First Workshop on Health Promotion for Children and Adolescents in Hospitals

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First Workshop on Health Promotion for Children

and Adolescents in Hospitals

Report on a WHO Workshop

Barcelona, Spain, 29-30 April 2004

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Abstract

Children and adolescents have special needs for health promotion in hospitals, but a lack of tools (i.e. guidelines, standards and indicators) for this target group limits the provision of health

promotion services. A taskforce under the WHO Health Promoting Hospitals Network has started to assess, develop and disseminate tools and organized a workshop to set directions for further work.

The participants of the workshop were representatives of the WHO European Office of Barcelona - Division of Country Support, of the task force of the A. Meyer University Children’s Hospital in Florence, representatives of children hospitals, university research units and of associations on children’s rights.

As conclusions of the meeting, participants agreed on the basic strategic directions of the task force and on an action plan for future work. Moreover, agreement was reached on the design and logistics of a survey to identify further existing tools for children's hospitals and paediatric departments of general hospitals in the European Region.

Further information is available on the web site of the taskforce (www.ao-meyer.toscana.it/hph/hph- ca/) and the WHO Regional Office for Europe (www.euro.who.int/healthpromohosp), Division of Country Support.

Keywords

HOSPITALS – trends CHILD CARE

HEALTH PROMOTION CHILD ADVOCACY

CHILD, HOSPITALIZED QUALITY ASSURANCE, HEALTH CARE ADOLESCENT, HOSPITALIZED EUROPE

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© World Health Organization 2004

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CONTENTS

Page

1. Introduction ... 2

2. Background... 3

The EACH Charter for Children in Hospital...3

The Italian ‘Charter on the Rights of Children in Hospitals’...4

The Greek Questionnaire on the implementation of the Convention on the Rights of the Child in hospitals...5

Standards for health promotion in hospitals ...5

Community of Practice: application to the working group...6

3. Discussion ... 8

4. Conclusions and recommendations... 11

5. Annexes... 13

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1. Introduction

The special needs of children and adolescent in health and health promotion and the possibilities of support from the Health Promoting Hospitals Network (HPH) was discussed during the 11^th International Conference on Health Promoting Hospitals and during the 9^th Workshop of HPH Co-ordinators (Florence, May, 2003).

The team of the Health Promotion Programme of the A. Meyer Children’s University Hospital of Florence, in collaboration with the WHO European Office for Integrated Health Care Services, established a net of relationships with important children’s hospitals and paediatric departments of general hospitals; university research units and associations for the hospitalised children that were interested in participating in a project on health promotion for children and adolescents in hospitals.

The objectives of the 1st Workshop on Health Promotion for Children and Adolescents in Hospitals were:

- to establish an international working group, co-ordinated by the task force leaders at the A. Meyer Children’s Hospital,

- to agree on the general orientations of the task force,

- to discuss the availability and application of guidelines, standards and indicators for children’s hospitals and paediatric departments of general hospitals,

- to prepare the organization of a specific workshop during the 12^th International HPH conference in Moscow,

- to agree on a common action plan for the future, considering the parallel project proposal to the European Commission.

The participants of the workshop were representatives of the WHO European Office of Barcelona, of the task force of the A. Meyer University Children’s Hospital, representatives of children hospitals, university research units and of associations.

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2. Background

The World Health Organization (WHO) started the Health Promoting Hospitals Project with the aim of reorienting health care institutions to integrate health promotion and education, disease prevention and rehabilitation services into care. Many activities have been carried out and more than 700 hospitals in 25 European Countries and worldwide have joined this WHO network since the establishment of national and regional networks in 1997.

Health Promoting Hospitals have committed themselves to integrate health promotion in daily activities, i.e. to become a smoke-free setting, and to follow the Vienna Recommendations, which advocate a number of strategic and ethical directions such as encouraging patient participation, involving all professionals, fostering patients` rights and promoting a healthy environment within the hospital.

