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Scotland study finds 'key benefits' from 11-check health visiting service

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The first enhanced health visiting programme to be introduced in Scotland, which includes 11 visits to families, has led to earlier identification of health and welfare concerns and extra help for parents, according to an evaluation of the scheme.

Researchers from the University of Edinburgh and Glasgow Caledonian University also found the service – set up by NHS Ayrshire and Arran – helped build trusting relationships between the nurses and families.

”Increased, structured home visiting made it possible for them to receive more support both for themselves and their children”

Evaluation of enhanced health visiting service

Their study, published in the PLOS ONE journal by the Public Library of Science, involved gathering information from managers, who helped bring in the programme, and interviews with 25 health visitors and 22 parents.

All health boards in Scotland are introducing the enhanced programme, which replaces health visitor drop-in clinics with more home visits.

However, it was recently warned that the introduction of the new programme across all boards could be jeopardised if the Scottish government failed to do more to meet its target of boosting the size of the health visiting workforce by next year.

Under the scheme, families get at least 11 home visits - with the first taking place at 11 to 14 days after birth and then weekly visits for the next five weeks.

The following visits are at six to eight weeks, then at 12, 16 and 24 weeks. The final two take place when a child is aged one and then at 27 to 30 months.

Health visitors also spend extra time working with families identified as having “additional” support needs, noted the evaluation.

To free up time to deliver the enhanced service, health visitors are no longer required to carry out immunisations or run drop-in clinics.

NHS Ayrshire and Arran was the first of 14 Scottish health boards to establish the programme in mid-2013.

“The majority of health visitors were keen to point out that with the previous service, concerns were often identified at advanced stages”

Evaluation of enhanced health visiting service

The research team used a “realist evaluation” approach - which recognises the complexities involved in delivering social programmes and strives to put results in context.

They found families “highly appreciated” the support provided by health visitors and felt they got more attention from the one-to-one visits with the chance to discuss issues in more depth.

“They felt that the increased, structured home visiting made it possible for them to receive more support both for themselves and their children,” said the research paper, called Realist evaluation of an enhanced health visiting programme.

Some parents said they did miss the social aspect of drop-in clinics and the chance to weigh their babies more regularly.

However, the fact they had the option of contacting health visitors by phone was “quite positive and reassuring” and most who took part in the research said they had used this service.

Many of the health visitors interviewed said the increased home visits helped to forge a trusting relationship and “ensured families were more open and confident to discuss sensitive issues with them”.

“The programme increased opportunities for monitoring and early identification of health and wellbeing concerns”

Evaluation of enhanced health visiting service

Most said they were able to identify concerns at an earlier stage and refer families to additional sources of support.

“The majority of health visitors were keen to point out that with the previous service, concerns were often identified at advanced stages,” noted the paper.

It was clear health visitors were making more referrals to wider services, including nursery placements “in ways, which were not previously possible”, it added.

Health visitors also felt the enhanced service helped define their role more clearly both to parents and other professionals and that this boosted partnership working.

However, one aspect of the programme both health visitors and parents were concerned about was the wide gaps between some home visits.

“A lot of the parents find [that] from a year to 27 months is too long not to be seeing anybody,” said one health visitor who took part in the research. “And I think that is quite a gap too.”

The researchers said the evaluation highlighted a number of ”key benefits” from the enhanced service.

“The programme increased opportunities for monitoring and early identification of health and wellbeing concerns,” concluded the paper.

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