The Child with Special Health Care Needs: A Comparison Between the UK and Finland - Essay Example

 social care: the Child with Special health care Needs A Comparison Between the UK and Finland 1.0 INTRODUCTION The family is the primary growing environment for children and remains the most important care provider, welfare state policies can only support and supplement the family’s efforts to generate desired social and economic outcomes (Bettio & Plantenga, 2004). A measure of the goodness of a society is how well it cares for its children. This standard has particular importance for vulnerable groups of children, such as those facing special health challenges. Thus, the level of care that children with special needs receive could be seen as a critical marker of the success of the nations’ health programs. Most comparison studies focus on social security systems, risks covered, structure of entitlements, and the effects such systems have on income redistribution (Daly, 1997). Diversification of family forms; demographic change and rising employment rates of women; the rising rates of divorce and single parenthood; and dual career families, impact the child care needs outside the family and the ability of the state to provide this has led to a revaluation of state policies with the aim to establish a new balance between the different providers of care: the family, the market and the state (Bettio & Plantenga, 2004). This essay reviews the social and medical care systems that characterise practice in the UK and Finland as applying to children with special health care needs, the types of publicly funded programs that serve them in two different countries, and the challenges involved with providing them with quality health care. 2.0 Parameters of Study 2.1 Selection of Care Area Several EU member countries had begun to deal with the issue of child care in the 1960’s and 1970’s; however, very little attention was given to this area as priorities lay elsewhere. Priority matters that concerned governments were in generating a system that ensured equal pay, equal treatment in employment, social security. The lack of equality was marked down to the lack of facilities (Ross, 2001). However, the next two decades saw a gradual shift toward care of children and the elderly. Emphasis has to be laid on care provision for children since it is they who will form the workforce of tomorrow and are vital for the nation has to remain competitive globally. The young children with special health care needs add to the challenge that governments face in social care programs. 2.2 Selection of Countries for Comparison In Europe three models of child care provision can be identified: 1. The neo-familialist model adopted by Finland and France bases itself on a conservative view of gender difference. This model offers a choice to women to opt between a temporary housewife-mother role and participation in the workforce – as different from a choice between different forms of non-parental care. 2. The ‘Third Way’ design is followed by the UK and Holland. It finds its basis on gender equality and focuses on public support. However, complete gender equality is not assured and the emphasis remains on the mother’s role as the primary caregiver (Lewis, 2001). 3. The egalitarian model that the Danish and Swedish states follow. In this system total gender equality is assured and the responsibility for care provision rests equally between the parents. These are reflective of the models suggested as the post war norm by Nancy Fraser (1997). Fraser suggested three models; the universal breadwinner model; the caregiver parity model (similar to the neo-familialist model); and, the universal caregiver model. The topology of Esping-Andersen is used to identify the two countries for comparison. Finland may be described as a social democratic regime where the role of the family is marginal, so also the role of the market and care is a central state issue. On the other hand the UK is a conservative regime gradually transiting to the liberal topology. Here the role of the family is central to care provision and the role of the state moving from being subsidiary to becoming marginal. 3.0 SECTION 2 - Data and Information Care for the children with special health needs may consist of a combination of the following: Basic Care: In home parental or societal care provided by the family, and society (public provision of health care and social service. Primary Care Providers (Medical Home): where health care services are "accessible, family-centred, continuous, comprehensive, coordinated, compassionate, and culturally competent" (Szilyagi, 2003). A medical home is not a specific site, but rather a comprehensive approach to providing optimal health care in partnership with children and their parents. Providers at the medical home assist children and families in obtaining comprehensive and other educational and community-based services. Community-Based and Ancillary Providers: including a wide range of allied health services such as nursing, physical and occupational therapy, speech and developmental supports, and durable medical equipment. In addition, many such children have special educational needs, and school-based providers become exceedingly important (Zeira et al. 2007). Often these services are not handled through the health care system. Safety Net Providers: A range of academic medical centres, neighbourhood health centres, public health clinics, school-based health centres, and other organisations: For service delivery to be effective in any of these forms it has to be accessible, comprehensive, coordinated (between family centred service, medical help, school etc.), compassionate, unbiased and culturally effective. Continuity and coordination of care is of vital importance (Drolet et al., 2006). 