Children’s rights in primary health care Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18
Children’s rights in primary health care Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 ABSTRACT This publication presents a Manual and Tools for the assessment and improvement of children’s rights in primary health care (PHC) for five groups of stakeholders, namely PHC services’ management, health professionals, parents and carers, children aged 6-11 and children and adolescents aged 12-18. The Manual contains a short methodological guide and the five tools, which may be used through focus group discussions or as a survey. The series Children’s rights in primary health care consists of 6 volumes: Volume 1. Manual and Tools for assessment and improvement Volume 2. Assessment and improvement Tool for Children aged 6-11 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 Volume 4. Assessment and improvement Tool for Health Professionals Volume 5. Assessment and improvement Tool for Management Volume 6. Assessment and improvement Tool for Parents and Carers Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2015 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. TABle of ConTenTS AcknOWledgments 7 IntrOductIOn 8 stAndArd 1: QuAlIty servIces fOr cHIldren 10 1.1. All PHC services are based on the best evidence available and staff are adequately trained. 10 1.2. All PHC services delivered are regularly monitored and evaluated. 11 1.3. PHC services have adopted a Charter on Children’s Rights in PHC, in line with the United Nations Convention on the Rights of the Child. 12 1.4. PHC services ensure continuity of care and articulation with key services and institutions working for and with children. 13 1.5. Services for children are designed and delivered taking into account children’s needs and characteristics. 13 stAndArd 2: eQuAlIty And nOn-dIscrImInAtIOn 17 2.1. PHC services fulfil the rights of access of all children without discrimination of any kind. 17 2.2. PHC services deliver a patient-centred care, which recognises not only the child’s individuality and diverse circumstances and needs, but also those of his or her parents or carers. 18 2.3. PHC services ensure the respect of children’s privacy at all times. 19 stAndArd 3: PArentIng 22 3.1. PHC services provide ante-natal and post-natal care for mothers and newborn babies and child care, which complies with a concept of continuity of care for children, starting with pregnancy, through a life course approach. 22 3.2. PHC services support the role of parents and promote health literacy. 24 stAndArd 4: InfOrmAtIOn And PArtIcIPAtIOn 27 4.1. PHC services fulfil children’s right to information and participation. 27 4.2. Staff in PHC services have the skills to engage in dialogue and information-sharing with children of all ages and maturity. 29 4.3. PHC services engage with children and parents/carers for the development and improvement of health care services. 30 stAndArd 5: sAfety And envIrOnment 32 5.1. The infrastructure of the PHC facility is designed, furnished and equipped to meet children’s health, safety and mobility needs. 32 5.2. Spaces for children are designed and delivered taking into account children’s needs and characteristics. 33 stAndArd 6: PrOtectIOn 36 6.1. PHC services have in place a system that ensures the protection of children against all forms of violence. 36 6.2. The PHC service ensures that all appropriate staff have the adequate skills to identify, protect, treat and refer children who have been a victim of any kind of abuse or unintentional injury. 36 stAndArd 7: cHrOnIc Illness And OtHer lOng-term HeAltH cAre needs 38 7.1. PHC services ensure the management of child chronic illness or other long-term health care needs. 38 stAndArd 8: PAIn mAnAgement And PAllIAtIve cAre 42 8.1. PHC services’ policy and practice ensure the prevention and management of pain. 42 temPlAte fOr fOcus grOuP dIscussIOn WItH cHIldren And AdOlescents Aged 12-18 47 Discussion themes 47 7Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 ACknowledgmenTS The Manual and Tools for the assessment and improvement of children’s rights in primary health care have been prepared by Ana Isabel F. Guerreiro. Its development was carried out in consultation with Ana Margarida Sola, Cristina Gouveia, Natа´lia Correia and So´nia Coelho (ACES Central – Group of primary health care Centres of the Algarve I) (Portugal); Jim Robinson (University of Edinburgh), Janice Allister and Imran Rafi (Royal College of General Practitioners), Andrew Clarke (Lancashire Care Foundation NHS Trust), Anne-Marie Comber (Edinburgh Community Health Partnership) and Jillian Taylor (University of the West of Scotland) (UK); Kristin Wik (Department of Health and care, Enebakk municipality), Kjersti Johanne Fløtten and Einhild Selnes (Akershus University Hospital) (Norway); Sergey Sargsyan, Eva Movsesyan and Marina Melkumova (Arabkir Medical Centre, Institute of Child and