Child Welfare Research Articles

Effect of problem‐solving training for mothers of children with special needs: A randomised controlled study

AbstractThis study investigates the effect of problem‐solving training on the interpersonal problem‐solving skills of mothers of children with special needs. The parallel randomised controlled trial was conducted between August 2021 and March 2022. A priori power analysis was conducted, and 98 mothers who met the inclusion criteria were included in the study. The analysis indicated that a sample size of 39 participants per group was required. Data were collected using a personal information form and the Interpersonal Problem Solving Inventory. The mothers were divided into control and experimental groups. The participants in the experimental group were given a problem‐solving training program, while the control group was not exposed to any intervention. There was no significant difference in the pre‐training test scores for any of the dimensions (p > 0.05). However, the post‐training test scores in the experimental group were significantly higher than post‐training test scores in the control group (p < 0.05). There were significant differences between the pre‐training and post‐training test scores in the experimental group (p < 0.05). Interpersonal problem‐solving skills can be improved by providing problem‐solving training to the mothers of children with special needs. Based on the findings of this study, it is recommended that psychiatric nurses provide training to protect and improve the wellbeing of children with special needs and their families.

Children, Border(land)s and mixed economies of welfare

This special issue is a comprehensive exploration of the pivotal role of state borders in shaping child welfare in various European borderlands from the First World War to the present. The richly detailed articles present a diverse range of historical and social-scientific perspectives, offering a comprehensive understanding of the complex dynamics at play. Each case study sheds light on a unique aspect of the mixed economies of welfare in borderland areas, collectively proposing a framework for analysing the intricate influence of welfare providers on children’s well-being in the intermediary spaces.

Understanding caregivers' needs: supporting families of autistic children

Parenting a child with autism spectrum disorder (ASD) poses significant emotional, financial, and social challenges to caregivers. This paper examines the experiences of caregivers, highlighting their increased stress, burnout, and mental health concerns. The importance of accessible information resources, respite care services, emotional support networks, and financial assistance programs is emphasized. Effective strategies for supporting caregivers include educating them about ASD symptoms, treatments, and therapies, teaching coping mechanisms for managing challenging behaviors, and promoting collaboration between healthcare providers and caregivers. Policy implications are discussed, including advocating for legislative modifications that prioritize caregiver needs, promoting inclusionary practices within educational systems, and increasing funding for early intervention programs and caregiver support services. The implementation of parent training programs, collaborative relationships between educators and caregivers, and professional development opportunities for educators are also recommended. This study aims to inform policymakers, healthcare professionals, and educators about the critical role of caregiver support in improving outcomes for children with ASD. By addressing caregiver needs and providing comprehensive support, we can enhance the well-being of both caregivers and children with ASD.

SENSORY-FOCUSED FOOTWEAR DESIGN: MERGING ART AND WELL-BEING FOR INDIVIDUALS WITH AUTISM

The application of art in footwear design presents a unique opportunity to enhance the well-being of children and adults with autism by incorporating controlled sensory stimuli. This approach integrates natural elements—like trees, flowers, and serene colors—into shoes, creating a calming sensory experience. Colors such as blue, green, and lilac are strategically chosen for their soothing effects, fostering emotional stability and reducing stress. Research indicates that these hues promote relaxation, with blue associated with tranquility, green symbolizing nature, and lilac evoking spirituality. The texture of the footwear plays a crucial role as well, incorporating raised patterns inspired by natural forms to provide subtle, relaxing tactile stimulation. This allows for pleasant sensory interaction, particularly for individuals sensitive to excessive stimuli. Comfort is further enhanced by the inclusion of soft, non-slip insoles that distribute weight evenly and ensure safety, especially in environments where slips may occur. Recent studies reinforce the importance of creating environments that promote calm and comfort, highlighting innovative solutions that improve quality of life for individuals with sensory challenges. The design of therapeutic gardens and the development of responsive smart clothing illustrate a growing recognition of the benefits of integrating art and nature into everyday experiences. Overall, this focus on empathetic and inclusive design reflects a societal shift toward understanding and addressing the unique needs of those with autism. By prioritizing sensory-friendly features in everyday products, the integration of art into footwear not only enhances aesthetic value but also contributes significantly to emotional and physical well-being, creating a more inclusive world.

