Seizing opportunities: the health visitor

Transcription

1 Seizing opportunities: the health visitor Dr Karen Whittaker Reader in Child and Family Health, School of Nursing, College of Health and Wellbeing University of Central Lancashire Presented at: #HVweek 28 th Sept

2 Overview Look at the role of the health visitor Drawing on history and research examples Consider why focus on children Share a little of my own career story Consider the chance to seize opportunity For health of children For families and communities For nurses 2

3 19th Century Origins years in the making 1862: Manchester and Salford Sanitary Association Employed home visitors to 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. Standardised employment and universal right to service : Implementation plan expansion of Health Visiting workforce and reshaping of both health visiting and school nursing years anniversary 3 Policy enabling universal approach 1974: Health Visitors transferred from local authority employment into the NHS Health determinants and protecting children targeted Endorse need for knowledgeable, skilled practitioners, clear on focus to work with families and communities

4 Historically Why Focus on Children? the need to invest in & protect children - address cruelty, poor conditions and nutrition (Dingwall 1982) Improve the survival and fitness of future citizens in the interests of national efficiency mothers were ignorant of the correct methods of childrearing and needed to be educated (view noted by Bryder 2002) Assisting children requires support for mothers - mothers friend (Davies, 1988) 4

5 For me. 5 Student nurse and health visitor at the University of Manchester - placements in City of Salford, where I went on to practice during the 1990 s

6 Evolving Politics 6 General Election 1997 New Politics & New Labour Fresh focus on children and families, proposals included: An enhanced and expanded role for health visitors Work beyond health Shift from dealing with to preventing problems Acheson (1998) Public health inquiry Child poverty and health divide

7 Seizing opportunities.. New job UCLan 1997 Lecturing and practice in health visiting 7

8 Parenting as Public Health Concern Theory Parenting self-efficacy Resources - wellbeing Salutogenesis (Cowley & Billings 1999) Programmes Visiting e.g. Nurse Family Partnership & Group based Evidence base Cochrane reviews (Barlow & Coren 2000) 8

9 Complexity 9 Parenting programmes are social and complex

10 Being Bold Starting a PhD Seizing opportunities Ask the question.. 10 Take on the challenge Funding application Distance learning Venture into the unknown

11 The Study Question? How do parenting services work and for whom in what circumstances? Specific interest in the Positive Parenting Programme Realistic evaluation Contexts, Mechanisms and Outcomes Theory driven self-efficacy Social programmes have layers Mixed methods to collect data Survey Detailed analysis of selected cases (Whittaker, 2008) 11 11

12 Find out Get there Be there Stay there Move on or move out Personal world with informal systems Parent-child group Positive parenting course Home visiting Community events/activities Course for parents Parenting Service 12 12

13 Main Messages for Application Different facilities can work in a complementary fashion Interpersonal relationships were key features of parents journeys Informal networks are distinct sources of influence and support Practitioners have a key role in shaping environments through use of interpersonal skills Improve exposure to +ve sources of self-efficacy (Whittaker, 2008) 13 13

14 Public health evidence Life course research (Graham & Power 2004; Kuh & Ben-Schlomo 2004) Early child development inequalities UNICEF survey (Irwin et al. 2007) Mental Public Health (RCPsych 2010) Family & domestic violence (Abramsky et al 2011; NICE 2014) Inequalities in health (Marmot 2010) Impact on individuals and society 14

15 Evolving Politics Coalition government 2010 Promised radical programme of 4,200 extra health visitors and service transformation. 15

16 Opportunity. NNRU Team at the 2012 CPHVA Conference National Nursing Research Unit King s College London Policy Research Programme on Health Visiting to support the Call to Action Three research studies 16

17 Project background Literature review Narrative synthesis of health visiting practice Available at: ublications/index.aspx Empirical study Recruitment and retention for health visiting AIMS Empirical study Exploring service users views Start and Stay What people want from their job Aspirations Promotion of job satisfaction What attracts & keeps people 17 17

18 What was valued What was valued 18 Whittaker et al

19 The programme of health visitor research Parents value enabling respectful relationships from practitioners able to listen and match service to need Existing literature shows a purposeful orientation to practice, realised through relationships, home visiting and needs assessment Research detailing health visiting practice that makes a difference to children and families The relationship with parent remains at the centre of the health visitor work Health visitors value respectful line management enabling professional autonomy for flexible client focused service 19

20 Developmental science Infant brain development and care giver relationships (Shonkoff & Philips 2000 ) Nurturing strong parent-child relationships for violence prevention (WHO 2009) Lancet series on early childhood (2007, 2011) Toxic stress (Shonkoff et al. 2012a ; 2012b) Calls for policies and investment that support universal early childhood development interventions including home visiting (UNICEF 2012; Garner 2013) 20

21 WHO 2013 Meeting on Human Capital 21 Considerable progress has been made in improving child survival. However, in order to help children reach their full development potential, to avoid later chronic disease and to move towards sustainable development and social equity, the child survival and child development agendas need to be intertwined. (WHO 2013, page 13) See YouTube clip by Prof Heckmann

