Universal Health Visiting Pathway evaluation - phase 1: main report - primary research with health visitors and parents and case note review

The Universal Health Visiting Pathway was introduced in Scotland in 2015 to refocus the approach to health visiting. This is the first report of 4 that provides findings of the National Evaluation of Health Visiting. It focuses on primary research with health visitors and parents and case note review.

Appendix 2 Revised Logic Model – Universal Health Visiting Pathway


  • Universal pathway home visits by HVs (0-5yrs)
  • Funding for additional HVs
  • HB’s employ sufficient HV’s to deliver the universal pathway
  • Resources for training and continuous workforce development
  • Workforce planning and caseload weighting tool
  • Evidence informed national and local guidance, resources and tools


  • All families offered all core visits, additional visits provided if required.
  • Build and maintain strong relationships with families from pregnancy onwards, providing information on the role of the HV to enable better understanding among families
  • Early assessment of family wellbeing and strengths identification of current/potential needs and care planning
  • Ensure continuous, consistent use of GIRFEC National practice model to assess, evaluate ,analyse and plan for the child with a focus on outcomes
  • Ensure continuous, consistent and effective assessment of families strengths and concerns (e.g. finance, mental health, domestic abuse, learning difficulties) using open and inclusive routine enquiry.
  • Ensure continuous, consistent and effected assessment of child and family relationships
  • Where necessary deliver/promote timely tailored interventions advice signposting and support for children and families using a strengths bases model (e.g. positive attachment, child development and behaviour, in fact nutrition, oral health smoking, child safety).
  • Children assessed as having additional needs (HPI-A) receive support and interventions over and above the minimum core visits by either HV or referral to appropriate agencies
  • Facilitate and/or contribute to multi-agency support for children and families (e.g. child protection, wellbeing) where required.
  • Develop and apply appropriate protocol for collecting and sharing information with multiple agencies.
  • Continuous professional development, including provision of clinical supervision and education, training opportunities and evidence based resources.
  • Develop and implement a sustainable national workforce plan to meet national and professional guidance.

Process outcomes

  • Families receive core visits and additional visits by HV as required
  • Improve continuity of care and partnership working between HV and families
  • Early identification of family strengths and concerns
  • Early identification of child strengths and concerns (e.g. HPI-A, child development, neglect)
  • Improve families understanding of children's development, wellbeing and safety
  • Improve family understanding of healthy lifestyle and behaviour choices (e.g. smoke free home, breastfeeding, oral health
  • Provision of timely and proportionate support to families by HV
  • Appropriate and timely referrals to other agencies/disciplines
  • Effective multi-agency working and information sharing with other agencies/disciplines
  • Increased strength based/outcome focused working
  • HVs feel well supported (e.g. Caseload management) and valued in their role
  • HVs are competent and skilled with appropriate training and resources
  • HV participate in clinical supervision, education and training
  • HV have knowledge and awareness of community assets, care and referral
  • pathways
  • HVs are equipped to deliver appropriate interventions to children and families

Intermediate Outcomes

  • Positive and trusting relationships between families and HV
  • Families feel well supported by HV and able to access relevant other support options if required
  • Improved family confidence in, and knowledge and application of, good parenting techniques
  • Improved family understanding of attachment and its impact on child's brain development, resulting in secure attachment
  • Improved family home learning environment, (e.g. play, reading)
  • Increase in number of secure family/child relationships
  • Improved wellbeing and safety practices by families
  • Improved health behaviours within families (e.g. smoke free homes, breastfeeding, weaning and early diet, oral health).
  • Appropriate use of health services for children (e.g. A&E attendance, out of hours)
  • Sustained engagement with universal and wider support groups/services, including increased engagement with services referred to.
  • Appropriate HV support provided regarding strengths and concerns identified and/or referral to appropriate agency.
  • Increased family awareness and uptake of local groups/services
  • Increase in HV job satisfaction
  • Decrease in HV sickness, absenteeism, staff turnover
  • Sustained effective multi-agency partnership working and information sharing with other agencies/disciplines

Longer Term Outcomes

  • Improved confidence and resilience among children and families
  • Earlier intervention and prevention for children and families
  • Reduced inequalities in outcomes and reduced impact of wider inequalities (e.g.
  • changing parents approach to parenting despite inequalities)
  • Improved child development and school readiness
  • Improved child safety and protection
  • Improved health outcomes for children and families (e.g. healthy child weight,
  • reduced hospital admissions for serious injuries, maternal mental health, reduced substance misuse)
  • HVs and other agencies contribute to effective multi-agency partnership working
  • HV workforce retention and satisfaction of staff


Email: Justine.menzies@gov.scot

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