What do parents, professionals and policy colleagues want from a universal assessment of child development?

Researchers at the NIHR Children Policy Research Unit have published their latest paper “What do parents, professionals and policy colleagues want from a universal assessment of child development in the early years? A qualitative study in England” in the BMJ Open.

Launching the paper on social media, the researchers summarised the findings stating, “Parents and health visiting professionals in England want a measure of child development at 2-2½ years to be a springboard for a ‘warm conversation about what’s going on – covering child, sibling and parent wellbeing. Not just ‘tick, tick, tick’”.

Objective: Every child in England should be offered a health and development review at age 2-2½ years by the health visiting service, part of which includes an assessment of child development. To inform policy and practice, the study gathered the views and experiences of parents and health visiting professionals on key priorities for, and barriers to, a universal assessment of early child development at age 2-2½ years.

Design, setting, participants: Data were collected through 15 focus groups with 29 parents, 24 health visitors and nursery nurses, five service managers and five policy colleagues in England. Participants were asked to reflect on their experiences of, and priorities for, measuring child development at the 2-2½ year universal review.

Analysis: The research team analysed data using Reflexive Thematic Analysis.

Results: Two overarching themes were identified in the data:

The first theme, ‘just a part of the puzzle’: a useful tool in a holistic review, reflected a consistent priority – across all focus groups – for a measure of child development that was well embedded in the wider review, that facilitated conversations about the child and family system and allowed negotiation of parent and professional judgement of the child’s development, and had a clear stated purpose.
The second theme, ‘they need to know why they’re doing it: a need for clarification’, reflected the need for a clear purpose for, and less variable delivery of, the tool, including a need for clarification on its intended purpose to provide population-level data.

Conclusions: Parents and practitioners wanted a tool that facilitated a holistic conversation about development, wellbeing and health across the family system, with direct observation of the child by the professional. Used skilfully, the Ages and Stages developmental assessment tool can constitute an intervention in itself, as it helps scaffold a conversation about how parents can support their child’s optimal growth and development. Consideration should be given to the experience of and support available to the practitioner using the tool within the health and developmental review.

Responding to the publication, Alison Morton, iHV CEO said:

“The findings from this important research paper are no surprise – but it’s important to have them validated through research. When parents and health visiting practitioners were asked what they want from child development reviews, they both agreed – put the child in the centre, observe how they are developing and interacting with the world around them – listen to parents and work together to gain an understanding of the child as a unique person.

“And, above all, be focused on the purpose of the review and stop ‘ticking the box and missing the point’.

“The universal health visiting service in England only reviews all children at four mandated reviews between birth and school entry (the number of reviews, and programme of health visiting support, is much higher in the other UK nations) – at the very least, we owe it to our babies, children and families, to get this right.

“I hope that this research will act as a powerful catalyst for change and a shift back to more personalised care. Any tool that is used to support the assessment of child development and wellbeing must be used as part of a holistic assessment to support professional’s observation, parental report and clinical decision-making – not to replace it.”

iHV would like to extend thanks to the research team (Joanna L Lysons, Rocio Mendez Pineda, Maria Raisa Jessica Aquino, Hannah Cann, Pasco Fearon, Sally Kendall, Jennifer Kirman and Jenny Woodman) for this important research which brings out what parents and health visiting practitioners want from child development reviews.

Read the paper here

New report launched: An audit of practice education infrastructure for SCPHN in Greater London

The Institute of Health Visiting (iHV) and London NHS England Workforce Training and Education Directorate (NHSE WTED) launch a new report: An audit of practice education infrastructure for Specialist Community Public Health Nurses (SCPHN) in Greater London.

iHV was delighted to be awarded funding by NHSE WTED to complete an audit of practice education infrastructure for SCPHN in Greater London.

