HEALTH
FOR ALL CHILDREN
Changes
in the health visiting service to families
There
is anxiety about the changes taking place in the health
visiting service to families. Change is always scary for
people and many parents and professionals are worried that
the service is being cut and that families will receive
a poorer service because of less child development health
checks. I have read all the changes carefully and while
there will be changes in the way we deliver the service,
health visitors will continue to offer services to all families
with children from birth to five years. We will also make
contact with families during the pregnancy.
Background to Changes
There have been many changed in the Health Visiting Service
to families in the past eighteen years.
Health for all Children was first published in 1989 following
the establishment of a multi-disciplinary working group
by
The Royal College of Paediatrics and Child Health. The purpose
of this group was to review routine health checks for young
children. This report has been reviewed three times over
the years and was extended beyond routine checks to include
activity to prevent illness and promote good health, the
most recent report is commonly known as Hall 4 (named after
Sir David Hall Professor of Paediatrics who chaired the
group). It looked at the evidence for the child health screening
programme which includes the routine checks and monitoring
carried out by Health Visitors.
Recommendations
Reflected in the recommendations is a move away from screening
for disorders and placing more emphasis on health promotion,
primary prevention and more active intervention for children
and families at risk. The main recommendations that effect
health visiting are:
-
Establish an evidence-based core child health programme
of child health checks, monitoring and health promotion
that effectively supports children’s health and
development
-
Ensure that parents are supported and empowered to keep
their children healthy and safe
-
Ensure the needs of vulnerable children and families are
identified and met
The
difference, as I see it, is that it is now a parent led
service which recommends that we ensure that parents are
supported and empowered to keep their children healthy and
safe. This recommendation is recognizing that parents are
the best at recognizing problems. They know their children
best and often their intuition tells them when something
is wrong. Part of our role now is to support parents in
a way that will help them increase in confidence. Routine
checks provided an opportunity for parents to discuss any
concerns they had and there is evidence that while many
parents may not have been sure what exactly the problem
was, they had picked up that something was wrong.
Hall 4 has been implemented in England & Wales
for some time and has just recently (October 31st) been
introduced in Scotland.
The New Service
Each family is different. Some parents may need information
and access to professional advice when they are worried
about their child’s development or when their child
is ill. While other parents may need considerable support
and help over a longer period. The new service will offer
a Universal Core Programme to all families which will include
core screening, immunization, information and advice. Most
of this will occur during the first year of a baby’s
life. There will be the usual visits following the birth
of the baby and support and advice about feeding. There
will be a six week check as usual and mothers will be asked
to complete a questionnaire to check for post natal depression
following this Health visitors will see parents at the three
primary immunizations and spend some time assessing the
baby’s development and any parental concerns. The
mother will be asked to complete a second post natal questionnaire
at around three months. There will be clinic or home contact
with the family as usual until the MMR vaccine which is
given between 12-14 months. At this point a Family
Health Plan will be agreed with the family and
there are three levels.
The
following is a simple sample of what it may look like:
-
Contact
or appointments on request – Families where there
are no identified needs.
-
Structured support
Most
families will be in this level during the first year
-
First time mothers
-
Breast
feeding problems
Other identified needs
3.
Intensive support
Those requiring Interagency support for a range
of problems which could include:
At two
years parents will receive a letter asking them to contact
their health Visitor, there is no formal two year check but
parents can see their Health Visitor then if they wish to
discuss their child’s progress and any concerns will
be checked and referred to the appropriate service. The
Family Health Plan will also be reviewed.
The next point of contact will be for Pre-School Boosters
at four years. There will be no formal check but there will
be an opportunity to discuss any concerns with the health
visitor and have them checked.
However during the five years of a child’s life
you can contact your Health Visitor at any time and
the Family Health Plan can always be reviewed
and changed depending on the need at the time, so as things
change during the family’s or child’s life they
may move in and out of the above levels depending on need.
I hope that things will not get missed and that parents will
continue to contact us if they are worried or their intuition
tells them that something is wrong.
Look out for the health promotion groups with Health Visitor
involvement such as Parent & Baby groups, Support for
Breastfeeding Groups, Weaning Talks, Development in the first
three years, Sleep and Parenting Courses in your area and
watch this web site for information on all aspects of child
development and how to improve your skills and understanding
of child development.
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