SOP Title: SCPHN SOP No 4A: The Universal 6 to 8
week Developmental Review by the SCPHN Team
NHS Unclassified
THE UNIVERSAL 6 TO 8 WEEK
SPECIALIST COMMUNITY PUBLIC HEALTH NURSE
HEALTH VISITOR (SCPHN HV) CONTACT
SCPHN Standard Operating Procedure No 4A
Prepared by: Christine Timmon, Andrea Bouchaib, Maria Gaskins,
Sarah Reddington-Bowes, Ann Horsler, Vicky Peters, Kerry Pearce,
and Emma Sidebottom
Presented
Ratified by:
to:
Care & Clinical Policy Group
Date: 14.08.15
Care & Clinical Policy Group
Date: 14.08.15
Review date: One year (August 2016)
Links to Policies:










South West Safeguarding & Child Protection Group Guidelines
Torbay and Southern Devon Health and Care NHS Trust (TSDHCT) Safeguarding
Adults Multi-Agency Policy and Procedure
TSDHCT Lone Working Policy
TSDHCT INFANT FEEDING SCPHN POLICY (Health Visiting) 2015
TSDHCT SCPHN SOP No 4: The Perinatal Infant Mental Health Contact and the
Initial Assessment of Early Attachment by the Specialist Community Public Health
Nurse (SCPHN) Health Visitor (HV) 2014
TSDHCT SCPHN Family Health Needs Assessment (FHNA) Tool 2014.
TSDHCT SCPHN SOP No 7: The Transfer In and Out Process by the SCPHN HV
Team 23/7/14
Southern Devon Healthcare NHS Foundation Trust (SDHCT). New-born Blood
Spot Screening Ref: 0744 version 8
SDHCT Medium Chain acyl COA Dehydrogenase Deficiency and other Medium
Chain Oxidation Disorders (MCAD Deficiency)Ref: 1564 Version 2
SDHCT BCG Vaccination in the Newborn. Ref: 0317 Version 6
1. Purpose of this Document:
This document offers best practice guidance on the universal 6 to 8 week health promoting
contact to a family or carer of a baby by the Torbay and South Devon NHS Foundation
Trust (TSDFT) Specialist Community Public Health Nurse (SCPHN) Health Visitor (HV).
The 6 to 8 week universal contact described in the 2015 -16 National Health Visiting Core
Service Specification (NHS England) will be offered. This will be a face-to-face, one-to-one
interview, in a confidential setting, based on a promotional narrative listening interview.
2. Scope of this Standard Operational Procedure (SOP):
This Standard Operating Procedure (SOP) will be followed by all TSDFT Specialist
Last Review Date: August 2015
Version: 1
Page 1 of 13
SOP Title: SCPHN SOP No 4A: The Universal 6 to 8
week Developmental Review by the SCPHN Team
NHS Unclassified
Community Public Health Nurse Health Visitors.
3. Competencies Required:
i.
To have attended the Institute of Health Visiting (iHV) Perinatal Mental Health
Champion Training.
ii.
To have attended the iHV Domestic Abuse Health Visiting Champion Training.
iii.
To have attended the annual immunisation update for SCPHN.
iv.
To have evidence of attendance on a 2 day UNICEF Baby Friendly course followed
by a practical skills review completed by the Responsive Feeding Team 6 weeks
after the initial 2 day training.
v.
To have attended the iHV Infant Mental Health Champion training for health visitors.
vi.
To have attended the Solihull Foundation training.
vii.
To have attended the Family Partnership Model training.
viii.
To have completed an annual prescribing update
Patients / Clients Covered: This SOP is applicable to all families and carers with a
6 to 8 week old baby who are resident permanently or temporarily in the borough of Torbay.
4. Procedure:
i.
It is best practice for the HV who completed the 28 week antenatal contact and the
new birth visit to complete the subsequent 6 to 8 week contact with the family
wherever possible.
ii.
The 6 to 8 week contact will be arranged at a suitable time and venue for the family or
carers giving both parents/ carers the opportunity to attend.
iii.
The HV will review the Action Plan in the Family Health Needs Assessment (FHNA)
prior to the 6 to 8 week contact.
iv.
The HV will give the family or carer the opportunity to discuss any concerns or
parenting issues at the 6 to 8 week contact. The HV will offer to weigh and measure
the length of the baby and measure the baby’s head circumference recording the
measurements in the Personal Child Health Record (PCHR – Red Book).
v.
The HV will enquire if the family have received appointments for the 6 to 8 week NHS
New-born and Infant Physical Examination (NIPE screen) by their General Practitioner
(GP) and the baby’s first immunisation appointment.
vi.
The HV will promote immunisations specifically as follows:
a. To give the family or carer the opportunity to discuss the Child Health
Immunisation Schedule.
