HEALTHY CHILD WALES PROGRAMME 2016 Jane O’Kane

Health Visiting Lead ABMU Health Board on behalf of the

All Wales Health Visiting & School Health Nursing Leads

The Ambition

Making an Impact

The Strategic fit

The Principles

The challenges, the opportunities and the risks

Assurances

The So What

Our plan for 2020 and beyond

THE AMBITION

Development of a one Wales model of universal early intervention: committed to safeguarding the health and welfare of all children

A model delivered in collaboration with key partners in the Third Sector & across the Public Sector that will equate with more resilient families; parents able to support their children to achieve better health, social and educational outcomes

Comprise evidence based interventions that build upon research relating to the impact in childhood of early experiences and impact upon infant brain development, and immunological and nervous system development.

A lack of appropriate experiences can

lead to alterations in genetic plans.

Moreover although the brain retains

the capacity to adapt and change

throughout life, this capacity

decreases with age Keuroghlian et al 2007

MAKING AN IMPACT & REDUCING HEALTH INEQUALITIES: PUBLIC HEALTH NURSING

154 year old profession; introduced in 1862 during the philanthropic movement.

1914: State regulated profession and in NHS ACT 1948 Birth Visit imbedded

1966: Contribution to the decline in infant mortality in the1900’s recognised (PJ Cunningham)

1990s: community orientated approach to support social change

Remit to incorporate older population & targeting vulnerable groups

2000: safeguarding children policy reforms and perception of state surveillance

2000: WG recognition of HV interventions - Sure Start and Flying Start

2010: The WG Vision for Health Visiting & key priorities

THE STRATEGIC FIT

Reflect strategic guidance, legislation, & professional recommendations:

Social & Economic Impact :

Build upon the increasing evidence of investing in early years interventions in order to improve the future for the next generation – with long term health gain & associated financial savings; noting social & economic links

(ACES, 2016 ,Marmot,2010, Acheson 1998 and The Black Report,1980)

Reflecting and Learning from local reviews:

Thematic reviews & translation into practice

Measuring outcomes :

Alignment with existing frameworks ( Early Years Outcome Framework & Public Health Outcomes Framework PHW, 2016)

THE PRINCIPLES

Model of progressive universalism

Key Health Visiting contacts underpinned by a comprehensive

assessment of family resilience to help determine ongoing

requirements in partnership with families

Health Visiting service provision to be offered at 1 of 3 levels;

Universal, Enhanced and Intensive dependant upon resilience

assessment outcome

Delivery of consistent public health messages delivered by a

workforce trained in motivational interviewing

THE CHALLENGES, OPPORTUNITIES & THE RISKS

Alignment of 7 Health Boards local programmes

Financial envelopes and constraints

Workforce: variations and capacity with 2 HBs risk

managing programme priorities

Prioritisation of minimum requirements, poverty profiles

and characteristics specific to some communities

Policy & strategy reforms & a knit between

PROVIDING ASSURANCES

Quality Assurance Framework underpinning the programme:

Minimum Standards

Learning from Francis Inquiry: Supportive Practice Review to

encompass audit of values & behaviours

One Wales HV Job Description

National training programme

RBA framework

Single Record aligning with WCCIS

AN EARLY YEARS PATHWAY

Health Visitor Birth Visit & Follow-up 1-6 weeks

Measurements

FRAIT, Domestic Abuse Pathway, Peri Mental Health Pathway

Baby Friendly Initiative Breast or

Bottle Feeding Assessment.

Infant weight measurement at

birth visit, 02 exam, at each

primary immunisation, 03 exam

and 12 months or as requested

by parent.

Apply guidance for BMI and

growth measurement from UK –

WHO Growth Charts and

RCPCH – Weight Monitoring

Guidance

Antenatal Contact by Health Visitor 28-40 wks

All

Universal Clinic Contacts

02 Exam: GP

assessment at 6 to 8

weeks:

Measurements

Family Health

Review: at 8 weeks,

12 and 16 weeks

Immunisations

Measurements Mental

Health Pathway

Health Visitor Family Health Review 15 Months

Measurements

FRAIT, Domestic Abuse pathway, Developmental Assessment

Health Visitor Family Health Review 27 Months

Measurements

FRAIT, Domestic Abuse pathway, Developmental Assessment

Family Health Review 13 Months

Immunisations

Measurements

Healthy Child Wales Programme (HCWP)

Health Visitor Family Health Review 6 Months

Measurements

FRAIT, Domestic Abuse pathway, Mental Health Pathway

Health Visitor Family Health Review 3.5 Years

Key Interventions throughout the pathway

Assessment of family resilience and need

Promotion of secure parent & infant relationships

Promotion of breast feeding, safe infant feeding

and infant, toddler and family nutrition.

Promotion of baby and child safety

Assessment and monitoring of growth and

development

Promotion of maternal emotional health

Childhood immunisations

Assessment of visual development

Promotion of speech, language and

communication

Promotion of dental health

Promotion of Childs behaviour

Toilet training

Key Public Health messages are offered

throughout the programme i.e.

Smoking cessation

Contraception and sexual health

Pet safety

Reading and play. Pre School Booster

Immunisations

School Health Nursing Service

4-5 years

Deliver Fluenz vaccination. Height, weight and vision screening.

Provide CMP data on height and weight

Community Midwife Home Visits

Day after discharge from hospital-full breastfeeding/bottlefeeding

assessment

72 hours after discharge -Weigh baby. Full breastfeeding/ bottlefeeding

assessment

Day 5 for PKU assessment. Full breastfeeding assessment.

10-14 day visit - Health Visitor takes over care.

Community Midwife Home visits

Frequency of visits assessed for on individual basis. For

breastfeeding issues - Midwives work closely with

Maternity Care Support Workers who carry out additional

visits.

Flying Start Enhanced HV programme

Universal Antenatal Contact @ 24+ weeks with

targeted Hello Baby / Parent Nurture programmes

Birth Visit at 10-14 days + weekly home contacts

up to 6 weeks

8-16 week contact (weaning)

6-9 month family health review

9-12 month family health review

15-18 month family health review

2 year family health review and SOGS

3 year family health review and SOGS

3 ½ - 4 year Family Review

Access to Drop-in Parent groups offering Baby

Massage, Speech and language support, Parenting

programmes.

Childcare for 2.5 hrs per day, 5 days/week between

2 and 3 years.

AND SO WHAT ? OUR CONTRIBUTION ( IN PARTNERSHIP)

All parents to have the opportunity, the

aspiration & confidence to parent well

All children to have optimum health & be

prepared for school entry & achieve their

potential

A healthy Wales

2020 AND OUR AMBITION FOR THE FUTURE

Clearly articulated outcomes

Results Based Accountability framework will be

imbedded and demonstrate high standards of

practice/interventions

Primary Care collaboration to develop specific

programmes including Advanced HV Practitioner roles in

Child Health

Research and developments in the fields of perinatal

mental health, oral care and positive parental

relationships in collaboration with peer groups, local teams

& Third Sector.

Thankyou