David Ebbevi

Children’s oral health in Sweden is generally good

however, children living in socioeconomically disadvantaged areas have a higher risk of developing dental caries, and preventive measures are not sufficiently effective. In Stockholm, a parental support program is offered that includes extended home visits from the child’s birth until 15 months of age. A previous study showed that participants in this program had better toothbrushing habits and a lower prevalence of caries at 18 months

however, by the age of 3 years, caries levels were again high. One possible explanation for the findings at 3 years of age is that neither the dental services nor child health services routinely meet families with children between 2 and 3 years of age. The planned intervention involves oral health coaches continuing to support families from 18 months of age—shortly after the extended home-visit program has ended—until the child reaches 3 years of age, through group meetings, individual consultations, and telephone contact. The aim is to strengthen parents’ knowledge and confidence in their own ability to care for their child’s oral health. There is also a well-established strong association between parental stress and an increased prevalence of caries. Against this background, there is a need to build on the initiatives currently provided by child health services and social services and to continue supporting children at high risk of caries. The project is expected to result in fewer caries lesions, improved quality of life for the child, and, in the long term, reduced strain on the family. It may also lead to important insights into how healthcare services can best collaborate to improve children’s health.

Research problem and specific questions. This programme studies preventive interventions for child maltreatment. Specific questions are: What’s the effect and mechanisms of extended home visits on child maltreatment? What’s the effect of dental care follow-up on child medical outcomes and markers of child maltreatment? What’s the effect and mechanism of health assessment on medical outcomes in children interrogated by police at children’s advocacy centre? How do children, legal actors and social workers assess clinical examinations of children and what mechanisms control if they are ordered? What’s an effective best practice for forensic reporting of child physical abuse?Data and method. The programme covers four interventions: extended home visits, dental follow-up, health assessment, and guidelines for forensic reporting. RCT and quasi experimental designs are used. Effects and mechanisms are evaluated with mixed methods. Data sources are literature review, semi-structured interviews, documents, surveys, registry data, and medical records. A multitude of measurements capture maltreatment.Relevance and utilization. Children subject to abuse constitute a vulnerable group that remains invisible if they are not specifically targeted. Maltreatment impacts future health and socioeconomic status of the child. Therefore, maltreatment need to be prevented, discovered, and interrupted. The long-term effects of ongoing child maltreatment mean that interruption of maltreatment is a preventive health intervention. The programme is aligned with the national strategy against child maltreatment recently presented for consideration to the Swedish government. Findings are directly applicable to the work at the children’s advocacy centre. Assessment of implementation factors is part of evaluating intervention mechanisms and costs will be evaluated for new interventions. Dissemination will be performed through the institutional network of the programme participants.Plan for programme realisation. The programme will be hosted at Karolinska Institutet, Department of Clinical Science, Intervention and Technology, and operationally based on the children’s advocacy centre in Stockholm. Interventions are performed at the children’s health centre/children’s home, local family centre and the children’s advocacy centre. Most of the staff work clinically at the children’s advocacy centre and this programme funding would enable us to a establish a research group at the children’s advocacy centre focusing on interventions to prevent child maltreatment. The programme has a strong capacity building aim with 3 clinically active doctoral students and a transdisciplinary approach. A children’s panel and a stakeholder panel will be recruited. The funding will cover costs for salaries, representation, research participants and data management. The programme would enable us to reshape everyday operations from being reactive to fundamentally preventive and health promotive.