The age between childhood and adolescence represents a particularly sensible phase of life for the adoption of healthy lifestyles and the acquisition of coping mechanisms that will prove helpful in adulthood and old age. The hospital should play an increasing role in contributing to the promotion of a healthy development of children and adolescents, and should represent an opportunity of growth on the level of awareness of health promotion possibilities.

In this context, the task force prepared a project on health promotion for children and adolescents in hospitals, with the aim of developing and sharing knowledge, competencies, standards and good practices, following the principles and criteria of the Health Promoting Hospitals Network. Based on this project, a proposal will be presented to the EU VI Framework Public Health Programme (2003-2008). If the EU proposal is successful, the project will built on the WHO task force activities.

Several initiatives were presented as background for discussion during the workshop.

The EACH Charter for Children in Hospital

The European Association for Children in Hospitals (EACH) has worked extensively on the rights of children and adolescents and has agreed to support the WHO working group.

An important deliverable of EACH has been the development of a Charter for Children in Hospitals. The 10 points of the EACH Charter refer to the child’s three main needs:

a. The continuous support by the family throughout the hospital stay (# 1,2,3,6) The EACH Charter should apply from the first moment a child is born (including pre-term babies), whether it is in neonatal care, intensive care or maternity wards. “The relationship between the family and the baby should be respected, bonding facilitated, and their privacy ensured.

The baby’s global needs can be assessed by the New-born Individualised Developmental Care and Assessment Program (NIDCAP).

b. Being cared for by healthcare professionals with a good training in communication and psychological preparation (#6,7)

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Communication is not simply “information”: it is the most important premise to create a good, trusting relationship between the caring team and the patient and his/her family.

The trauma of hospitalisation can be prevented or at least reduced if children are informed about hospital in kindergarten and primary school, sharing this experience with their peers (program “Better informed, less scared”).

A short hospital stay can be more frightful than a long one, especially if the parents think that the child will easily forget this experience if they just ignore it. But the child needs to talk about his/her experience in order to understand and elaborate it.

c. Play, recreation and education as an important part of the child’s life, more so during a hospital stay (4,5,8,9,10).

Teaching or playing with a hospitalised child is different from teaching or playing with a healthy child: therefore this activity needs a special training that takes into account not only the patient’s situation, but also his/her age and cultural background.

Children shall not be admitted to adult wards, because their different needs request a specific professional training and a child adequate environment.

The Italian ‘Charter on the Rights of Children in Hospitals’

The ‘Charter’ has been elaborated by staff members of four major Italian Children’s Hospital, (‘Burlo Garofolo’ - Trieste, ‘Meyer’ - Florence, ‘Bambino Gesù’ – Rome, and

‘Giannina Gaslini’ – Genova’) in the period of time between 2000-2002, supported by a grant of the Italian Ministry of Health and Save the Children Italia.

It represents a specification of the International Convention on Rights of the Child (1989) ratified by the Italian Government in 1991. Article 24 guarantees all children the highest possible standard of health and access to health services. The fourteen Articles which compose the ‘Charter’ are intended to promote the best interest of children admitted to hospital guaranteeing their right to live, develop, be protected and to participate without distinction or discrimination.

The Charter of Rights for Children in Hospital was developed in collaboration with Parents’

and Volunteers Associations, based on the 1989 U.N. Convention and with reference to Child Care national and International Legislation, Statutory Regulations and other related documents.

The Charter is not the first developed, but it represents an evolution of comparable statements, as it extends sensibly the responsibilities of paediatric in-patient services in achieving and developing capability to interact and co-operate with any person or institution which has a role in young persons’ mental and physical development.

The fourteen articles address four general principles:

¾ the need to respect the child as an individual,

¾ to guarantee the promotion of his health,

¾ to achieve a global approach to cure and care,

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¾ to assure and promote his and his family’s involvement in making decisions regarding health processes and organisation.

Recent new developments and work perspectives:

¾ Further Italian Children’s Hospitals, members of the Steering Conference of the Italian Paediatric Hospitals, co-ordinated by the ’Meyer’ Hospital, are adopting the ’Charter’.

