ZDRUŽENJE nsocuun Revijo Socialna pedagogika izdaja Zdru; na sekcija FICE. Revija izhaja četrtletni Socialna pedagogika is a quarterly ^ al pedagogy - Slovenian national FICE Naslov uredništva je: Addres of the editors: Urednika^ To številko uredila/This issue edited by: Uredniški odbor sestavljajo: Members of the editorial board: Oblikovanje in prelom: Naslovnica: Lektorirala: Translations by: Tisk: Letnik XIII, 2009, št. 2 Vol. XIII, 2009, No. 2 ISSN 1408-2942 Spletni naslov: http://www.zzsp.org Naročnina na revijo za leto 2009 je 25 člane Združenja vključena v članarino Izdajanje revije v letu 2009 finančno p Republike Slovenije ter Ministrstvo Članke v reviji abstrahirata in indeksiral Abstracts. ženje za socialno pedagogiko - slovenska nacional-o. Vse izdajateljske pravice so pridržane. fessional journal published by Association for soci-section. Združenje za socialno pedagogiko Uredništvo revije Socialna pedagogika Kardeljeva pl. 16 (pri Pedagoški fakulteti) 1000 Ljubljana tel: (01) 589 22 00 ; Fax: (01) 589 22 33 E-mail: matej.sande@guest.arnes.si Matej Sande (glavni urednik; Ljubljana) Darja Zorc Maver and Bojan Dekleva Margot Lieberkind (Danska, Denmark) Marta Mattingly (ZDA, USA) Friedhelm Peters (Nemčija, Germany) Andreas Walther (Nemčija, Germany) Stephan Sting(Avstrija, Austria) Jacek Pyzalski (Poljska, Poland) Walter Lorenz (Italija, Italy) Ali Rahimi (Iran, Iran) Josipa Bašić (Hrvaška, Croatia) Antonija Žižak (Hrvaška, Croatia) Vesna Zunić Pavlović (Srbija, Serbia) Darja Zorc (Slovenija, Slovenia) Jana Rapuš Pavel (Slovenija, Slovenia) Olga Poljšak Škraban (Slovenija, Slovenia) Špela Razpotnik (Slovenija, Slovenia) Mitja Krajnčan (Slovenija, Slovenia) Nenad Maraš Beograjsko romsko naselje Deponija, foto Andreja Gimpelj Katarina Mihelič Urša Zavodnik Tiskarna Vovk EUR za pravne osebe. Naročnina na revijo je za odpirata Agencija za raziskovalno dejavnost šolstvo in šport RS. ita Family Studies Database in Sociogical Socialna pedagogika, 2009 vol. 13, številka 2 Kazalo/Contents Articles Članki Darja Zorc-Maver Darja Zorc-Maver Social pedagogy for the Socialna pedagogika za Reduction of Social Exclusion 109 zmanjševanje socialne izključenosti Špela Razpotnik and Bojan Dekleva Homelessness and the Accessibility of the Health Care System Špela Razpotnik in Bojan Dekleva Brezdomstvo in dostopnost zdravstvenega sistema Helena Jeriček Changes in the Behaviour of School-aged Children: new or old Educational Challenges Helena Jeriček Spremembe v vedenju šoloobveznih otrok: novi ali stari 131 vzgojni izzivi Mitja Krajnčan Mitja Krajnčan Behavioural and Emotional Vedenjske in čustvene Disorders of Children and motnje otrok in Adolescents in Slovenian mladostnikov v slovenskih Juvenile Educational Institutions 147 vzgojnih zavodih Zdravka Poldrugač Zdravka Poldrugač and Dejana Bouillet in Dejana Bouillet Social Pedagogues - from Socialni pedagogi - od Knowledge to Faith in Change 175 znanja do vere v spremembe Matej Sande Matej Sande The Use of Alcohol among Uporaba alkohola med Secondary School Students on udeleženci maturantskih Graduation Tours 197 izletov Instructions to authors 215 Navodila avtorjem ISSN 1408-2942 Darja Zorc- The texts featured in this issue' rëfîéct 'sOm^^Of- thema; Maver, PhD recent lines of research in the field of social pedagogy. All in s°dal the studies carried out, except for one that is limited to pedagogy, the Croatian space, refer to the Slovenian space. Social @ j pedagogy comprises a broad field of identifying and ariies si" researching social problems in society and represents Faculty of a scientific discipline which tries to reduce the social Education in exclusion of social groups at risk (the homeless people, Ljubljana, the unemployed, children and youth with problems), Kardeljeva Looking at it in the broadest sense, it could be said that pl, 16, 1000 social pedagogy is a scientific field that strives to attain Ljubljana, greater social justice, Its contribution is precisely in the Sl°venia fact that it tries to contribute to better living conditions and to develop a greater coping with life in the aforementioned social groups at high risk, This also represents the focal and common theme of the contributions published, The article by Špela Razpotnik and Bojan Dekleva titled »Homelessness and the Accessibility of the Health Care System« represents the first Slovenian research of this kind, The authors, on the basis of data obtained, show the deficiencies of the health care system for groups at risk and point to the need to change it in terms of lowering the entrance threshold to access health services and to create a more integral, individualized treatment of the individual groups of homeless people, The second cluster of studies is about the research of children/youth and the various forms of risky behaviour, Within this framework special attention is paid to children/youth with behavioural and emotional 110 Socialna pedagogika, 2009 vol.13, št. 2, str. 109 - 110 problems, who are due to various circumstances placed into specialized institutions such as juvenile home institutions and residential groups. In the article titled »Changes in the Behaviour of School-aged Children: new old Educational Challenges« Helena Jeriček analyzes the changes in the behaviour of children/youth, experiencing school and the spreading of forbidden substances. In the research she particularly emphasizes the feeling of greater burdening of children/youth in school and a greater degree of violence especially present among girls, whereas in the features of forbidden substances consummation there are no basic changes among youth, except for the decrease in the use of canabis. The contribution by Matej Sande »The Use of Alkohol among Secondary School Students on Gradiation Tours« is likewise centred on the alcohol use research at final secondary-school graduation excursions, which represents a specific and a widespread phenomenon of risky behaviour of youth. Prevention in order to lower the damaging consequences in this field represent a new challenge for social pedagogy. Mitja Krajnčan presents the results of a research in the field of children and youth with bahavioural and emotional problems who are placed in the various residential institutions. He tries to ascertain the criteria that make the experts in the Centres of Social Work decide about the need to place a child/youth into a special institution. He comes to the conclusion that in Slovenia there are no clearcut criteria and models and pleads for more transparent criteria in this field and a greater participation of a child/youth and parents in this decision. The contribution by Zdravka Poldrugač and Dejana Bouillet is a Croatian view of social pedagogy and its future development. The authors research the various competences which are typical of the various fields of social pedagogy activity and on this basis postulate the scientific grounding and future development of social pedagogy in Croatia. We believe that the existing social problems are not exclusively limited to the Slovenian space, although they do have certain specificities of this socio-cultural system: perhaps this is precisely what makes them interesting for the broader European space of social pedagogy. This issue in English aims exactly at this, namely to enable the broad professional community to gain access to the results of Slovenian research and to attain greater international connections and exchanges in this scientific field. Ljubljana, June 2009 Abstract Spela The article describes the results of the first Slovenian RazP°tnik, research of the health situation of the homeless people, (SocDl With a special emphasis on the accessibility of the Pedagogy) health care system. A field survey was carried out spelal on 122 homeless persons from six Slovenian towns. razpotnik The analysis has shown that the experience with the @guest.arnes. accessibility of the health care system by the homeless si; Bojan people is not optimal and that the accessibility of this ^PhE). system is smaller for those with greater risk factors. (Psychology)' Particularly threatened in this sense are the individuals bcjan.dekleva with the so-called double diagnoses. On the basis of this @guest.arnes. analysis recommendations are given for lowering the si; both threshold in health organisations, for a more integral from the and individualised approach to the homeless persons, Faculty of and for the development of outreach (health) work. Education in Ljubljana, Kardeljeva Key words: homelessness, social exclusion, health, pl. 16, 1000 accessibility of the health care system, discrimination, Ljubljana, mental health problems, alcohol, drugs, low threshold Slovenia field work, proactive work. 112 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 Povzetek Članek opisuje rezultate prve slovenske raziskave zdravstvenega stanja brezdomcev s posebnim poudarkom na dostopnosti zdravstvenega sistema. Izvedeno je bilo terensko anketiranje 122 brezdomnih oseb iz šestih slovenskih mest. Analiza je pokazala, da doživljanje dostopnosti zdravstvenega sistema s strani brezdomcev ni optimalno ter da je dostopnost tega sistema manjša za osebe, ki imajo več ogrožajočih dejavnikov. Posebej ogroženi so v tem smislu posamezniki s t. i. dvojnimi diagnozami. Na osnovi analize so podana priporočila za nižanje praga v zdravstvenih organizacijah, za bolj celosten in individualiziran pristop k brezdomcem ter za razvoj terenskega (zdravstvenega) dela. Ključne besede: brezdomstvo, socialna izključenost, zdravje, dostopnost zdravstvenega sistema, diskriminacija, težave z duševnim zdravjem, alkohol, droge, nizkopražno delo terensko delo, proaktivno delo. Introduction Homelessness in Slovenia is a relatively new phenomenon, which, as recently as a few years ago, was accompanied by rather astonished reactions of