Strength in numbers

20 September 2021

Michelle Thomas, David Pontin and Carolyn Wallace on establishing a health visiting community 
of practice in Wales to support family resilience.

This piece describes the development of a health visiting community of practice (CoP) for the Family Resilience Assessment Instrument and Tool (FRAIT) in Wales. At the request of the chief nursing officer for Wales, the FRAIT (Wallace et al, 2017) was developed and validity-tested by academics at the University of South Wales and health visitors in Wales. The FRAIT was launched in 2017 to contribute to HV assessments and is embedded in the Healthy Child Wales Programme (Welsh Government, 2016).

The FRAIT is used to assist HVs in their decision-making, care planning and planning for further interventions and resources (Wallace et al, 2017). Negativity among HVs in Wales about the FRAIT and resistance to using it became apparent through social media postings and general feedback to the FRAIT development team. HVs disliked asking about finances, educational achievement and experiences of being parented. Responding to this negativity, the development team were keen to bring practitioners together to facilitate a solution-focused discussion to explore emerging issues with the FRAIT. In February 2018, the FRAIT CoP first met to work towards realistic practice-based solutions.

The FRAIT CoP addresses and responds to queries and issues raised by HVs in a timely manner. The CoP members, all of whom are HVs, often provide evidence-based answers at the time of the CoP meeting or participate in additional work to address these issues. Examples include alterations to the FRAIT and the recent inclusion of a no-concerns column in response to HV requests. Operational issues – for example, storage of the FRAIT in records and timings of assessment – are referred back to the SCPHN leads for Wales for advice and guidance.

CoPs are generally informal and integrated into daily life (Wenger, 1998). The FRAIT CoP meets as a structured forum for discussion and learning, and does this through exploring ongoing practice developments and the use and interpretation of the FRAIT by HVs. Wenger (1998) first explored the concept of CoPs as a means of supporting developments and offering solution-focused approaches to problems in the workplace or educational establishments. He referred to practice as a shared history of learning and as being conversational. He also stated that a CoP is a group of people who share a concern (in the case of FRAIT terminology, a domain) or have a passion for learning how to improve their skills (practice health visiting) through regular interactions (community-FRAIT CoP).

Interaction between the three constructs reinforces the learning between all participants. While considering this concept before establishing the FRAIT CoP, we searched the literature on CoPs. This yielded much information on CoPs in engineering, the arts, and learning and education, but very little about CoP in nursing and, more explicitly, health visiting. Two papers relating to health visiting (Cuthill et al, 2017; McCullough et al, 2013) indicated that CoPs were attended and run by managers rather than HVs delivering a service and working in communities. These two papers referred to project management, defined timelines and communities of learning practice.

The CoP is a thriving community of hvs who support each other and contribute to quality assurance with a validated assessment tool

Learning from experience

Today, the FRAIT CoP addresses ongoing issues raised by its members. It benefits from the membership’s variety of experience to create solution-focused outcomes for the issues raised, which are then fed back to practice. Recent examples include child adoption and completion of the FRAIT, and FRAIT completion where children are in local authority care.

Initially, CoP meetings were physical meetings held at a variety of venues across Wales. This was important to recognise the contribution that HVs across the principality make to the CoP, and to ensure fairness of access to the meetings. Online access was also offered; this was initially through Zoom, with varying success due to problems with Wi-Fi connections and accessibility of suitable equipment. Since the Covid-19 pandemic started, FRAIT CoP meetings have continued using Microsoft Teams. This aligns well with the swift transfer to the use of Teams by many of the health boards in Wales.

The CoP encourages a safe and supportive environment for any questions or observations regarding use of the FRAIT to be discussed in a solution-focused way. Its membership comprises 35 HVs working in the seven Welsh health boards. Members hold a variety of health visiting roles, have been practising for varying lengths of time and have co-opted themselves onto the CoP. Many members are FRAIT Champions for their health board, providing a point of access support to their colleagues. Members are also FRAIT trainers, although the training has now altered to e-learning accessed via the FRAIT.Wales website.

Traditionally, CoPs are led by managerial staff and contribute to strategic discussion or project work, but the FRAIT CoP is open to all HVs in Wales interested in supporting the development of the FRAIT and supporting colleagues and student HVs to develop confidence and expertise in completing FRAIT assessments. Meetings were initially bi-monthly in response to need. Now the FRAIT is established in health visiting practice in Wales, meetings are held every three months. Meeting notes are easily accessible on the FRAIT website.

The success of the FRAIT CoP relies upon the engagement and contribution of the membership, who provide feedback about the usability of the FRAIT, commit time to attending meetings and participate in discussions about the FRAIT in varying situations experienced by HVs. Examples include children in foster care, multiple births and differing family constructs.

Quick response

CoP members are very responsive to requests for information or support – for example, providing case studies or validity testing where alterations are made responding to HV observations. The CoP is a thriving community of HVs who support each other and contribute to quality assurance with a validated assessment tool. The strength of the membership might be because of the variety of health visiting roles or communities in which they practice, promoting discussion about interpreting the findings of their FRAIT assessments and potential interventions that would benefit families.

Establishing the FRAIT CoP has been extremely beneficial. Negativity around the use of the FRAIT has been reduced, and members are continuing to offer support in developing materials and resources that support best practice through validated health visiting assessments. The FRAIT CoP offers a new Wales-wide, solution-focused forum for HVs. It is resource-effective and promotes social learning within a professional identity, characterising all aspects of a successful CoP.    

Michelle Thomas is a senior lecturer for SCPHN at the University of South Wales, alongside emeritus professor David Pontin and professor of innovation and engagement Carolyn Wallace.


Cuthill F, Anderson, J, Shiel, A. (2017) Creating a community of learning practice. Community Practitioner 90(8): 35-8

McCullough B, Small N, Prady S. (2013) Improving smoking cessation data collection via a health visiting community of practice. Community Practitioner 86(5): 22-5. 

Welsh Government. (2016) An overview of the Healthy Child Wales Programme. See: https://gov.wales/healthy-child-wales-programme-0 (accessed 18 August 2021).

Wallace C, Dale F, Jones G et al. (2018) Developing the health visitor concept of family resilience in Wales using Group Concept Mapping. Rural and Remote Health 18(4): 4604. 

Wenger E. (1998) Communities of practice: learning, meaning and identity. Cambridge University Press: Cambridge.

Image credit | iStock


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