Routines important in childhood

BarnSäkert is a universal, structured and interdisciplinary approach for identifying psychosocial risk factors in a young child’s environment at an early stage and offering parents support and help when needed. It is a collaboration between child healthcare services in Sweden and social services’ outpatient care and is based on the American SEEK model (Safe Environment for Every Kid), which has been tested and adapted to Swedish conditions.

“This is very new. Social services have almost never been involved in the daily lives of young children before, except when there were really serious problems. With this model we come into contact early with families that we would otherwise never reach,” says researcher Eva Randell, senior lecturer at the Department of Social Work. She forms part of the research group together with Maria Engström, affiliated researcher at the Department of Women’s and Children’s Health, and the national process manager for BarnSäkert.

“Sweden’s child healthcare services are unique, and one of our biggest public health arenas. Our mission is to promote health and prevention, and we come into contact with almost all children in Sweden, following them from birth up to the age of six, when the School Health Service takes over,” explains Maria Engström.

The BarnSäkert study is being carried out within child healthcare services in Region Dalarna. A two-year intervention ran between 2018 and 2020, with half of the child health centres working according to the BarnSäkert model and half according to standard procedures.

The risk factors identified by the model are worry about finances, depression, extreme stress, alcohol and drug abuse, and domestic violence.

Training is vital

The first step in the model is training paediatric nurses and family counsellors.

“They had to note and deal with aspects of parenting other than purely medical ones in collaboration with a family counsellor (a social worker). It was a completely new model for everyone,” according to Maria Engström.

During six pre-arranged visits, parents are then invited to fill in a form with questions that are based on the five risk factors.

“Ask and you shall receive,” says Eva Randell, noting that one parent said: “If I hadn’t been asked those questions, I would never have told anyone.”

It can make all the difference, according to the researchers. As many as 24 per cent of parents have indicated that they received help that they would not otherwise have received. In addition, the analysis showed that the effects of the interventions were stronger among younger parents, foreign-born parents, and those with lower levels of education.

Stress experienced by new parents

“Our research shows that stress and depression are very common, among mums as well as dads. They lack routines and structures and need help with setting boundaries, for example,” says Eva Randell. “If we can help parents to feel in control at an early stage, we can also help create a better environment for their young child to grow up in.”

The thresholds for a family to be offered a joint visit from a paediatric nurse and family counsellor should be low. The project has also developed a common toolkit that lists the help and support available at the local, regional and national levels. This palette of family support aims to support equality in how problems are managed, regardless of where people live.

The researchers have collected a large dataset from 25,000 children, parent questionnaires, and interviews with family counsellors, paediatric nurses, parents, etc.

“We have seen that nurses and family counsellors are surprisingly positive and feel that their skills are complemented by the skills of social services,” the researchers conclude.

Gunilla Styr