the media and the public, while there had been practically no publications on the topic of homelessness in the Slovenian expert and scientific press until the end of the previous millennium. A turning point occurred mostly in the past five years when homelessness became - within the social issue - one of the more frequent topics, first in mass media and then increasingly also in the professional journals. In the last 20 years, and particularly intensively in the last five, a network of organisations operating in the field of homelessness has also been developing. With the heterogenising of the phenomenon of homelessness (the representation of an increasing number of different specific populations according to gender, status, age, Špela Razpotnik and Bojan Dekleva: Homelessness and theAccessibility of the Health Care System 113 origin ...) this network has also expanded and heterogenised itself. Both the expanding and the heterogenisation of the organisational network, in relation to the expanding and heterogenisation of the phenomenon of homelessness itself, are naturally carried out slowly and with a time lag. The organisational network in the field of homelessness is developed best in the capital Ljubljana, and has also been developing in other Slovenian towns in the past few years: Maribor, Celje, Koper, Slovenj Gradec, Murska Sobota, Kranj ... While the European trend lies mostly in the surpassing of shelters and their replacement with more permanent, stable, and in the long run more promising forms of housing for the individual, such that would enable the individual a starting point for organising other areas of his or her life as well, in the mentioned smaller Slovenian towns, on the other hand, mostly shelters have been set up in the past years. During the wave of a new interest in homelessness in 2005 and 2006 the first larger and more complex research project was carried out specifically on the topic of homelessness (Dekleva & Razpotnik, 2007; Razpotnik & Dekleva, 2007). In the period after this research more specific topics began to open up, new expert activities and work models developed, and an awareness of new topics still left to be treated began. Among such topics are for instance the model of the housing support to the homeless in their inclusion into a more conventional way of life, the models and approaches of outreach work, the issue of the development of the model or the (internationally comparable) system of counting the homeless (which is becoming topical with Slovenia's inclusion in various European projects) and the topic of the development of the standards of treating homelessness or in general of the development of politics in this area. One of these more specific topics also concerns the health care issue or the question of the health situation of the homeless population, the question of their health care treatments, the question of how the homeless experience the health care system, what they think of its accessibility and what its attitude is towards them. The health care's attention was turned in this direction, in the broadest sense of the word, when we began to contemplate which the particularly vulnerable and threatened groups within healthcare are, and connect this concept with the notion of social 114 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 exclusion. In connection with this topic the Slovenian Ministry of Health ordered the elaboration of an analysis on the topic of Homelessness and Health. This article discusses a part of the results of this analysis1. Homelessness and the Health Care Issue One of the most pressing problem themes, connected with homelessness, is the health care issue. It also presents one of the key challenges in the forming of a policy in the field of homelessness. Numerous research in this field (for example, Riley et al., 2003; Masson & Lester, 2003) reports on the relation between homelessness and the poor medical condition or on the worse medical condition of the homeless in comparison with the general population. At the same time, this research also testifies of the more serious disease patterns within the homeless group. The medical problems of the homeless are said to be, according to the findings of much of the foreign research (for example Carter et al., 1994, and Grumbach et al., 1993; both quoted by Savage et al., 2006), mostly of a chronic nature and not as urgent, which is why long-term care and nursing is more suitable for them than an urgent one. According to the findings of numerous surveys there are three key medical problems that can be understood as causally connected with homelessness or with extreme social exclusion: mental illnesses (or in a broader sense, mental health problems), addiction to alcohol and addiction to illegal drugs. Various surveys thus find among the homeless, in addition to worse physical health, also a high level of mental health problems. Certain surveys records as much as 80 to 95 % of the homeless with mental health problems (Riley et al., 2003). Other authors report that mental health problems (often measured with a prevalence of former psychiatric hospitalisations or treatments in general) are present in 10 to 60 % of the entire homeless population and that 70 % of the homeless or more are addicted to different psychoactive substances (Scott, 1993; Savage 1 More complete information on this analysis is available in the publication »Brezdomstvo, zdravje in dostopnost zdravstvenih storitev« (Razpotnik and Dekleva, 2009), where certain segments of this article are also published. Špela Razpotnik and Bojan Dekleva: Homelessness and theAccessibility of the Health Care System 115 et al., 2006). All of the problems listed, of course, condition the creation of new ones and enable the deepening of the vicious circle of social exclusion, which in turn conditions also the exclusion from health care systems and the deepening of an unhealthy life style, thus only increasing the medical problems listed, as well as others. In addition to the three areas mentioned, within the field of homelessness/health care, infectious diseases (tuberculosis, certain liver diseases, sexually transmitted diseases) are also often discussed in professional articles, mostly from an epidemiological perspective, the risk of which increases in poor living conditions, such as that of the homeless. Research on other threatening factors frequently connected with homelessness has shown that the issue of homelessness is often connected with childhood abuse (Mounier & Andujo, 2004) and with disfunctional families (Tyler, Cauce & Whitbeck, 2004). In Scotland, for instance, among the homeless youth there is a third of those who had spent their childhood living outside the family, in an institution or a foster family (Jones, 2003). Very often the issue of homelessness and the use of various substances and addiction is connected with increased medical risks and a risky sexual behaviour (especially among the young), which increases the risk for this population to become infected with the HIV virus (Bell et al., 2003). With the latter, prostitution is also connected (Gwadz et al., 2004). Likewise, the issue of homelessness is also frequently specifically connected with the affiliation to subcultures (ethnic, cultural, regarding sexual orientation, or others) and disability (Whitbeck et al., 2004). The differences are naturally derived from the unequal position of different social groups within different societies, are connected with obstacles in the accessibility of important social sources and with the discrimination which one or the other subcultural group experiences in the (non)treatment within the health care system. The consequences of the above-mentioned characteristics are manifestly often shown as psychological peculiarities of individuals, which hinder them from establishing permanent and satisfying social relationships with others and indirectly also affect their life style, which brings health risks and worsens the accessibility of health care services. The poor medical condition of the homeless is most often contributed by authors (for example Riley et al., 2003) to the 116 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 following factors: ♦ less suitable medical care, ♦ financial obstacles in the use of health care services, ♦ nonfinancial obstacles in the use of health care services, such as problems (psychological, relationship, social ...) deriving from mental health problems and/or addictions to psychoactive substances. Masson and Lester (2003) add that much of the research confirms that the attitude of the medical staff towards the homeless creates important obstacles in the accessibility of the health care system to these people. It would be reasonable to add to this list at least one more item, namely, the health threatening life style of the homeless, which is represented by the absence of a safe residence or living in an unstable, insecure and dangerous environment, exposed to unpredictable weather and social influences. This is therefore more of a secondary consequence of the way of life itself than an independent factor. The authors Turnbull, Muckle and Masters (2007) find that despite a higher level of different illnesses and diseases the homeless, often due to different reasons, do not use medical services or feel there is a lack of effective medical services for them. The lack of medical care which the population in dicussion would feel and label as suitable is evident in the fact that the homeless visit medical institution less often than needed, resulting in their medical problems becoming accumulated, remaining untreated, often becoming old and consequently harder to solve. The lack of accessible medical care is also shown in an often mentioned phenomenon (for example Savage et al., 2006), that