which support the child’sdevelopment. In other Nordic Countries,structured parenting supportprogrammes are widely used. Finnish,nationally 2 developed, cross-occupationaltraining programmes includeSupporting early interaction (VAVU),Theraplay, Taking up one’s worries,Educational partnership and Let’s Talkabout Children. The family centre ofWestern Turunmaa supports its knowhowwith the ICDP programme 3 , originallydeveloped in Norway and knownin Sweden as Vägledande samspel.The international and widely disseminatedInternational Child DevelopmentProgramme (ICDP) encourages positiveinteraction with the child. This pro-3 The International Child Development Programme(ICDP) is a parenting support programmedeveloped by Norwegian professors KarstenHundeide and Henning Rye at the University ofOslo. It is applied in more than 20 countries.

family training, parent group activitiesand home visits for families expectingtheir first child has been amended inparticular. The Child Welfare Act laysdown provisions on preventive childwelfare, confirming child health clinics,child day care, school and youthwork as co-operators in child welfarework. The Act on Children’s Day Carewill probably be transformed intoan Early Childhood Education Act.Several sector-specific Acts lay downprovisions concerning multi-sectoralco-operation working groups. Peergroup activities also hold a strongerlegislative position than before.The family centres has been promotedby means of sector-specificlegislation, but there is no legislationconcerning family centres as such. Inaddition to national and local developmentefforts, steering by way oflegislation is needed to establish thefamily centre model.ReferencesJanhunen Kristiina & Oulasmaa Minna(toim) (2008). Äidin kielletyt tunteet.Väestöliitto. Nykypaino Oy, Helsinki.Joensuu Johanna, Halme Nina, Nummi Tapio& Perälä Marja-Leena (2011). Lasten japerheiden palvelujen yhteensovittamistakuvaavan rakenneyhtälömallin kehittäminenja arviointi. (unpublished manusckript)National Development Plan for Social andHealthcare Services Kaste Programme2008–2011. Publications of the Ministry ofsocial Affairs and Health 2011:1Oosi, Olli, Wennberg, Mikko, AlavuotunkiKaisa, Juutinen Sirpa, Pekkala Henrik,PricewaterhouseCoopers Oy (2009)Sosiaalialan kehittämishankkeen arviointi.Loppuraportti: tulosten ja vaikutustenarviointi. Sosiaali- ja terveysministeriönselvityksiä 2009:12. Helsinki.Paavola, Auli (toim.) (2004) Perhe keskiössä.Ideoita yhteistyöhön perheidenparhaaksi: kokemuksia Ruotsin Leksandistaja useista Suomen kunnista. LastensuojelunKeskusliitto. Helsinki. GummerusKirjapaino Oy.Perälä Marja-Leena, Halme Nina & HammarTeija & Nykänen, Sirpa (2011). Hajanaisiapalveluja vai toimiva palvelukokonaisuus?Lasten ja perheiden palvelut toimialajohtajiennäkökulmasta. Institute for Health andWelfare. Reports 29/2011. Helsinki.Pietilä-Hella Riitta, Viinikka Anne (2006)Kumppanuus kannattaa. Verkostot voimavaranauudessa perhevalmennuksessa.Raportti Espoon kaupungin ja Diakoniaammattikorkeakoulunkumppanuushankkeesta.Suomen Kuntaliitto. Helsinki.Pietilä-Hella, Riitta (2010) Tuntemattomistavertaistuttaviksi. Esikoisäitien ja –isienperhevalmennusprosessi Espoon uudentyyppisessäperhevalmennuskokeilussa.Diakonia-ammattikorkeakoulun Julkaisuja ATutkimuksia 29.Raatikainen, Tuija (2010) Perheiden parissa.Perhekeskukset hyvinvointia edistämässä.Humanistinen ammattikorkeakoulu. Opinnäytetyö.Kansalaistoiminnan ja nuorisotyönkoulutusohjelma 11/2010.Risikko, Paula (2010) Kaste jalkautuvan kehittämistyönairueena. Teoksessa:Siltala, Elina , Paananen, Maiju (toim.)(2010) Mitä Kasteesta on kasvamassa?Lasten Kaste-seminaari 5.10.2010. Avauksia23/2010. Terveyden ja hyvinvoinnin laitos.Helsinki.Siltala, Elina , Paananen, Maiju (toim.)(2010) Mitä Kasteesta on kasvamassa?Lasten Kaste-seminaari 5.10.2010. Avauksia23/2010. Terveyden ja hyvinvoinnin laitos.Socially sustainable Finland 2020. Strategyfor social and health policy. Publicationsof the Ministry of Social Affairs and Health2011:6Sosiaalisesti kestävä Suomi 2020. Sosiaalijaterveyspolitiikan strategia. STM Julkaisuja2011:1.Viitala Riitta, Kekkonen Marjatta, PaavolaAuli (2008) Perhekeskustoiminnan kehittäminen.PERHE -hankkeen loppuraportti.Sosiaali- ja terveysministeriön selvityksiä2008:12. Sosiaali- ja terveysministeriö.Helsinki.28

The Family’s House in Norway – aninterdisciplinary, municipal/communityhealthcare service for children, adolescentsand their familiesAnette M. Thyrhaug, Gørill W. Vedeler, Monica Martinussenand Frode AdolfsenThis chapter presents a description of the Family’s House/ Family CentreModel, as it is applied in Norway following a national pilot study of FamilyCentres during 2002–2004. An overview is also given of the numberof municipalities that have organised their services in the form of aFamily’s House, based on a survey carried out in 2008. One new studyassociated with the model which focuses on how an open kindergartencan act as a parental support initiative, is also described.The Family’s House provides interdisciplinaryservices in the municipalitieswhich addresses mental andphysical health of children, adolescentsand their families. The municipality’sprimary health and socialcare services aimed at children,adolescents and their families arecoordinated, co-located and anchoredlocally through this service. The aimis for families to receive both wellcoordinated and family supportedservices within the same building.During the period 2002-2004, theRegional Centre for Child and YouthMental Health and Child Welfare atthe University of Tromsø conducteda national pilot study involving familycentres (now Family’s Houses)on behalf of the Norwegian HealthAuthorities. The pilot study wasbased on the Swedish family centremodel, but was adapted to Norwegianconditions (Haugland, Rønning, andLenschow, 2006). At that time, theproject was anchored in the NationalPlan for Advancing Mental HealthCare that was implemented between1999 and 2008 (Ministry of Healthand Care Services, 1998).The Norwegian authorities recommendthat municipalities shouldorganize their services accordingto the Family’s House model, andemphasise that the model is in linewith the intentions of the Co-ordinationReform currently being implemented(Ministry of Health and CareServices, 2009). The model is alsohighlighted by the National Instituteof Public Health, which in a new reporton health-promoting and preventiverecommendations recommends thatthe model be further tested as a coordinatinginitiative and that it shouldbe systematically assessed togetherwith other models (National Instituteof Public Health, 2011).Many different services and departmentsare collectively responsible forthe health, development and wellbeingof children and adolescentsin Norway. These are financed indifferent ways, have a specialist supportfunction in different departmentsand directorates, and have differentlegal frameworks to adhere to. Thefragmentation of responsibility fordifferent areas which are neverthelessclosely associated with each othercan represent a significant challengefor children, adolescents and familieswith complex needs. In an officialreport on the co-ordination of servicesfor vulnerable children and adolescents,the Family’s House is promotedas a suitable model for the organizationof the collaboration covering thistarget group (Ministry of Children,Equality and Social Inclusion, 2009).The Family’s Houseco-ordination modelThe services that are often co-locatedin Family’s Houses are a health centrethat offers healthcare service forchildren including pregnancy care,preventive child welfare services, ped-29

agogical-psychological services andan open kindergarten. Professionalsfrom the various services make up aflexible interdisciplinary team thatdelegates the work according to thewishes and needs of the users. Thegoal for the work is to promote wellbeingand good health amongst children,adolescents and their families,and to improve conditions for childrenand young people (RKBU Nord, 2008).Amongst other means, this goal canbe achieved by:How many Family’s Houses arethere in Norway?A national survey of Family’s Housesconducted in the autumn of 2008indicated that many different formsof interdisciplinary collaboration haddeveloped within Norwegian municipalities(Thyrhaug and Martinussen,2009). All Norwegian municipalitieswere contacted and asked to givefeedback as to whether they hadan organization corresponding tothat of a family centre or plannedto establish such a centre. The 19County Governor offices were alsocontacted in order to find out whatthey knew about municipalities withsuch organizations. This resulted ina total of 59 organizations spreadacross 40 municipalities. Many of the59 organizations that responded tothe survey were designated as familycentres, Family’s Houses or similar.These were in turn sorted into fourcategories (see Figure 2). Upon closerinspection, it was apparent that 14 of• Identifying the physical, mentaland social challenges faced by thechild and the family at an earlystage• Providing readily accessible supportand initiatives• Supporting and reinforcing parentsin their role as caregivers• Enabling children, adolescents andtheir families to strengthen theirsocial networks• Developing communication andworking methods with the involvementof children and parents• Developing appropriate, coordinatedand interdisciplinary servicesfor users• Being available as a meeting placein the areas where people live• Disseminating relevant informationThe goal is to develop a good dynamicand ensure that assistance is wellcoordinated,whether at a universal,targeted or indicated level (see Figure1). The model is intended to ensurethat services that are co-located worktogether to develop an integratedservice that includes initiatives at alllevels.Figure 1Levels of initiative and interventionswithin a Family’s HouseThird floor – IndicatedinterventionsChildren, adolescentsand families with particularneedsSecond floor/level –Selected interventionsChildren, adolescentsand families with individualneedsFirst floor/level –Health promotive anduniversal interventionsAll children andadolescents with theirfamiliesFoundationsProfessional infrastructureand competence30

the participating organizations consistedof all the same services thatwere included in the model formulatedin the trial project, and thereforequalified as a Family’s House. 16of the organisations were given thename Resource Health Clinic. Thesewere developed on the basis of ahealth centre, but had only integratedcertain individual elements from theFamily’s House model.Two groups of organizations wereconstructed in an entirely differentmanner. We found 10 organizationsthat we decided to refer to asspecialist referral teams. These hadestablished an interdisciplinary teamconsisting of various types of personnelwith expertise within mentalhealth work. Amongst the participatingorganizations, we also found ninemore independent open kindergartenswith additional resources. Thelink for collaboration with healthcentres was unclear for the latter twocategories. It was our understandingthat it was the parents themselveswho contacted the centres, or otherchild-oriented services referred familiesthere, in cases where the problemsfacing the child and the familywere so great that extended assistancewas needed. During the survey,contact was established with nineorganisations who informed us thatthey were in the process of establishinga Family’s House. However, weare unaware of the direction in whichthese Family’s Houses developed.Figure 2Proportion of different types of organisation16 %16 %17 %24 %27 %and preventive initiative in order toprovide users with readily accessibleparental support by serving as a pedagogical,open and inclusive meetingplace for the parents of young children.The goals of the initiative are tostimulate the development and healthof children, to support and reinforceparents in their role as caregivers,to promote a good level of interactionbetween parents and childrenand to strengthen the social networkof parents. Open kindergartens areopen to everyone with children up tothe age of six, and the service is freewith no one being allocated a permanentplace. Parents are given theopportunity to use the kindergartenservice at times that suit them duringopening hours. Other people caring forchildren within the target group arealso welcome.Users are invited to actively contributeto the formulation of the kindergarten’sprogramme and to the performanceof daily activities. Pedagogicalstaff are responsible for ensuring thatsuch participation takes place.Open kindergartens supplementFamily’s House services in severalways. First and foremost, they adda new dimension to the range ofThe Family’s House,n=14Resource healthclinics, n=16Specialised referralteams, n=10Open kindergartenwith extra resources,n=9Organizations underestablishment, n=9Open kindergarten– a parentalsupportive effortOpen kindergarten in the the Family’shouse are a health-promoting31

ReferencesHaugland, R., Rønning, J. and Lenschow, K.(2006). Evaluering av forsøk med familiesentrei Norge. Tromsø: Regionsenter forbarn og unges psykiske helse, region Nord(Regional Centre for Child and AdolescentMental Health – North), University ofTromsø.Ministry of Children, Equality and SocialInclusion. (2009). Det du gjør, gjør dethelt. Bedre samordning av tjenester forutsatte barn og unge (NOU 2009:22).Downloaded from http://www.regjeringen.no/pages/2272040/PDFS/NOU200920090022000DDDPDFS.pdfMinistry of Health and Care Services. (1998).Om opptrappingsplanen for psykisk helse,1999–2006 (Storting Bill no. 63). Oslo:Ministry of Health and Care Services.Ministry of Health and Care Services. (2009).Samhandlingsreformen. Rett behandling –på rett sted – til rett tid (Storting Report No.47 2008–2009). Oslo: Ministry of Health andCare Services.National Institute of Public Health (2011). Bedreføre var – Psykisk helse: Helsefremmende ogforebyggende tiltak og anbefalinger (Report2011:1). Oslo: National Institute of PublicHealth.Reedtz, C., Martinussen, M., Wang Jørgensen,Mørch, W.-T. and Handegård, B.-H. (in press).Parents seeking help in child rearing: Are theyin need of intervention? Journal of Children’sServices.RKBU Nord. (2008). Brochure: Familiens hus.Et tverrfaglig lavterskeltilbud. RKBU-Nord,University of Tromsø.Thyrhaug, A. M. and Martinussen, M. (2009).Familiens hus. Nasjonal kartleggingsundersøkelse2008 (Report no. 3). RKBU Nord,University of Tromsø.Vedeler, G. (2009). Åpen barnehage i Familienshus – en brukerundersøkelse blant foreldre.Master’s thesis. Institute for Pedagogics andTeacher Training, University of Tromsø.Contact information: Gørill Warvik Vedeler(gorill.vedeler@uit.no), Monica Martinussen(monica.martinussen@uit.no), FrodeAdolfsen (frode.adolfsen@uit.no) andAnette Moltu Thyrhaug (anette.thyrhaug@uit.no). Regional Centre for Child and YouthMental Health and Child Welfare, Universityof Tromsø, NO-9037 Tromsø, Norway.33

Danish family policy and the Child ReformAnna Jin RolfgaardDanish family policyStrong, self-supporting families areessential for a secure and strong societyexperiencing growth. Families arethe focal point for people throughouttheir lives. It is first and foremostwithin the family that individualsacquire their basic values, attitudesand perspective on life, and thefamily is the unit that performs awide variety of basic and particularlyimportant functions. This applieswhen it comes to both having childrenand providing them with key socialskills which equip the individual forlife and enable them to understandand function as a citizen in society.Furthermore, families are an absolutelyessential prerequisite for theexistence of society, simply becauseit is within families that the populationreproduces.Family policy is not just aboutmaternity rules and day care provision;it is also about health policy,social policy, environmental policy,etc. The circumstances and well-beingof families are therefore key parametersin the formulation and implementationof new political initiatives.The Danish government sees asuccessful family policy as a familypolicy as one that gives families thefreedom to organise their own lives.The initial assumption is that familiescan and want to take responsibility34for themselves and those closest tothem. The task of society is to provideservices which secure families’freedom of choice and uninhibiteddevelopment and provide a safety netfor those who find it difficult to copeon their own. Society must provide anappropriate framework, but the familiesthemselves also have a responsibilityto create a good family life.There are five underlying principles inDanish family policy:• The family policy must give familiesthe flexibility and freedom toorganise their family life as theywish• The family policy must help to promotea balance between family andworking life• The family policy must ensure goodframework conditions for familiesacross initiative areas• The family policy is based on thenecessity of utilising the resourcesthat are available within civil society• Family policy and social policy areinterlinked. Vulnerable familiesmust receive the help and supportthat will enable them to takeadvantage of society’s opportunitiesand create a secure frameworkfor their children’s upbringing andthe family’s well-beingThe vast majority of children inDenmark grow up in appropriate andsecure surroundings with parentswho support them throughout theirchildhood. However, this is not truefor all children. Some children do nothave a secure framework or receivethe support they need at home. It is akey task of society to support thesechildren and their families, in orderto ensure that the children have thesame opportunities as their peersfor personal self-realisation, developmentand health in spite of theirdifficulties and challenging circumstances.Achieving this goal will require theframework behind the initiative to beoptimal. This framework was considerablystrengthened through thechild welfare reform of 2006, whichamongst other things focused onthe importance of a comprehensivereview of the child’s problems and anaction plan for the initiative. Throughthe agreement – the Child’s Reformof 2009 – the political parties behindthe rate adjustment pool agreementbrought focus to the following threethemes:1. Closeness and care (Strengtheningof foster family programmes)2. Children’s rights and the previousinitiative (The legal position of vulnerablechildren must be strength-

ened, so that the child’s interestsare always the most important consideration,and prevention and anearly response are of vital importancein order to secure vulnerablechildren a good childhood)3. Quality in the initiative (Many areasmust be considered if it is to beensured that the initiative will makea positive difference to vulnerablechildren and in the long term helpto ensure that they get the sameopportunities as other children,including the elimination of redtape, knowledge production anddissemination, etc.)The parents of vulnerable childrenplay a major role in their children’slives, regardless of any failure or deficiencieson their part. It is thereforeimportant to be aware of the parents’needs for special support if theyare to contribute to their children’swell-being and development. In somecases, placement in foster care isessential, but this does not alterthe fact that a placement outsidethe home is always an unhappysituation which must be preventedwherever possible. At the same time,the parents still have a major role toplay for the children during a fosterplacement. It is therefore vital thatefforts are made to resolve the family’sproblems during the placementwherever possible, both so that thetime which the child and the parentsspend together can be as positive aspossible and in order to ensure thatthe child can return to their parentswherever possible.“Family centre provision” inDenmarkAs part of the Child’s Reform, fundingwas allocated to the development ofthe “Mødrenes Hus” (The Mothers’House) model. The Mothers’ Househas the characteristics of a modelthat local authorities, in partnershipwith a voluntary association, willimplement and test. The model wasdeveloped by drawing on inspirationfrom practice, including “Familiehuse”(Family’s Houses) in the Nordiccountries and the Netherlands, andthe “I gang” (Underway) project,which is being carried out underthe direction of the Danish NGO“Mødrehjælpen” (Mothers’ Help).The model is based on our currentbest knowledge of how an initiativeaimed at vulnerable young mothersshould be organised so that the goalsfor education, employment, parentingskills, networks and housing areachieved. The model’s starting pointis a holistic and non-stigmatisingapproach to the target group of vulnerableyoung mothers, their children,networks, etc.If you have any questions regardingDanish family policy, please contactHead of Section Anna Jin Rolfgaard(anr@sm.dk) or Special ConsultantAnne Katrine Bertelsen (atb@sm.dk)at the Danish Ministry of SocialAffairs.35

Child and family services in theIcelandic welfare systemSigrun Juliusdottir and Elisabet KarlsdottirThe aim of this chapter is to present a picture of the range of servicesavailable to children and families in the Icelandic welfare systembased on three perspectives: the public, state and municipal sector,the voluntary sector and the private sector. The principal focus hastherefore been placed on the general and preventive, rather than onvulnerable families or marginalised groups.Welfare services in Iceland for children and families are in manyrespects similar to the Nordic welfare system, particularly whenit comes to public sector childcare. Various general services aredescribed, along with social initiatives for various types of familybased on their varying needs. Finally, the presentation is linked toresults from Icelandic family research, amongst other things on thebasis of family policy aspects and the role of social work in postmodernfamily development.The public, state and municipalsectorCare and services for children, familiesand young people represent animportant part of the welfare society.Formal, public sector family servicesare enshrined in Icelandic lawsconcerning social support for familiesand children in the form of socialservices and maternal and children’shealthcare, as well as geriatric care.According to Icelandic legislationcovering welfare and social services,municipal authorities are requiredto ensure the financial and socialsecurity and welfare of the population.This must take place throughimprovements in the living conditionsof vulnerable groups and throughensuring the development of generallyfavourable upbringings for childrenand young people (Act No. 40/1991).The purpose of this is welfare withsocial and financial support for all(universal). There are also specialistservices for those with specialneeds, particularly children andyoung people. Services and resourcesare provided by both the state andthe municipal authorities. The rangeof services provided for childrenand families in the Icelandic welfaresociety varies from municipality tomunicipality. Framework legislationprovides scope for differing interpretationsof the laws and the range ofservices offered by municipal authoritiesunder family policy. A furtherfactor that plays a part in this respectis the fact that the 76 municipalitiesin Iceland vary greatly in terms ofsize and therefore also their needs interms of services and support. Reykjavikis the largest municipality, withapproximately 119,000 inhabitants,compared with the smallest municipalitywhich has 52 inhabitants. Atotal of 33 municipalities have fewerthan 1,000 inhabitants. Over 60% ofthe Icelandic population live in theReykjavik area (203,000 out of theentire population of 318,452) (HagstofaÍslands, 2011). A recent surveyof municipal services for children andfamilies in Iceland (in municipalitieswith more than 1,000 inhabitants)showed that, of 58 different servicesavailable, Reykjavik provided 50,compared with one of the smallestwhich only offered 20 of the services(Félags- og tryggingamálaráðuneytið,2010).The range of services offered tochildren and families can be dividedinto six areas: welfare and socialservices, educational initiatives, leisure,cultural issues, communication,third sector and non-governmentalorganisations (Félags- og tryggingamálaráðuneytið,2010). The36

ange of services offered to childrenand families from a preventiveperspective covers the provision ofboth preventive advice and supportfor parents, as well as varyinglevels of financial support for singleparents, the unemployed, those onsick leave, parents living below thepoverty threshold, etc. Financialsupport includes for example asibling discount at nurseries, discountsfor childcare in the home anddiscounts for single parents, as wellas financial support for participationin leisure activities for children,totalling 23 different benefits. Thispreventive service is offered to47% of the population (Félags- ogtryggingamálaráðuneytið, 2010).Another resource concerns statecontributions to families withchildren in the form of, for example,parental leave, child benefit,children’s pensions for disabledparents and parental allowances forsingle parents (Hagstofa Íslands,2009). Parental leave in Iceland canbe taken by both the mother and thefather. A total of nine months’ leaveis given: three months for mothersonly, three months for fathers onlyand three months which the parentscan allocate between themselves(Eydal & Gíslason, 2008). Childbenefit is paid via taxes and variesaccording to the income of the family,except that the same amount ispaid to everyone with children underthe age of seven (Arnaldur SölviKristjánsson, 2011).There are opportunities to takepart in educational initiatives forchildren of non-Icelandic origin(mother tongue lessons), and forprioritisation or special treatmentas regards admission to nurseryfor disabled children. In addition,certain municipalities offer allowancesfor the care of children in thehome. Eydal and Rostgaard (2010in Gíslason and Eydal (ed.)) havediscussed the concept of “börnepasning”(childcare) with regard tothe integration of care and learning.One of their findings is thatall Nordic countries except Icelandoffer daycare centre allowances asa direct continuation of parentalleave. Some of the family servicesconcern leisure activity provision.This area includes social club activitiesfor children aged 13–16, sportscentres for the whole family, andthe provision of employment andleisure activities during the summerfor children of school age. Italso includes free entry for childrento swimming pools, entertainmentfor children at libraries and freebus travel for children. Healthcarecentres in the larger municipalitiesprovide not only maternal care butalso access to certain family supportservices, particularly for familieswith very young children, but thefocus is primarily on the physicalhealth and development of children.Some healthcare centres providetargeted parental care with teachingand advice.Very little family work is carriedout through schools, but the ordinaryparents’ associations cooperatein various “home and school”programmes and the schools themselvesare to some extent involvedin collaboration with social andchildcare services. A few schools,mainly in the Reykjavik area, havestudy advisors and/or school welfareofficers, usually the same person.Services for families, childrenand young people provided bythe third sectorVoluntary work has traditionallyplayed a role within social and nonprofitorganisations in Iceland andrepresents what is known as “thethird sector” (Juliusdottir, 1999:Juliusdottir & Sigurdardottir, 1997).This activity falls between the publicand private sectors and is aimed atnon-profit services for the benefit ofthe general public (Hrafnsdóttir &Kristmundsson, 2010). It is commonfor various interest groups in Icelandto do voluntary work and, accordingto Hrafnsdóttir (2006), around 40%of people now participate in varioustypes of voluntary work. This mostlyconcerns sports and parents’ associations,as well as various charitableorganisations. One unexpectedfinding was that it is the age groupwhich is most likely to have theirown children that contributes mostto voluntary work. Activities thatare specifically aimed at families,children and young people are themost comprehensive, both now andin the past, and these activities areoften supported by the public sector(Steinunn Hrafnsdóttir, 2008).Parents often participate with theirown children in various sports andyouth organisations on a voluntarybasis. A major voluntary contributionis the involvement of parents withvarious service programmes and theprovision of advice to children andyoung people with various types of37

disability or long-term illness, suchas Sjónarhóll (http://www.sjonarholl.net) and Þroskahjálp (http://www.throskahjalp.is).Another organisation that works inthe interests of children and familiesand for attitude change concerningtheir affairs is Barnaheill (Save theChildren), which works both nationallyand internationally. There are alsoorganisations such as Kyrkans välgörenhet(Charity work of the Church),the Red Cross and Mödrahjälpen(The Aid of Mothers), which havespecifically dealt with parents andchildren living below the povertythreshold since the economic crisis in2008. Voluntary work has long beenimportant in family welfare issues inIceland (Steinunn Hrafnsdóttir, 2006).Family services in the privatesectorPrivate sector services covering familyissues are not particularly extensivein Icelandic society. It is primarilysocial workers and psychologistswho have clinical expertise or whoare authorised psychotherapists.This service is primarily available inthe Reykjavik area. The first receptionclinic, Föräldrarådgivningen, wasstarted by two female psychologistsin 1979 and reorganised to formPsykologcentrum in 1983, an organisationwhich is still active and offersboth individual and family therapy.In 1982, a team of family therapists,three social workers and two psychologistsfounded FamiljemottagningenTengsl, which also offered familycourses and management, as well aslonger family therapy education programmes,e.g. in collaboration with38the University of Iceland’s institutefor continuing education. All five werefull-time public sector employees,two of whom still run a private clinicfor couples, parents and children.Kyrkans familjerådgivning providesaccess to family advisors, threesocial workers and a psychologist.Some clergymen have specialised inbereavement counselling for families,whilst a few lawyers work with socialworkers and psychologists providingmediation to divorcing couplesin conflict over child custody andaccess issues. The limited provisionof family services due to a failure toacknowledge the need for specialistexpertise relating to families (Félagsogtryggingamálaráðuneytið, 2009;Nososco, 2009) has contributed to agrowing number of social workers andpsychologists opening private clinicsfor families with special needs, e.g.associated with Alzheimer’s disease,ageing, relationships, etc. Researchhas shown that the need and demandfor family advice and support, particularlyin connection with divorceissues and step-child relationships,has increased in line with the postmoderndevelopment of families(Juliusdottir, 2009 a & b).Welfare services and evidencebasedknowledgeIcelandic society has changedsince the banking crisis in 2008with (almost previously unheard of)unemployment and reduced spendingpower as a result. This has had amarked negative effect, particularlyin terms of the ability of families withchildren to provide for and maintaintheir quality of life. The Ministry ofWelfare has implemented comprehensivemeasures to deal with thisnew situation, including initiatives tocounteract the financial difficultiesfaced by families and the threat ofbankruptcy and wherever possible toprotect the public sector welfare servicethat had previously been built up(Félags- og tryggingmálaráðuneytið,2009a).Greater acknowledgement of theimportance of evidence-based knowledgewithin the social arena has contributedto social services for childrenand families now being increasinglybased on research and evaluationsof various service programmes andmethods. This has resulted in greaterambitions amongst social workersand other professionals within socialcare for participation in developmentprojects and the evaluation of services,and thus helping to raise thelevel of quality of post-modern socialwork. The result is a better developedrange of services for users of socialservices (Guðmundsson, Jónsdóttir& Júlíusdóttir, 2010). An example ofa service that is based on evidencebasedpractice within the state andmunicipal sector (Reykjavik) is Kvennasmiðjan,which is a collaborativeproject between the City of Reykjavikand the Social Insurance Administration(Guðmundsson, Jónsdóttir andJúlíusdóttir, 2010; Hrafnsdóttir &Karlsdóttir, 2009).

