rhaglen plant iach cymru healthy child wales...

Rhaglen Plant Iach Cymru Healthy Child Wales Programme Health Visiting and School Health Nursing Component 0-7 years

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Mae’r ddogfen yma hefyd ar gael yn Gymraeg / This document is also available in Welsh

Contents

Foreword by the Chief Medical Officer for Wales and the Chief Nursing Officer for Wales

Page 3

Introduction

Page 4

Summary of HCWP Universal Scheduled Contacts for 0-7 year olds

Page 7

The Healthy Child Wales Programme Schedule

Page 8

Annex 1: Programmes in the Community that Tackle Health Inequalities

Page 42

References

Page 45

Links

Page 47

Contributions to the Healthy Child Wales Programme

Page 48

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Foreword by the Chief Medical Officer for Wales and the Chief Nursing Officer for Wales It is essential that we take a collaborative approach to delivering services across Wales in the early years of life. This will ensure that we provide the opportunity for children and their families to receive a robust, comprehensive programme of public health focused and evidence based services. Historically, the recommended health contacts have been administered by Health Boards without national co-ordination, resulting in programme variations across Wales. The absence of a single ‘template’ for Health Visitor contacts in the pre-school years has allowed Health Boards to develop their own programmes in isolation. Whilst it is positive that local programmes are delivered in response to local needs and services, this has led to poorly co-ordinated services with variation and the potential for inefficiency. There is a risk of children falling through service gaps if they move areas (more likely for children in poverty), and an inability to ensure effective coverage and performance management of the programme outcomes. The Healthy Child Wales programme offers a remedy to these problems, leading to better outcomes for children.

We would like to thank all those who have contributed to producing this All Wales programme.

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Introduction The Healthy Child Wales Programme (HCWP) sets the strategic direction for Health Boards in Wales for the delivery of early intervention health services that are designed to ensure that children achieve optimum health. This will be achieved through collaborative working with families, partner agencies and providers of services in pregnancy and the early years of life. The HCWP is a key recommendation of A Vision for Health Visiting (Welsh Government (WG) 2012) and demonstrates the commitment from Specialist Community Public Health Nurses (SCPHN) to improve health outcomes for the population of Wales. There is consistent evidence to suggest that an investment in early years significantly improves health, social and educational development and long term outcomes (Black Report 1980, Acheson 1998, Marmot, 2010). The HCWP provides a structured national programme for children and their families to achieve these outcomes. It provides opportunities to implement prudent health care to create services that address inequality and provide social benefit with better outcomes for children and young people (WG 2014). The HCWP is built on strong evidence as set out in a number of key influential documents including Health For All Children (Hall and Elliman 2006) It is underpinned by a universal screening programme supplemented by the National Institute for Clinical Excellence (NICE) and National Service Framework for Children Young People and Maternity (2004). Additionally, evaluations of the Child Measurement Programme (PHW 2012) and Flying Start Programme in Wales (Welsh Government 2014) have demonstrated the significant impact that SCPHN practice has on achieving better outcomes for families and their children. In Wales we face significant challenges in terms of child poverty. The Children’s Commissioner for Wales Annual Report (2014) identified that Wales has the highest rate of child poverty in the United Kingdom (UK). Therefore, the HCWP aims to support the drive to address inequality as highlighted in the report. The HCWP and associated documents are all underpinned by the Rights of the Child (UNCRC 1989). The HCWP provides an early intervention and preventative public health programme which is central to public health practice. It is fundamental in promoting the delivery of positive health and well being to families and communities in Wales. It`s underlying ethos is to help reduce the effects of inequality through efficient and effective use of resources.

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Introducing the Programme The Welsh Government anticipates that every child and family will be offered the HCWP. The programme underpins the concept of progressive universalism and aims to identify a minimum set of key interventions to all families with pre-school children, irrespective of need. For some families there will be a need to increase intervention to facilitate more intensive support. The implementation of the HCWP ensures a commitment to safeguard the health and welfare of all children aged 0-7 years and aims to achieve the following key priorities: • To deliver key public health messages from conception to 7 years, so that families

are supported to make long term health enhancing choices. • To promote bonding and attachment to support positive parent-child relationships

resulting in secure emotional attachment for children. • To promote positive maternal and family emotional health and resilience. • To support and empower families to make informed choices in order to provide a

safe, nurturing environment. • To assist children to meet all growth and developmental milestones enabling them to

achieve school readiness. • To support the transition into the school environment.