is, in the use of urgent help (emergency unit) as the source of basic or any kind of medical care. In other words, this means that from various reasons the homeless acquire medical care only when their medical condition is so poor that they are brought there by others or when in distress they come there themselves looking for urgent help. Many articles include contributions expressing the need for adapting the health care system, which is in many places directed towards stratification, to the most vulnerable part of the population, to which health care is the least accessible. This need is being realised across the world in the formation of proactive services accessible to the homeless and Špela Razpotnik and Bojan Dekleva: Homelessness and theAccessibility of the Health Care System 117 incorporated into the community, whose workers do not wait for the homeless to start looking for their services themselves, but make the first step and come to the environment of those that need help. Such services ought to be founded on forms of work that are based on individualised, non-discriminatory paradigms, integrated in the living space. In Slovenia as well the appearance of dispensaries intended for citizens without health insurance has taken this path, however, the problem is that these dispensaries are not included in the public health care system. When contemplating the attitude of the medical staff towards the homeless the results of the study by Masson and Lester (2003) from Great Britain deserve mention. The authors researched the attitude of medical students towards the homeless at the beginning of their study and at the end. The results have shown that within the five-year period of study the attitude of the students towards the homeless becomes worse, which mostly points to a need for programmes that educate medical workers to also include in their curriculum the issues of social exclusion, the equal treatment of all pacients and the understanding of their peculiarities. Melvin (2004) reports that the homeless feel unwelcome in general medical practices, while many have also felt an unwanted, patronising attitude of the medical staff towards them. Within the already threatened group of the homeless there can also be identified the particularly threatened groups and their specifics contemplated and discussed. As has already been said, many authors report on a high degree of mental illnesses among the homeless. Many believe that such widespread mental health problems among the homeless are a result of the disintegration of a system of institutions that were decades ago still intended for the long-term stay of people with mental health problems. Craig and Timms (1992) believe that the roots of the problem are much more complex than the mere deinstitutionalisation or breakdown of asylums. They are of the opinion that the increased extent of mental health problems among the homeless has been contributed to by the tendency towards the shortest and most intense treatments as possible, also in the events of serious, protracted and complex mental health problems. The need for medium-term and long-term care of such mental health problems and for (social) rehabilitation remains unsatisfied. And the homeless patients with mental health problems who would require a more lasting rehabilitation, and above 118 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 all continuous social care, are often designated as those that only "occupay the beds in today's often crowded health care system". The same authors (Ibid.) identify the main cause of the problems with the accessibility of suitable medical services for homeless people (with mental health problems) also in the lack of assertive field services. Melvin (2004) similarly finds that effective outreach work is recognised by many authors in the discipline today as the most successful form of engaging and including an otherwise hidden segment of users. With the change of social circumstances the structure of the population, threatened with homelessness, changes as well, including its characteristics and needs. An always interesting and important view within this is, among other things, the age structure of the homeless population, since the group of younger homeless people has different needs than the group of older ones, while the needs of both are connected with the physical health of the individual and the sociological characteristics of an individual generation. A survey performed in the USA (Garibaldi, Conde-Martel & O'Toole, 2005) dealt precisely with the comparison of the medical condition and the unsatisfied medical needs between the groups of younger and older homeless persons. The researchers included persons aged from 18 to 49 in the younger group, and persons aged 50 and above in the older group. They discussed the researched topics with the homeless in interviews. The need for medical care ranked second among the most urgent needs within the older group, right after the need for housing support. The older group reported 3.6-times more often chronic diseases, the older ones had arranged health insurance 2.8-times more often than the younger group and were addicted to heroin 2.4-times more often than the group under the age of 50 (this finding is unusual from the Slovenian viewpoint and is probably connected with the fact that the tradition of the use of heroin is much longer in the USA than in Slovenia). Those over 50 also used medical care intended especially for the homeless more often than the younger group, for instance shelter-based clinics and street outreach work. However, the older homeless persons reported rarely on the need for treating addiction with different substances (despite a greater degree of substance abuse among them). The study by Crane and Warnes (2001) has confirmed that people with combined problems, double diagnoses or the coexistence Špela Razpotnik and Bojan Dekleva: Homelessness and theAccessibility of the Health Care System 119 of problems with alcohol abuse and other drugs are particularly problematic from the point of view of the accessibility of health care services. This study has also determined that services which would fully take care of this segment of the users, that is, people with combined problems, or that would assume responsibility for them are either nonexistent or too few. Providing the users with combined problems integral care in one place would, due to their way of life, marked precisely by their lack of looking for various clinics or using their services, be of key importance. Purpose of the Research and the Methodology Used The purpose of the aforementioned analysis was to study the basic area of the medical needs of the homeless, their experiences with the health care system and their impression of the system, including the accessibility of the system, the level of their trust in this system and the experience of the attitude of the system towards them. This contribution reports only on the experiences of the accessibility of the health care system among the Slovenian homeless and on which - as regards the accessibility of the health care system - the especially threatened groups of the homeless are. The data has been obtained with individual field surveys of 122 homeless persons from six Slovenian towns. In Ljubljana the search for respondents was carried out in different locations, among which often on the streets, while in the five smaller towns only in the local homeless shelters. Our definition of homelessness which was read in the beginning to the persons surveyed goes as follows: You are homeless if you sleep outside, in basements, vestibules, bases, temporary sanctuaries, shelters or other temporary housings intended for the homeless, in housing groups for the homeless; if day to day you do not have a guaranteed roof over your head or a home of your own and have nowhere to go even if you are facing eviction. The interviewers were specially trained persons with plenty of past experience in field work with the homeless. In addition to demographic questions and many questions on the various aspects of the medical condition, the survey also included 120 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 another 40 questions on the experience with the accessibility of the health care system. Results of the Analysis The experiences with the health care system and its own treatment within it was determined with the use of two scales or item groups. The first (Table 1) was comprised of eight statements on the topic of the accessibility of medical help, information, the possibilities of participation and respectful treatment. This set was named in short »integral evaluation of the quality of medical treatment«. The respondents could choose within every item among five answers ranging from »not true at all« to »very true«. Table 1 shows the percentage of answers expressing disagreement with the claims and therefore an explicitly negative experience of the health care system. The repondents with such an experience of the system ranged from 11.6 to 26.9 %. It could be concluded in a simplified way that approximately a fifth of the respondents evaluates the possibilities of the accessibility of medical help, the possibilities of participation and of respectful treatment within it as poor. Table 1: Percentages of the repondents in disagreement with individual claims of the scale of experiences with the health care system Claim referring to the experiences with the health care system % of those who replied »not true at all« or »not true« Medical help is accessible enough when I need it. 11.6 The questions that I had posed to the medical staff were answered in an understandable way. 15.0 Before the beginning of treatment, the process of the treatment and the risks connected with the treatment were clearly explained to me. 23.1 I always participated in the decisions regarding my treatment whenever I wanted to. 26.7 I was treated with dignity and respect. 