Last review date: 14/08/15
Version 1
Page 2 of 13
SOP Title: SCPHN SOP No 4A: The Universal 6 to 8
week Developmental Review by the SCPHN Team
NHS Unclassified
b. To check the maternal rubella status on the postnatal summary. If positive, a
course of 2 postnatal measles, mumps and rubella (MMR) vaccinations are
recommended. The HV will check that the first vaccine was given by the
maternity service, and the second 4 weeks later by the GP surgery (ref: South
Devon Healthcare NHS Foundation Trust (2013) Patient Group Direction (PGD)
Administration of MMR Vaccine).
c. To review the hepatitis B schedule in babies born to mothers who are hepatitis
B positive (Appendix 1: Guidance on Hepatitis B: the Green Book Ch. 18).
d. To review if the baby requires a BCG in accordance with the TSDHCT BCG
vaccination in the Newborn Ref: 0317. The HV will make a written referral to the
Chest Clinic at Torbay Hospital, if required, with parental consent.
vii.
The HV will check the status of all screening results and take prompt action to ensure
appropriate referrals and treatment pathways are followed in line with UK National
Screening Committee (NSC) Standards. By 6 to 8 weeks, the parents will have
received the blood spot results by post; the HV will ensure these results are recorded
in the PCHR on page 25.
viii.
The family will be contacted earlier if the screen is positive: the TSDHCT Newborn
Blood Spot Screening Protocol Ref: 0744 describes the care pathways for babies with
a positive result.
ix.
For children moving in from abroad, the Health Visitor must check if he/she has been
offered a new-born blood spot screening and, if so, that a record of the result has been
recorded. If not, arrangements should be made to offer screening, in line with the
National Standards “within 15 days of notification of the residency”. To arrange for the
screening test to be undertaken, the HV will contact the Paediatric Outpatients
department at Torbay Hospital (Tel: 01803 656356) and request an appointment for
the Blood Clinic. The HV will ensure the mother takes the child’s PCHR with her. The
HV should complete the attached letter (Appendix 2) and return to Child Health.
x.
The HV should ensure that mothers have the opportunity to discuss responsive
feeding, and should reassure mothers that breastfeeding can be used to feed, comfort,
and calm babies. Breastfeeding can be long or short. Breastfed babies cannot be
overfed or ‘spoiled’ by too much feeding and breastfeeding will not, in itself, tire
mothers any more than caring for a new baby without breastfeeding. Parents will be
given information about local parenting groups that are available such as Feeding
Groups and the breastfeeding support mobile number (0750 095 2216 – office hours
only) recorded in the PCHR.
xi.
When exclusive breastfeeding is not possible, the value of continuing partial
breastfeeding will be emphasised and mothers will be supported to maximise the
amount of breast milk their babies receive. Mothers will be given the opportunity for a
discussion about their options for continued breastfeeding (including responsive
feeding, expression of breast milk and feeding when out an about or going back to
work), according to individual need. Sign post to www.nhs.uk/change4life (site
accessed 25.09.15) to promote complementary foods from 6 months (26 weeks) of
age.
Last review date: 14/08/15
Version 1
Page 3 of 13
SOP Title: SCPHN SOP No 4A: The Universal 6 to 8
week Developmental Review by the SCPHN Team
NHS Unclassified
xii.
The HV will advise parents on what to do when their child is ill and check that the
Sepsis Assessment and Management (SAM) insert is in the PCHR.
xiii.
The HV will provide information on Action for Children Children’s Centres and other
support groups locally.
xiv.
The HV will review the mother’s mental health in accordance with SCPHN SOP No 4,
The Perinatal Infant Mental Health Contact, and the Initial Assessment of Early
Attachment by the SCPHN HV.
xv.
The HV will ask the routine enquiry questions (Appendix 3) if safe to do so.
xvi.
The 6 to 8 week HV contact will be recorded in the HV index card and on the HV diary
sheet under UC1. The HV will add relevant information gathered at this contact to the
GP Newborn Infant Physical Examination (NIPE) 6 to 8 week review page in the
PCHR.
xvii.
The Family and Friends questionnaire will be sent out with each appointment letter and
the HV team will ask the family if this has been completed and, if necessary, forward it
to TSDFT headquarters at Bay House, Nicholson Road, Torquay TQ2 7XA.
Monitoring Tool Standards:
Item
Key Performance Indicator
% Exceptions
95 Q4 at 90%
Equality Statement.
The Trust is committed to preventing discrimination, valuing diversity and achieving equality
of opportunity. No person (staff, patient or public) will receive less favourable treatment on
the grounds of the nine protected characteristics (as governed by the Equality Act 2010):
Sexual Orientation; Gender; Age; Gender Reassignment; Pregnancy and Maternity;
Disability; Religion or Belief; Race; Marriage and Civil Partnership. In addition to these nine,
the Trust will not discriminate on the grounds of domestic circumstances, social-economic
status, political affiliation or trade union membership.
The Trust is committed to ensuring all services, policies, projects and strategies undergo
equality analysis. For more information about equality analysis and Equality Impact
Assessments please refer to the Equality and Diversity Policy
References:




2015 – 16 National Health Visitor Core Service Specification (NHS England)
NICE guidance: Antenatal and Postnatal Mental Health: Clinical Management and
Service Guidelines, Dec 2014
Information on all vaccinations can be found at
https://www.gov.uk/government/publications/green-book-the-complete-current-edition
(site accessed 25.09.15)
Public Health England (2013) Immunisation Against Infectious Disease: Rubella
Last review date: 14/08/15
Version 1
Page 4 of 13
SOP Title: SCPHN SOP No 4A: The Universal 6 to 8
week Developmental Review by the SCPHN Team
NHS Unclassified





(German measles): guidance, data and analysis. Chapter 28 Rubella.