ReferencesArnaldur Sölvi Kristjánsson (2011). Fjölskyldubæturá Íslandi. Fjárstuðningur vegnaframfærslu barna árið 2010. Greining ogsamanburður við önnur lönd,ásamt útfærsluá nýju kerfi barnatrygginga. Reykjavik:Þjóðmálastofnun Háskóla Íslands.Eydal G B and Gíslason I., (2008). Paidparental leave in Iceland – history andcontext. In Eydal and Gíslason (ed.). Equalrights to earn and care – Parental leave inIceland. Reykjavik: FélagsvísindastofnunHáskóla Íslands.Eydal G B and Rostgaard T (2010). Dagpasningsordiningerog tilskud tilpasningaf börn i hjemmet. Í Gíslason and Eydal(ed.) Föräldraledighet, omsorgspolitík ochjämställdhet i Norden. pp. 62–104. Copenhagen:Thema-Nord 2010:595.Félags- og tryggingamálaráðuneytið(2009). Skýrsla nefndar um stöðu barna ímismunandi fjölskyldugerðum. Reykjavík:Félags- og tryggingamálaráðuneytið.Félags- og tryggingamálaráðuneytið(2009a). Greinargerð um grunnþjónustuog aðferðir við hagræðingu í efnahagsþrengingumReykjavík: Félags- og tryggingamálaráðuneytið.Félags- og tryggingamálaráðuneytið(2010). Þjónusta sveitarfélaga við börn ogbarnafjölskyldur. Reykjavik: Höfundur.Hagstofa Íslands (2009). Heilbrigðis-, félagsogdómsmál. 19 October 2009.Hagstofa Íslands (2011:1). Mannfjöldi.29 March 2011.Hrafnsdóttir S & Kristmundsson O(2010).Challenges in the Icelandic Non-Profit Sector.ISTR Volume VII . Conference Working PaperSeries – 9th International Conference, Istanbul,Turkey.Hrafnsdóttir S (2006). The Icelandic voluntarysector. Development of research. In Aila-LeenaMatthies (ed.) Nordic civic society organisationsand the future of welfare services. Amodel for Europe? pp. 194-211. TemaNord:517.Copenhagen: Nordic Council of Ministers.Hrafnsdóttir S (2008). Frjáls félagasamtökog sjálfboðaliðastörf á Ísland. Ómar H.Kristmundsson and Steinunn Hrafnsdóttir(ed.) Stjórnun og rekstur félagasamtaka, (pp.21-41). Reykjavík: HáskólaútgáfanHrafnsdóttir S & Karlsdóttir, E (2009). Communitywork in Iceland in Hutchinson (ed.).Community work in the Nordic Countries – NewTrends. Oslo: Universitetsforlaget.Juliusdottir S & Sigurðardottir S (1997). Hversvegna sjálfboðastörf? Reykjavik: Háskólautgáfan.Juliusdottir S (1999). Humanism – voluntarism– professionalism. Om frivilligt arbete i Island.Nordic conference: Frivilligt arbete, forskningoch förmedling. NOPUS report 1999:13Juliusdottir S (2009 a). Icelandic familiesand intergenerational relationships: Youngpeople’s experiences, views and values.REASSESSING THE NORDIC WELFARE MODEL.Conference 18-20 May, 2009. Soria MoriaHotel. OsloJuliusdottir S (2009 b). Félagsleg skilyrðiog lífsgæði. Rannsókn á högum einstæðraforelda á Ásbrú/Keili í Reykjanesbæ. Reykjavík:RBF.Lög um félagslega þjónustu (40/1994).NOSOSKO 2007-9. (2009). Social Protectionin the Nordic Countries 2007-2008. Scope,expenditure and financing. Copenhagen:Nordic Social Statistical Committee.39

Promotion of the well-being ofparents and children40

The Swedish strategy for developedparental support and the family centreas an arena for the provision of municipalparental support servicesJohanna AhnquistIn order to support the country’s parents, the Swedish government hasformulated a national strategy for developed parental support – A benefitfor all (Nationell strategi för ett utvecklat föräldrastöd -En vinst för alla).The aim of the strategy is to promote local collaboration surrounding theprovision of support and assistance to parents in their parenting. Thestrategy places an emphasis on the family centre as an example of both aform of collaboration and a health-promoting arena for parents and theirchildren. During 2010–2012, some 10 pilot projects are being carried outin various locations across the country with the common aim of developingand evaluating municipal strategies for parental support in accordancewith the national strategy. Some interesting development work is underwayin many of these projects using the family centre as a starting point.The aim of this article is to give an account of the Swedish strategy fordeveloped parental support and to present a number of specific examplesof the way in which family centres can play a key role in building up newstructures and forms of collaboration for parental support provision.Parents are importantParents are the most important peoplein every child’s life and are bestplaced to influence their children’shealth. Whilst a good and trustingrelationship between a child andhis or her parents acts as a safetyfactor for a child, deficiencies in thehome environment can also have anegative impact on the child. Inadequatesupervision, parents whohave a positive attitude towardsnorm-breaking behaviour and seriousconflicts between children andtheir parents are known risk factors.Poor relationships within a familycan for example increase the risk ofmental ill-health as well as high-riskbehaviour such as alcohol and drugabuse, smoking, obesity, etc. in children(Resnick et al, 1997; Rhoades,2008; Stewart-Brown, 2008; Weich,Patterson, Shaw & Stewart-Brown,2009).When children themselves areasked, they consider that the mostimportant factor for feeling good isto have parents who get involved,i.e. who set aside time, who careabout and who listen to their children(Backett-Milburn, Cunningham-Burley & Davis, 2003).41

Support for parentsThe preamble to the Convention ofthe Rights of the Child states “Convincedthat the family, as the fundamentalgroup of society and thenatural environment for the growthand well-being of all its membersand particularly children, should beafforded the necessary protection andassistance so that it can fully assumeits responsibilities within the community”(Ministry of Foreign Affairs,1990). A fundamental concept ofSwedish welfare policy has been tooffer parents good living conditions,which are one of the preconditionsfor good parenting. Sweden thereforehas a well-developed safety net thatprovides families with fundamentalsupport and protection in the form of,for example, child allowance, a parents’allowance that enables parents42to be at home with their children foraround a year, good access to care,school and nursery provision, leisureactivities, etc.The health of Swedish childrenstands up well in a historical andinternational perspective. However,despite a well-developed safety net,there are still a number of disturbingtrends. One of these trends is theincrease in mental and psychosomaticdisorders amongst adolescentsthat has become apparent in recentyears (Danielson & National Instituteof Public Health, 2006; NationalBoard of Health and Welfare, 2009).Developing social support for parentsis therefore an important pieceof the jigsaw associated with reversingthis negative trend.The government’s initiativeconcerning support for parents– “A benefit for all”From a social perspective, it is vitalto provide parents with support andassistance that strengthens themin their parental role and helps toreinforce the safety factors withinthe family. In order to better enableSwedish parents to give their childrena secure and good upbringing, theSwedish government has establishedthe “National Strategy for ParentalSupport – a benefit for all” (Ministryof Health and Social Affairs, 2009).The Swedish national strategy forparental support forms part of thegovernment’s long-term initiative topromote health and prevent ill-healthamongst children and adolescents.The strategy is based around the viewthat the responsibility for the child’sbest interests is a joint one and thestrategy is therefore aimed at promotinglocal collaboration concerning theprovision of support and assistanceto parents in their parenting. Thestrategy is one of universal parentalsupport, i.e. all parents are offeredthe same opportunities for supportand assistance. The strategy offersa definition of parental support andone overarching objective and threesecondary objectives.The overarching objective of thestrategy is to offer parental supportto all parents until their child reachesthe age of 18. The Swedish nationalstrategy for developed parentalsupport highlights the view thatthe support must build on existingstructures, promote collaboration andprovide the right circumstances toenable parents to meet.Parental support is defined in thestrategy as an activity that “teachesparents about their child’s health,emotional, cognitive and social developmentand/or strengthens the socialnetwork of parents”.Forms of parental supportThere are many occasions during achild’s upbringing when support insome form may be needed. The reportentitled “Föräldrastöd – en vinst föralla. Nationell strategi för samhälletsstöd och hjälp till föräldrar i derasföräldraskap” (Parental support – abenefit for all. National strategy forsocial support and assistance for parentsin their parenting) (Föräldrastödsutredningen,2008), which forms thebasis for the Swedish government’snational strategy, states that there isa void when it comes to support forparents. Studies have, for example,

shown that many Swedish parentssay that they need support in theirrole as parents (Lagerberg, Magnusson,& Sundelin, 2008) and that theywould be interested in becominginvolved in various parental supportactivities. This is particularly true ofparents with young children (Bremberg,2004; Bremberg & Eriksson,2008).The government’s strategy emphasisesthat it is the parents themselveswho are experts on their children andthat it is therefore the needs of parentsand children that will determinethe content of the support that isoffered. According to the strategy, itmust also be voluntary to participateand take advantage of the opportunitiesthat are available.If all needs are to be met, a broadrange of types of support will beneeded. In Swedish society today,many different players provideservices which, if they were to bedeveloped, could provide parentswith better help and support in theirparenting. One of the secondaryobjectives of the strategy is thereforeto increase co-operation overparental support between playerswhose services are aimed at parents.Examples of such organisationsare local authorities, county councils,religious communities, parentassociations, sports clubs and othernon-profit organisations and adulteducation associations. Anothermeans of achieving the overarchingobjective is to create the right conditionsto enable parents to meet andexchange experiences and knowledgeby promoting a greater number ofhealth-promoting arenas and meetingplaces. The third and final means ofachieving the overarching objectiveis to ensure that the parentalsupport offered is based on scienceand tried and tested experience byincreasing the number of parentalsupport players with training inhealth-promoting methods anduniversal evidence-based parentalsupport programmes.The strategy also emphasises theview that no one can do everything,but each initiative is a piece of thejigsaw which, when combined, canform an entirety.The family centre – a wellestablishedhealth-promotingarena for parentsThe family centre (Familjecentralen)is an example of both a form of cooperationand a health-promotingarena for parents and their children,a view that is given particularemphasis in both the report and thestrategy. At family centres, the promotionand prevention work relatingto children aged 0-18 is coordinatedand co-located. There is no officialinterpretation of the term, hencethe meaning can vary. The centresnormally provide an open nursery,as well as maternal healthcare,children’s healthcare and social services.Many professional categories,such as midwives, nurses, nurseryteachers, social workers, family advisors,recreational leaders, psychologists,etc., work together around thefamily with children. According to aninventory drawn up in autumn 2007,there were 131 family centres acrossSweden in 2007 (National Board ofHealth and Welfare, 2008).In its review and overview of familycentres, the National Board of Healthand Welfare stated that no evaluationshave been published concerningthe effects of family centres. Thereports and evaluations that do existare limited to processes and collaborationat family centres and the way inwhich staff and visitors perceive theservice (National Board of Health andWelfare, 2008). However, accordingto the National Board of Health andWelfare’s overview, the reports andevaluations that examined what thevisiting families thought of the familycentres showed great appreciationamongst the parents. The childrencan meet and play with other children,whilst the parents can interactwith other parents and combine visitsto a number of services. The criticismthat is put forward often concerns43

short opening hours, an insufficientnumber of waiting rooms and a lackof activities (National Board of Healthand Welfare, 2008).Development of municipalstrategies for parental supportDuring the period 2010–2012, anumber of government projects areunderway within the framework ofthe national strategy with the aim ofdeveloping and evaluating municipalstrategies for parental support inaccordance with the national strategy.On behalf of the government, theNational Institute of Public Health(FHI) has, for example, distributedSEK 70 million in stimulation grantsto a total of 10 principal municipalitieswhich, together with researchersand in co-operation with other44municipalities, will develop municipalstrategies for parental support. Withinthe framework of the project, manyprojects have been initiated to developmunicipal strategies for parentalsupport. The work carried out withinthe framework of the project hasprimarily involved the development ofstructures for the local co-ordinationof parental support bodies, partlythrough the appointment of projectleaders/project coordinators, work oncross-sectorial co-operation, constitutedsteering groups, reviews, etc.Structures have also been built upfor the dissemination of information,e.g. websites and the preparation ofinformation and training material. Thesupply and demand of parental supportmethods has also been reviewedand among other things courses havebeen held for leaders within existingparental support methods. Most projectsare also aimed at expanding therange of parental support activitiesby developing new forms of parentalsupport that can attract new groupsof parents, e.g. single parents, youngparents, parents with several childrenand parents with an immigrant background,who do not normally attendparental support groups.Many of the projects are also aimedat developing the family centre intoan important part of the municipalfamily support services as well as ameeting place and health-promotingarena for parents and their children.Examples are given below of twoprojects that have been allocatedfunding within the framework of theparental support initiative, wherethe work to develop the provision ofparental support is being carried outin close co-operation with the familycentres.Parental support partnershipwithin the Umeå region – theFamiljepeppen project“Familjepeppen” is a collaborativeproject that is aimed at all parentswith children aged 0–17 in the Umeåregion. The principal aim of theproject is to help ensure that childrenhave a secure and good environmentin which to grow up. The startingpoint for the project is that all parentsneed meeting places in order to havethe opportunity to reflect on theirrole as parents and to learn positiveapproaches in order to handle futureconflicts in the best possible way.Within the framework of the project,a broad range of activities is thereforeoffered in the form of talksand eight general parental supportprogrammes around the Umeåregion. The idea is that the range ofprogrammes and methods shouldbe suitable for as many parents aspossible. A special website has alsobeen developed where parents canfind easily accessible information onthe parenting courses that are availablein their municipality within theUmeå region. The parental supportis offered to all parents in the regionthat have children under 18.Co-operation with family centresis an important aspect of the projectand there is co-operation with all thefamily centres in the Umeå region,including the “family centre-like services”that are available.The project is being carried out inclose collaboration with researchersfrom the Department of Clinical

Sciences at Umeå University, whichis evaluating the results. No resultshave yet been published. However,experience from the project so farindicates that the family centres haveacted as an enabler for both Familjepeppenand the parental supportwork as a whole. This has resultedin the family centres becoming thearena for the most comprehensiveparental group services within theframework of the project.It has also proven easier to attractparents of children aged 0–4 toparticipate in parental groups via thefamily centres. It is believed that thisis primarily because parents trust inthe staff at the family centres and theparents listen to what they recommend.The reason why the family centreshave succeeded in recruiting theparents of young children in particularis believed to partly be becausenew parents are more open to newnetworks and information concerningtheir children than parents who havea few years of parenthood behindthem. They have finished the groupsat the BVCs (the childcare centres)and many people find that they stillhave a need to meet up with otherparents in order to discuss issues.Younger children are also involved infewer activities, which provides scopefor the parents of young children toparticipate in groups.Another experience from theproject is that the family centresthemselves have been given a boostby the project in terms of their workintroducing and running parental supportgroups. Today, six out of a totalof eight family centres run parentalsupport groups, either under theirown auspices or in collaboration withan adult education association. Allthe staff at the family centres havecompleted Stage 1 training in theparental support method entitled“Guiding interaction” (Vägledandesamspel). One person from each familycentre will also undergo Stage 2.This initiative is expected to result inan improvement in the quality of thegroups at MVCs (maternal healthcarecentres) and BVCs (childcare centres).It is also believed that the fact thatall staff at the family centres haveundergone training will also resultin greater uniformity in interactionand the views concerning children atthe family centres. Follow-up of staffwho completed the course this springshows that they have found that theynow have a common language andcommon values as a basis for talkingabout children and parenthood. Theseissues have been put on the agendathrough the “Guiding interaction”course.Interacting parental support– a network for research anddevelopment in ÖstergötlandLinköping, together with nineother municipalities in the countyof Östergötland, are collaboratingon the project entitled “Interactingparental support – a network forresearch and development” (Samverkandeföräldrastöd – nätverk förforskning och utveckling), which hasthe aim of creating a network forthose in the county who are involvedin the provision of parental support:municipal authorities, countycouncils, non-profit associationsand adult education associations, aswell as Linköping University (TemaBarn), which is evaluating the resultsof the project. The aim is to createa parental support network whichreaches all parents. The network willwork to raise awareness of children’scircumstances amongst parents andprofessionals who work with childrenand parental support. The guidingwords for the project are: “universal,complementary, long-term”. The projectinvolves activities that concern,among other things, parental supportat school parents’ evenings, parentalsupport in connection with SFI (SwedishFor Immigrants), parent forums (ashorter alternative to traditional parentingcourses), a network for COPEleaders and group leader training.Within the framework of the project,the family centres are an importantarena for developing the workrelating to coherent parent groups.Activities that directly involve familycentres are aimed at creating a countywidenetwork for family centres aswell as greater cultural expertise atfamily centres (“bridge-builders”).Within the sub-project “Countywidenetwork for family centres” (Länsnätverkför familjecentraler), a networkis being established for the county’sfamily centre staff as well as otherstaff who carry out similar work, i.e.maternal healthcare nurses, children’shealthcare nurses, educationalistsand social workers. The familycentre network is a forum where staffcan meet and share good ideas andchallenges that they face in their(fairly special) profession. There areregular meetings (once a term) withvarious relevant themes and talksand with relevant research. The aim is45

to provide an opportunity for discussionand the exchange of experiencebetween the county’s family centresand thereby promote method developmentand interaction.The aim of the sub-project “bridgebuilders”is to increase the linguisticand cultural expertise available atfamily centres in multicultural areasusing “bridge-builders”, who canact as a cultural and linguistic linkbetween parents and professionals.The project utilises staff withinmunicipal authorities and countycouncils who have a mother tongueother than Swedish and who possesscultural expertise that is importantin order to inform people of andpromote parental support initiatives.An example of such a staff categoryis mother tongue instructors/teachers,who normally possess culturalexpertise in two cultures. Anotherexample is teaching assistants. Thebridge-builders work to motivatepeople with an immigrant backgroundinto visiting the family centre andtaking part in the family programmesthat are offered. The demand arosewhen staff at the family centres saidthat they did not feel they were ableto communicate with all visitorsbecause of language barriers andthat they were therefore unable tooffer the same support and providethe same information to all visitors.The “bridge-builders” concept haspreviously been successfully developedat the family centre at Skäggetorpin Linköping Experience to dateindicates that the “bridge-builders”initiative has been a success andachieves its purpose in the areas concerned.The method is currently being46evaluated by Tema Barn at Linköping.University, which is also evaluatingother sub-projects.Researchers from Tema Barn atLinköping University are also carryingout a qualitative research studyof family centres with the aim ofdescribing and analysing the experiencesof staff and parents concerningvarious types of initiatives at thefamily centres. The research studyis being conducted at three familycentres in three municipalities inareas with different characteristics.Interviews with staff members havebeen concluded and interviews ofparents are currently underway. Theresults so far indicate that externallythe family centres differ through thediffering characteristics of the areas,the length of time that the familycentre has been in existence, actualco-location or “visiting”, the layoutof the rooms and premises, openinghours and accessibility, the degreeof structure in activities (“we decidewhat to do as we go along” or “at 10o’clock, we sing songs”) and the wayin which the staff relate to targetedgroups. The similarities between thefamily centres are also striking. Thereis pride in the initiative amongst thestaff and a belief that the family centresare appreciated by the parents.The analyses present certain themes,e.g. the family centre as a meetingplace and the network-building that isbeing carried out, something that isconsidered to be the main task of thefamily centre. It is also clear that thestaff place an emphasis on a professionalapproach – it is important forthe staff not to be “a close friend”.Many members of staff have basedtheir arguments on the concepts: professional,personal and private. Someparents are identified as being inneed of more support from the staff inthe network-building work than others.As an individual member of staff,it is about observing and supporting,sitting next to people with a cup ofcoffee and trying to involve peoplein conversation. One member of staffsaid something along the lines of:“no one should have to go home andfeel that there was no one for themto talk to today.” Another theme isthe relationship between the differentareas of expertise. In relation toparents, social services are the leastclear area of expertise. People whowork within social services approachtheir work in slightly different ways.One approach is to become a “name”rather than a professional role, eventhough you are working as a professionalof course. The research studywill be concluded and the results publishedduring the latter part of 2012.

ReferencesBackett-Milburn K, Cunningham-BurleyS & Davis J (2003) Contrasting lives, contrastingviews? Understandings of healthinequalities from children in differingsocial circumstances. Soc Sci Med, 57(4),613-623.Bremberg S (2004) Nya verktyg för föräldrar:förslag till nya former av föräldrastöd.Stockholm: Swedish National Institute ofPublic Health.Bremberg S & Eriksson L (2008) Kartläggningav föräldrars erfarenhet och intresse avföräldrastöd. Swedish National Institute ofPublic Health.Danielson M & Swedish National Instituteof Public Health (2006). Svenska skolbarnshälsovanor 2005/06 grundrapport. Stockholm:Swedish National Institute of PublicHealth.Föräldrastödsutredningen (2008).Föräldrastöd – en vinst för alla: nationellstrategi för samhällets stöd och hjälp tillföräldrar i deras föräldraskap : betänkande.SOU 2008:131, Stockholm: Fritze.Lagerberg D, Magnusson M & Sundelin C(2008). Barnhälsovård i förändring: resultat avett interventionsförsök (1st edition). Stockholm:Gothia.Resnick M D, Bearman P S, Blum R W, BaumanK E, Harris K M, Jones J et al (1997). Protectingadolescents from harm. Findings from theNational Longitudinal Study on AdolescentHealth. JAMA, 278(10), 823-832.Rhoades K A (2008) Children’s responses tointerparental conflict: a meta-analysis of theirassociations with child adjustment. Child Dev,79(6), 1942-1956.Ministry of Health and Social Affairs (2009).Nationell strategi för ett utvecklat föräldrastöd:en vinst för alla. Stockholm: Ministry of Healthand Social Affairs.National Board of Health and Welfare (2008).Familjecentraler: kartläggning och kunskapsöversikt.Stockholm: National Board of Healthand Welfare: Institute for the development ofmethods in social work.National Board of Health and Welfare(2009). Folkhälsorapport 2009. Stockholm:National Board of Health and Welfare.Stewart-Brown S (2008). Improving parenting:the why and the how. Arch Dis Child,93(2), 102-104.Ministry of Foreign Affairs (1990). Konventionenom barnets rättigheter: Conventionon the Rights of the Child. [Stockholm]:[Ministry of Foreign Affairs].Weich, S, Patterson J, Shaw R & Stewart-Brown S (2009). Family relationshipsin childhood and common psychiatricdisorders in later life: systematic review ofprospective studies. Br J Psychiatry, 194(5),392-398.47

