Transcript for
Including children and young people in practice and policy decisions

Narrator (00:02): Welcome to the Emerging Minds Podcast.

Dan Moss (00:08): Hi, everybody. Welcome to the Emerging Minds Podcast. I’m Dan Moss, and today I’m talking to Dr. Ben Lohmeyer. Ben is a lecturer in social work at Flinders University. Welcome, Ben. Thank you for coming today.

Ben Lohmeyer (00:23): Oh, great. It’s great to be here. Thank you.

Dan Moss (00:26): So Ben, tell me a bit about your work with future social workers at Flinders University.

Ben Lohmeyer (00:32): Sure. So, I joined the social work team at Flinders at the start of this year, just over six months. My job is to teach the social policy topics, so that sounds super boring, which is what most students expect as well when they come in. I would say this regularly on the kind of conversations I have with students, and most of them don’t come in thinking they want to work in policy or all that sort of paperworky stuff, but the approach for the topic is actually a lot more fun than that. We talk about big ideas and big questions. Because that’s what policy is about at the social policy level, right?

(01:08): It’s about us thinking about how do we all live together and work together and how do we make this work when we’ve got issues like healthcare or education, or even some more specific issues like domestic and family violence or immigration, that sort of stuff. So in my classes, we just come in and we talk about that and we think about, “Is there a better way for us to do this? Can we bring a social work lens to that?” And yeah, usually it’s a lot of fun.

Dan Moss (01:33): Yeah. I know that a lot of what you do is thinking about how we conceptualise problems within social policy and a lot’s been, I suppose, thought about in terms of how we conceptualise children and children’s mental health over the past decades. Can you tell me a little bit about how you think that’s evolved and what’s important in terms of how we conceptualise our work with children?

Ben Lohmeyer (01:56): Yeah. Great question. The bit about problems is really interesting because that’s the kind of language we use in this social policy approach, but it sounds really negative as well, doesn’t it? Usually we try and, when we’re working with young people, take a sort of strength-based approach, but the idea of problems is just kind of acknowledging that we think about issues in a particular way.

(02:17): How do we approach any given social issue and how do we think about that and that kind of shapes how we’re going to respond to it. So when we’re thinking about children and young people, traditionally, we’ve thought about them as kind of passive, people who perhaps aren’t quite adult yet. They’re not quite old enough or intelligent enough or something to really kind of think about issues and problems. My challenge in my topics is to say well, maybe there’s other ways of thinking about these issues, other ways of problematizing or shaping the problems.

(02:47): So I think you are asking, how do we thought about children and young people? It’s got a bit of a long history and I’ll do a really short snapshot without getting too boring, but largely we’ve thought about children and young people as just passive and unable to think about issues. Even in research, sometimes we’ve gone to talk to adult proxies instead of children and young people themselves. We want to hear about children and young people, but we go talk to their parents, or their teacher, or a doctor instead of talking to them directly.

(03:16): Thankfully there’s a bit of a shift in that, because I think it’s really an important to actually listen to the voices of young people themselves and treat them as experts in their own lives. There’s a kind of classic article in the UN Convention on the Rights of the Child that sort of says young people and children should have a voice in things that affect their lives.

(03:34): So that’s a really good starting point for thinking about how do we approach problems in young people’s lives? Maybe they’re important and their voice is important in what they have to say. There’s some interesting moves that happened since then. So that idea of participation in decisions that affect their lives is really important, but there’re some shifts that happened after that, around perhaps thinking ideas like citizenship. Do we think of children and young people as citizens holding rights, or they’ve got partial rights and responsibilities?

(04:06): There’s this shift that comes after that in a lot of the thinking about it towards civic engagement, which is kind of this strange term, but it almost tries to speak to how do we prepare young people and children to have an influence around decision-making things, but that also has this other side to it, which is suggesting that young people aren’t prepared, and we kind of have to train them and educate them. So there’s lots of ways which these thoughts about children and young people can encourage us to include them, but also ways of excluding them.

(04:35): Those exclusionary things are really an interesting part of my research. That’s what I’m interested in. How do we exclude young people from decision making? There’s a little bit of work, I’ve done some writing recently looking at things like young people’s protest. Young people were involved in things like climate strike movements and how their voices in those spaces actually kind of keep getting disqualified.