26.9 I was ensured privacy during talks and the performing of procedures. 15.1 I was acquainted with the rights and obligations as a pacient. 16.7 I evaluate the treatment I received as good. 25.8 Špela Razpotnik and Bojan Dekleva: Homelessness and theAccessibility of the Health Care System 121 The second scale was comprised of 23 claims, with a two-level option of answering, YES or NO, This scale (Table 2) contains more specific and concrete views of (mostly) negative characteristics of the operation of the health care system, again from the point of view of the persons treated within it, the accessibility, adaptation and attitude of the medical staff, It has been named »obstacles in the accessibility of medical services«, This term, of course, includes both the objective and the subjective aspects, in addition to the awareness of the fact that this is a process which is realised with the cooperation between users and individual segments of the health care system, The percentages of the critical respondents vary in the case of individual items from 15 to 70 %, with approximately 45 % on average, Some of the items may not have much to do with the health care system directly (for example I have problems with transportation to the place of help or The location of the institution is unsuitable for me); others are of a sort of subjective nature (for example I do not know how to seek help); the third could be called systematic (for example The entry waiting line is too long); while the fourth allegedly reflect both the conduct of the staff as well as the experiences of the users, most likely precisely in connection with the special characteristics of the homeless (for example Ifeel discriminated in the medical institution), Three of the claims express a positive evaluation, while the remaining 19 express a negative one (if the respondents agree with them), Viewed on the whole, a majority of the viewpoints that the scale inquires about is perceived negatively by between 30 and 50 % of the users, which is most certainly worrisome, 122 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 Table 2: Percentage of the repondents in disagreement with individual claims of the scale of experiences with the health care system Claim referring to the experiences with the health care system % of those who agree with this claim The health care workers are not kind or friendly. 37.8 The health care workers do not properly understand my needs, problems ... 50.8 The health care workers assess and judge me too much. 37.8 I have problems with transportation to the place of help 32.5 I do not have the necessary documents to enter a programme (for example health insurance). 31.1 The location of the institution is unsuitable for me (hard to access .). 16.8 I do not know how to seek help. 15.3 I feel discriminated in the medical institution. 33.3 I have bad experiences with experts/I do not trust them. 34.5 The entry waiting line is too long 69.7 The time for a checkup/conversation is limited. 65.5 Medical institutions cannot help me. 21.3 Medical services are too expensive. 63.6 The atmosphere in medical institutions is too chaotic. 55.5 The employees do not possess enough knowledge to work with the homeless. 58.5 The expectations and demands of the medical institutions are too great (for example abstinence). 55.1 No confidentiality. 42.0 The programmes are not adapted enough to special groups (for example the homeless, users of illicit drugs .). 61.9 Limited working hours of the services. 65.5 I have the option of filing a complaint against the medical services I have received. 66.1 The preparation period for the inclusion into a treatment programme that I need is too long. 56.4 I am satisfied with the attitude of the doctors towards me. 63.2 I am satisfied with the attitude of other health care workers (nurses, technicians ...) towards me 67.8 A few separate questions also inquired about the specific (critical) aspects of treatment within health care. Two of these questions explicitly inquired about the experience of discrimination, namely, one question asked about an experience regarding the homeless status, and the other regarding the status of a drug user. Answers Špela Razpotnik and Bojan Dekleva: Homelessness and theAccessibility of the Health Care System 123 in Table 3 show that both statuses are largely connected with discrimination in the experiences of the users, and in a far greater degree with the status of the drug user than with the homeless one. A certain not negligible portion of the respondents was of the opinion that they had been discriminated positively, however, there were approximately four times less of them than of those who had experienced negative discrimination. Table 3: Answers of respondents (in percents) to two questions on discrimination, connected with two stigmatised statuses (the answers to both similarly set questions shown separately in two columns). ^^^^^^^ To whom or what does Have you the question refer? ever had the feeling of being treated differently in medical ^^^^^^^ institutions because you are homeless/a drug user? ^^^^^^^^ Refers to the homeless status Refers to the status of drug user (N = 44) Yes, in a negative sense (stigmatisation, isolation, avoidance, insults ...)• 33.9 50.0 Yes, in a positive sense (special privileges, extra attention of the medical staff and social service ...). 8.3 11.4 I did not have a feeling of being treated differently because I am homeless/a drug user. 36.4 13.6 In my opinion the medical staff did not know I was homeless/ a drug user. 14.0 9.1 After reviewing the distribution of answers to the questions on the accessibility of the health care system we tackled the question of whether there are any systematic differences in the perception of the health care system between individual groups of homeless persons. Two key indicators of the experiencing of the health care system have been chosen, namely: - on the basis of the set of questions shown in Table 1 a composite variable has been formed, called »integral evaluation of the quality of medical treatment«. The scale has proved to be very reliable (Cronbach alfa amounted to 0.91), which is why this indicator was formed by adding up the values of the answers to all eight questions: - on the basis of the set of questions shown in Table 2 a second composite variable has been formed, called »obstacles in the accessibility of medical services«. In the case of this scale as 124 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 well a high Cronbach alfa (0.87) was reached, which is why we have added up the values of the answers to all the 23 questions in the scale. Table 4 shows the correlations between 18 independent variables (characteristics of the subgroups of the homeless persons) and between these two criterion indicators. In the cells of the table the degree of statistical importance has been entered (where the difference between groups was statistically important on the level of at least 0.100) and a description of the relation between the independent and criterion variable. If this relation was not statistically important the appropriate cell only contains the dash mark (-). Seen on an example: in the cell defined by the fourth row and second column, the value of 0,000 is written, which indicates that the groups of homeless persons, which differ according to the age at which they had experienced their first period of homelessness, differ greatly as regards their average integral evaluation of the quality of medical treatment, namely so that the higher age of the first homelessness is connected with a higher evaluation of the integral evaluation of the quality of medical treatment. Table 4: Relation between 18 independent variables and two criterion indicators of the experiences with the health care system. Each cells contains the statistical probability of error (if smaller than 0.10; ANOVA) and a description of the direction of the correlation (if it is statistically significant). Characteristics of subgroups of the homeless Integral evaluation of the quality of medical treatment Obstacles in the accessibility of medical services Gender - - Age - - Higher education 0.096 A higher evaluation of quality. - Higher age of first homelessness 0.000 A higher evaluation of quality. 0.003 Experiences less obstacles. Total duration/state of homelessness - - Visited a doctor in the past year. - - Resided in a youth home. 0.031 A lower evaluation of quality. 