Journal of the National Institute of Public Health
Online ISSN : 2432-0722
Print ISSN : 1347-6459
ISSN-L : 1347-6459
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Toward the realization of a society free of child abuse: Challenges and expected strategies for preventing child abuse
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  • Challenges and expected strategies for preventing child abuse
    Eri OSAWA
    Type: Preface
    2021 Volume 70 Issue 4 Pages 337
    Published: October 29, 2021
    Released: December 08, 2021
    JOURNAL OPEN ACCESS
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  • Kenji KUBO, Keiko YUKAWA
    Type: Review
    2021 Volume 70 Issue 4 Pages 338-351
    Published: October 29, 2021
    Released: December 08, 2021
    JOURNAL OPEN ACCESS

    The number of reports of child abuse has increased in recent years, while the number of deaths has held steady. Since 2000, when the Child Abuse Prevention Law was enacted, many amendments to the Child Abuse Prevention Measures, including the Child Welfare Law and the Maternal and Child Health Law, have been made. The most recent amendment to the Child Welfare Act, enacted in June 2019, prohibited corporal punishment of children, and measures to prevent child abuse are expected to be promoted in the future. This paper discusses the history of the most recent revision of the Child Welfare Act and the mechanism of child abuse prevention in the region. It also discusses the ideal way for professionals involved in child abuse prevention to collaborate, as well as multidisciplinary and multi-institutional cooperation for child abuse prevention. I will explain the history of Japan's child abuse prevention measures from the perspective of the revision of the legislation, touching on the major revisions of the law linked to child abuse prevention to date, with an emphasis on the most recent revision of the Child Welfare Act in 2019. In the future, creating a system that protects children from abuse in the entire region through the collaboration of local resources will be a pressing concern.

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  • Ikumi NAKAITA
    Type: Review
    2021 Volume 70 Issue 4 Pages 352-363
    Published: October 29, 2021
    Released: December 08, 2021
    JOURNAL OPEN ACCESS

    The revised Child Welfare Law of 2019 (enforced on April 1, 2022) stipulated that “at least one doctor and one public health nurse (PHN) should be included in the staff in charge of guidance that requires specialized knowledge and skills concerning the health and physical and mental development of children.” Doctors and public health nurses have begun to be assigned to Child Guidance Centers (CGCs), the core institutions dealing with child abuse. The CGCs were established in response to the 1947 Child Welfare Law and have played a pivotal role in child welfare administration. In 1964, the Manual for the Administration of Child Guidance Centers defined the role of PHNs working in CGCs for the first time, stating that “PHNs should collaborate with other staff members, particularly when it comes to counseling children, performing precise examinations of three-year-old children, and managing the health of temporarily protected children”[11].However, public health nurses assigned to CGCs have been appointed in various capacities, such as “child welfare officer (CWO)” or “concurrently serving as PHN and CWO.” This has led to some difficulties in connecting with consistent role activities and some fluctuations in the professional identity of public health nurses. The anticipated growth in the number of PHNs in CGCs is one of the ways to enhance and strengthen the expertise of CGCs. Therefore, the expertise and the roles of PHNs working in CGCs have been analyzed through a review of the literature.

    The results showed that, despite their designation as a CWO, the PHN working in CGC is engaged in a variety of activities. They incorporated PHN skills such as integrating social work and public health activities, emphasizing a team approach, assessing families from medical and lifestyle perspectives, providing protective support, leveraging the strengths of maternal and child health law within the CGC, identifying potential cases requiring support through maternal and child health services, providing health management including assessment of the relationship between parents and children, seamlessly providing childcare support at home when terminating child protection, mediating between mental health, psychiatry and child welfare, guiding those who need counseling and support to counselors, and being with them.

    In the near future, more PHNs will be required to work in CGCs, and they will be expected to propose novel ideas and skills that are distinct from those of other child welfare professionals.

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  • Kazuhiro KAMIKADO
    Type: Review
    2021 Volume 70 Issue 4 Pages 364-376
    Published: October 29, 2021
    Released: December 08, 2021
    JOURNAL OPEN ACCESS

