Features

Health visiting support: raising the bar

11 May 2017

In response to heightened needs in Devon, a programme of intensive health visiting is delivering tailored early interventions to vulnerable families. Victoria Howard, Lee Beardsmore and Elaine O’Flaherty from the Virgin Care team describe the project.

It is well recognised that a child’s early experience and environment influences their brain development during early years, when warm and positive parenting helps to create a strong foundation for the future (Department of Health (DH), 2011). As Allen (2011) states, early intervention ‘offers our country a real opportunity to make lasting improvements in the lives of our children’ that can result in ‘long-term savings in public spending’.

In a bid to offer the early intervention approach to families in Devon, a model of intensive health visiting has been developed, drawing on the existing skills of the workforce and established partnerships with other agencies. The model was named the Devon Health Visiting in Partnership programme (DHViP) and plays an important part of the Healthy Child Programme (DH, 2009), which acknowledges how vital the early months of pregnancy and infancy are for babies’ brain development. The aim of the DHViP is to improve health outcomes and reduce inequalities by working in partnership with women, their partners and babies to help build confidence and improve knowledge around good parenting, health and positive relationships.

At the start of the DHViP development in 2014, it was recognised by the public health team leaders working in Devon that many practitioners were visiting families over and above the mandated five core contacts outlined by the Healthy Child Programme (DH, 2009) and the Health Visiting Programme (NHS England, 2011), due to the level of need identified by a family health needs assessment. But when the additional visits were made, there was no framework to measure the health visiting interventions and subsequent outcomes.

High risk, low protection

The overall aim was to create a framework of intensive health visiting incorporating a progressive, universal service around the five core contacts and focusing on high-impact areas to reduce inequalities, to be delivered within the existing workforce and budget. This is highlighted within the Healthy Child Programme (DH, 2009), which encourages focus on the most vulnerable children where risk factors are high and protective factors are low. As a result, a total of 24 planned home visits were scheduled covering a two-and-a-half-year period. These visits are categorised as episodes of care (see box).

The initial work for the steering group involved researching intensive health visiting programmes across the country. These included the family nurse partnership and the maternal early childhood sustainable home visiting programme. Both schemes are recognised, evidence-based, intensive programmes focusing on early intervention strategies to change life outcomes for families and children.

A common feature of these programmes is family partnership model (FPM) training, which focuses on working in partnership with families, building strength and resilience. As a result, FPM training was delivered to 40 of the 120 health visitors in Devon. While the training was rated by staff as useful to practice, it was not deemed essential to the roll-out of the DHViP due to the workforce’s existing skills.

The DHViP

It appeared from the research that it is often families with two or more identified vulnerabilities that require and benefit from intensive health visiting support, but this is challenging to provide within the existing framework. As such, the DHViP and its design creates the opportunity for health visitors to work more flexibly and creatively when meeting a variety of complex needs.

To support staff in delivering the DHViP, the steering group developed and devised a suite of resources, including a guide for professionals, a leaflet for parents and a personal handbook for those families who consented to the DHViP. 

These documents initially supported the DHViP roll-out in six pilot areas in Devon. Exeter, north, south and east Devon were selected due to higher levels of need. The criteria for enrolment were decided based on existing programmes and those raised by our own practitioners. They included: childhood abuse; women at risk of maternal mental health issues; substance misuse; single or young parents; and parents who had been part of the care system.

It was also decided that the caseload for health visitors should initially be no more than one family per day the practitioner worked, and that the addition of a DHViP family should be discussed with the team leader prior to the family being accepted onto the programme.

Measuring outcomes

Early input and discussion in the antenatal period with families has been found to be an important foundation for the rest of the DHViP. With the antenatal contact well established across Devon, the most vulnerable women are being identified at an early stage for the programme, which has led to 80 families being enrolled.

A vital yet challenging component of the DHViP is the evaluation of its outcomes. Each health visitor working with a DHViP family evaluates the work undertaken at the end of each episode of care, to demonstrate that identified outcomes are being met.

The outcomes currently measured from the DHViP include breastfeeding data, accidents and hospital admissions and the ages and stages questionnaire.

Interestingly, initial findings indicate that the majority of DHViP families have a mental health component and as such, referrals to mental health support services is shown in the data, which encourages appropriate assessment and an opportunity to build on strengths within the family. This is integral to the infant’s wellbeing and highlights the benefits of the DHViP.

But there’s an ongoing need to capture the outcomes of such essential work.Resources and tools to evaluate and measure outcomes are being considered to ensure the DHViP continues to improve outcomes for children and families in our care.


Episides of care

  • Episode 1 Two antenatal contacts
  • Episode 2 Weekly contacts for six weeks after the baby is born
  • Episode 3 Fortnightly contacts for two months
  • Episode 4 Monthly contacts until the baby is seven months old
  • Episode 5 Every other month until the baby is 15 months old, which will include a one-year review of development
  • Episode 6 Quarterly until the child is two years and three months, when a 2.3 assessment is undertaken. 

References 

Allen G. (2011) Early intervention: the next steps. See: gov.uk/government/uploads/system/uploads/attachment_data/file/284086/early-intervention-next-steps2.pdf (accessed 10 April 2017).

Department of Health. (2009) Healthy child programme: pregnancy and the first five years of life. See: gov.uk/government/uploads/system/uploads/attachment_data/file/167998/Health_Child_Programme.pdf (accessed 10 April 2017).

Department of Health. (2011) Health visitor implementation plan 2011-2015: a call to action. See: gov.uk/government/uploads/system/uploads/attachment_data/file/213759/dh_124208.pdf (accessed 10 April 2017).

NHS England. (2011) Health visiting programme. See: england.nhs.uk/ourwork/qual-clin-lead/hlth-vistg-prog/ (accessed 10 April 2017).

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