0.031 Experiences greater obstacles. Spent time in prison. - 0.009 Experiences greater obstacles. Špela Razpotnik and Bojan Dekleva: Homelessness and theAccessibility of the Health Care System 125 Continuation of table 4: Higher social support 0,027 A higher evaluation of quality, 0,013 Experiences less obstacles, Addiction to alcohol (by their own evaluation) 0,001 A lower evaluation of quality, 0,002 Experiences greater obstacles, Higher result on the AUDIT scale (harmful drinking of alcohol) 0,000 A lower evaluation of quality, 0,000 Experiences greater obstacles, addiction to drugs (by their own evaluation) 0,003 A lower evaluation of quality, 0,075 Experiences greater obstacles, Has tried heroin, 0,009 A lower evaluation of quality, 0,041 Experiences greater obstacles, Resided in a unit for treating addiction, 0,075 A lower evaluation of quality, 0,086 Experiences greater obstacles, Higher number of signs of mental problems/ psychiatric treatment 0,000 A lower evaluation of quality, 0,001 Experiences greater obstacles, Resided in a psychiatric hospital, 0,003 A lower evaluation of quality, 0,020 Experiences greater obstacles, Has in addition to mental problems (at least one sign of four) at least one more diagnosed addiction (either to alcohol or to illegal drugs), 0,000 A lower evaluation of quality, 0,000 Experiences greater obstacles, The results in Table 4 can be briefly (and in a simplified manner) summed up as follows: the more of the different threatening factors a subgroup of homeless persons has, the worse it evaluates the quality of the health care system, the more obstacles it experiences in the use of it and the harder accessible it seems, If we analyse Table 4 in greater detail, we see that: - persons who had experienced the first period of homelessness earlier in life evaluate the health care system as worse and experience it as less accessible, This result can be interpreted in at least three ways, The first being that perhaps those who had first become homeless in a lower age are more often users of illicit drugs, while those who had first become homeless when older are users of licit drugs or nonusers, The obtained result can be explained with the supposition that the health care system is less inclined towards the users of illicit drugs or is not adapted enough to them, The other possible explanation is that the 126 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 homeless who had become such later in life have a longer period of experience with conventional life and were socialised in a way that also implies a greater acceptance of a (conventional) health care system. The third explanation could be that in the case of the homeless who had become such earlier in life there are several types of the threatening and disadvantageous bio-and psychosocial factors present and more of them, giving them more characteristics today, which means that the health care system accepts them with greater difficulty, and is at the same time harder to access; - persons who had already resided in a youth home, an teratment establishment or prison evaluate the health care system as worse and experience it as less accessible. Residing in one of the mentioned institutions also indicates the existence of several types of the threatening and disadvantageous bio- and psychosocial factors present and more of them, which are obviously connected with worser accessibility of the health care system; - persons with worse social support networks evaluate the health care system as worse and experience it as less accessible. The problem here is that the formal networks (among which belongs the health care one) could - ideally - compensate for the worse developed and active informal social networks, however, our data does not point to such an effect; - persons who are addicted to alcohol and use it in more harmful ways evaluate the health care system as worse and experience it as less accessible; - persons who are addicted to illicit drugs and use them in more harmful ways evaluate the health care system as worse and experience it as less accessible; - persons who show several signs of mental health problems or have already been psychiatrically hospitalised evaluate the health care system as worse and experience it as less accessible; - persons with the so-called double diagnoses, comorbidity or a simultaneous presence of addiction and certain other mental problems/illnesses particularly obviously (statistically significantly) evaluate the health care system as worse and experience it as less accessible. Špela Razpotnik and Bojan Dekleva: Homelessness and theAccessibility of the Health Care System 127 Conclusions The basic finding of the analysis is that the health care system is less accessible and of lesser quality for those homeless persons who are by themselves more at risk, more burdened with disadvantageous factors, with a worse medical condition (here mostly mental problems and addictions were checked), with an otherwise worse psychosocial support and less (positive) experiences with conventional life and would therefore need a better, increased and easier accessibility of the system. Such a result is in accordance with most of the research in this field. For the successful use and operation of the health care system there is hence a multitude of social and individual suppositions for which we assume are realised for all users, however, it has turned out that in the case of the homeless this is often (or even as a rule) not valid. The reflection on the medical treatment (or on the handling of the health care issue) of the homeless people must therefore include more than just a reflection on the »treatment« in the narrow sense of the word, that is, more than just offering relatively narrowly defined health care services. Thus it is not enough to offer professionally suitable procedures of diagnosis and treatment, but it must be actively (actually »proactively«) reflected on how the homeless will understand and use the medical options and offers, and then, naturally, take action in accordance with the actual living situation of the homeless. Our survey has shown (as had much of the other quoted surveys) that in this case the persons particularly at risk are the ones with the so-called double diagnoses or combined problems or that these persons should be offered special care. In literature several models of proactive and special, specific health care for the homeless are often mentioned. In Slovenia a model of a »social dispensary« has been developed, which on its own already sets certain eliminating entry criteria (the use of illicit drugs!). The key recommendations deriving from our analysis show the need for: - lowering the threshold for entry into the health and dental care system; - integral treatment or at least the integral acceptance of an 128 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 individual within a single (medical) organisation (nonstigmatising and nondiscriminatory treatment); - a more individualised help and one adapted to the individual; in particular the specific groups of the homeless ought to be emphasised (the young homeless, users of illicit drugs, individuals with double diagnoses, the elderly, the infirm and invalid homeless); - developing models of outreach work with the purpose of reaching the hidden subgroups of the homeless and placing such work within the public health and social security, Literature 1, Bell, D, N,, Martinez, J,, Botwinick, G,, Shaw, K,, Walker, L, E,, Doods, S,, Sell, R, L,, Johnson, R, L,, Friedman, L, B,, Sotheran, J, L,, and Siciliano, C, (2003), Case finding for HIVpositive youth: a special type of hidden population, Journal of Adolescent Health, 33/2, pp, 10-22, 2, Craig T, and Timms P, W, (1992), Out of wards and onto the streets? De-institutionalisation and homelessness in Britain, Journal of Mental health, 1, pp. 265-275. 3, Crane M, and Warnes, A, (2001), The responsibility to care for single homeless people, Health and Social Care in the Community, 9/6, pp. 436-444. 4, Dekleva, B, and Razpotnik, Š, (2007), Brezdomstvo v Ljubljani. Ljubljana: Pedagoška fakulteta v Ljubljani, 5, Garibaldi, B,, Conde-Martel A, and O'Toole T, P, (2005), Self-Reported Comorbidities, Perceived Needs, and Sources for Usual Care for Older and Younger Homeless Adults, Journal of General Internal Medicine, 20/8, pp. 726-730. 6, Gwadz, M, V,, Clatts, M, C,, Leonard, N, R, and Goldsamt, L, D, (2004), Attachment style, childhood adversity, and behavioral risk among young men who have sex with men, Journal of Adolescent Health, 34/5, pp. 402-413, Špela Razpotnik and Bojan Dekleva: Homelessness and theAccessibility of the Health Care System 129 7. Jones, G. (2003). Youth homelessness and the 'underclass'. In R. MacDonald, (ed.), Youth, the ' Underclass', and the Social Exclusion. London, New York: Routledge, pp. 96-113. 8. Masson, N., and Lester, H. (2003). The attitudes of medical students towards homeless people: does medical school make a difference? Medical Education, 2003/37, pp. 869-872. 9. Melvin, P. (2004). A nursing service for homeless people with mental health problems. Mental Health Practice, 7/8, pp. 2831. 10. Mounier, C., and Andujo, E. (2003). Defensive functioning of homeless youth in relation to experiences of child maltreatment and cumulative victimization. Child Abuse & Neglect, 27/10, pp. 1187-1204. 11. Razpotnik, Š., and Dekleva, B. (eds.) (2009). Brezdomstvo, zdravje in dostopnost zdravstvenih storitev. Ljubljana: Ministrstvo za zdravje. 12. Razpotnik, Š., and Dekleva, B. (2007). Na cesti - brezdomci o sebi in drugi o njih. Ljubljana: Pedagoška fakulteta. 13. Riley, E. D., Wu, A. W., Perry, S., Clark, R. A., Moss, A. R., Crane, J., and Bangsberg, D. R. (2003). Depression and Drug Use Impact Health Status among Marginally Housed HIV-Infected Individuals. AIDS Patient Care & STDs; 17/8, pp. 401-406. 14. Savage, C. L., Lindsell, C. J., Gillespie, D. L., Dempsey, A., Lee, J. R., and Corbin, A. (2006). Health Care Needs of Homeless Adults at a Nurse Managed Clinics. Journal of community health and nursing, 23/4, pp. 225-234. 15. Scott, J. (1993). Homelessness and mental illness. British Journal of Psychiatry, 162, pp. 314-324. 16. Turnbull, J., Muckle, W., Masters, C. (2007). Homelessness and health. Poverty and human development, 177/9, pp. 10651066. 17. Tyler, K. A., Cauce, A. M., and Whitbeck, L. (2004). Family risk factors and prevalence of dissociative symptoms among homeless and runaway youth. Child Abuse & Neglect, 28/3, pp. 355-366. 