Abstract
This study examined the relationship between health conditions and poverty. The study groups were selected by the community team according to their own perception of the poverty condition. Totally 458 children from 4 provinces, namely Bangkok, Samut Sakron, Samut Prakan and Nakhon Pathom, were enrolled. The study revealed that children living in low income families (< 3000 baht per person per month), in severe deprived families (deprivation index ≥4 in 9 factors), and in dysfunctional families (family dysfunction index ≥2 in 5) were associated with poor parenting leading to unmet health needs (poor grade care profiles ≥2 in 6 categories). Low income families (< 3000 baht per person per month) increased risk 2.4 times. Severe deprived families (deprivation index ≥4 in 9 factors) increased risk 1.8 times and dysfunctional families (family dysfunction index ≥2 in 5) increased risk 2.6 times. We grouped all children with family dysfunction index ≥2 and those with the combination of low income index and multiple deprivation index together as a high risk group. It was found that this group had three times more risk than those with a low risk group (the group of children with family dysfunction index <2, without or only one index of low income and deprivation family). This study developed the Integrated Health – Learning – Protection team (H-L-P team) to promote the well-being of poor children. This community based team composed of the community leaders, child care providers, health care volunteers and community development volunteer. Totally the 39 H-L-P teams were developed in 4 provinces. The integrated team has been trained in programs for building newborn childcare skills and enhancing health and promoting early childhood learning for the community, caring for a child who has had an adverse childhood experiences, children's rights and how to protect them, and how to refer for help. This training give staff members confidence in assessing and promoting poor children's health before visiting areas of their responsibility. A health promotion model for poor and needy children was developed by the H-L-P team, which consisted of 4 steps: 1) Identify the complex health and development problems by the home visit program 2) Action planning by the various members of the H-L-P team 3) Assisted operations by members of the integration team each side and connect relevant local or state departments in each area, including education and advice to empower the families. 4) Evaluation by the model development team in cooperation with the integrated health team. A total of 101 cases in the high-risk groups were followed up by the H-L-P team. It was found that only 38% of children in this high-risk group were enrolled in the government's cash transfer program for children in poor families (600 baht per month until the age of 6 years). 69 % of the high-risk groups experienced the poor parenting leading to unmet health needs (poor grade care profiles ≥2 in 6 categories). 73% were not receiving adequate emotional care, with either neglect or emotional and physical abuse. 65% had to live in the single, divorced, or separated families. 55 % experienced the domestic violence. 26 % were in families with drug abuse or drug trafficked. 31 % were in the incarcerated families. 24% had developmental delays and 9% had a severe development Even though the children were in an extremely poor, deprived, and low potential family, 64% of them were still raised by their own family without using the community early childhood learning and care services in any way. The assessment of the H-L-P team by the model development team found that the factors that promote the team's work were the specific knowledge and skill training program for the different work of the member in the team and getting them to know each other. Each member in the H-L-P team had different strengths. The child care provider had a strong role in finding vulnerable children and promoting cognitive development, learning and mental well-being of children. Public Health Volunteers strength was the expertise in home visits. This allowed children to be continuously monitored for health problems. The social development and human security volunteers (NGOs) or the community leaders had a strength to make it easy for children to have access to those welfare system. At least 2 home visitation sessions will see a positive change in results. The professional teams such as health workers, psychologists, social workers, occupational therapist, child protector, supplementing the H-L-P team in some home visits was a great addition, and might get the better results for the high-risk groups. Encouraging caregivers to enjoy giving closed supervision for children, being interest in stimulating the learning skill for children was easily starting by introducing them for the program of making-toy-yourself, practicing playing with children, practicing storytelling, supporting toys and some books as a starting point. Supporting the ongoing work processes of the the H-L-P team with the systematic quality improvement process (PDCA cycle) will enable the poor children and their families to receive real and sustainable assistance. Tackling the child in poverty and family dysfunction must be supported by a public and local policy that had an extensive understanding and practice. The power of community volunteer, in conjunction with various community based health centers and early childhood development centers, was a complementary force that was an important community capital. In caring for these vulnerable children, we need to expand our results to policy by: 1. Promote public and local support policies in establishing the H-L-P integrated team for early childhood development and protection and implementing screening mechanisms for high-risk groups with an intensive home visit for this group as a key of success. 2. Promote the investment for more physical structures related to early childhood learning and care for children in poor families and dysfunctional family to cover all early childhood age groups from birth to 6-8 years. 3. Driving innovation of early childhood education and care such as tools, process manuals, training courses to create knowledge, awareness, care and protection skills for poor children and children in adversity. Those innovations were needed for the child care-takers, community administrators, community volunteers, child care providers in nursery-daycare center kindergarten school, or other community based health centers or development learning centers established for early childhood or families. 4. Currently, early childhood development centers are systematically established in most communities. It must be the central network of the H-L-P integrated teams to work with poor children in the communities. This should be supported and invested by both local and national policy.