Numbers of SCPHN health visitors and school nurses have decreased by more than 40% in England and London is one of the hardest hit areas[1]. To address workforce expansion needs, the London SCPHN workforce was offered a range of training and educational programmes to support practitioner professional development and growth of a learning culture. Reversing workforce shortfalls requires action to expand and improve training opportunities. Specifically, SCPHN workforce education infrastructure was identified as an important factor which could impact on the sustainable expansion of SCPHN Student community placements across all London 0-19 provider organisations.

The iHV completed an audit of practice education infrastructure at two separate time points – when the training was introduced and 6 months later. The audits explored whether targeted investments in practitioner development had been matched with an upturn in the organisational learning culture and infrastructure to support learning. The audit questions were framed using the four levels of learning (reaction, learning, behaviour, results) from the Kirkpatrick Evaluation Model[2].

Key findings from the audit included:

Improvements were seen in the learning environment across the duration of the project.
There is evidence to suggest that the education infrastructure and learning culture within London has been strengthened with:
- Practitioners reporting greater use of learning in practice over time
- Examples of perceived ability to provide better care
- Improved professional development
- Improved job satisfaction
- An improved learning environment.
Factors considered important to support learning in practice included:
- Supervision and a supportive learning environment
- Embedding learning for impact
- Improved time and capacity for practitioners to participate in Continuous Professional Development (CPD).

Our findings have been presented in a report and summarised into two engaging infographics. Whilst this audit has provided information on the unique context of the SCPHN workforce in London, it is also hoped that the findings will provide transferable learning to SCPHN providers across the UK who may be experiencing similar workforce issues.

You can view the report and infographics here
(to cite this report, please use this link https://bit.ly/3Y4rw3E).

The Audit for Education project forms part of a wider commissioned piece of work with London NHSE WTED which includes the student SCPHN recruitment pathway development review and a charter for enabling a good learning environment.

Nicky Brown, Senior Nurse for CYP OHID London, said:

“It has been such a pleasure working within the London system to develop the role of specialist public health nurses and their teams. This project has enabled London’s 0-19 Public Health Nursing workforce to explore areas of development in their own practice and the way they learn and teach others. It is hoped that this project is the beginning of an integrated approach to learning and development for all qualified health visitors and school nurses and their teams across London.”.

Caroline Ward, Clinical Workforce Transformation Manager – Maternity and Neonates, Children and Young People, Public Health and Community Nursing and Return to Practice, said:

“I am so pleased that I was able to achieve funding through legacy HEE to support such a vital piece of work. A well-trained and sustainable specialist community public health nursing workforce supply is vital to improving the health and wellbeing of our children, young people and families in London. Working with our London systems and service providers is key to the project’s philosophy to enable those who recognise the huge workforce challenges to be supported to work together with us to find solutions and ultimately make a difference within London and beyond.”

Jenny Gilmour, Lead for NHSE WTE London Improving SCPHN (HV/SN) Education Infrastructure and SCPHN Student Expansion Project, said:

“It has been a pleasure to work with the iHV to lead on the Audit of Education as evaluation of this important opportunity to invest in improving the SCPHN Education Infrastructure across London. The report evaluates the impact of the initiative within the current SCPHN workforce. And these results are positive, as evidence suggests that the current workforce, despite the very real pressures of achieving service delivery, has risen to the challenge. As a result, the SCPHN workforce has been prepared, and is ready and able to improve the quality of SCPHN student placements, as well as support expansion across London 0-19 Provider Organisations over the next few years as required under the NHS Long Term Workforce plans.”

Georgina Mayes – iHV Health Visiting Professional Lead (Quality and Policy) said:

“I was delighted to lead on this very important project which has the experiences of London SCPHN practitioners at its heart. SCPHN workforce shortages are of national concern and this project showcases how increasing and improving training opportunities can support professional development and growth of a learning culture which in turn can address SCPHN workforce expansion needs. I’m excited to see how our recommendations will be translated into practice.”

