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ObjectivesOver 50,000 children and young people in England are subject to a child protection plan.1 It is well established that abuse is detrimental to many aspects of child health in the short-, medium- and long-term.2 This project sought to build on existing knowledge to further understand the role health plays in child protection conferences. Specifically it sought to understand the health needs of vulnerable children and young people subject to child protection plans, how health needs are discussed at child protection conferences and which professionals are advocating for children and young people's health through the child protection process.MethodsRetrospective cohort study of case notes relating to 24 families (40 children) who underwent initial and review child protection conferences from January 2019-February 2021 in one local authority. This included accessible NHS notes and minutes from child protection meetings. Conference notes were reviewed to understand why conferences were taking place, which professionals were present, what health needs were discussed and what steps were taken in child protection plans to address health needs.ResultsHealth needs were almost universally addressed in child protection plans (23/24), with plans most commonly reporting on the need for school nurse assessment or health visitor monitoring. Health visitors and school nurses attended almost all conferences. Only seven children in this cohort were offered a Child Protection Medical Assessment with a paediatrician. High BMI and emotional distress were the most common health needs discussed. Emotional health was regularly commented on in conferences, particularly when domestic abuse was a factor. Plans commented on the need for CAMHS referral or to access emotional support in school. Access to emotional support in school was limited by school closures due to Covid-19 restrictions.Eighteen adolescents (10–17 years old) were involved in the analysis, many of whom had emotional health needs (14/18) or physical health needs (13/18);3 had contextual safeguarding needs. School nurses played an important role during and between conferences in identifying and managing the health needs of this vulnerable cohort of young people. Fourteen adolescents had school nurse assessments as part of their child protection plan, which provided an opportunity for health promotion and enabled identification of new health needs. School nurses were also able to offer psychosocial support, particularly to young people with contextual safeguarding concerns.ConclusionsHealth was well addressed in child protection conferences and plans. Health needs were almost exclusively represented by health visitors and school nurses. Emotional health needs were recognised and discussed in conferences, with limited avenues for children and young people to access support, particularly when support available through school was affected by Covid-19-related school closures. School nurses played a particularly important role for vulnerable adolescents subject to child protection plans as they were able to identify health needs, take appropriate steps to ensure management was in place and provide psychosocial support in the school setting.ReferencesChild protection plan statistics: England 2017–2021. NSPCC, 2021.State of Child Health. Royal College of Paediatrics and Child Health, 2020.
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Having achieved a foothold in the community hospital she performed minor surgery, carried out x rays, and applied plaster casts. In January 2021 she became the first person in Monmouth to receive the covid vaccination, administered by Brian Harries in the surgery she set up, now a teaching practice, which includes a list of 5000 patients, three partners, and a nurse practitioner, plus attached midwives, health visitors, and counsellors In a video of the occasion, made for Monmouth County Council, she urged patients to get vaccinated, recalling her time as a medical student when she saw polio patients in iron lungs. Charlotte Jones (b 1927;q Royal Free Hospital Medical School, London, 1952;DObst RCOG), died from the frailty of old age on 27 October 2022
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BACKGROUND: Dental caries in childhood is a burden on the daily lives of children and their families, and associated with poor oral health in adulthood. In England, dental caries is the most common reason for young children to be admitted to hospital. It is believed that most tooth extractions (due to decay) for children aged 10 years and under, could be avoided with improved prevention and early management. National public health policy recommendations in England include specific oral health initiatives to tackle tooth decay. One of these initiatives is delivered as part of the Healthy Child Programme and includes providing workforce training in oral health, integrating oral health advice into home visits, and the timely provision of fluoride toothpaste. This protocol seeks to assess the delivery of the First Dental Steps intervention and uncertainties related to the acceptability, recruitment, and retention of participants. METHODS: This study seeks to explore the feasibility and acceptability of the First Dental Steps intervention and research methods. First Dental Steps intervention will be delivered in local authority areas in South West England and includes oral health training for health visitors (or community nursery nurses) working with 0-5-year-olds and their families. Further, for vulnerable families, integrating oral health advice and the provision of an oral health pack (including a free flow cup, an age appropriate toothbrush, and 1450 ppm fluoride toothpaste) during a mandated check by a health visitor. In this study five local authority areas will receive the intervention. Interviews with parents receiving the intervention and health visitors delivering the intervention will be undertaken, along with a range of additional interviews with stakeholders from both intervention and comparison sites (four additional local authority areas). DISCUSSION: This protocol was written after the start of the COVID-19 pandemic, as a result, some of the original methods were adjusted specifically to account for disruptions caused by the pandemic. Results of this study will primarily provide evidence on the acceptability and feasibility of both the First Dental Steps intervention and the research methods from the perspective of both families and stakeholders.
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In 2020, the NMC changed its standards for first-year undergraduate students of pre-registration programs in response to the Covid-19 pandemic. This change recognized the pressures on the health and care workforce during that period and allowed for the required overall 50-50 split of theoretical and clinical hours to be made up over the remainder of the program. Here, Heffernan and Grundy share their experience of providing a virtual placement with the health visiting team for pre-registration student nurses.
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In the second of a two-part series, Holland shares the outstanding work done during the pandemic. Among others, Rachel Raymond supported the development of local health visiting hubs and ways to deliver the Welsh Government's Healthy Child Wales Programme from 2016. She also supported staff through the Covid-19 pandemic as they adapted to different ways of working and assisted at vaccination centres.
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As the UK adjusts to life in lockdown, how are CPs carrying out crucial work while staying safe? Here's just a snapshot of your current situations...
