komt een kind bij een dokter…’ · ‘komt een kind bij een dokter…’ bernice doove, arts...
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‘Komt een kind bij een dokter…’
Bernice Doove, arts M&G-jeugdarts Department of Social Medicine, School for Public Health and Primary Care
Department of Psychiatry and Psychology, School for Mental Health and NeuroScience
Maastricht University
bernice.doove@envida.nl
The MOM study 12 September 2016
Faculty name 2
Komt een kind bij een jeugdarts…
• Wat heeft dit kind eraan?
• Vroegsignalering ontwikkelingsproblemen
• Public health personalized health care
Promoting physical and mental fitness: Evidence into practice and practice into evidence:
closing the circle? ….....attachment!?
Academische Werkplaats Publieke Gezondheid Limburg
The MOM study
12 september 2016 FHML –Social Medicine –Bernice Doove
Faculty name 3
Maatschappelijke context
NRC 3 dec 2013: “Meer kinderen groeien arm op”
Bron: Armoede signalement 2013 CBS-SCP
•Psychosociale problemen •Overgewicht / obesitas •Onveilige omgeving •Middelengebruik / verslaving
•Chronische ziekten
Kinderen In Tel 2014
FHML –Social Medicine –Bernice Doove 12 september 2016
Faculty name 4
Infant Welfare Centre
Couleur locale
12 september 2016 FHML –Social Medicine –Bernice Doove
Centrum voor Jeugd en Gezin
Preventie
Faculty name 5
Couleur locale
Kinderen in Tel 2014:
Nr 85 Brusselsepoort
Nr 98 Beatrixhaven
Nr 209 Mariaberg
Nr 212 Oostermaas
Nr 259 Oud Caberg
Nr 326 Pottenberg
Nr 467 Bosscherveld
Nr 658 Daalhof
FHML –Social Medicine –Bernice Doove 12 september 2016
Faculty name 6
Bestrijding kans armoede
Doen we de goede dingen goed genoeg?
JGZ ‘toolkit’ vroegsignalering?
Participatie voor alle kinderen!?
INTERNATIONAAL VERDRAG INZAKE DE RECHTEN VAN HET KIND
ook als basis voor lokaal jeugdbeleid
FHML –Social Medicine –Bernice Doove 12 september 2016
The MOM study Monitoring Outcome Measurements of child development Monitoring Ontwikkeling kinderen in Maastricht en Heuvelland
Faculty name 7
The MOM study
Competent
On track At risk
Not on track
Not competent
T1
Succesful social participation + ‘Life long learning’
Competention
Age
07-08 Sept 09 Sept 11
Stakeholders Convenant Workshop Training Pilots Subsidie Application
Theoretical framework Instruments PEDS Pilot +Research License
3 4 5/6
T2
T3
PEDS Parents’ Evaluation of Developmental Status + VAS Risk and protective factors
Bridging the gap..
17-12-09
FHML –Social Medicine –Bernice Doove 12 september 2016
Faculty name 8
Unieke interactie biologisch genetische kwetsbaarheid omgeving
12 september 2016 FHML –Social Medicine –Bernice Doove
Rutter M. Resilience as a dynamic concept. Dev Psychopathol. 2012;24(2):335-44.
Faculty name 9
‘Growing into deficit?’
!Syurina EV, Hens K, Feron FJM. Literature Review: Use of Family History for Primary Pediatric Care as the Next Step Towards use of Genomics in Healthcare. Current Pediatric Reviews 2013
12 september 2016 FHML –Social Medicine –Bernice Doove
diagnose
Faculty name 10
Participatory Child Health Care
!Syurina EV, Hens K, Feron FJM. Literature Review: Use of Family History for Primary Pediatric Care as the Next Step Towards use of Genomics in Healthcare. Current Pediatric Reviews 2013
Symptomen & lijdensdruk?
12 september 2016 FHML –Social Medicine –Bernice Doove
Faculty name 11
Preventive Predictive Child Health Care
!Syurina EV, Hens K, Feron FJM. Literature Review: Use of Family History for Primary Pediatric Care as the Next Step Towards use of Genomics in Healthcare. Current Pediatric Reviews 2013
Hielprik
Family History
12 september 2016 FHML –Social Medicine –Bernice Doove
Faculty name 12
Diathesis-stressmodelPersonalized PCHC
!Syurina EV, Hens K, Feron FJM. Literature Review: Use of Family History for Primary Pediatric Care as the Next Step Towards use of Genomics in Healthcare. Current Pediatric Reviews 2013
Early life stress
12 september 2016 FHML –Social Medicine –Bernice Doove
Faculty name 13
‘Goodness of fit’ environment ?
Attachment
Preschool Mental Health
De relatie is ‘de patient’
12 september 2016 FHML –Social Medicine –Bernice Doove
Faculty name 14
Dynamic life course perspective
Shifts in the child shifts in the environment
+ representation
personal
contextual
regulation
12 september 2016 FHML –Social Medicine –Bernice Doove
Sameroff, A. A unified Theory of Development: A Dialectic Integration of Nature and Nurture. Child Development, January/February 2010, Volume 81, number 1, pages 6-22.
