Barriers to delivering effective dental health promotion

Bethany Boddy explores the health visitor role in oral health promotion, the evidence supporting effective interventions and barriers to embedding oral health promotion in practice

The influence of the health visitor

Crystal Oldman discusses why health visitors need to be able to tell their stories in a way that demonstrates their knowledge and skills, and the real impact they have on the communities they serve

Using the Strengths and Difficulties Questionnaire in practice

This article is intended to draw the attention of any practitioners who are unaware of the Strengths and Difficulties Questionnaire (SDQ) to this excellent and accessible resource. It is an instrument that lends itself to the evaluation of practice by any qualified practitioner, health visitor, teacher, social worker, community nurse, school nurse or researcher who wishes, with the parents' permission, to understand whether their work with a child's family or teachers is having the desired impact. It is brief and straightforward to administer and is readily accessible online. This article explores the SDQ and its usefulness.

Functional gastrointestinal disorders and the health visitor role

Bethany Boddy explores the guidance and evidence into functional gastrointestinal disorders in infants and how to support parents to support their infants

‘Making the Most of Together-Time’: Development of a Health Visitor Led Intervention to Support Children’s Early Language and Communication Development at the 2-2½ Year-Old Review

Background: Early interventions to support young children’s language development through responsive parent-child interaction have proven efficacy but are not currently delivered universally. A potential universal delivery platform is the Health Visitor (HV) led 2-2½ year old review in England’s Healthy Child Programme. It is unclear if it is feasible to offer such interventions through this platform. We report an intervention development process, including extensive stakeholder consultation and co-design to develop an acceptable, feasible and equitable early language intervention for delivery in this context.Methods:The study involved five phases including 13 stakeholder co-design workshops with 7 parents and 39 practitioners (HVs, early years practitioners and speech and language therapists). 1) Identification of existing intervention evidence. 2) Qualitative review of intervention studies extracting candidate target behaviours for intervention and intervention techniques. 3) Co-design workshops with parents and practitioners examining acceptability, barriers and enablers to those behaviours and techniques. Particular attention was paid to diverse family circumstances and the range of barriers which might exist. 4) Findings were analysed using COM-B and theoretical domains frameworks and a prototype intervention model designed. 5) Co-design workshops iteratively refined the proposed model. Results:Practitioners were committed to offering language intervention at the 2-2½ year old review but were not sure precisely how to do so. Parents/caregivers wanted to be proactive and to have agency in supporting their own children, and to do this as soon as possible. For equitable intervention it must be proportionate, with higher ‘intensity’ for higher levels of disadvantage, and tailored, offering differing approaches considering the specific barriers and enablers, assets and challenges in each family. The importance and potential fragility of alliances between parent/caregiver and practitioner were identified as key and so strategies to engender successful collaborative partnership are also embedded intervention design. Conclusion: It is possible to develop an acceptable, feasible and equitable universal intervention for use at the 2-2 ½ year review to promote children’s language development. The result is one of the most explicitly developed universal interventions to promote children’s language development. Further development and piloting is required to develop materials to support successful widespread implementation.

Evaluation of staff knowledge; attitudes and experience of breastfeeding on a mother and baby unit

AimsTo evaluate the knowledge and experience of breastfeeding of staff working on a Mother and Baby Unit (MBU).To assess the level of breastfeeding education of Staff on the MBU.To identify any area of concern around breastfeeding on the MBU.MethodA fourteen question questionnaire was designed with assistance of the medical team, midwife, and health visitor on the unit. The questionnaire was comprised of questions requiring “yes/no” and free text responses alongside Likert scales. The questionnaire focused on staff experience on breastfeeding, education levels and whether they felt Mothers were sufficiently supported. This questionnaire was distributed to all staff groups within the team to ascertain the level of expertise. 29 questionnaires were returned from a staff team of 31.ResultStaff on this unit is made up of Multi-disciplinary professionals. Most respondents were Nursery Nurses (15%). 79% of staff had a lived experience of breastfeeding. Only 5 out of 29 respondents have had any breastfeeding training which was mainly in-house training, and these were the Health Visitor; Midwife and Nursery nurses. Of the respondents, 21% felt mothers who choose breastfeeding as their preferred mode of infant feeding were not adequately supported on the MBU. Seven percent were unsure and 72% felt women were adequately supported. 54% of staff were not aware of breastfeeding initiatives. 63% were able to list contraindications including names of psychotropic medications as well as personal choice and past medical history. The median rating in relation to confidence in skills on Likert scale of 1-10 was 5.Conclusion23 out of 29 professionals felt that Training would increase their confidence and skills in breast feeding support for women admitted to the unit. There is clear indication from the Staff Members that mothers on the MBU who choose breastfeeding as their preferred mode of infant feeding require further support. There is lack of confidence in staff's breastfeeding support in the MBU. An evaluation of patient's own experience of breastfeeding support they receive from staff is being undertaken alongside this, but data will be analysed later.

Development and use of the Early Attachment Observation tool for infant mental health

The Early Attachment Observation (EAO) is a simple assessment tool that has been developed by the Leeds Infant Mental Health service in collaboration with Leeds Health Visiting Service for use by health visitors to identify emerging attachment difficulties. The EAO is delivered as part of the universal offer at the routine 6–8-week health visitor contact. The EAO protocol requires the health visitor to ask the primary caregiver three questions about the emerging relationship between themselves and their infant: Describe your relationship with your baby in three words; What is the best thing about your relationship with your baby?; and What is your biggest fear about your relationship with your baby? The health visitor completes a 2-minute observation of the interactions between the infant and parent. The purpose of the EAO is to screen for emerging attachment difficulties, in line with the WAVE report Conception to Age 2: The Age of Opportunity. The EAO is now a crucial element of the Leeds Early Start infant mental health pathway. The purpose of this article is to outline the development, pilot, implementation and evaluation of the use of the EAO in Leeds.

Organising health visiting services in the UK: Frontline perspectives

The organisation of health visitor work is an important part of service design, which can have an impact on when and where services are provided and who gains access. This article reports a 2018 survey of UK health visitors conducted to provide an overview of the range of ways in which health visitor cases and workloads are organised. The 584 respondents confirmed the operation of three broad types of health visitor service delivery models; namely, the individual case, the corporate case and the combination model. Themes that emerged from practitioners' experiences of working with the different models reflected concerns about continuity and staffing, accommodating different needs and different services in different places. Overall, the data indicated a lack of consistency in health visitor service across the UK. The advantages and disadvantages of each workload model are detailed and considered with respect to markers of a quality service, including achieving relationships with clients and sufficient communication within and across teams.

Newly qualified health visitor: Promoting parent–infant interaction for infant mental health

Bethany Boddy reflects on the importance of the first 1001 days for infant and child mental health