Universal Health Visiting Pathway in Scotland: pre-birth to pre-school

Pre-Birth (Suggested time: 10 minutes)

• Standard service letter to pregnant women on notification of pregnancy
• Introduction to Health Visiting Services/National Leaflet

Parent/carer aware of the Health Visiting Service and contact details

Pre-Birth

Contact

32 – 34 weeks (Suggested time: 45 – 60 minutes)

• Face to face contact to introduce Health Visiting Service and to begin to develop and build therapeutic relationship with mother/family
• Begin early assessment of maternal/family health, wellbeing and early identification of vulnerability or additional needs
• Initiate additional interventions as appropriate such as Alcohol Brief Interventions
• Commencement of transition of care from Midwife to Health Visitor
• Introduction of Red Book
• Initiate additional joint visit with the Midwife where additional need is identified
• Engage and share public health information and guidance to promote positive attachment and health and wellbeing
• Assessment and support for infant nutrition; making an informed feeding decision, benefits of breastfeeding, value of skin-to-skin and support decision making and access to Support Workers for Breastfeeding including in-reach into the post-natal ward
• Routine enquiry about family finances/money worries and raise awareness of the advice available and offer families a direct referral to advice services

• Edinburgh Postnatal Depression Scale
• Getting it right for every child (GIRFEC) National Practice Model
• National Risk Assessment Tool
• Learning Disability

Assessment Tools

• Early development of a therapeutic relationship
• Identification of parent/carer and child strengths
• Early identification of vulnerability/need and active request for assistance or referral is made for clients at an early stage
• Uptake of services/tailored support from third sector agencies to address wider determinants
• Family awareness of Health Visiting Service and support available on transition from Midwifery care
• Families recognise the Health Visitor as a professional offering credible and positive information, advice, support and help to access services
• Parents/carer receive appropriate public health advice to maximise child/family wellbeing
• More structured continuity of care and continuous assessments
• Income of pregnant women and families with young children who are at risk of, or experiencing, poverty is maximised
• Clear documentation of intervention

Child’s Age

Purpose of Visit

National Assessment Tools

National/Local Outcomes

11-14 days (Suggested time: 60 – 90 minutes)

• Engage with family following birth
• Assessment and initiation of Getting it right for every child (GIRFEC) and identification of child/family strengths and health/mental health and wellbeing needs and provisional HPI
• Engage and share public health information and guidance to promote positive attachment and health and wellbeing
• Physical developmental check of the baby
• Introduce immunisation and developmental assessment schedule
• Advice on sources of community support
• If not previously carried out carry out routine enquiry for gender based violence and risk assessment undertaken following disclosure. Build on and strengthen therapeutic relationship between practitioner and mother/family
• Agree future plan of care with parents/carers
• Routine enquiry about family finances/money worries and raise awareness of the advice available and offer families a direct referral to advice services

• Standard assessment/ recording proforma (Child

Health Surveillance

Programme)

• National Risk Assessment Tool
• Getting it right for every child (GIRFEC) National Practice Model
• Learning Disability Tools
• Refer to Chief Executive

Letter (CEL) 41 and

Edinburgh Postnatal Depression Scale as appropriate

• World Health Organisation

(WHO) Guidelines for

Child Growth

• Families experience continuity of care through timeous information sharing between services
• Partnership between practitioners and parents/carers is established
• Profile of significant factors
• Any risk or potential risk to child or parent/carer health and wellbeing is identified/ addressed early
• Identification of physical and prolonged jaundice
• Consideration should be given to early visual support to babies born to parents with addictions
• Parents are empowered to understand and support child’s developmental progress
• Improved nutrition for child or parent/carer
• Children are protected against infections through engagement/ uptake of immunisation programme
• Increased breastfeeding initiation
• Families recognise Health Visitor as professional offering credible and positive information, advice, support and help to access services
• Parent/carers are supported to maximise wellbeing of self/baby
• Continual assessment of child and development of a therapeutic relationship with family
• Uptake of services/tailored support from third sector agencies to address wider determinants
• Parents/carers receive appropriate public health advice to maximise child/family wellbeing
• Income of families with young children who are at risk of, or experiencing, poverty is maximised
• More structured continuity of care and continuous assessments
• Clear documentation of any required intervention

3 – 5 weeks

(All Families) (Suggested time: 30 – 45 minutes)

• Continued Getting it right for every child

(GIRFEC) assessment process and identification of child/family health strengths and wellbeing needs

• Build on and strengthen therapeutic relationship between practitioner and mother/father/ family
• Engage and share public health information and guidance to promote positive attachment and health and wellbeing
• Observe/ discuss developmental progress of infant
• If previously disclosed, routine enquiry for gender based violence and risk assessment undertaken
• Agree plan of ongoing care