(04:58): There are things like thinking about students and young people as kind of just puppets of other people’s agenda, or thinking about them as perhaps indoctrinated. These are the kind of language that we use to discount their voices, but I’m really interested in saying that young people can be really important leaders in this space as well.

Dan Moss (05:14): Yeah, because there are some quite profound effects throughout history really, of the effects of this exclusionary way or passive way of thinking about children, which obviously in recent times have been connected to the way we view children’s rights. Do you want to talk a little bit about that in your own research?

Ben Lohmeyer (05:33): Sure, yeah. How they’ve been excluded and the effects on that. Yeah, look, if we treat young people as not capable, we start with that way of thinking, then we can end up creating kind of policies or programmes or practise… Because part of my background as well, as a youth work practitioner prior to getting into academia, that has really sort of strange effects on young people’s lives. So one of the things I’m interested in at the moment is young people’s experiences of bullying in school.

(06:01): My broader interests are around violence, but less from a way of thinking about it that identifies risk and resiliency factors in young people, thinking about the things that we might want to change to improve their lives as being the young person themselves, to thinking about perhaps the places that they inhabit. You know, where do they live and exist?

(06:22): If we’re thinking about school bullying, why don’t we think about the school? What is it about the school that makes bullying more likely to happen or perhaps legitimises or sanctions it at times? So if we start with adult perspectives on things, we kind of have a range of assumptions that come along with that, with where the problem is. If we start with the young person-centred one, we might find something a little bit different.

(06:44): My research recently on bullying looked at this dominant way of thinking about it. It’s been around for about 30 years. A guy by the name of Olweus came up with a definition of bullying and we kind of still use the same one. It talks about repetition, bullying has to be repeated, there has to be some sort of power imbalance in there as well. There’s a third category name… Which I’m struggling to remember on the spot, but there was a third thing.

(07:07): Anyway, he has this definition that has kind of kept going for about 30 years, but recently people have been questioning it a bit, and saying, “Is this really what bullying looks like?” Because sometimes there’s some strange results we get, if we take this definition of bullying and we go to talk to children about it. There’s some research that shows that children don’t identify these factors of bullying, like repetition and power imbalance and that sort of stuff.

(07:29): And so, well, what do you do with that? If you’ve got this definition of bullying and young people aren’t recognising it, how do we fix that problem? Or the solution seems to be that we educate them better, right? We teach young people what bullying is. Thought, okay, that’s maybe one solution, but that’s starting with this added assumption of what bullying is.

(07:46): Another way of looking at the data is to say, “What are young people actually worried about? What are children worried about?” It seems that they mixed bullying in with a whole range of other harmful negative behaviours. Maybe they’re just interested, worried about harmful and negative behaviours. Maybe they just want to have a good time at school, and it doesn’t matter whether we call it bullying, or if it’s harassment, or if it’s just fighting or if it’s something else. Maybe what’s important is the harm bit. So yeah, if we start with added assumptions, I think we end up potentially approaching problems in ways that don’t make sense for the young people.

Dan Moss (08:18): Yeah. It’s really fascinating, Ben. One of the things that we’ve been interested in at Emerging Minds is changing practitioners’ perspective shifts, and one of those main perspective shifts has been from a passive understanding of children to an active understanding of children. That’s really how, when you’re in front of them in a professional engagement, how do you ask them questions around their preferences, knowhow, strengths, rather than implying that adults are the font of all wisdom within the room.

Ben Lohmeyer (08:48): Yeah, correct.

Dan Moss (08:48): This certainly, what you’re talking about resonates now. When you’re working with young social workers, or social work undergraduates, how do you kind of work to instil this questioning within them to think about how children have been excluded from practical policy in the past and to help them much more aware of what children can contribute?

Ben Lohmeyer (09:08): My way of doing that is probably a couple of different things. One is making them aware of some of the things that we’ve already talked about, like the connection on Rights of the Child and ways and values of giving them options to have a say and participate and have an influence over decisions. So you’re kind of giving them some sort of frame of reference for the conversation. So that’s really important. But the other part of it, I think, is giving people an experience of what that’s like. So if, I want people as practitioners, to engage with others as equals, so engage with children as equals to bring them into a conversation, I have to kind of embody that in my teaching as well. Right. So it’s easy as a teacher, as a lecturer to go, “Oh, I’ve got all the knowledge and I’ve just got to kind of give that to you.”

