The Finnish baby box : From a volunteer initiative to a renowned social security benefit

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The baby box : Enhancing the wellbeing of babies and mothers around the world

The baby box is a Finnish social innovation that has captivated interest around the globe. This book highlights the journey of the baby box in over 60 countries, offering a comprehensive overview of the Finnish baby box and its many international adaptations. The story of the baby box begins in post-war Finland, where it evolved from a community-based resource to a nationally-funded and internationally recognized social benefit. The global mapping of the baby box presented in this book expands on this history by exploring the influence of the baby box concept internationally, from refugee camps and high-income countries to remote islands and prisons. Written by an international, multi-disciplinary team of researchers, this book explores the baby box concept from various angles. The diverse and expansive nature of this study makes it an excellent resource for parents, researchers, and anyone generally interested in the baby box concept. Also showcased are the many creative solutions that baby box programme organisers have devised to address context-specific challenges, making it additionally useful as a handbook for policy-makers or professionals developing their own programme.The baby box is a social innovation: a maternity package with baby clothes and other items for expectant mothers to promote the wellbeing of baby and family. In Finland, the baby box (officially called the maternity package) has been a universal benefit since 1949 and is given to all expectant mothers provided they attend antenatal care (ANC). The baby box is still considered to be a valuable social benefit in Finland today, with 95% of first-time mothers choosing the box instead of a cash grant. Although it is known that the baby box concept has been adapted across the world, there is little information available about how these adaptations have been made and for what purpose the boxes are given out. In order to map these programmes, we conducted a research project on baby boxes globally. Based on our findings, this report introduces the baby box concept, its various adaptations, and its possible uses to improve maternal and child health and wellbeing globally. The contents of this report are based on a mapping of 91 baby box programmes and an in-depth study of 29 programmes across different world regions in high-, middle- and low-income countries. These programmes were initiated by governmental bodies, non-profit organisations, United Nations (UN) agencies, hospitals, and academic institutions. Although we use the term baby “box” throughout the report, many programmes used a different container, such as a basket or bag, to package the items. The programmes ranged in scale from small to nationwide and targeted various groups, from specific vulnerable communities to all pregnant women in a country. Programmes set various goals, including reducing infant or maternal mortality, promoting the wellbeing of babies and mothers, easing financial and parenting burden, encouraging the uptake of health and community support services, and strengthening communities and reducing inequalities. They intended to achieve their goals through the practical support provided by the box and items, as well as the conditions attached to claiming the box (e.g. attendance at services) and additional education (e.g. booklets or arranged groups) included in the programme. The impact of the baby box is of timely concern, as governments are increasingly interested in the concept. However, it is difficult to provide an unequivocal answer to the question of whether the baby box “works,” as this depends on the desired outcomes of the programme. In addition, due to resource constraints, few programmes measure the impact of their intervention systematically. In response to this question and these restraints, we outline the potential current contributions of the baby box to the wellbeing of mothers and babies and provide a commentary on its possible future impact. For example, there is emerging evidence globally that baby box programmes can increase the rates of attending ANC or giving birth at a health facility, which may save lives in contexts where these rates are traditionally low. Baby box programmes may also provide psychosocial support for the mother during the vulnerable time of childbirth. Beyond their potential to support families in their everyday lives, baby box programmes may also be valuable in contexts where families have been forced to flee their homes, such as natural disasters or refugee camps. In addition to our findings, we also discuss high-interest topics surrounding the baby box, including safety issues. Ultimately, we intend for our report to serve as an overview of baby box programmes and a foundation for further research, as well as a reference for those interested in the topic or aiming to implement or evaluate a baby box programme themselves. The baby box is not a one-size-fits-all solution to intricate health challenges. However, it offers significant health and social gains, especially for those who are commonly the most vulnerable in communities: mothers and babies.31,00 euroanonPeerReviewedVertaisarvioimato