We would like to say a heartfelt thank you to London NHS England Workforce Training and Education Directorate (NHSE WTED) for their generous funding of this project, and to OHID London and the Chief Public Health Nursing Directorate (DHSC) for their professional advice. We would also like to thank the survey respondents, co-design workshop participants for generously sharing their experiences and insights with us, and to members of the iHV Health Visiting Advisory Forum (HVAF) who tested the audit survey.

Download report: An audit of practice education infrastructure for Specialist Community Public Health Nurses (SCPHN) in Greater London

(to cite this report, please use this link https://bit.ly/3Y4rw3E).

References

[1]NHS Digital Source: NHS Digital. NHS Hospital & Community Health Service (HCHS) monthly workforce statistics October 2023. 2024. [accessed 23 April 2024]. Available from: https://bit.ly/3JUw3h6

[2] Kirkpatrick Partners (2024) Demonstrate Training Effectiveness with The Kirkpatrick Model. 2024. [accessed 23 April 2024]. Available from: https://bit.ly/44wd5H6

Scottish Government publishes updated National Framework for Child Protection Learning and Development

On 1 March 2024, the Scottish Government published its updated version of the National Framework for Child Protection Learning and Development which will be relevant to health visitors working in Scotland.

This updated Framework replaces the previous version, published in 2012 to support the design and delivery of child protection learning and development. It provides a resource for all learning and development relevant to child protection, regardless of which agency practitioners work in and can be used flexibly and alongside single agency frameworks for learning to emphasise the key themes of the National Guidance for Child Protection in Scotland 2021 – updated 2023 .

The longstanding key message is that safeguarding is ‘Still Everyone’s Job’. All practitioners have a responsibility to remain aware of changes to legislation, policy and practice that impact on how frontline services should respond. The updated Framework incorporates recent legislation and several key policy documents:

The National Guidance for Child Protection in Scotland 2021 – updated 2023 (NGCP2023) highlighted important themes for practice, and these will be key to updating all learning and development resources within the ‘Getting it right for every child’ (GIRFEC) continuum – wellbeing to welfare to protection – supporting a proactive, preventative approach to practice. Key themes are:

rights-based approach (supporting and embracing UNCRC)
needs-led/strengths-based approach (supporting relationship-based practice)
trauma-informed/enhanced practice (supporting understanding of childhood adversity and trauma)
holistic assessment (supporting strengths/resilience, identifying risk/concerns within a child’s experiences)
recognising diversity and inclusion (supporting sensitivity of language, culture and communication differences).

The Framework aims to provide a resource which clarifies child protection learning needed at four levels – “Wider Workforce, General Workforce, Specific Workforce, and Intensive Workforce”, to:

promote collaborative multi-agency practice to support children’s wellbeing, welfare and protection
support the multi-agency task of assessing, managing and addressing identified need or risk to children, young people or parents/carers
provide a multi-agency learning and development framework adaptable for local learning and development strategies and evaluation
contribute to best practice through the development of a competent and confident workforce
support the design, implementation and evaluation of multi-agency child protection learning
establish agreed competencies, identifying the relevant knowledge and skills required, according to the roles and responsibilities of the various groups that make up multi-agency workforces, including those likely to encounter children, young people and their families as part of their day-to-day work
emphasise the importance of shared learning and collaborative practice to achieve better outcomes for children

Read the revised Framework in full here

Ofsted Early years report – continued impact from pandemic

Today, the Government published the second set of four reports in a series looking at the pandemic’s continued impact on education recovery and how schools, prisons, early years providers and further education and skills providers are responding to the impact of the COVID-19 pandemic.

The ‘Education recovery in early years providers: spring 2022’ report draws on inspection evidence gathered in the spring 2022 term and discussions with early years inspectors about the ongoing implications of the pandemic on children.

The pandemic has continued to affect young children’s communication and language development, with many providers noticing delays in speech and language. Others said babies have struggled to respond to basic facial expressions, which may be due to reduced social interaction during the pandemic.