130 _Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 18. Whitbeck, L. B., Johnson, D. K., Hoyt, D. R. and Cauce, A. M. (2004). Mental disorder and comorbidity among runaway and homeless adolescents. Journal of Adolescent Health, 35/2, pp. 132-140. Empirical article, submitted for translation in May 2009. Helena Jeriček Summary Helena The article presents a result comparison of the Jeriček, international study Health Behaviour in School- I tPtlDt*, aged Children, relating to children aged 11-, 13- and of Public 15- (n=5130). The purpose of the research study is Health of to gain insight into and to increase understanding of Republic children's and adolescent's health, well-being, health of behaviour and social context. The article focuses on Slovenia, some important differences between the years 2002 ~ and 2006 regarding leisure time, school-related Ljubljana stress, bullying, physical fighting and risk behaviours helena' - alcohol, tobacco and cannabis use among children jericek and adolescents. It ascertains that children spend their @ivz-rs.si leisure time more passively, they are less physically active, are less sociable and more aggressive in 132 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 their behaviour and feel more burdened with school than back in the year 2002. Moreover, the use of tobacco and cannabis is less frequent, while alcohol consumption remains more or less the same. These changes present new - old educational challenges for social pedagogues. Key words: leisure time, television use, computer use, socializing, violence, school-related stress, tobacco, alcohol and cannabis consumption. Povzetek Članek predstavi primerjavo rezultatov mednarodne študije Z zdravjem povezano vedenje v šolskem obdobju med 11-, 13- in 15-letniki pri nas (n = 5130). Namen raziskave je dobiti vpogled ter bolje razumeti vedenja otrok in mladostnikov. Članek se osredotoči na nekatere pomembne razlike med letoma 2002 in 2006 v preživljanju prostega časa, obremenjenosti s šolo, trpinčenju, pretepanju in tveganih vedenjih: uporabi alkohola, tobaka in marihuane pri otrocih in mladostnikih. Ugotavlja, da otroci preživljajo svoj prosti čas pasivno, se manj gibljejo, manj družijo z vrstniki, se bolj nasilno vedejo in se čutijo bolj obremenjeni s šolo kot leta 2002. Poleg tega jih manj uporablja tobak in marihuano, medtem ko pri opijanju ni bistvenih razlik z letom 2002. Te spremembe so za socialne pedagoge novi - stari vzgojni izzivi. Ključne besede: preživljanje prostega časa, gledanje televizije, uporaba računalnika, druženje z vrstniki, nasilje, obremenjenost s šolo, uporaba tobaka, alkohola in marihuane. Helena Jeriček: Changes in the Behaviour of School-aged Children: new or old Educational Challenges 133 Introduction and purpose of the research study Children and adolescents are the group most frequently dealt with and discussed by social pedagogues in theireducational, preventive, consultative and group work (e,g, Poljšak Škraban, 2003, Rozman, 2003, Plajnšek, 2004), That is why it is important to be familiar with typical features of their lifestyle and habits, as well as with the changes having occurred within this population group over the recent years, In this way we can gain a better understanding of their world and emotional responding, be better prepared to work with them, gain target training for certain skills, and react more adequately in case of problems, The article presents results of the international study Health Behaviour in School-aged Children: a WHO collaborative Cross-National Study (acronym HBSC), This is an international research project taking place every four years; Slovenia first participated in the year 2002, and the second round was made in 2006 (including fourty-one states), The aim of the research is to gain more profound understanding of life and health of children and adolescents in the broadest sense, The notion of health in this research study is not understood as absence of disease in individual, but rather as his prosperity, full use of personal potentials, as satisfaction and successful tackling everyday problems, good relations, communication skills, etc, The research study includes different indicators, i,e, demographic data, nutrition habits, oral health, physical activity, smoking, alcohol and cannabis consumption, life satisfaction, self-rated health, stress in school, violence, injuries and other behaviour types, reflecting children's and adolescent's lifestyle, My article refers only to a certain types of behaviour, relevant for the work of a social pedagogue and pointing to educational shifts and possible directions of future activities, Methods HBSC is a research project, carried out every four years in schools and based on data, acquired by a questionnaire, completed by elementary/secondary school pupils in classrooms, The age of 134 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 target groups is 11,5, 13,5 and 15,5 years, respectively. According to international standards, the sample includes about 1.500 representatives of each age group in every participating state. The research project applies quantitative methodology, i.e. a standard international questionnaire, based on the questions from former rounds, each round also going through a few corrections. The questionnaire results from cooperation between members of the HBSC research network, including all the member states. The questionnaire should imply all the obligatory questions in the sequence and form, prescribed by the research protocol, except for some inevitable translation adjustments. As Slovenia has been going through a reform of the school system in recent years - the introduction of a nine-year elementary school - the sampling was more difficult than in the schoolyear 2001/2002. The sampling unit was class/department; a sample numbering over 6000 children and adolescents (about 2000 from each age group) was randomly selected from the list, comprising 280 classes. The final structure of the base was 5130 children and adolescents, about half of them were boys. The anonymous opinion poll took place in classrooms, during classes. It was carried out by the consultative workers we contacted when preparing class lists. After examination of the collected questionnaries and data insertion, the base was organized in accordance with international standards and sent to Norway for purification. When it came back cleaned, it was submitted to the SPSS program processing. Results As already mentioned, a limited number of behaviour types will be discussed, i.e. leisure time activity, violence, school-related stress and risk behaviours. Leisure-time activity Leisure time is the time when an individual is free to do whatever he likes, i.e. engage into activities he enjoys and finds interesting as well as relaxing. Research studies indicate that the way how Helena Jeriček: Changes in the Behaviour of School-aged Children: new or old Educational Challenges 135 children and adolescents spend leisure time largely depends on sex, age, school success, socio-economic status of their families, as well as on schoolmates and friends (Derganc, 2004). The data on family structure show that in the year 2006 statistically significant lesser number (2,6 %) of respondents lived with both parents (84,3 %). On the other hand, the share of children and adolescents living with one parent only (mostly mother, 86%) increased (by 1,5 %), as compared to the year 2002. Different research studies refering to the youth of Slovenia ascertain (Ule, 1995; Ule, 1996; Ule & Rener, 1998; Ule, 2000; Ule & Kuhar, 2002; Gril, 2004) that their leisure time is mostly dedicated to associating with friends, TV watching, listening to music and sports. These activities were also included into the HBSC researchstudy, where our main interest was how much of their after-school time was spent on social activities, TV watching, games, computer use and physical exercise. a.) Associating with friends Associating with friends is an important aspect of adolescence and emancipation, affecting child's and adolescent's identity, self-image, emotions, behaviour, social contacts, etc. Children and adolscents were inquired about size of peer group affiliation - about numbers of close friends, about frequency of meeting them, as well as about other forms of communicating - by phone, SMS messages and email. Compared to the year 2002, in the year 2006 there was a significant increase in the share of adolescents (by 8 %, HBSC 2002 29,8 %, HBSC 2006 37,8 %) never associating with friends in their leisure-time (in the evenings). The share of adolescents getting together with friends more often than 4 days a week decreased by almost 5 % (HBSC 2002 12,1 %, HBSC 2006 7,8 %). This means that the youngs are now less sociable than in the year 2002 (graph 1). Likewise, it is interesting that the number of respondents without any friends appears to be slightly higher than in 2002, although this difference is not statistically significant. Compared to boys, girls have less friends of both sexes. The share of 15-year olds spending 4 or more evenings a week with friends (14,9 %) is higher than with 13-year olds (11,7 %) or 11-year olds (10,8 %). 136 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 Graph 1: Proportion of young people, associating with friends in leisure-time in the evenings, comparison between HBSC 2002 and HBSC 2006 by gender (HBSC 2002, n=3956; HBSC 2006, n=5064, p<0,05). 