Adolescent Health), Anna Balyan (University Clinic Heratsi) and Grigor Nazinyan (Ijevan Policlinic) (Armenia); Vivian Barnekow, Aigul Kuttumuratova and A° sa Nihle´n (WHO Europe) and Marcus Stahlhofer (WHO Headquarters). InTRoduCTIon In the 25 years since the adoption of the Convention on the Rights of the Child (CRC) (1), significant experience and knowledge has been generated in relation to the interpretation of article 24 on children’s right to health and its respect, protection and fulfilment in children’s various life settings. The importance of adopting a human-rights based approach to health is reinforced in the recently adopted WHO Strategy ‘Investing in children: child and adolescent health strategy for Europe 2015 –2020’, which states that “as human rights become better respected, they become more effective in helping governments to strengthen their health systems, deliver health care for all and improve health (2).”Within children’s right to health, the CRC places a great emphasis on primary health care (PHC), which is to be the gateway to pregnant women, mothers, newborns and children throughout their life stages. This is reinforced by General Comment №15 on article 24, which declares that “States should prioritize universal access for children to primary health care services provided as close as possible to where children and their families live, particularly in community settings” (3). Furthermore, the centrality of the role of PHC within health systems is recognised by WHO in a number of strategies and legal instruments, including the Declaration of Alma-Ata1 (4) and the European policy for health and well-being - Health 2020 (5). PHC is the closest care to the population and most children will have contact with its services and professionals throughout their development, which makes it a privileged setting to invest in. At the same time, PHC services have a great responsibility to provide quality services to children, to give them a voice and to enable them to reach their full potential. The development of the Manual and Tools for the assessment and improvement of children’s rights in PHC is part of an ongoing process at international level that aims to translate children’s rights as enshrined in the CRC into practical principles and actions that health care services can apply in daily practice. The Manual and Tools should serve as a means of assessment, identification of areas for improvement and of raising awareness on children’s rights of health professionals and other stakeholders working for and with children in the health sector. The Manual and Tools for PHC have been adapted from the Children’s Rights in Hospital: Manual and Tools for assessment and improvement, published in 2012 (6). The aforementioned tools addressed five groups of stakeholders namely, hospital management, health professionals, children aged 6-11, children and adolescents aged 12-18 and parents and carers. In 2012-2013, WHO Europe implemented successfully the tools in hospitals in Kyrgyzstan, Tajikistan and Moldova, in the framework of its work on improvement of hospital care for children (7, 8). This experience demonstrated both the importance and the need to address and assess the respect of children’s rights in healthcare settings. Taking into account the growing recognition of the importance of children’s rights in healthcare and the good acceptance of the Manual and Tools in the aforementioned countries, WHO Europe initiated a process to prepare a similar set of tools on assessing and improving the respect of children’s rights in PHC. For the preparation of the present Manual and Tools for the assessment and improvement of children’s rights in PHC, working groups were established in Armenia, Norway, Portugal and the UK. Health 1 The Declaration of Alma-Ata defines Primary Health Care as essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process. professionals working at different levels of health care service provision gave their inputs regarding the development and applicability of the standards and sub-standards, as well as, the suitability of the questions in their contexts. The development of the Manual and Tools was prepared in consultation with a team at the WHO European Office and Headquarters. The contents of the Manual and Tools include: • methodology section, which provides general information about assessment processes and a proposed work methodology for the implementation of the tools in PHC settings; • Assessment and improvement tool for management. Depending on the health system, this group of stakeholders may include managers of a health facility and senior health staff. If the PHC facility is organized under a regional structure, it may also include regional managers or equivalent. • Assessment and improvement tool for health professionals. This group of stakeholders may include any professional working at a PHC facility, from medical to administrative and cleaning