Analysis

Early intervention: how Blackpool’s health visitors are bucking the national trend

A health visiting initiative – the first of its kind in England – is transforming services for Blackpool’s young children and vulnerable families 

A health visiting initiative – the first of its kind in England – is transforming services for Blackpool’s young children and vulnerable families 


Picture: Matthew Walker

Infants and parents in Blackpool will be seen by their health visitor at least eight times in the first three years of the child’s life as part of an early intervention initiative designed to improve outcomes for young children.

5 to 8 

Blackpool is the first town in England to increase the minimum number of universal health visits from five to eight

Source: Blackpool Better Start

Blackpool’s redesigned health visiting service launched in April. It is the first in England to increase the number of universal visits from the statutory minimum of five to at least eight. The most vulnerable families and those with additional needs will be seen up to 30 times under the Universal Plus and Universal Partner Plus schemes. The town’s health visiting service is delivered by Blackpool Teaching Hospitals NHS Foundation Trust.

Blackpool Better Start

The changes have been made possible thanks to a £1 million investment from Blackpool Better Start as part of their wider ten-year programme to improve life chances for children aged 0-4 years. The funding has paid for a review of the previous health visiting service,  consultation on the new approach and the development and production of new tools for health visitors.

‘By increasing the number of visits, we foresee parents receiving more support and attention from the one-to-one visits’

Merle Davies

‘By increasing the number of visits, we foresee parents receiving more support and attention from the one-to-one visits as it will give parents the chance to discuss issues in more depth,’ says Merle Davies, director at Blackpool’s Better Start’s Centre for Early Child Development.

From 28 weeks

Additional health visits begin with an antenatal contact 

Source: Blackpool Better Start

Ms Davies adds: ‘This will help the health visitors to identify concerns at an earlier stage and refer to additional sources of support.’

Early infancy visits

The additional visits begin with an antenatal contact from 28 weeks. This is followed by three early infancy visits at birth to 14 days, three to five weeks and six to eight weeks. Children will have a review at three to four months and an assessment at 9-12 months.

The final two visits will provide a developmental assessment at around two years, and a school readiness assessment around three years. Each child will also have a full review of their health record at 18 months.

‘The ultimate aim of this early intervention focus is to get more children school-ready’

Julie Carter-Lindsay

1,600 

The approximate number of babies born in Blackpool each year

Source: Blackpool Better Start

‘It is hugely exciting for us,’ says Blackpool health visitor, Julie Carter-Lindsay. ‘We are changing for the better with this approach. In the space of baby being three months old, we will have seen the family at least four times as part of the universal programme, which is  brilliant.

‘Following the 1001 Critical Days campaign and the Building Great Britons research, we know that early intervention is what makes a difference to giving children the best start in life.

‘In Blackpool, we have a high percentage of children starting school who are not toilet trained, their dental hygiene is poor and their speech and language skills are underdeveloped,’ adds Ms Carter-Lindsay. ‘The ultimate aim of this early intervention is to get more children school-ready.’

‘Blackpool’s early intervention initiative is not a quick fix’


Cheryll Adams: ‘Health visitors
are often dealing with mental
health challenges’ 

‘Cuts to public health budgets in England have had a devastating effect on the services many health visitors can deliver. We have seen the growth of enormous differences in the quality of services up and down the country, which will serve to increase health inequalities,’ says Institute of Health Visiting executive director, Cheryll Adams.

Fantastic investment

‘That Blackpool is bucking the trend and investing is fantastic. Without time to get to know families and to assess their needs, it is so much harder for the health visiting service to have an impact,’ adds Dr Adams.  

‘They are often dealing with mental health challenges and much of their work is not a quick fix.’

 

Encouraging parents to take more control

The way visits are structured has changed. Parents are encouraged to take more control of the conversation and discuss topics of interest to them using a conversation starter tool. This leads to collaborative planning and agenda matching – a way of creating tailored plans based on each family’s strengths and needs that was core to the national Family Nurse Partnership programme.

‘In Blackpool, we have a high percentage of children starting school who are not toilet trained, their dental hygiene is poor and their speech and language skills are underdeveloped’

Julie Carter-Lindsay


Additional visits begin with an antenatal contact from 28 weeks followed by three
early infancy visits at birth to 14 days

Health visitors also use motivational interviewing techniques, such as the elicit-provide-elicit approach – a technique that aims to ‘elicit’ what the parent already has, then fill in any gaps or misconceptions – to build parental confidence and enhance their knowledge and skills. This approach helps the health visitors to explore prior knowledge, provide information that parents need (or would like to know) and verify their understanding of what has been discussed.

The health visitors in Blackpool have also received training in the use of new assessment tools, including a speech and language assessment, observing and assessing newborn and young children’s progress, and identifying and supporting mums with depression or mental health concerns.

‘As health visitors, we wanted to talk more in the early days about infant responsiveness and how to promote the infant’s mental health’

Dee McGregor

Building relationships

Two health visitors from the trust, Dee McGregor and Vicky Barkworth, have been seconded to the Centre for Early Child Development in the role of development support officers to oversee the service’s redesign and implementation. An evaluation of the redesigned service will be carried out after 12 months.


Blackpool Teaching Hospitals NHS
Foundation Trust health visitor
Dee McGregor

‘We wanted to stake the majority of early contacts in the first year because parents were telling us that is when they needed the most help,’ says Ms McGregor.

‘Mindful of parental mental health’

‘We wanted to talk more in the early days about infant responsiveness and how to promote an infant’s mental health. We were also mindful of parental mental health because of high levels of perinatal depression,’ adds Ms McGregor

Ms Barkworth says: ‘Having the early infancy visits close together helps us to build a relationship with families. 

‘Building trust in those early weeks gives parents more confidence to tell their health visitor if they are experiencing mental health issues or have any concerns.'

Therapeutic relationships

‘We have a lot of expertise as health visitors and it is great that we are being supported to do our job well,’ says Blackpool health visitor, Tracy Greenwood. ‘The links to Better Start have been crucial in improving the way we work. 

‘Working with families, you have to build that therapeutic relationship and gain their trust and respect.

Connecting with families

‘Parents have to feel comfortable to open up and we can offer better support when that trust is in place.

‘More visits helps us to build that trust as we have more opportunities to connect with families. This approach gives parents the opportunity to talk about what matters. We’re no longer just coming in and providing a blur of information.’

 


Further information


Julie Penfold is a health writer

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