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Publication - Guidance

Universal Health Visiting Pathway in Scotland: pre-birth to pre-school

Published: 26 Oct 2015
Part of:
Children and families, Health and social care
ISBN:
9781785447709

The Pathway sets out the minimum core home visiting programme to be offered to all families by Health Visitors.

64 page PDF

4.5MB

64 page PDF

4.5MB

Contents
Universal Health Visiting Pathway in Scotland: pre-birth to pre-school
Health Visitors Home Visiting Pathway

64 page PDF

4.5MB

Health Visitors Home Visiting Pathway

PRE-BIRTH TO PRE-SCHOOL

Pre-Birth to Pre-School

Health Plan Indicator Definition

An additional HPI indicates that the child (and/or their carer) requires sustained (>3 months) additional input from professional services to help the child attain their health or development potential. Any services may be required such as additional HV support, parenting support, enhanced early learning and childcare, specialist medical input, etc.

Child's Age

Purpose of Visit

National Assessment Tools

National/Local Outcomes **

Pre-Birth
(Suggested time: 10 minutes)

  • Standard service letter to pregnant women on notification of pregnancy.
  • Introduction to Health Visiting Services/National Leaflet.

Parent/carer aware of the Health Visiting Service and contact details

Pre-Birth Contact
32 - 34 weeks
(Suggested time: 45 - 60 minutes)

  • Face to face contact to introduce Health Visiting Service and to begin to develop and build therapeutic relationship with mother/family.
  • Begin early assessment of maternal/family health, wellbeing and early identification of vulnerability or additional needs.
  • Initiate additional interventions as appropriate such as Alcohol Brief Interventions
  • Commencement of transition of care from Midwife to Named Person
  • Introduction of Red Book
  • Initiate additional joint visit with the Midwife where additional need is identified
  • Engage and share public health information and guidance to promote positive attachment and health and wellbeing
  • Assessment and support for infant nutrition; making an informed feeding decision, benefits of breastfeeding, value of skin-to-skin and support decision making and access to Support Workers for Breastfeeding including in-reach into the post-natal ward
  • Routine enquiry about family finances/money worries and raise awareness of the advice available and offer families a direct referral to advice services.
  • Edinburgh Postnatal Depression Scale
  • Getting it Right for Every Child ( GIRFEC) Practice Model
  • National Risk Assessment Tool
  • Learning Disability Assessment Tools
  • Early development of a therapeutic relationship
  • Identification of parent/carer and child strengths
  • Early identification of vulnerability/need and active request for assistance or referral is made for clients at an early stage
  • Uptake of services/tailored support from third sector agencies to address wider determinants
  • Family awareness of Health Visiting Service and support available on transition from Midwifery care
  • Families recognise Health Visitor as professional offering credible and positive information, advice. support and help to access services
  • Parents/carer receive appropriate public health advice to maximise child/family wellbeing
  • More structured continuity of care and continuous assessments
  • Income of pregnant women and families with young children who are at risk of, or experiencing, poverty is maximised
  • Clear documentation of intervention

* Throughout each visit/contact utilise Public Health Resource Toolkit ( Appendix 4 )

** This is current thinking. Ongoing work will determine the precise nature of measures to be captured

Child's Age

Purpose of Visit

National Assessment Tools

National/Local Outcomes **

11-14 days
(Suggested time: 60 - 90 minutes)