¾ Recently a check-list, an accreditation process and a calendar for visits were elaborated by Italian children’s hospitals.

¾ The ’Charter’ constitutes a reference point for the further work of the working group, concerning the comparison of the existing charters, and the definition of the fundamental rights.

The Greek Questionnaire on the implementation of the Convention on the Rights of the Child in hospitals

The Department of Social Medicine “P.& A. Kyriakou” in Athen’s Children’s Hospital, Greece, has developed a questionnaire on implementing the Convention on the Rights of the Child in hospitals:

Even though the U.N Convention on the Rights of the Child was ratified in Greece in 1992 the issue of children’s rights remains complex and inconsistent, despite various recommendations, guidelines and legislation.

In order to evaluate the way that paediatricians comply with the charter on a day to day basis, a questionnaire was developed and answered by 186 doctors working in the two main Children's Hospitals in Athens.

The questionnaire addressed the following areas:

¾ Environment

¾ Hospital personnel

¾ Respect of the individuality and confidentiality of Child

¾ Respect of the minority rights

¾ Participation of the Child

The conclusions of the study were that doctors agree that there are problems in hospitals regarding the sensitivity and personnel training in areas such as privacy and confidentiality of children. Children and adolescents belonging to minority groups are particularly vulnerable regarding rights such as information and participation. Details of the work were presented at the HPH conference in Moscow.

Standards for health promotion in hospitals

Usually formal hospital accreditations and quality assessments do not fully consider health promotion activities. To fill this gap and to support the evaluation of health promotion activities in hospitals five standards and complementary performance indicators have been developed.

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The standards address: hospital management policy; patients’ assessment, information and intervention; a healthy workplace; and continuity and cooperation with other providers of health promotion services. A pilot test of the five standards yielded a positive assessment of their relevance and applicability, and showed that compliance with the standards can be assessed.

A self-assessment tool for the assessment of health promotion standards and indicators has been developed and is currently being pilot implemented in 177 hospitals in 10 European countries. It is expected that all health promoting hospitals will use the standards and indicators to assess and to improve their quality of care. Further information on the health promoting hospitals project and on the standards can be found on the Regional Office web site.¹

Although the current version of standards and indicators do not address specifically the needs of children and adolescents in hospitals, they are applicable to paediatric institutions and departments and address important quality dimensions of all hospital care.

Nevertheless, further work will be carried out to identify those special needs of children and adolescents not contained in the standards and indicators, that may be included in the next revision of the document.

Community of Practice: application to the working group

A Community of Practice defines itself along three dimensions:

- a joint enterprise understood and continually renegotiated by its members;

- mutual engagement that bind members together into a social entity;

- shared repertoire of communal resources (routines, sensibilities, artefacts, vocabulary, styles, etc.) that members have developed over time.

The community of practice approach was chosen to collect and disseminate information between the working group members. Its advantage is its informal character and to use of multiple sources and methods and explore, extract and distribute information.

The basic elements for building a Community of Practice are:

− Learning is fundamentally a social phenomenon;

− Knowledge is integrated in the life of communities that share values, beliefs, languages, and ways of doing things;

− The processes of learning and membership in a community of practice are inseparable;

− Knowledge is inseparable from practice: it is not possible to know without doing; by doing, we learn;

− Empowerment - or the ability to contribute to a community - creates the potential for learning.

A community of practice defines itself through some characteristics such as being informal (non institutional) and without precise confines; to be more creative and more directed to

1http://www.euro.who.int/eprise/main/who/progs/hph/home, http://eprise/main/WHO/Progs/HPH/Publications/20040318_1

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supplying identity to its own members. A community of practice enhances tacit knowledge and adaptation to new environments.

