The evaluation identified the following areas for further consideration:
- The antenatal visit should be prioritised in the pathway schedule, because of its role in building positive and trusting relationships between families and health visitors, as well as facilitating the earlier identification of concerns relating to maternal mental health.
- The pathway should be considered in terms of perceived gaps in the visit schedule as identified by parents and health visitors. Additional visits could be introduced at 6 months and 18 months.
- Health visitors seem to be providing a substantial number of additional visits to families outside the core visits, and this should be adequately monitored and incorporated into their workload planning.
- The frequency of the pathway facilitates timely referrals to relevant services. However, in some instances, services for onward referrals such as speech and language therapy may not be available or accessible to families. It might be helpful to develop robust referral strategies in conjunction with such services to ensure families receive timely support.
- The scope for the heath visiting service to deliver appropriate interventions to children and families should also be explored. This could ensure that families receive some support whilst on the waiting lists of other services.
- Caseload sizes were a concern for many health visitors and may benefit from careful and regular review.
- Continuity of carer is important to families and seems to have improved since the introduction of the pathway. However, older children are more likely to see different health visitors during the last few pathway visits. This could be monitored and improved by Health Boards.
- More efficient ways of reducing or simplifying documentation and paperwork should be explored.
- A good proportion of parents felt they could benefit from more information about ways to manage their own mental health and wellbeing. Further attention to this is required to ensure parents are well informed and supported appropriately.
The above recommendations seek to address challenges identified around the delivery and implementation of the pathway. However, health visitors are generally very positive about the pathway and the overall Phase 1 findings indicate that the UHVP is supporting children and families in a constructive way.
The Phase 2 evaluation will use a similar methodology to ensure some of the findings from Phase 1 can be compared with Phase 2 to further increase understanding of implementation and delivery processes and the impact of the UHVP over a relatively medium to longer term.
That said, due to the emergence of the COVID-19 pandemic when the Phase 1 evaluation was nearing completion (with the exception of the parents survey), it is unlikely that a full direct comparison between Phase 1 and Phase 2 will be feasible. As a result, the Phase 2 evaluation will also include identification of key lessons learned from the delivery of the UHVP during the COVID-19 pandemic and how these lessons can be used sustainably to improve the health visiting service in Scotland in the future.
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