Child Rights, Abuse and Mitigating Options in Nollywood Films: A Study of <i>Wives on Strike</i> and <i>Itoro</i>

Child rights are those fundamental privileges that contribute to the overall development of children in society. The increasing rate of child abuse impinges on the rights of children resulting in numerous negative effects that are harmful to their growth and well-being. Although some Nollywood films portray the problem of child abuse in society, not much has been done to examine the rights of children and how these rights are violated as a result of cultural and social factors that condition the well-being of children. The study examined the representation of child rights, abuse and mitigating options in Omoni Oboli’s <i>Wives on Strike</i> (2016) and Precious Adeyemi’s <i>Itoro</i> (2017). These Nollywood films were selected through a purposive sampling technique because the have thematic importance relevant to the problem of the study. James Garbarino’s Social Habitability theory was adopted as the theoretical framework for the study. Findings revealed that child labour and marriage are dominant abuses of children and teenagers in Nigeria with adverse consequences on their development. It also revealed that the girl child is at the greatest risk of abuse due to cultural and social factors. The study recommended further exposition of this crime, especially other forms of child abuse by Nollywood film practitioners to mitigate its scourge because the future of every nation depends on children.

The Impact of Foster Care on Child Development: The Role of Sibling Separation

This paper explores the impact of sibling relationships on children’s development within the foster care system, focusing particularly on how sibling separation affects children of different ages emotionally, cognitively, and socially. To address this, the study synthesizes existing literature and theoretical models by combining the developmental stages of children with the role of siblings in child development. Findings reveal that sibling separation at different ages leads to distinct developmental challenges: infants experience severe disruptions in attachment and emotional regulation, middle childhood separations hinder cognitive and social skills development, and adolescent separations result in long-term relational and identity challenges. Previous research underscores the importance of maintaining sibling bonds in foster care, highlighting that these relationships can provide crucial emotional support and stability, mitigating the adverse effects of family disruptions. This study emphasizes the necessity for age-appropriate actions and support services in foster care to minimize the detrimental impacts of sibling separation and promote healthy development. Additionally, it calls for further longitudinal studies to track the developmental trajectories of children separated from their siblings and consider variables such as age differences between siblings and the dynamics of step-sibling relationships. This comprehensive understanding is essential for informing policies and practices that enhance the well-being of children in foster care.

Autism Spectrum Disorder in Children: Early Signs and Therapeutic Interventions

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by challenges in communication, social interaction difficulties, and repetitive behaviors that can hinder a child’s development. The growing prevalence of autism necessitates early detection and effective intervention strategies. This review summarizes the current knowledge of early indicators of ASD, including brain development markers and behavioral signs visible in infants. It investigates diagnostic processes, emphasizing the importance of timely detection at 18 to 24 months using established screening tools. We discuss a variety of therapeutic approaches, including behavioral interventions, educational strategies such as music therapy, and technological advancements such as speech-generating devices. Furthermore, we investigate pharmacological options for treating associated symptoms, emphasizing the lack of targeted medications for core ASD symptoms. Finally, we present evidence highlighting the positive effects of early intervention on developmental outcomes, advocating for individualized treatment plans to enhance the well-being of children with ASD. This comprehensive overview aims to inform ongoing ASD research and clinical practices.