0 10 20 30 40 50 Peer contact in the evening frequency HBSC 2002 HBSC 2006 Boys Girls Boys Girls F % F % F % F % Never 520 26.1 657 33.6 854 34.0 1061 41.6 1 to 2 days 740 37.2 761 38.9 972 38.7 1003 39.3 3 to 4 days 434 21.8 361 18.5 430 17.1 349 13.7 More than 4 days 298 15.0 179 9.1 256 10.1 145 5.4 Majority - 80 % of boys and 88 % of girls - communicate with friends at least once a week by phone, written messages or internet; 39,6 % of girls and 30,8 % of boys do that every day, and 10,1 % of male and 13,1 % of female respondents do that five or six times a week. The use of electronic communication media increases with age. Compared to the year 2002, the share of adolscents having daily communication with their friends increased by almost 2 %. Helena Jeriček: Changes in the Behaviour of School-aged Children: new or old Educational Challenges 137 b.) Physical activity Contemporary way of life with all the social, cultural and technological changes is leading to an increasingly sedentary lifestyle, so with young people as with adults (Elgar, Roberts, Moore and Tudor-Smith, 2005; Koprivnikar, 2005), despite the fact that regular physical activity appears to be a significant protective factor against bad health and development of different noncontagious diseases. One of the questions of our research study was how many days per week - before answering the questionnaire - were you physically active of at least moderate intensity for at least 60 minutes per day? Compared to the year 2002, respondents were less physically active than in 2006. The number of boys and girls who were not physically active in the week before questionning was higher (3,2 % of boys and 5 % of girls in the year 2006; 2,9 % of boys and 3,8 % of girls in the year 2002); on the other hand, the number of those having at least one hour of physical exercise every day decreased (21,9 % of boys and 13,3 % of girls in the year 2006, 29,0 % of boys and 16,4 % of girls in the year 2002). The average number of active days per week (see table 1) thus decreased. 15-year olds were the least and 11-year olds the most physically active among our respondents. Table 1: Mean number of days when adolescents are physically active per week - comparison between HBSC 2002 and HBSC 2006 by gender (HBSC 2002, n=3859; HBSC 2006, n=5063, p<0,05) Year Gender Boys Girls HBSC 2002 4.59 3.83 HBSC 2006 4.26 3.62 c.) Television and computer TV and computer are the favourite media of young people. Children and adolescent use these two mostly at home, which is why family environment plays decisive role in one's susceptibility to a sedentary lifestyle (Salmon, 2005). Our research study focused on the amount of leisure-time dedicated to television and computer games, as well as to chatrooms, internet, email and homeworks, during weekends and through the week. 138 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 The data indicate (table 2) that the number of young people not watching television during the week was higher in 2006 (4,6 %; boys 3,4 %, girls 5,7 %), although, on the other hand, the number of those watching TV more than 6 hours a day was also higher (4,6 %; boys 5,6 %, girls 3,4 %). Slightly less than half of the respondents watch TV two to three hours a day, so during the week as during the weekends, whereby the share of during-the-week decreased by almost 4,0 % (HBSC 2002 49,8 %, HBSC 2006 46,1 %), while the weekend share increased by almost 2 % (HBSC 2002 43,1 %, HBSC 2006 45,0 %). There are no other significant differences regarding weekends between 2002 and 2006. It is interesting, though, that boys are keener TV viewers and game players than girls. Table 2: Frequency of television watching among young people during the week and during weekends by gender - comparison between HBSC 2002 and HBSC 2006 (HBSC 2002, n=3956; HBSC 2006, n=1530, p<0,05) HBSC 2002 HBSC 2006 Television use on weekdays Boys Girls Boys Girls F % F % F % F % None at all 42 2.1 85 4.2 86 3.4 146 5.7 30 minutes to 1 hour 526 26.5 566 29.0 771 30.4 866 33.9 2 to 3 hours 998 50.2 968 49.5 1195 47.2 1150 44.9 4 to 5 hours 341 17.1 294 15.0 336 13.2 310 12.1 6 hours or more 82 4.2 43 2.2 144 5.6 88 3.4 Television use on weekend Boys Girls Boys Girls F % F % F % F % None at all 46 2.3 61 3.1 55 2.2 64 2.5 30 minutes to 1 hour 286 14.5 366 18.8 412 20.7 389 15.2 2 to 3 hours 830 42.0 862 44.1 1090 43.0 1201 47.0 4 to 5 hours 572 29.0 491 25.1 661 26.1 670 26.2 6 hours or more 242 12.3 172 8.8 314 12.4 232 9.0 d.) Watching television during weekends The 2002 - 2006 comparisons regarding game playing and the use of computer for chatting, internet, email and homeworks are not possible as these very questions were not posed in 2002. The data for 2006 indicate (table 3) that boys are more frequent game players than girls; on the other hand, the share of girls using computer for internet, chatting, email and homeworks is higher than with boys. Almost half of the girls (49,5 %) don't indulge in playing computer Helena Jeriček: Changes in the Behaviour of School-aged Children: new or old Educational Challenges 139 games on weekdays, this percentage being considerably lower with boys, i.e. 15 %. Game playing is more frequent on weekends, so with boys as with girls. There are 12 % of boys playing games for six hours or more on weekends. The highest share of those not playing computer games is among the 15-year olds. It is interesting that on weekdays 31,4 % of boys and 28,4 % of girls do not use computer for chatting, internet, email and homeworks. The corresponding shares for weekends are 31,2 % and 26,8 %, respectively. The highest share of children not using computer for these activities is among the 11-year olds. Table 3: The frequency of computer use for playing games and for chatting, internet, email and homeworks among young people on weekdays and weekends in 2006 by gender (HBSC 2006, n=5130, p<0,05) HBSC 2006 - on weekdays HBSC 2006 - on weekend Playing computer games Boys Girls Boys Girls F % F % F % F % None at all 379 15.0 1267 49.5 274 10.9 944 36.9 30 minutes to 1 hour 1004 39.9 975 38.1 641 25.4 1008 39.4 2 to 3 hours 756 29.2 246 9.4 885 35.2 421 16.5 4 to 5 hours 6 hours or more 239 9.5 57 2.2 416 16.5 138 5.4 146 5.7 17 0.6 301 12.0 44 1.7 Using computer for internet, chatting,... Boys Girls Boys Girls F % F % F % F % None at all 794 31.4 726 28.4 787 31.2 684 26.8 30 minutes to 1 hour 977 38.6 1060 41.5 750 29.7 816 31.9 2 to 3 hours 812 19.6 540 21.1 657 22.5 645 25.3 4 to 5 hours 156 6.2 251 6.1 231 9.1 276 10.8 6 hours or more 80 4.3 72 2.8 190 7.5 131 5.1 Violence (bullying, physical fighting and victimization) Violence and its growth - so among schoolmates as within family (Kordič, 2007) - is nowadays a very widely discussed topic (Dekleva, 1996; Antončič, 2006; Chapell et al., 2006). The HBSC research study also focuses on this kind of violence, i.e the frequency of fighting, bullying and victimization. The latter was defined as violence which can either be verbal (pricking, abuse), or 140 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 psychological (intimidation, threats, exclusion from the peer groups or rejection), and physical (kicking, boxing, beating), including unbalance of strength between victim and attacker. According to the obtained results, violence among young people is increasing. The share of children and adolescents involved in bullying over the last 12 months increased by almost 4% in 2006. The increase is higher with girls than with boys. Thus, 45,1 % of the respondents were involved in fights in 2006 (61,5 % of boys and 28,7 % of girls). There were 14,3 % of frequent bullies in the sample (20,6 % of boys and 8 % of girls). The share of frequent bullies was highest among 13-year olds (16,7 %) and lowest among 15-year olds (10,6 %). The increase was also observed in the share of children and adolescents having responded they were victims of bullying over the last few months, i.e. by 2,2 % (from 22,4 % to 24,8 %). The share of respondents who had taken part in bullying also increased by over 4 % (from 23,1 % to 27,8 %, see table 4). Those most often involved in bullying were 13-year olds. Table 4: Proportion of young people who bully others and who are being bullied - comparison between HBSC 2002 and HBSC 2006 (HBSC 2002, n=3956; HBSC 2006, n=5130, p<0,05) Being bullied HBSC 2002 HBSC 2006 F % F % Never 3054 77.6 3790 75.2 1 or 2 times 603 15.3 781 15.5 2 or 3 times a month 99 2.5 141 2.8 About once a week 81 2.1 144 2.9 Several times a week 99 2.5 182 3.6 Bullying others F % F % Never 3009 76.9 3634 72.1 1 or 2 times 692 17.7 1033 20.5 2 or 3 times a month 86 2.2 158 3.1 About once a week 60 1.5 123 2.4 Several times a week 67 1.7 89 1.8 Helena Jeriček: Changes in the Behaviour of School-aged Children: new or old Educational Challenges 141 School pressure Apart from family school has a major role in child's and adolescent's development (Samdal, Nutbeam, Wold and Kannas, 1998).. Out of the cluster of questions concerning school we selected the question on whether and to what degree respondents consider themselves pressured with and how they like school. According to the HBSC research results, Slovenian parents' expectations regarding school success are high, as 97 % encourage their children to work well at school. According to our findings respondents feel they are now more pressured with school than in the year 2002. The share of respondents claiming they find school rather burdensome increased by almost 5 %; on the other hand, the number of respondents not suffering from school pressure at all decreased (Table 5). There are no statistically significant differences regarding sex, but only age. 11-year olds are the ones least pressured by schoolwork. Table 5: »How pressured do you feel by the school-work you have to do?« -comparison between HBSC 2002 and HBSC 2006 (HBSC 2002, n=3912; HBSC 2006, n=5115, p<0,05) Pressured by schoolwork HBSC 2002 HBSC 2006 Not at all 444 11.3 370 7.2 A little 1656 42.3 2113 41.3 Some 1245 31.8 1864 36.4 A lot 567 14.5 768 15.0 Girls like school better than boys (34,8 % of girls and 28,3 % of boys responded they like school very much); 13-years olds are most and 15-year olds are least happy with school. Compared to the year 2002, respondents enjoyed school less in the year 2006. The share of respondents who do not like school at all increased (from 9,7 % to 10,3 %), same as the share of those who do not like it very much (from 11,1 % to 19,3 %). 