Tutkimuskatsaus Suomen sosiaaliturvan monimutkaisuuteen

Sosiaaliturvan monimutkaisuus on nostettu yhdeksi keskeiseksi ongelmakokonaisuudeksi sosiaaliturvauudistuksessa. Tässä työpaperissa tehdään ensimmäinen katsaus suomalaisen sosiaaliturvajärjestelmän monimutkaisuuteen tutkimuskirjallisuuden kautta. Monimutkaisuutta tarkastellaan lainsäädännön, toimeenpanon ja asiakkaiden kokemusten tasoilla. Lisäksi Suomen järjestelmän monimutkaisuutta vertaillaan lyhyesti muihin maihin. Tutkimusten perusteella monimutkaisuus on ongelma esimerkiksi silloin, kun se aiheuttaa etuuksien alikäyttöä, kansalaiset eivät tiedä oikeuksistaan etuuksiin tai monimutkaisuus tekee etuuksien hakemisesta hankalaa. Monimutkaisuuden on myös esitetty aiheuttavan byrokratialoukkuja, mutta aiheesta ei ole juuri tutkimusnäyttöä. Tutkimukset osoittavat monimutkaisuuden rakentuvan ja ilmenevän kaikilla kolmella edellä mainitulla sosiaaliturvajärjestelmän tasolla. Etuuslainsäädäntö esimerkiksi koostuu useista perhe- ja tulokäsitteistä. Koska sosiaaliturvan toimeenpano on hajautettu eri viranomaisille, viranomaisten välinen yhteistyö ja erityisesti viimesijaiseen toimeentuloturvaan liittyvä harkinta vaikeuttavat sosiaaliturvan toimeenpanijoiden työtä. Tutkimusten mukaan kokemukset sosiaaliturvan monimutkaisuudesta kasautuvat usein niille asiakkaille, jotka saavat samanaikaisesti useita etuuksia ja palveluita

Understanding the complexity of lowered work ability: Individuals’ perceptions of factors that affect returning to work after sickness absence

Background: Work ability is a multidimensional issue encompassing a person’s physical and mental health as well as capabilities, work demands, and many social and environmental factors. Lowered work ability is a wicked problem as it has numerous underlying reasons, requires multi-sectoral cooperation and cannot be completely solved as a social problem – only eased. This study has a multidisciplinary approach utilizing literature from public health, work psychology and occupational rehabilitation. The background section introduces the Finnish health care, rehabilitation and benefit systems and some of the recent multi-sectoral and multi-professional models that have been designed to support work ability and returning to work after sick leave. Aims: More qualitative research on factors affecting work ability is needed. Therefore, the overall purpose of this qualitative study is to add knowledge on partial work ability, focusing on individuals’ perceptions of factors that affect returning to work after sick leave. The purpose is divided into two aims: (1) to build a holistic under¬standing of the challenges that sick-listed individuals experience in their quest for resolving their situations and (2) to examine the individuals’ perceptions of available services and other factors that help or hinder them in returning to work. Sixteen individuals with prolonged sickness absence due to a musculoskeletal disease (MSD) participated in semi-structured phone interviews for this study. The interviews included questions on health, work ability, wellbeing, service use and employment. The Social Insurance Institute of Finland (Kela) had contacted the potential interviewees earlier and advised them to contact a TOIKE Work Ability Centre to receive holistic counselling. The analysis process was data-driven and utilized narrative and thematic analysis. Findings: For many, lowered work ability posed a triple-burden of sickness, unemployment and financial difficulties. This study identified five distinctive groups among those with lowered work ability based on their self-assessed health and work ability, orientation towards work or pension, and perceptions concerning their future: (1) The Successful, who had recovered well, were motivated and had returned to work. (2) The Persevering, who had not recovered well but had returned to work despite persisting work ability concerns. (3) The Forward-looking, who had not recovered nor returned to work, but were optimistic about finding a new career. (4) The Stuck, who had not recovered nor returned to work, but in contrast to the previous group, were passive and hesitant about returning to work. (5) The Pension-oriented, who were demotivated to return to work and had complex problems. The interviewees regarded the health care, rehabilitation and benefit systems as too complicated and frag¬mented. The TOIKE Work Ability Centre had provided useful counselling to some of the respondents, but unfortunately, most of the interviewees had not contacted the TOIKE Centre due to a lack of knowledge or understanding of the purpose of the pilot service. Conclusions: Individuals with lowered work ability are a heterogeneous group and therefore their service needs vary. Identifying distinctive groups among the partially disabled, as done in this study, and considering their own perceptions and needs in planning and promoting services may prove useful in designing interventions to support returning to work. This study focused on individuals with MSDs, but the five categories could possibly be applicable to other disease groups as well. Therefore, it would be important to study the perceptions of individuals whose work ability is lowered for other reasons, such as mental health disorders, for example