(09:52): And that’s the kind of traditional model of teaching, I suppose, that lots of people might have experienced at school. There’s a description of that as the ‘Banking’ model of education. So I deposit knowledge in your mind and then you kind of regurgitate that back to me later in some sort of assessment, but that’s really a limited way of thinking about what education can be. But also it’s kind of antithetical towards the practise that we want them to do. So instead of doing that, I try and create spaces in education that have that democratic dialogue between equals involved and the students can be at the centre of the learning experience rather than me as the expert. And then hopefully that’s… Whilst we are talking about the idea of putting young people at children at centre and giving control, we’re also doing that in our teaching. That’s kind of the two approaches that I have.

Dan Moss (10:41): Yeah, that’s great Ben. And then taking that a step further, what can social workers do when they’re practising with children to really be centering children’s wisdom and their preferences and what they know particularly when talking about their social and emotional wellbeing or their mental health?

Ben Lohmeyer (10:58): Great question. There’s some really good research around this and there’s probably a couple of really great frameworks that I’ll point to. There’s one that’s called Hart’s ‘Ladder of Participation’, which people have probably heard of before, and it has a really great description of different levels of participation and ownership over the process that children and young people can have, and some great principles in there for us to think through. At the very top of the ladder, it talks about how we can create ways for child initiated-decision making. So rather than adults coming in saying, “I want to talk about this with you.”, what are the young people and children already talking about? How do we join in on that? So that’s a really interesting and challenging idea.

(11:38): I think, particularly for service delivery that so often adults started like, how does a service begin? Well, it usually begins because… I kind of link back to social policy. Somebody identified a problem somewhere in a policy setting and said, “We’re going to fund this service.” So immediately that’s, it’s an adult, their decision, isn’t it? So we want to deliver this service to young people and that’s setting the conversation up in the agenda already. So maybe that’s just a reality we have to work with. So how do we actually then turn that around when we’re working with a child or a young person? And I will point to actually a recent podcast that I did with an interview with a colleague of mine, her name’s Carmela Bastian, and she’s been doing some great research about child center’s practise in child protection. Which is so funny, because you’d think child protection, right, it’s got to be child centred, surely. Yeah, that’s what it’s all about. But her research showed that it’s actually quite difficult to balance the desires of the child in there alongside the institutional requirements of keeping children safe.

(12:34): So there’s some great techniques and ways of thinking again about the problem of child protection through different kinds of knowledges. And she talks about kind of your child protection practises, as well as your knowledge of adolescent and psychological development theory. But alongside that is practise wisdom, she says that over time practitioners learn what’s going to actually work in a conversation. And that can be as simple as if I just sit with you in a room and try and talk about this, it’s probably not going to work and the child or young person is just not going to be interested.

(13:08): But what if we go and get some food together? Or one of the things that I used to love doing is go for a drive and you know, just sitting in a car with the young person and we’re going somewhere and it changes the orientation of you physically, but also somehow the conversation because you’ve got this other journey destination that you’re going to. And you have a conversation about so many amazing things that perhaps are less focused on the agenda that I have as an adult and more spontaneous in the space. So yeah, there’s some of the things I think about.

Dan Moss (13:37): Yeah, that’s great Ben. And then thinking about how to privilege a child’s voice or to make them more active within a social work context, how do you then extend that to your work with whole of families, where maybe a parent is accompanying their child to a session, a parent might be feeling stressed or anxious about their ability to provide the level of support that their child needs or they’re at their wit’s end. How do you make sure that you’re both child focused, but not providing a punitive response to adults in the room?

Ben Lohmeyer (14:09): That’s a really great question, and a really hard one. I almost have to make a bit of confession at this point. I’m not actually a social worker in the sense that I don’t have a social work degree. So I’m part of the social work programme and I teach knowledge and experience and ideas around social work, but I’m actually a youth worker. And so my background as a youth worker brings a certain orientation and ethical framework to it where youth workers, just part of what makes them distinct from other kind of social, community care workers, have the young person as the primary client. So we see them as… Our sole responsibility is actually not to manage the multiple demands that other professionals might, but we have to be interested in the young person first. And part of that is built on a theory and a philosophy that young people are inherently excluded from decision making and from society because of their age and therefore they need somebody who’s… Not need in a really kind of negative sense, but it’s beneficial for there to be somebody who’s oriented mainly towards them.