  • Engage with family following birth
  • Assessment and initiation of Getting it Right for Every Child ( GIRFEC) and identification of child/family strengths and health/mental health and wellbeing needs and provisional HPI
  • Engage and share public health information and guidance to promote positive attachment and health and wellbeing
  • Physical developmental check of the baby
  • Introduce immunisation and developmental assessment schedule
  • Advice on sources of community support
  • If not previously carried out carry out routine enquiry for gender based violence and risk assessment undertaken following disclosure Build on and strengthen therapeutic relationship between practitioner and mother/family
  • Agree future plan of care with parents/carers
  • Routine enquiry about family finances/money worries and raise awareness of the advice available and offer families a direct referral to advice services
  • Standard assessment/ recording proforma (Child Health Surveillance Programme)
  • National Risk Assessment Tool
  • Getting it Right for Every Child ( GIRFEC) Practice Model
  • Learning Disability Tools
  • Refer to Chief Executive Letter ( CEL) 41 and Edinburgh Postnatal Depression Scale as appropriate
  • World Health Organisation ( WHO) Guidelines for Child Growth
  • Families experience continuity of care through timeous information sharing between services
  • Partnership between practitioners and parents/carers is established
  • Profile of significant factors
  • Any risk or potential risk to child or parent/carer health and wellbeing is identified/ addressed early
  • Identification of physical and prolonged jaundice
  • Consideration should be given to early visual support to babies born to parents with addictions
  • Parents are empowered to understand and support child's developmental progress
  • Improved nutrition for child or parent/carer
  • Children are protected against infections through engagement/ uptake of immunisation programme
  • Increased breastfeeding initiation
  • Families recognise Health Visitor as professional offering credible and positive information, advice, support and help to access services
  • Parent/carers are supported to maximise wellbeing of self/baby
  • Continual assessment of child and development of a therapeutic relationship with family
  • Uptake of services/tailored support from third sector agencies to address wider determinants
  • Parents/carers receive appropriate public health advice to maximise child/family wellbeing
  • Income of families with young children who are at risk of, or experiencing, poverty is maximised
  • More structured continuity of care and continuous assessments
  • Clear documentation of any required intervention

* Utilise Public Health Resource Toolkit ( Appendix 4 ) for key contacts and all interventions

** This is current thinking. Ongoing work will determine the precise nature of measures to be captured

Child's Age

Purpose of Visit

National Assessment Tools

National/Local Outcomes

3 - 5 weeks (All Families)
(Suggested time: 30 - 45 minutes)

  • Continued Getting it Right for Every Child ( GIRFEC) assessment process and identification of child/family health strengths and wellbeing needs.
  • Build on and strengthen therapeutic relationship between practitioner and mother/father/ family
  • Engage and share public health information and guidance to promote positive attachment and health and wellbeing
  • Observe/ discuss developmental progress of infant
  • If previously disclosed, routine enquiry for gender based violence and risk assessment undertaken
  • Agree plan of ongoing care
  • Domestic Abuse Risk Assessment Checklist ( DASH RIC)
  • Getting it Right for Every Child ( GIRFEC) Practice Model
  • National Risk Assessment Tool
  • Continuum of parent/carer and child assessment and care providing maximum opportunity to intervene early where additional support is required.
  • Co-production approach to support parents/carers to maximise the wellbeing of their baby
  • Women and children are protected through provision of support and referral to Multi-Agency Risk Assessment Case Conferences as appropriate when abuse identified
  • Families recognise Health Visitor as professional offering credible and positive information, advice, support and help to access services
  • Parents/carers receive appropriate public health advice to maximise child/family wellbeing
  • Income of families with young children who are at risk of, or experiencing, poverty is maximised.
  • More structured continuity of care and continuous assessment

6 - 8 weeks
(All Families)
(Suggested time: 45 - 60 minutes)