The Icehearts Europe Implementation Guide to promote a mentoring programme for youth mental health

Abstract Issue/problem In Europe, 9 million young people (10-19) suffer from mental disorders and 70% of children and adolescents with mental health problems do not receive appropriate interventions at a sufficiently early age. Moreover, during the Covid-19 pandemic a high prevalence of depressive symptoms, anxiety and sleep disorders was observed in the population aged 4-19 years. The Icehearts Europe project (funding: EU4Health 2022 Programme) aims to disseminate at EU level a long-term programme for supporting health and wellbeing of disadvantaged children and adolescents. It is inspired by the Finnish best practice Icehearts, a 12-year long mentoring programme. Five pilot countries (Italy, Denmark, Spain, Slovenia, Estonia) will test the model to raise European awareness of how it works and to get more countries and organisations involved. Description of the problem Icehearts Europe is a preventive mentoring programme based on team sports, recreation and school support activities, with a child-centred community approach. To facilitate its implementation, a practical guide has been developed for grassroots sport and social promotion organisations to help them implement the model in their own contexts. The guide is the result of both a multisectoral cooperation between grassroots sport, health, universities, NGOs, and qualitative study activities (bibliographic research, study visit, group work, analysis of the situation and needs of local contexts). Results From February 2024 the Icehearts Europe Implementation Guide is available in six languages at https://www.icehearts.eu/resources. It is now being adapted by the Icehearts Europe partners into an online training programme for managers. Lessons The guide has incorporated lessons learnt from the Finnish model, considered as an evidence-based approach. It contains several operational tools to implement Icehearts Europe and can be adopted using different approaches: there is no one-size-fits-all solution. Key messages • Developed as a support to the Icehearts Europe piloting partners and as a basis for a fully-fledged online training programme for future Icehearts Europe managers. • To facilitate the implementation of early interventions to promote health and wellbeing of children and adolescents and enable them to cope with disadvantaged conditions.

The influence of post-traumatic stress on the intention to leave among Korean child welfare workers

Abstract Background and aims Previous research have highlighted the challenges faced by social workers who are exposed to traumatic events, such as client violence, and vicarious traumas. These experiences often lead social workers to leave their agencies. However, it is commonly assumed that child welfare workers are immune to such experiences as they primarily work with non-violent children. This study aims to investigate whether post-traumatic stress among Korean child welfare workers influences their intention to leave, and whether peer support and organizational culture mediate this relationship. Methods A total of 246 participants were recruited in 2021 through purposive sampling. Due to the ongoing Covid-19 pandemic, a self-administered online survey method was employed. Only workers who reported direct and/or indirect traumatic experiences at their workplaces were included in the final analysis. Structural equation modeling was utilized to examine the relationships among variables in this study. Results While organizational culture had a partial mediating effect in the relationship between post-traumatic stress and intention to leave, peer support did not show a significant effect. This suggests that fostering a supportive organizational climate may be crucial in reducing work-related stress, including post-traumatic stress. It also highlights the need for social work administrators to actively promote such climates to prevent turnover within the child welfare workforce. Discussion and conclusions The findings of this study suggests that child welfare organizations can take proactive measures to address this issue. Creating a supportive organizational culture that fosters resilience and provides resources for coping with post-traumatic stress is crucial. Organizations may explore additional strategies for reducing workforce turnover, which will have negative effects on their clients and organizations as well. Key messages • Fostering a supportive organizational climate may be crucial in reducing work-related stress, including post-traumatic stress. • Child welfare organizations may explore additional strategies for reducing workforce turnover, which will have negative effects on their clients and organizations as well.

Analisis Perlindungan Hukum Terhadap Anak Korban Kekerasan Seksual di Dinas Pemberdayaan Perempuan dan Perlindungan Anak Kota Tanjungbalai