The importance of social support andreflective functioning for parenthoodMirjam KallandFamily centre provision is based on the basic idea that the best thingwe can do to support public health as a whole in the long term is towork for a secure childhood. This basic idea is underpinned by extensiveresearch into how our childhood circumstances, starting duringpregnancy, influence our physical and mental health later in life.In Finland, most of our children andfamilies are happy and healthy.However, there is a growing proportionof children who are at risk.The proportion of children living infamilies with low incomes or belowthe poverty threshold has risen fromless than 5% to 13% over the past15 years. We have received reportsof increasing alcohol abuse at alevel which poses a risk in familieswith young children (Halme, 2008),and we are seeing a steady risein the number of children who arecovered by the child welfare opencare system (5.4%) or who aregrowing up outside the home (1.2%,equivalent to over 16,000 children).Children are also increasingly beingaffected by their parents divorcing.Divorce has consequences for thehealth and life expectancy of adults(it increases both mortality andmorbidity amongst both genders,(Köhler et al, 1986)). The way inwhich divorce affects children haslong been debated, but a comprehensivestudy published in The Lancetin 2003 shows that children who livewith single parents run a greater riskof suffering mental illness than otherchildren. The study covered 65,085children with single parents (primarilysingle mothers) and compared theirdevelopment with that of 921,257children from families with two parents(Ringbäck et al, 2003).The care that children receive duringtheir early years has far-reachingconsequences for their developmentand factors such as abuse anddomestic violence pose a seriousrisk for subsequent marginalisationand drop-out from society (Kalland etal. 2001; Kalland et al, 2006). If themother experiences stress during herpregnancy, this will have an adverseeffect on the unborn child (Mulder etal, 2002). During the past decade,a group of researchers in the USAhas been studying the links betweenan insecure upbringing and mental andphysical ill-health as an adult. Theyfound strong links with both subsequentmisuse and mental ill-health and ourmost commonly occurring widespreaddiseases such as cardio-vascular disease(see for example Felliti et al, 1998).A Finnish study also demonstrated thatthe most important psychosocial factorfor contracting cardio-vascular diseaselater in life was the emotional distancebetween the mother and her child and alack of support and appreciation (Keltikangas-Järvinen,2001). More recently,the significance of stress during childhoodas regards the brain’s development,the immunological system as awhole and the link between traumaticevents during childhood and depressionhas also been highlighted. In summary,it can be said that stress duringchildhood can result in a reduction inthe volume of the brain, adversely affectthe child’s ability to learn, increase therisk of diseases relating to the immunologicalsystem and affect the child’scapacity to handle stress in the future(Middlebrooks & Audage, 2008).In turn, epigenetic research hasbegun to explore the way in which traumaticevents experienced by parentscan leave their mark on their children’sgenetic make-up and thus affect thecharacteristics of future generations.Traumatic experiences do not affectDNA, but they do affect the way in whichDNA is read. A group of methyls whichcan be connected to or disconnectedfrom the genes seems to be of decisiveimportance. The important factor in thiscontext is that the interaction betweeninheritance and the environment ismore complicated than was previ-48

ously believed, and this points tothe importance for future health of asecure environment in which to growup (Franklin et al, 2010; Yehuda R &Bierer L, 2009).Parenthood, a sense ofcoherence and the importanceof social supportWhen people become parents, theiridentity undergoes a change, as theyhave to make room in their innerself not just for the child, but also tobecome a mother or father to theirchild. This change is fundamentaland irreversible – Daniel Stern hasdescribed it as a gate which you passthrough and which then closes behindyou. However, becoming a parent isnot just a psychological change; itmust also be anchored in a culturaland sociological context.One must therefore ask oneself: what does parenthoodmean in the post-modern society? In simplifiedterms, it can be said that well-being in post-modernsociety could mean a perception that anything is possible,on-line, at any time. The sense of freedom and infinitepossibilities can be total amongst young, well-educatedand resourceful parents-to-be. However, the child canbe described as anti post-modern, as the child demandscontinuity, stability and recurring routines. It could even besaid that post-modern life ends with the birth of the child.This can have consequences for the parents which can beperceived as both positive and negative.In Aaron Antonovsky’s theory onSense of Coherence, the individual’sperception of life as meaningful, comprehensibleand manageable is highlightedas fundamental. Antonovskyassumes that this perception of theworld arises at an early age, when theinfant experiences emotionally andcognitively correct responses to his orher needs. He refers to examples fromSeligman, who assumes that learnedhelplessness has its origins inexperiences of a lack of synchronicitybetween response and outcome or,seen from the child’s perspective, alack of synchronicity between activityand response. If the child finds thatnothing it does makes any difference,it will decide that it is unable to influenceits surroundings and give up.Children grow up in an environmentwith “a lot of noise, but no information”about how they should act(Antonovsky, 1979). An example ofsuch an environment is a home wherethe parents have an addiction or sufferfrom mental problems, with theresult that they are neither physicallynor mentally available to meet theirchild’s needs in a predictable wayand the parents’ actions are dictatedby their own mental condition ratherthan the child’s needs.However, Antonovsky notes thatthe sense of coherence is not abouthaving absolute internal control. Ifone wants to experience absolutecontrol, it is a question of an innerrigidity, where the tolerance of uncertaintyis low and the capacity for flexibilityprior to changes can be limited.If the need for control is too strong, itcan lead to a spasmodic orientationtowards the outside world, wherethe existence of the uncontrollableis not tolerated. At the same time, healso points out that his theory has asociological anchoring and that whatdefines stress factors and the way inwhich they are handled is anchored inmacrocultural and cultural contexts.Compared with post-modern society,people in industrial and agrariansociety were tied to their workplaceor home in a different way than isthe case today. The days and weeksrevolved around routines. One canimagine that the transition to parenthoodwas a lower stress factor than itis in today’s society. On the contrary,being tied to the home because of achild could give life more meaning,whilst today it can be seen as aninterruption in the lifestyle that onehas grown accustomed to leading.49

organised within the third sector(non-governmental organisations),whilst closed (and often targeted)groups are also organised withinthe primary healthcare sector,under the child welfare service andwithin the framework of the familyadvice service. However, bothreports and practical experienceindicate that a special effort shouldbe made to include parents with animmigrant background.Few ambitious comparativestudies have been carried outinto the effects of open universalparent groups, and those that doexist do not give strong supportto the view that they have anydemonstrable effect. Carrying outresearch in this form is problematic,as both the activity and theintensity of participation can varygreatly. However, there is evidenceto suggest that closed and structuredgroups can have a positiveeffect (Thomas & Zimmer-Gembeck,2008). One study (Cox & Docherty,2008) shows that perceived healthis improved amongst parents whoreceived group support after thebirth of their first child, but morestudies are needed in order to showthe possible long-term effects.An excellent summary of what weknow about structured groups wasprepared by the Swedish NationalInstitute of Public Health (Bremberg,2004), but our knowledge inthis area needs to be updated. Thereport states that structured groupbasedsupport (closed groups)has positive effects on the mentalhealth and attachment of children,and that:• the effect becomes clearer, theyounger the child• the best effect is achieved whenthe child is younger than 6 months• the effect becomes markedlyweaker if the group meets morethan 16 times, i.e. relatively shortand focused initiatives seem towork bestThe report also states that opengroups (at family centres/familycafés/open nurseries) are difficult toevaluate, but they are appreciated byparents. Parents are generally verysatisfied, but many would like to seea clearer structure. It can also be difficultto include fathers and parentswith an immigrant background.More theoretically anchored interventionsand ambitious experimentalresearch are needed in order toimprove our knowledge within thisarea.Mentalising capacity andreflective functioning inparenthoodAn individual’s reflective functioningconcerns the (metacognitive) capacityto think about how one thinksand feels, and the links betweenthese inner thoughts and feelingsand how one acts. The basis forthis process is mentalising capacity,which in turn embraces a sort ofobvious basic assumption that peoplehave an actively processing mindor consciousness. The mentalisingprocess is initiated when an individualattempts to understand how hehimself or someone else thinks andfeels, and the reflective functioningis characterised by being interpersonal.During the past decade, agroup of researchers from Londonand Yale has created a theory concerningthe way in which this reflectivefunctioning affects our ability toform relationships with other people(Fonagy et al, 2002). According toPeter Fonagy, reflective functioningprotects the individual’s development,as it gives us the opportunityto understand and predict the feelingsand actions of other individuals.With the aid of this reflective function,we create a “theory of mind”, aconsciousness theory. An individualwith a high reflective functioning canthus distinguish between internaland external reality, separate hisor her own feelings and needs fromthose of others, and understand hisor her own feelings and needs in differentways (Fonagy, 1996).According to Peter Fonagy, theindividual’s reflective functioningcan also represent a modifying factorbetween one’s early experiencesand the way in which one practisesparenting. Of particular importanceis the observation that individualswith difficult experiences but a highreflective level have the capacity tocreate secure relationships with theirown children. Fonagy’s colleagues,Professor Linda C. Mayes and DrArietta Slade ,of Yale University andCity College of New York, have developeda research tool and interventionmodels based on these theorieswhich are applicable to both thenormative population and to parentsin various high risk situations.In parenthood, reflective functioningis particularly important. Thiscapacity is both commonplace and51

sophisticated: a mother who realisesthat her baby is crying because he ishungry needs to have the capacity torespond to both the child’s physicalneeds and the child’s emotionalneeds for affection and security –only meeting the physical needs ofthe child is not enough to ensure thedevelopment of the child. The motherthen understands that the child iscrying in order to express both a needand a feeling, and she understands(intuitively) that the way in whichshe responds to the child’s needswill affect the child. If she is irritatedand heavy-handed or indifferent andmechanical when she feeds the child,this will have an adverse effect on thechild, but if she is calm and playful,she will affect the child in a favourableway.Reflective functioning in parenthoodis therefore less about havingability and knowledge, and moreabout being open and receptive tothe child’s signals. As parents, it is52A parent with a highreflective functioning canobserve, receive and processtheir child’s feelings and needswithout being affected by anxietyor frustration. The child isseen as a separate individualand the parent is able to link thechild’s feelings to the child’sbehaviour.important to observe one’s child andits reactions, to consider and wonder,to take an interest in the feelings andneeds of one’s child and to see one’schild at all times as a unique personwith a unique way of perceiving theoutside world and a unique way ofexpressing their feelings and needs.Relatively little empirical researchhas so far been carried out concerningthis capacity, but research intoparenting in high risk situationsshows that it is possible to influencethe reflective functioning of parentsin interventions and that this is linkedto their capacity for parenthood(Schechter et al, 2002 and 2003;Slade et al, 2005; Pajulo & Kalland,2006).The Parents First programme is thefirst support service for parenthoodto be explicitly developed to supportthe reflective function in parenthood(Goyette-Ewing et al, 2002).The parent groups are organisedinto 12-week periods and have beendeveloped and tested by Yale ChildStudy Center, Yale University, NewHaven. The aim of the groups is tomeet other parents to consider whatfeelings and needs (newborn) infantsexpress through their behaviour. Thegroups do not focus on strategies orsolutions, but on giving meaning andsignificance to the infant’s or child’ssignals. The Parents First groupstherefore offer a forum for parentsto discuss parenting and family life,to understand their child better andsupport their development, and towork for changes in family life wherenecessary. They also act as a sourceof social support for parents. Theparent groups are also a source ofinformation for other forms of supportwhich are available and which maybe needed, e.g. family advice, familywork, etc. In Finland, the ParentsFirst groups (Föräldraskapet Främstin Swedish and Vahvuutta vanhemmuuteenin Finnish) are intended forboth parents who come to the grouptogether with their child. After theconclusion of a parent group, the parentscan hire parent cafés and otherservices linked to family centres ornon-governmental organisations.Folkhälsans förbund has adaptedand developed the manual forParents First groups through fourpilot groups: two in Helsinki (oneorganised by Folkhälsan and anotherorganised by the City of Helsinki),one in Uusimaa (Nyland) and onein Ostrobothnia (Österbotten). Themanual was completed in January2010 and has been translated intoFinnish. From 2010 onwards, theMannerheim League for Child Welfarehas, in collaboration with Folkhälsan,developed the method furtherand intends to implement the modelacross the entire country in collaborationwith the municipal authorities.Parents who are expecting their firstchild are recruited to the groups bythe antenatal groups and are giventhe chance to continue attendingmeetings after the birth when thechild is around four months old. Theproject is linked to research accordingto a “case-control design” withfollow-up until the child reaches theage of two. The principal researchissue is whether it is possible, viathese theoretically anchored, closedand structured groups intended forboth parents together with their

child, to improve family health andthe marital relationship after the birthof the child.Why support reflectivity inparenthood?The National Institute of PublicHealth’s report states that all involvementin parenthood is a sensitiveissue, as it can violate the family’sright to self-determination. On theother hand, here in Finland we haveperhaps been unnecessarily sensitivetowards the right of the family toindependence and individual solutions.One could even claim that wehave developed a “non-interventionethic”, where in the worst casescenario we sacrifice the well-beingand health of the child and family inthe name of humanism and respect.As a result of this initial exaggeratedrespect, we can be forced to intervenemore dramatically later, e.g. by takingcustody of the child.However, it is also clear that whatwe offer parents on a universal basisshould be voluntary, and that whatwe do should be based on tried andtested evidence that we really cansupport the well-being of families andchildren in this way. There is also arisk that parents will become lost ina jungle of contradictory advice andthat their parenting could actuallybe adversely affected by increasingconfusion. The theoretical startingpoint for parent groups based onreinforcing the reflective functioningof parents is based on the simpleassumption that meeting the emotionalneeds of the infant/child is aunique process which each individualparent and each individual child mustlearn together. This process cannotbe learned through an “ABC bookwith tricks and tips”, but the parentshave natural preconditions which canbe supported in a respectful mannerby exploring the reality together.Through the groups, parents alsodiscover the value of not knowingand of not being able – as opportunitiesfor discovery arise when uncertaintyis endured. By not knowingtoo much and giving good advice,one also paves the way for parents tolearn about their child themselves.This reinforces the parents’ selfconfidenceand increases the positiveexperience of being a good parent.Reflectivity is shielding, as throughthe development of our reflectivity wecan protect our child from any harmor traumatic experiences that wemight have been through ourselves.Reflectivity is also liberating, as ithelps us to understand that thereare various ways of being here in theworld. Reflectivity releases us fromthe shackles of childhood and helpsus to distinguish between the way inwhich we have been treated and whowe are (“he was unloving, but I amnot unlovable”). Reflective thinkingis also dynamic: nothing is everfinally achieved; we have our wholelife ahead of us at every stage of ourlives. The dynamic aspect is alsorestorative by nature – we can returnto what was wrong, we can repairdamaged relationships and we cangive and receive new chances.Finally, I would go so far as to claimthat supporting reflectivity increasesthe resilience of individuals andfamilies. Resilience is about a sort ofmental elasticity, about being ableto bounce back after experiencinghardship, about picking yourself upand dusting yourself off, and so on.In international literature, resilienceis defined as an individual’s positivedevelopment in spite of the presenceof harmful factors during their childhood.Harmful factors are defined asfactors that have statistically beenshown to be linked to an increasedrisk of physical, mental and socialproblems, such as a childhood environmentcharacterised by violence,abuse or poverty. Positive development,on the other hand, is aboutcoping with the task of developingwhich the development stage presupposeswithout any major difficulties.Research into resilience is consideredto have potential for findingopportunities for the prevention ofdiseases and for promoting individualcompetence and adaptation in spiteof perceived difficulties, and couldtherefore form the basis for a social,health and education policy that cansupport human resources in the bestpossible way and reduce the “erosion”of aptitude and potential that isbrought about by mental illness andmarginalisation (Luthar & Cicchetti,2000).It was originally believed that therewere, or could be, a number of specialprotective factors that contribute toresilience which are of importancefor those who are not vulnerable.Today, we work more to a cumulativeor compensatory model. The cumulativemodel is based on the assumptionthat the more supporting factorsan individual has, the less risk therewill be of problems in the future. Thecompensatory model is based on53

the assumption that the factorsthat support children in general(such as good self-esteem, goodrelationships with parents, goodrelationships with friends) alsosupport children with regard torisk factors in their surroundings(Fergusson & Horwood, 2003),and that we can support thehealth of individual children andfamilies with very ordinary things,with the “magic of the ordinary”.This approach can be reflectedagainst the fact that what weighsdown parents more than anythingelse are these very everydayconcerns.Perhaps this is precisely themagic of the family centres, thefamily cafés and other open meetingplaces? That we support veryordinary families with ordinaryproblems in a way that is downto-earthand mundane? And thatall this is so mundane that it evenevades strictly scientific investigation,so that we just have to trustthe mundane words of ordinaryfamilies – they make me feelbetter, they help me get throughthe day and I now have some newfriends?ReferencesAntonovsky A (1979) Health, stress and coping.Jossey Bass. San Fransisco.Bremberg S ed. ( 2004) Nya verktyg för föräldrar– förslag till nya reformer av föräldrastöd.Swedish National Institute of Public Health.Stockholm.Brockington I (1996) A portfolio of postpartumdisorders. In “Motherhood and mental illness”,pp. 134–198. Oxford University Press Inc., NewYork.Cox J L, Holden J M & Sagovsky R (1987) Detectionof postnatal depression. Development ofthe 10-item Edinburgh Postnatal DepressionScale. Br J Psychiatry 150, 782-786.Cox P & Docherty K (2008) Assessing the impactof a first-time parenting group. Nursing Times;104: 21, 32-33.Copeland D & Harbaug BL (2005) Differences inParenting Stress between Married and SingleFirst Time Mothers at Six to Eight Weeks AfterBirth. Issues in Comprehensive Pediatric NursingVol. 28, No. 3, Pages 139-152.Crnic KA & Greenberg MT (1990) Minor parentingstress with young children. Child Development61, 1628-1637.Eriksson M & Lindström B (2005) Validity ofAntonovsky’s sense of coherence scale: asystematic review. Journal of Epidemiology andCommunity Health 59: 460-466.Felliti Vj, Anda RF, Nordenberg D, WilliamsonDF, Spitz AM, Edwards V, Koss MP et al (1998)The relationship of adult health status tochildhood abuse and household dysfunction.American Journal of Preventive Medicine 14:245-258.Fergusson, DM, & Horwood, LJ (2003) Resilienceto childhood adversity. In S. Luthar (ed)Resilience and vulnerability (pp. 130–155).Cambridge University Press. Cambridge.Fonagy P (1996) The significance of the developmentof metacognitive control over mentalrepresentations in parenting and infant development.J Clin Psychoanalysis 1996;5:67-86.Fonagy P & Target M (1996) Playing with reality:Theory of mind and the normal development ofpsychic reality. International Journal of Psycho-Analysis, 77. 217-233.Fonagy P, Gergely G, Jurist E L, Target M (2002)Affect Regulation, Mentalization and the Developmentof the Self. Other Press. New York.Franklin TB, Russig H, Weiss IC, Gräff J, Linder N,Michalon A, Vizi S, Mansuy IM (2010) Epigenetictransmission of the impact of early stress acrossgenerations. Biol Psychiatry 2010 Sep 1; 68:408.Goyette-Ewing M, Slade A, Knoebber K, GilliamW, Truman S & Mayes L (2002) Parents first: adevelopmental parenting program. Manual. YaleChild Study Center.Halme N (2009) Isän ja leikki-ikäisen lapsenyhdessäolo. Yhdessäoloa, isänä toimimiseen liittyvästressi ja isän tyytyväisyyttä parisuhteessakuvaavan rakenneyhtälömallin kehittäminen jaarviointi. Akateeminen väitöskirja. Tampereenyliopisto.Kalland M, Pensola T, Meriläinen J, SinkkonenJ (2001) Mortality in children registered in theFinnish child welfare registry: population basedstudy. BMJ no 7306, pp 207–208.Kalland M, Sinkkonen J, Gissler M, Meriläinen J,Siimes MA (2006) Maternal smoking behavior,background and neonatal health in Finnish childrensubsequently placed in foster care. s, ChildAbuse & Neglect 2006.Keltikangas-Järvinen L (2001) Sydän ja verisuonitautienpsykososiaaliset riskitekijät lapsilla.Duodecim 117(13):1389-94.Krech KH & Johnston C (1992) The relationshipof depressed mood and life stress to maternalperceptions of child behavior. Journal of ClinicalChild Psychology 21, 115-122.Köhler L, Lindström B, Barnard K, Itani H (1986)Health implication of family breakdown. Familieswith children in divorce. NHV report 1986:3.Lundahl B, Risser HJ, Lovejoy MC. 2006 A metaanalysisof parent training: moderators andfollow-up effects. Clin Psychol Rev 26 (1): 86-104.54

Luthar S & Cicchetti D (2000) The construct ofresilience: Implications for interventions andsocial policies. Development and Psychopathology12, 857-885.Middlebrooks JS, Audage NC. (2008) The Effectsof Childhood Stress on Health Across theLifespan. National Center for Injury Preventionand Control.Milgrom J & McCloud PI (1996) Parenting Stressand Postnatal Depression: Stress Medicine, 12,(3), 177-186.Mulder JH, Robles de Medina PG, Huizink AC,Van der Bergh BRH, Buitelaar, JK, Visser GHA(2002) Prenatal maternal stress: effect onpregnancy and the (unborn) child. Early HumanDevelopment 70 3-14.Murray D & Cox J L (1990) Screening for depressionduring pregnancy with the EdinburghPostnatal Depression Scale (EPDS). Journal ofReproductive and Infant Psychology 8, 99-107.Olds D (2002) Prenatal and infancy homevisitingby nurses: from randomized trials tocommunity replication. Preventive Science 3,153-172.Pajulo M, Suchman N, Kalland M, Mayes L(2006) Enhancing the effectiveness of residentialtreatment for substance abusing pregnantand parenting women: focus on maternal reflectivefunctioning and mother-child relationship.Infant Mental Health Journal 2006, Vol.27(5),448-465 (2006).Peterson Ch, Peterson K, Håkanson A (2005) Ettkvartsekel med föräldragrupperi i barnhälsovården– var står vi idag? Läkaretidningen 39Vol 102 2754-2755.Prinz RJ & Sanders MR (2007) Adopting apopulation-level approach to parenting andfamily support interventions. Clinical PsychologyReview, 27, pp. 739-749.Ringbäck G, Hjern A, Haglund B, Rosen M(2003) Mortality, severe morbidity, and injuryin children living with single parents in Sweden:a population-based study. The Lancet 361:289-295.Schechter D S, Kaminer T, Grienenberger J F, &Amat J (2003) Fits and starts: a mother-infantcase-study involving intergenerational violenttrauma and pseudoseizures across three generations.Infant Mental Health Journal, 24(5),510-528.Schechter D S, Zeanah C & Myers M M (2002)Negative and distorted maternal attributionsamong violence-exposed mothers of very youngchildren before and after single-session feedback:are maternal psychopathology and reflectivefunctioning predictive? Paper presented atthe meetings of the World Association of InfantMental Health, Amsterdam, The Netherlands.Slade A (2005) Parental Reflective Functioning:An introduction. Attachment and Humandevelopment, 7, 269-281.Slade A (2002) Keeping the baby in mind: acritical factor in perinatal mental Health. Zeroto Three 22:10-16.Sepa A, Frodi A, Ludvigsson J (2002) Couldparenting stress and lack of support/confidencefunction as mediating mechanisms betweencertain environmental factors and the developmentof social strain in the family, seems tobe involved in the induction, or progression,of diabetes-related autoimmunity in the childduring the 1st year of life.Thomas, R. & Zimmer-Gembeck, M. (2007)Behavioral outcomes of parent-child interactiontherapy and Triple P ¿ Positive ParentingProgram: A review and meta-analysis. Journal ofAbnormal Child Psychology, 35, pp. 475–495.Sanders MR, Turner KMT, Markie-Dadds C.(2002) The development and dissemination ofthe Triple P Positive Parenting Programme. Amulti-level evidence based system of parentingand family support. Prevention Science.2002;3: 173-189.Sanders MR, Cann W, Markie-Dadds C (2003)Why a universal population level approach tothe prevention of child abuse is essential. ChildAbuse Review. 2003;12:145–154.Stern, D. (1999) En mor blir till. Natur ochkultur. Stockholm.Stewart-Brown S (1998) Public health implicationsof childhood behaviour problemsand parenting programmes. In: Parenting,Schooling & Children’s Behaviour: Interdisciplinaryapproaches.Buchanan A, Hudson BL, editor. AshgatePublishing. Aldershot.Spoth RL, Kavangh KA, Dishion TJ. (2002)Family Centred Preventive Intervention Science:toward benefits to larger populationsof children, youth and families. PreventionScience 2002;3: 145-152.Yehuda R & Bierer L (2009) The Relevanceof Epigenetics to PTSD: Implications for theDSM-V. Journal of Trauma and Stress 22 (5),427-434.55

Child’s right to an upbringing– Family centre as a promoter of a rearingculture which respects the childMaria Kaisa AulaThis article examines upbringing from the point of view of Finnish children.What constitutes a good upbringing from a child’s perspective?How can family services promote an upbringing culture which respectsthe child? The information used in this text has been collected fromFinnish school children, but the same questions are topical throughoutthe Nordic Countries. The UN Convention on the Rights of the Childemphasises the mother’s and the father’s primary and shared responsibilityfor a child’s upbringing. A child has the right to parental care,nurture and guidance. Public services should support parents, actingas educational partners both at schools and in daycare. At its best,a family centre can promote a culture in child-rearing which respectschildren, helping the parents to recognise their value as guardians.“Because they have always beenaround, asking me about things”(secondary school pupil).In addition to parents, important childrearersoften include grandparents,who are associated with providing arole model and experience of life.“Let’s also mention my lategrandma, because she was alwaysencouraging, tolerant and proud ofeach of her children and grandchildren”(secondary school pupil)For children, the most importantupbringing is provided byparentsBased on children’s own opinions,it is clear who the most importantchildrearer is. One of the principles offamily centre activities is to supportparenthood and, by doing so, increasechildren’s well-being. The parents, i.e.the mother and father, both together56and separately, were mentionedmost often when, in the spring of2010, the office of the Ombudsmanfor Children in Finland asked overtwo hundred school children aboutthe most important person involvedin their upbringing (Nivala 2010).The position of parents was justifiedby their closeness, care andsupport:Other relatives are also consideredimportant to upbringing. As closefamily members, siblings, especiallyolder sisters and brothers, arementioned as child-rearers. Personsnamed from outside the family includegodparents in particular, as well asaunts and uncles in general. Childrenalso name “professional child-rearers”such as teachers and hobby instructorsas important childrearers, but

their status is not as clear as that ofparents. Hobby instructors becomeimportant childrearers if they supportthe child in ways other than teachingthe hobby.Children see upbringing as animportant activity which affects them.It partly overlaps with teaching, butis not entirely the same. Upbringingincludes teaching, but also somethingmore. Support, help, care, teaching todistinguish right from wrong, listening,understanding, caring, spendingtime together and being present arecomponents of this.“It’s like teaching, but you alsotake care of the child you’re bringingup” (girl, 10 years)“Upbringing is supporting someone,teaching them the differencebetween right and wrong, spendingtime together with that person,etc (girl, 12 years)A good child-rearer is present, caresand wants to listen to and understandtoday’s children and adolescents. Heor she is also interested in the childas an individual and wants to get toknow him or her better.“He always helps me and takesan interest in my life” (secondaryschool pupil).A good child-rearer is encouragingand can be trusted. Limits are importantfor children, but they also wantthose bringing them up to demonstratesuitable, situation-specificflexibility.A good child-rearer is nonviolent,while offering affection andtenderness. Children and adolescentsalso wish that those bringingthem up show patience and listenand encourage more, rather thanshouting. Violence does not makefor a more effective, but a moredamaging, upbringing.“Some people believe that achild learns through punishment,but that’s not true. Heor she only feels terrible orbecomes angry with the parent.”(primary school pupil)”Moreaffection, no bossing around,etc.” (primary school pupil)“The ability to listen, and notbeing pointlessly judgemental”(secondary school pupil)Children want their child-rearersand parents to be actively at theirdisposal. This includes caring, askingquestions and offering support,even when the child does not askfor these things:“That they take care of the childand ask how the child is reallydoing” (secondary school pupil)A good child-rearer is useful in aconcrete way, being able to giveadvice and guidance on the importantmatters in life. He or she does notconcentrate solely on a single aspectof the child, but views the child oradolescent as a whole. A good childreareralso grows with the task, nottreating an adolescent like a child.Shared time, good food andharmonyUpbringing cannot be distance work.It is living and being together. Insurveys conducted by the office ofthe Ombudsman for Children, schoolchildren wished for a greater adultpresence in their lives and for lessloneliness. In addition, they wishedfor more harmony and fewer quarrels.A tense atmosphere and tetchinessin the home are often connected tohurry and stress. (Tuononen 2008)“(I’d like to persuade) Mum andDad to stop arguing, but I’venoticed that it’s no use trying (primaryschool pupil)Common mealtimes are the kind ofshared family time which Finnishfamilies seem to lack: according tosurveys, in Finland, children andparents eat together less frequentlythan in other European countries. Themeaning of good food and mealtimesto children’s experience of care athome should not be underestimated.Not all children are beset by parentswho lack time, or by loneliness.Naturally, most children have a lot ofgood and positive things to say abouttheir families.57

“I’m safe, I have food, a lovingfamily and a roof over my head,”summarises a primary schoolpupil.In another survey recently conductedfor the Council of Europe,Finnish children felt that home wasthe very place where they were bestheard, taken seriously and wherethey could influence their life. Theycompared their homes to schooland hobbies, among other things.However, when there is room forimprovement, children’s wishes usuallyconcentrate on common time,doing things together and interactingin harmony:“Everything is fine in my family,but my sister and I often needto spend almost the whole dayalone, as the grown-ups areworking late or running importanterrands” (primary school pupil,the “It concerns adults!” report).According to Leena Valkonen’sdoctoral dissertation (2006), 5thand 6th grade pupils mention givingtime as one of the characteristics ofa good parent. A good parent giveshis/her time, thinks that the child isimportant, is easy to get along with,sets limits, provides the child withan appropriate upbringing and hasa suitable way of life. In addition,the children surveyed by Valkonensometimes viewed work as a rival fortheir parents’ time: “I wish they [my58parents] were rich and unemployed”(boy, 12 years).From children’s point of view,family services need to encourageparents to remember their value,to maintain a family-work balance,to cherish their relationship, and toavoid over-programming free timeand putting pressure on their childrento achieve.Value for children – time forupbringingHow have parents’ status and thechallenges of parenthood developedin recent decades? Many things havechanged for the better. More parentsnow support their children’s schoolingand hobbies, and are present intheir children’s lives than, for example,in the 1960s or 1970s. Levelsof mild violence (pulling the child’shair, spanking) used for upbringingpurposes are around half of whatthey were 20 years ago. Progress alsoincludes understanding the significanceof mutual respect betweenparents and children, and the wish tolisten to their children.“Everybody gets along well, andeveryone’s opinions are taken intoaccount. Everyone has a good timetogether. Our family is big buteveryone gets the same amountof attention” (secondary schoolpupil)However, growing inequality betweenchildren poses a problem. A smallportion of parents lack the means toprovide their children with a positiveupbringing and to set limits. Theyare burdened by relationship problems,mental illness and substanceabuse, for which support is tooslow to arrive. Changing relationshipsmay see the child cast aside.Adolescents in particular experiencedifficulties in finding one’s place ina blended family. Work and careerorientednesscan be all-consuming,resulting in the child’s needs beingneglected or going unnoticed.“They could keep a closer eyeon their alcohol consumption.Another thing is the amount ofwork. They are under terriblestress at work -- and they take itout on me”“I don’t like my stepfather,because he sometimes shouts atme for nothing” (primary schoolchild)Parenting involves more tasksthan before. Media and advertisingpenetrate a child’s world at a whollydifferent level than they did, forexample, during my own childhoodin the 1970s. Parents are neededmore than before, to filter messagesfrom the media and advertising, andto define the limits of moderation.On the other hand, parents oftentake care of upbringing alone. Migrationcan mean that relatives livefar away. Friends and relatives alsohave their own work and priorities.

