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Support that can be offered at 9-12 month assessment

29th September 2016

Health visitors have a unique role in offering 5 universal contacts. During these contacts we are uniquely placed to encourage a stimulation of awareness of health needs, one of the 4 principles of health visiting. The majority of families will follow the universal pathway. However, changes in circumstances can lead to families requiring extra support via the universal plus and universal partnership plus pathways. Parents are not always aware of support available or may not even realise there is a detrimental health impact either physical or emotional on their child due to their current circumstances. During these universal contacts parents are given the opportunity to express issues regarding their child’s development, family/environmental circumstances and other issues affecting their parenting capacity such as mental health. This case looks at support that can be offered at 9-12 month assessment.

9-12 month assessment case study

This child attended clinic for her routine 9-12 month assessment. She had followed a universal pathway and had been born full-term. She had an older sibling aged three years who had commenced nursery and attended regularly. His developmental assessments had been completed in a timely manner and no concerns had been highlighted. His immunisations were up to date. Family were British Pakistani: Dad spoke good English; Mum spoke English, however an interpreter was offered for mum as sometimes her understanding could be limited due to the language barrier.

The family were seen at home for new birth contact and 6 week health visitor review. Although dad worked, he was very supportive and extended family also lived in the area. There had been no issues highlighted regarding maternal mental health, domestic abuse or substance misuse. The home conditions were satisfactory and the family lived in a council flat that was appropriately furnished. Mum was invited to attend clinic post the 6 week health visitor review. She attended her GP for a 8 week medical and had all her primary immunisations.

At the 9-12 month assessment, the Ages and Stages Questionnaire (ASQ) was completed by mum, with support from a nursery nurse from the health visiting team to ensure that mum understood all the questions. Although this little girl was reaching all her developmental milestones and her scores were all within the white area of the evaluation sheet, mum presented as very anxious regarding her daughter’s health. She highlighted recent hospital admissions with a high temperature and viral wheeze. She reported there was damp in the flat and that this was affecting her daughter’s health. The nursery nurse fed this back to the health visitor and requested the health visitor to complete a home visit.  This baby had been born in spring and it was now winter.

I arranged a home visit with an interpreter.  When the home visit was completed, there was a distinct smell of damp in the flat. Mum became very upset taking me around the flat. There was mould on the wall in the kitchen and lounge and she was unable to use certain drawers in the house due to the damp. The family had reported the issue to the council but she didn’t feel she was being listened to. She felt the damp was the cause of all her daughter’s health issues.

As we explored health issues further, it became apparent that this child had been referred to a paediatrician for weight /height by the GP as both were following 0.4th centile suggesting she was very small. Mum also had other anxieties regarding her daughter. Using the Solihull Approach containment of mum was important at this point. Giving her the opportunity to express her thoughts, she reported that the GP had completed a letter for the council to support her with a house move but the council were not helpful. Mum’s mental health was also explored utilising the Whooley questions to ensure she was not suffering from depression.

Following the visit, a discussion with the council highlighted that, although they had not been able to offer a new property, work could be done to improve the situation. The parents had not been made aware of this. Support via the Early Help process was discussed and parents were in agreement. The council and parent support advisor from nursery were invited to the meeting alongside an interpreter to ensure that mum could fully engage in the process.

Since this initial meeting new flooring has been fitted in the bathroom, and repointing and damp proofing has been completed. Further visits were offered to review their child’s weight, health and mum’s anxiety. The parent support advisor was another community resource that mum could access as her son attended nursery every day. The dietician has recently reviewed the child’s nutritional status and vitamin supplements are now being taken regularly.

Early help has now been closed. However, mum wanted to emphasise that she was very grateful for the support she received from the health visitor during the process, particularly as an interpreter was available at each contact. Her daughter’s health has improved and, although she has had colds/ temperature, she has not needed to attend hospital.

Diane Crutchley, Health Visitor for Walsall Healthcare NHS Trust