staff. • Assessment and improvement tool for children aged 6-11. This tool does not follow the same structure of the remaining tools. It is adapted to young children and aims to assess their overall experience in PHC services. It is made-up of open-ended questions, which enable children to expand on their views and provide suggestions for improvements. • Assessment and improvement tool for children and adolescents aged 12-18. This tool follows the same structure of the tools for management, health professionals and parents and carers. The tool includes a simple template for focus group discussions that can be adapted to groups made up of children or parents and carers; • Assessment and improvement tool for parents and carers. This tool aims to gather the views of parents and other carers. As mentioned above, it also includes a template that can be used for a focus group discussion. 10 Children’s rights in primary health care STAndARd 1: QuAlITy SeRvICeS foR ChIldRen (Convention on the Rights of the Child, Articles 9, 24 and 31) All services provided to children aim at delivering the best quality possible health care. Sub-Standards 1.1. All PHc services are based on the best evidence available and staff are adequately trained. 1.1.1. Do you think that you received the best care here? Yes No Not applicable/ don’t know Comments 1.1.2. Do you feel you are included in planning your own care? Yes No Not applicable/ don’t know Comments 1.1.3. Have you been given any advice/information about keeping yourself healthy in the future? Yes No Not applicable/ don’t know Comments 1.1.3.1. If yes, was this information given verbally or in written/pictorial form? (Please tick) verbally written pictorial 11 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 1.1.4. Have you seen any professional other than a general practitioner or practice nurse, such as a psychologist, social worker, school nurse or other? Yes No Not applicable/ don’t know Comments 1.2. All PHc services delivered are regularly monitored and evaluated. 1.2.1. Have you participated in any survey or been asked what you think about the services and care? Yes No Not applicable/ don’t know Comments 1.2.2. If you have participated in a survey or other programme for evaluating and/or improving health care services for children; did you receive clear feedback about how your contributions were used and/or influenced any outcomes? Yes No Not applicable/ don’t know Comments 1.2.3. Are you aware whether Primary Health Care services have a satisfaction and/or complaints’ mechanism whereby you can make suggestions and complaints? Yes No Not applicable/ don’t know Comments 12 Children’s rights in primary health care 1.2.4. Have you ever made a suggestion or complaint? Yes No Not applicable/ don’t know Comments 1.2.4.1. If yes, did you receive feedback about how your opinion was used? Yes No Not applicable/ don’t know Comments 1.3. PHc services have adopted a charter on children’s rights in PHc, in line with the united nations convention on the rights of the child. 1.3.1. Has any health professional talked to you about your rights in PHC? Yes No Not applicable/ don’t know Comments 1.3.2. Have you seen a Charter or poster displayed in the PHC service about children’s rights? Yes No Not applicable/ don’t know Comments 13 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 1.3.3. Have you been given a copy of a Charter on Children’s Rights in PHC, in a language which you can understand? Yes No Not applicable/ don’t know Comments 1.4. PHc services ensure continuity of care and articulation with key services and institutions working for and with children. 1.4.1. If you have needed, has your school put you in contact with local PHC services? Yes No Not applicable/ don’t know Comments 1.5. services for children are designed and delivered taking into account children’s needs and characteristics. 1.5.1. Did you use a medical service without a parent or carer? Yes No Not applicable/ don’t know Comments 1.5.2. Have you ever received family planning or sexual and reproductive health services? Yes No Not applicable/ don’t know Comments 14 Children’s rights in primary health care 1.5.3. Have you ever asked for a contraceptive pill or condom? Yes No Not applicable/ don’t know Comments 1.5.3.1. If yes, did the doctor/nurse give you a contraceptive pill or condoms? Yes No Not applicable/ don’t know Comments 1.5.3.2. If not, would you know where else to get a contraceptive pill or condom? Yes No Not applicable/ don’t know Comments 1.5.4. Can you get there by bus or other public transport? Yes No Not applicable/ don’t know Comments 15 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 1.5.5. If you had a specific problem that you needed help for, were the health professionals able to help you? Yes No Not applicable/ don’t know Comments Please use this space to record any ideas or evidence Standard 1: Quality Services for Children complementary indicators or information (Add any complementary indicators or other information, which may be relevant to the PHC facility and was not covered by the questions above) 16 Children’s rights in primary health care Additional indicators (Add existing local PHC facility indicators you may want to consider for the Action Plan) 17 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 STAndARd 2: eQuAlITy And non-dISCRImInATIon (Convention on the Rights of the Child, Articles 2 and 16) All children should be able to access health care and undergo any type of care and treatment without discrimination of any kind, irrespective of the child’s or his or her parent’s or legal guardian’s race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status. Sub Standards 2.1. PHc services fulfil the rights of access of all children without discrimination of any kind. 2.1.1. In your opinion, are there sufficient health care facilities for children and adolescent in quantity and quality in the area where you live? Yes No Not applicable/ don’t know Comments 2.1.2. Do you know of any children who are not able to receive health care because they live far away? Yes No Not applicable/ don’t know Comments 2.1.3. Have you ever paid for the care you received in PHC services? Yes No Not applicable/ don’t know Comments 18 Children’s rights in primary health care 2.1.4. Have you ever been prevented from receiving the care you needed? Yes No Not applicable/ don’t know Comments 2.1.4.1. If yes, what was the reason? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 2.2. PHc services deliver a patient-centred care, which recognises not only the child’s individuality and diverse circumstances and needs, but also those of his or her parents or carers. 2.2.1. Were you treated with respect at the PHC service by all professionals? Yes No Not applicable/ don’t know Comments 2.2.2. Do the health professionals always use your preferred name? Yes No Not applicable/ don’t know Comments 19 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 2.2.3. If you needed, did the PHC service offer you translation services? Yes No Not applicable/ don’t know Comments 2.3. PHc services ensure the respect of children’s privacy at all times. 2.3.1. Were you given the opportunity to be examined by a health professional of the same sex, upon your request? Yes No Not applicable/ don’t know Comments 2.3.2. Were you given information in a private area? Yes No Not applicable/ don’t know Comments 2.3.3. If you have a health condition, did the health professional discuss with you difficulties you may find in your daily life, including in school; and how to deal with them? Yes No Not applicable/ don’t know Comments 20 Children’s rights in primary health care 2.3.4. Were you examined in a private area? Yes No Not applicable/ don’t know Comments Please use this space to record any ideas or evidence Standard 2: equality and non-discrimination complementary indicators or information (Add any complementary indicators or other information, which may be relevant to the PHC facility and was not covered by the questions above) 21 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 Additional indicators (Add existing local PHC facility indicators you may want to consider for the Action Plan) 22 Children’s rights in primary health care STAndARd 3: PARenTIng (Convention on the Rights of the Child, Articles 5, 18 and 24) PHC services support the realization of the mother’s right to health and healthy pregnancy and the role of parents, as a key determinant of children’s health, nutrition and development. Sub Standards To be answered by adolescents only if they are a parent. 3.1. PHc services provide ante-natal and post-natal care for mothers and newborn babies and child care, which complies with a concept of continuity of care for children, starting with pregnancy, through a life course approach. 3.1.1. If you are a mother, have you received family planning, ante-natal and post-natal care at your local PHC service? Yes No Not applicable/ don’t know Comments 3.1.2. Upon returning home, after delivering your baby, did you or your newborn receive a home visit? Yes No Not applicable/ don’t know Comments 23 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 3.1.3. Have you experienced any ante-natal or post-natal mental health problem, including post-natal depression? Yes No Not applicable/ don’t know Comments 3.1.4. If yes, have you received mental health support at your local PHC service? Yes No Not applicable/ don’t know Comments 3.1.5. Have you received any support about exclusive breastfeeding for infants up to 6 months, including awareness raising, counselling and support services, home visits or other programmes? Yes No Not applicable/ don’t know Comments 3.1.6. Have you been offered information on or samples of breast-milk substitutes, such as infant formula? Yes No Not applicable/ don’t know Comments 24 Children’s rights in primary health care 3.1.7. Has your child been monitored in terms of adequate nutrition, growth and development in early childhood? Yes No Not applicable/ don’t know Comments 3.1.8. If you have an older child, has s/he received regular check-ups at your local PHC service? Yes No Not applicable/ don’t know Comments 3.2. PHc services support the role of parents and promote health literacy. 