3.1 Basic Care The two nations come from unique histories and have differing and evolving socio-political philosophies that guide overall social service provision. The areas of convergence and difference in the provision of social service, as they apply to young children, are highlighted below: Finland operates on a Nordic model of universalism under which the government is expected to provide the same level of public service to all citizens. The UK government sees a more limited role in provision of public social service. It does offer some universalised services, such as a national health care system, paid family leave benefit and public education. Finland supports high-quality early learning and constantly works to improve the available services and benefits. Early learning has become a priority in the UK only in the last decade and the government has instituted national initiatives to extend high-quality programs to at-risk children throughout the country. Young children in both nations are cared for in a similar setting consisting of: parental care, family and neighbour care, nannies, public childcare centres, private childcare centres, family-home care, and preschool. In both countries children, are guaranteed some amount of public-funded early learning services. All three and four year old British children are entitled to 15 hours of free education per week. Finnish children have the right to low-cost all-day and extended-day placement in municipal day care. Unlike in the UK, the majority of all child care in Finland is public or publicly funded. In 1998, England initiated ‘Sure Start’, a national program that provides child care, health care, parenting assistance and information to all children under four and their parents in targeted low-income areas. Both the UK and Finland offer extensive and generous parental leave; Finland provides paid maternity, parental, paternity, and care leaves that subsidize parental care of children from birth though age 3. The UK grants paid maternity, paternity, and parental leaves that extend though the child’s first year, plus an additional 13 weeks to be taken before the child is five years old. Both countries provide benefits in the form of tax-exempt monetary grants. The payments are made to families regardless of income and the total amount depends only on the number of children in the family, though single parents in Finland receive an additional monthly supplement. Mothers in the UK who are personally responsible for child care also have the right to request flexible working hours from their employers. In Finland parents pay only 15% of the cost of early education and care, representing 4% of median household income, whereas parents in the UK pay 45% which represents 20%. The balance being borne by the government or business. Finland spends 1.3% of its GDP on early education and care services, compared to roughly a half a percent for UK. Both the UK and Finland require good training for members of the childcare and early learning workforce. In Finland, 1/3rd of childcare centre teachers have post-secondary degrees and in the UK all nursery school teachers are required to have a university degree. In Finland, wages are more equitable and the average childcare centre teachers earn only slightly less than primary school teachers and professional nurses. 3.2 Primary and Secondary Care Current trends in the United Kingdom suggest that the basic organisational structure of the primary care system and those of Finland are on a course of convergence. One such trend is the shift toward increased central management and integration of providers. The differences in the existing system and similarities are discussed below: In Finland the national government is responsible for funding and cross-regional coordination; most of the financing and control is decentralized to the community level. Physicians and administrators usually play an important role in day-to-day management of delivery organizations, but locally elected citizens maintain ultimate control. In Finland most aspects of primary care system governance are highly decentralized, with elected local community members responsible for their areas. In Finland, local communities also control the hospitals, but where population size does not warrant a dedicated facility, multi-area collectives have been formed. In the United Kingdom, the National Health Service (NHS) is centralized, with funding and control emanating almost entirely from the national government. Day-to-day management is decentralized to a network of 17 regions. Hospitals and the "community nursing" component of the primary care system are administered through this "district authority" hierarchy. General practitioners (GPs) are considered