22 Actions on Survival Save the Children training midwives, nurses and doctors in mother kangaroo care to keep the baby warm through skin-to-skin contact to improve the survival chances of low birthweight babies Early child development (ECD) Chan (2013) of WHO noted Health services have a unique responsibility due to potential reach with all families UNICEF and WHO have been developing resources and Networks Promotion of universal ECD support via Home Visiting 22

23 Action through Home Visiting Internationally Health visitor - UK, Denmark & Norway Child health nurse - Sweden Public health nurse - America, Canada, Ireland Child & family health nurse Australia Plunket nurse - New Zealand Social nurses - Belgium Lady health visitors & Lady Health Workers Pakistan Patronage nurse Serbia, Kosovo 23 23

24 The essence of practice Research evidence shows that UK 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 See: Cowley et al. (2013) Why Health Visiting? At: 24

25 Working in context of public health A focus on early life Aware of social determinants of health Keeping in mind the: child parent family neighbourhood and larger community Drawing on the ideas of Bronfenbrenner (1986) human ecology 25

26 UNICEF in Eastern Europe Working with a range of countries to: Develop regional framework Standards for practice Design of service of educational modules Facilitate networks Influence policy Creating a road map Universal Maternal child health & ECD Nurse education and professional regulation Comprehensive system 26

27 England - good practice model Dedicated workforce, specifically educated and skilled in family home visiting & community practice Evidence informed guidance for services Healthy Child Programme (DH 2009; Axford et al 2015) Clear plan for service investment and development Detailing levels of service based on principles of proportionate universalism Community Universal Universal plus Universal partnership plus Building Capital Universal Enhanced Intense 27 27

28 UNICEF Home Visiting Standards Developed for Central Eastern European Countries Emphasis on universalism Supporting ECD Engaging parents as an imperative Working with and not on Purposeful home visiting Skilled, knowledgeable home visiting nurses - continuity Comprehensive 28

29 A privileged worthwhile role As explained by a student and an experienced health visitor in the Start and Stay Study (Whittaker et al 2015) It highlights peoples strengths in the face of adversity. 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. 29

30 What health visitors need to keep doing.. Connecting and working closely with families Build on knowledge and breadth of education and be ready to learn some more Collect evidence of practice Network and share to inform future practice and service commissioning Seize the opportunities! 30

31 Thank you Contact: 31

32 References 1 32 Abramsky T., Watts C., Garcia-Moreno C.,et al. (2011) What factors are associated with recent intimate partner violence? BMC Public Health 11, 109. Axford, N et al Rapid Review to Update Evidence for the Healthy Child Programme 0 5. Public Health England /150520RapidReviewHealthyChildProg_UPDATE_poisons_final.pdf Bronfebrenner, U. (1986) Ecology of the family as a context for human development: Research perspectives. Developmental Psychology 22(6): Bryder L. (2002) The Plunket nurse as a New Zealand icon. Accessed: Chan M. (2013) Linking child survival and child development for health, equity, and sustainable development The Lancet 381: Cowley, S., Whittaker, K., Malone, M., Donetto,S., Grigulis, A., Maben, J.,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 (2014), Davies, C. (1988) The Health Visitor as Mother's Friend: A woman's place in public health. The Society for the Social History of Medicine, 1(1), Dingwall, R. (1982) Community nursing and civil liberty, Journal of Advanced Nursing, 7,

33 Garner, AS (2013) Home Visiting and the Biology of Toxic Stress: Opportunities to Address Early Childhood Adversity. Pediatrics 132(Supplement 2):S65-S73 Graham H, Power C (2004) Childhood disadvantage and health inequalities: a framework for policy based on lifecourse research. Child: Care, Health & Development 30(6): Irwin, L., Siddiqi, A., and Hertzman, C. (2007) Early child development: A powerful equalizer - Final report for the World Health Organization s Commission on the Social Determinants of Health. University of British Columbia: Available at: Kuh, D., Ben-Shlomo, Y. (Eds) (2004) A Life Course Approach to Chronic Disease Epidemiology. (2 nd Edition) Oxford, Oxford University Press The Lancet (2007) and Child Development in Developing Countries 2 ment/en/ The Lancet (2011) Marmot M (2010) Fair Society, Healthy Lives. The Marmot Review. Marmot (2013) Universal health coverage and social determinants of health The Lancet 382,

34 34 National Institute for Health and Care Excellence (NICE) (2014). Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively. NICE public health guidance Shonkoff JP, Garner A S, Siegel BS, et al. (2012a) The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics, 129 (1), Shonkoff JP, Akil H, Chang HI, et al. (2000 and 2012b) From neurons to neighborhoods: an update. National Research Council and IoM. National Academy Press, Washington DC. Shonkoff JP (2014) Changing the Narrative for Early Childhood Investment JAMA Pediatr. 2014;168(2): doi: /jamapediatrics WHO (2013) Nurturing human capital along the life course: Investing in early child development Whittaker, K. (2008) A realistic evaluation of how parents experience the process of formal parenting support. PhD Thesis. Kings s College, London. Whittaker, K.A., Malone, M., Cowley, S., Grigulis, A., Nicholson, C., Maben, J. (2015) Making a difference for children and families. An appreciative inquiry of health visitor values and why they start and stay in post. Health and Social Care in the Community. doi: /hsc.12307