ReferencesNivala Elina: Lasten ja nuorten omianäkökulmia kasvatukseen. Address at theOmbudsman for Children’s 5th anniversarycelebration on 1 September 2010. http://www.lapsiasia.fi/nyt/puheenvuorot/puheet/puhe/view/1530920Tuononen, Päivi 2008. It concerns adults!The opinion of children and young peoplein Finland on the realization of theirrights. Reports of the Office of the Ombudsmanfor Children 4:2008. Jyväskylä: Office of theOmbudsman for Children.Ministry of Social Affairs and Health,Publications 2010:7. Don’t hit the child!National action plan to reduce corporalpunishment of children 2010–2015.Valkonen, Leena 2006. Millainen on hyvääiti tai isä? Viides- ja kuudesluokkalaistenvanhemmuuskäsitykset. Jyväskylä Studiesin Education, Psychology and SocialResearch. Jyväskylä: University of Jyväskylä.61

Family centre is based on preventive workand collaboration62

Preventive services – a guarantee for thewell-being of children and familiesSirkka Rousu, Aila Puustinen-Korhonen and Marju Keltanen“Today’s decisions will define future child policy. Creating a balancedgrowth and development conditions for children is the mostimportant investment society can make – nothing surpasses achild in importance. The welfare of children is much discussed andacted upon by adults, but do value choices that respect the childand childhood steer decision-making in society, or are childhoodand the child population dwarfed by “big” issues and marketorientedvalues? Our globalising world strives for efficiency.This is characterised by selfishness and short-sighted pursuit ofindividual gain. Protection of a child’s – a human being’s – lifefrom exploitation and neglect requires a policy of assuming jointresponsibility, based on sustainable underlying values.”Child Policy Programme “Long live the children” 2000–2015, bythe Association of Finnish Local and Regional AuthoritiesThis article describes the developmentof child and family policy inFinnish municipalities. It describespreventive work promoting health andwelfare, the steering and preparationof welfare programmes for childrenand adolescents, and the status offamily centre activities in municipalities.The article utilises the results ofa survey of municipalities conductedby the Association of Finnish Localand Regional Authorities in 2010.Finland’s approximately 1.1 millionchildren live with some 590,000families. Children account for aroundone-fifth of the entire population,but child and adolescent age groupsare shrinking. While well-being of themost Finnish children and adolescentshas been good over the lastfifteen years the number of childrenand adolescents requiring specialservices has increased.Many factors underlying this trendcan be identified, such as Finland’sdeep economic recession of theearly 1990s, which saw reductionsin many basic municipal services forchildren and families, among guidanceand counselling centres, daycare, schools, youth work, etc. Forinstance, the availability of home-63

help services for families with childrenplummeted. High unemploymentamong families with children, thinningout of basic services supportingchildren and families, and a drasticreduction in preventive service activitiesresulted in an increase in the useof specialised services for childrenand adolescents.Change of direction in municipalchild and family policySeveral national development programmesand legislative initiativesare indicating the increasing malaiseamong children and adolescents,as well as problems in the servicesystem. In Finland, municipalitiesare largely responsible for providingbasic and specialised services forchildren and families. Service systemreform in the municipalities hastherefore been considered essential.Together with municipalities, theAssociation of Finnish Local andRegional Authorities launched a childpolicy reform process in the late1990s. This was based on the ideathat child welfare is a common concernthroughout the whole municipality.The Child Policy Programme “Longlive the children’, which steers theactivities of the Association of FinnishLocal and Regional Authorities, wasapproved in 2000. Programme objectivesare anchored in the Conventionon the Rights of the Child. Theprogramme will continue to guide theAssociation’s activities until 2015. Itskey theses are as follows:• A child is prepared for life and findsbasic security from the home, butit takes a “whole village” to raise a64child. Child protection is a commonconcern. (Protection)• Childhood is a social investmentthat benefits all. A long-termsocial and child policy that preventsproblems is the lowest-coststrategy. (Provision)• Social skills do not appear oftheir own accord, but via inclusionand being heard. Appreciatinga child’s views fosters healthyself-esteem in the child and preventsinsecurity. (Participation)The aim of the Association of FinnishLocal and Regional Authorities’child policy document was to triggera broad-based discussion of thestatus of children and services forfamilies with children. In municipalities,the need arose to developbasic services and preventive work,in order to halt the growth of specialisedservices. The Association ofFinnish Local and Regional Authoritiesrecommended that municipalities,too, draw up a municipal orregional child policy programmein support of decision-making onchildren and adolescents’ welfarepolicy, the management and developmentof activities, and practicalwork with children, adolescents andfamilies. In addition, local actorswere encouraged to engage in anextensive preparation and learningprocess involving various partiesand actors.The 2005 follow-up survey onchild policy programmes by theAssociation of Finnish Local andRegional Authorities revealed thatthe majority of municipalities hadprepared municipal programmes forcomprehensive development of childand adolescent welfare.In these programmes, the keywas to develop a child and familyoriented working method in order tostrengthen parenthood. The intentwas to provide a natural providerof services for families during eachphase of childhood, which would beresponsible for supporting parenthood.At child welfare and prenatalclinics, staff skills in supporting earlyinteraction between child and parentwere improved and co-operationmodels developed between the clinicsand day care, and day care andpre-primary education. Renewal ofchild and family policy, and co-operationbetween actors in municipalities,were also promoted via otherprogrammes. The most significantof these was the Harava projectimplemented in 2000–2004. Haravawas a national joint project betweenthe public and various NGOs aimed atproducing collaboration and servicemodels for children and adolescents’psycho-social services. The projectalso generated numerous new toolsfor practical work.Inspired by the project, a familycentre called “Pihapiiri” was establishedin the city of Raisio in southwestFinland in 2002. This familycentre, operating on a low thresholdprinciple, is one of Finland’s first. Itwas established in co-operation withthe City of Raisio, the local parish andvarious NGOs which jointly developeda strategic partnership for serviceprovision. Pihapiiri provides open,alternative activities to standard daycare services for those families andparents, who are looking after their

children at home. The objective wasto develop forms of child welfaresupport for non-institutional careand healthcare, to provide diversifiedsupport for parenthood, to introducepeer support and early supportmodels and to develop co-operationbetween the authorities, NGOs andvolunteer organisations (records ofthe Raisio Social Welfare Board 27February 2002). According to customersurveys conducted in Pihapiiri,parents bring their children to thecentre for the chance to meet otherchildren, and in order for the parentsto meet other childrearers in a similarsituation. Parents also feel that theyreceive support in their personalparenthood, raising children and incoping. In 2005, Pihapiiri’s operationswere rendered permanent. Thecentre centre continues to operate(http://lapsitieto.fi).In developing Finland’s municipalservices in the 2000s, the key conceptposits that the best way to helpa child is to offer support to child’sown everyday environments at home,school and day care. Opportunities toreceive support for the healthy developmentof children and adolescents,and parenting activities, should bemade available for all families andchildren.Emphasis on preventive childwelfareChild welfare is currently viewedas a broad process protecting thewelfare of children. This involves notonly the social welfare authorities,but also other public authoritiesand all citizens. The primary objectiveof child welfare is to secure theright of all children to a safe growthenvironment, balanced and diversedevelopment, and special protection.Parents are responsible for bringingup children and ensuring their wellbeing,but society is responsible forsupporting parents and child welfareprofessionals in this task.The amended Child Welfare Act(417/2007) entered into force on1 January 2008. In particular, thepurpose of the Act was to enhancethe inclusion and legal protection ofchildren and families, to ensure thatthe authorities co-operate in supportingfamilies and to specify localauthority obligations with respectto child welfare. Key issues in termsof family centre activities includedthe incorporation of the concept ofpreventive child welfare in the Act,as well as imposing an obligation onmunicipalities to draw up a fouryearlycomprehensive welfare planfor children and adolescents. The Actthereby also obliges municipalitiesto manage preventive work on a morecomprehensive basis, and to developservices for families with children insupport of upbringing activities.The new Child Welfare Act clarifiedthe extent to which promoting andsecuring the welfare of children andadolescents is a matter for municipalchild welfare authorities in particular.It also defined the extent to whichthis should be carried out by othermunicipal authorities or other actorsand through co-operation. Being theresponsibility of the municipality,tasks concerning the developmentof growth conditions and supportfor parenthood, and those involvingpreventive child welfare, involvevarious municipal sectors. Governmentdecree (380/2009), issuedon the basis of the Primary HealthCare Act and adopted in 2009, alsostrives to support families. Accordingto the decree, some of a child’sregular check-ups at prenatal andchild health clinics, and in schoolhealthcare, concern the entire family.The role of preventive healthcare, andco-operation with other operators,have been confirmed by decree.Correspondingly, municipalities’responsibilities for developing theliving conditions of adolescentswere strengthened by the Youth Act(72/2006), amended in 2006. Validsince 1 January 2011, an obligationon municipalities to establish amulti-sectoral co-operation group fordeveloping the living conditions andservices of adolescents was added tothe Youth Act. A provision was alsoadded which obliged municipalitiesto perform outreach youth work.Through this, all adolescents must beprovided with the possibility of earlysupport. For instance, early supportmust be offered in situations where ayoung person encounters trouble infinding a study place or employment.Child and adolescent welfare planThe Child Welfare Act obligesmunicipalities to prepare, either ontheir own, or together with othermunicipalities, a child and adolescentwelfare plan that must be revisedat least once every four years. Thischild and adolescent welfare planmust also be taken into account whenpreparing the municipal budget. Asa consequence of the amended ChildWelfare Act, municipalities’ child65

policy programmes have been largelymerged in line with the statutorychild and adolescent welfare plan.Initiated by the Association of FinnishLocal and Regional Authoritiestogether with the municipalities, childpolicy development work helped pavethe way for enshrining the child welfareplan more extensively in legislation.The child and adolescent welfareplan must also include objectives andmeasures of preventive child welfare.This plan is prepared in co-operationwith various administrative sectorsand actors. In many cases, representativesof NGOs, parishes or othercorresponding parties also contributeto its preparation. The views ofclients, i.e. children and adolescents,must also be consulted.Among other issues, strategicobjectives and measures facilitatingthe implementation of supportfor parents and parenthood, as partof preventive child welfare serviceswithin primary social and healthcareservices, must be recorded in thechild and adolescent welfare plan.Children and parents must be providedwith the support they need at theearliest possible stage, in their familiar,ordinary environments. Activitiessupporting the health and welfare ofchildren include physical activitiesand cultural and artistic activities ofvarious types. In addition, in terms ofthe well-being of children and parentsalike, it is vital for them to experiencea sense of togetherness and to seethemselves as part of a communitythey view as significant. Today’s familiesneed a new sense of community.Family centre activities, among otherfactors, can create this.66Preventive child welfare servicesare also provided by other municipalservices, such as prenataland child health clinics and otherhealthcare providers, home-helpservices, day care, primary education/schoolor youth work asspecialised support, even whenthe child or family is not a clientof child welfare services. Organisations,associations and othercivic activity may offer valuablesupport to the child and family,without defining any particularproblems (Taskinen, S. lastensuojelulaki(417/2007), Soveltamisopas.Stakes, Oppaita 65).The family centre as apreventive child welfarestructureWhen adopting the child policy programme,the Association of FinnishLocal and Regional Authorities alsodecided to monitor the programme.The 2010 follow-up survey handledthe implementation and enforcementof the new Child WelfareAct on an extensive basis. Withinmunicipalities, the survey analysedthe status of child and adolescentwelfare plans and services forchildren and families. A total of 252municipalities, out of 326 in continentalFinland, responded to thesurvey, conducted in co-operationwith the Ministry of Social Affairsand Health, the National Institutefor Health and Welfare and theMinistry of Education and Culture’spolicy programme for children, adolescentsand families. The researchreport on the follow-up survey wascompleted in June 2011.Resourcing, goal-setting andmanagement of preventive workResourcing of preventive childwelfare, goal-setting for work, andmanagement of preventive workwithin municipalities is vital. Of themunicipalities that responded to thesurvey by the Association of FinnishLocal and Regional Authorities,94 per cent (192 municipalities)reported that the statutory child andadolescent welfare plan had beencompleted, or was underway. Nineout of ten municipalities prepared thewelfare plans under the guidance ofa multi-sectoral co-operation groupcomprising several service sectors.Welfare plans had been prepared bymulti-sectoral co-operation groupsin more than one half of the municipalitiesresponding to the survey. Amulti-sectoral preparation processwas viewed as a factor that enhanceda more comprehensive review of childand adolescent welfare and services.Implementation of the plans, andmonitoring of development, was alsoimplemented by a multi-sectoralco-operation group in almost allrespondent municipalities.In general, the municipalities hadtaken careful account of service systemdevelopment needs included inthe plan, and the set goals had beenmet. However, less than one-third ofrespondents were of the view that theplan took good account of childrenand adolescents’ possibilities toparticipate and influence matters,and of developing such a possibility.Objectives involving appropriationsand human resources were fulfilledwell in only every fourth municipality.The municipality’s financial situation

was regarded as the main reason forthis shortcoming.According to the survey results,multi-sectoral management andpolitical decision-making were stillevolving in the municipalities. Managementof preventive child welfare isbeing implemented in more than fiftyper cent of respondent municipalitiesin such a way that multi-sectoralexpert groups can integrate anddevelop their activities during clientwork. On the basis of the results, itcan be concluded that, pursuant tothe Child Welfare Act, the joint longtermpreparation process for childand adolescent welfare plans will promotethe emergence of multi-sectoralmanagement and decision-makingstructures in municipalities. Suchstructures can promote responsibilitywithin the entire municipality for thewell-being of children and adolescents,and families.Availability of preventive servicesThe results of the survey revealthat the services assessed by therespondents as at least moderatelysuccessful in preventing the needfor child welfare measures are stillquite poorly or not at all available tochildren and families. In the municipalities’view, basic services, and theindividual, group and communitylevelsupport measures availablethrough them, could well prevent theneed for child welfare measures fromarising. The survey indicates that,to at least a moderate extent, familycentre activities could prevent theneed for child welfare.For families with children underschool age, and those expecting achild, the need for child and familyspecific child welfare services wasassessed as best prevented with thehelp of support services by familyworkers. More than 80 per centof respondents found that supportservices by family workers preventedthe need for child welfare fairly orextremely well. These support serviceswere fairly or fully available in halfof the municipalities that responded.The situation has improved considerablyfrom the recession years in the1990s.As regards children in primaryschool, early support family work wasassessed as the best method for preventingthe need for child welfare (80per cent of respondents). Only some40 per cent of respondents, however,regarded family work as rather easilyor easily available. Early family workrefers to support that can be offeredto families on the initiative of childhealth clinics, day care or schoolhealthcare services. In some municipalities,families can apply for familywork services on their own initiative,without a referral.For lower secondary level students,the most efficient method of preventingthe need for child welfare wasevaluated as having a safe adultclose by, with preventive social workservices being available (68 per centof respondents) from school. However,preventive school-based socialwork services are easily or fairlyeasily available in only 47 per cent ofthe municipalities that responded. Itis noteworthy that a safe adult closeby is at least fairly easily availablein only 11 per cent of municipalities.However, responses by municipalitiesexpressed most concern about themental well-being of children betweenthe ages of 13 and 20.Number of family centres increasingThe key aim of family centres is to supportparenthood. Such activities arecharacterised by family-oriented, community-orientedand multiprofessionalco-operation, family work based onearly support and groups for childrenand parents. In 2005–2007, the focusof family centre development was onpreventive work through basic servicesand creating supportive co-operationnetworks involving child and familyservices. In 2008–2011, the operatingmethod and model was developedfurther, based on a municipality-drivenapproach in projects receiving stateaid, under the National DevelopmentProgramme for Social Welfare andHealth Care (Kaste).The survey by the Association ofFinnish Local and Regional Authoritiesindicated that the number of familycentres was increasing, with 45 municipalities,i.e. approximately a quarterof the municipalities that responded,reporting that they provided familycentre services. More than half ofmunicipalities providing family centreservices produce them as one of themunicipality’s own activities. On thebasis of free-form responses, familycentre activity seems to be intendedfor children under school age. However,information on the number of familycentres, and implementation methodsand practices, varies between studies 1 .1 The National Institute for Health and Welfareis conducting a survey into the overall status offamily centres in Finland.67

The development of family centreshas concretised the goals ofpreventive child welfare in a numberof ways, while bringing structure tothe preventive child welfare. Familycentres should therefore develop inthe direction of providing a basis forpreventive child welfare in every partof every municipality. Family centreactivities create preventive co-operationstructures for services aimed atfamilies with children and for thoseco-operating within such services. Atvarious stages of life, family centreactivities promote the partnershipbetween professionals and parents,peer support by other parents, andearly support for families and childrenand adolescents of different ages.Family centres could also form a childand family-oriented approach thatsteers all implementation of child andfamily policy within municipalities.Referenceshttp:// www.lapsitieto.fi > Harava-aineistot> Strategista kumppanuutta perhekeskusPihapiirissä -raportti.Kuoppala Tuula, Säkkinen Salla (2010):Lastensuojelu 2009. Tilastoraportti29/2010. Terveyden ja hyvinvoinnin laitos.Neuvolatoiminta, koulu- jaopiskeluterveydenhuolto sekä ehkäiseväsuun terveydenhuolto. Asetuksen(380/2009) perustelut ja soveltamisohjeet.Sosiaali- ja terveysministeriö. Julkaisuja2009:20.THL (2009): Lasten asema ja palvelut1990-luvun lamasta tähän päivään.Diasarja. Valmistettu Lasten januorten terveyden ja hyvinvoinninneuvottelukunnan aloitteesta.Rousu, Keltanen (tulossa 2011).Kuntien lakisääteinen lasten ja nuortenhyvinvointisuunnitelma sekä hyvinvoinnin japalveluiden tila 2010. Kuntaliitto, Helsinki.Mannerheimin Lastensuojeluliitto (2011).“Kun riittävästi lahjoittajia on koossa, minälupaan…”. Tiedotteet ja uutiset. Saatavillahttp://www.mll.fi/ajankohtaista/tiedotteet_ja_uutiset/?x41088=13383110 (viitattu 29.3.2011Kasvun kumppanit (2011). Perhekeskus.Saatavilla http://www.thl.fi/fi_FI/web/kasvunkumppanit-fi/palvelut/perheita/perhekeskus (viitattu 30.3.2011)Riitta Viitala, Marjatta Kekkonen, Auli Paavola(2008). Perhekeskustoiminnan kehittäminen.PERHE-hankkeen loppuraportti. Sosiaali- jaterveysministeriön selvityksiä 2008:12.Sosiaali- ja terveysministeriö: Helsinki.Puska, Pekka (2010). Hyvinvointia jaterveyttä edistävä perhekeskus. Diasarja.Terveyden ja hyvinvoinninlaitos.68

The Swedish Leksand model – familypreparation as a starting point forthe family centreThomas Johansson“Support for parents makes for happy and secure children who can grow upinto sociable and responsible adults.”Introduction: The Swedish Leksand model has become widespread acrossmany countries, particularly within the Nordic region. The reason for the successof the model is probably the simplicity of the concept.This article summarises 15 years of work experience related to the Leksandmodel.The article presents a number of results and factors that have playeda major role in the development of the Leksand model, factors which arerepeatedly referred to in the various evaluations. The article describes theoriginal Leksand model in brief and the way in which various staff groupsand voluntary organisations cooperate with regard to the support. The articlealso describes the additional initiatives relating to fathers, the topics thatare usually covered and the methods for parental support that are usuallyused. A brief overview is also presented of the results produced by variousevaluations over the 15-year period concerned and the success factors thatwe were able to identify through the evaluations. Finally, a number of proposalsare presented ahead of the future work relating to parental support inLeksand.I hope the article will inspire the creation of appropriate and comprehensiveparenting support provision and that between the Nordic countries wecan develop our knowledge exchange and experience associated with parentalsupport.The original Swedish Leksandmodel in briefSince 1996, Leksand has offeredparents various forms of support inorder to improve the circumstancesof children and make life easier forparents. This support is primarilyprovided through a structure that isbased on extended and reinforcedparental education in groups, wherethe groups learn skills and establishcontacts with various functions insociety. As the staff have sharedgoals and cooperate around a clearremit, the sense of social togethernessin the groups and the level ofknowledge and awareness of the child’sneeds are increased.Parental support starts with thefirst antenatal appointment with themidwife. Both mum and dad attend thisappointment. Both must feel welcomeafter the appointment and have nodoubts about joining a parent groupsome weeks later. In the group, the parentsget advice, support and education.Initially, the parents meet in theirgroups around eight or nine timesbefore the birth and an equal numberof times afterwards, right up until thechild’s first birthday. Three out of fourgroups choose to continue meeting intheir groups. Some groups have beenmeeting for 10 years. The responsibilityfor activities after the child’s firstbirthday rests with the group itself, theadult education association and theopen nursery.When a problem arises within a family,it is easy to obtain advice, supportand treatment, as the parents alreadyknow many of the relevant professionalsthrough their visits and talks to theparent group. The service is providedin partnership between Dalarna CountyCouncil, the Municipality of Leksand,religious communities, adult educationassociations and voluntary organisations.The aim is to equip parents withthe tools they need in order to handletheir family situation, whilst at thesame time reinforcing social interactionand networks between parents andother adults surrounding children andyoung people. Special support eitherin groups or individually is offered toparents who find their children difficultto manage.69

70Before the birthProvision of the support begins whenthe midwife meets the future parentsat their first antenatal appointment.The midwife greets the parents andwelcomes them to the parent group,which starts at around pregnancyweek 25. If the marketing of the groupis successful, virtually all of the 12-20parents who are invited will attend.Each parent is given the opportunityto be seen and heard. The numberof parents in a group varies with thenumber of pregnancies. Children whoare due at around the same time willend up in the same group. Peopleremain with their original group whensiblings are born. At this initial meeting,the aim is for the parents to feelsecure and to want to continue in thegroup. One way of creating identityand a good atmosphere is for the parentsto choose a name for their group,e.g. Potty 98, the Millennium Group,the Rising Stars, the Spring Flowers,End-game and The Untouchables.A meeting often starts with a shorttalk or presentation by an invitedguest, either professional or voluntary.After perhaps a half-hour talk,the day’s topic is discussed, withmums and dads in separate groups.A dads’ mentor usually leads thedads’ discussion. The meeting isclosed with the mums and dads discussingthe day’s topic together overa cup of coffee.The professional groups involvedprior to the birth are midwives fromthe maternal healthcare unit, nursesfrom the child healthcare (paediatrichealthcare) unit, psychologists, nurseryteachers, family advisors, familytherapists, social workers and administratorsfrom the Swedish SocialInsurance Agency. The midwives areresponsible for the meetings beforethe birth. Dads’ mentors and coupleswho have recently had children alsotake part.After the birthWhen all the children in the grouphave been born, all the parents will beinvited to a postnatal meeting whichreinforces the sense of solidarity withinthe group. Nurses from the childhealthcare (paediatric healthcare) unitare responsible for the meetings rightup until the child’s first birthday. Inaddition to the professional groupsreferred to above, other professionalswill also participate, including familylaw experts, nursery head teachersand dental hygienists. The parentsalso make visits to a library, wherethe children’s librarian will tell theparents about children’s literature.Through to the child’s first birthday,the parents will have plenty of time toget to know each other and the variousprofessional groups in the team,as well as take part in other activitieswithin the community. Representativesof local authorities, adult educationand other associations, religiouscommunities and businesses can visitthe group.Dads’ mentorsDads’ mentors have been a naturalpart of the Leksand model ever sincethe very beginning in 1996. Dads’mentors normally take part in two tofour meetings before and two to fourmeetings after the birth, right up untilthe child’s first birthday. The groupwill then agree with the dads’ mentoras to how often he will be needed. Adads’ mentor is a completely normal,slightly more experienced dad with twoor more children. He will attend a shortcourse/introduction before participatingin the groups and receive a smallfee from the county council. The role ofthe dads’ mentor is to support the dadsand answer their questions. He canalso tell them about his own experiences.Evaluations indicate that the dads’mentor is appreciated by the dads ingeneral and the mums in particular.The role of volunteersAn important role is played by the adulteducation associations 1 , especially duringthe early years. (The Swedish StudyPromotion Association (Studiefrämjandet)is extremely important. When thechild is older, other adult educationassociations will also take part.e.g. BF,NBV, Studieförbundet Vuxenskolan andBilda.) Voluntary organisations giveguest lectures and talk to the parentgroups, or alternatively the parents canmake study visits to see the work ofthe association in practice. Examplesof participating voluntary organisationsinclude the various municipalbodies, the Civil Defence Association,the Red Cross, the parents’ associationsLek i Leksand and Kids & Dadsand the local hockey team Leksands1 Adult education associations are organisationsthat promote popular education throughstudy circles, meeting programmes, projectsand arrangements/events with the aim of givingthe participants knowledge. The study circle, asmall group that learns together, is the core ofpopular education and an educational conceptthat has been around in Sweden for over a hundredyears. The adult education associationsare collectively the largest cultural organiser inSweden. (Source: sv.wikipedia.org)