The aim of this research is to find out how the Office of Women's Empowerment and Child Protection has attempted to implement legal protection in accordance with Law Number 35 of 2014 concerning Amendments to Law Number 23 of 2002 concerning Child Protection against cases of sexual violence against children, as well as to find out efforts made by the Tanjung Balai City Women's Empowerment and Child Protection Service to help child victims of sexual violence. This research was conducted at the Women's Empowerment and Child Protection Service in Tanjungbalai City, North Sumatra. The method used in this research is a qualitative descriptive research method. The qualitative descriptive method has the main characteristics, namely conducting research involving direct involvement in the field, acting as an observer, creating categories of actors, observing phenomena, recording them in an observation book, not manipulating variables, and focusing on scientific observation. The data collection technique used to obtain data is through interviews and documentation. The results of this research found that the efforts of the Tanjung Balai City Women's Empowerment and Child Protection Department have been running optimally, in accordance with Law Number 35 of 2014 concerning Amendments to Law Number 23 of 2002 concerning Child Protection against cases of sexual violence against children. The form of legal protection used is in the form of preventive and repressive legal protection. One of the programs being implemented is synchronizing and coordinating the prevention of violence against children, which is expected to reduce the number of cases of sexual violence against children in Tajung Balai City.

Promoting Equity: Child & Adolescent Health Service

Abstract The health and well-being of children and adolescents face significant challenges, particularly in times of social instability. In response to these challenges, the Norwegian government allocated funding in 2021 to establish a national center for Child and Adolescent Health Promotion Services. Situated within the Norwegian Institute of Public Health, this center focuses on enhancing expertise, professional development, and research within municipal maternity and child health clinics, school health services, and youth health clinics. This presentation delves into the crucial role of Universal Health Promoting Services (UHPS) in mitigating the adverse effects of social inequality on child and adolescent health. By leveraging evidence-based practices and identifying knowledge gaps in health promotion and disease prevention in primary care settings, UHPS serve as catalysts for reducing health disparities and enhancing outcomes among expecting parents, children, and adolescents. Moreover, UHPS plays a vital role in addressing the underlying determinants of health inequality, including social network, lifestyle factors, promotion of health literacy and ensuring accessible health care services for all. UHPS empowers individuals and communities to actively participate in health promotion efforts, fostering a culture of health equity and resilience. Through targeted health education programs, early intervention strategies, and community empowerment initiatives the UHPS work both at a systems and individual level to address social inequality in health. This presentation contextualizes UHPS within a broader picture aimed at promoting child and adolescent health while addressing social inequality in health. By highlighting effective approaches and areas requiring further research, it aims to contribute to the ongoing discourse on optimizing health outcomes for young populations.

What challenges exist within the child welfare system in meeting the health needs of children in care?

Abstract From society’s perspective, the goal of societal care is to protect disadvantaged children and provide them with improved opportunities. In the realm of social care, the child welfare system takes the place of parental responsibilities to safeguard children’s well-being and developmental needs, including their health. However, while holding child welfare agencies responsible, national legislation often lacks specific methods for fulfilling this mandate. Over the years, evidence has shown that limited health care access and unmet health needs often endure in care. In Sweden, efforts to address the issue include mandatory health assessments upon entry into care and collaborative agreements between social services and health care sectors. However, recent studies reveal that only one-third of children undergo these assessment, and collaborative agreements remain lacking in many local authorities. This suggests that additional legal requirements do not offer a straightforward solution. Dr Forsman, with a background in social work, will discuss the child welfare system’s responsibilities and the traditional reliance on social workers and foster carers to address health needs and coordinate care. What are the underlying barriers to successful advocacy and comprehensive health care coordination within the child welfare system? How can the system better respond to the health needs of children in care?

Maternal health in conflict-affected settings: a case study from a frozen conflict zone

