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Targeting health visitor care: lessons from Starting Well
C M Wright1, S K Jeffrey, M K Ross
1PEACH Unit, Faculty of Medicine, University of Glasgow, Glasgow, UK. charlotte.wright@clinmed.gla.ac.uk
Insights
Early identification of high-need families by health visitors is challenging. Many at-risk families, especially in deprived areas, require ongoing support for accurate assessment and intervention.
Area of Science:
- Child Health
- Public Health
- Family Support Services
Background:
- UK guidelines mandate health visitor assessment of family needs by 4 months postpartum.
- Accurate prediction of family needs at this early stage is crucial for targeted interventions.
Purpose of the Study:
- To evaluate the accuracy of predicting family needs at the 4-month infant stage.
- To identify factors influencing health visiting intensity and social work referrals.
Main Methods:
- Analysis of routinely recorded data from 1202 families in an intensive health visiting program (Starting Well project, Glasgow).
- Health visitor ratings of family needs were used as predictors.
- High visiting rates and social work referrals served as main outcome measures.
Main Results:
- Only 47% of families rated as high need were identified by 4 months.
- High visiting rates and social work referrals were often not preceded by an initial high-need rating.
- Key predictors of high contact rates included lack of income, preterm birth, multiple pregnancy, South Asian ethnicity, prior social work/criminal justice involvement, and parental history of care.
- 83% of families had at least one risk characteristic or lived in a deprived area.
Conclusions:
- Individual-based identification of at-risk families in early weeks is often inaccurate.
- Continued support and input for families in deprived areas are essential for reliably identifying the most vulnerable.
- Rethinking early identification strategies may be necessary to ensure timely and effective support for all at-risk families.
Background:
UK child health promotion guidelines expect health visitors to assess family needs before new babies are aged 4 months and offer targeted care on that basis thereafter. Data from an intensive family support programme were used to assess how accurately family needs can be predicted at this stage.
Design:
A population based cohort of 1202 families with new babies receiving an intensive health visiting programme. Analysis of routinely recorded data.
Setting:
Starting Well project, Glasgow, UK.
Predictors:
Health visitor rating of family needs.
Main Outcome Measures:
Families receiving high visiting rates or referred to social work services.
Results:
Of 302 families rated high need, only 143 (47%) were identified by age 4 months. Visiting rates in the first year for those initially rated high need were nearly double those for the remainder, but around two thirds of those with high contact rates/referred to social work were not initially rated high need. Six family characteristics (no income, baby born preterm, multiple pregnancy, South Asian, prior social work/criminal justice involvement, either parent in care as a child) were identified as the commonest/strongest predictors of contact rates; 1003 (83%) families had one such characteristics and/or lived in a highly deprived area, including 228 (93%) of those with high contact rates and 157 (96%) of those referred to social work.
Conclusions:
Most families at risk will not be identified on an individual basis in the early weeks. Most families in deprived areas need continued input if the most vulnerable families are to be reliably identified.
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