IF (Idrottsförening). Companies canalso be invited to the parent group, oralternatively the group can be invitedto visit the company on a study visit.Examples of such companies areinsurance companies and banks. Afterthe child’s first birthday, the importanceof the voluntary organisationsfor the parent group increases, as theactivities are customised to meet theneeds and wishes of the parents andthe children.ThemesThemes prior to the birth and duringthe first year of parental educationinclude emotional ups and downs;safe and secure bonding; the lovingrelationship; task delegation and newroles; the child’s needs and development;male-female language; breastfeeding;children’s food; accidentrisks; fairy tales; songs, music andvisits to libraries; dental health; familylaw; parental leave; householdfinances and insurance; child safety;maturity and self-esteem; balancingfamily and work; information onmedicines, alcohol and other drugs;and siblings and step-siblings.MethodsExamples of methods 2 that are usedwithin the framework of the Leksandmodel include PREP – PreventionRelationship Enhancement Programme(a programme for couples),ICDP – International Child DevelopmentProgramme/Guiding interaction(for parents with infants/nursery agechildren), Active Parenting (for parents2 all methods are universal, i.e. they areintended for everyonewith children aged 2-12 years), Familjeverkstan(for parents with childrenaged 3-12 years), COPE – CommunityParent Education Programme (forparents with children aged 3-12 years),ÖPP – Örebro Prevention Programme(for parents with children aged 13-16)and LUT – Leksand Utbildar Tonårsföräldrar(for parents with childrenaged 12-18).Results and evaluations of theSwedish Leksand modelAttendanceThe proportion of parents who attendthe groups is high. The averageattendance amongst mums at the eightto nine meetings prior to the birthwas around 95%, whilst attendanceamongst the dads for the same periodwas around 90%. During the subsequenteight to nine meetings throughto the child’s first birthday, attendanceamongst mums was just under 90%,whilst that for dads was just under70%. The control groups were givena traditional programme with fewermeetings. This resulted in much lowerattendance, particularly amongst dads.Attendance prior to the birth is currentlyalmost 100%.Some more results from thesame evaluationsOn average, seven new parent groupsstarted each year in Leksand (15,500inhabitants with 120 births/year).• Each parent group had around 12-18parents and siblings were included inthe original group• Participation was very high in anational comparison• Two questionnaire surveys showedthat parents had a lot of confidencein the staff• The parents appreciated the genderseparateddiscussions, as thisapproach often led to a more opendiscussion• The dads’ mentors were appreciatedby both the mums and the dadsAttendance in 17 parent group meetings, pregnancy – one year old children1009080706050403020100Project groupControl groupThe attendance above concerns the period up to 2000.Women – pregnancyMen – pregnancyWomen – child oneyear oldMen – child oneyear oldEvaluation ofKertin Hopstadius,Research Councilof Dalarna (DalarnasForskingsråd)1998 och 200071

• Parents in control groups whoreceived traditional parental supportwere dissatisfied with thissupport• The taking of leave amongst thedads increased during the period by3.3%ContinuityUp until 2006, an average of three outof every four parent groups continuedto meet after the child’s first birthday.Around half have continued to meetover a period of five years. After thechild’s first birthday, the parents meetbetween six to eight times per yearon average during the first four years.Attendance amongst mums during thisperiod averaged around 60%, whilstthat for the dads was around 30%.The success factors for theSwedish Leksand model1. Continuity – the same parent groupscontinue to meet over time, and thestaff have a holistic perspective.The continuity stems from havingthe same leaders for the variousmeetings before and after thebirth right up until the child’s firstbirthday. It also stems from notbreaking up the original group, i.e.the same parents continue to meetafter the birth of the child. Also ofimportance for continuity is the factthat the staff encourage the parentsto continue to meet and throughtheir attendance “overlap” thevarious stages through which thegroup passes. Another importantfactor is that political decisions andorganisational changes interact overtime and facilitate and support thecollaborative structure722. Early startThe Leksand model starts “early”with the first antenatal appointmentand parent groups with a high level ofattendance. This enables early discoveriesand initiatives. When a parentfeels secure in their environment andsurroundings, he or she will be morelikely to seek help for a problem. Helpthat is given at this stage will often bemore effective and far less expensivefrom every perspective than if ithad been provided a few years later.Economist Ingvar Nilsson has calculatedthe profitability of the Leksandmodel from a social and individualperspective. Source: “Det är bättre attstämma i bäcken än i ån” www.seeab.se3. Support for the dada. Dads are welcomed to the first antenatalappointment and receive theirown invitation to join the parentgroupb. Dads have their own dads’ mentorat most meetings of the parentgroupc. Dads’ mentors are given brief trainingand receive some remunerationd. There is open provision for dads onSaturdays, with a special “Kids &Dads” club for all dads with childrenThese dads’ initiatives have resultedin more paternity leave and parentalleave being taken, as well as more dadsparticipating in nurseries and spendingmore time with their children.4. “We feeling”Networks, a “we feeling” and identityare probably the decisive reasonswhy the Leksand initiative has wonsupport amongst both parents andstaff. A lot of time and care has beenput into creating well-being and asense of solidarity, with the resultthat networks have subsequentlybeen formed and further developedin various forms, as the child growsolder. Parents meet over a commonand important goal – the good of thechild5. Own strengthGradually increasing the parents’own involvement in a group reinforcesthe group spirit and increasesthe parents’ own strength andinsight into their own abilities as aparent and role model. Parents havealso had representatives on developmentgroups, enabling them tobe involved and influence developments6. Co-operationDespite many setbacks and financialdifficulties, the staff still believed inthe working method and have continuedto perform their role as groupleader. The Leksand model is theresult of (a) collaboration betweenthe county council and municipalauthority. Decisions are taken byboth of these bodies individually.The collaborative body is the politicalcollaboration committee (PolitiskSamverkans-beredning) (POLSAM).There have always been groups forcollaboration between differentprofessional groups, whilst groupsbetween civil servants and politicianshave fluctuated over the years.Voluntary organisations have beeninvited to meetings. It is importantfor the survival and success of the

Mother and father – for the first timeHenriette WebergThis article describes the experiences gained through the project entitled“Mother and father – for the first time.” The project was previouslycarried out in Greve Municipality as an attempt to test the Leksandmodel in practice in a Danish context. At a time when resources arescarce, it is unfortunately not yet possible to adopt the method on apermanent basis, but there are now signs of political interest in theproject once again.Being a child or adolescent inGreve MunicipalityGreve Municipality is situated justsouth of Copenhagen. There areapproximately 48,000 inhabitantsand around 500 births a year. In thework with families, there is a long traditionof interdisciplinary initiatives.Within Greve Municipality, thiswork is carried out on the basis ofan overarching Child and AdolescentPolicy, which states amongst otherthings that children and adolescentsshould thrive in Greve Municipality.They should be happy in themselvesand they should be part of communities.They should be looked after, sothat they are safe. Yet they must alsobe challenged, so that they grow upbelieving in themselves and their ownabilities. Greve Municipality wants tocreate the best possible frameworkand opportunities to enable bothchildhood and adolescence to becomea valuable period in itself duringwhich children and adolescents withwidely varying circumstances,needs and interests can developand realise themselves. Similarly,it is also an aim that childhoodand adolescence will provide thefoundations for a meaningful adultexistence. Greve Municipality is ofcourse unable to guarantee this onits own. The vital factors for all childrenand adolescents are alwaystheir parents and their close network.Greve Municipality thereforeaims to help parents and familiesachieve the best for their childrenand adolescents, even when theyfind life difficult. We also want toensure that all our institutions,schools, clubs and other placesinvolved with children are permeatedby our ambition on behalf ofour youngest citizens, i.e. that theycan lead a good and happy life.More specifically, this results in aseries of overarching objectives forthe work with families:Children and parents belongtogether:The work is based on the view thatchildren and parents should betogether. When there is a need to workwith the family, the approach musttherefore be based on the provision ofextensive support and assistance andthe least possible intervention withregard to the child.Prevention and health promotion areaccorded a high priority:Children and adolescents are offeredassistance within this area at an earlystage in order to reduce the need formore comprehensive measures later onin the child’s life.A targeted service is offered to peoplewho are in need of assistance:The family is a very real and activecollaboration partner and is alwaysinvolved in the objectives of the initiative,regardless of whether assistance,support or supervision is required.It must be ensured that a broadrange of services is provided at alltimes in order to meet the individualneeds of families for support anddevelopment insofar as this is possible.An interdisciplinary approach shallbe ensured:The family services that are providedare based on an interdisciplinary collaboration,bringing together a broadrange of knowledge concerning thefamily’s resources and ensuring anindividual and holistic approach.Professional, methodicaldevelopment shall be ensured:75

Professional development shall beensured at all times, so that relevantsupport can be given to families atany one time.Why a parents’ course? – abrief historyIn line with developments withinsociety and changes in the structureof the family, there is an ongoingneed to adapt the healthcare servicesthat are provided to future first-timeparents in the municipality. Futureparents are part of the hypercomplexsociety. As there is an enormousamount of information, advice andguidance available in connection withbecoming a parent, it can be difficultto decide what to listen to and whatto ignore.Many future parents have a welldevelopednetwork, yet no idea letalone experience of what challenges,joys and worries the parental role willbring. Even if they do have a goodnetwork of friends and family, mostpeople today lead very busy lives; thegrandparents are still working andprioritise their own interests in theirspare time. Many people have neverheld a newborn baby in their armsuntil they hold their own for the veryfirst time. There is therefore a lot totake on board and a lot to learn, andthere are few if any role models tofollow. There is considerable interestand motivation amongst futureparents when it comes to creating thebest possible circumstances for boththemselves and their future children.Evaluations from both internationaland Danish studies have shown thata preventive approach in the formof the creation of parent groups for76first-time parents starting before thebirth has a good preventive effect onfamily stability, parent well-being,and the well-being and developmentof the child. Starting up a preventivegroup project aimed at couplesexpecting their first child and startingbefore the birth of the child can giveparents an opportunity to improvetheir parenting skills and enjoythe role of parent more, as well aspreventing family problems which inthe longer term can be both resourceintensiveand difficult to repair. It canbe difficult to predict and assess inwhich families parents are likely toexperience difficulties with their roleand therefore be in need of additionalsupport in order to safeguard thechild’s development and well-beingwhen adopting an individual-orientedperspective. There are both ethicaland professional problems associatedwith identifying and thereby stigmatisinga particular group of parents inadvance, and it is difficult to recruitparents to initiatives that are aimedat special groups.Parent support workSupport initiatives aimed at parentsas early as the pregnancy stage havea decisively positive effect on thechild’s weight at birth and the numberof complications, and thus also on thechild’s health at birth 1 . By targetingthe initiatives at the factors thatlie behind inappropriate behaviour,instead of at individual risk factors, itis possible to promote the child’s generalhealth and well-being to a greaterdegree. This process is supported1 L. Lier, M. Gammeltoft, IJ Knudsen: “Earlymother-child relationship”through universal preventive parentsupport work, 2 which involves offeringinitiatives to new parents basedon the relationship between thechild and its parents, as well as theparents’ resources.The parent support work musttherefore help parents to promotetheir child’s positive and healthydevelopment as well as developingthe parents’ ability to act in relationto both their own health and that oftheir child.In Greve Municipality, we in theHealthcare Service have worked onthe provision of support for parentsthrough the project “Mother andFather – for the first time”.The goal of this project is to supportand develop the parents’ capacityto care and act with the aim ofestablishing a strong bond betweenparent and child and developing andmaintaining healthy habits for thewhole family. The aims of the projectare therefore:• To give first-time parents theopportunity to participate in agroup programme;• To establish networks within thegroups;• To provide the parents with thetools needed to deal with criticalsituations at an early stage;• To provide professional supportand guidance at an early stage,thereby preventing dissatisfactionand inappropriate development inthe individual child;• To support and guide the family,so that they are able to make2 The Leksand model. http://www.leksand.se

healthy choices for both the childrenand the adultsThe unique aspect of this model isthat the work is aimed at both thefuture father and the future mother.The couple participate in the projecttogether and attend the same meetings.When the child has become a littleolder – about a year – good experiencewill have been gained concerningthe provision of supplementaryservices for fathers and their children.Overall organisation“Mother and Father – for the firsttime” is a working method that isstrongly based on interdisciplinarycollaboration.One of the fundamental ideas isthat both internal and external, aswell as public and private, professionalsprovide the professional basis inthe work relating to the method.When the project was carried outin Greve Municipality, there was ahealth visitor who acted as anchor forthe group. This decision was made inview of the fact that the healthcarevisitor would in all circumstanceshave contact with the family when thechild was born.The health visitor has a broad interdisciplinaryinternal network withinthe municipality, as well as knowledgeand experience of communicationpaths and collaborative relations.Links with external collaborationpartners will also be establishedin the primary sector, e.g. with theGP, and with collaboration partnerswithin the region.Recruiting the families who willparticipateA pivotal aspect of the method islinked to the meetings before the childis born, so it is vital that the group isestablished as early as possible duringthe pregnancy.Here, the midwives are key collaborationpartners, as they are in contactwith the couples at an early stage andable to invite the couples to take partin the project.It is vital that the midwives aremotivated into setting aside time totell couples about the opportunity andthat they distribute material aboutthe group to the couples in the formof a leaflet which gives the couples achance to find out more about whatis on offer and decide whether or notthey wish to take part.When the couple has been offeredthe chance to take part in the project,it is the project leader whotakes responsibility for the furtherorganisation regarding group startup,information on the meeting place,dates, etc.Composition of the groupThe families that take part in thegroups come from all walks of life.This means that families from everysocial class participate.It is actually one of the fundamentalideas behind the model that the groupwill use the resources that are availableand that the participants all havesomething to learn from each other.A learning community thus developswithin the group.The idea is that the group will provideeach other with a network in boththe short and the long term, throughwhich they can develop and exchangeexperiences and thoughts, enablingthem to acquire new skills. This helpsto enable the participants to supporttheir child’s healthy and positivedevelopment.In addition to being from every tierof society, the participants in thegroup can also be of many differentnationalities.Danes with a non-Danish ethnicorigin can participate if they are ableto speak enough Danish to get somethingout of the programme whilstat the same time not restricting thegroup process and the discussionsthat take place.The method is an obvious opportunityto reinforce integration, asthroughout the programme there willbe a focus on how people as parentscan support their child’s developmentas much as possible. Throughoutthe programme, there will thereforebe opportunities to discuss values,upbringing, attitudes towardschildren, family life, couple relationshipsand so on. In this way, all theparticipants gain a greater insightinto the thoughts and attitudes ofother people, as well as an excellentopportunity to sweep away prejudicesand misunderstandings.Topics for the meetingsParticipants in “Mother and Father– for the first time” take part in 12meetings, split between three meetingsbefore the birth and nine afterthe birth. A wide variety of topics aretouched upon at these meetings.There will be many different ways inwhich to combine the topics, as wellas many ways of tackling the meet-77

ings. This will depend on both theparticipants and the professionals.Some examples are given below oftopics which were brought up duringthe “Mother and Father – for the firsttime” meetings.Before the birth, there are topicsthat concern the impending birth, aswell as things that relate to the birthitself. Examples of topics which werebrought up are:Expectations of parenthood &preparation for the birth:The preparations that the couples canmake for the birth are discussed atthis meeting.Mutual expectations are also discussed,with an emphasis on the rolesof the father and mother.Here, the meetings can touch upontopics that are practically-oriented,but more emotional topics such assexuality can also be considered.Law – finance and/or insurance:parental authority and its importance,as well as the key legal issues concerningparenthood, are discussed atthis meeting.The family’s financial prospects andchallenges can be discussed, and theinsurance policies that you shouldtake out when you become a familymay also be considered.Once the child has been born,the topics that have already beendiscussed are followed up and newtopics are also brought up. Thesetopics particularly relate to the child’sdevelopment – how parents can supportthe development of their childin a positive way, the relationship78between the child and its parentsand the role of a parent.The child in the family:The child’s development and wellbeing.How can parents “talk” withtheir child? How can parents readthe signals that a new-born babygives out? And how should parentsreact to these signals? Here, it isimportant to draw the participants’experiences into the discussion.When are people (un)sure aboutwhat they are experiencing?The early days as a parent:Parent dynamics and the rolesof parents. What kind of mother/father do the participants wantto be? What has surprised theparticipants? – Here, we can talkboth about what “new” aspects ofthemselves the participants havebecome aware of since they becameparents and what aspects of theirpartner they have been surprisedby.It will also be relevant to discussthe participants’ views as regardswhat is good for the child, what canhelp to support its development,and what personality traits of thechild should be encouraged.At some of the meetings, it maybe appropriate to follow up whatwas discussed at the last meetingand also to expand on the discussionswith new angles and aspects.It can be a good idea for theparticipants to give examples fromtheir everyday lives and to createa forum where there is scope to airprejudices and discuss values andnorms.Making a special effort“Mother and Father – for the first time”was carried out in Greve Municipality,but at a time when resources are scarce,it has not yet been possible to launchthe method as a permanent initiative.However, there are signs of politicalinterest in “Mother and Father – for thefirst time” once again and the Child andAdolescent Committee has asked for abrief overview of what it would cost torun a number of groups a year for thisprogramme in Greve Municipality.There are currently many other servicesavailable for parents who are inneed of support and guidance. Theseare services which are both preventiveand, for some people, more therapeutic.In all cases, the focus is on the provisionof assistance at as early a stageas possible and on drawing on as manyinterdisciplinary resources as necessary.The healthcare service in GreveMunicipality is working on special initiativesaimed at vulnerable young mothers,families with children who wereborn prematurely, families with twinsand also families of non-Danish ethnicorigin. Work is also carried out to seekout post-birth reactions without usingadditional resources.ReferencesL. Lier, M. Gammeltoft, IJ Knudsen: “Earlymother-child relationship”http://www.leksand.seInterdisciplinary knowledge gathering forthe rate pool. The Healthcare Service andother early interdiscplinary initiatives.Danish National Board of Health, 2008

The Non-governmental organisationas a player within the family centre– a vision of collaborationMilla KalliomaaThis article describes the special role which organisations and volunteeringplay in the operation of family centres. The special role oforganisations is based on the voluntary work they organise. Organisations,or the third sector, integrate with the fourth sector, which consistsof families and social networks between people. Partnership-basedco-operation between municipalities and NGOs faces the challenge ofmoving from parallel, partly overlapping production of services towardsco-operative planning and implementation of family centre operations.The Mannerheim League for Child Welfare is a nationwide organisationwhich, in the context of family centres, concentrates on developing peergroup activities and family cafes.The Finnish family centre model isbased on co-operation between manycontributing players, aimed at enhancingchild and family welfare. Familycentre work by organisations, municipalitiesand other partners have thejoint goal of providing support forparenting and children’s growth anddevelopment at the earliest possiblestage. In organisations, such as theMannerheim League for Child Welfare(MLL) and Folkhälsan, developmentof family centre work has focused ondifferent forms of peer support, parentgroups and open activities.The idea of family centres wasintroduced in Finland nearly thirtyyears ago, when the first familycentre was founded by the MannerheimLeague for Child Welfarein Rovaniemi in 1987. Following amodel set in the United Kingdom, theaim was to bring together municipalchild health clinic services, MLL’stemporary childcare services andparent groups. Due to the economicrecession in the 1990s, this kindof family centre was never realised(Kalliomaa, 2004). Thereafter, thefocus of MLL’s family centre workhas been on developing peer supportgroups and open activities forfamilies with children. Family cafesin particular have gained favour withfamilies. There are currently hundredsof family cafes throughout Finland,operated by Folkhälsan, the MannerheimLeague for Child Welfare, andother players.MLL’s current family centre operationis mainly based on volunteering.Nationwide and regional developmentis financed by Finland’s Slot MachineAssociation (RAY). Municipalitiesalso provide financial support for theregional direction of family centres.Nationwide operation includesvarious peer support groups, familycafes, children’s clubs and supportpersons for families with children. Inaddition, MLL’s district organisationsoffer temporary child care help tofamilies with children. Family centresare operated by MLL’s local associationsand their volunteers. Districtorganisations, whose personnel havethe task of supporting co-operationbetween local associations and themunicipality, are responsible fordirecting the operations of familycentres.Municipalities hold the mainresponsibility for family centre servicesand develop their operations inco-operation with organisations, congregationsand other local players.Indeed, the role which organisationsplay in the co-operation between familycentre partners is characterisedby creating and strengthening mutualsupport between families, throughvolunteering and offering an easilyapproachable, low-threshold environment.To achieve this, an organisation79

equires structures and resourcesfor supporting volunteers, and mustguide their work and forge co-operationwithin the multifaceted familycentre network.Volunteering and the fourthsectorDue to the voluntary work which theyorganise, organisations play a centralrole in family centre operations. Itcould be said that the third sectorenfolds the fourth, which consists offamilies and social networks betweenpeople. Volunteers rarely engagein direct participation in municipalservices or the activities of municipalprofessional working communities.The reason for this is understandable.Voluntary work is directed by adifferent operating logic to paid work.Several co-operative projects haveshown that, when seeking the participationof volunteers, a communityis required which volunteers can joinon the basis of their own terms andvalues, and through which they canreceive help from the organisations’workers.For many people, voluntary workis a path which begins with participationin peer support activitiesand that continues with meaningfulvolunteer work, suited to the volunteer’scurrent life situation, withinan organisation. A volunteer is oftenmotivated by the experience of havingbeing helped and consoled byothers. This is something they wouldlike to pass on.It is important to create an environmentin which volunteers can bothlearn and obtain support in theirwork. Volunteers have the right to80narrow down their task and volunteeringhours as they see fit. Theycommit to ethical principles, such asrespecting other people, appreciatingchildren and childhood, and dependability,confidentiality and equality. Inreturn, they have the right to supportand guidance.Support structures for voluntarywork consist of basic trainingprovided for each task, continuingeducation, peer meetings for volunteers,and guidance offered by aworker at the organisation. They alsocomprise adherence to consistentpractices in various activities (e.g. infamily cafes). Organisations’ pivotalpartners in volunteer training includestate-supported study centres offeringliberal adult education, such asthe OK Study Centre and the Svenskastudiecentralen operating in Swedish.VolunteersMLL volunteers, such as group leaders,family cafe volunteers or supportpersons, are not required to have avocational education and are not paidfor their work. Volunteering is consideredvaluable, as the additionaleducation and experience gained insuch activities complement volunteers’professional skills. Indeed,one-third of peer group leaders reportthat the benefit to their professionallives is a motivating factor. However,even more important motivators forbecoming a peer group leader includewillingness to help others (48.7%)and to share one’s own experiences(42.3%).In voluntary work, motivation issupported by volunteer peer meetings,training and feedback, organisedby the organisation. Voluntarypeer group leaders describe theirmotivation in the following manner:“Without the supportof peer discussions,I don’t think I would leadanother group”“Finding a collaboratorto run the peer group andbecome a second groupleader was truly motivational”(Halonen, Sourander &Viinikka 2010)In addition to mutual feedbackbetween volunteers, it is importantthat they receive support and feedbackfrom the organisation’s workers.Peer meetings organised by theorganisation’s workers are indispensableto keeping voluntary work alive.FamiliesFamilies usually find their way toMLL’s family activities after hearingabout them at their child health clinic(32%). In almost as many cases, afriend or acquaintance has told themabout MLL’s family work and theparticipation possibilities offered.Nearly every parent participatingin peer groups refers to the need totalk to other parents facing the samesituation as the reason for partici-

pating. Six out of ten participantsjoin a group in the hope of findingnew friends. These hopes are oftenfulfilled, with nearly 70% of participantsreporting that their socialnetwork has grown stronger andthat they have made new friends.The second most important effectof group participation was thatparticipants felt better when theyhad the opportunity to talk to otherparents. Participants felt that thegroup contributed to their wellbeing(35.8%). Over a third felt thatthis helped them to settle into thearea (Halonen, Sourander & Viinikka2010).Participants in groups led byvolunteers feel that the most significantparenting support is providedby friends, spouses and relatives.Child health clinics are first on thelist of professional help, occupyingfourth position on families’ helpnetworks after the persons mentionedabove. It is therefore worthwhileinvesting in early support,bolstering families’ own resources.Families know how to benefit frommutual support and openly reportthat participating has providedthem with new strength (Halonen,Sourander & Viinikka 2010).According to the preliminaryresults of the family cafe surveycurrently underway, parents thinkthat children finding company is themost important element in attendinga family cafe. Strengtheningof the parents’ social network isviewed as the second most commoneffect.A family cafe reaches a very widevariety of families, whose educationalbackground can be dividedfairly evenly into three groups.A lower academic degree is themost common educational background,while vocational school isthe second most common, almostmatched by the number of higheracademic degrees. Approximatelyhalf of all visitors visitors feel thattheir subsistence is secured andtheir social networks are functioning.Many worry about subsistenceand the scarcity of social networks.Over one-third of family cafe visitorsoften feel weary or fear that the family’sincome is insufficient to coverits needs.Two-fifths of those who havetaken the survey report that thefamily cafe helped them to settledown in a new location. They alsoreferred to the cafe as the place atwhich they heard about services forfamilies with children. The surveycurrently being conducted suggeststhat family cafes offer help andsupport to families whose socioeconomicstatuses may differ butwho have a certain life situation incommon. Open responses from visitorsprovide encouraging feedbackto local associations and the entireorganisation.NGOs support for andmanagement of family centreworkNGOs co-operate closely with municipalfamily centres. Such co-operationis hampered by the fact that thevolunteer-based family centre workof local associations is insufficientlyintegrated with the rest of theservice network. MLL has 566 local“For many, familycafes offer indispensablesettings for makingfriends, sharing parentingexperiences and receivingpeer support. If it wasn’t forthem, many things wouldbe worse. Not everyone issurrounded by relatives,and relationships formedat the family cafe make upfor these. Being a parent isnot an easy or carefree task;without peer support andfriends you can’t get throughit!!!” (Halonen, Sourander &Viinikka 2011)associations, which are independent,registered associations. These associationsplan their activities as theysee fit and according to the needs ofparticipating families. There is notalways even time to co-operate withthe municipality. Such co-operation isalso beset by volunteers’ perceptionof an imbalance in their relationshipwith the municipality’s professionals(Carpelan 2007).Concrete co-operation requiresco-operative planning; municipalorganisations do not have a traditionof planning their services togetherwith families. Co-operation with thebroad field of organisations alsotakes time. In a report on partner-81

ships, municipal players viewedtheir co-operation with organisationsas highly important, but alsofelt that no working time had beenallocated for this (Carpelan 2007).This is the key development challengein managing organisations’family centre activities.In 2009, MLL began a developmentproject with the goal ofrenewing professional guidance ofvoluntary work and responding tothe challenges posed to co-operationbetween municipalities andorganisations. This project aims toimplement a regional control modelfor family centre work throughoutFinland by the beginning of 2014.Instructors hired for the project bythe organisation are social services,health and education professionals.Together with municipalities,82they have the task of assisting localassociations. Each worker operatesat the junction of the public,third and fourth sectors. Municipalworkers can reach a worker duringoffice hours, in order to negotiate onissues or plan meetings. The workermeets families in open meetingplaces and events, and visits familycafes organised by volunteers. Heor she also assumes responsibilityfor directing demanding voluntarywork, which includes e.g.support person work for familieswith children, for which trainingand a longer-term commitment arerequired of volunteers.The organisation’s worker helpsits volunteers to recognise situationswhere a parent, who is a memberof a parents’ group or visits afamily cafe, needs to be referred forprofessional help. Lengthy periodsof dejection, relationships in crisisor exhaustion require professionalhelp. In such cases, the family inquestion is referred by the group orfamily cafe for further help.The organisation’s workerensures that families are familiarwith the entire service path and thatmunicipalities are aware of whatorganisations offer to families. Familiesneed support from organisationsand municipal services rangedside by side. This service pathmodel is illustrated in the figure (1)attached to the end of this article.The figure reveals that, in additionto voluntary work, organisationsoffer professional services. In mostcases, such services are based onoutsourcing service contracts withmunicipalities.Vision for family centreco-operationIn Finland, the family centre model isstill taking shape. In some municipalities,this model is based on networkco-operation between services indifferent locations and mainly focuseson family training. Some municipalitiesassemble various municipalservices and open activities, providedby organisations under a single roof.Sometimes, family centres run bymunicipalities and organisationsoperate side by side and may evenoffer similar services for families withchildren.Regardless of the model, sincearound the turn of the millennium,municipalities and organisations familycentre thinking has directed thedevelopment of services for familieswith small children. A set of serviceshas been under development, basedon multi-professional co-operationand a multiple player model, with allplayers sharing the goal of supportingfamilies at the earliest possiblestage. The forerunners of the familycentre model have referred to aparadigm shift, which has broughtfamilies to the centre of services.Families are viewed as proactiveexperts in their own welfare, capableof creating and receiving help throughtheir peer relationships. In the familycentre model, volunteers and familiesthemselves are recognised as players,as well as municipal professionalsand organisation workers.In practical everyday life, muchremains to be done in order toachieve the goals mentioned above.Co-operation between municipalitiesand organisations continues to be

it would probably not be worthwhileto even plan a single, shared familycentre model. It is essential that theorganisations, other local playersand municipalities engage in jointplanning as the nature of their workchanges. Co-operative planningensures that the open services of themunicipality do not overlap with theorganisations’ operations, and thatfamilies in different life situationsfind the right kind of support. Thisvision outlines a new, shared workingculture and a flexible path for families,from peer support to servicesand vice versa.The MannerheimLeague for Child Welfare is a nationwidenon-governmental organisation whichpromotes the welfare and inclusion of children,adolescents and families with children, by developing differentforms of support and by influencing decision-making.The organisation has over 92,000 members and its operationsare based on active volunteering within its 566 local associations,and on a nationwide network of 13 districts. Its associationsand districts are independent associations which organise variousfamily-supporting activities. They are also responsible for theirown finances and operating. Activities are guided by the organisation’scommon strategy and national programmes. About8,500 people throughout Finland volunteer for workwhich strengthens families with children. In openactivities, over 900,000 contacts are madeeach year with children, adolescentsand parents.NGOsare an essential partof the Finnish welfare state. Theydevelop services, produce informationon people’s needs, and create environments inwhich people can participate and help each other.In comparison to other Nordic Countries, NGOs operateexceptionally widely in Finland. The Register of Associationsholds about 120,000 associations, and the numberof social and health associations alone is 13,000. Volunteerhours across the entire field of organisations are notannually surveyed in Finland, but in 1996 their numbertotalled 123 million hours. Among the Member statesof the European Union, Finland is in the secondhighest category in terms of volunteer activity(Volunteering in the EuropeanUnion, 2010).84