142 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 Risk behaviour (tobacco, alcohol, cannabis) The use of tobacco, alcohol and psychoactive substances is one of the behaviour forms helping adolescents find their place, understanding and approval within their generation. However, such behaviour can become dangerous if it starts too early in child's development, if it becomes habitual and is no longer limited to occassions and special events, and also if it involves a lifestyle that is unsuitable for an adolescent, aggravating and preventing constructive activities (Tomori et al., 1998), or even leading to addiction. That is why it is highly important to have control over the use of these substances. Children and adolescents were asked if they ever smoked tobacco, got drunk or tried cannabis; we were also interested in their favourite alcohol drinks, etc. Table 6 presents data on tobacco smoking and alcohol intoxication. According to these data, the share of those who have already smoked tobacco decreased by 5,4% in the year 2006; regarding alcohol intoxication there were no essential differences between the two years. Table 6: Proportion of adolescents who had contact with the listed risk behaviour types - HBSC 2002 and HBSC 2006 comparison by gender (HBSC 2002, n=3956; HBSC 2006, n=5130, p<0,05) Risk behaviours HBSC 2002 HBSC 2006 Yes No Yes No F % F % F % F % Have you ever smoked tobacco? 1437 36.4 2541 63.6 1584 31.0 3538 69.0 Have you ever had so much alcohol that you were really drunk? 1243 31.6 2693 68.4 1576 31.0 3501 69.0 The question on the use of cannabis was only posed to 15-year olds. According to the obtained data, the share of those who didn't tried it yet, is higher in 2006 than in 2002. Boys are more frequent consumers of cannabis than girls. Helena Jeriček: Changes in the Behaviour of School-aged Children: new or old Educational Challenges 143 Table 7: The frequency of cannabis use anytime in life among 15-year olds -comparison between HBSC 2002 and HBSC 2006 (HBSC 2002, n=1059; HBSC 2006, n=1524, p<0,05) Cannabis use in lifetime HBSC 2002 HBSC 2006 F % F % Never 759 71.7 1252 82.2 Once or twice 92 8.7 117 7.7 3 to 5 times 49 4.6 41 2.7 6 to 9 times 26 2.5 33 2.2 10 to 19 times 40 3.8 23 1.5 20 to 39 times 27 2.5 16 1.0 40 times or more 66 6.2 42 2.8 The importance of the HBSC research study for the work with young people The HBSC research study provides an insight into behaviour, emotions and views of children and adolescents in Slovenia. Moreover, data resulting from such representative studies, attempting to simulate longitudinal studies, provide ground for: - keeping abreast with development trends of certain behaviour types among young people, - comparing data according to sex, age, socioeconomic status, etc. - comparing data with other states (with some time difference). All this is a highlly valuable information for experts dealing in one way or another with children and adolescents, especially for those engaged in preventive and promotional activities, based on population approach. These experts use the acquired data for priority setting, planning, intervention evaluation and activities aimed on entire population. Such approach is reflected in the activities, embracing all or most schools, like children's parliament, healthy schools, compulsory optional subjects, etc. Unfortunately, behaviour of concrete individuals or groups cannot be foreseen on the basis of such and similar studies. People are alive, unpredictable, unique, constantly changing and free in their choice of lifestyle, responding and understanding. 144 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 The work with people (including children and adolescents) is very unpredicatble, evading generalizations and demanding a high degree of adaptability and flexibility. An expert has to deal separately with each individual, and get to know his emotions, thinking, actions, wishes, problems, etc. Yet even an expert can never be quite familiar with another person's emotions and reactions, nor can he foresee tha nature of interaction. This uncertainty is a cause of permanent tension and fear on the part of experts, generating a wish for clear standards, rules and recipes for action. But, is this (rules, standards, set procedures) really a way to get rid of insecurity, or is it just shifting responsibility for our actions on other people or external factors? Personally I believe such quantitative research studies to be useful, especially if they are international and carried out periodically. Conclusions The HBSC research study includes 11-, 13- and 15-year olds, categorized, according to some theories, into preadolescent and early adolescent period. This is a difficult period of adolescence, often characterized by psycho-social crisis and identity confusion, when the adolescent is neither sure who he is nor what he would like to become. Children are more sensitive and emotional in this period, having conflicts inside themselves and with others. Apart from physical and emotional changes, their thinking and behaviour is also affected by family patterns, social climate, media and society values. Development trends and changes of certain behaviour types and emotional responses of children and adolescents, proceeding from the research study, therefore also reflect wider trends in families and society, which are not altogether new. Considering the contemporary trends of social, technological and economic development, generally accepted values, as well as increasing carreer- and school-pressure, the acquired data are no longer so surprising. The increasing use of contemporary technologies generates an ever more sedentary lifestyle, as well as passive leisure-time spending in the safe shelter of home. This is the probable cause of less frequent »in vivo« associating with friends and classmates, as well as of growing popularity of phone contacts, internet chatrooms Helena Jeriček: Changes in the Behaviour of School-aged Children: new or old Educational Challenges 145 and email. Since certain types of behaviour are group related only - smoking, alcohol consumption, cannabis use - this might be the reason of their decrease in the year 2006. Another surprising trend is the increase of violence, especially among girls. On the one hand, violent behaviour can result from increasing burdens and pressures (so in school as from parents), and on the other hand it can also serve as a kind of defence. However, a more detailed research study would be necessary to confirm or disprove these hypotheses. References 1. Antončič, E. (2006). Vretniško nasilje in prestopništvo pri otrocih in mladostnikih. V A. Črnak Meglič (ur.), Otroci in mladina v prehodni družbi. Ljubljana: Ministrstvo za šolstvo in šport in Aristej. 2. Chapell, M. S., Hasselman, S. L., Kitchin, T., Lomon, S. N, MacIver, K. W., Sarullo, P. L. (2006). Bullying in elementary school, high school, and college. Adolescence, 41(164), 633-48. 3. Dekleva, B. (1996). Nasilje med vrstniki v zvezi s šolo - obseg pojava. Revija za kriminalistiko in kriminologijo, 47 (4), 355-365. 4. Derganc, S. (2004). Prosti čas mladih. Ljubljana: Društvo Mladinski ceh. 5. Elgar, F. J., Roberts, C., Moore, L., Tudor-Smith, C. (2005). Sedentary behaviour, physical activity and weight problems in adolescents in Wales. Public Health, 6 (119), 519-525. 6. Gril, A. (2004). Prosti čas mladih v Ljubljani: Psihosocialna analiza potreb in možnosti za njihovo uresničevanje. Raziskovalno poročilo. Ljubljana: MOL. 7. Koprivnikar, H. (2005). Telesna dejavnost pri mladih v svetu. Zdrav življenjski slog srednješolcev. Ljubljana: Inštitut za varovanje zdravja Republike Slovenije, s. 48-54. 8. Kordič, B. (2007). Etiologija, dinamika in posledice nasilja v družini. Socialna pedagogika, 11 (4), 429-452. 9. Plajnšek, N. (2004). Razumevanje socialno-pedagoške diagnostike in njenih uporabnikov v šolskem prostoru z vidika šolskega svetovalnega dela. Socialna pedagogika, 8 (3), 367-384. 146 Socialna pedagogika, 2 009 vol.13, št. 2, str. 111 - 130 10. Poljšak Škraban, O. (2003). Razlike v doživljanju družinskih interakcij med posameznimi člani družine mladostnic. Socialna pedagogika, 7 (2), 125-158. 11. Rozman, D. (2003). Vzgojni in preventivni programi socialnega učenja med vrstniki v osnovni šoli. Socialna pedagogika, 7 (2), 159-178. 12. Salmon, J., Timperio, A., Telford, A., Carver, A., Crawford, A. (2005). Association of Family Environment with Chilldren's Television Viewing with low Level of Physical Activity. Obesity research, 13 (11), 1939-1951. 13. Samdal, O., Nutbeam, Wold, B., Kannas, L. (1998). Achieving health and educational goals through school - a study of the importance of the school climate and the student' satisfaction with school. Health education research, 13 (3), 383-97. 14. Tomori, M., Stergar, E., Pinter, B., Rus Makovec, M., Stinkovič, S. (1998). Dejavniki tveganja pri slovenskih srednješolcih. Ljubljana: Ministrstvo za znanost in tehnologijo in Ministrstvo za zdravstvo RS. 15. Ule, M. (1995). Vsakdanji svet mladih. V M. Ule in V. Miheljak, Pri/ehodnostmladine, 73-88. Ljubljana: Urad Republike Slovenije za mladino in DZS. 16. Ule, M. (1996). Identiteta študentske mladine v Sloveniji. V M. M. idr., Predah za študentsko mladino. Ljubljana: Urad Republike Slovenije za mladino in Juventa. 17. Ule, M. (2000). Spremembe v življenjskem svetu mladih ali odgovor mladih na vrnitev negotovosti. V M. Ule (ur.), Socialna ranljivost mladih. Ljubljana, Maribor: Urad Republike Slovenije za mladino in Aristej, s. 57-70. 18. Ule, M., Kuhar, M. (2002). Sodobna mladina: Izziv sprememb. V V. Miheljak (ur.), Mladina 2000. Ljubljana, Maribor: Urad Republike Slovenije za mladino in Aristej, s. 40-78. 19. Ule, M., Rener, T. (1998). Prosti čas mladih v Ljubljani. Raziskovalno poročilo. Ljubljana: MOL. Empirical article, submitted for translation in January 2008. vzgojnih zavodih Mitja Krajnčan Abstract Mitja Children and adolescents with behavioural and Krajnčan, emotional disorders are very inconsistently placed in Phpe