3.2.1. As a parent, have you ever received any type of training during pregnancy or about early childhood and other stages of childhood, including adolescence? Yes No Not applicable/ don’t know Comments 3.2.2. If yes, did you find the programme contents relevant and adequate to your needs? Yes No Not applicable/ don’t know Comments 25 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 3.2.3. If yes, in your opinion, did you receive an appropriate balance of information, skills, support and resources? Yes No Not applicable/ don’t know Comments 3.2.4. Do you feel confident about how and where to seek health care when your child is in need? Yes No Not applicable/ don’t know Comments Please use this space to record any ideas or evidence 26 Children’s rights in primary health care Standard 3: Parenting complementary indicators or information (Add any complementary indicators or other information, which may be relevant to the PHC facility and was not covered by the questions above) Additional indicators (Add existing local PHC facility indicators you may want to consider for the Action Plan) 27 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 STAndARd 4: InfoRmATIon And PARTICIPATIon (Convention on the Rights of the Child, Article 12) All children receive health-related information and information about their health problem, in ways that are understandable to them, can express their views and participate in decision-making about their care and treatment, in a manner consistent with their evolving capacities. Sub Standards 4.1. PHc services fulfil children’s right to information and participation. 4.1.1. Have you received information about what PHC-related services are available to you and how to access them whilst you were at the PHC facility? Yes No Not applicable/ don’t know Comments 4.1.2. Have you received information at your school, community, sports centre or other place about what health care services are available to you and how to access them? Yes No Not applicable/ don’t know Comments 4.1.3. Have you participated in the design of health information materials? Yes No Not applicable/ don’t know Comments 28 Children’s rights in primary health care 4.1.4. Have you received confidential counselling and advice at your local PHC service? Yes No Not applicable/ don’t know Comments 4.1.5. Do health professionals explain to you how to make informed choices in relation to your lifestyle? Yes No Not applicable/ don’t know Comments 4.1.6. Did you find the information useful? Yes No Not applicable/ don’t know Comments 4.1.1. Have you ever given your written informed consent to any treatment or procedure, which you received? Yes No Not applicable/ don’t know Comments 29 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 4.2. staff in PHc services have the skills to engage in dialogue and information-sharing with children of all ages and maturity. 4.2.1. Did the health professionals explain to you about your situation or condition? Yes No Not applicable/ don’t know Comments 4.2.2. Did you understand everything that you were told by the health professionals? Yes No Not applicable/ don’t know Comments 4.2.3. Do you think that you were given enough information about what is your situation or condition and what treatment or preventive care you might need? Yes No Not applicable/ don’t know Comments 4.2.4. Have you been told that you can ask the health professionals questions? Yes No Not applicable/ don’t know Comments 30 Children’s rights in primary health care 4.3. PHc services engage with children and parents/carers for the development and improvement of health care services. 4.3.1. Have you ever participated in a consultation or other programme for evaluating and/or improving health care services for children? Yes No Not applicable/ don’t know Comments 4.3.2. If yes, did you receive clear feedback about how your contributions were used and/or influenced any outcomes? Yes No Not applicable/ don’t know Comments 4.3.3. If yes, did you feel your contributions influenced decisions? Yes No Not applicable/ don’t know Comments Please use this space to record any ideas or evidence 31 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 Standard 4: Information and Participation complementary indicators or information (Add any complementary indicators or other information, which may be relevant to the PHC facility and was not covered by the questions above) Additional indicators (Add existing local PHC facility indicators you may want to consider for the Action Plan) 32 Children’s rights in primary health care STAndARd 5: SAfeTy And envIRonmenT (Convention on the Rights of the Child, Article 3) All services for children are provided in a safe environment designed, furnished and equipped to meet their needs. Sub Standards 5.1. the infrastructure of the PHc facility is designed, furnished and equipped to meet children’s health, safety and mobility needs. 