    Despite the fact that child abuse counseling at child guidance centers is on the rise, less than 10% of children are separated from their parents and placed in social care, while the rest live at home without adequate support. Not just early identification and intervention but also preventative challenges such as family support throughout the early stages of separation and children's social care following separation need to be identified and resolved. In Japan, children's social care services are characterized by a low rate of out-of-home placement and a high rate of institutional care. Over 40% of the looked-after children have experienced abuse, with neglect being the most prevalent. Therefore, it is necessary to address the abuse of children placed in social care. What is expected of children's social care is demonstrated by the voices of those who have experienced it. The child's rights and the principle of prioritizing family-based care, as articulated in the 2016 amendments to the Child Welfare Law, as well as the specific goals outlined in the new 2017 Children's Social Care Vision, respond to these voices. The most critical aspect of dealing with abused children is ensuring they have a safe and secure place to live. However, this goal has not yet been fully realized. According to the children's social care promotion plan formulated by the prefectural governments, care for abused children from their parents will transition from institutional to family-based care. A system based on team care by foster caregivers and fostering agencies is being developed. In addition, permanency must be ensured through preventive measures, family reunification, and adoption, all of which are being pursued. Fostering agencies are expected to contribute to the establishment of children's social care systems by preventive measures, such as utilizing short-stay foster care and considering the future of children's social care from the perspectives of prevention and permanency. It is necessary to ensure continuous support for abused children in order for them to become self-sufficient, regardless of whether the child has been placed in social care or not. If a linkage between “research,” “practice,” and “measures” is promoted toward the establishment of a new children's social care system and increased awareness among those who work with children in need of social support as “corporate parents,” it is believed that a society free of child abuse can be realized.

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  • Perspectives on a national certification training system
    Masashi AIZAWA
    Type: Note
    2021 Volume 70 Issue 4 Pages 377-384
    Published: October 29, 2021
    Released: December 08, 2021
    JOURNAL OPEN ACCESS

    We will discuss the content of the achievement goals that define the expertise (specialized knowledge, skills, and attitudes) that child and family social workers need to acquire to provide appropriate consultation on a wide range of children's problems and promote their overall wellbeing and development. Thus, the following four points are put forth:

    (1) The Ministry of Health, Labour and Welfare's Working Group on Qualifications and Other Measures for Improving the Qualifications of Those Who Provide Support Requiring Specialized Knowledge and Skills in the Field of Child and Family Welfare has examined the following issues concerning the enhancement of the expertise of supporters in the field of child and family welfare: (1) the nature of qualifications in the field of child and family welfare, (2) the nature of training and human resource development, and (3) the nature of national qualifications.

    (2) In the Notification of the Director-General of the Bureau of the Equal Opportunity Employment and Family Affairs, Ministry of Health, Labor and Welfare, titled “Implementation of Training for Child Welfare Officers and Persons in Charge of Coordination at Child Welfare Institutions for Children in Need of Protection,” specific examples are provided based on the attainment goals of post-appointment training for child welfare officers, which is mandatory training. 

    (3) In terms of the training curriculum necessary to meet the attainment goals of a child and family social worker, it was stated that gaining practical experience while being supervised in the field of practice is an effective means of acquiring expertise.

    (4) Currently, university education for a nationally qualified social worker must be knowledge-oriented, a situation that presents difficulties.

    To address the difficulties associated with acquiring practical skills and enhancing practical abilities, it is necessary to consider a mechanism that solves these problems, such as adding conditions.

    like having a certain amount of work experience and practical training experience for the training of child and family social workers to attain national qualification.

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  • challenges and prospects from the perspective of integrating public health approaches and integrated care systems
    Eri OSAWA, Manami OCHI
    Type: Note
    2021 Volume 70 Issue 4 Pages 385-393
    Published: October 29, 2021
    Released: December 08, 2021
    JOURNAL OPEN ACCESS

    The recent spike in child abuse and child mortality reports has significantly impacted public health and welfare. This has evolved into a major challenge for society. The Child Welfare Act and related acts have been continuously revised in recent years; in particular, the 2016 revision clearly stated two centers as core functions for child abuse prevention and child-rearing support in municipalities: the development of community-based integrated support centers for child-rearing generation and support centers for children and families. Municipalities around the country have begun developing such centers. However, many challenges remain due to the lack of a clear description of functions and roles.

    Since 2000, there has been a shift in worldwide child abuse prevention and response from a post-incident response to a public health approach focusing on prevention. The current state of child abuse, its risk factors and protective factors, the impacts of abuse, and prevention strategies have all been studied globally. In addition, a level-based approach to child abuse prevention, from primary to tertiary prevention, has been proposed. Furthermore, the necessity for an integrated care and system approach has been linked to implementing the evidence-based approach.

    The provision of integrated care for the elderly has been implemented in Japan as a “community-based integrated care system” since 2006, although difficulties in the integration of care (welfare) and health (public health) have been reported in the process of building the system. To begin the process of creating mechanisms for child abuse prevention, it is necessary to understand the purpose of building an integrated care system, the type of integration to aim for, and the identification of what needs to be integrated, based on the theory of integrated care and the lessons learned from the “community-based integrated care system in Japan.” It is expected that effective strategies for building integrated care systems to prevent child abuse will emerge in the near future.