- to improve and diffuse new knowledge and abilities;

- to sustain the organisational process of change toward health promotion;

- to build an inter-professional identity (health promoters, teachers, health professionals, architects...);

- to facilitate the solution of situations in difficulties;

- to support actions of the working group on Health Promotion for children and adolescents in hospital

A community of practice in the field of health promotion for children and adolescents in hospitals can contribute to provide continuing support to its members, offering them a identity and professionalism through communication, sharing, collaboration and generating new knowledge and experiences. Tools to achieve this are using the Internet, conferences, meetings, workshops, guidelines, benchmarking, research and projects in common, exchanges.

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3. Discussion

Health Promotion for Children and Adolescents in Hospitals Project² Health as a process of social and personal growth aims at the development of individual’s potential and starts in early childhood and lasts until the end of life.

Hospitals should play an increasing role in contributing to the promotion of the healthy growth of children and adolescents, implementing health culture practices and helping children and adolescents through the crucial episodes of development they are experiencing.

Health promotion for children and adolescents in hospitals should also involve their parents, considering not only the child or adolescent, but also his/her family as a fundamental resource for the improvement of his/her health.

Currently, hospital cultures and practices pay little attention to the specific health needs of children and adolescents and although excellent clinical services may be available, developing the children and adolescents’ full health potential may not be achieved.

The objectives of the task force therefore are:

development of a hospital culture and practice based on the respect for the children’s and adolescents’ rights in hospitals;

development of surveys and studies on the health promotion needs of children and adolescents in hospitals;

re-orientation of the hospital setting and services towards health promotion needs of children and adolescents, through the identification of a shared set of standards and indicators;

creation of a map of good hospital practices on health promotion for children and adolescents;

elaboration of recommendations and guidelines on health promotion for children and adolescents in hospitals;

growth of a new international Community of Practice on health promotion for children and adolescents;

development of a new Open Network on this issue and collaboration and cooperation between relevant networks and international programmes for children’s and adolescents’ health promotion;

general growth of health promotion activities for children in hospitals and in pediatric department of general hospitals.

To achieve these objectives the task force is based on 5 pillars:

1. an international Working Group to share ideas, knowledge and experiences, paying attention to six target groups of the population:

A) parents of the hospitalized children and adolescents;

B) hospitalized children with acute illnesses;

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C) hospitalized adolescents with acute illnesses;

D) hospitalized children with severe/chronic illnesses;

E) hospitalized adolescents with severe/chronic illnesses;

F) hospital staff;

2. an Observatory on health promotion activities for children and adolescents in hospitals; to identify and disseminate knowledge and exemplary practices on the issue of children’s and adolescents’ health promotion ;

3. an Open Network of hospitals, institutions and associations, which acquires and spreads new models and initiatives of health promotion for children and adolescents in hospitals to establish:

- connections to international programs on children’s health (e.g. WHO and E.U.

Projects, ‘Millennium project’, ‘The Child Friendly Healthcare Initiative’, UNICEF Projects e.g. ‘Baby Friendly Hospitals’, IUHPE, etc.);

- connections to other international networks, working in the field of health promotion for children and adolescents, out of the hospital context (e.g. WHO Regions for Health Network, WHO Health Promoting Schools Network);

- co-operations with hospitals for children and adolescents in developing countries;

- partnerships with other relevant parties (HOPE, Save the Children);

- recommendations and guidelines for children’s and adolescents’ hospitals and for paediatric departments of general hospitals;

- useful proposals and suggestions for policy makers.

A Community of Practice, which will promote the dissemination of the proceedings, collaborations, consensus conferences, as well as cultural and scientific comparisons;

4. an Internet-based Dialogue and Communication System (Website):

- to share scientific knowledge;

- to exchange information between partners about their activities and results;

- promoting the Community of Practice and the Open Network;

The project is divided into three phases:

1) The preliminary phase aims at:

- determining the basic conditions for the development of the project;

- analysing the general and specific conditions of the work;

- starting up an international Working Group (composed by heads of the health promotion programmes, medical directors, heads of the training programmes or university researchers), the group will be co-ordinated by the A. Meyer Children’s University Hospital of Florence, with the support of WHO.