(15:10): So that’s really hard. And I was thinking about how has this worked out in practise for me, sometimes. There’s one story that really comes to mind. I was working with a young person who was new to our service and I was having a conversation with him, which was going reasonably well. And then after the session, I got a call from his mum, and mum just wanted to have a bit of an insight into what we’re up to. So within the framework that I’ve described, having a primary client, I tried to give her some details, but also give a little bit of clarity that there’s actually a little bit of a need for me to have confidentiality here. Otherwise, your son just won’t trust me. We can’t have meaningful conversations about things. And she seemed to understand that, which was great, but clearly she went and had a chat with her son afterwards because the next time he came in, he didn’t talk to me.

(15:54): He actually said, “You talked to my mom, I don’t want to talk to you anymore.” And it was really awkward, and we sat there for a long time in silence. I sort of had blown that in a way. Now, I thought I’d stuck as best as I could to my principles of that. But clearly for that young person, there wasn’t a level of trust there anymore that made it safe for him to have any further conversations. So how do you do that? I don’t know, it’s really tough, right? Perhaps part of it is having those really open conversations at the start and saying, “Well, this is what my job is. These are what I can talk about, and these are what I can’t talk about. And here’s some ways that I can support you.” So that’s really important.

(16:31): The only other part to that I’d put is, youth worker’s job is to have the personal relationship with the young person, but also care about their social context. So you still have to think about the family that they’re part of, that the community they’re part of, the society that we’re part of. And so there still is a responsibility to work alongside those other members of that community as well. So there’s not really straightforward answer, but it sort of is complex.

Dan Moss (16:54): Very interesting one though, thanks Ben. But I suppose thinking about the young person or the child’s ecology, as you’ve just described there, has really been heightened within social work practise or youth work practise over the past decades where more traditional practise, you were assessing the individual deficits or of the problems within a child or a young person. How do you think practises change hopefully for the better in terms of thinking about the whole child or the whole young person?

Ben Lohmeyer (17:23): Yeah, great question. I think there is lots of positive shifts around that and there is a part of this conversation around problems that we’re talking about. And the policy approach that we have in my topics is to say, where is that problem located? Is it located in a person? Or perhaps it’s in their ecology or perhaps it’s in our society and perhaps that can be the focus of our change instead. And I think that’s really great, and that’s where a lot of my research interest is in as well, is less about that individual and more about their context.

(17:53): But I also see it as a pushback on that. I think it’s also really hard for that focus to be maintained in practise purely because of things like funding models and the arrangement or the way in which services are delivered. So you have a funded service of some sort, it’s likely to be government funded. If you’re working with children and young people. There’s some great philanthropy, you kind of go around the place as well, but a large part of that is kind of source through, if not government funded, some sort of competitive tendering or grant funded way of funding a service. And that I think has an inherent bias towards individual solutions and short term outcomes to things. And that’s not anybody’s personal fault, that’s just kind of how you win a grant or how you demonstrate your outcomes or how you compete against other services to similar things. So I think that kind of directs us, unfortunately, back towards trying to change people rather than looking at the ecology and the systems around them.

Dan Moss (18:54): Yeah, thanks Ben. Given your intensive research into social policy and particularly how it includes or excludes children and young people, where do you think some of our opportunities lie for change over the next decade? So if I was interviewing you in another 10 years, where would you like to have seen changes being made?

Ben Lohmeyer (19:13): Great question. Oh, that’s a really hard one to answer and to think about on the spot, but I think any opportunity for us to really give the people who are the focus of our work, more voice in the conversation is really, really important and valuable. In the research that I am part of and seeing it being done, that is an increased focus. So you have people with lived experience being prioritised in the process, and I mean that not just in the sense of we’re talking to those people and hearing from them, but even more in the kind of design and planning stages of projects. So you’ve got people having input to saying, we should talk about this, this is the thing that we should have a focus on rather than me as the researcher generating the idea of what we should talk about. Or you’ve got groups who are focus groups or advisory groups who you then go to and say, “Okay, this is the process that we think we want to use. Is in line with what you want to do?”