• Domestic Abuse Risk

Assessment Checklist

(DASH RIC)

• Getting it right for every child (GIRFEC) National Practice Model
• National Risk Assessment Tool

• Continuum of parent/carer and child assessment and care providing maximum opportunity to intervene early where additional support is required.
• Co-production approach to support parents/carers to maximise the wellbeing of their baby
• Women and children are protected through provision of support and referral to Multi-Agency Risk Assessment Case Conferences as appropriate when abuse identified
• Families recognise Health Visitor as professional offering credible and positive information, advice, support and help to access services
• Parents/carers receive appropriate public health advice to maximise child/family wellbeing
• Income of families with young children who are at risk of, or experiencing, poverty is maximised.
• More structured continuity of care and continuous assessment

6 – 8 weeks

(All Families) (Suggested time: 45 – 60 minutes)

• Continued GIRFEC assessment process and

identification of child/family health/mental health strengths and wellbeing needs and update recording of Health Plan Indicator

• Discuss and enquire about depressive symptoms and complete the Edinburgh Post Natal Depression Scale (EPDS)
• If not previously carried out undertake routine enquiry for gender based violence and risk assessment undertaken following disclosure
• Build on and strengthen therapeutic relationship between practitioner and mother/family
• Engage and share public health information and guidance to promote positive attachment and health and wellbeing
• Agree plan of ongoing care

• Domestic Abuse Risk

Assessment Checklist

(DASH RIC)

• Edinburgh Postnatal

Depression Scale

Questionnaire

• Standard assessment/ recording proforma (Child

Health Surveillance Programme) as appropriate

• National Risk Assessment Tool
• Getting is right for every child (GIRFEC) National Practice Model
• Chief Executives Letter (CEL) 41

• Continuum of parent/carer and child assessment and care providing maximum opportunity to intervene early where additional support is required.
• Early identification and management of perinatal mood disorders
• Early intervention to reduce risk of dental caries
• Initial recording of Health Plan Indicator
• Early evidence of attachment
• Routine enquiry, recording of disclosure and risk assessment as appropriate
• Women and children are protected through provision of support and referral to Multi-Agency Risk Assessment Case Conferences as appropriate when abuse identified.
• Early referral and intervention where assessment of growth and or development indicates that child is not achieving age appropriate milestones
• Families recognise Health Visitor as professional offering credible and positive information, advice, support and help to access services
• Parents/carers receive appropriate public health advice to maximise child/family wellbeing
• More structured continuity of care and continuous assessments

3 Months

(Suggested time: 45 – 60 minutes)

• Continuous assessment and identification of child/family health/mental health and wellbeing needs
• Discuss and enquire about depressive symptoms and complete Edinburgh Postnatal Depression Scale
• Engage and share public health information and guidance to promote positive attachment and health and wellbeing
• Continue to observe child’s developmental progress
• If not previously carried out undertake routine enquiry for gender based violence and risk assessment undertaken following disclosure
• Advise on sources of community support
• Following assessment commission additional support via Early Years Support Workers as required
• Complete Getting it right for every child (GIRFEC) assessment process and update Health Plan Indicator
• Introduce the subject of weaning and highlight importance of delaying introducing solids until around 6 months.
• Agree plan of ongoing care

• Edinburgh Postnatal

Depression Scale

Questionnaire

• Domestic abuse Risk Assessment Checklist

(DASH RIC)

• National Risk Assessment Tool
• Getting it right for every child (GIRFEC) Practice

Model

• Continuum of parent/carer and child assessment and care providing maximum opportunity to intervene early where additional support is required.
• Early identification and management of perinatal mood disorders
• Early intervention to reduce risk of dental caries
• Women are supported and risks reduced to children through support provided where gender based violence is identified
• Women and children are protected through provision of support and referral to Multi-Agency Risk Assessment Case Conferences as appropriate when abuse identified.
• Prevention of unintentional injury
• Evidence of timeous immunisation uptake
• Weaning at appropriate age
• Parents/carers receive appropriate public health advice to maximise child/family wellbeing
• Families recognise Health Visitor as professional offering credible and positive information, advice, support and help to access services
• More structured continuity of care and continuous assessment

4 Months

(Suggested time: 45 – 60 minutes)

As above

Agree future plan of care

As above

As above

8 Months

(32 weeks) (Suggested time: 30 – 45 minutes)

• Review Getting it right for every child (GIRFEC) assessment and identification of child/family health/mental health and wellbeing needs and update Health Plan Indicator if required
• Engage and share public health information and guidance to promote positive attachment and health and wellbeing
• Continue to observe child’s developmental progress and undertake additional interventions as required e.g. advice; referral
• Signpost to local Community Services
• Agree future plan of care