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  • Takuya MATSUSHIGE, Manami OCHI, Keiko YUKAWA, Eri OSAWA
    Type: Report
    2021 Volume 70 Issue 4 Pages 394-398
    Published: October 29, 2021
    Released: December 08, 2021
    JOURNAL OPEN ACCESS

    Child maltreatment and related issues affecting children and families have become increasingly complex in recent years, emphasizing the importance of early detection and response. Cooperation between institutions such as child guidance centers, public health centers, child welfare facilities, police, municipalities, and medical institutions is indispensable to ensure an early response. In 2020, the National Institute of Public Health partially merged two training programs, “Mid-level Staff Training for Interprofessional Work”for the staff of child guidance centers and “Child Maltreatment Prevention Training”for public health nurses. It began efforts to develop human resources to strengthen multidisciplinary and multi-agency collaboration. This report will introduce the outline of this initiative, analyze the contents of the questionnaire for trainees, and discuss the possibilities and challenges of multidisciplinary and multi-agency collaborative education. The group work that involved child welfare caseworkers, child psychologists, and public health nurses validated the trainees' awareness and learning by rediscovering the strengths of their occupations and deepening their understanding of multidisciplinary expertise. For future training, it was recommended that interprofessional education must create a system that effectively exploits group dynamism and enables each trainee to understand their partner's perspective.

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  • Changes in the public health system in times of disaster
    Hiroko OKUDA
    Type: Review
    2021 Volume 70 Issue 4 Pages 399-406
    Published: October 29, 2021
    Released: December 08, 2021
    JOURNAL OPEN ACCESS

    The Great East Japan Earthquake struck off the Pacific coast of the Tohoku region on March 11, 2011, wreaking havoc. The earthquake and tsunami triggered the loss of power at the Fukushima Daiichi Nuclear Power Plant, resulting in a complex disaster of unprecedented scale, with the largest scale of human and property damage in Japan since World War II. Immediately following the disaster, the affected areas experienced a decline in medical treatment and administrative functions, resulting in a delay in the initial response and a variety of challenges, such as securing support personnel. In addition, earthquake-related fatalities occurred even after the acute phase, highlighting the significance of establishing public health measures in evacuation centers early on. On the other hand, a survey of support workers related to health and medical welfare in local governments identified systematic concerns such as a poor chain of command and insufficient information collection and sharing in the recipient local governments. Based on these verifications, it was suggested that in the event of a major disaster on a scale that would paralyze the local government's functioning, it would be necessary to create a new mechanism to provide early professional support for supporting management functions, such as the development of systems for disaster countermeasures, information gathering, and coordination and decision-making. In response to this, the government established the Disaster Health Emergency Assistance Team (hereinafter referred to as “DHEAT”) in March 2018 to supplement the public health activities of the affected municipalities. The first DHEAT operation was conducted during the torrential rains and floods of July of that year. This paper outlines the changes in public health activities during disasters as a result of lessons learned from the Great East Japan Earthquake, as well as the development of local government systems and human resources to provide standardized support in preparation for future large-scale disasters.

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  • Michiko BANDO
    Type: Review
    2021 Volume 70 Issue 4 Pages 407-417
    Published: October 29, 2021
    Released: December 08, 2021
    JOURNAL OPEN ACCESS

    There are many deaths and health hazards that occur during evacuation apart from disaster-related deaths. Most of these deaths are among older adults and people with disabilities.

    The purpose of this paper is to assess trends in evacuation after the Great East Japan Earthquake and address future implications regarding the supply of evacuation shelters and emergency temporary housing for older adults and people with disabilities and health issues.

    Data were obtained from the Cabinet Office, the Reconstruction Agency, the Ministry of Health, Labour and Welfare, and research papers and materials published after the Great East Japan Earthquake, and analysed.

    Owing to the magnitude of the damage caused by the Great East Japan Earthquake and the difficulty in opening evacuation shelters and temporary housing in tsunami-damaged areas, various ingenious evacuation shelters and temporary housing systems were installed and operated. For example, rental type emergency temporary housing was introduced. However, the Disaster Relief Act had to deal with other issues such as “refugee at home”that it had not envisioned.

    The situation has gradually improved because of increased research on evacuation shelters and emergency temporary housing, and the system reforms based on them. However, the physical environment issues, such as barrier-free of evacuation shelters and emergency temporary housing have not yet been resolved. In addition, problems with the indoor environment, such as dew condensation, mould, and mites, continue to remain.

    As the Japanese population continues to age, improving the environment for evacuation shelters and temporary housing for older adults and people with disabilities is an issue that should be addressed immediately to prevent disaster-related deaths and any subsequent health hazards.

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  • Tomohiro KAKINUMA
    Type: Review
    2021 Volume 70 Issue 4 Pages 418-427
    Published: October 29, 2021
    Released: December 08, 2021
    JOURNAL OPEN ACCESS

    The Great East Japan Earthquake occurred ten years ago, in 2011. Even during this time period, Japan was struck by a slew of disasters. On the basis of the lessons learned from these disasters, policies on healthcare and welfare in disasters have been implemented to solve the problems, and improvements have been made for the future. This paper focuses on the policies, systems, and organizations that have been in place to manage healthcare and welfare during disasters over the past decade and discusses them chronologically.