  • Continued Getting it Right for Every Child ( GIRFEC) assessment process and identification of child/family health/mental health strengths and wellbeing needs and update recording of Health Plan Indicator
  • Discuss and enquire about depressive symptoms and complete the Edinburgh Post Natal Depression Scale ( EPDS)
  • If not previously carried out undertake routine enquiry for gender based violence and risk assessment undertaken following disclosure Build on and strengthen therapeutic relationship between practitioner and mother/family
  • Engage and share public health information and guidance to promote positive attachment and health and wellbeing
  • Agree plan of ongoing care
  • Domestic Abuse Risk Assessment Checklist ( DASH RIC)
  • Edinburgh Postnatal Depression Scale Questionnaire
  • Standard assessment/ recording proforma (Child Health Surveillance Programme) as appropriate
  • National Risk Assessment Tool
  • Getting it Right for Every Child ( GIRFEC) Practice Model
  • Chief Executives Letter ( CEL) 41
  • Continuum of parent/carer and child assessment and care providing maximum opportunity to intervene early where additional support is required.
  • Early identification and management of perinatal mood disorders
  • Early intervention to reduce risk of dental caries
  • Initial recording of Health Plan Indicator
  • Early evidence of attachment
  • Routine enquiry, recording of disclosure and risk assessment as appropriate
  • Women and children are protected through provision of support and referral to Multi-Agency Risk Assessment Case Conferences as appropriate when abuse identified.
  • Early referral and intervention where assessment of growth and or development indicates that child is not achieving age appropriate milestones
  • Families recognise Health Visitor as professional offering credible and positive information, advice, support and help to access services
  • Parents/carers receive appropriate public health advice to maximise child/family wellbeing
  • More structured continuity of care and continuous assessments

3 Months
(Suggested time: 45 - 60 minutes)

  • Continuous assessment and identification of child/family health/mental health and wellbeing needs
  • Discuss and enquire about depressive symptoms and complete Edinburgh Postnatal Depression Scale
  • Engage and share public health information and guidance to promote positive attachment and health and wellbeing
  • Continue to observe child's developmental progress
  • If not previously carried out undertake routine enquiry for gender based violence and risk assessment undertaken following disclosure
  • Advise on sources of community support
  • Following assessment commission additional support via Early Years Support Workers as required
  • Complete Getting it Right for Every Child ( GIRFEC) assessment process and update Health Plan Indicator
  • Introduce the subject of weaning and highlight importance of delaying introducing solids until around 6 months.
  • Agree plan of ongoing care
  • Edinburgh Postnatal Depression Scale Questionnaire
  • Domestic abuse Risk Assessment Checklist ( DASH RIC)
  • National Risk Assessment Tool
  • Getting it Right for Every Child ( GIRFEC) Practice Model
  • Continuum of parent/carer and child assessment and care providing maximum opportunity to intervene early where additional support is required.
  • Early identification and management of perinatal mood disorders
  • Early intervention to reduce risk of dental caries
  • Women are supported and risks reduced to children through support provided where gender based violence is identified
  • Women and children are protected through provision of support and referral to Multi-Agency Risk Assessment Case Conferences as appropriate when abuse identified.
  • Prevention of unintentional injury
  • Evidence of timeous immunisation uptake
  • Weaning at appropriate age
  • Parents/carers receive appropriate public health advice to maximise child/family wellbeing
  • Families recognise Health Visitor as professional offering credible and positive information, advice, support and help to access services
  • More structured continuity of care and continuous assessment

4 Months
(Suggested time: 45 - 60 minutes)

As above

Agree future plan of care

As above

As above

8 Months
(32 weeks)
(Suggested time: 30 - 45 minutes)

  • Review Getting it Right for Every Child ( GIRFEC) assessment and identification of child/family health/mental health and wellbeing needs and update Health Plan Indicator if required
  • Engage and share public health information and guidance to promote positive attachment and health and wellbeing
  • Continue to observe child's developmental progress and undertake additional interventions as required e.g. advice; referral
  • Signpost to local Community Services
  • Agree future plan of care
  • National Risk Assessment Tool
  • Getting it Right for Every Child ( GIRFEC) Practice Model
  • Ages & Stages Questionnaires: ( ASQ:3)
  • Continued relationship building with family
  • Continuum of parent/carer and child assessment and care providing maximum opportunity to intervene early where additional support is required
  • Parents/carers receive appropriate information and support to maximise the wellbeing of their child
  • Achievement of age appropriate developmental milestones
  • Early identification of concerns
  • Commission of additional intervention and support as required
  • Early identification and management of perinatal mood disorders
  • Parents/carers receive appropriate public health advice to maximise child/family wellbeing
  • Families recognise Health Visitor as professional offering credible and positive information, advice, support and help to access services
  • More structured continuity of care and continuous assessment