Abstract Background Reproductive, maternal, newborn and child health are negatively impacted in conflict-affected settings, and may be acutely affected in frozen conflicts due to fragile health systems and uncertain geopolitical contexts. To better understand maternal health in a frozen conflict zone, we examined maternal health outcomes in Nagorno-Karabakh during a ceasefire period prior to the forced displacement of the entire population. Methods Multistage cluster sampling was used to sample 1023 households in Nagorno-Karabakh during the summer of 2022. From each household, one woman, age 18 to 49, participated in an interviewer-administered survey. Maternal health outcomes were assessed among all married women who had ever given birth. Women with at least one child under 5 years were also asked about their most recent pregnancy. Results Among all married women, 85.5% had ever given birth, 19.0% ever had a miscarriage, and 2.8% ever had a stillbirth. Of the 299 women with at least one child under 5, 97.7% received antenatal care, of which 90.4% had at least 4 visits. Over half experienced toxicosis (51.8%), 16.4% high blood pressure, 13.0% anemia, and 6.4% hemorrhage during their most recent pregnancy. The most common delivery complications were uterine scarring (19.7%), breached birth (7.0%), prolonged labor (6.4%) and hemorrhage (5.7%). Age was found to be a significant factor, with the odds of toxicosis (p = 0.039) and breached birth (p = 0.009) decreasing, yet the odds of miscarriage (p = 0.001) and hypertension (p = 0.007) increasing with age. Conclusions Almost all women reported adequate antenatal care with birth outcomes comparable to global statistics, demonstrating the ability of Nagorno-Karabakh to provide sufficient maternal healthcare while in a frozen conflict. Fortifying and ensuring access to maternal and reproductive healthcare, particularly antenatal care, is vital for ensuring the health and wellbeing of women and children in conflict-affected settings. Key messages • Women in Nagorno-Karabakh received antenatal care and experienced birth outcomes similar to global rates, demonstrating the value of access to reproductive healthcare in conflict-affected settings. • Future studies should examine the impact of forced displacement on the women of Nagorno-Karabakh to better understand the effect of conflict on reproductive and maternal health.

Paid Family and Medical Leave: Policy Statement.

Paid family and medical leave (PFML) helps parents balance the competing obligations of work, personal illness, and family. PFML is needed when adding a new member of the family or when a family member or individual becomes acutely or chronically ill. The United States lacks universally available PFML, despite the benefits for child and family health and well-being. Universally available PFML is a key component of improving the health of children and families and is critically needed in the United States.

Why is regulation of the online world urgently needed to protect children’s wellbeing?

Abstract Background The online world affords children many benefits, such as connectivity and access to educational and cultural content. Simultaneously, it increases their likelihood of encountering harmful or distressing web-based content and behaviour, such as marketing for harmful products, violent or discriminatory material, and cyberbullying. Yet, there is a dearth of objective research globally on children’s real-time experiences, with current research relying on self-reports or observations made in experimental conditions. This paper reports on the nature and extent of children’s online world. Methods Kids Online Aotearoa is a cross-sectional observational study of children’s real-time experiences of the online world. A strategic sample of 180 12-year-olds from schools in the Wellington region of Aotearoa, New Zealand, used Zoom video conferencing software to record their online world for four days. Recordings were analysed manually and using AI. Results Children spend most of their time online on their phones, often using TikTok. Children spend 25 % of their online phone time gaming or watching games (game time). They encounter many gambling and gambling-like activities while doing so. Of game time, 16% of the time children are exposed to marketing. Preliminary analysis reveals that children are exposed to marketing for alcohol, junk food, tobacco, vapes and gambling. This is counter to national legislation prohibiting or restricting such marketing to children. Conclusions This novel methodology reveals the actual online experiences of children as they go about their daily lives. This includes engaging in harmful behaviours such as gambling and encountering harmful product marketing. While from New Zealand, this study is likely to be relevant for other countries given the global reach of the online world. The research indicates the urgent need for national and global government regulation of the online world to protect the rights of children and ensure their wellbeing. Key messages • Kids Online Aotearoa reveals the nature and extent of children’s online world, including their exposure to harmful product marketing. • National and global regulation of the online world is urgently needed to protect child rights and wellbeing.