Understanding the complexity of lowered work ability: Individuals’ perceptions of factors that affect returning to work after sickness absence

Background: Work ability is a multidimensional issue encompassing a person’s physical and mental health as well as capabilities, work demands, and many social and environmental factors. Lowered work ability is a wicked problem as it has numerous underlying reasons, requires multi-sectoral cooperation and cannot be completely solved as a social problem – only eased. This study has a multidisciplinary approach utilizing literature from public health, work psychology and occupational rehabilitation. The background section introduces the Finnish health care, rehabilitation and benefit systems and some of the recent multi-sectoral and multi-professional models that have been designed to support work ability and returning to work after sick leave. Aims: More qualitative research on factors affecting work ability is needed. Therefore, the overall purpose of this qualitative study is to add knowledge on partial work ability, focusing on individuals’ perceptions of factors that affect returning to work after sick leave. The purpose is divided into two aims: (1) to build a holistic under¬standing of the challenges that sick-listed individuals experience in their quest for resolving their situations and (2) to examine the individuals’ perceptions of available services and other factors that help or hinder them in returning to work. Sixteen individuals with prolonged sickness absence due to a musculoskeletal disease (MSD) participated in semi-structured phone interviews for this study. The interviews included questions on health, work ability, wellbeing, service use and employment. The Social Insurance Institute of Finland (Kela) had contacted the potential interviewees earlier and advised them to contact a TOIKE Work Ability Centre to receive holistic counselling. The analysis process was data-driven and utilized narrative and thematic analysis. Findings: For many, lowered work ability posed a triple-burden of sickness, unemployment and financial difficulties. This study identified five distinctive groups among those with lowered work ability based on their self-assessed health and work ability, orientation towards work or pension, and perceptions concerning their future: (1) The Successful, who had recovered well, were motivated and had returned to work. (2) The Persevering, who had not recovered well but had returned to work despite persisting work ability concerns. (3) The Forward-looking, who had not recovered nor returned to work, but were optimistic about finding a new career. (4) The Stuck, who had not recovered nor returned to work, but in contrast to the previous group, were passive and hesitant about returning to work. (5) The Pension-oriented, who were demotivated to return to work and had complex problems. The interviewees regarded the health care, rehabilitation and benefit systems as too complicated and frag¬mented. The TOIKE Work Ability Centre had provided useful counselling to some of the respondents, but unfortunately, most of the interviewees had not contacted the TOIKE Centre due to a lack of knowledge or understanding of the purpose of the pilot service. Conclusions: Individuals with lowered work ability are a heterogeneous group and therefore their service needs vary. Identifying distinctive groups among the partially disabled, as done in this study, and considering their own perceptions and needs in planning and promoting services may prove useful in designing interventions to support returning to work. This study focused on individuals with MSDs, but the five categories could possibly be applicable to other disease groups as well. Therefore, it would be important to study the perceptions of individuals whose work ability is lowered for other reasons, such as mental health disorders, for example

The Complexity of Decreased Work Ability: Individuals’ Perceptions of Factors That Affect Returning to Work after Sickness Absence