• National Risk Assessment Tool
• Getting it right for every child (GIRFEC) National Practice Model
• Ages & Stages

Questionnaires: (ASQ:3)

• Continued relationship building with family
• Continuum of parent/carer and child assessment and care providing maximum opportunity to intervene early where additional support is required
• Parents/carers receive appropriate information and support to maximise the wellbeing of their child
• Achievement of age appropriate developmental milestones
• Early identification of concerns
• Commission of additional intervention and support as required
• Early identification and management of perinatal mood disorders
• Parents/carers receive appropriate public health advice to maximise child/family wellbeing
• Families recognise Health Visitor as professional offering credible and positive information, advice, support and help to access services
• More structured continuity of care and continuous assessment

13 – 15 months (Suggested time: 45 – 60 minutes)

• Review Getting it right for every child (GIRFEC) assessment and identification of child/family health/mental health and wellbeing needs and update Health Plan Indicator if required
• Assessment should include: quality of parent – child relationship and mental health of the principal carer
• Engage and share public health information and guidance to promote positive attachment and health and wellbeing
• Undertake developmental and wellbeing review
• Child Health Review – refer to guidance in Appendix 2 (Guidance on delivery and national minimum dataset)
• Advise on local services for children and families
• Review immunisation status and prompt attendance where required
• Routine enquiry about family finances/money worries and raise awareness of the advice available and offer families a direct referral to advice services
• Agree future plan of care

• Standard assessment/ recording proforma (Child

Health Screening

Programme)

• Ages & Stages

Questionnaires: (ASQ:3) should be used universally with continued access to validated development assessment tools and their appropriate age range as listed in

Appendix 2 and 3.

• Continuum of parent/carer and child assessment and care providing maximum opportunity to intervene early where additional support is required.
• Early identification of growth/ developmental concerns
• Parents/carers receive appropriate support and advice to maximise the wellbeing of their child
• Children’s listening and communication skills are enhanced through the introduction of early reading
• Children are protected from infectious disease
• Ensuring follow up when concerns are identified
• Request for assistance as appropriate
• Attendance at appointments
• Parents/carers receive appropriate public health advice to maximise child/family wellbeing
• Income of families with young children who are at risk, or experiencing, poverty is maximised
• Families recognise Health Visitor as professional offering credible and positive information, advice, support and help to access services
• More structured continuity of care and continuous assessments

27-30 Months (Suggested time: 45 – 60 minutes)

• As above
• In addition to the above routine enquiry for gender based violence and risk assessment conducted

• Ages & Stages

Questionnaires: (ASQ:3) should be used universally with continued access to validated development assessment tools and their appropriate age range as listed in

Appendix 2 and 3. These should be used in conjunction with 27 - 30 Month Guidance.

• Domestic Abuse Risk Assessment (DASH RIC)
• Standard assessment/recording proforma (Child Health Screening Programme)

• Continuum of parent/carer and child assessment and care providing maximum opportunity to intervene early where additional support is required.
• Parents involved and received advice and support in maximising the wellbeing of their child.
• Children are protected against infectious diseases
• Referral where necessary
• Women are supported and risks reduced to children through support provided where gender based violence is identified
• Women and children are protected through provision of support and referral to Multi-Agency Risk Assessment Case Conferences as appropriate when abuse identified.
• Parents/carers receive appropriate public health advice to maximise child/family wellbeing
• Income of families with young children who are at risk, or experiencing, poverty is maximised
• Families recognise Health Visitor as professional offering credible and positive advice and support
• More structured continuity of care and continuous assessments

4 - 5 Years (Suggested time: 30 – 45 minutes)

• Undertake pre-school review
• Child Health Review – refer to guidance in Appendix 3 (Guidance on delivery and national minimum dataset)
• Update Getting it right for every child (GIRFEC) assessment and Health Plan Indicator
• Engage and share public health information and guidance to promote positive attachment and health and wellbeing
• Routine enquiry about family finances/money worries and raise awareness of the advice available and offer families a direct referral to advice services
• Arrange discussion/meeting with School Nurse for children with an Health Plan Indicator of additional
• Transition to School
• Arrangements for transition to the incoming named person e.g. Education.

• Ages & Stages

Questionnaires: (ASQ:3) should be used universally with continued access to validated development assessment tools and their appropriate age range as listed in

Appendix 2 and 3.

• Continuum of child assessment
• Seamless transition to School Nursing Services
• Parents/carers receive appropriate support/advice to maximise the wellbeing of their child
• Income of families with young children who are at risk, or experiencing, poverty is maximised
• Children benefit from effective care planning between services