Impact of park renovation on children’s quality of life in New York City

Abstract Background Despite increasing interest in the role of parks on children’s health, research on the impact of park interventions is limited. This study uses a quasi-experimental pre-post design with matched controls to evaluate the effects of park redesign and renovation on children’s quality of life (QoL) in underserved New York City (NYC) neighborhoods with predominantly Hispanic and Black populations. Methods Utilizing longitudinal data from the Physical Activity and Redesigned Community Spaces (PARCS) Study, we examined the parent-reported QoL of children aged 3-11 years living within a 0.3-mile radius of 13 renovated parks (N = 201) compared to 11 (N = 197) control parks before and after the park intervention. QoL was measured using the modified KINDL questionnaire, a health-related QoL scale that assessed children’s physical and emotional well-being, self-esteem, and well-being in home, peer, and school settings. A difference in difference (DID) linear mixed model was used to compare QoL between intervention and control groups. Results We found a significant improvement in the physical well-being subscale of KINDL in the intervention vs. control group (DID=6.35, 95% CI = 0.85-11.85, p = 0.024). The differential improvement was strongest among girls (DID=7.88, p = 0.023) and children with parents in the lowest socioeconomic background (education high school or less DID=8.38, p = 0.024; Not employed DID=7.53, p = 0.048; Single/Widowed/Divorced DID=8.67, p = 0.025). No significant differences were found in other subscales. Conclusions Our study indicated a beneficial impact of improving park quality on the physical well-being of children residing in underserved neighborhoods. These findings support investments in neighborhood parks to advance health equity.

Professional support for children or adolescents whose mental well-being is at risk

Abstract Background Children and adolescents’ mental health issues are globally among the most significant concerns. Research on the topic often focuses on already manifested mental health problems, and research concerning mental well-being and the preferences of service users regarding early-stage support is scarce. This study aimed to define what professional support experts-by-experience hope for a child or adolescent in situations where mental well-being is threatened. Methods The qualitative study with focus group interviews was conducted in Finland during the autumn of 2022. Participants (n = 26) were experts-by-experience who had experienced threats to mental well-being either during their own childhood (before the age of eighteen years) (n = 19) or through the perspective of being a parent (n = 3), or both (n = 4). The data was analyzed using inductive content analysis. Results In situations where the mental well-being of children or adolescents is at risk, professionals working with families were expected to 1) demonstrate an appreciative and compassionate attitude, 2) provide a daycare environment or school environment that supports mental well-being, 3) support the participation of children and adolescents, 4) involve and support family, 5) organize peer support, and 6) provide services that are seamless and need-adapted. Conclusions The results help to develop services supporting mental well-being, considering the perspective and preferences of service users. During the study, one model identified to meet the participants’ desires was the Open Dialogue Approach originally developed in Finland. Key messages • In services supporting mental well-being, ensuring the child’s or adolescent’s participation and involving parents is important. • In addition to the support provided by professionals, the significance of peer support was highlighted. Professionals should actively refer service users to peer support.

1.N. Scientific session: Child injuries monitoring and reporting: Challenges and technological developments

Abstract Globally, more than 1,600 children and adolescents below the age of 19-years die every day from preventable injuries. Road traffic injuries, drowning and self-harm represent leading causes of death and injury among children and adolescents (WHO 2021; WHO Regional Office for Europe, 2021; Unicef, 2021). Most unintentional injuries in early childhood occur at home and children from less advantaged backgrounds are exposed to more hazardous home environments due to overcrowding or unsafe structures over which parents often have limited control (WHO, 2020). According to the IDB data analysis approximately 15% of home injuries could have been prevented by improved product safety and parental education. The COVID-19 pandemic and the conflict in Ukraine have created a complex and challenging situation for children and adolescents in the region, increasing their vulnerability and compromising their well-being. To efficiently prevent child injuries, one must account for a complex interplay between human factors as well as physical and socio-cultural environments. Multiple determinants of child injury cannot be addressed by the health sector alone, this is why a whole-of-government and a whole-of-society approaches are required. Schools have a crucial role to play for promoting the well-being of children and serve as a platform to increase access to health services. However, EU countries are still missing intersectoral collaboration and strong information systems to enable efficient response to the problem. Data on child injuries are still inconsistently collected in Europe due to substantial differences in coding systems, variation between injury mechanisms, different general policies pertaining to the admission of patients, and legal policies on reporting requirements. EU-wide networks such as the Eurosafe study (IDB network) collecting information on child injuries, are scarce. Likewise, access to healthcare services and support systems are unevenly distributed, particularly in underserved communities. Building country capacity in collecting, analysing and increasing the use of child injury data for decision making at global, regional, and national levels, is critical. Adequate epidemiological data on the burden of child injuries are necessary to allow governments prioritize areas for intervention and maximize the impact of their resources. Utilizing evidence-based tools and procedures and promoting intersectoral collaboration is vital. The workshop aims to discuss trends and inequalities of injury burden and present efficient measures and latest developments in monitoring and reporting child injuries across EU countries. The workshop will further discuss the methodological challenges in collecting and analysing data on child injuries. Evidence-informed tools for sharing health information and improved measurements of injury burden that are feasible and usable in both research and clinical contexts will be presented and success stories will be presented. Key messages • There is an EU-wide need for epidemiological data on the burden of child injuries. • Validated tools, well-designed injury data management systems and standard data collection procedures are missing.