(20:14): So there’s a lot of that valuing of lived experience and the target group throughout the process, which I think shifts our direction right from the start, because we’ve got a different kind of evidence base that comes out of that, so therefore practise is different as well. So if we can continue to prioritise that, I think that gives us a lot of hope for where services and research will go. I think that presents a lot of challenges as well though, right? Like when you’re setting up a organisation, it’s really hard to prioritise those groups as part of the structure of your organisation, like really embedding them. That’s not efficient. That makes it really hard. Often, we don’t know how to make sense of the value that those groups bring outside of our usual measures of competence. So, I’ve read some research lately, they kind of looked at things like a programme that wanted to address relationship violence amongst young people, because there’s quite a bit of evidence around that.

(21:07): That’s a fairly consuming concern in Australia that there is a lot of relationship violence going on. And so this programme designed a peer-led intervention education programme. And it was peer-led to the point of not just the facilitators doing the education, but the young people designed the education and they actually also were the employees of the organisation, and they were kind of like this ‘Board of Advisory’ group as well. So that angio existed, but they kind of set up this separate little entity within it, which is entirely young people led and run.

(21:41): And it was great. The young people were involved and the research said that they loved it, they really enjoyed the experience, that it was really valuable, that they felt empowered through it. But the other part of the research also showed that the professionals in the space were still not convinced by it. They still were like, “Ah, they’re not really very good at project management. They’re not really following the right processes at times.” Well, yeah, of course they’re not because they’re not professionals, but are we willing to give some of those things up so that we can have those voices more central?

Dan Moss (22:07): Do you think that maybe sometimes it’s that we don’t like the answers that we receive when we ask the questions?

Ben Lohmeyer (22:12): Yeah, of course! Yeah, I think that’s absolutely true. Or even it’s just kind of really personally and professionally challenging. I’ve invested a huge amount of time in getting to this point in my career. I’m not going to bring some young person in who could just do the same job with no training. That’s really hard to hear, but yeah, I think definitely sometimes we don’t get the answers that we would expect.

Dan Moss (22:31): Yeah. So I want to go back to, for a second, some of the work you’ve done around exclusionary approaches to children or young people. A lot of the work that we’ve done here at Emerging Minds has been focused around secrecy and how children or young people aren’t encouraged to disclose some of the challenging things that have happened in their lives either, as you mentioned, through violence or trauma or their own mental health. What can we do in practise to ensure that we’re more inclusive and we offer opportunities at every step for children and young people to have conversations around the matters that concern them?

Ben Lohmeyer (23:11): I had a really interesting experience just last night that I think relates exactly to what you’re talking about. I was invited into a group who have had a really full-on experience this week of sort of exposure to social justice issues and stuff. And I was asked to come in and talk to them a little bit about what they could do with that next. You know, what do you do, now you’ve had this experience? And they’re high school students and they’re kind of making sense of it, which is great.

 (23:35): But part of the activity that I did with them was allow them to use a web-based platform where they could offer anonymous reflections on their experience for that week and, again, anonymous kind of feedback on what they were thinking at the time. And as you might expect for a group of teenagers, we got some unexpected results on the screen, since this is where they would give anonymous feedback and it would instantly go off on a projector, and so everyone gets to read it. We didn’t get any swear words or anything like that, but we got a few, clearly, running jokes in the group or random things that they wanted to put up there or things that maybe some people might get a little bit offended by, got put up on the screen as well. And I think that was really interesting outcome for me because I’m not particularly bothered by the jokes and things that they put up there. In fact, some of them actually quite funny.

 (24:24): There were also some very honest things in there, like ‘I’m bored’ or ‘I’ve done this week and I’m not inspired’ and that’s actually really important feedback. And if we don’t create spaces where people can be that honest, then you don’t get that feedback. You don’t get to hear what’s really going on in young people’s lives. So I think the challenge is for us to be taking that risk and to be okay with the discomfort of finding out things that we might not have wanted to know, or expected, or perhaps aren’t relevant like we wanted to. So I think the challenge is, how do we create honest spaces? How do we create safe spaces for people to do that?

Dan Moss (25:04): Yeah, that really resonates. A lot of what what we hear from practitioners, Ben, is that, “I don’t want to ask the question of a child or a young person because I don’t want to open up a can of worms.” That is a real fear for lots of practitioners.

Ben Lohmeyer (25:17): Sure, yeah.