Faculty name 15
Schoolreadiness: a dynamic outcome of preschool health/participation
Transition home stage - elementary stage
Shifts in the child shifts in the environment
12 september 2016 FHML –Social Medicine –Bernice Doove
Sameroff, A. A unified Theory of Development: A Dialectic Integration of Nature and Nurture. Child Development, January/February 2010, Volume 81, number 1, pages 6-22.
Faculty name 16
ICF International Classification of Functioning, Disability and Health
Theoretical framework of health related functioning
Symptoms, concerns, distress
Schoolreadiness
FHML –Social Medicine –Bernice Doove 12 september 2016
Faculty name 17
Growing into schoolreadiness ? The MOM study
• Multi- and cross- informant
• Multi-axial
• Dimensional assessments of symptoms and behaviour
• PCHC setting
• Repeated measures: 3 4 5/6 years
A prospective observational cohort study
Monitoring Outcome Measurements of child development Monitoring Ontwikkeling kinderen in Maastricht en Heuvelland
FHML –Social Medicine –Bernice Doove 12 september 2016
Faculty name 18
MOM PCHC ‘toolkit’ of instruments
!
COLLABORATION
01-03-10
CBCL SF-36 NOSIK
Parent
PEDS SNEL SDQ
Competence
Participation Life events
Nurture Health Life events
TRF
Kindergarden/ ( pre) school
Preventive Child Health Care
Parental, Environmental + Child developmental factors PEDS-score, Risk- and protective factors/CAP-J
! STEP + interventions
PEDS SNEL SDQ
FHML –Social Medicine –Bernice Doove 12 september 2016
Faculty name 19
MOM PCHC ‘toolkit’ of instruments
!
COLLABORATION
01-03-10
CBCL SF-36 NOSIK
Parent
PEDS SNEL SDQ
Competence
Participation Life events
Nurture Health Life events
TRF
Kindergarden/ ( pre) school
Preventive Child Health Care
Parental, Environmental + Child developmental factors PEDS-score, Risk- and protective factors/CAP-J
! STEP + interventions
PEDS SNEL SDQ
FHML –Social Medicine –Bernice Doove 12 september 2016
58 Pre-school 46 Day-care
33 Preventive Child Health
Care professionals
347 children
Faculty name 20
Developmental pathways impacting school readiness
1. What is the predictive value of multi-informant perceived concerns in the preschool period at the age of 3 to 6 years in relation to school readiness?
2. What parental and environmental factors are most strongly associated with school readiness at the age of 3 to 6 years?
1. To what extent is the level of school readiness predicted by childhood developmental and environmental factors?
2. Can the outcomes of the MOM study be translated to the practice of monitoring and multi-screening in PCHC?
Faculty name 21
MOM articles
• School readiness from the perspective of personalized child health care
• B.M. Doove, MD , M. Drukker, PhD, F.J.M. Feron, MD PhD , J. van Os, MD PhD
• Validation of short instruments for personalized preventive child health care
• B.M. Doove, MD, J.E.R. Feron, MD, F.J.M. Feron, MD PhD, J. van Os, MD PhD, M. Drukker, PhD .
• Early life stress and social participation • B.M. Doove, MD, B.A.A.H. Schiffelers, MD, C. Lukkien, MD, M. Drukker, PhD, J. van Os, MD PhD, F.J.M. Feron, MD PhD
• Language and communication
• Developmental D-score
• Prevention of child abuse
FHML –Social Medicine –Bernice Doove 12 september 2016
Faculty name 22
In een buurt, achter de voordeur
150 kinderen < 4 jaar
146 kinderen uit 128 gezinnen
12% instabiele opvoedingskwaliteiten
50% heeft ouder(s) met persoonlijke problemen
9% ontoereikend sociaal netwerk
etc..
27% leeft in risicovolle omstandigheden
‘Buurt nr 658’: De brede opvoedingscontext in 2010…..
1100 kinderen: 10 % heeft problemen op 3 of meer leefgebieden
FHML –Social Medicine –Bernice Doove 12 september 2016
Faculty name 23 FHML –Social Medicine –Bernice Doove
Academische Werkplaats Publieke Gezondheid Limburg
Promoting physical and mental fitness: Evidence into practice and practice into evidence:
closing the circle ….....
Onvoldoende randvoorwaarden Attachment/hechting!?
Visionair beleid!?
12 september 2016
Faculty name 24 FHML –Social Medicine –Bernice Doove 12 september 2016
Niet nog meer van hetzelfde maar anders…
& MOM
Faculty name 25
Hechting prakijk, beleid en onderzoek?
• Positief aansluiten?
• Voorspelbaarheid door ritme en structuur?
• Comfortzone? omgaan met stress en prikkels?
• Betrokkenheid en inlevingsvermogen? Goed ‘lezen’ en er naar handelen?
• Voldoende balans?
Zone van de naaste ontwikkeling
Resilience / Weerbaarheid
FHML –Social Medicine –Bernice Doove 12 september 2016
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