『保健医療科学』 2021 第70巻 第4号 p.352-363（2021年10月）
特集：子どもへの虐待のない社会の実現に向けて―児童虐待予防に向けた課題と戦略― ＜総説＞
児童相談所保健師に期待される役割
中板育美
武蔵野大学看護学部
Expectations of the public health nurses to activate the Child Guidance Center
NAKAITA Ikumi
Faculty of Nursing, Musashino University
抄録
令和元年の児童福祉法の改正で，「児童の健康及び心身の発達に関する専門的な知識及び技術を必要とする指導をつかさどる所員の中には，医師及び保健師が，それぞれ 1 人以上含まれなければならないこと」と規定され，児童虐待の中核的機関である児童相談所に「医師及び保健師」が配置されることになった（令和 4 年 4 月 1 日施行）．
児童相談所は，児童福祉法（昭和22年）を根拠として設立され，児童福祉行政の最前線の役割を担ってきている．そこで勤務する保健師の役割は，1964（昭和39）年の「児童相談所執務必携」に「保健婦は，－中略－とくに育児相談，三歳児の精密検査，一時保護児童の健康管理などに他の職員とともにあたる必要がある」と記載されたのが初めてである．しかし，これまでの児童相談所保健師は，「児童福祉司」，「保健師と児童福祉司の兼務」など任用もさまざまで，系統的な役割活動につながるには困難もあり，職業的アイデンティティの揺らぎも生じていた．児相の幅広い専門性を充実・強化する一端として，児童相談所の保健師の増員が見込まれることは重責である．そこで，児相保健師の専門性を文献から分析し，そこから役割を展望した．
その結果，児相保健師は，人事の発令上「児童福祉司」であっても，「ソーシャルワーク的思考と公衆衛生活動を組み合わせた活動をする」「チームアプローチを重視する」「医学的視点と生活の視点で家族を観て保護的に支える」「母子保健法の強みを児相内で活用する」「母子保健事業で要支援の潜在ケースを顕在化させる」「親子の関係性の評価も含めた健康管理をする」「措置解除から在宅養育への切れ目のない支援を実現する」「精神保健と精神医療と児童福祉の橋渡しをする」「相談・支援を要する人を相談者に導き，必要な時に傍にいる」など活動の実際は多様であり，従来の保健活動スキルを生かしていた．児相に保健師として必置となる今後は，「児童福祉を担う他職種には不足していて，保健師が提案できる視点・考え方・技術は何か」の分析が問われていく．
キーワード：児童相談所，保健師，歴史，公衆衛生，役割
Abstract
The revised Child Welfare Law of 2019 (enforced on April 1,2022) stipulated that “at least one doctor and one public health nurse (PHN) should be included in the staff in charge of guidance that requires specialized knowledge and skills concerning the health and physical and mental development of children. Doctors and public health nurses have begun to be assigned to Child Guidance Centers (CGCs), the core institutions dealing with child abuse. The CGCs were established in response to the 1947 Child Welfare Law and have played a pivotal role in child welfare administration. In 1964, the Manual for the Administration of Child Guidance Centers defined the role of PHNs working in CGCs for the first time, stating that “PHNs should collaborate with other staff members, particularly when it comes to counseling children, performing precise examinations of three-year-old children, and managing the health of temporarily protected children”[11].
However, public health nurses assigned to CGCs have been appointed in various capacities, such as “child welfare officer (CWO)” or “concurrently serving as PHN and CWO.” This has led to some difficulties in connecting with consistent role activities and some fluctuations in the professional identity of public health nurses. The anticipated growth in the number of PHNs in CGCs is one of the ways to enhance and strengthen the expertise of CGCs. Therefore, the expertise and the roles of PHNs working in CGCs have been analyzed through a review of the literature.
The results showed that, despite their designation as a CWO, the PHN working in CGC is engaged in a variety of activities. They incorporated PHN skills such as integrating social work and public health activities, emphasizing a team approach, assessing families from medical and lifestyle perspectives, providing protective support, leveraging the strengths of maternal and child health law within the CGC, identifying potential cases requiring support through maternal and child health services, providing health management including assessment of the relationship between parents and children, seamlessly providing childcare support at home when terminating child protection, mediating between mental health, psychiatry and child welfare, guiding those who need counseling and support to counselors, and being with them.
In the near future, more PHNs will be required to work in CGCs, and they will be expected to propose novel ideas and skills that are distinct from those of other child welfare professionals.
keywords: Child Guidance Center, Public Health Nurse, history, public health, role
