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Client involvement is the sure way to better health

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VOL: 97, ISSUE: 40, PAGE NO: 36

Alice Webster, MSc, BA, RGN, RHV, RM, is health visitor/development, Eastbourne and County Health Care NHS Trust

The idea behind Sure Start is to reshape and add value to local services for families. The project offers support for parents and carers by delivering a variety of multi-agency services.

The idea behind Sure Start is to reshape and add value to local services for families. The project offers support for parents and carers by delivering a variety of multi-agency services.

Our Sure Start area, known as Ore Valley, is about two miles from Hastings town centre and has a population of around 10,185. It is made up of four housing estates, surrounded by privately owned or rented accommodation. There are many flats and maisonettes, with little suitable family housing. Unemployment in the area is high at 6.7%, almost double the average in East Sussex, and many residents rely on state benefits. A quarter of all families in the area receive income support. Teenage pregnancy is a problem, and the number of people aged 17 and over who are not in full-time education is 70.6%, again almost double the county average (Office of Population Censuses and Surveys, 1991).

Before Sure Start there was a lack of amenities, with the nearest primary schools and playgroups located on the outskirts of the area.

Ore Valley has no pharmacy, dental or primary health care services and the population is served by 45 GPs. Shopping is limited, as only one estate has a parade of shops.

Ore Valley already had a community development worker and had identified the health and social needs of local children. As part of Sure Start, a partnership was set up between residents and professionals. Planning meetings were open to anyone and were held on the estates at different times throughout the day. Residents were encouraged to become involved in the process. This has worked well and a second part-time community development worker is now in post.

The success of Sure Start relies on collaboration between residents, practitioners and service providers in health and social care. Housing is a central issue and a housing association has made flats available.

There are plans to turn the project into a trust, with a board run by professionals and residents that will also have legal input. This is expected to happen next year.

When the service was established, the steering groups identified the following key aims:

- To work with parents and children to promote the physical and social development of preschool children;

- To provide a range of high-quality outreach support, health and play services for families living in Ore Valley through a partnership approach.

Four main objectives were agreed: to improve children's social and emotional development; improve their health; improve their ability to learn; and strengthen families and the community.

As we work towards these goals, we are aware that we must be creative in our practice and question traditional ways of working. The residents' voice is a strong one, and we always seek the opinions of client groups and members of the partnership before making any changes in practice.

Improving children's social and emotional development
When the team considered how to improve children's social and emotional development, the following key areas were identified:


The Playlink service has six home visitors and five drop-in sessions across the valley. Working with other agencies such as health and education, as well as local voluntary groups, it offers a music group, a 'get cooking' course and a young parents' group.

Home Start

In time we aim to offer the involvement of Home Start volunteers with specific skills. For example, a woman who has problems breastfeeding may be linked with a volunteer who has knowledge or training in this area.

Improved family support

This will be provided by the National Children's Home (NCH) Action for Children, which offers practical support to families in the home setting, as well as access to other services.


At the start of the project, there was only one registered childminder in the area. The project offers training and encourages parents to become registered childminders themselves.

Improving children's health
We assess a client's situation and work on the areas they feel need improvement. For example, a woman with two young children - a three-year-old and a baby - complained that the toddler misbehaved while she was breastfeeding the baby. Working around the baby's breastfeeding times, we planned activities the child and her mother could do while this was happening: reading, making up a story or drawing a picture. The mother also started to have her meals with the older child.

The result was that the toddler no longer felt left out. She responded more positively to both her mother and baby brother and became happier and less disruptive.

A collaborative approach is taken towards the provision of health care involving the input of several professionals/agencies.

Health visitors

The project has two full-time health visitors with a caseload of 500 children aged under four. Before Sure Start, there were around 25 health visitors covering the area.

Family support health visitor

The family support health visitor focuses on supporting families who can self-refer or be referred by team members. The emphasis is on short, intensive work: the health visitor sees the family over six to eight weeks, with a review date after three months. The health visitor has counselling skills and a diploma in play therapy, and is a useful resource to the team.

Nursery nurse

The nursery nurse works with the health visitors and acts as a link to other service providers such as Playlink. The support to families may include accompanying parents to drop-in sessions and groups which they may be reluctant to attend alone.

Antenatal care

Midwifery-led antenatal care takes place at a Sure Start building, with parentcraft and smoking cessation sessions available; other services are still being developed.

One target is to reduce the number of teenage pregnancies: the number for women aged 12-24 stands at around 9.8% on one estate and 9% on another. The average for Hastings is 8.1%.

Speech and language therapy

Before Sure Start, about half the children referred to the language therapy service failed to attend. Of those seen, 20% had delayed speech at 18 months and 15% at three years. The service is hoping to improve this by offering group sessions called 'Chatterbox' for parents and children.

Occupational therapy

A part-time occupational therapist for children with special needs has been a bonus. Before this, there was a waiting list of about a year. Families are assessed in their own homes rather than in the formal clinic settings.

Accident prevention

We offer stair gates and fireguards to residents at a cost of £2.50 each, made possible through a subsidy from the Sure Start budget. The cost includes delivery and fitting.

Improving children's ability to learn
There was low uptake of playgroup places in the area, so two free sessions a week are now being offered for every child aged over three.

Book Start, for example, aims to offer every child the chance to learn. Introducing a book at the seven to nine-month review and at the three-year review is intended to encourage parents to interact with their child on a one-to-one basis. This could involve them allocating a quiet time - with the television turned off - to allow them to focus on a single activity such as reading a story. Money has been pooled with another local Sure Start scheme to employ a coordinator for this part of the project.

Adult education courses, run in conjunction with the University of Sussex, provide free creche facilities.

Pocket Parks (small areas located at sites that are visible to houses) and Home Zones (areas where children play outside in their localities) have been made safer by the use of traffic-reduction measures. This has been done with the cooperation of the council and the traffic department. We cannot stop children playing in the street, but we can make it safer.

The Early Years Service, run by the local education authority, focuses on preschool children with special needs who require support in the nursery environment. They now have a significant input into the area and access families through Playlink and the Chatterbox group.

Strengthening families and the community
The central focus of Sure Start has been to establish the needs of the community and tailor services to meet them. NCH Action for Children has been working on the peripheries of the area for some time but is not well used or always well received, possibly because the programme touches on child protection issues. Two workers are now based in the area and are valued members of the Sure Start team. They offer advice on parenting issues such as managing tantrums and provide support packages within the home. They access parents through drop-in sessions and groups already in existence.

Reduced price counselling is offered by Relate to individuals or couples in the area with relationship difficulties.

There are after-school clubs for children, as well as groups for older people that provide companionship, entertainment and meals. Hopefully, the community will become further involved as time goes on.

A food cooperative, funded by the Department of Health, supplies fruit and vegetables. There is a £1 charge to join, after which residents can order produce at cost price. Members also get tasters, recipe leaflets and a news sheet.

There are many people delivering Sure Start services: it is an important and exciting development in child public health. However, the project will only succeed if the community is involved and takes responsibility for any activities; core services must be delivered in such a way that they can be accepted and owned by clients.

This will only happen if residents feel they have had a say in the development of new services. Individuals cannot reach their full potential in isolation - they form part of a family and part of a community - together they can make a difference.

Sure Start demonstrates the potential of multi-agency collaboration and teamwork to benefit the communities most in need of support and least able to access services.

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