Dan Moss (25:17): I mean, how do we support practitioners to be happy to ask the question in a supportive and safe way, but also to hear honest answers?

Ben Lohmeyer (25:27): Great question. I mean, you never want to encourage people to go somewhere they’re not prepared for. So that’s important to know your boundaries and know what you can respond to and know when you need to get help or refer. I think, I work with community services and particularly with children and young people is really quite dangerous if you’re doing it on your own, in any context. I’m never the expert on everything, so I should always be part of a group of support. So that would be my first thing, I think, definitely make sure you have your networks of support around.

(25:56): But I also think if you are asking questions and creating spaces, then you’re only ever going to go places that the child or the young person wants to. And that’s actually kind of the most important thing. They might open a can of worms, but imagine if we hadn’t opened that can of worms and the young person really wants to talk about that and it’s really important in their lives, we can end up with a much worse situation. So I’d never encourage people to kind of force a conversation and go somewhere that they think is really important because that can be really damaging, you can be re-traumatising people. But if you’re asking questions, you’re opening spaces, you’re giving a chance for them to talk about what’s important to them, that might be personally challenging and it might professionally require you to take action, but I think it’s really important for young people and children to have that opportunity.

Dan Moss (26:42): Mm. And in your experience, are children and young people often making good decisions around who they choose to disclose information to or who they choose to talk with things about?

Ben Lohmeyer (26:53): Maybe. Maybe not, as well. I think about as an adult, I don’t always make the best decision about who to talk to something about. But I think it’s important to have spaces for them to talk about it, right? And if you are going to be a professional in this space, then you should be a safe person for them to talk to about it. I also, like we’ve talked about, as well, we have this orientation to see young people as capable in the first instance, rather than seeing them as passive or incapable. So if they want to talk about something, I try to approach this saying, “Well, you are able to make some sense, probably better sense than me of your experience.” And so if we start from that, then I can try and bring supports in it as we need. But yeah, I don’t know. I don’t know if we always make good decisions. I think that’s almost part of the thing, right? We’re here because people don’t always make good decisions.

Dan Moss (27:42): Yep. Another perspective shift at Emerging Minds, we talk about this idea of thinking about children as knowledgeable, rather than naive. And a lot of what you’re saying is resonating in terms of really having that basic assumption, that children and young people, although it might take some support for them to be able to articulate, have a sense of what they think about the world and what their experiences have meant and what their preferred outcomes are.

Ben Lohmeyer (28:10): Yeah, absolutely. And the ways that children and young people choose to communicate are likely to be different to ours. So we may not always understand fully or appreciate exactly what they’re saying, but that doesn’t mean that their way of thinking and communicating isn’t important. I think if we think about the ideas that children and young people have as a different, but equally valuable form of knowledge or information, so they know their lives experience better than, than we do. I barely remember what it’s like to be a child or young person myself, so my constant challenge is to go, “Don’t assume that that makes sense.”

(28:45): And that is very real to me in my current job as well, where I get to talk about youth, right? As a theory, as a bit of research, and I’m often talking about youth to young people and so I’m teaching them about this idea that they’re living. So, what right do I have to do that? That doesn’t make a lot of sense at that level. I should have a level of awareness about my distance from that lived experience that they have now. So yeah, how do we give them a space to bring their knowledges and their experience to the centre of the conversation?

Dan Moss (29:19): Thanks, Ben. It’s been great, so great talking to you today. I mean, I think part of what you’ve been talking about is this ethical striving that is very apparent in your work with social workers, in your research, but also in terms of how you’d like social workers to be able to practise in terms of striving for the inclusion wherever and however possible.

Ben Lohmeyer (29:38): Yeah, that’s a great way of putting it. Yeah, definitely sort of an ethical orientation that’s embedded there. And I love thinking about, then, the implications of that. You know, how our society and our attitudes towards young people are a result of kind of their assumptions around their value and their role in that broader social context.

Dan Moss (29:55): Ben, it’s been so fascinating talking to you today. Really thank you for your time. And yeah, I hope the listeners enjoyed. Thank you.

Narrator (30:03): Visit our website at www.emergingminds.com.au to access a range of resources to assist your practise. Brought to you by The National Workforce Centre for Child Mental Health led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under The National Support for Child and Youth Mental Health Program.