The negative impact on children’s personal, social and emotional development has also continued, with many lacking confidence in group activities.

Children’s social and friendship-building skills have been affected. Some providers reported that toddlers and pre-schoolers needed more support with sharing and turn-taking. To address this, staff were providing as many opportunities as possible for children to mix with others and build confidence in social situations.

There continues to be an impact on children’s physical development, including delays in babies learning to crawl and walk. Some providers reported that children had regressed in their independence and self-care skills. As a result, several have increased the amount of time that children spend on physical activities, to develop gross motor skills.

An increasing number of providers were concerned that, compared with before the pandemic, fewer children have learned to use the toilet independently. This means that more children may not be ready for school by age 4. Providers were also concerned about obesity and dental health, so have focused on providing well-balanced meals and increased time for physical activity.

Alison Morton, iHV Executive Director said:

“Today’s report lays bare the far-reaching and largely overlooked impacts of the pandemic on babies, young children and their families. It is vital that this is taken seriously by policy makers with a COVID recovery plan and investment to address growing levels of need and vulnerability.

“We have a longstanding problem in this country with invisible vulnerable children who are not getting the support that they need, and the pandemic has made this situation worse. Therefore, it is vital that any enhanced package of support for ‘Covid recovery’ also includes investment in the universal safety net for our youngest citizens provided by the health visiting service.

“Babies, young children and families need joined up support – to achieve this we need more health visitors who are uniquely placed to reach all families, ideally preventing problems happening in the first place, but also who have a crucial role in identifying babies and young children with developmental delay and unrecognised disabilities that need early intervention and targeted support to achieve their full potential. I hope that this report will provide further impetus for much needed investment to turn the Best Start for Life Vision into a reality.”

Find details of the series of Ofsted reports here: https://www.gov.uk/government/collections/ofsted-education-recovery-series

Go to Education in early years providers: spring 2022 report

New GPPs – foot and walking development

In support of National Feet Week (#NFW 8-14 March 2021), we are delighted to publish two new Good Practice Points (GPPs) for health visitors.

Children’s feet should follow a typical pattern of development, however, these changes are often poorly understood by both parents and health professionals. Health visitors have an important role in helping parents to navigate this information and, to support you in practice, we have produced two new Good Practice Points:

GPP – Foot development in infancy and early childhood

Foot development is important. Changes in the shape, structure and function of feet occur throughout infancy, childhood and into late adolescence. During infancy (birth – two years old), there are rapid changes in foot size and shape. Health visitors should consider healthy feet as key to supporting infants as they begin to stand, learn to walk and explore their world. Understanding about how feet change in size, structure, shape is helpful to convey positive health messages and reassurance where needed

GPP – Overview of walking development in infancy and early childhood

Common concerns around milestones related to walking include whether the development is typical (or not), if the shape and development of the feet are correct, if the infant is walking correctly, and what types of shoes parents should buy to support their infant’s feet during early weight bearing. Through understanding the typical changes that take place during the early years, health visitors can advise parents, offer reassurance and refer for additional support and assessment when it is appropriate.

Also read great Voices blog by Stewart C. Morrison, Reader in Children’s Podiatry, School of Health Sciences, University of Brighton – Thinking about feet….

Please note that GPPs are available to iHV members.

If you’re not a member, please join us to get access to all of our resources.

The iHV is a self-funding charity – we can only be successful in our mission to strengthen health visiting practice if the health visiting profession and its supporters join us on our journey. We rely on our membership to develop new resources for our members.

So do join us now!

Apply now for NHS Leadership Academy Development Programmes

The following individual leadership development programmes are open now for applications:

The Mary Seacole Programme for first time leaders is open until 09 January to study in Leeds – apply here
The Rosalind Franklin Programme for mid-level leaders will open soon for applications – register your interest here
The Edward Jenner Programme for health and care staff at all levels is open year-round and free to access – start here

iHV launches new evidence-based leadership development programme

The Institute of Health Visiting (iHV) is delighted to announce the launch of its new leadership development programme.