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2) The development phase, aims at:

- elaborating data, information, orientations and collecting experiences recognised in the preliminary phase; setting up a common perspective; dividing the

accepted tasks, the criteria of action, and the evaluation methodologies.

- developing research activities and analysis of the children’s and adolescents’

health promotion needs in hospital;

- creating a map of good practices on health promotion for children and adolescents in hospitals;

- defining criteria, standards and indicators for evidence in health promotion for children and adolescents in hospitals;

- helping the exchange of information between partners;

- elaborating recommendations and guidelines on health promotion for children and adolescents in hospitals;

- setting up a specific Community of Practice and a new Open Network on health promotion for children and adolescents in Hospitals.

3) The Evolution phase, aims at:

- spreading the project results;

- spreading recommendations and guidelines on health promotion for children and adolescents in hospitals;

- connecting and co-operating with other relevant networks and international programmes for children’s and adolescents’ health promotion;

- elaborating specific contributions to the development of health policies addressed to children and adolescents.

The project development has to consider the possible acceptance and funds of the project proposal sent on the European Commission on this issue (Project acronym HP-CA-H) and find the right ways of connection and integration the complementary objectives.

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4. Conclusions and recommendations

An agreement was reached to continue with the Task Force. The working group will further develop the project for a proposal to the EU with due regard for the following issues:

1. Take into consideration the principles and guidelines of the HPH Network, adapting them to the context;

2. Use the knowledge and know-how worked out in the HPH Network;

3. Share with other experiences and resources from the Health Promotion field and which are available at children’s hospitals, paediatric departments of general hospitals, university research centres; associations and scientific societies;

4. Ensure that initiatives take into account the resources at disposal;

5. Avoid future possible overlap between the activities of the working group and the future activities planned in the project proposal presented to the European Commission;

6. Start up a cultural change for hospital professionals which allows to communicate the importance of the health promotion and its methodological connotations;

7. Consider complementary aspects for health promotion for children in hospitals, such as the respect of the children’s rights in hospital, implementation and assessment of standards and indicators, selection of groups with homogeneous pathology, methodologies of intervention and evaluation;

8. Add ‘Children as visitors in hospital’ to the target groups. They can be an important target-population for which plan new health promotion interventions;

9. Begin a preliminary exploration able to provide a general vision of the issue;

10. Kick off the project at the 12th HPH International Conference in Moscow. Three activities have already been planned:

a. a plenary session: ‘Investing in health for the future: promoting the health of children and youth’,

b. two poster session on: ‘Health promotion for children and adolescents in hospitals’. These sessions will allow to work out a meaningful picture of experiences all over European Region;

c. a parallel session entitled: ‘Health promotion for children and adolescents’

set up as a workshop. This will represent the moment of presentation and official start of the project, with the hope to collect further adhesions to the working group.

11. Follow the definitions and general orientations as described in the background paper prepared by the task force leaders at the A. Meyer Children’s Hospital;

12. Prepare a survey on the availability and application of guidelines, standards and indicators for children’s hospitals and in the paediatric departments of general hospitals in European countries;

13. Finalize the protocol for the survey. The methodology will be discussed and agreed upon by following task force members: Isabelle Aujoulat (Louvain University),

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Irmgard Eichler (Vienna University), Giuliana Filippazzi (EACH Association) and Oliver Gröne (WHO EURO);

14. Prepare a workshop on children and adolescents in hospitals for the 12th International HPH Conference in Moscow (May 2004);

15. Ensure that both the task force and EU project are complementary and not overlapping. Planning will only proceed for a 6 months period as to wait for the possible acceptance of the project proposal presented to the European Commission.

