Komt een kind bij een dokter

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1 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 The MOM study 12 September 2016

2 Komt een kind bij een jeugdarts Wat heeft dit kind eraan? Vroegsignalering ontwikkelingsproblemen Public health personalized health care The MOM study Academische Werkplaats Publieke Gezondheid Limburg Promoting physical and mental fitness: Evidence into practice and practice into evidence: closing the circle?...attachment!? Faculty name FHML Social Medicine Bernice Doove 2 12 september 2016

3 Maatschappelijke context Psychosociale problemen Overgewicht / obesitas Onveilige omgeving Middelengebruik / verslaving Chronische ziekten NRC 3 dec 2013: Meer kinderen groeien arm op Bron: Armoede signalement 2013 CBS-SCP Kinderen In Tel 2014 Faculty name 3 FHML Social Medicine Bernice Doove 12 september 2016

4 Infant Welfare Centre Preventie Centrum voor Jeugd en Gezin Couleur locale Faculty name FHML Social Medicine Bernice Doove 4 12 september 2016

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 Faculty name 5 FHML Social Medicine Bernice Doove 12 september 2016

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 The MOM study Monitoring Outcome Measurements of child development Monitoring Ontwikkeling kinderen in Maastricht en Heuvelland Faculty name 6 FHML Social Medicine Bernice Doove 12 september 2016

7 The MOM study Sept 09 Sept 11 Bridging the gap.. Theoretical framework Instruments PEDS Pilot +Research License Competention Stakeholders Convenant Workshop Training Pilots Subsidie Application T1 T2 T3 Competent On track At risk Not on track Not competent 3 4 5/6 Age PEDS Parents Evaluation of Developmental Status + VAS Risk and protective factors Succesful social participation + Life long learning Faculty name 7 FHML Social Medicine Bernice Doove 12 september

8 Unieke interactie biologisch genetische kwetsbaarheid omgeving Rutter M. Resilience as a dynamic concept. Dev Psychopathol. 2012;24(2): Faculty name FHML Social Medicine Bernice Doove 8 12 september 2016

9 Growing into deficit? diagnose! 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 Faculty name FHML Social Medicine Bernice Doove 9 12 september 2016

10 Participatory Child Health Care Symptomen & lijdensdruk?! 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 Faculty name FHML Social Medicine Bernice Doove september 2016

11 Preventive Predictive Child Health Care Hielprik Family History! 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 Faculty name FHML Social Medicine Bernice Doove september 2016

12 Diathesis-stressmodel Personalized PCHC Early life stress! 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 Faculty name FHML Social Medicine Bernice Doove september 2016

13 Goodness of fit environment? De relatie is de patient Attachment Preschool Mental Health Faculty name FHML Social Medicine Bernice Doove september 2016

14 Dynamic life course perspective Shifts in the child shifts in the environment + representation contextual personal regulation Sameroff, A. A unified Theory of Development: A Dialectic Integration of Nature and Nurture. Child Development, January/February 2010, Volume 81, number 1, pages Faculty name FHML Social Medicine Bernice Doove september 2016

15 Schoolreadiness: a dynamic outcome of preschool health/participation Transition home stage - elementary stage Shifts in the child shifts in the environment Sameroff, A. A unified Theory of Development: A Dialectic Integration of Nature and Nurture. Child Development, January/February 2010, Volume 81, number 1, pages Faculty name FHML Social Medicine Bernice Doove september 2016

16 ICF International Classification of Functioning, Disability and Health Theoretical framework of health related functioning Symptoms, concerns, distress Schoolreadiness Faculty name 16 FHML Social Medicine Bernice Doove 12 september 2016

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 Faculty name 17 FHML Social Medicine Bernice Doove 12 september 2016

18 MOM PCHC toolkit of instruments Parent Kindergarden/ ( pre) school PEDS SNEL SDQ Nurture Health Life events CBCL SF-36 NOSIK PEDS SNEL SDQ Competence Participation Life events TRF Preventive Child Health Care Parental, Environmental + Child developmental factors PEDS-score, Risk- and protective factors/cap-j! STEP + interventions ! Faculty name 18 FHML Social Medicine Bernice Doove 12 september 2016

19 MOM PCHC toolkit of instruments Parent 347 children PEDS SNEL SDQ Nurture Health Life events CBCL SF-36 NOSIK 58 Pre-school 46 Day-care Kindergarden/ ( pre) school PEDS SNEL SDQ Competence Participation Life events TRF Preventive Child Health Care Preventive Child Health Parental, Environmental + Child Care developmental professionals factors PEDS-score, Risk- and protective factors/cap-j! STEP + interventions ! Faculty name 19 FHML Social Medicine Bernice Doove 12 september 2016

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 20

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 Faculty name 21 FHML Social Medicine Bernice Doove 12 september 2016

22 In een buurt, achter de voordeur Buurt nr 658 : De brede opvoedingscontext in kinderen < 4 jaar 146 kinderen uit 128 gezinnen 12% instabiele opvoedingskwaliteiten 50% heeft ouder(s) met persoonlijke problemen 9% ontoereikend sociaal netwerk etc kinderen: 10 % heeft problemen op 3 of meer leefgebieden 27% leeft in risicovolle omstandigheden Faculty name 22 FHML Social Medicine Bernice Doove 12 september 2016

23 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!? Faculty name FHML Social Medicine Bernice Doove september 2016

24 Niet nog meer van hetzelfde maar anders & MOM Faculty name 24 FHML Social Medicine Bernice Doove 12 september 2016

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 Faculty name 25 FHML Social Medicine Bernice Doove 12 september 2016