13 - 15 months
(Suggested time: 45 - 60 minutes)

  • Review Getting it Right for Every Child ( GIRFEC) assessment and identification of child/family health/mental health and wellbeing needs and update Health Plan Indicator if required
  • Assessment should include: quality of parent - child relationship and mental health of the principal carer
  • Engage and share public health information and guidance to promote positive attachment and health and wellbeing
  • Undertake developmental and wellbeing review
  • Child Health Review - refer to guidance in Appendix 2 (Guidance on delivery and national minimum dataset)
  • Advise on local services for children and families
  • Review immunisation status and prompt attendance where required
  • Routine enquiry about family finances/money worries and raise awareness of the advice available and offer families a direct referral to advice services
  • Agree future plan of care
  • Standard assessment/ recording proforma (Child Health Screening Programme)
  • Ages & Stages Questionnaires: ( ASQ:3) should be used universally with continued access to validated development assessment tools and there appropriate age range as listed in Appendix 2 and 3 .
  • Continuum of parent/carer and child assessment and care providing maximum opportunity to intervene early where additional support is required Early identification of growth/ developmental concerns
  • Parents/carers receive appropriate support and advice to maximise the wellbeing of their child
  • Children's listening and communication skills are enhanced through the introduction of early reading
  • Children are protected from infectious disease
  • Ensuring follow up when concerns are identified
  • Request for assistance as appropriate
  • Attendance at appointments
  • Parents/carers receive appropriate public health advice to maximise child/family wellbeing
  • Income of families with young children who are at risk, or experiencing, poverty is maximised
  • Families recognise Health Visitor as professional offering credible and positive information, advice, support and help to access services
  • More structured continuity of care and continuous assessments

27-30 Months (Suggested time: 45 - 60 minutes)

  • As above
  • In addition to the above routine enquiry for gender based violence and risk assessment conducted
  • Ages & Stages Questionnaires: ( ASQ:3) should be used universally with continued access to validated development assessment tools and there appropriate age range as listed in Appendix 2 and 3 . These should be used in conjunction with 27 - 30 Month Guidance.
  • Domestic Abuse Risk Assessment ( DASH RIC)
  • Standard assessment/recording proforma (Child Health Screening Programme)
  • Continuum of parent/carer and child assessment and care providing maximum opportunity to intervene early where additional support is required.
  • Parents involved and received advice and support in maximising the wellbeing of their child.
  • Children are protected against infectious diseases
  • Referral where necessary
  • Women are supported and risks reduced to children through support provided where gender based violence is identified
  • Women and children are protected through provision of support and referral to Multi-Agency Risk Assessment Case Conferences as appropriate when abuse identified.
  • Parents/carers receive appropriate public health advice to maximise child/family wellbeing
  • Income of families with young children who are at risk, or experiencing, poverty is maximised
  • Families recognise Health Visitor as professional offering credible and positive advice and support
  • More structured continuity of care and continuous assessments

4 - 5 Years (Suggested time: 30 - 45 minutes)

  • Undertake pre-school review
  • Child Health Review - refer to guidance in Appendix 3 (Guidance on delivery and national minimum dataset)
  • Update Getting it Right for Every Child ( GIRFEC) assessment and Health Plan Indicator
  • Engage and share public health information and guidance to promote positive attachment and health and wellbeing
  • Routine enquiry about family finances/money worries and raise awareness of the advice available and offer families a direct referral to advice services
  • Arrange discussion/meeting with School Nurse for children with an Health Plan Indicator of additional
  • Transition to School
  • Arrangements for transition to the incoming Named Person e.g. Education.
  • Ages & Stages Questionnaires: ( ASQ:3) should be used universally with continued access to validated development assessment tools and there appropriate age range as listed in Appendix 2 and 3 .
  • Continuum of child assessment
  • Seamless transition to School Nursing Services
  • Parents/carers receive appropriate support/advice to maximise the wellbeing of their child
  • Income of families with young children who are at risk, or experiencing, poverty is maximised
  • Children benefit from effective care planning between services

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