Optimising Health in the Early Years

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Optimising Health in the Early Years

• The Contribution Community Practitioners make to
  Public Health
• Maggie Fisher Professional Officer
• Unite/Community Practitioners and Health
  Visitors Association

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Addressing the childrens and family policy
agenda, rhetoric or reality?

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This presentation will cover

• Relationship development
• The population paradox and the dangers inherent
  in targeting
• Skill mix friend or foe?
• Outcomes for children and families the
  contribution health visiting and school nursing
  can make

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Building therapeutic relationships

• The traditional model of a continuing
  personalised care by the same health visitor, who
  has built up a trusting relationship with the
  family and has detailed knowledge of them is
  often cited as the main cornerstone of primary
  care and is strongly associated with client
  satisfaction.

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Building partnerships with others

• The Childrens Plan (2007) and the Child Health
• Promotion Programme (2008) place a major
• emphasis on parenting support to include
• Supporting strong couple relationship and stable
  positive relationships within families.
• Supporting mothers and fathers to attuned
  parenting in particular during the first months
  of life.
• Ensuring contact with the family routinely
  involves and supports fathers, including
  non-resident fathers and supporting the
  transition to parenthood for first time mothers
  and fathers

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The Population Paradox

• Prevalence of childhood behaviour disorder at ten
  years of age in different social classes

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The Population Paradox

• Distribution of childhood behaviour problems by
  social class (Stewart-Brown 1998)

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Skill mix

• Addition of other workers to health visitor teams
  community nursery nurses, staff nurses,
  clerical workers
• Enhance or dilute?
• Issues relating to staff nurses
• Supervision

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YouGov polled 2827 expectant parents or parents
(27-29 May 2008) and 2337 adults, not just
parents (11-15 July 2008).

• When parents were asked what support should be
  more widely available to help parents who
  experience relationship pressures after the birth
  of a child, the largest category of people, 53,
  said more help from health visitors
• When asked how helpful they thought free
  counselling sessions with professionals (e.g.
  family therapists or psychologists) would be for
  vulnerable parents bringing up 0 - 3 year old
  children, 71 of parents thought these would be
  helpful or very helpful but 80 thought more
  frequent visits from health visitors would be
  helpful or very helpful

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YouGov Poll (2008) on health visiting continued
The Centre for Social Justice (2008) The Next
Generation

• 72 adults were fairly confident or very
  confident that health visitors are competent and
  well trained.
• In contrast only 28 had that perception of Sure
  Start staff, 37 of social workers and 53 of
  childcare professionals
• And if they were concerned about being able to
  cope with being a parent, 35 of adults would
  prefer to go to a health visitor for help,
  compared with 26 preferring a GP, 3 Sure Start
  staff and 3 a social worker

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Outcomes for children and families the
contribution of health visitors and school nurses

• Accident prevention
• Promoting immunisation
• Developmental delay and disorders
• Combating obesity and malnutrition
• Safeguarding and the prevention of NAI

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Outcomes for children and families the
contribution of health visitors

• Prevention of SIDS (Back to sleep campaign)
• Promoting attachment and the early detection of
  child mental health issues
• The prevention and early detection of post natal
  depression

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Caseload sizes

• Over 42 of health visitors have responsibility
  for 500 children or more (CPHVA 2008)
• 63.6 report that it is not always possible to
  deliver the core universal service
• Size of caseload does not reflect vulnerability
  of clients (FPI, 2007)
• Family-nurse partnership 25 families

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CPHVA Omnibus, 2008 (n829)

• 69.2 of health visitors are saying they no
  longer have the resources to respond to the needs
  of the most vulnerable children.
• I in 5 health visitors believe there is a serious
  risk of a child death, as arose in the case of
  Victoria Climbe

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Stress

• 45 health visitors had suffered work related
  stress (highest across all occupational groups)
  
• Healthcare Commission NHS Survey 2006

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Solutions

• Central workforce planning based on need
• Increase in health visitor numbers
• Skill mix based on evidence
• Central government protection of the public
  health workforce E.g. steps taken to do this
  for school nurses and now needs to happen for
  health visitors in policy
• Optimum size of health visitor caseload advised
  in policy

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Ultimately

• Evidence shows that providing a service which
  can make a difference to reducing social
  inequalities and improving the health and
  wellbeing of children and families will require
• More health visitors
• More appropriate skill mix
• A new training programme based on research
  evidence not current philosophy

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We all want to feel we are providing a quality
service to children and families
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References

• Acherson, D.(1998) Independent Inquiry into
  Inequalities in Health Report. TSO London
• Adams, C. and Craig, I. (2007) Health Visitor
  cuts affecting vulnerable families. Community
  Practitioner. May 2007. Vol 80. No 5.
• Barlow J, Kirkpatrick S, Stewart-Brown S,
  Davis H 2005, "Hard-to-reach or out-of-reach?
  Reasons why women refuse to take part in early
  intervention", Children and Society, vol. 19, pp.
  199-210.