Once notice is given by EU on the financing of the project future planning can proceed further;

16. Prepare a report on the results of the workshop at the 2004 International HPH Conference in Moscow.

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5. Annexes

Programme

List of participants

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PROVISIONAL PROGRAMME

THURSDAY,29APRIL 2004

14.00 – 15.00 Welcome and presentation. Mila Garcia-Barbero, Head of the Office

The Health Promoting Hospitals Network and the Working Groups. Oliver Gröne, Technical Officer Health Services

15.00 – 16.30 Presentation of members of the Working Group 16.30 – 17.00 COFFEE BREAK

17.00 – 17.30 Overview of the project. Health Promotion Programme Team, ‘A. Meyer’ University Children’s Hospital of Florence, Italy

17.30 – 18.30 Discussion

FRIDAY,30APRIL 2004

09.00 – 09.30

THE EACH CHARTER. GIULIANA FILIPPAZZI – EUROPEAN COORDINATOR OF THE

EUROPEAN ASSOCIATION FOR CHILDREN IN HOSPITALS

09.30 – 10.00

THE CHARTER ON THE RIGHTS OF THE CHILDREN IN HOSPITALS. THE TEAM OF THE

‘HEALTH PROMOTION PROGRAMME’ OF THE ‘A. MEYER’, UNIVERSITY CHILDREN’S

HOSPITAL OF FLORENCE,ITALY

10.00–

11:00

STANDARDS AND INDICATORS OF HEALTH PROMOTION FOR CHILDREN AND

ADOLESCENTS IN HOSPITALS. OLIVER GRÖNE, TECHNICAL OFFICER HEALTH

SERVICES

11.00 – 11.30

COFFEEBREAK

11.30 – 13.00

DISCUSSION

13.00 – 14.00

LUNCH

14.00 – 14.30

BUILDING A ‘COMMUNITY OF PRACTICE’ ON HEALTH PROMOTION FOR CHILDREN AND

ADOLESCENTS IN HOSPITALS.THE TEAM OF THE ‘HEALTH PROMOTION PROGRAMME’

OF THE ‘A.MEYER’,UNIVERSITY CHILDREN’S HOSPITAL OF FLORENCE,ITALY

14.30 – 15.00

12TH INTERNATIONAL CONFERENCE ON HEALTH PROMOTING HOSPITALS (HPH) OF

MOSCOW. KICK-OFF OF THE INTERNATIONAL WORKING GROUP ON HEALTH

PROMOTION FOR CHILDREN AND ADOLESCENTS IN HOSPITALS. 15.00 –

16.00

CONCLUSIONS OF THE WORKSHOP (TO BE PRESENTED AT THE HPH NATIONAL &

REGIONAL COORDINATORS WORKSHOP AND AT THE INTERNATIONAL CONFERENCE)

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List of Participants Temporary advisers

Ms Isabelle Aujoulat-Simonazzi Unité d'éducation pour la santé RESO

Health Systems Research Ecole de Santé Publique Université catholique de Louvain

50, av. Mounier B-1200 Brussels BELGIUM

Telephone: +32.2.764.50.70 Fax: +32.2.764.50.74

E-mail: isabelle.aujoulat@reso.ucl.ac.be

Dr Laurence Bentz Public Health Physician Nice University Hospital Hôpital de L’Archet 1 BP 3079

06202 Nice Cedex 3 FRANCE

Telephone: +33 4 92035635 Fax: +33 4 92035627 E-mail: bentz.l@chu-nice.fr

Dr Manuel del Castillo Rey Director

Hospital de Sant Joan de Déu Passeig de Sant Joan de Déu, 2 08950 Esplugues de Llobregat SPAIN

Telephone: +34 93 253 21 00 Fax: +34 93 203 39 59

E-mail: mcastillo@hsjdbcn.org

Mr Jose Antonio Díaz Huertas Hospital Universitario Niño Jesus Avda. Menendez Pelayo, 65 28001 Madrid

