Scope - CP12 PROTOCOL FOR UNIVERSAL ANTENATAL CONTACT (FOR USE BY HEALTH VISITING TEAMS) RATIONALE The Healthy Child Programme Pregnancy and the first five years of life (DH, 2009) states that health professionals, such as health visitors are the universal first point of contact for families during pregnancy and the first years of life. The National Service Framework for Children, Young People and Maternity Service (DH, 2004) focuses on assessing needs and intervening early. It highlights the Health Visitors as the professional that should start the process of assessing the needs of the child and family before birth, thus ensuring a smooth transition between midwifery and health visiting services. According to Hall (2003) the antenatal contact promotes good parental understanding of the role of the Health Visitor. A protocol for universal antenatal contact is required for the Health Visitor antenatal assessment to provide direction and rationale for health visitors undertaking this visit and to ensure that service users across the Trust receive an equitable Health Visitor antenatal service. TARGET GROUP This protocol applies to all Health Visiting teams employed by the Trust who are required to follow this protocol as part of their role and job description. There may be occasions where Specialist Community Public Health (health visiting pathway) students will be appropriately delegated to carry out this contact under the supervision of a health visitor. TRAINING Please refer to current core clinical training for health visitors RELATED POLICIES Please refer to relevant Trust policies and procedures The client led antenatal contact provides the opportunity for assessing the health and social care needs of the family which will determine levels of support the family will require following birth. This is an opportunity for discussion around maternal mental health and relationships. It also provides an opportunity for health improvement activity particularly around the benefits of breastfeeding, prevention of sudden infant death and promoting positive bonding and attachment. Midwives from Wirral University Teaching Hospital NHS Foundation Trust, Liverpool Women s NHS Foundation Trust, Countess of Chester NHS Trust and One to One Page 1 of 5
midwives will refer clients to the appropriate Health Visiting team at 28 weeks gestation. This aims to ensure that all pregnant women within Wirral are offered an antenatal contact. Prior to contact with the client, a member of the health visiting team must contact the client s midwife and/or General Practitioner (GP) to ensure the client is still pregnant to prevent any insensitive contact. Health Visitors are then required to contact their client via telephone or letter to arrange a mutually convenient appointment between 30 36 weeks gestation. This will ensure consistency in the offering and the timing of antenatal visits. A family health record will be commenced to adhere to the principles of safe record keeping. If a woman declines an antenatal contact, it must be documented in the Health Visitor record to adhere to the principles of safe record keeping. During the antenatal contact the Family Health Review will be initiated if appropriate. This will ensure any problems are identified and referrals are made to appropriate services, this will demonstrate multidisciplinary working across all agencies and the family health review will ensure a consistent approach to antenatal care. At all antenatal contacts the Health Visiting and Protecting Privacy Leaflet will be given to ensure that clients have essential contact details for the health visiting service. At all antenatal contacts, direction to the Birth to Five Book (DH, 2009) website should be given and discussed and documented in the health visitor records. This will ensure consistency of health visitor advice and education around key health promotion and health prevention topics. If safe to do so, ask the question Do you feel at risk of domestic abuse? If abuse is disclosed, an Interagency Monitoring Form (IAMF) should be completed in agreement with the client and forwarded to the Safeguarding Adults Lead. Discussing domestic abuse in pregnancy may provide women with the opportunity for disclosure as it is recognised that domestic abuse may start or escalate in pregnancy. Information should be offered to clients regarding the Zero Centre and the Family Safety Unit to provide women with telephone numbers where they can obtain help, support and advice. The benefits of breastfeeding should be discussed with all clients antenatally, to ensure that all women are aware of the benefits of breastfeeding and the support that is available in the community. All pregnant women will be asked 2 key mental health questions as detailed in National Institute for Health and Clinical Excellence (NICE 2007) clinical guideline 45. Mental health disorders during pregnancy can have serious consequences for the health and well being of a mother and her baby (NICE 2007). By asking key questions, it will help identify depression and anxiety prior to the birth of the baby. If a woman answers yes to either of the two questions, then a third question should be considered. If a woman answers yes to the third question, then a mental health assessment needs to be completed, and the Perinatal Mental Health Specialist Midwife informed. This approach will aid early intervention and referral to the GP/Mental health services. Page 2 of 5
If needs are identified at the antenatal contact, the Health Visitor will implement a Package of Care in partnership with the family and this will be recorded in the family health record. This will ensure identified needs are documented in the records and appropriate referrals made in relation to: Universal Universal Plus Universal Partnership Plus If a family is identified as having additional needs above the core health visiting programme, a Common Assessment Framework (CAF) will be offered. This is the responsibility of the health visitor as the professional identifying need. A CAF s aim is to identify, at the earliest opportunity, a child or young person s additional needs which are not being met by the universal services and to provide timely and co-ordinated support to meet those needs. How staff will demonstrate procedure is being followed: Family Health Record will have evidence of a client led antenatal contact Family Health Record will have evidence of an initiated client led Family Health Review. Family Health Record will have evidence of a completed CAF (if relevant). Family Health Record will have evidence a Package of Care has been implemented (if relevant). WHERE TO GET ADVICE FROM This list is not exhaustive advice can be sought from any relevant agency Health Visitor Team Leader Health Visiting Managers Safeguarding Team Central Advice and Duty Team Family Safety Unit Relevant partner agencies INCIDENT REPORTING Clinical incidents or near misses must be reported in line with the Trust Incident Reporting Policy SAFEGUARDING In any situation where staff may consider the client/child(ren) to be at risk, they must follow the Trust Safeguarding Policy and discuss with their line manager and document outcomes. EQUALITY ASSESSMENT During the development of this protocol the Trust has considered the clinical needs of Page 3 of 5
each protected characteristic (age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief, sexual orientation). There is no evidence of exclusion of these named groups. If staff become aware of any clinical exclusions that impact on the delivery of care, then the Trust Incident Reporting Policy must be followed and an appropriate action plan put in place. REFERENCES DH (2009) Birth to Five Book, Department of Health Publications Hall, D.M.B & Elliman, D (2006) Health for all Children: Revised Fourth Edition. Oxford University Press, Oxford National Institute for Health and Clinical Excellence (2007) Antenatal and Postnatal Mental Health, Clinical Management and Service Guidance 45, NICE, London Page 4 of 5
CONTROL RECORD Title Protocol for Universal Antenatal Contact Purpose To provide consistency in practice across the Trust Author Quality and Governance Service (QGS) Equality Assessment Integrated into procedure Yes No Subject Experts Alison Nugent Document Librarian QGS Groups consulted with :- Clinical Policies and Procedures Group Infection Control Approved N/A Date formally approved by Risk and Governance Group April 2012 Method of distribution Email Intranet Archived Date 3 rd April 2012 Location:- S Drive QGS Access Via QGS VERSION CONTROL RECORD Version Number Author Status Changes / Comments Version 1 Quality and Governance Service N First version Page 5 of 5