Folkhälsan is anon-profit social and healthcareorganisation founded in 1921. The organisationemploys about 1,800 people in health services,research, education and health-promotion. 100 localassociations and a total of around 17,500 members operatethroughout Swedish-speaking Finland. Hundreds of volunteerssupport children and families, for example by assisting in schools,and acting as family cafe leaders, support for women in labour (doulas),or by participating in or organising swimming schools and otherevents. Folkhälsan seeks to encourage people to care about theirand other people’s health, by both offering practical activities andinfluencing societal development. Its health-promoting activitiesare divided into four fields: volunteering, families and relationships,lifestyle questions (physical activities, food,rest, youth work, sexual health), and languagedevelopment and communication.ReferencesCarpelan Christa, 2007. Kumppanuusvertaistukea järjestettäessä -kunnan jakolmannen sektorin yhteinen haaste. Opinnäytetyö.Kymenlaakson AMK, sosiaali- jaterveysala, ylempi ammattikorkeakoulututkinto.Terveyden edistämisen koulutusohjelma.Halonen Elisa, Sourander Johanna andViinikka Anne: MLL’s peer group workassessment survey 2010, The MannerheimLeague for Child Welfare.Kalliomaa Milla, artikkeli julkaisussa Perhekeskiössä, toim. Auli Paavola, LastensuojelunKeskusliitto, 2004.Study on Volunteering in the European Union,Country Report Finland, 2010. Final Reportsubmitted by GHK. 17 February 2010Ruralia Institute, University of Helsinki, 2011.Vapaaehtoistoiminnan kansantaloudellisetvaikutukset, Helsingin yliopiston Ruraliainstituutinraportti 70/2011.85

Is preventive work cost-effective?86

Effectiveness and costs of preventiveservices for children and familiesIsmo Linnosmaa, Antti Väisänen, Eero Siljanderand Jukka Mäkelä 1Introduction: This article discusses issues related to the economicevaluation of preventive services for children and families. A concreteexample is presented in the form of child welfare and its financialevaluation, chosen because child welfare costs have sharply increasedthroughout the new millennium. The number of children placed outsidethe home increased until 2009. Especially rapid growth has been seenin the number of 16–17-year-olds outside the home.We begin the article by describing the aims of services for childrenand families. We discuss the concept of preventive measures and,with the help of two examples, demonstrate the possible result if earlyintervention fails, alongside the costs of such an outcome. In terms ofeffectiveness, we take a closer look at services for children and familieswhich might reduce the risk of a child being placed outside the home.We then examine the concept of cost-effectiveness and current researchdata on the effects and costs of prevention. In conclusion, we discussthe possibilities and problems involved in preventive measures.1 We thank Aija Puustinen-Korhonen and Marjatta Kekkonen for their constructive commentson our manuscript.Starting point: securing thewelfare of children and familieswith childrenAlthough the majority of Finnishpeople are better off than before, partof the population is becoming sociallymarginalised. There is a danger ofsocial marginalisation, poverty andsocial deprivation continuing downthe generations. Many services forchildren and families aim to securethe most equal starting points possiblefor children. Early interventionin problems and support for theeveryday life of families with childrenenhances family life and the safedevelopment of children. Sometimes,situations become so grave that theyendanger the provision of a safe environmentand balanced developmentfor the child, in which case it may benecessary to resort to child welfare.87

Placing a child outside the homeis a child welfare measure of the lastresort. It can have long-term effectson his/her life, affecting, for example,his/her education and career (Heinoand Johnson, 2010). Placing a childoutside the home is also expensivefor society.Among other things, the ChildWelfare Act 417/2007 lays down provisionson preventive child welfare,support for parenthood, supportinterventions in community care, andplacing children and adolescentsoutside the home. The Act determinesthe circumstances in which thethreshold for child welfare supportmeasures is considered to have beencrossed. Child welfare measures assuch cannot be eliminated, withoutchanging the unfavourable developmentconditions which make suchmeasures necessary. Rather, demandfor child welfare can be affectedby means of preventive measuresand child welfare community-basedservices. Since placement outsidethe home is a drastic measure fromthe viewpoints of child and adolescentwelfare and municipal finances,means of preventing such placementsare required.Family centre work is a new methodof organising services which supportchildren and families with children. Itcombines easy accessibility, lowthresholdactivities and family inclusion.The idea is that families find iteasy to approach service providers,and that problems related to familywelfare and health can be solved ascomprehensively as possible. Thetask of family centres is to promotefamily welfare and prevent problems88in the growth environment. Thispreventive role can be viewed as acounterbalance to heavy child welfaremeasures. Family centre activities areuniversally available to all familieswith small children, but services arealso targeted to those who are beinggiven help and specialised support.Through family centres, it is alsopossible to offer families non-institutionalchild welfare services and,if necessary, to refer clients onwards(THL, Kasvun kumppanit).Cost-effectiveness of preventivemeasuresConcept of preventive measuresThe concept of prevention has beendefined by the literature on primaryhealthcare and health economics (seeKenkel, 2000). Primary preventioncovers measures which reduce therisk of falling ill. For example, regularexercise and a healthy diet mayreduce the risk of illness. Secondaryprevention denotes measureswhose aim is to improve the patient’scondition after he/she has fallenill. For example, cancer screeningprogrammes may help to discoverthe illness in time, in which case it ispossible to significantly improve thecancer patient’s condition. Tertiaryprevention refers to measures takento reduce detriments/disabilitiescaused by permanent illness. As anexample, Kenkel (2000) mentions theappropriate podiatric treatment ofdiabetes patients, which can preventcertain serious complications causedby the disease. Preventive work ispreceded by a promotive approach,which refers to strengthening theexisting resources, knowledge andskills of children and families, inorder to promote physical, mentaland social health, and welfare.These definitions are also applicableto services for children and families,especially child welfare. Primaryprevention covers everything whichsupports the functioning of familiesand thus reduces the likelihood of thechild becoming a client of child andfamily-specific child welfare. Meanwhile,secondary prevention denotesall work aimed at positively affectingthe child’s welfare during communitybased care. Tertiary preventionincludes those measures which areused to secure a child’s welfare aftera decision has been made to takehim/her into care. In other words,prevention includes a wide variety ofmeasures before and during the timethe child is a child welfare client, aswell as before and after a decisionhas been made to place the childoutside the home or take him/her intocare.Family centre work is a new way oforganising preventive measures. Itincreases families’ opportunities toreceive both peer and professionalsupport at an early stage, when theirown resources still are reasonablysufficient. This is an ideal stage atwhich to increase the child’s possibilitiesof faring well, since a changeof direction at an early stage significantlyaffects the situation later inlife. The origins of a possible need forchild welfare at a later stage beginto develop long before the actualconcern has emerged.Family centre work is an example ofa universal social policy service. An

activity is termed universal when itis targeted at all members of a givengroup, such as families with children,while the aim of targeted measures isto improve the life situation and welfareof a selected group, for examplea certain high-risk group. Primaryprevention is universal and all childrenand adolescents in Finland aresubject to it. Meanwhile, secondaryand tertiary preventive measures aretargeted at a certain child or family,whose problem or risk has beenrecognised.A significant element of preventionconsists of recognising high-riskgroups and allocating resourcesto the most vulnerable populationgroups. Child welfare can be usedas an example, since there appearsto be a clear connection betweenfamily poverty and the need for childwelfare. Consequently, it can be seenthat financial subsidies allocated tothe poorest families have preventiveeffects.Failure to take preventive measuresleads to the culmination of problemsand major costsServices for children and adolescentscan also be seen to have a broadrole in supporting lives and development,as well as preventing problems.Below are two examples of the possibleconsequences of failed preventionor insufficient early intervention, andthe resulting costs to society.Trends in child welfare use andcostsIn Finland, problems experiencedby families experiencing ill-beingamongst children and adolescentsare particularly reflected in thegrowing number of municipal childwelfare clients. Cuts in servicesduring the recession of the 1990salso affected services for familieswith children, such as domestic aid.Poverty among families with childrenhad been decreasing over a longperiod, but began to increase in 1995and continued to do so until 2005(Salmi et al., 2009). These factorswere expressed in a growing need forchild welfare. The number of childrenplaced outside the home grew steadilyfrom 1991 all the way to 2009.During this period, the figure almostdoubled to more than 16,600 childrenand adolescents. With respect toteenagers in particular, the numberof children placed outside the homehas been growing steadily throughoutthe 2000s. This is probably explainedby growing ill-being among youngpeople (Kuoppala and Säkkinen,2009). The same trend can also beexplained by the increasing mentalhealth problems faced by youngpeople and insufficient availability ofmental health services for childrenand adolescents (Child Welfare Act417/2007).In 2009, almost a billion euros wasspent on child welfare services. Ofthis sum, almost 600 million euroswere spent on out-of-home careservices (Sotkanet), which entailedyearly costs of about 40,000 eurosper each child placed outside thehome (Kumpulainen, 2010). Childwelfare costs are clearly increasing ata faster pace than in other social andhealth services, excluding the costsof services for older and disabledpeople. Such growth in expenses isexplained by increased use of servicesand higher unit costs, but also,first and foremost, by the institutionalisationof all services. (Kuoppalaand Säkkinen, 2010). An increasingportion of children placed outsidethe home are placed in child welfareinstitutions, a trend clearly reflectedin growing costs. The daily cost ofinstitutional care is four times thatof foster family care (Väisänen andHujanen, 2010). Municipalities arebeing faced with difficult decisionsdue to high costs. Indeed, childrenare in danger of inequitable treatmentbetween municipalities due tothe municipalities’ varying financialsituations. All in all, the economicincentives to reduce the out-of-homeplacement are great.Early intervention and the costsof antisocial behaviour and socialmarginalisation in young peopleEarly intervention is a working methodbased on which the child’s school,social services and families co-operateto prevent antisocial behaviourand social marginalisation, throughtimely recognition of problems inyoung people’s lives and in theireducational progress (Työministeriö,2004). It is possible to intervene at anearly stage in such problems, steeringthe young person’s developmentin a positive direction before moreserious and expensive action is initiatedby the authorities.Antisocial behaviour and socialmarginalisation in young peoplemay incur expenses for society. Afollow-up study conducted in theUnited Kingdom (Scott et al., 2001),surveyed the costs of antisocial89

ehaviour in young people and adultsaged 10 to 28. The study noted thata young person with behaviouralproblems costs society three timesas much as a young person belongingto the average population, whencosts are assessed in terms of publicexpenditure on public services. Mostcosts caused by antisocial young peopleare incurred in the form of policeand judicial services (about 60%of total costs), while the educationsector (about 20%) accounts for thesecond greatest cost levels and childwelfare comes third (about 10%).Health service costs were significantlysmaller. When the costs of publicservices are taken into account, atits highest the total cost can amountto almost 70,000 pounds at 1998prices (Scott et al., 2001), or around100,000 euros at current prices. One2 The base figures from the year 1996were 3 million marks in losses to nationalincome and a 2 million mark increase inpublic expenditure.90international study (Healey et al.,2004) noted that workforce participation,the employment rate and theincome of young people exhibitingantisocial behaviour are lower thanthose of the whole population at both18 and 32 years of age, i.e. long afterthe period of youth. Young peoplein whom antisocial tendencies areobserved at an early age tend tospend longer periods unemployedand have a criminal record. Culminationof such antisocial behaviour canlead to social marginalisation fromeducation and working life.The National Audit Office of Finlandhas estimated that a young person ina state of permanent social marginalisationfrom the labour market costssociety around one million euros (Valtiontaloudentarkastusvirasto, 2007).This figure corresponds to the cost ofyouth unemployment to the nationaleconomy. According to Nilsson andWadeskog (2008), this million-europrice tag measures only around halfof the actual costs of social marginalisation.This is because, in addition toproduction losses, the socially marginalisedare associated with greaterthan average use of services such asthe police and the judicial system,employment authorities, social welfareand social security.Kajanoja (2000) has also estimatedthe costs of social marginalisation.According to his calculations, permanentsocial marginalisation causesa loss to national income of around700,000 euros and an increase of450,000 euros to the public economy,at current values. 2 Loss of nationalincome has been calculated accordingto the lowest wage group, with theemployer’s additional expenses added.The impact on the public economy consistsof lost tax revenue and increasedservice expenditure. However, Kajanoja(2000) points out that these calculationsare likely to underestimate thetotal costs of social marginalisation.The need for child welfare, andsocial marginalisation amongst youngpeople, are extreme examples of thepossible consequences of allowingyoung people’s problems to accumulate.Although the situation is nowherenear as grave for most children andyoung people, appropriate and timelyprevention and early intervention mayalso improve the lives of “ordinary”children. Clearly, some problems areonly noticed at a later age and cannotalways be solved, but this does noteliminate the clear need for preventivemeasures. Family centre work can beused to combine professionals frommultiple sectors to co-operate for thebenefit of children. Family centres alsosupport families and parents, whileencouraging parents to participate invarious activities. This makes it easyto approach problems and enablesearly-stage intervention. Although, inits current form, family centre workfocuses on early childhood, servicesavailable in the centres include socialand family work services, home-helpservices, child welfare services andnon-institutional adolescent psychiatryservices (THL, Kasvun kumppanit).Family centre work represents anew method of organising preventiveservices for children and families.However, no direct research evidenceexists on the effectiveness and costsof this, although indirect evidence isavailable on its effectiveness.

Cost-effectivenessBasic concepts in the evaluation ofcost-effectivenessThe concept of cost-effectivenesscan be defined with the help ofthe concepts of inputs, output andeffectiveness (see Fig. 1).Figure 1From input to effectivenessInputs(e.g. personnel,premises)Output(e.g. inpatientdays)Effectiveness(changes inwelfare)Input denotes the resources usedin service production, such as workforce, equipment, machines andproduction materials. In municipalchild welfare services, a focalproduction factor can be found inthe input of a social worker and, forexample, family worker, but serviceproduction also requires physicalcapital such as premises. If socialworkers decide to place a child ina professional family home insteadof a foster family home, productionfactors include input and the necessarypremises, as well as factorsneeded to maintain the premises,such as energy. Input use is oftenmeasured based on productioncosts.Combining different kinds ofinputs creates an output comprisingthe amount of services andgoods produced. For example, childwelfare services include social workcase management and guidance,support interventions in childwelfare community care (e.g. familywork and family rehabilitation) andsubstitute care services which canbe realised as institutional care,professional foster care or fosterfamily care. Nonetheless, servicesas such are not the actual outcome.Instead, the use of servicescan hopefully contribute towardsSource: Sintonen and Pekurinen (2006)achieving positive effects in termsof clients’ welfare.Sintonen and Pekurinen (2006)define effectiveness as a change infinal output which is in accordancewith the goal of the action taken. Todefine the effectiveness of services,information is needed on both thelength and quality of life (Williams,1985). In the case of child welfare,the child’s well-being is a naturalcandidate as the life quality variable(see e.g. Knapp, 1984).Fig. 2 depicts the effectiveness ofa child welfare service. For example,this service may involve placingthe child outside the home or takingthe child into care. In the example,the child care service is effectivebecause the welfare of a child whois provided with the service isgreater than that of a child who isleft without. The effectiveness ofthe service can be measured withthe help of area E. Effectivenesstakes into account both the changein welfare at any given moment, andthe duration of the effect. It shouldbe noted that service use does notalways result in the desired outcome– service effectiveness can remainsmall or even negative in value.The cost-effectiveness of preventivemeasuresEvaluating the cost-effectiveness ofpreventive measures is difficult dueto the fact that the benefits of suchmeasures are usually realised only inthe future. Chronologically, a preventivemeasure precedes any positiveeffects it may have. In such a case,variations in effectiveness are usuallyalso explained by other factors influencingthe child’s welfare, such as hisor her education. A research-relatedchallenge in evaluating the effectivenessof preventive measures lies indistinguishing the measure’s effectivenessfrom changes in the child’swelfare which are due to other factors(see Fig. 3). This is probably themain reason for the scarcity of directresearch evidence on the effectivenessof preventive measures.91

Figure 2The effectiveness of child welfare servicesWelfareStart of serviceDecision-making in the evaluation ofcost-effectivenessWhen cost-effectiveness is assessed,two or several alternative measuresof services are compared to each other.In child welfare, these can include,say, enhanced community care servicesand the child’s placement in afoster family. Different measures areoften used to pursue the same goal,which is usually that of securing orimproving child welfare. Alternativemeasures all have a certain effectivenessand scant financial resourcesare required in order to put them intopractice.Fig. 4 depicts a situation in whicha social welfare decision-maker hasWelfare with services;observed welfareEWelfare without servicesTimedecided to implement two, mutuallyexclusive alternatives in organisinga child’s care. In alternative A, thedecision-maker chooses enhancedcommunity care, whose expectedeffectiveness is E Aand costs C A.Under alternative B, the decisionmakerchooses to place the child in afoster family. Care in a foster familyis expected to yield efficiency E Bandcosts C B. For the sake of simplicity, letus assume that the costs and benefitsof the two alternatives are known tothe decision-maker.Which of these two alternativesshould the decision-maker choose?In economic evaluation literature, asimilar decision-making situation isdepicted as shown in Fig. 5, in whichthe costs and effectiveness of communitycare are compared to those of carein a foster family. In the figure shownabove, the effectiveness and costs ofcommunity care are positioned in themiddle.If the costs and effectiveness ofplacing a child in a foster family are inarea I, the placement costs more thancommunity care and it is less effectivethan child welfare community care. Insuch a case, for the decision-makercommunity care is a better alternativethan foster family care. Whereas, if thecosts and effectiveness of placing thechild in a foster family are located inarea IV, foster family care is a betteralternative than community care, sincethe costs of placing the child in a fosterfamily are smaller and the effectivenessgreater than in the case of child welfarecommunity care.Areas II and III are more challengingfrom the viewpoint of decision-makingthan areas I and IV. Let us begin byexamining a situation in which thecosts and effectiveness of foster familycare land in area II. In this case, fosterfamily care costs more than communitycare, but is also more effective. Nowthe decision-maker needs to evaluatehow much extra he/she is willing topay for additional effectiveness E B– E Agenerated through foster family care. Ifthe additional cost 3 calculated for each3 In economic evaluation literature, additionaleffectiveness E B– E Aand additional costs C B– C Aare termed incremental effectiveness and costs.On the other hand, the cost calculated for aneffectiveness unit is termed the incrementalcost-effectiveness ratio and calculated using theformula ICER = (C B-C A)/(E B-E A).92

Figure 3Effectiveness of preventive measuresWelfareEducationdPreventive measureFigure 4Comparing the alternativesA: community careB: foster family careABWelfare with education and preventivemeasures; observed welfareWelfare with educationWelfare without preventionor educationTime(E A ,C A )(E B, C B )effectiveness unit (C B– C A)/(E B– E A) islower than the decision-maker’s willingnessto pay, placing the child ina foster family is a better alternativethan community care. If the additionalcost surpasses the decision-maker’swillingness to pay, community carewould be a better alternative. (Seee.g. Sintonen and Pekurinen, 2006)If the costs and effectiveness ofplacing the child outside the homeare located in area III, communitycare will yield greater effectivenessbut it will also cost more than placingthe child in a foster family. The samedecision-making rules as in case IIapply to this situation.What is known about preventivework?Can family centre work reduce thesubsequent need for child welfare orother specialised services, that is tosay, is it an effective form of primaryprevention? No direct answer to thiscan be found based on research.However, the theoretical basis of familycentre work can be demonstratedthrough research. A child’s survivalthrough the various challenges oflife, without developing serioussymptoms, is a process involvingmultiple factors. Some of these factorsarise from the child’s own profileof abilities or special difficulties, andhis or her temperament. Most factors,however, are related to how theadults close to the child respond tothe child’s needs and support his orher development.Parenthood is an important variable,any lack of which in the child’s oradolescent’s current situation leadsto a growing need for child welfare:93

in child welfare, society assumespart of the parent’s primary responsibilityfor the child’s development.Nonetheless, insufficient parentingis not only connected to parents butalso to the broader context in whichthe community provides parents withthe support they need. This basicassumption of a communally-borneburden of parenthood is characteristicof the way human beings care forchildren. It is also indispensable inlight of human maturation, which isexceptionally long and wearing on theparents’ resources.Although children are a hugeblessing, even an ordinary childhooddemands an immense amount of timeand mental and emotional resourcesfrom parents. In a situation in whichthe child faces developmental challengesor the parents are otherwise94Figure 5Decision-makingIIIIC(E A ,C A )E B - E A(E B ,C B )C B – C AIIIVunder a notable burden, the need forwider resources is obvious. The morenaturally support is available, theeasier it is to receive. Consequently,child health clinics and the relatedhome-help services, home visits andfamily work as well as parent groupsare all forms of work which can beassumed to help parents when thereis a need, but not too great a need,for support. In a family centre, supportservices can be organised in away which allows the maximum numberof players working with familieswith children to offer their servicesand forms of support, all within thesame environment. Such an organisationalapproach may increase theusability of services and the effectivenessof early prevention.The greatest existing sourceof evidence on different forms ofEprimary prevention relates to homevisits made during pregnancy andthe child’s early years. According toa longitudinal study of internationalsignificance conducted in Finland,supervised home visits by nursesduring the child’s early years significantlyreduced mental disorders andoutwardly visible behavioural disordersin young people (Aronen andArajärvi, 2000). Although the studydid not directly evaluate child welfaremeasures, outwardly visible symptomsin young people were usuallyamong the factors creating a need totake the child into care. Consequently,as home visits reduce the numberof symptoms, the need to takechildren into care is likely to decreaseamong this population. In a Swedishstudy evaluating the economic effectsof interventions, it was concludedthat, purely on the basis that theyreduce depression, the cost-benefitratio of home visits is twofold comparedto ordinary cost-effectivenesslimits used in healthcare (one DALY,or a disability-adjusted life year, wasobtained with 25,000 euros, while theacceptable cost-effectiveness limitis considered to be 50,000 euros inSweden) (Bremberg, 2007). Similarly,in the US, the Nurse-Family Partnershipprogramme (Eckenrode et al.,2010) has been deemed an effectiveway of reducing social marginalisationin socially high-risk families.These home visit studies have beenconducted in child health clinics categorisedas universal. The effectivenessof home visit work has also beenstudied amongst a group of youngpeople, namely the group in whichthe number of children taken into care

has grown most in Finland. In the US,the most heavily researched intensivehome visit work method is multisystemictherapy, MST. In Finland,for example the Nopsa family workconducted by the Social ServicesDepartment of the City of Helsinkihas been piloted based on the sameprinciples. Nopsa family work intensivelyaddressed families throughhome visits, in a situation in whicha young person is under an immediaterisk of being taken into care. In2009, Nopsa work involved 110 youngpersons, of which only 19 were laterplaced outside the home. Earlier on,a social worker evaluated all of theyoung people involved as being inimmediate need of entry into care,but this was the eventual fate of only17% (Hovi and Mansikkasalo 2010).Consequently, within only two years,Nopsa work has proven an effectiveway of preventing young people frombeing taken into care.Another form of preventive workclosely associated with family centresis peer support. Peer support is usuallyunderstood to take place betweenpeople in a certain type of situation,such as the parents of small childrenmeeting in a family centre’s familycafe. Peer group activities can alsoincorporate professional guidancefor supportive parenthood, a formof work comparable to many effectiveinternational programmes witha proven track record of cost-effectiveness,such as the Incredible Yearsprogramme (O’Neill et al., 2010). Themore systematically parent groupsare used to support the parenthood ofparents whose children have behaviouraldisorders, as in structured andevaluated programmes (IncredibleYears, ICDP/Vägledande samspel,COPE, etc.), the more directly this willprevent developments which result ina need for child welfare.Family group conferences are anexample of effective secondary prevention,because they usually lead toa solution other than taking the childinto care. In family group conferences,parents can aim at a solutionalongside their own close family andassociates, which is then approvedor rejected by a social worker (Heino,2003). This form of work requires achange in professionals’ attitudesrather than their work input, sinceresponsibility for the actual conferencelies with the family and theirclose acquaintances. Family groupconferences have proven able to solvevarious, dead-end situations, such asthe threat of the child’s being immediatelytaken into care.Investments in the service networkmay also prevent children from beingplaced outside the home. Väisänenand Linnosmaa (2011) ask whetherthe number of municipal social workersaffects the number of childrenplaced outside the home. This studybegan from the hypothesis that ifthe number of social workers in amunicipality is large, it is possible tomonitor the welfare of children andfamilies in an effective manner andto take measures at a sufficientlyearly stage to prevent children beingplaced outside the home. Earlydetection of family problems maylead to increased use of communitybased services and decreased thenumber of placements outside thehome. The researchers observedthe ratio of municipal social workersto the number of children withinthe municipality placed outside thehome during the following year.According to the results, employing asocial worker reduces the number ofchildren placed outside the home inthe following year. Hiring one socialworker in the previous year (in 2001and 2003) reduced the number ofchildren placed outside the home byan average of 0.37 children in 2002and an average of 0.38 in 2004.Why no investment inprevention?Many factors influence decision-makers’commitment to preventive work.The most important of these is uncertaintyabout what is viable. Manymeasures and programmes which aresaid to prevent a later need for moreexpensive investments, but no directevidence is available on their effectiveness.Collecting direct evidence isgenuinely difficult. As in this article,it is therefore necessary to rely partlyon indirect evidence. For example,this has been done in Imatra, wherethe total costs of specialised servicesin various sectors had risen steeplythroughout the 2000s. There, homevisits by child health clinics weresupported by a new team. In just oneyear, a downward turn in the costs ofexpensive specialised services wasseen at macro level (Imatra, 2011).This highlights another problemrelated to investing in preventivework, namely sectoral thinking. Sincesectors hold budget responsibility,preventive work ought to createsavings in the sector in question.However, the situation may be such95

that an investment in healthcarereduces costs in the social sector,or that supporting the group formationof school classes with educationsector resources prevents costs inspecialised healthcare. It is difficultto envisage a solution to this problemwithout multisectoral management ofpreventive work. It is equally difficultto resolve the issue of thinking anddecision-making being closely connectedto budget, council or electionperiods. When investments are madein child and family welfare, a wait ofseveral years is often unavoidablebefore the results of the investmentshow. The savings in the Imatra andHelsinki Nopsa cases were seenquickly, in the following budget year,but in practice this still involvesa transition period during whichexpenditure exceeds savings. Sincefuture savings can be significant, surmountingthis problem should be animportant topic in economic research.The key question is whetherdecision-makers believe that preventivework is possible and useful. Dothey believe that, even in difficultsituations, development of child andadolescent welfare can be supportedin a way which reduces the need forcumbersome and expensive activities.This problem, too, is best overcomeby means of research and providingdecision-makers with researchdata. For example, it is important tobe familiar with developments whichcan lead to a need for child welfareand which could be transformed intogreater ability to cope at an earlierstage. This is the only way to plansensible, universal and specialisedpreventive measures which are alsocost-effective.96

