Community-Based Inclusive Development
CBID Good Practices

Howawa Day Care Center for Children (Musou, Social Welfare Corporation)

（Setagaya Ward, Tokyo）

Key Words　Special Needs, Children with Severe Disabilities Needing Medical Care, Collaboration of Medical Care and Welfare

◆Background

In reality there is no perfect social system that allows people to live happily, to be cared for, and to die with dignity, but special medical care and support is vital for sick children with disabilities – the kind of support which enables them to live a fulfilled life as they grow according to their stage of development, no matter how severe their sickness or disabilities may be.

◆Service Outline

In collaboration with pediatricians who provide home medical care and with home-visit nursing stations, Howawa was established in Sumida Ward and Setagaya Ward of Tokyo for children with severe disabilities requiring special medical attention. Without such collaboration, and by depending only on a welfare organization, round-the-clock services would be impossible to render. Our day care centers are rented and renovated homes, just like in other similar projects of Musou in Handa City, Aichi Prefecture.

■Year of Establishment

Azumabashi of Sumida Ward was opened in January 2013, and another one in Seta of Setagaya Ward was opened in June 2013.

■Contents of Services

●Objectives: To improve the quality of life of children who need special medical care through the collaborative efforts of developmental medical care and welfare

●Purpose of Services and Target Groups: To support children with developmental disabilities between zero (0) and six (6) years old in need of medical attention by providing medical care and welfare services to improve their and their families’ quality of life by connecting them to the community.

●Stakeholders:

• 70 persons, including children in need of special medical care and their families
• Clinics providing home medical care by doctors and home-visit nursing stations
• Staff who support clients’ activities during the day
• People in the community

●Main Source of Revenue: Remuneration from our welfare services for children with disabilities and subsidies

●What We Have Implemented: At Howawa Day Care Centers for sick children (in Azumabashi and Seta), pediatricians specializing in home medical care, visiting nurses from home-visiting nursing stations, physiotherapists, and welfare specialists of Musou collaborate in providing medical care for the children. Regular staff members of Musou who have undergone requisite training (e.g. for the right way to perform the suction of sputum) are in principle assigned a ratio of 1:1.

(Figure text)

■Special Festures

■New Services in Tokyo (for Special Needs)

If we think about the mission behind the services we provide in Handa City, Aichi Prefecture, it all boils down to providing the support needed by people with disabilities to help them live a full life, no matter how severe their disabilities may be, and even after their parents are gone. This mission of giving support whenever and wherever to children needing special medical care in daily life is what Musou was aiming for as the welfare system had not provided it yet. To begin our support for such children, we decided to launch Howawa’s services, which combines medical care and welfare services.

It must be noted that these children needing special medical care are not covered by any long-term care insurance unlike the elderly or even by child welfare policies. In order to generate support for these children, we chose to offer our services first in Tokyo, as we were convinced by our collaborating nurses who said that “Unless we improve the situation in Tokyo, it’s impossible to save children all over Japan.”

■Making use of existing local resources

Instead of spending several billion yen to build a large-scale facility, we decided to rent a house and renovate it as a small-scale, barrier-free day care center with the capacity of five (5).

Since Howawa Seta was formerly a western-style house that used to be rented out to foreign residents, and since it was already barrier-free, all we had to do was to install an elevator.

(Figure text)

■Creating a community-based system (implementing medical care and welfare services)

Howawa Azumabashi is located not far from Aozora Clinic, which also offers home medical care. It has been about 20 months since we began our close collaboration.

This area of Tokyo still retains the warm atmosphere of the good old days when people in community took care of children.

About a year has passed since Howawa Seta was established in July 2013. Since there is an international school and many foreign residents, including children, who live in the community, local residents are quite ready to accept diversity in people, which made it easier for Howawa to blend into the community.

These children can hardly go out if not for the medical and welfare support that Howawa is providing. At Howawa, they come to know the world outside their own homes, and by playing with friends, they can live normally as other members of society.