Much of what has been written about decreased work ability is based on quantitative studies and has been written from the perspective of professionals, service providers or authorities. In our qualitative study, we sought to understand how affected individuals themselves perceive and experience the multifaceted factors that are related to their decreased work ability. Sixteen individuals in Finland with musculoskeletal diseases (MSD) participated in semi-structured interviews. The participants were potential clients of a multi-professional service pilot model, the TOIKE Work Ability Centre. Narrative and thematic analyses were utilised. The study found that individuals with decreased work ability have differing perspectives towards returning to work and often complex life situations. Five distinctive groups were identified based on self-assessed health, work ability and orientation towards work or pension: (1) the Successful; (2) the Persevering; (3) the Forward-looking; (4) the Stuck; and (5) the Pension-oriented. Health problems, unemployment, age discrimination, financial difficulties and skill deficits were the major challenges of the interviewees. Furthermore, they perceived the service and benefit systems as complicated. The TOIKE service proved useful to some of them. However, many had not utilised it due to a lack of understanding of its purpose. Identifying the distinctive groups and their needs may improve interventions. Ultimately, this may help to achieve Target 8.5 of the UN Sustainable Development Goals, which advocates the right to employment for all ages and for those with disabilities

The complexity of decreased work ability : Individuals’ perceptions of factors that affect returning to work after sickness absence

Much of what has been written about decreased work ability is based on quantitative studies and has been written from the perspective of professionals, service providers or authorities. In our qualitative study, we sought to understand how affected individuals themselves perceive and experience the multifaceted factors that are related to their decreased work ability. Sixteen individuals in Finland with musculoskeletal diseases (MSD) participated in semi-structured interviews. The participants were potential clients of a multi-professional service pilot model, the TOIKE Work Ability Centre. Narrative and thematic analyses were utilised. The study found that individuals with decreased work ability have differing perspectives towards returning to work and often complex life situations. Five distinctive groups were identified based on self-assessed health, work ability and orientation towards work or pension: (1) the Successful; (2) the Persevering; (3) the Forward-looking; (4) the Stuck; and (5) the Pension-oriented. Health problems, unemployment, age discrimination, financial difficulties and skill deficits were the major challenges of the interviewees. Furthermore, they perceived the service and benefit systems as complicated. The TOIKE service proved useful to some of them. However, many had not utilised it due to a lack of understanding of its purpose. Identifying the distinctive groups and their needs may improve interventions. Ultimately, this may help to achieve Target 8.5 of the UN Sustainable Development Goals, which advocates the right to employment for all ages and for those with disabilities.publishedVersionPeer reviewe

Kelan erityispalvelu tarjoaa nuorille kokonaisvaltaista ohjausta

Yhteiskunnallisessa keskustelussa kannetaan huolta nuorista, jotka jäävät syrjään koulutuksesta ja työelämästä. Kelassa on kehitetty erityispalvelua, jossa nuori saa pitkäjänteistä neuvontaa ja tukea elämäntilanteeseensa ja asioidensa hoitamiseen.Tutkimuksen tavoitteena oli selvittää, miten nuoret kokivat Kelan erityispalvelun ja mitä se heille merkitsi. Lisäksi selvitettiin, miten erityispalvelulla oli konkreettisesti edistetty nuorten toimintavalmiuksia. Tutkimusaineistona käytettiin yhdeksän erityispalvelua saaneen nuoren haastatteluja. Tutkimukseen osallistuneet nuoret kokivat Kelan erityispalvelun pääsääntöisesti myönteisesti. He kertoivat erityispalvelun eduiksi erityisesti sen kokonaisvaltaisuuden ja henkilökohtaisuuden. Nuoret kertoivat saaneensa tärkeää ohjausta monimutkaisiksi kokemiinsa sosiaaliturva-asioihin. Erityispalvelun myötä useat nuoret kokivat toimintavalmiuksiensa parantuneen ja elämäntilanteensa helpottuneen tai selkeytyneen

Selvitys kuntoutustukea saaneista. Aiempi tutkimus ja rekisteriseuranta vuonna 2015 kuntoutustuen aloittaneista