5.1.1. If you have mobility restrictions, have you been able to move around all areas of the building, which you needed to go, easily? Yes No Not applicable/ don’t know Comments 5.1.2. Were there clean rest rooms? Yes No Not applicable/ don’t know Comments 5.1.3. In the time where you stayed at the PHC facility, was there always electricity? Yes No Not applicable/ don’t know Comments 33 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 5.1.4. In the time where you stayed at the PHC facility, was there heating? Yes No Not applicable/ don’t know Comments 5.1.5. Was there drinking water at the PHC facility? Yes No Not applicable/ don’t know Comments 5.2. spaces for children are designed and delivered taking into account children’s needs and characteristics. 5.2.1. Do you think the waiting areas are comfortable and welcoming? Yes No Not applicable/ don’t know Comments 5.2.2. Were there play areas in waiting areas where you have been? Yes No Not applicable/ don’t know Comments 34 Children’s rights in primary health care 5.2.3. Did you feel comfortable in the room where you were seen by the doctor or nurse? Yes No Not applicable/ don’t know Comments Please use this space to record any ideas or evidence Standard 5: Safety and environment complementary indicators or information (Add any complementary indicators or other information, which may be relevant to the PHC facility and was not covered by the questions above) 35 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 Additional indicators (Add existing local PHC facility indicators you may want to consider for the Action Plan) 36 Children’s rights in primary health care STAndARd 6: PRoTeCTIon (Convention on the Rights of the Child, Articles 6, 19 and 39) Children are protected from all forms of physical or mental violence, unintentional injury, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse. Sub Standards 6.1. PHc services have in place a system that ensures the protection of children against all forms of violence. 6.1.1. Have you ever received information about services for children and adolescents who need support against physical or mental violence? Yes No Not applicable/ don’t know Comments 6.1.2. If you suffered any kind of abuse, would you know where to go for help? Yes No Not applicable/ don’t know Comments 6.2. the PHc service ensures that all appropriate staff have the adequate skills to identify, protect, treat and refer children who have been a victim of any kind of abuse or unintentional injury. 6.2.1. Has your doctor/nurse ever talked to you about physical or mental violence? Yes No Not applicable/ don’t know Comments 37 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 Please use this space to record any ideas or evidence Standard 6: Protection complementary indicators or information (Add any complementary indicators or other information, which may be relevant to the PHC facility and was not covered by the questions above) Additional indicators (Add existing local PHC facility indicators you may want to consider for the Action Plan) 38 Children’s rights in primary health care STAndARd 7: ChRonIC IllneSS And oTheR long-TeRm heAlTh CARe needS (Convention on the Rights of the Child, Article 23) All children have the right to individualized, gender-specific, culturally and age appropriate management of chronic illness and other long-term health care needs. Sub Standards To be answered by children who have a chronic illness or other long-term health care need. 7.1. PHc services ensure the management of child chronic illness or other long-term health care needs. 7.1.1. If you have a chronic illness or other long-term health care need, do you receive care at your local PHC service? Yes No Not applicable/ don’t know Comments 7.1.2. Do you also receive care in hospital, at your school or home? Yes No Not applicable/ don’t know Comments 7.1.3. Do you feel supported in the management of your own illness? Yes No Not applicable/ don’t know Comments 39 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 7.1.4. Have you received a written care plan for the management of your illness? Is your plan updated for you? Yes No Not applicable/ don’t know Comments 7.1.5. Did you participate in writing the care plan? Yes No Not applicable/ don’t know Comments 7.1.6. Have you been assessed for readiness for transition and provided with a personalised transition care plan? Yes No Not applicable/ don’t know Comments 7.1.7. Do you have any suggestions or complaints about the management of your illness? Yes No Not applicable/ don’t know Comments 40 Children’s rights in primary health care 7.1.7.1. If yes, please specify: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Please