■Ripple Effect (Project as a Model)

Since its inception, we have always hoped to expand the number of Howawa centers like a franchise. Livelihood support for children needing special medical care tends to follow the medical model, but at Howawa, we see to it that each child can enjoy life and childhood by receiving support based on the life model, which became possible through the professional cooperation of contract doctors, visiting nurses, physiotherapists and caregivers. By combining the ideas from the support given to persons with disabilities in Handa city, Aichi Prefecture, with the day care services for sick children in Tokyo, another form of service will begin in Sendai City, Miyagi Prefecture. This shows that the Musou model is steadily increasing in number and in coverage.

In September 2014, Florence, an authorized non-profit organization (in Chiyoda Ward, Tokyo) and a pioneer of day care services for sick children also started a day care center for children with disabilities called Helen in Suginami Ward, Tokyo, to provide day care services for extended hours. It may seem like competition to us, but behind the scenes, we work with each other by accepting Helen’s staff for training on Howawa’s projects, which probably best illustrates that Howawa’s program is gaining influence.

◆How Things Changed

●Working on Individuals

Howawa offers day care services for children aged zero (0) to six (6) who are highly dependent on medical care in daily life. According to Mr. Toeda, the Chairperson of the Board, visiting nurses always ask this question to the parents at detailed interviews prior to admission, “When are you planning a second/third child?” When their first child became disabled and started needing medical care, many parents naturally gave up the thought of having another child, but here at Howawa, we think having a brother or a sister will do good for children highly dependent on medical care. Considering the future life of children with disabilities after their parents are gone, their siblings could give them invaluable support, no matter how severe their disabilities might be, by following the life model instead of the medical model. For these reasons, clinics specializing in home medical care and home-visit nursing stations, which closely collaborate with Howawa, give their full support to parents when the 2nd and 3rd child are born.

●Working with Communities

Itabashi area, where Itabashi-kai is located, is known as a post-station town for the old Nakasendo road, just like Shinagawa is for the Tokaido road, and has always been known for welcoming people from the outside. Like any other old residential district of Tokyo, there is a shopping district next to the railway station where people come and go. Some unique approaches have utilized its local characteristics, leading to the creation, for instance, of the Café of Nakao Kogyo Co., Ltd. and the Mamorinbo House of the Kamiita Minamiguchi Ginza Shopping Street; and so there are an increasing number of opportunities for transitional employment in the community. A heightened awareness of such people in the community is apparent, as they are more cooperative in helping with our charity bazaar, and shop owners in the shopping district show an increased interest in our activities. Overall awareness and understanding has been definitely enhanced. The Mayor of Itabashi Ward talks of the need for more collaboration with residents in executing the policies of the local administration. The long-standing relationship between the government and the JHC Itabashi-kai has positively impacted the community through this new type of public-private partnership.

■Current lssues and Way Forward

One of the current issues is the need for a place where children can go to after school. Since the mission of Musou is to provide continuous support “from birth to death,” the day care services offered by Howawa for children highly dependent on medical care between the age of zero (0) to six (6) is only a part of Musou’s ideal. To carry out the mission of Musou, which is to provide comprehensive care services, it would be important, for instance, for such children to be able to stay at Howawa until late, just like when they are at home, and even to stay overnight if necessary. To pursue its ideal, Musou may have to create accommodation sites for small-scale programs, while creating systems that are flexible enough to respond to possible changes in disability category resulting from advanced medical technologies, and challenging some legal restrictions.

■Analysis Using the CBR Matrix

◆Areas covered by Howawa

Howawa offers day care services for children highly dependent on medical care, and it mainly covers the area of “Health” through the collaboration of medical care and welfare. Some positive impact may have been felt indirectly, but since it started only a year ago, its objectives probably have not been attained yet.

<CBR Matrix 1>

(Figure text)

◆What Howawa aims to achieve

The present services of Howawa only covers the area shown in the CBR Matrix1, but Howawa has a vision of becoming a “second home” for children with severe disabilities and their families. This vision may be achieved either by creating a service model similar to those of Musou (the social welfare corporation based in Handa, Aich Prefecture) or by having those service models complement each other.

<CBR Matrix 2>

(Figure text)