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References (continued)

• Brandon, M. Beldrson, P. Warren, C. Howe, D.
  Gardner, R. Dodsworth, J. Black, J. (2008)
  Analysing child deaths and serious injury through
  child abuse and neglect what can we learn? A
  biennial analysis of serious case reviews
  2003-2005. DCSF Research Report DCSF-RRO23 London
• Branson, C. Badger, B. and Dobbs, F. (2003).
  Patient satisfaction with skill mix in primary
  care a review of the literature. Primary Health
  Care Research Development, 4, pp 329-339.
  doi10.1191/1463423603pc162oa

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References (continued)

• Cowley S, Caan, W. Dowling, H. Weir, H. (2007)
  What do health visitors do? A national survey of
  activities and service.. Public Health. Journal
  of the Royal Institute of Public Health.
  doi10.1016/j.puhe.2007.03.016
• Cowley, S. and Frost, M. (2006) The Principles of
  Health Visiting. Amicus/CPHVA
• Centre for Social Justice (2008) Breakthrough
  Britain The Next Generation A policy report from
  the Early Years Commission Chaired by Dr Samantha
  Callan September 2008. The Centre for Social
  Justice,

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References (continued)

• Davis, H. Spurr, P. 1998, "Parent counselling
  an evaluation of a community child mental health
  service." Journal of Child Psychology and
  Psychiatry, vol. 39, pp. 365-376
• Department of Health (2008) Our NHS Our Future.
  NHS Next Stage Review Leading Local Change DH
  London
• Department of Health (2007) Facing the Future A
  review of the role of health visitors. Department
  of Health. www.dh.gov.uk/cno
• Earls F (1994). Oppositional defiant and conduct
  disorders in Rutter M, Taylor E, and Hersov L
  (Eds). Child and Adolescent Psychiatry Modern
  Approaches, Blackwell Science, Oxford.

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References (continued)

• Gimson, S. (2007) Health Visitors- an endangered
  species. Family and Parenting Institute.
• HM Government (2007) PSA Delivery Agreement 19
  Ensure better care for all. HM Treasury, HMSO
  Norwich.
• Jack S, DiCenso A, Lohfeld L 2005, "A theory of
  maternal enagagement with public health nurses
  and family visitors", Journal of Advanced
  Nursing, vol. 49, no. 2, pp. 182-190

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References (continued)

• Kirkpatrick, S., Barlow, J., Stewart-Brown, S.,
  Davis, H. 2007, "Working in Partnership User
  Perceptions of Intensive Home Visiting", Child
  Abuse Review, vol. 16, pp. 32-46
• Netmums.com (2007) Families Need Health Visitors.
  Jan 2007 http//www.netmums.com/h/n/SUPPORT/HOME/A
  LL/547//

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References (continued)

• Olds DL, Robinson J, OBrien R, Luckey DW,
  Pettitt LM, et al. (2002) Home visiting by
  paraprofessionals and by nurses a randomized,
  controlled trial. Pediatrics 110 48696
• Rose, G. (1993) The Strategy of Preventative
  Medicine. Oxford University Press. Oxford.
• Unite/CPHVA (2007) Community Practitioners and
  Health Visitors Association response to Facing
  the Future-A review of the role of health
  visitors October 2007. Unite/CPHVA

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References (continued)

• Social Justice Policy Group (2006) Breakdown
  Britain Interim report on the state of the
  nation London Centre for Social Justice
• Social Justice Policy Group (2007) Breakthrough
  Britain Ending the costs of social breakdown
  London Centre for Social Justice
• Woodruffe et al 1993 in Stewart-Brown 1998
  Stewart-Brown S (1998) Public health implications
  of childhood behaviour problems and parenting
  programmes in Parenting, Schooling and Childrens
  Behaviour Hudson B, Buchanan A (Eds.) Ashgate
  Publishing Ltd, Aldershott Hants