use this space to record any ideas or evidence Standard 7: Chronic illness and other long-term health care needs complementary indicators or information (Add any complementary indicators or other information, which may be relevant to the PHC facility and was not covered by the questions above) 41 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 Additional indicators (Add existing local PHC facility indicators you may want to consider for the Action Plan) 42 Children’s rights in primary health care STAndARd 8: PAIn mAnAgemenT And PAllIATIve CARe (Convention on the Rights of the Child, Article 24) All children have the right to individualized, gender-specific, culturally and age appropriate prevention and management of pain and palliative care. Sub Standards 8.1. PHc services’ policy and practice ensure the prevention and management of pain. 8.1.1. Were you in pain here? Yes No Not applicable/ don’t know Comments 8.1.2. Were you given any treatment for this pain? Yes No Not applicable/ don’t know Comments 8.1.3. Was anything else been done to make you feel more comfortable if you have pain (apart from medicine)? Yes No Not applicable/ don’t know Comments 43 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 8.1.4. Did the health professionals ask you if you have pain? Yes No Not applicable/ don’t know Comments Please use this space to record any ideas or evidence Standard 8: Pain management and palliative care complementary indicators or information (Add any complementary indicators or other information, which may be relevant to the PHC facility and was not covered by the questions above) 44 Children’s rights in primary health care Additional indicators (Add existing local PHC facility indicators you may want to consider for the Action Plan) last question What have been the good things about the services provided here? 45 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 What have been the bad things about the services provided here? If you were in charge, what are the first things you would change to make things better for children and adolescents? Do you think that there should be some specific services for young girls/boys? 46 Children’s rights in primary health care THANK YOU Printed name and initials of Interviewer __________________________________________________________________________________ Post held __________________________________________________________________________________ Signature of Interviewer ______________________________________________ Date _____________________________ 47 Volume 3. Assessment and improvement Tool for Children and Adolescents aged 12-18 TemPlATe foR foCuS gRouP dISCuSSIon wITh ChIldRen And AdoleSCenTS Aged 12-18 The template for Focus Group discussions with children and adolescents aged 12-18 focuses on what is good or not good about the services provided to children in specific PHC facilities. It includes discussion themes for each standard of the assessment and improvement tools. Date ____________________________________________________________________________ Country ____________________________________________________________________________ Health facility ____________________________________________________________________________ Clinik area ____________________________________________________________________________ Number of children and adolecents ____________________________________________________________________________ Age range of participants ____________________________________________________________________________ Gender: Number of Male Number of Female Rules and boundaries of the group discussed and agreed: Yes No discussion themes • What is good here? • What is not good? • Quality Services for Children – do we think we receive good quality care; making suggestions and complaints about services; learning about our rights in PHC • Equality and non-discrimination - feeling welcome here; being treated equally; having privacy, dignity and being respected • Parenting – receiving information about how to take care of children; children receiving care throughout their various ages and stages 48 Children’s rights in primary health care • Information and participation – receiving information; being consulted about making decisions about our own health; giving our opinion about the services received and how to improve them • Safety and environment – moving around the health service; friendly spaces; friendly services • Protection - being safe and feeling safe • Chronic illness and other long-term health care needs – receiving care for chronic illness • Pain management and Palliative Care – receiving care for things that make us upset and uncomfortable • Our ideas for things that would make it better here. Please record the findings below: Record of Focus Group discussion and summary of key points raised
Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: contact@euro.who.int Website: www.euro.who.int