Tämä selvitys liittyy yleiseen yhteiskunnalliseen tavoitteeseen ehkäistä kuntoutustukien pitkittymistä ja muuttumista pysyviksi työkyvyttömyyseläkkeiksi. Selvitys on toteutettu Kelan tietopalvelujen ja ETK:n tutkimuksen yhteistyönä. Selvityksessä kartoitettiin aiempaa tutkimusta ja toteutettiin rekisteripohjainen tarkastelu kuntoutustuen vuonna 2015 aloittaneista. Selvityksen rekisteritarkastelut perustuvat Eläketurvakeskuksen ja Kelan rekisteritietoihin. Paluu kuntoutustuelta takaisin työelämään ei ole yleistä. Kotimaisissa työeläkejärjestelmään kohdistuneissa tutkimuksissa työhön palanneiden osuudet vaihtelivat pääosin reilusta kymmenestä prosentista 25 prosenttiin. Työhön paluuta ennustavia tekijöitä olivat voimassa oleva työsuhde ennen kuntoutustuen alkamista, nuorempi ikä ja kuntoutustoimenpiteisiin osallistuminen. Tuki- ja liikuntaelinten sairauksien vuoksi kuntoutustukea saaneilla työhön paluu oli todennäköisempää verrattuna mielenterveyden häiriöihin. Aiemmat suomalaiset tutkimukset ovat rajoittuneet työeläkejärjestelmästä kuntoutustukea saaviin tai yksittäisen eläkelaitoksen vakuutettuihin. Tämän selvityksen rekisteritarkastelut kohdistuivat vuonna 2015 kuntoutustuen aloittaneisiin (N = 9 699) kattaen sekä työeläke- että kansaneläkejärjestelmän kuntoutustuet. Kuntoutustuen aloittaneiden tilannetta tarkasteltiin kahden ja neljän vuoden kuluttua kuntoutustuen alkamisesta jakaen kuntoutustuen aloittaneet näissä seurantapisteissä kymmeneen mahdolliseen tilaan. Kuntoutusta tarkasteltiin sen osalta, oliko henkilö saanut työeläkekuntoutusta, Kelan kuntoutuspalveluja tai kuntoutusrahaa ensimmäisen vuoden aikana kuntoutustuen alkamisen jälkeen. Kahden vuoden kuluttua kuntoutustuen alkamisesta pysyvälle työkyvyttömyyseläkkeelle oli siirtynyt 23 % ja neljän vuoden kuluttua 31 %. Työhön palanneita kahden vuoden kuluttua kuntoutustuen alkamisesta oli 10 % ja neljän vuoden kuluttua 13 %. Miehet ja iäkkäämmät olivat naisiin ja nuorempiin verrattuna hieman useammin siirtyneet pysyvälle työkyvyttömyyseläkkeelle. Nuoremmissa ikäryhmissä pysyvää työkyvyttömyyseläkettä saavien osuudet kuitenkin kasvoivat seuranta-ajan pidentyessä ja kuntoutustuen jatkuminen nuorilla oli yleistä. Kuntoutusta ensimmäisen vuoden aikana saaneilla kuntoutustuen jatkuminen ja pysyvälle eläkkeelle siirtyminen oli harvinaisempaa ja työhön palaaminen yleisempää kuin niillä, jotka eivät olleet saaneet kuntoutusta. Erityisesti nuorimmilla kuntoutusta saaneilla kuntoutustuen jatkuminen oli selvästi harvinaisempaa. Kuntoutusta saaneet nuoret olivat myös harvemmin siirtyneet työkyvyttömyyseläkkeelle ja useammin työhön. Koska kuntoutustuelta palataan keskimäärin harvoin työelämään, opiskelu- ja työkykyä edistävään kuntoutukseen ja muihin palveluihin pitäisi päästä aiempaa varhemmin ennen kuin riski pitkittyvään työkyvyttömyyteen kasvaa merkittävästi. Selvityksen tulokset toivat esille kuntoutukseen liittyvän mahdollisuuden vähentää pysyvälle työkyvyttömyyseläkkeelle siirtymistä ja edistää työhön paluuta, vaikka kuntoutustuki olisi jo alkanut.nonPeerReviewe