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Abstract
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[via Google Translate]
Purpose: In order to prevent child abuse, it is necessary to start supporting high-risk pregnant women during pregnancy. We will examine the current status and results of the "support for mothers and children who are worried about during pregnancy" communication system that Okayama Prefecture independently started.
Method: Looking back on the eight years of efforts since the start of operation in 2011, we examined the situation before operation, preparations for start, actual operation, and the content of contact cases. Of the 4,598 contact forms for "Mother and Child Support from Pregnancy", a simple tabulation was performed regarding the timing of sending the contact form and the types of risk for 17 items. In addition, the change in the number of child abuse consultations handled in Okayama Prefecture was clarified from the 2018 welfare administration report example of the Ministry of Health, Labor and Welfare.
Results: Of the 52 medical institutions that handle childbirth and those that do not handle childbirth but carry out maternity medical examinations in Okayama Prefecture, all medical institutions (100%) participated in the Okayama model. The time when the medical institution grasped the pregnant women who were interested and sent the contact form was 56.1% during pregnancy, 43.6% after childbirth, and 0.3% blank for the entire eight years from 2011 to 2018. It was. Looking at the content of the contact cases, as social risk factors, 1,318 cases (28.7%) were "unmarried", 1,090 cases (23.7%) were "needing psychiatric support", and 769 cases (16.7%) were "pregnant teenagers". "Insufficient support for husbands and families" was high in 801 cases (17.4%). The number of child abuse consultations in Okayama Prefecture has been declining since 2012, the year after the system started using the "Mother and Child Support from Pregnancy" contact form, compared to 1,641 consultations in 2012. ， In 2018, it was halved to 850 cases. Through liaison meetings between each health center and obstetrics medical institutions, etc., this system was becoming widespread and established in Okayama Prefecture as we continued to discuss contact cases and how the cooperation system should be.
Conclusion: By overcoming the hurdles of the workplace and sharing the feeling of being "worried", an environment is being created in which pregnant women in need of support are not overlooked. In addition, since then, Neubora's efforts according to the region, maternity medical examinations, postnatal care projects, childcare support visits, etc. have been disseminated, and liaison meetings between medical institutions and the government have been held regularly at each health center. By starting support for pregnant women who may be at risk of abuse at an early stage, the number of consultations and notifications after the abuse became serious may have decreased.
目的 子どもへの虐待防止のためには，妊娠中から社会的ハイリスク妊産婦への支援を開始する必要がある。岡山県が独自に開始した「妊娠中からの気になる母子支援」連絡システムの現状と成果を検討する。
方法 2011年運用開始からの8年間の取り組みを振り返り，運用前の状況や開始のための準備，運用の実際，連絡事例の内容等について検討した。「妊娠中からの気になる母子支援」連絡票4,598件のうち，連絡票送付時期および17項目のリスクの種類について単純集計を行った。また厚生労働省の平成30年度福祉行政報告例より岡山県の児童虐待相談対応件数の推移を明らかにした。
結果 岡山県内の分娩取扱医療機関および分娩取扱いはないが妊婦健診を実施している医療機関52施設のうち，すべての医療機関（100%）が岡山モデルに参加していた。医療機関で気になる妊産婦を把握し，連絡票を送付した時期は，2011年～2018年の8年間全体でみると，妊娠中が56.1%，産後が43.6%，無記入0.3%となっていた。連絡事例の内容をみると社会的リスク因子として「未婚」1,318件（28.7%），「精神科的支援が必要」1,090件（23.7%），「10代の妊娠」769件（16.7%），「夫・家族の支援不足」801件（17.4%）などが高率であった。岡山県内における児童虐待相談対応件数は「妊娠中からの気になる母子支援」連絡票を活用したシステム開始の翌年である2012年以降は減少に転じており，2012年度の相談件数1,641件に比べ，2018年度は850件と半減していた。各保健所と産科医療機関等との連絡会議などを通じて，連絡事例の検討や連携システムのあり方などについて継続的に協議を重ねていくなかで，岡山県内において本システムが浸透し，定着しつつあった。
結論 職域のハードルを越えて，「気になる」という感覚を共有することで，支援を必要とする妊産婦を見落とさない環境が整いつつある。また，その後も地域に応じたネウボラの取り組みや産婦健診，産後ケア事業，養育支援訪問等の普及や医療機関と行政の連絡会議が各保健所単位で定期的に行われていること等により，虐待リスクの可能性がある妊産婦への支援を早い段階で開始することで，虐待が深刻になってからの相談や通告件数が減少してきている可能性がある。
Language: ja |