The programme, suitable for health visitors, school nurses, nurses, midwives and other health and social care professionals, aims to develop knowledge, skills and enhance confidence in clinical and public facing leadership.

Dr Cheryll Adams CBE, executive director of the iHV, said:

“Our new leadership development programme has been informed by recent health visiting research, and is thoroughly tested and evidence-based. Originally developed for a health visiting and school nursing audience, evaluation of the programme as part of its rigorous testing also suggested it is suitable for other health and social care professionals wanting to develop their leadership skills.”

Delivered over a six-month period, the new programme includes: two days of initial training; followed by two further development half-days to develop a Community of Practice (CoP); and a final summative half-day Community of Practice meeting to review outcomes.

The initial two-day training event develops knowledge and skills in leadership in relation to the health visitor/school nurse/professional as a leader and on leadership in a team and organisation setting. It builds on leadership evidence and incorporates ongoing activities to ensure the programme is delivered within the context that practitioners work in.

Dr Adams continued:

“The programme aims to embed good practice, and promote and strengthen local leadership with integrated services across health and social care boundaries which, in turn, supports the opportunity for good health outcomes for children and families.”

For more information on new iHV evidence-based leadership development programme, please go to our training page or contact [email protected]

Download iHV Leadership Development Programme Flyer

Download updated iHV Training Portfolio

The Florence Nightingale Foundation 2016/17 Scholarships are now open

The Florence Nightingale Foundation raises funds to provide scholarships for Nurses, Midwives and Health Visitors, to enable them to extend knowledge and skills, and to promote innovation in practice.

All available scholarships are a chance for nurses and midwives to better their professions, advance their own career, and ultimately are an opportunity to contribute to the improvement of care of patients and users in the UK.

Applications for the 2016/17 Florence Nightingale Foundation Scholarships open on Tuesday 1 March.

Leadership Scholarships of up to £15,000 are available for those who want to become leaders with the skills and self-confidence to contribute positively and with some significance to the rapidly changing world of healthcare.

Research Scholarships of up to £5,000 are available for scholars to undertake a course in research methods, research modules or a dissertation/thesis as part of an academic course of study. All of these must be able to demonstrate impact on patient care and be academically supervised or supported.

Travel Scholarships of up to £5,000 are a real opportunity to study practice elsewhere in the UK and/or overseas to enhance patient/user care in the UK. These scholarships are awarded for projects connected with the applicant’s field of work and which will benefit their patients/users and the professions more widely.

Research and Travel Scholarships are available to Nurses and Midwives who have current registration with the NMC and who work and are resident in the UK. Leadership Scholarships are additionally available to all registered healthcare professionals who have current registration and are resident in the UK.

For further details on the criteria for application and how to apply for a scholarship

Or contact The Florence Nightingale Foundation [email protected]

HV wins Mary Seacole Development Award

Hillie Halonen, Health Visitor at Bradford District Care Trust, has been awarded a prestigious Mary Seacole Development award.

The awards provide the opportunity to undertake a specific health care project or other educational/development activity that benefits and improves the health outcomes of people from BME communities.

Hillie is using the award to develop a project which will support EU-Migrant Families with parent and infant relationships for positive mental health. She will pilot an infant-parental cue card tool kit, specifically focusing on families who have moved to Bradford from Eastern Europe. A prize of £6,250 was awarded to Hillie, enabling her to fund the pilot.

Hillie said: “This is an exciting project which will contribute to the growing evidence around the importance of early parent infant relationships on neurological development. It will also help me to develop my leadership skills.”

The awards were created in 1994 in honour of pioneering Victoria nurse Mary Seacole who cared for wounded British Soldiers during the Crimean War.

Phil Hubbard, Head of Bradford City Services at Bradford District Care Trust, said: “This has provided Hillie with the opportunity to explore how all health visitors will be able to positively engage and support EU families.”