ReferencesAronen, E.T., Arajärvi, T., 2000, Effects ofearly intervention psychiatric symptoms ofyoung adults in low-risk and high-risk families,American Journal of Orthopsychiatry70(2), pp. 223-232Bremberg, S., 2007, Hälsoekonomi forkommunala satsingar på barn och ungdom,En method for att uppskatta nyttan I förhållandetill konstnaden för olika insatser,statens FolkhälsoinstitutEckenrode, J., Campa, M., Luckey, D.W.,Henderson, C.R., Cole, R., Kitzman, H.,Anson, E., Sidora-Arcoleo, K., Powers,J., Olds, D., 2010, Long-term effects ofprenatal and infancy nurse home visitationon the life course of youths, Arch PediatrAdolesc Med., 164(1), pp. 9-15Healey, A., Knapp, M., Farrington, D.A.,2004, Adult labour market implicationsof antisocial behaviour in childhood andadolescence: findings from a UK longitudinalstudy, Applied Economics, 36(2), pp.93-105Heino, T., 2003, Kokemuksia läheisneuvonpidoista.Päiväkirja-aineiston raportointi.Stakes. Aiheita 4/2003.Heino, T., Johnson, M., 2010, Huostassaolleet nuorina aikuisina, teoksessaHämäläinen, U., Kangas, O., 2010, Perhepiirissä,KELA, HelsinkiHovi, A., Mansikkasalo, K. 2010. Nopeanpuuttumisen perhetyö – Nopsa. Infotilaisuus18.03.2010. Dia-esitysImatran, Sosiaali- ja terveystoimi. 3/3osavuosikatsaus 1.1.-31.12.2010. Sosiaalijaterveyslautakunta 24.2.2011Kenkel, D., 2000, Prevention in Culyer A.and Newhouse J. (eds.), 2000, Handbookof Health Economics, Elsevier Science,AmsterdamKajanoja, J., 2000, Syrjäytymisen hinta,teoksessa Heikkilä M., Karjalainen, J. (toim.),2000, Köyhyys ja hyvinvointivaltion murros,Gaudeamus, HelsinkiKnapp, M., 1984, The economics of social care,Studies in social policy, MacMillan EducationLtd, LondonKuoppala, T., Säkkinen, S., 2010, Lastensuojelu2009, THL, Tilastoraportti 29/2010.Nilsson, I., Wadeskog, A., 2008, Det är bättreatt stamma i backen an i ån, Institute of Socio-Ecological EconomicsO’Neill, D., McGilloway, Donelly, M., Bywater,T., Kelly, P., 2010, A cost-benefit analysis ofearly childhood prevention: Evidence from anexperimental evaluation of the incredible yearsparenting program, Department of Economics,NUI Maynooth.Scott S., Knapp M., Henderson J., Maughan B.,2001, Financial cost of social exclusion: followup study of antisocial children into adulthood,British Medical Journal, 323, pp. 191-194.Salmi, M., Sauli, H., Lammi-Taskula, J., 2009,Lapsiperheiden toimeentulo, teoksessaLammi-Taskula, J., Karvonen, S., Ahström, S.,2009, Lapsiperheiden hyvinvointi, Terveyden jahyvinvoinnin laitos, HelsinkiSintonen, H., Pekurinen, M., 2006, Terveystaloustiede,WSOY Oppimateriaalit Oy,Helsinki.Valtiontalouden tarkastusvirasto, 2007,Nuorten syrjäytymisen ehkäisy, Toimintakertomus146/2007, Valtiontalouden tarkastusvirastoVäisänen, A., Hujanen, T., 2010, Sosiaalihuollonyksikkökustannukset Suomessa vuonna2007, THL, Avauksia 1/2010Väisänen, A., Linnosmaa, I., 2011, Exploringthe demand for child welfare services: Do socialworkers have a preventive role? Working paper,Center for Health and Social Economics,National Institute for Health and WelfareWillams, A., 1985, Economics of coronaryartery bypass grafting, British MedicalJournal, 291(3), pp. 326-329Acts and provisions:Finlex, Child Welfare Act 417/2007.Online publications:Kumpulainen, A., 2010, Kuuden suurimmankaupungin lastensuojelu vuonna 2009,Lastensuojelun työryhmä, http://www.kuusikkokunnat.fi/THL, Kasvun Kumppanit:http://kasvunkumppanit.thl.fi/fi_FI/web/kasvunkumppanit-fiSotkanet: http://uusi.sotkanet.fi/portal/page/portal/etusivuTyöministeriö, 2004, Early Interventionas an Employment Policy Method – TheObjective: A Good Work Career, EU project/VS/2003/0678s, Ministry of Labour,Helsinki: http://www.esr.fi/mol/en/99_pdf/en/90_publications/earlyintervention_finalreport.pdf97

Family centre entails changes in professionalskills and knowledge98

Knowledge advancementconcerning family centresVibeke BingKnowledge advancementconcerning a new practiceThe composition and completenessof family centres is a new practicethat was formulated in a partnershipbetween various professionalgroups and thanks to interactionwith parents and children. If weconsider what knowledge favours adevelopment towards a new practice,Vanderbroucke (2008) believes thatthe ranking of the suitability andstrength of study designs within theknown evidence pyramid must beturned upside down. In these cases,case studies and qualitative data arethe most suitable design, whilst randomisedcontrolled studies (RCT) areconsidered to be the least suitable.Despite this, evidence of the effectsof family centres is still sought.However, no studies of these effectsare available, nor are they appropriatefor such a relatively new initiative.Controlled effect studies are intendedto assess whether previouslyresearched and proposed methodsactually achieve the effect they areexpected to give. In the case of familycentres, knowledge which contributesto observations and clarification froman internal perspective has advantagescompared with studies whichcan demonstrate the effects of thefamily centres. The best knowledgethat is currently available concerningfamily centres is based largely onobservational studies, case studiesand qualitative data whose aim is toprovide new knowledge through findingsand explanations.Family centres are an organisationalform that is filled with learning.A working group learns about the parents’daily life, captures each other’sknowledge and is influenced by itand changes its working method. Thedynamic means that the work can berevised and the level of knowledgeand the quality of the work are graduallyraised. The working method usedby the family centres is not static.Over the years, new researchobservations have been added to thework. The initiative has benefitedfrom knowledge concerning the wayin which the foundations for healthare laid during pregnancy, the developmentof the brain and attachment,relationships and infant research. Valuesand political messages today arenot the same as they were yesterday.The Convention on the Rights of theChild and equal treatment are requirementsthat leave their mark on practice.If the aim was once to preventthe failure of care, the aim today is toprovide more scope for self-esteemand good relationships.The context of the familycentresAs part of strategic public healthwork, family centres are expectedto contribute to the reduction of differencesin health. In all the Nordic99

countries, both child poverty andrelative poverty have increased inrecent decades. The gap between richand poor has increased. With differencesin income come differences inhealth, and a recurring question iswhether the family centres, with theirexpanded resources, reach out tothe socio-economically vulnerable orwhether they are only visited by thewell-heeled.A family’s general quality of lifeis after all the factor that has thebiggest influence on the health ofyoung children. The family centresform part of a context, and theirimportance must be interpreted withregard to the way in which childrenand families live their lives (Bing,2003). Nordic children tend to livetheir lives between home and school.From a fairly young age, they spenda lot of their time at nursery andschool amongst other children andprofessionals. Mothers and fathersare well-educated and both are inpaid employment. The family memberstherefore spend their time eachday in different arenas. Fathers, likemothers, are becoming increasinglyinvolved in their children’s lives andhave to make an effort to balancetheir working life and family life. Thestatutory parental leave has thereforebecome an exclusive period forparents and children, time that theyown together.The way in which the link with anopen nursery at a family centre benefitsthe parents of young children hasbeen evaluated in a qualitative studyof six family centres (Abrahamssonet al, 2009). The study shows thatit is the open nursery which makes100the family centre more accessible.Parents say that when they are there,they learn about children and parenting.They expand their social contactnetwork and get a chance to relaxin a secure environment where theyknow that social support is in reach.The staff is important, as professionalscreate structure and a friendlyatmosphere, so that parents feelwelcome. They get support to enjoyand bond with their children. WhenLindskov (2010) interprets familycentres in relation to modernity, shedescribes the parents’ perception ofthe initiative. At family centres, parentsreceive professional advice fromexperts. They also say that they canshare experiences with other parentsand thereby learn about child-rearingand parenthood. According to theparents, the task of the staff is thereforeto facilitate the meetings. Familycentres are also used as play centres,where children can socialise, play andsing with adults and other children.The staff prepares and organiseseverything. Finally, the family centresact as a living room for socialisingand social interaction. According toparents, the role of the staff is thereforeto be a good host with the task ofinviting guests and making sure thateveryone is happy.In other words, the professionalrole is changing. Staff are expectedto perform a broad spectrum ofroles. The professional role will varydepending on whether one is actingas an expert, hostess, play leader orcircle leader. As a member of staff,you must continually switch betweenall these roles. The new professionalisminvolves consciously adaptingoneself to physical and psychologicaldistance and depth. At a universallevel, easy-going contacts areestablished which lead to individuallyadapted initiatives. Interviewedparents testify that they received theright help at the right time thanksto this availability and the fact thatthey got to know the staff at an earlystage. For the staff, the collaborationclarifies the professional roles,and knowledge is increased throughthe proximity to other professionalgroups. The everyday contact withall the ever-present young childrenreinforces the child perspective(Abrahamsson, 2009).So, are all social groups reachedby the family centre’s resources?The answer is yes. A study of all theparents who visited the open nurseriesat 16 family centres in VästraGötaland shows this to be the case.The visitors accurately reflected thesocio-economic structure of the populationin the area where their familycentre was located. Information fromthe 437 parent visitors also showedthat the family centres are of particularimportance for immigrants. Thereis therefore an argument that familycentres have the potential to contributeto social inclusion and greaterequality in terms of health.

Collaboration in the Family’s HouseAnette M. Thyrhaug, Gørill W. Vedeler, Monica Martinussen and FrodeAdolfsen,The competence, commitment andco-operation of employees are ofcrucial significance for the quality ofthe services that are provided for children,adolescents and their families.It has long been a requirement withinthe healthcare sector that professionalsshould work together notonly in order to make services moreefficient, but also because childrenand parents with problems have manyneeds and different competence arerequired in order to help them. It istherefore vital that the various professionalsare able to work together withregard to solutions, so that those inneed of help receive the best possibleservice in a timely manner andhave the opportunity to participate.A number of evaluations have beencarried out of the Plan for AdvancingMental Health Care (Research Councilof Norway, 2010). Amongst otherthings, these evaluations indicatedthat a number of improvements havebeen made, such as the provision ofmore municipal health personnel.However, in the opinion of both usersand health personnel, there is roomfor improvement with regard to collaborationbetween professions andservices (Andersson and Ose, 2007;102Research Council of Norway, 2010;Sitter, 2008). Other studies from thehealth sector indicated that the lackof collaboration could have serioushealth consequences for patients, inaddition to reduced levels of satisfactionwith services (Fewster-Thuenteand Velsor-Friedrich, 2008). Thecollaboration between professionsand services is thus viewed as animportant resource within mentalhealth work by those who will receivethe services, personnel within thehealthcare and care services and theNorwegian authorities.Working with other people is bothrewarding and stressful. Several studieshave suggested an increased riskof burn-out amongst health and pedagogicalpersonnel (Maslach, Schaufeliand Leiter, 2001). On the other hand,such jobs also provide opportunitiesto help others and to have a valuableand meaningful job with opportunitiesto work with other colleagues.We have therefore decided to look inmore detail at employees who workat Family’s Houses in Norway and theway in which they assess their worksituation and the collaboration thattakes place within Family’s Houses(Adolfsen and Martinussen, 2010).Study participantsAll the employees of the six originalFamily’s Houses in the pilot projectwere invited to participate in a questionnairesurvey. A total of 71 people(91% of which were women) respondedto the survey. This represents aresponse rate of 51%. The majority ofparticipants were married/living withpartners (90%), and a large proportionhad children under the age of 18 livingat home (66%).ResultsThe questionnaire presented variousstatements regarding what it is like towork at a Family’s House. Responsesto the questions were given using afive-point scale, ranging from “to avery little extent” through to “to a verygreat extent”. Table 1 presents theproportion that were in agreement withthe statements to a great or very greatextent.Participants were also asked todescribe what was positive or beneficialabout the Family’s House organizationand what was challenging. Severalparticipants mentioned that readilyaccessible low-threshold services werebeneficial for users and that the model

had led to increased user participation.As regards challenges anddisadvantages, the use of time andthe considerable number of meetingswere mentioned, along with thefact that this meant less time spentwith users. Other challenges werethat the collaboration did not workas expected, and that the employeesfound that maintaining professionalsecrecy was challenging. A considerablenumber (50%) considered it tobe easy to obtain assistance fromother departments, and that therewas mutual respect between thedepartments (60%). The employeeswere also asked what was needed inorder to do a good job. Of the suggestedalternatives, training/coursesand guidance were mentioned asbeing either important or extremelyimportant (around 73%), whilst bettercollaboration was considered to beeither important or extremely importantby 66%.Burnout and engagement werealso surveyed amongst the employ-Tabell 1Professionals’ views of working in the Family’s HouseFamily’s House has helped to improve the opportunities for informal collaborationbetween the different services.To a great/very great extent85%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 betweenthe various services.There has been a stronger focus on the mental health of children and adolescents sincethe establishment of the Family’s House.I have become aware of how other services work in my municipality through working at aFamily’s House.The courses in which I have participated in during the establishment of the Family’s Househave 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 theFamily’s House.The Family’s House has led to changes in the way in which my service works in relation tochildren and adolescents.82%71%65%64%58%53%103

ees. The employees generally scoredlower than a comparative group ontwo of the three aspects of becomingburnout (exhaustion and cynicism)and higher on engagement (Adolfsenand Martinussen, 2010).ConclusionThe majority of employees weretherefore very positive about workingin a Family’s House and thoughtthat this had led to a more extensiveprofessional network and betteropportunities for both formal andinformal collaboration between theservices. The Family’s House modelwas reported as being favourabledue to the ease of access for usersand greater user participation. Thechallenges associated with themodel concerned the use of theprofessional secrecy, and the factthat a considerable amount of timewas wasted on meetings, whichresulted in less time being spent withthe users.ReferencesAdolfsen, F. and Martinussen, M. (2010).Samhandling i familiens hus i Norge. Presentationat the Nordisk familiecenterkonferens(Nordic Family Centre Conference).Helsinki, Finland, 6-7 May 2010.Andersson, W. W., and Ose, S. O. (2007).Unmet mental health service needs amongNorwegian children and adolescents. Childand Adolescent Mental Health, 12, 115-120.doi: 10.1111/j.1475-3588.2006.00423.xFewster-Thuente, L. and Velsor-Friedrich, B. (2008). Interdisciplinarycollaboration for healthcare professionals.Nursing Administration Quarterly,32, 40-48. doi:10.1097/01.NAQ.0000305946.31193.61Maslach, C., Schaufeli, W., and Leiter, M.P. (2001). Job burnout. Annual Review ofPsychology, 52, 397-422. doi: 10.1146/annurev.psych.52.1.397Research Council of Norway. (2010). Evalueringav opptrappingsplanen for psykisk helse(2001-2009). Sluttrapport – syntese og analyseav evalueringens delprosjekter. Oslo: ResearchCouncil of Norway.Sitter, M. (2008). Brukerbasert evaluering avdet kommunale tjenestetilbudet for barn ogunge med psykiske vansker 2004-2008. Trondheim:SINTEF Report A5204.Contact information: Gørill Warvik Vedeler(gorill.vedeler@uit.no), Monica Martinussen(monica.martinussen@uit.no), Frode Adolfsen(frode.adolfsen@uit.no) and Anette Moltu Thyrhaug(anette.thyrhaug@uit.no), RegionalCentre for Child and Youth Mental Healthand Child Welfare, University of Tromsø,NO-9037 Tromsø, Norway.104

children and adolescents, and otherparents. They also form a multivocalreality together, while strengtheningthe sense of community.The core of the good practicesdialogue process comprises twointeractive dialogue forums. A firstmeeting identifies well-functioningand worrying situations related tothe activity. The second shares good,everyday practices and ways of actingthat keep worry at bay, arising fromthemes based on these situations. Inaddition, face-to-face advance planningwith management and personnelis important to good practicesdialogue processes. Aspirations andobjectives for the dialogue processare negotiated in planning sessions.At the end of the process, agreementis reached on how the community andmanagement intend to continue processinggood practices and developmentthemes in the future.Zones of subjective worry (see illustration)provide support in reflectingon situations. A method developed bythe National Institute for Health andWelfare, “zones of subjective worry”is a tool for developing co-operationbetween children, adolescents andfamilies, and employees working withthem. “Zones of subjective worry”is a figure of speech, a metaphordescribing the degree of worry andworking conditions. The phrase alsorepresents an attempt to form alanguage facilitating discussion ofcomprehensive experiences. With thehelp of these zones, an employee cananalyse the degree of worry he or shefeels, the sufficiency of his or her personalscope for action, and the needfor additional resources. Children,adolescents and families too can usesuch zones to assess their personaldegree of worry and need for support.The zones are not intended as a toolenabling employees to interpret situationsin a similar way. Rather, the aimis to promote the possibilities of peopleand various actors to develop aninterest in mutual differences. Neitherare the zones intended for the classificationor registration of children,adolescents or families (Pyhäjoki &Koskimies 2009).Gp-dialogues constantly functionat the interfaces of private and publicknowledge. How might we managethe public sharing of individuals’ tacitknowledge so that it is sufficientlydetailed, but not too general? Andvice versa, how can we put generalknowledge into a form, and conveyit in a way, which touches individualsand gains traction with them?Such bridges have been constructedthrough good practice dialogues,by combining and applying variousFigure 1The zones of subjective worryNo worry1No worries at allArnkil Tom & Eriksson Esa 1998Minor worry2Feelings of worryor wonderHigh confidencein own possibilitiesThoughts of needfor additionalresourcescooperative learning tools, includingthe learning café and open spacemethods, and other variants. Inthe development process for Gpdialogues,it has proven essential toform a functioning basic model, onwhose basis leaders can tailor andmodify different variations, as necessary.Tailoring and modification areboth the Gp-dialogue’s strength, andthe prerequisite for its functionality. Aguide will be completed by the end of2011 on the purpose and use of goodpractices dialogue processes, andleadership of dialogues (Koskimies &Pyhäjoki & Arnkil 2011).So far, good practice dialogueshave been arranged and developedin intensive co-operation with staffand managers of services for children,adolescents and families in thecities of Nurmijärvi and Rovaniemi. InRovaniemi, good practice dialogueshave been employed in activitiessuch as the Napero project, whichdeveloped a family services centre,Considerableworry3The worry isconsiderableRunning out ofown resourcesNeed foradditionalresources andgreater controlMajor worry4Worry is extremelygreatUnable to resolvesituation usingown resourcesImmediatechange in situationrequired106

and in developing co-operation withorganisations. Within municipalities,the National Institute for Healthand Welfare is training leaders ofgood practice dialogues as part ofthe development of early open cooperation.Written feedback is collected for allrounds of good practices dialogue.Giving, receiving, joint handling andutilisation of feedback are integralto dialogicality and the creationand development of a dialogicaloperational culture. Several hundredinstances of feedback have been collectedfrom Gp-dialogues arrangedso far. Such feedback is extremelypositive and enthusiastic. Employeeshave an intense need and willingnessto discuss and perform their work,coupled with a desire to share anddevelop their competence together.According to the experiences of participants,Gp-dialogues are practicaland make everyday work easier. Theyare regarded as a safe way of raisingideas and concerns, while beingfound to enhance a sense of community,motivation, well-being at work,and dialogicality. Such dialogues arealso viewed as a light, fast way ofbringing out tacit community knowledgeand the operational culture ofthe community. According to supervisorsthemselves, they are able tomake direct use of the results of Gpdialoguesin the preparation of developmentplans. People often have funin good practice dialogues, even ifdialogicality is no easy, comfortableoption. A dialogical encounter alwaysrequires participants to pause, committhemselves, tolerate uncertainty,show confidence and proceed in aprocess-based manner.Dialogue process for practicesthat ease the worries ofchildren, parents and classteachersThe following is a description of howthe good practices dialogue processwas utilised in developing the schooloperational culture together with children,parents and teachers. Children’sworries and good practices for alleviatingsuch worries, and the issue ofhow adults at home and school cancombine to support and contribute tochildren’s growth and development,lie at the core of the process.Seventh-grade students at Iso niittuSchool in Nurmijärvi consideredtheir worries, and good practices foralleviating them, by class, led by theirteachers. Work began with reflectionon their worries, with the help ofthe zones of subjective worry. Usingthese zones, the children recordedthe kinds of issues related to schoolattendance, teachers, friends, hobbies,home, family, etc. that madethem happy and feel good, as well asthose which caused small, considerableand/or major worries. A summaryof these anxieties was prepared.Next, in small groups the childrenconsidered good practices relevantto the situations they selected withineach zone of worry. Finally, situationsand practices were reviewedin mutual discussions. The childrenwere told in advance that parents andclass teachers would also examinetheir worries and practices at a futureparents’ meeting, and consider howthey might best support the childrenin facing these concerns. After theparents’ meeting, the results, plans,feedback and messages to the childrenfrom parents and class teacherswere reviewed with the children.Later in the autumn, a parents’meeting themed “Good practices foralleviating the worries of children”was arranged for the parents. Inthe invitation, parents were askedin advance to record worry-free andworrisome situations in the zones ofsubjective worry. The parents andclass teachers began by familiarisingthemselves with the summary ofworries and good practices createdin connection with the children’s Gpdialogue.In small groups, they thenreflected on the worries identified bythe children and what kind of supportthey might give to help the child actin such a way that could alleviate thechild’s worries and make him/herfeel better. Small groups of parentsand class teachers considered andexchanged experiences of good“everyday” “small” acts and activitieswhich might ease children’s fearsand comfort them. Themes includedfriendships of children and adolescents,coping, sufficient rest andgood nutrition, preparing for examsand doing homework, use of computers/theinternet, spending money andfamily relationships. Group discussionswere reviewed and debriefingsconducted together. Finally, the parentspresented their own impressionsof teachers’ discussions, focussingon what particularly pleased and concernedthem about the discussions.As a concrete next step, it was agreedthat an event would be arranged forthe parents at which various methods107

of providing learning support wouldbe presented. Secondly, it was decidedthat a joint discussion would bearranged, on buying and consumingsweets and soft drinks during schoolhours. In addition, a message on theevening’s discussions was agreed, forcommunication to the children.The teacher leading the Gpdialogueswith children mentionedthat the students greatly appreciatedseparate enquiries being madeabout their concerns. This made iteasier for them to open up about theirworries. The children pointed outthat while reflection on worries andgood practices was enjoyable andeasy, implementing such practicesin one’s personal life was not alwaysso straightforward. For instance, anumber of sound exam preparationmethods had been collected (beginpreparing in time, go to bed early,spend only limited time during the daysurfing the Web) but pupils did notalways comply with these. Accordingto the teacher, children were eager toparticipate in consideration of goodpractices, concentrated well on listeningto proposals by classmates, anddiscussed them in earnest.Feedback from parents and teachersindicated that gathering children’sworries and practices was considereda wonderful, useful and importantexercise. The opportunity to hear theirchildren’s ideas was rewarding, interestingand thrilling. It was consideredextremely positive that children werethe genuine starting point, with everyonegiven the chance to participateand share their worries. The parentsmeeting was deemed extremely useful.Exchanging ideas and experienceswith other parents and class teacherswas considered interesting and valuable.According to parents, fruitfuldiscussions and getting to knowother parents were the best aspectsof the evening. They mentioned theexchange of everyday practices,experiences, ideas, tips, viewpointsand peer support as particularly useful.Parents found it extremely importantand relieving to find out thatothers, too, had similar worries. Theyhoped that these practices wouldcontinue and that parental meetingsof this kind, in which even childrencould participate, would form part ofthe school’s working culture.ConclusionThe creation of new, communalknowledge requires the transformationof tacit individual knowledge intounderstandable shared knowledge.Personal knowledge and experiencemust be shared in a reciprocal processwith others. The foundation forReferencesArnkil, Tom Erik and Eriksson, Esa (ed.)(1998) Huolen harmaa vyöhyke. Dialogi7/1998.Melkas Helinä & Uotila Tuomo 2008. Tietoja tietämys alueellisissa innovaatioverkostoissa;teoreettista pohdintaa. TeoksessaHarmakorpi V. & Melkas H. (toim.) Innovaatiopolitiikkaajärjestelmien välimaastossa.Lappeenrannan teknillinen yliopisto.Suomen kuntaliitto. Helsinki.creating new collective and organisationalknowledge lies in individuals,and their interaction within a groupand the working community.The first steps in creating newknowledge involve bringing out tacitknowledge, sharing competence andcreating new understanding (VonKrogh 1998). It is the task of managementto provide the time, place andspace for learning by the community.Good practice dialogues are spacesand processes for learning that createnew knowledge, skills, meanings andinterpretations. These spaces supportthe professional growth of participantsand strengthen the competenceof individuals. A successful dialoguerequires a context where people canspeak safely about their competence,worries and development needs in apositive atmosphere. Developing suchspaces, or dialogue forums, for sharingcompetence is essential. There,people can be and are heard, and canshare everyday best practices.Pyhäjoki Jukka & Koskimies Mimosa 2009.Varhainen puuttuminen ja dialogisuudenedistäminen huolen vyöhykkeillä. TeoksessaLammi-Taskula J., Karvonen S. & AhlströmS. (toim.) Lapsiperheiden hyvinvointi 2009.Helsinki: Terveyden ja hyvinvoinnin laitosVon Krogh, Georg 1998. Care in KnowledgeCreation. California Management Review.Spring; 40; 3.133–153.108