SPAIN

Telephone: +34 915035900 ext. 487 Fax: +34 915744669

E-mail: josea.diaz@madrid.org

Ms Irmgard Eichler

Universitätsklinik für Kinder- und Jugendheilkunde Währinger Gürtel 18 - 20

A-1090 Vienna AUSTRIA

Telephone: +43-1-40400-3232 Fax: +43-1-40400-3194

E-mail: irmgard.eichler@meduniwien.ac.at

Ms Giuliana Filippazzi Co-ordinator

European Association for Children in Hospitals via Tesio 7

20151 Milan ITALY

Telephone: +39 02 4521260 Fax: +39 02 4521260

E-mail: g.filippazzi@libero.it

Dr Tiiu Härm HPH Coordinator

National Institute for Health Development Hiiu 42

11619 Tallinn ESTONIA

Telephone: +372 6 771 850/514 108 Fax: +372 6 771 801

E-mail: tiiu.harm@mail.ee; tiiu.harm@tai.ee;

tiiu.harm@itk.ee

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Dr J.W. Hartog-Dammer

Staff member "Ethnic Diversity"

Emma Children's Hospital

Academic Medical Center/University of Amsterdam F8Noord P.O. Box 22700

1100 DD Amsterdam NETHERLANDS

Telephone: +31 205663167 Fax: +31206912231

E-mail: j.w.hartog@amc.uva.nl

Dr Evgenyi V. Karpukhin Head physician

Republican Clinical Children's Hospital of Kazan Orenburgskyi Trakt, 140

420048 Kazan, Republic of Tatarstan RUSSIAN FEDERATION

Telephone: +7 8432 69-82-78 Fax: +7 8432 69-55-28

E-mail: PRIEMN@chmcrt.kcn.ru

Dr Jaume Pérez Payarols Hospital Sant Joan de Déu Passeig de Sant Joan de Déu, 2 08950 Esplugues de Llobregat SPAIN

Telephone: +34 93 253 21 00 Fax: +34 93 203 39 59

E-mail: jperezpayarols@hsjdbcn.org

Mr James E. Robinson

Health Equalities and Inclusion Facilitator Royal Hospital for Sick Children

Lothian University Hospitals NHS Trust Sciennes Road

Edinburgh

UNITED KINGDOM

Telephone: +44 131 536 0055 Fax: +44 131 536 0001

E-mail: James.Robinson@luht.scot.nhs.uk

Dr Stella Tsitoura Director

Department of Social Medicine

P. & A. KYRIAKOY Children’s Hospital 24 Messoghion Av.

115-27 Athens GREECE

Telephone: +30 210 7484233 Fax: +30 210 7484233 E-mail: socmed@otenet.gr

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Task Force on Health Promotion for Children and Adolescents in Hospitals

Dr M José Caldés Pinilla

Regional Co-ordinating Centre of the HPH Network of Tuscany

A. Meyer Children’s University Hospital Via Pico della Mirandola, 24

50123 Florence ITALY

Telephone: +39 055 5662939 Fax: +39055 5662940 E-mail: mj.caldes@meyer.it

Ms Katalin Majer

Telephone: +39 055 5662399 Fax: +39 055 5662940 E-mail: k.majer@meyer.it

Dr Paolo Morello Marchese

General Director and Co-ordinator of the HPH Network of Tuscany

A. Meyer Children’s University Hospital Via Luca Giordano 7/m

50132 Firenze ITALY

Telephone: +39 055 5662319 Fax: +39 055 5662334 E-mail: p.morello@meyer.it

Dr Fabrizio Simonelli

Telephone: +39 055 5662311 Fax: +39 055 5662940 E-mail: f.simonelli@meyer.it

World Health Organization Regional Office for Europe

Dr Mila Garcia-Barbero Head of the Office

WHO Office for Integrated Health Care Services Country Support Division

c/ Marc Aureli, 22-36 08006 Barcelona SPAIN

Telephone: +34932418270 Fax: +34932418271

E-mail: mgb@es.euro.who.int

Mr Oliver Gröne

Technical Officer, Health Services

WHO Office for Integrated Health Care Services Country Support Division

Telephone: +34932418270 Fax: +34932418271

E-mail: ogr@es.euro.who.int