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AimsThroughout the development of the NHS Lothian Perinatal Mental Health Service, their goals alongside maternity and neonatal teams, family nurse and health visiting services have been to strengthen interdisciplinary working and improve the quality of perinatal mental health care delivered to birthing people. The aims of developing a programme of multidisciplinary education sessions were to develop the knowledge and confidence of non-mental health professionals in caring for birthing people experiencing mental health difficulties, and aid understanding of available services and referral pathways to facilitate appropriate care.MethodsThe programme has been delivered by a Perinatal Psychiatrist and Clinical Midwifery Educators in bimonthly sessions lasting two hours. Sessions have included scenario-based learning, education regarding illnesses and disorders, and promotion of infant mental health and trauma-informed care.Participants have attended virtually via Microsoft Teams or in person. Sessions have been recorded and accessed following teaching. Confidentiality is upheld throughout. A standard operating procedure utilising multi-modal methods has been designed to maximise staff engagement with sessions. Feedback accessed via a QR code has been collated via a Microsoft Forms questionnaire comprising of Likert scale and free-text answer questions. Feedback has guided programme development and topic selection.Initially, sessions were open to inpatient maternity services, but now outpatient maternity services, neonatology, and health visiting and family nursing colleagues are invited to maximise the reach of the staff delivering sessions.ResultsSessions have been well accessed by a variety of professionals, with increasing attendance at each session. Feedback has been obtained from 43% of those attending. Results have been very positive: 100% of respondents strongly agreed or agreed that the format of the session worked well with 92% of respondents strongly agreeing or agreeing that the session content was pitched at the appropriate level. 100% of respondents felt that the content covered was useful in their clinical role which supports the emphasis of the sessions on linking knowledge to clinical application to build confidence. 100% of respondents would recommend these education sessions to a colleague.ConclusionFeedback to date has shown that participants have found the sessions to be accessible and the content appropriately pitched and clinically valuable. Despite launching the programme amidst the challenges of COVID-19, participants have found the delivery of the sessions to be supportive and collaborative.The next phase in the development of the programme will be to understand in more detail what participants are learning and the impact on their practice.
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A nurse who set up innovative projects to support isolated families during the pandemic has demonstrated the hugely positive impact that the health visiting service can have on vulnerable parents and their children.
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Our public health capabilities have been tested to the limit during COVID-19. In particular, the value of an effective health visiting service is being recognised, with families speaking out on social media about the effects on them and their children when they miss out on this vital support. Frustrated parents have criticised health visitors for a lack of face-to-face contact, with suggestions that they have been ‘allowed to bow out’ during the pandemic. Some stories on social media are heartbreaking.
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A health visitor reveals how she coped and thrived while in post (and shielding) during the pandemic, plus member recognition is presented. Griffin is a 63-year-old health visitor living in West Sussex and she has remained in her post throughout the pandemic. She worked from home for much of 2020 and into the autumn of 2021 as part of the shielding population. The positives from this were that she had time to reflect and plan her work far more, without the daily stresses that we all face driving to see different families and trying not to run late with visits. The pandemic offered the chance to remember that we are all human. It has given me time to work hard and give her best to families, and to think through all the doubts we share as practitioners.
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As we approach the end of the second year of the pandemic, there is hope that 2022 will mark a return to normal life. Perhaps when the community is virus free, health visitors will be recognised for the valuable work they do, says Jane Hanley
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With families home schooling their children, caring for young babies and managing housework during lockdown, it is important for health visitors to promote home safety advice to help prevent unintentional accidents and injuries
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Jane Powell and Julie Taylor at Birmingham Women's and Children's Hospital NHS Foundation Trust explain how a collaborative approach to safeguarding, maximising capacity within the service, will help to ensure better outcomes for children
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Bethany Boddy reflects on the findings of the State of Health Visiting survey alongside current evidence of the impact of the Covid-19 pandemic on children and families. What does this year have in store for practice?
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Globally, children have been profoundly affected by the Covid-19 pandemic in many ways. While the majority of children with acute Covid-19 infection experience mild illness and fully recover, many go on to experience Long Covid. Long Covid is clinically identified by experience of persistent (and sometimes different) symptoms for several months after the acute infection (even in children who were asymptomatic). There is currently no agreed consensus on the case definition of Long Covid, but real-world data from American health insurance firms and the UK Office for National Statistics report that children may experience intestinal symptoms, pain, breathlessness, cognitive dysfunction and post-exercise malaise. The current understanding of the natural history, diagnostics and treatments of Long Covid is limited, meaning the medical model in isolation is not helpful. Health visitors and school nurses are ideally placed to case-find children with Long Covid and co-produce child and family-centred care.
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Based on data collected through Freedom of Information requests, researchers at University College London generated a detailed picture of the effects of the pandemic on health visiting services in England. Dave Hancock reveals some highlights
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Those working as specialist community public health nurses--health visitors and school nurses--as well as leaders of the Healthy Child Programme are all guided by the four principles of health visiting: search for health needs, stimulation of an awareness of health needs, influence policies affecting health and facilitation of health-enhancing activities. Here, Halnan discusses the importance of using digital technology to maintain a Healthy Child Programme service during lockdown and perceptions from service users.
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The highlights from the latest Unite-CPHVA 2021 Virtual Professional Conference held in November are discussed. Janet Taylor, chair of the CPHVA Executive, opened this year's conference. She welcomed Sharon Graham, the newly elected general secretary of Unite. In her speech to conference, Graham said the pandemic has emboldened employers to 'think they can get away with things they would never have got away with' before. She outlined plans to introduce 'combines' to the union--committees with budgets set by the union executive that bring together all of the reps for a particular industry to work together on their own biggest bargaining agendas.