    The requirements for designated disaster hospitals have been reviewed, and designated disaster psychiatric hospitals were established. Business Continuity Plan (BCP) is now required as part of the designation. BCPs are now being developed for all designated disaster hospitals. In addition, the Medical Care Plan has designed and reviewed evaluation indicators for the use of EMIS, DMAT, and other systems, and many initiatives have been linked to these indicators. BCPs are now required for the long-term care insurance system. Disaster welfare assistance teams and disaster welfare support networks are now being developed. Future issues include systematically organizing the measures taken so far and designing evaluation indicators. Disaster management must consider the future population decline, changes in disease structure, and the functions of healthcare and welfare.

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Articles
  • Mai FUJII
    Type: Review
    2021 Volume 70 Issue 4 Pages 428-437
    Published: October 29, 2021
    Released: December 08, 2021
    JOURNAL OPEN ACCESS

    This article uses literature review to overview trends in civil registration and vital statistics (CRVS) in low- and middle-income countries and international cooperation in its implementation. CRVS, consisting of civil registration (CR) and vital statistics (VS), is the administrative recording system of births and deaths. Regarding CR, the birth registration rate still does not reach fifty percent in some regions. The situation of death annual registration is even worse, and every year, more than two-thirds of the deaths in the world are not registered. Regarding VS, progress has been made in the digitalization of documents in the past decade, although many issues remain in low- and middle-income countries.

    With respect to international technical cooperation in CRVS, the UNFPA started its aid activities in 1972, and in the 1980s, its projects were implemented in Asia and Africa. UNICEF has continued its existing activities around birth registration. Since the 1990s, information-sharing sessions and workshops have enabled countries to refer to other counties and build a network. Additionally, more support activities are being accelerated by “MOVE-IT,”the evaluation of data management in 2008, and the joint statement of UNICEF and WHO in 2018.

    To illustrate cases of individual countries, one country each from Africa, Asia, and South America was selected.

    Mauritius began with the amendment of legislation and conducted the grant of IDs and the digitalization of the administrative system. Sri Lanka started with a simple method: the digitalization of documents using scanning technology. Brazil connected personal information to make family history records searchable.

    Regarding the evaluation of the CRVS projects, it is not easy to conduct an evaluation of VS for an entire country, instead of a quick, simple evaluation tool that has been developed. These are used for one country to assess from various aspects or multi-country comparisons.

    Due to the COVID-19 pandemic, the expectation of online registration is increasing. CRVS has also been used to generate reports of COVID-19–related death counts. Thus, the importance of CRVS is increasing.

    In low- and middle-income countries, particularly, with the slow progress of death registration, Verbal Autopsy(VA)has also been conducted in recent years. To establish a decent CRVS mechanism, IT technologies should be used to consider CRVS from multiple angles such as those of capacity building, advocacy, data collection in a multilingual environment, creation of effective methods for data centralization, and the development of systems for further advancement.

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  • Jonathan KILWORTH, Hideto TAKAHASHI, KILWORTH Kumiko ODA, Mayumi HAYAS ...
    Type: Report
    2021 Volume 70 Issue 4 Pages 438-446
    Published: October 29, 2021
    Released: December 08, 2021
    JOURNAL OPEN ACCESS

    From 2010, English local authority budgets for social care were drastically reduced due to financial difficulties, and policies that produced the maximum cost effectiveness were required. The Department of Health (DH, now DHSC) asked the Health & Social Care Information Centre (HSCIC, now NHS Digital), a non-departmental public body, to co-produce a new social care data framework that better measures the results. This was an unprecedented new data production project, the Zero-Based Review (ZBR).

    The ZBR project is divided into five areas: (a) Safe Guarding Stakeholder Group, (b) EQ-CL Stakeholder Group, (c) SALT (Short and Long Term support) Stakeholder Group, (d) ASC-FR (Adult Social Care Finance Return) Stakeholder group, (e) Communications group.

    Traditional data shows the support system and status, such as the number of service users and the number of supports provided, but the SALT data shows the state after the care assessment. New items such as leading to independence, leading to long-term support, transition to end-of-life care, refusal of support, etc. have been added. The ZBR project emphasized “outcomes” rather than traditional service “structures” or “processes” so that the data collected can improve the practice of delivering social care support. Some of the data is reflected in the Adult Social Care Outcomes Framework (ASCOF), an important indicator set of local government achievements in social care policies and practices. The ZBR project started in 2011, and the data was constructed over several years. The data items are still being revised as appropriate in response to the revision of the law and social care policy.

    We believe that examining this new construction effort for social care data in England will also be helpful for Japan, which is currently working on the realization of a “data-driven society” in society 5.0.

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