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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.african family

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.

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:

  1. Contact or appointments on request – Families where there are no identified needs.
  2. 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:

  • Children with disabilities
  • Family Stresses
  • Prematurely

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.

More information can be found on:

Frances Byatt-Smith - Health Visitor

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