South Devon Healthcare NHS Foundation Trust (2013) Patient Group Directive:
Administration of MMR Vaccine.
Information on NHS screening programmes and tests for mothers and babies can be
found at NHSchoicesyourhealthyourchoice@www.nhs.uk (site accessed 25.09.15)
Public Health England. UK National Screening Committee (NSC)
www.screening.nhs.uk (site accessed 25.09.15)
Signs And Symptoms (SAM) leaflet for parents
http://www.southdevonandtorbayccg.nhs.uk/your-health/Pages/child-sepsisguidance.aspx (site accessed 25.09.15))
Professional resources for paediatric sepsis http://www.england.nhs.uk/south/dcisat/professionals/sepsis/resources/ (site accessed 25.09.15)
Appendices (1) Guidance on Hepatitis B:
Public Health England Neonatal and Infant Hep B Immunisation Programme
(2) Blood Spot Results Form for Children Moving in From Abroad
(3) Routine Enquiry Questions
Amendment History
Issue
Status
Date
V1 Final Ratified
25.09.15
Last review date: 14/08/15
Version 1
Reason for Change
Authorised
C Timmon
Page 5 of 13
SOP Title: SCPHN SOP No 4A: The Universal 6 to 8
week Developmental Review by the SCPHN Team
NHS Unclassified
APPENDIX 1:
PHE NEONATAL AND INFANT HEP B IMMUNISATION PROGRAMME
Last review date: 14/08/15
Version 1
Page 6 of 13
SOP Title: SCPHN SOP No 4A: The Universal 6 to 8
week Developmental Review by the SCPHN Team
NHS Unclassified
Last review date: 14/08/15
Version 1
Page 7 of 13
SOP Title: SCPHN SOP No 4A: The Universal 6 to 8
week Developmental Review by the SCPHN Team
NHS Unclassified
Last review date: 14/08/15
Version 1
Page 8 of 13
SOP Title: SCPHN SOP No 4A: The Universal 6 to 8
week Developmental Review by the SCPHN Team
NHS Unclassified
Last review date: 14/08/15
Version 1
Page 9 of 13
SOP Title: SCPHN SOP No 4A: The Universal 6 to 8
week Developmental Review by the SCPHN Team
NHS Unclassified
Last review date: 14/08/15
Version 1
Page 10 of 13
SOP Title: SCPHN SOP No 4A: The Universal 6 to 8
week Developmental Review by the SCPHN Team
NHS Unclassified
Last review date: 14/08/15
Version 1
Page 11 of 13
SOP Title: SCPHN SOP No 4A: The Universal 6 to 8
week Developmental Review by the SCPHN Team
NHS Unclassified
APPENDIX 2 - BLOOD SPOT RESULTS FORM FOR CHILDREN MOVING IN FROM ABROAD
Child Health Department
Vowden Hall
Torbay Hospital
Lawes Bridge
TORQUAY TQ2 7AA
Date
Dear Health Visitor
Name of Child:
Date of Birth:
NHS No:
The above child has moved in from abroad. Can you please check if he/she has been offered newborn blood
spot screening and if so that a record of the result has been recorded. If not, arrangements should be made
to offer screening, in line with the National Standards.
Please enter details below and return to Child Health.
To arrange for the screening test to be undertaken please contact the Paediatric Outpatients at Torbay
Hospital (Tel: (01803) 656356) and request an appointment for the Blood Clinic. Ensure the mother takes the
baby’s personal Child Health Record with her.
Thank you for your help.
Child Health Dept.
Referred to Outpatients
YES [ ]
Declined
YES [ ]
or:
TEST
RESULT
DATE
PKU
TSH
CYF
MCADD
SCD
Last review date: 14/08/15
Version 1
Page 12 of 13
SOP Title: SCPHN SOP No 4A: The Universal 6 to 8
week Developmental Review by the SCPHN Team
NHS Unclassified
APPENDIX 3 – ROUTINE ENQUIRY QUESTIONS FOR SCPHNs
Domestic abuse: IS IT SAFE TO ASK THIS QUESTION?
As violence in the home is so common we now ask contacts about it routinely.
Before asking questions consider the environment:
 Is the woman/man alone?
 Do not ask with any other adult present or a child over 2 years.
 Use an interpreter/create the opportunity.
Validate before asking questions below by clarifying the above.
Direct question:
“Are you in a relationship with someone who hurts or threatens you?”
or, if there is evidence of injuries:
“Did someone cause these injuries to you?”
Assess:
 “Is your partner with you?”
 “Where are the children?”
 “Do you have any immediate concerns?”
 “Do you have a place of safety?”
Signpost person to appropriate support.
If the questions were not asked, document why in service user records.
Document when planning to ask questions i.e. clinic/next contact/next home visit.
Last review date: 14/08/15
Version 1
Page 13 of 13