independent providers, and are paid and monitored through a separate network of 98 Family Practice Committees. Organizationally Finland has similar primary care delivery systems as Britain. In Finland, the majority of primary care is provided by physicians, nurses, and other practitioners who are salaried and work in government health centres. In Britain, almost all primary care is provided by self-employed physicians who contract with the government to care for patients who appear on their list. In Britain, community-based primary care nurses are employed directly by government, whereas, in Finland the employer is the local community. In both countries specialist care is delivered mostly by hospital based physicians who are salaried government employees. The primary and secondary care systems are quite distinct; with few exceptions, only hospital-based specialists can admit patients to acute care facilities. In each of the countries patients may seek care from private specialists, many of whom are government-employed physicians seeing patients after their work hours. 4.0 DISCUSSION Parenting is defined as the ability of the caregiver to provide an environment that promotes the optimum growth and development of another human (Pressler 1990). Growth and development of a child would encompass health, education, emotional and behavioural development, Identity, family and social relationships, social presentation and self care skills. These needs can be met through a continuum of basic care, ensured safety, emotional warmth, stimulation, guidance and boundaries and stability (Land, 2002). Most of the intervention research in the acute care setting has focused on parental presence, parental participation in care giving, or parental support (Palmer 1993) Family-centred services culture at the centre/ organization was also positively associated with parent satisfaction (Law et al. 2003). While parents may be supported through childcare allowances and other incentives but the ultimate responsibility remains theirs. In some countries policies may focus more on providing substitutes for family care rather than supporting the parents (Gornick, Meyers and Ross, 1997). Szilyagi (2003) profiles the needs and characteristics of children with special needs they are more likely to be over age three, white, and living with parents having low income and education levels; are likely to have poorer health; have higher rate of unmet health care needs; use more time and services of health care providers and spend more time in bed and higher absence from school; many require high-technology and specialised service; are more likely to have multiple and chronic health problems; and also have developmental, social and behavioural problems. The main strategy for providing service to children in care would essentially begin with family-centred care or family centred services (Callery & Franck, 2004). This is based on the current view that involvement of the family is essential to the humane healthcare of children in hospital and community settings (Ahmann 1994; Bond et al. 1994). Family centred services are the first option service delivery for children with disabilities. Family-centred care and service need to target: parental participation in children’s healthcare; partnership and collaboration between the healthcare team and parents in decision-making; family friendly hospital environments that normalize as much as possible family functioning within the healthcare setting; and care of family members as well as of children. During the process of identification of need and treatment tensions between the interests of children and other family members may arise. These are reflected in the emerging National Service Framework for children. The Standard for Hospital Services appeals for pathways of care to be built around the child and family, seeing services through their eyes (Department of Health, 2003). In some cases children may be best placed to identify their own objectives, for example, the National Service Framework suggests that disabled children and those with long-term conditions can help to plan their own treatment goals (Department of Health 2003; Eydal & Satka, 2006). Parents do have privileged knowledge of their children, particularly changes in behaviour that vary from the norm for their children. However, differences in reports of symptoms and quality of life by children and parents (Manne et al. 1992) suggest that parents may not be best placed to assess symptoms and quality of life from their children’s point of view. Therefore, it cannot be assumed that children’s perspectives about the objectives and preferred methods of healthcare are the same as their parents and therefore the need for skilled intervention becomes essential to determine a path of care provision that meets the goals of the child and is satisfactory for the parents as well. Some of the problems faced by the providers of social and medical help to children in care that are affecting the quality of care in the UK are: 1. The recruitment and retention of social care staff, which could provide quality assessments and interventions, is a well known concern. The case load of the existing mangers is so heavy that they do not have time for more direct work with children. The need is to make the profession more attractive. Foster Care Minimum Standards in England; published in 2002 (Department of Health 2002), bring the independent sector under the same regulatory framework as the state sector. Retention is the second problem with a number of in-house carers being poached by the private care providers. Finland on the other hand, has no such problem for the skills available are adequate and wages commensurate. Private sector openings are extremely limited. 