Experts in promotion and prevention - The 100th Anniversary of Finnish public health nurse education

Abstract Issue/Problem Two key public health issues at present are mental health problems and obesity. Both typically begin before adulthood and once occurred, typically persist. Prevention would be important but also economically and humanely sensible. For this, competent experts in preventive work and health promotion are needed. Description of the problem Public health nurse education, originally known as health sister education, was initiated in Finland in 1924, by the Mannerheim League for Child Welfare. The six-month health sister education was targeted at nurses and began from the desire to focus not only on treating diseases but also on promoting health. In the 1940s, education was reformed and in the 1950s significantly expanded. In the 1970s, the professional title changed from ‘health sister’ to ‘public health nurse’. In 1987, the education was extended to 3 years, including the education of registered nurses. In 1992, the education was further extended to 3.5 years. By the beginning of the 21st century, education evolved into 4 years bachelor’s degree. Results In 2024, eighteen Universities of Applied Sciences provide public health nurse education in Finland. The 4-year Bachelor of Health Care in Public Health Nursing -degree (240 ECTS credits) also qualifies for a registered nurse. Nearly half of the education consists of clinical training. In addition, registered nurses can supplement their degrees by completing a one-year education (60 ECTS credits) that qualifies them as public health nurses. Lessons In Finland, approximately 700 new public health nurses graduate annually. They are trained to work independently as experts in preventive work, health promotion, and public health. Around 9,500 Finnish public health nurses work in settings such as maternity and child health clinics, school health services, occupational health care, and outpatient clinics. Key messages • Due to the overcrowding in many healthcare services providing treatment, educating experts in health promotion and disease prevention is crucial now and in the future. • By ensuring competent experts in health promotion and disease prevention, future healthcare services can continue to provide economically and humanely sensible and effective help for people.

Balancing power struggles: Understanding the dynamics between standards set by the government, adolescents, and staff at a therapeutic residential care facility

ABSTRACT During four days of observation at a therapeutic residential care (TRC) facility for adolescents with complex behavioral issues, we encountered a growing trend in the Norwegian child welfare system. High demand for institutional beds, along with reduced capacity in psychiatric services and the legal system, has led to increased reliance on the Duty to Assist obligation of the TRCs, administered by the Office for Children, Youth and Family Affairs (Bufetat) in Norway. This obligation is legally binding, ensuring the provision of justifiable treatment. Our observations of staff interactions and documentation analysis of an adolescent, Peter, revealed that staff’s ability to deliver appropriate care and manage high-risk situations is constrained by governmental standards set through law and regulation. Through the theoretical lens of power and discretion, we found that the combination of forced treatment at open institutions, with a strong emphasis on user involvement, creates a power struggle. Without clear practice standards, staff are left to rely on their own competencies in managing conflicts, resulting in inconsistent and unpredictable interactions. This inconsistency increases the likelihood that Peter will resist the care and treatment being offered.