Health`s Role in Multi-Agency Assessments

Health's Role in Multi-Agency
together states
Norfolk Community Health
and Care (NCH&C)
• NCH&C provides community children’s services for children
• The healthy child programme includes health visiting, school
nursing and the Family Nurse Partnership. Plus four children's
centres based in Kings Lynn, Thetford, Cromer and
Mundesley, Bowthorpe in Norwich. There is also the Looked
After Children team and a paediatric liaison nurse based at
the NNUH.
• Disability and additional specialist health includes learning
disability teams, speech and language therapy, community
paediatrics, specialist team for children with complex care
needs (child development unit), occupational therapy and
community psychology, ADHD team, community nursing for
children with complex care needs and two residential units for
children with complex care needs
Health’s contribution to multiagency assessments
• These professionals between them have contact with all children
from pre-birth through to eighteen years of age. They have
contact with the wider network of health services such as
midwives, General Practitioners and Paediatricians as well as
other agencies such as Children’s services, children’s centres
and voluntary services.
• These professionals will have knowledge and information about
the children and families they work with. In particular they bring
skills and training in child development. Understanding child
development is crucial in ensuring best quality decision making
(Brandon 2012).
• They may also have a great deal of knowledge about the local
area and resources.
• There is a much wider health service provision through other
Trusts such as hospitals and adult mental health as well as our
GP colleagues.
Universal services
Health Visiting has a pivotal role in multi-agency assessments because of
their contact with all pre-school children.
The healthy child core programme includes an ante natal contact, a new
birth visit, a post natal visit around 6 weeks, a developmental assessment
around 8-12 months and a two year developmental assessment.
Health visitors (along with the community nursery nurses and family support
workers from the children’s centres) will offer additional services to those
families identified as needing more support. For example babies born
prematurely, low birth weight, vulnerable parents such as parental low
mood, domestic abuse, socially isolated, parents with a learning disability,
housing and debt needs etc
Those with safeguarding concerns are prioritised. Prior to any referral the
health visitor may be the only professional gaining access to the home,
especially with hard to reach families. Health visitors have to assess when
the threshold has been reached to refer any safeguarding concerns. As we
know sometimes there is a single event that triggers this but often it is a
matter of collating the necessary evidence for such a referral.
NCH&C receives and responds to C39d’s either as a joint response (MASH)
or may follow up as a single agency.
Health visiting developments
in NCH&C
The health visitor early implementation site
started in 2011
108 whole time equivalent Health Visitors
including Team Leaders and Family Nurse
Partnership (FNP)
Aim by March 2015
169 whole time equivalent Health Visitors
including Team Leaders and expanded FNP
• In 2012 we trained 35 Health Visitors, retaining
30 posts in NCH&C
• This year (2013) we have 45 students about to
qualify and hope to retain as many as possible
• The whole time equivalent of 31 March 2013 was
• We will see a reduction in the next few months
(retirements etc)
• Target for Health Visitors in post by March 2014
is 145.95 and 169 by March 2015
• We are on target to reach this
School Nursing Teams
• School nurses see children at school but also undertake some
home visits. They have a much larger cohort of children on
their case loads so are usually involved in child protection
when there is a specific health need such as enuresis, mental
health or sexual health concerns.
• School nursing teams provide universal health screening at
school entry (height and weight/ hearing and vision plus
height and weight at year 6).
• They offer drop in clinics at high schools and will provide
sessions on health and social development in schools when
• They attend case conferences as appropriate.
Examples of Developments in
Training for Health Visitors
• Ages and stages questionnaires provide a quick
snap shot of a child’s development in key areas
• ASQ-3 identifies a child strengths in respect of:
fine motor, gross motor, communication,
personal and social, problem solving skills
• ASQ-SE identifies a child strengths in relation to
social and emotional behaviours
What are the ages and stages
Questionnaires (ASQ-3)
• Not just another tool it will be the tool for developmental
• Based on 30 years of research, five major revisions and on
3rd edition (ASQ-3)
• Started in 1979 first edition in 1995, referenced in the HCP.
• Similar in theory to health screening such as a quick
hearing or vision screen
• Identifies a family that needs further support, more intensive
assessment or referral for a more specialist service.
Intentions Clinically?
• To provide a parent education process/ strength based tool
• To not provide a tick box approach
• Support you in assessing, planning, empower, help teach families,
evaluating and referencing.
• Detection Rates:
30% developmental disabilities
identified (Palfrey et al. JPEDS.
70-80% developmental
disabilities are identified (Squires et
al. JDBP 1996:17:420-427)
20% Mental Health problems
identified (Lavigne et. al. Podiatry 1993:
80-90% Mental health problems
identified (Sturner JDBP 19:51-64)
91: 649-655)
The Promotional Guide System
The promotional Guide system offers a
structured and flexible manualised
approach that promotes
• The early development of babies
• The transition of mothers and fathers to
• Better informed professional and parent
decisions about baby and family needs
Ref: Dr Crispin Day, South London & Maudsley NHS Foundation Trust
Structure of the Antenatal/Postnatal
Promotional Guides
Five core themes underpin the Antenatal
and Postnatal Guides:
the health, well-being and development of
the baby, mother and father
family and social support
the couple relationship
parent-infant care and interaction
the development tasks of early parenthood
and infancy
Ref: Dr Crispin Day, South London & Maudsley NHS Foundation Trust
FPM Antenatal Promotional Guide:
Ten Topics
The mother and fathers feelings about their pregnancy
Expected family and other support
Anticipated changes in family life and relationships
Self perception of the pregnant mother
The pregnant mothers current perceptions and
anticipation of her unborn child
The mothers and fathers anticipation of becoming
Anticipation of labour, delivery and birth
Anticipation of feeding, caring and looking after the baby
Current finances and housing
Life events
Ref: Dr Crispin Day, South London & Maudsley NHS Foundation Trust
Norfolk Family Nurse
• 6 Family Nurses, 1 Supervisor, with a
maximum of 150 families
• Intensive home visiting programme from
early pregnancy till child aged 2 years
• Safeguarding of children, young people
and adults at heart of FNP – one of two
programmes known to prevent child
maltreatment (Lancet 2008)
• Family Nurses enrich multi agency