Home Visiting Systems Universal Approaches Universal progressive home visiting systems in the UK

Transcription

1 Home Visiting Systems Universal Approaches Universal progressive home visiting systems in the UK Dr Karen Whittaker Senior Lecturer, University of Central Lancashire Fellow of the Institute of Health Visiting 1

2 Overview Brief history Role and purpose Education and preparation of health visitors Delivery of universal model Supporting research 2

3 19 th Century Origins 1862: Manchester and Salford Sanitary Association Employed home visitors Improve health hygiene, mother and baby care 1929: Local Government Act; required home visits by a health visitor to all new mothers, within a month of birth. 1974: Health Visitors transferred from local authority employment into the NHS 2012: Launch of the Institute of Health Visiting (ihv) as profession celebrated 150 years 3

4 Why Focus on Children? Historically the need to invest in & protect children - address cruelty, poor conditions and nutrition (Dingwall 1982) Today There is a need to give every child the best chance in life because of the existence of a social gradient of inequality (Marmot 2010; 2013) 4

5 National Framework: The Healthy Child Programme (HCP) 5

6 6 Healthy Child Programme (DH 2009) Universal Health and development reviews Screening and physical examinations Immunisations Promotion of health and wellbeing, e.g.: smoking diet and physical activity breastfeeding and healthy weaning keeping safe prevention of sudden infant death maintaining infant health dental health Promotion of sensitive parenting and child development Involvement of fathers Mental health needs assessed Preparation and support with transition to parenthood and family relationships Signposting to information and services an overview Universal plus Emotional and psychological problems addressed Promotion and extra support with breastfeeding Support with behaviour change (smoking, diet, keeping safe, SIDS, dental health) Parenting support programmes, including assessment and promotion of parent baby interaction Promoting child development, including language Additional support and monitoring for infants with health or developmental problems Common Assessment Framework completed Topic-based groups and learning opportunities Help with accessing other services and sources of information and advice Higher risk High-intensity-based intervention Intensive structured home visiting programmes by skilled practitioners Referral for specialist input Action to safeguard the child Contribution to care package led by specialist service Requirement to be alert to risk factors and signs and symptoms of child abuse, and follow local safeguarding procedures where there is cause for concern.

7 Types of need and service response Types of Need Predicted Population level e.g. PREview Assessed by HV (or others involved with family) Expressed by family Health Visitor Provide Service Delegate to Team member Information on sources of help Refer on 7 Service response (action through a 4 level Family Offer )

8 What the health visiting service is starting to look like: a family offer 8 Your community Health visitors work to develop these and make sure families know about them. Build community capacity to strengthen assets use local resources. Universal services Health visitor and team provide the healthy child programme (for example immunisations, health and development checks), support for parents and access to a range of community services/resources. Universal plus Health visitor team gives a rapid response when specific expert help is required, For example with postnatal depression, a sleepless baby, weaning or answering any concerns about parenting. Universal partnership plus Health visitor team works with others e.g. children s centres and/or specialist services, to provide ongoing support to deal with more complex issues over a period of time. More intensive focused help S A F E G U A R D I N G

9 Focus on 6 High Impact Areas Areas where health visitors have a significant impact on health and wellbeing and improving outcomes for children, families and communities. (Department of Health, 2014) 9

10 6 High Impact Areas Transition to Parenthood Maternal Mental Health Breastfeeding Healthy Weight -Nutrition Managing Minor Illness and Reducing Accidents Health, Wellbeing and Development of the Child Age 2 support to be ready for school 10

11 A health visitor today In England the health visitor is: Registered Nurse or Midwife and Specialist Community Public Health Nurse (SCPHN) Lead and deliver the universally available Healthy Child Programme (HCP) (DH, 2009) working with individuals, families and communities Through: Home visiting Community contact at doctors surgeries, children s centres or community groups Providing information about sources help Building relationships and being available as a continual service all important from the parent perspective (Whittaker et al 2014)) 11

12 Education and preparation Study of an additional degree of post-graduate qualification 45 programmed weeks with 50:50 theory and practice Regulated by the Nursing and Midwifery Council (NMC) Education informed by 4 Principles of Health Visiting The search for health needs The stimulation of an awareness The influence on policies affecting health The facilitation of health-enhancing activities 12

13 Working in context of public health A focus on early life Aware of social determinants of health Keepingin mind the: child parent family neighbourhood and larger community Drawing on the ideas of Bronfenbrenner (1986) human ecology 13

14 working to. principles of proportionate universalism Level of service support for everyone and additional help for those with greater needs Michael Marmot (2010) explains this means that the scale and intensity of action is proportionate to the level of disadvantage. 14

15 National Nursing Research Unit Health Visitor Work Programme Jill Maben, Sarah Cowley, Astrida Grigulis, Sara Donetto, Mary Malone, Karen Whittaker Government Commission Research to support the Implementation Plan: Completed July 2013 Disclaimer The NNRU health visitor research programme is an independent study commissioned and funded by the Policy Research Programme in the Department of Health. The views expressed are not necessarily those of the Department

16 The commissioned literature review health visiting characteristics: Research evidence shows that health visiting is concerned with: Health-creation (Salutogenic), Demonstrating a positive regard for others (human valuing), Recognising the person-in-situation (human ecology) This orientation underpinned delivery of the service through three core practices: health visitor-parent relationships, health visitor home visiting and health visitor needs assessment 16 See: Cowley et al. (2014) Why health visiting? Examining the potential public health benefits from health visiting practice within a universal service: a narrative review of the literature. International Journal of Nursing Studies. DOI: /j.ijnurstu

17 A privileged worthwhile role Experienced health visitors explain that they stayed in the job because they believed that working closely with families, visiting them in their homes meant they developed a unique insight into family life that was sometimes humbling. They referred to this as a privilege. See Whittaker et al (2013) 13/Health-visitor-workforce-motivated-by-making-adifference-to-children-and-families.aspx Throughout the 26 years of my health visiting career I have valued the unique and privileged opportunity to work with families with young children over a period of time. No two families are the same and each and every birth notification and movements in presents exciting challenge. The first time you knock on the door you are starting a new and exciting journey. (Experienced health visitor: HV-AI6) 17

18 The programme of health visitor research The relationship with parent remains at the centre of the health visitor work 18

19 19 Role Summary

20 Key characteristics of health visiting Underpinned by public health principles and flexible according to current public health priorities Universal service with interventions targeted to need Activities based on holistic family and community as well as individual needs assessment Health visitors form trusting relationship with the families Integrated in primary care and the community Wide reach, able to refer to statutory and voluntary services and create new services predicated on local need 20

21 Thank you Contact: Institute of Health Visiting Website: NHS employers website: workforce/healthvisiting/pages/healthvisiting.aspx 21

22 References Bronfebrenner, U. (1986) Ecology of the family as a context for human development: Research perspectives. Developmental Psychology 22(6): Department of Health (2009). Healthy Child Programme: pregnancy and the first five years of life. [On-line]. Available: Department of Health (2014). Overview of the six early years high impact areas. Marmot, M., (2010) Fair Society, Healthy Lives. Available at: Marmot (2013) Universal health coverage and social determinantsof health The Lancet 382, Whittaker, K. Cox, P. Thomas, N. Cocker, K. (2014) A qualitative study of parents experiences using family support services: applying the concept of surface and depth. Health and Social Care in the Community. Published online doi: /hsc