A picture of future competence needsin family centresHeidi Backman and Alexandra NordströmWhat does the future hold within the field of children’s and family services?What competencies will be needed under various possible future scenarios?What would happen if we did not actively develop the provision of services andwhat would a social disaster mean for the services that are aimed at childrenand families? What consequences would the digitalisation of society have andwhat consequences would there be if a family centre were to be provided inevery municipality?This article is based on a project carried out by the Finnish National Boardof Education during the period 2009–2011. The project working group consistedof representatives from the fields of day care, healthcare, social workand culture. The group developed four scenarios that describe the provision ofchildren’s and family services looking 10–15 years into the future. The first scenariothat was prepared was a “business as usual” scenario, where the currenttrends within the day care sector continue even if the outside world changes;the second scenario is a disaster scenario where the welfare and care systemsare dismantled. The following text presents a description of the third scenarioin particular, multi-professionalism and smorgasbord, a scenario in which thechildren’s and family centres are developed.Multi-professionalism andsmorgasbord – children’s andfamily centres are developedIn Finland, the economy is steady andthe employment situation is good.This has led to an increase in immigrationand the proportion of peoplein paid employment, as well as anincrease in the demand for day careprovision. Society can afford to investin public sector care provision. Theageing population is leading to anincrease in demand for care services,but the birth rate is not declining; itis instead rising in line with immigration,which is resulting in an increasein demand for various forms of servicesfor children and families.Local authorities have set up children’sand family centres or networkswith co-located services for families,based on a lifecycle approach withthe child in focus. A single centreoffers day care or early childhoodeducation, health services, schools,child welfare services and variousforms of special needs support,such as speech therapy. The familycentres are being developed into bothattractive and flexible workplaces interms of working hours and organisation,as well as into appropriatecreative learning environments for thechildren. This has helped to make itfashionable (amongst both men andwomen) to work with children, andthe status of the sector has risen.Family centres are multi-professionalcentres where healthcare providers,social workers, kindergarten teachers,special needs kindergarten teachers,nutrition therapists, family counsellors,cultural officers and co-educatorswork together. This multi-professionalapproach has made the centres morehealth-promoting and preventive.Special needs are identified at an earlystage and essential initiatives, suchas psychiatric care and special needseducation, are implemented. Healthpromotinginitiatives for exercise anddiet are integrated into the activities.The advice service makes preventivehome visits and social workers seekout clients with the aim of identifyingand rectifying problems as quickly aspossible.Society is increasingly becomingservice-focused and all sectors arebecoming more service-oriented,although day care provision is increasinglybecoming customer-oriented.People are expecting better andimproved services, as well as morecustomised services. They want tochoose the services they need froma smorgasbord of services. There arealso profiled day care centres and, atleast in larger municipalities, parentscan choose between these differentprofiles for their child, such as language,art and culture, gender issues,natural science or sustainable development.There is also an increasing needfor customer segmentation in order toproductively and efficiently develop109

different types of service, bothdigital services and face-to-faceservices. Families do not alwayswant to visit a health centre whentheir child is ill; they would ratherobtain information via the internetand have an opportunity to obtainadvice and guidance from experts ata distance or through peer supportgroups. Children’s and family centresare customer-oriented and theyare serving increasingly heterogeneousfamilies and family structures.Parents are offered a varietyof flexible day care solutions, suchas open day care, overnight andweekend care, as well as servicesthat are charged at an hourly rate.Some families are moving to ecotownsor communes in apartmentbuildings and working from homeor living on a citizen’s wage. A largegroup of parents are demandinglocally produced food without additives,are sceptical about vaccinationand want to work from homeand care for their children at home.There is an ever-increasing needfor professional groups that canguide and mentor families withregard to various issues concerninglife management, such as health,well-being and exercise, sleep anddietary issues, as well as financialissues or advice concerning thechoice of day care or educationalservices or leisure activities forchildren. Many of these services areprovided by the private sector. Thiscould involve services that combinechild day care and household services,such as cooking or gardening,or healthcare services which can beprovided in the home.110The multi-faceted knowledge ofthe personnelThe importance of pedagogic knowledgeis a key feature in the provisionof all children’s and family services,but it is of particular importance whenit comes to early childhood education.However, knowledge of children withspecial needs, gender issues, interculturalissues and media and art areimportant supplementary competencies.Emphasis is placed on supportingthe development of the child’s identityand taking an individual and respectfulapproach to children and families. Thepersonnel should also have knowledgeof the learning process, of childrenin groups, of creativity and of familydynamics. The ability to communicateand cooperate is important with regardto contact with parents, officials anddecision-makers within the municipality.The personnel should have thecompetence to counter, guide andsupport families and to cooperatewith other professional groups as wellas the parents, to create and work innetworks and to establish learningenvironments. The effects of digitalisationin society must be taken intoconsideration and it is important thatthe personnel is able to learn how touse information and communicationtechnology and new media in a waywhich supports and does not harm thedevelopment of children.The personnel at children’s andfamily centres are an importantlinguistic role model for the children,particularly for bilingual children andimmigrant children. The personnelmust be able to support the developmentof language skills in differentlinguistic environments. An excellentknowledge of the national languagesand an awareness of the importanceof language to the development andidentity of the child is therefore important,as is knowledge of bilingualismor multilingualism, home languagesupport and a knowledge of “languageshowers” and “language baths”. Apart of the personnel has an immigrantbackground and need further trainingin the national languages. Knowledgeof foreign languages, particularlyEnglish and Russian, is also necessary.Interpreters are in increasing demandwithin the day care, child welfare andchild advice sectors. Different culturalbackgrounds are taken into considerationand the personnel receive supportfrom a cultural interpreter if and whennecessary. It is becoming increasinglyimportant to understand different cultures,including one’s own culture andits subcultures, in order to be able tocommunicate with people with differentbackgrounds. The personnel needto have knowledge of multi-culturalism,intercultural competence and theability to educate about internationalisation.Due to the increase in immigrationand globalisation, the personnelmust also have knowledge of what arefor us exotic and previously unusualillnesses.The personnel should have a professionalismthat enables them to work inmulti-professional networks. Knowledgeof professional ethics, confidentialityand secrecy obligations, aswell as knowledge of law, is becomingincreasingly important. Professionalidentity and pride, as well as an abilityto market one’s own knowledge andthe sector, is becoming important in allprofessions within the sector, as well

as an ability to act as a role model forothers . The ever-changing nature ofsociety and working conditions meansthat the personnel should be development-orientedand flexible, possessan inner enterprising spirit and havethe ability to reflect and to work inprojects. It is important that the personnelis able to plan and evaluate theoperation, identify needs and developnew productive and efficient workingmethods, even in demanding situations.The role of the staff member asa tutor, coach or mentor is becomingincreasingly important both in relationto children and families and in relationto colleagues.Leadership is a skill which, althoughhighlighted in this scenario, is nota distinct part of current training.Knowledge of leadership as regardsmulti-professional work and work inchange is needed, as is a positive attitudetowards life-long leadership andvisionary leadership. Factors that contributeto the popularity of the sectorin the scenario are initiatives aimed atthe well-being of the personnel, e.g.the development of a work communityand the collaboration that takes place,the tutoring of personnel, support foroccupational well-being and mentalhealth at the workplace, as well asmethods for stress management. Businessknowledge and financial knowhow,as well as other administrativeskills, are becoming increasinglyimportant as public sector financesbecome ever-more limited.In order to provide sufficient competentstaff for all regions and areas,there is an increasing need for socialworkers and healthcare workers whoare mobile or who can provide servicesat a distance over the internet. Thereis a need for consulting kindergartenteachers, special needs kindergartenteachers and various types of educatorsand pedagogues, such as genderpedagogues who can act as a mobileresource and as a consultant. In thefuture, some of these services will beprovided at a distance, e.g. throughinformation technology. The need forIT support is increasing in line withthe broader utilisation of informationand communication technology withinoperations. The general areas of competenceare as follows:Communication and customer orientation:to be able to counter and supportdifferent types of families, to work withcolleagues and parents in an educationalco-operation, as well as theability to communicate digitally.Problem-solving and the ability to beinnovative: to be able to develop one’sskills and working methods in differentsituations according to the changingdemands of society and customers.Cultural aspects and language: to takeinto consideration in one’s work achild’s monolingualism, bilingualismor multilingualism, as well as familieswith different cultural backgrounds,including subcultures.Education: to possess fundamentalpedagogical skills, including skillswithin, for example, special needsteaching, gender issues, interculturalissues and media and art.Professional role and work culture:to be able to handle administrativeissues, particularly issues concerningleadership or teamwork, and tobe able to lead, guide, cooperate,develop, change, evaluate and contributeto occupational well-being in theworkplace.This article is based on the results ofthe Finnish National Board of Education’sESF-financed VOSE project, aproject which is aimed at developinga national model for the forecastingof future competence needs within allsectors. The results will support thedevelopment of vocational educationand training, polytechnic anduniversity education, including adulteducation and training in both theshort and the long term. A pilot groupwithin the provision of day care andother children’s and family serviceshas been working on the forecastingmodel in Swedish since autumn 2009.The educators and pedagogues whoparticipated in the group intend totake the results into consideration intheir own work with curriculums andstudy programmes. The VOSE projectwill conclude its work on the forecastingmodel in spring 2012.ReferencesHeidi Backman, Kristel Englund andAlexandra Nordström. Barnen ärframtiden – framtidsscenarier ochkompetensbehov inom dagvård och annanbarn- och familjeverksamhet, publishedin Swedish and Finnish in June 2011 onthe Finnish National Board of Education’swebsite. (http://www.oph.fi/utvardering_och_statistik/prognostisering/kompetensbehov/vose_projektet)111

Future challenges112

Developing family centres in the NordiccountriesMarjatta Kekkonen, Mia Montonen and Riitta ViitalaNordic collaboration is essential inorder to develop family centres. Inthis publication, we have attemptedto present a complete picture of thedevelopment of family centres in theNordic countries, describe the keythemes for family centres and outlinefuture development needs and visionsof the family centres. The Nordiccountries have a long tradition ofcollaboration with regard to childrenand family policy. The development offamily centres and the working methodsof the family centre are evidenceof a good Nordic collaboration thathas given rise to major benefits in theform of expertise and knowledge.The living conditions of familiesand the prerequisites for parentingare in the same state of change inall the Nordic countries. The workroutines, organisational approachand organisational culture of childand family services are changing. Theclient and family orientation is beingemphasised and this is changing servicestructures and service provision.The preventive work needs multiprofessionalpartnership structuresnot only in the client work and in thecross-border collaboration betweenthe service sectors, but also betweennon-governmental organisations. Inthe future, Nordic collaboration willbe needed within the developmentof the complete range of servicesoffered by the family centres in orderto establish a common Nordic threadfor strategies for parental supportand early prevention.The results of the evaluations offamily centre projects that have beencarried out of family centre projectshave generally been positive. Despitethese positive results, we currentlydo not know enough about the effectsof the family centre initiative and thecost-effectiveness of the preventionwork. With regard to future developments,evaluation and research shouldbe intensified with regard to the effectivenessof family centres. We needboth cross-sectional information andlong-term monitoring when it comesto family centre initiatives within themunicipal service system and theeconomic and human consequences ofthe effectiveness of mother and childadvice, family preparations, open daycare provision and the preventive familyand social work within the familycentre services. In this context, it isvital to formulate and realise commonNordic family centre research.In the Nordic countries, familycentres have generated a lot of verypractical knowledge, a wealth of goodpractice and tacit knowledge over theyears, which governs the activities infamily centres. In addition to research,there is also a need to compile thisexperience-based knowledge andgood practice. Within the work relatingto family centres, a diversifiedrange of education programmes hasbeen implemented diversified range113

of education programmes that couldbe of great benefit for all the Nordiccountries. The Nordic countries couldalso benefit from common threadsin a family centre manual. The keycontents of this manual should concernthe competence development ofprofessionals and other players, newfamily-oriented working methods,greater involvement of children andparents, and the management of thefamily centres.The ultimate aim of family centresis to promote a good childhoodthrough reinforcing parenting skills.The way in which family centresshould be developed and the effectivenessof the family centre servicesshould be analysed with greaterclarity and evaluated in relation tothe views of parents and children, thegoals established by the staff and theservice structures and activities thathave been implemented. The views,responses, experiences and suggestionsfor improvements of parentsand children are of pivotal importancein the development of the familycentres. It is therefore important tocompile information concerning theexperiences and values of mums,dads and children as regards familycentres in the Nordic countries.Finland hosted the Nordic familycentre conference in 2010, five yearsafter the first conference, which washeld in Sweden. The first Nordicfamily centre conference was held inSweden five years previously. Theseconferences showed that there is a lotof Nordic know-how surrounding thetheme of family centres and the issueof health promotion and early prevention.The large number of delegatesat the conferences also reflects thelevel of interest in and the desire toexchange information and becomeinvolved in health-promoting andpreventive collaboration.We hope that these joint Nordicconferences, which have alreadybecome something of a tradition, willcontinue to be held at regular intervalsin our respective countries inturn. Family centre stakeholders needa forum where they can meet theircolleagues and others interested indeveloping the family centres in theirhome country and across the Nordicregion. We hope that this publicationwill initiate a dialogue and anexchange concerning family centresat both Nordic and international level.114

The AuthorsFINLANDMaria Kaisa AulaLicenciate of Political SciencesOmbudsman for ChildrenOffice of the Ombudsman for ChildrenFinlandmariakaisa.aula@stm.fi+358-50-530 9697The Ombudsman for Children promotes therealisation of children’s rights in Finland. TheOmbudsman acts as a sounding board for thevoice of children and a bridge builder for childpolicy. The Ombudsman raises the awarenessof decision-makers and influences social policyby speaking out on behalf of children. Theintention is also to promote the development ofservices that support the welfare of children,young people and families.Heidi BackmanMaster of PoliticsDirector of EducationFinnish National Board of EducationFinlandheidi.backman@oph.fiThroughout the period 2009-2011, Heidi hasbeen involved in developing a national modelfor how to create future skills in different vocationsand industries. She has tested the modelwithin the daycare industry, as well as otherchild and family activities.Nina HalmeDoctor of Health SciencesSenior ResearcherChild, Adolescent and Family -servicesNational Institute for Heath and WelfareFinlandnina.halme@thl.fiMirjam KallandDoctorate in EducationAdjunct Professor in Social Work and FamilyResearch at University of Helsinki ,Adjunct Professor in Music Education at theSibelius AcademySecretary GeneralMannerheim League for Child WelfareFinlandMirjam’s main research interest has been riskand protective factors for children’s developmentand is currently working actively ondeveloping support for parenthood withinmaternal and children’s advisory activitieswithin primary healthcare in Finland. The MannerheimLeague for Child Welfare introducedthe family welfare centre activities in Finlandand currently has over 400 open meeting placesfor parents.Milla KalliomaaDirector, Organisational and Volunteer WorkMannerheim League for Child WelfareFinlandmilla.kalliomaa@mll.fiMilla has been involved in developing andexpanding MLL’s family centre activities inFinland.Marjatta KekkonenMaster of Politics, PhD, Group SupervisorSenior Planning OfficerChild, Adolescent and Family ServicesNational Institute for Heath and WelfareFinlandmarjatta.kekkonen@thl.fiMarjatta worked on the PERHE project between2005 and 2007. She has worked as an instructorfor the in- service training model of educationalpartnership for the ECEC- and familyservice personnel. She worked as an instructorfor the in-service training model of educationalpartnerships for the ECEC and family servicepersonnel. She participated in the organisationof the Nordic family centre conference inFinland 2010, as well as being involved in thedevelopment of the family centres within thenational KASTE programme from 2008 to 2011.Marju KeltanenMaster of EducationResearch AssistantThe Association of Finnish Local and RegionalAuthorities,marju.keltanen@kommunforbundet.fiMimosa KoskimiesMaster of Social SciencesSpecial Planning OfficerNational Institute for Heath and Welfaremimosa.koskimies@thl.fiIsmo LinnosmaaPhDResearch professorCentre for Health and Social EconomicsNational Institute for Health and WelfareFinlandismo.linnosmaa@thl.fiIsmo is responsible for the cost-effectivenessanalysis of child welfare services.Mia MontonenNurse, Master of PoliticsDevelopment ManagerAB Det Finlandsvenska Kompetenscentret inomdet sociala området – FSKC (The centre of excellenceof social welfare)Finlandmia.montonen@fskc.fiMia has worked on developing the Swedishfamily centre in Helsinki. She has worked indifferent positions of trust in the Swedishspeaking Finnish association Familjeparasolletas well as being involved in the founding ofthe Finnish Suomen perhekeskusyhdistys. Inaddition to that, she was one of the people incharge of arranging the Nordic family centreconference that took place in Finland 2010.115

Jukka MäkeläMD, Child Psychiatrist,Trainer-level ChildPsychotherapist and Theraplay-therapist,Development Manager for Promotive andPreventive Child Mental Health ServicesNational Institute for Health and WelfareFinlandjukka.makela@thl.fiJukka has a long experience in preventativework in the grey area between child protectionand child mental health.Alexandra NordströmBachelor of Social SciencesPlanning SpecialistFinnish National Board of EducationFinlandalexandra.nordstrom@oph.fiAlexandra wrote her bachelor’s thesis on childhoodresearch and on the questions that arelinked to daycare in Finland. She has workedwith the Finnish National Board of Education’sproject on forecasting future skills needs withindaycare and other child and family activities.Aila Puustinen-KorhonenMaster of Social SciencesSenior AdviserThe Association of Finnish Local and RegionalAuthoritiesaila.puustinen-korhonen@kuntaliitto.fiwww.kommunerna.netJukka PyhäjokiFamily Therapist, Educational Science,Vocational Education, 333 ECTS creditsSenior planning officerNational Institute for Health and Welfare (THL)Finlandjukka.pyhajoki@thl.fiSirkka RousuDoctor of Administrative Science, Social WorkerPrincipal Lecturer, Helsinki Metropolia Universityof Applied Sciences, www.metropolia.fiProject manager (on leave), The Associationof Finnish Local and Regional Authorities,www.localFinland.fiFinlandsirkka.rousu@metropolia.fiSince the beginning of 2000, Sirkka has beeninvolved in developing the family centre activitiesin the Harava project of The Association ofFinnish Local and Regional Authorities. Duringthe period 2004–2007, Sirkka participated inthe PERHE project, which is a family serviceprogramme within the national developmentprogramme for the social area. She has alsobeen responsible for a research project thatthe Association of Finnish Local and RegionalAuthorities carried out between 2010 and 2011together with its co-operation partners. Theproject investigates services and co-operationthat apply to children, young people andfamilies as well as how the statutory municipalwelfare plans have been met and how the FinnishChild Welfare Act is observed.Eero SiljanderLicenciate Political Science (Economics)Senior ResearcherNational Institute for Health and Welfare,Centre for Health and Social EconomicsFinlandeero.siljander@thl.fiAntti VäisänenMaster of Political Science (economics)ResearcherCentre for Health and Social Economics(CHESS), National Institute for Health andWelfare, Finlandantti.vaisanen@thl.fiAntti is a researcher and is currently investigatingcost efficiency in social services.Riitta ViitalaPsychologistDevelopment ManagerMinistry of Social Affairs and HealthFinlandriitta.viitala@stm.fiRiitta has been involved in the developmentof the family centres in Finland from the verybeginning. First in the control group as a representativeof the Ministry of Social Affairs andHealth for Espoo’s family centre project 2003-2005, then as a project manager within theNational PERHE project 2005–2007. She subsequentlydeveloped the family centres within thenational KASTE programme 2008-2011.116

NORWAYAnette Moltu ThyrhaugPublic Health Nurse. Qualifying as a Master ofPublic HealthAdviserUniversity of TromsøNorwayRKBU Nord (RBUP North), Faculty of HealthSciences, University of Tromsø, Norway E-mail:anette.thyrhaug@uit.noAnette has been a member of the project groupfor the Family’s House at RKUP North since2007.Gørill Warvik VedelerMaster of Education, PhD candidateAdviserUniversity of TromsøNorwayRKBU Nord (RBUP North), Faculty of HealthSciences, University of Tromsø, Norway E-mail:gorill.vedeler@uit.noGørill is currently project manager for theFamily’s House project at RKUP North. She isdeveloping a doctoral study on early parentsupport anchored in open daycare in the Family’sHouse. Member of the project group forThe Family’s House at RKBU North.Monica MartinussenMaster of Psychol. (1989) and Ph.D. (1997)ProfessorUniversity of TromsøNorwayRegional Centre for Child and Youth MentalHealth and Child Welfare, University of Tromsø,Norway E-mail: monica.martinussen@uit.noMonica is leader of the research group forpreventive and health promoting interventionsat the centre. The research group is responsiblefor supporting Norwegian municipalities inestablishing the Family’s House commissionedby the Norwegian Directorate of Health. Thisincludes information activities and teaching aswell as research linked to the Family’s Housein Norway.Frode AdolfsenMaster of Education, Research FellowAdviserUniversity of TromsøNorwayRKBU Nord (RKBU North), Faculty of HealthSciences, University of Tromsø, Norway E-mail:frode.adolfsen@uit.noFrode has carried out questionnaires amongemployees in six Norwegian family centres(Adolfsen & Martinussen, 2010). Member of theproject group for the Family’s House at RKBUNorth.SWEDENJohanna AhnquistBSc, MPH and PhDPublic Health Planning OfficerSwedish National Institute of Public Health.Swedenjohanna.ahnquist@fhi.se, tel. +4670199691Johanna works at the Swedish National Institute ofPublic Health, gathering and disseminating informationon methods and strategies for promoting childrenand young people’s health. The family centre constitutesan important promotional and preventative arenain this context.Vibeke BingSocial Worker and Nursery TeacherPublic Health Education via the Nordic School of PublicHealth (NHV) as well as journalism training.Development and quality coordinator in Backa Läkarhusgruppen.Vibeke@vibekebing.se ; vibeke.bing@backalakarhusgruppen.sePhone +46766451147As an administrative Officer at the National Institute ofPublic Health Vibeke established a national networkof family centres in Sweden and took the initiativeto create the Association of Family Centres and wasits chairman for many years. She was appointed asa consultant by different municipal authorities andmunicipalities to help start family centres and in 2004received the Allmänna Barnhuset’s Stora Prize for thiswork. She has also contributed to several books aboutChild Public Health and reports and evaluations ofthe family centres. She completed a course in 2010 atKristianstad University entitledy “Working at a familycentre”. In recent years, Vibeke has been engaged in aEuropean context regarding children’s health “parentingsupport” and child poverty.Thomas JohanssonCommunity Public Health CoordinatorAcademic education: sociology, psychology, psychologyof religion and astronomy.Municipality of LeksandSwedenthomas.johansson@leksand.se+46 247 801 37Thomas was involved in initiating and developing theLeksand model from 1996.One of the cornerstones of the model is early and continuousparental support through different ages.Another is inter-disciplinary co-operation and cooperationbetween professional and voluntary players.The model has received great acclaim in Sweden,Finland, Russia and recently in Denmark.School recreational leader/education as well associology, psychology, psychology of religion andastronomy.117

ICELANDSigrún JúlíusdóttirSocial worker, Family therapist, Social Worker,Authorised Psychotherapist, PhDProfessor of Social Work; Family TherapistFaculty of Social Work. University of Iceland.Private clinic (part-time)Icelandsigjul@hi.isSigrún initiated one of the first family therapycentres in Iceland in the early 1980s and startedthe Center for Children and family Research,University of Iceland, 2006. She is involved infamily politics and social debate surroundingfamily issues, contributing to the family therapyfield through therapeutic educational and trainingactivity and conducts family research.Elísabet KarlsdóttirMA, Diploma in Services to the ElderlySocial Worker, Project ManagerCentre for Children and Family Research,Faculty for Social Work, University of Iceland.Icelandelisabk@hi.isElísabet has worked as a social worker providingsocial support and advice to families,children and young adults in Reykjavik municipalityin relation to social problems in thefamily such as drugs, financial problems, careand more. She has worked as a lecturer in thesocial worker programme at the University ofIceland. Her job as leader of the research centreincludes family research, particularly in relationto violence against women, co-operation andpresentation of research in different contexts.DENMARKAnna Jin RolfgaardBatchelor of Administrative SciencesHead of SectionDanish Ministry of Social AffairsDenmark+4541851101anr@sm.dkAnna’s area of responsibility is young andvulnerable people.Henriette WebergHealth VisitorLeading Health VisitorCenter for Børn & Familie, Greve MunicipalityDenmarkhwe@greve.dkGreve Municipality was the first municipality inDenmark to follow a method in which first-timeparents received an offer that was stronglyinspired by the Leksand model. Henriette wasinvolved in testing the method and acted asfacilitator for the first group of parents. Shesubsequently devised a timetable for themethod, which can be used by other municipalitiesin Denmark.118

Steering group and editorial teamChairRiitta Viitala, Development Manager,Ministry of Social Affairs and HealthProject ManagerMarjatta Kekkonen, Senior PlanningOfficer, National Institute for Healthand WelfareMembersMilla Kalliomaa, Director, MannerheimLeague for Child WelfareMia Montonen, Development Manager,The Centre of excellence of SocialWelfare – FSKCSirkka Rousu, Project Manager, asfrom 21.2.2011Aila Puustinen-Korhonen, SeniorAdviser, the Association of FinnishLocal and Regional AuthoritiesElina Suontama (previously Siltala),Communications Officer, NationalInstitute for Health and WelfareTorbjörn Stoor, Managing Director,the Centre of Excellence in SocialWelfare – FSKCEditorial teamMarjatta Kekkonen, Senior Officer,National Institute for Heath and WelfareMia Montonen, Development Manager,the Centre of Excellence in Social Welfare– FSKCRiitta Viitala, Development Manager,Ministry of Social Affairs and HealthElina Suontama (previously Siltala),Communications Officer, NationalInstitute for Health and WelfareGeorge Henrik Wrede, ProgrammeDirector, Department for Cultural,Sports and Youth Policy, Ministry ofEducation and Culture119

120

Ved Stranden 18DK-1061 Copenhagen Kwww.norden.orgISBN 978-92-893-2303-1ANP 2012:701