2. There is concern about the availability of mental health services for children and young people, which may also be a cause of the lack of continuity and stability in care provision. The limited evidence that could be gathered also indicates the lack of stability in care in the UK; with the child being moved from one facility and from one carer to another with routine frequency. Several research studies have confirmed that there are high levels of emotional and behavioural problems amongst looked after children (Quinton et al. 1998; Minnis & Del Priori 2001). The existence of such problems is partly associated with placement disruption (Jackson & Thomas 1999). Unfortunately, there appears to be a widespread gap between need and availability of services for children with special health needs as well as emotional and behavioural difficulties. In Finland, social workers have more than 100 years of practice with various silent groups throughout society. They have developed methods ranging from radical community work to individual casework. Therefore, we believe that social workers have the means to construct innovative tools and appropriate theoretical knowledge to enable such a development. Through their close encounters with children as clients, social workers have a unique opportunity and ethical duty to work towards the realisation of children's rights (Eydal & Satka, 2006). In Finland the right to education is extended to the youngest children. The result is a continuum of parental leave, child care, pre-kindergarten, including the integration of pre-kindergarten into child care, and then into elementary school. Parents are the decision-makers as to the type of care received and when the transitions are made. Moreover, the implementation details emanate from the local municipalities. So local control and parental decision-making are at the heart of the Finnish system. Dropping fertility rates and population decline is a cause of major concern. One of the reasons for this is the increasing participation of women in the labour force more than 90 percent women in the age group of 20-40 are a part of the work force. Therefore, the Finnish government and society have established an extensive and comprehensive system to take care of children. Access and quality of care are both in focus and welfare state redesign includes the reconfiguration of both public and private responsibilities for the financing and provision of child care (Michel & Mahon, 2002). Lower birth rates and increasing life expectancy are bound to put pressures on the care provision in opposite directions. While lower birth rates will help decrease financial needs for child care provision the care provision for the frail and elderly is likely to become an increasing pressure on resources. It is “economically feasible to achieve a more egalitarian socio-economic order than the Third Way admits, but it will only be possible politically if the accepted ‘design for community living’ hews to a radical vision of equality such as that which inspires Fraser’s universal caregiver model” (Mahon, ibid). References: Ahmann, E. (1994): Family-centred care. Pediatric Nursing, 20, 113–117 Bettio, F. and Plantenga, J. (2004): Comparing Care Regimes in Europe, Feminist Economics 10(1), March 2004, p. 85-113 Bond, N., Phillips, P. & Rollins, J. (1994): Family centred care at home for families with children who are technology dependant. Pediatric Nursing, 20, 123–130 Callery, P. and Franck, L.S. 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(1992): Assessment of acute pediatric pain: do child self report, parent ratings, and nurse ratings measure the same phenomenon? Pain, 48, 45–52. Minnis, H. & Del Priori, C. (2001): Mental health services for looked after children: Implications from two studies. Adoption and Fostering, 25, 27–38. Pressler, J. L. (1990): Promoting attachment. In: Nursing Interventions for Infants and Children (eds. M. Craft & J. Denehy), pp. 4–17. W.B. Saunders, Philadelphia, USA Palmer, S. J. (1993) Care of sick children by parents: a meaningful role. Journal of Advanced Nursing, 18, 185–191 Quinton, D., Rushton, A., Dance, C. & Mayes, D. (1998): Joining New Families: A Study of Adoption and Fostering in Middle Childhood. John Wiley, Chichester. Ross, G. (2001): Europe: An Actor without a Role. In: Who Cares? Women, Work and Welfare State Redesign, Jenson, J. and Sineau eds. University of Toronto Press, Toronto Szilagyi, P.G. (2003): Care of Children with Special Health Care Needs, The Future of Children, Vol. 13, No. 1, 136-151 Zeira, A.; Canali, C.; Vecchiato, T.; Jergeby, U.; Thoburn, J and Neve, E. (2007): Evidence-based social work practice with children and families: a cross national perspective. European Journal of Social Work, Published on 12 November 2007 Read More