Poverty is known to be one of the highest risk factors that are linked to poor health outcomes in early childhood. Children who come from families with multiple risk factors such as parental mental health issues, substance misuse and domestic abuse may experience a range of poor outcomes, often placing a greater demand on NHS services and the wider public health sector (Social Services and Well-being (Wales) Act 2014a). The HCWP will sit at the heart of public health services for children and their families in Wales. For those families and children with increased need and risk, SCPHN Health Visiting (HV) and School Health Nursing (SHN) services will extend beyond the Universal service to provide Enhanced services and where necessary Intensive interventions.

http://www.legislation.gov.uk/anaw/2014/4/pdfs/anaw_20140004_en.pdf

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Delivering the Programme The HCWP will be central to the delivery of a progressive, universal service offering a range of preventative and early interventions for different levels of risk determined by an All Wales Health Visiting Family Resilience Assessment Instrument Tool (FRAIT) (Wallace et al 2016). The aims of the FRAIT are to identify protective factors within families as well as to identify additional need alongside potential safeguarding concerns. SCPHN’s will, in partnership with families, assess parental and family resilience in terms of coping with family life, and aim to identify the supportive factors required to improve health outcomes. The FRAIT will be used at key stages throughout a child’s first 5 years of their life and a plan will be agreed with families encompassing interventions and reviews to evaluate distance travelled. The FRAIT is a comprehensive and holistic family assessment that takes into account a complex range of factors to include parental mental health, bonding and attachment, child development, family relationships and parenting capacity. It takes full account of the diverse needs of families including mothers, fathers, partners, carers and grandparents. The assessment will facilitate a robust analysis of these factors and ensure that interventions are delivered though the mechanism of prudent health care. A Quality Assurance Framework accompanies the HCWP. This will provide assurance of the quality and effectiveness of SCPHN professional practice and services delivered across Wales. It will enable local service improvements, support service planning and delivery and provide a vehicle to review and update the HCWP in future years. The Quality Assurance Framework and the All Wales Health Visiting Acuity Tool in connection with FRAIT will enable each Health Board to determine local workforce requirements through the application of a standardised acuity tool.

Summary of HCWP Universal Scheduled Contacts for 0-7 year olds

The following screening, immunisation and monitoring and supporting child development (surveillance) contacts are what each child and parent can expect to receive.

Antenatal care from Midwifery service Book by 10 weeks gestation

Targeted visit by Health Visitor (HV) from 28 weeks if:

• Expecting 1st Baby • Learning Difficulties • Safeguarding Concerns • Emotional / mental health

Issues • Unborn baby has a medical

condition • Multiple pregnancy

Physical examination of newborn within 72 hours

Bloodspot screening at 5 days old (by 8 days old) Newborn hearing screening within 4 weeks

HV home contact by 14 days old Family resilience assessment

Maternal mental health assessment

Physical examination at 6 weeks

HV service contact at 8, 12 & 16 weeks Growth assessment

HV service contact at 15 months Assessment of growth & development

Family resilience assessment

HV service contact at 27 months Assessment of growth & development


Handover from Health Visitor to School Nurse at the age 4/5

Routine vaccinations at 8, 12 & 16 weeks

Routine vaccinations at 12 months

Routine vaccinations at 3 years 4 months

HV service contact at 6 Months Weaning and baby safety advice


HV service contact at 3.5 years. Assessment of growth & development


School Nurse service between 4 and 7 years Vision and growth screening

Hearing impairment screening Child Measurement Programme

Influenza – annual flu

nasal spray at 2, 3 and 4 years of

age

School nurse service administered flu vaccination Programme between

4 and 7 years

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The Healthy Child Wales Programme Schedule This section describes the progressive universal core programme for all families with children under 7 years. The level of intervention will be determined by SCPHN’s assessment of family resilience and will range from a standardised Universal service, through to Enhanced or Intensive support. In addition, the Flying Start Programme offers an enhanced Health Visiting service to those families with children under 4 years of age, in the most deprived areas of Wales (WG 2015). The schedule is set out illustrating the specific contacts embedded within the HCWP. The following overview of the HCWP outlines core components that will be offered to all families. The core components are offered at 3 levels:

• Universal – the core minimum intervention offered to all families, regardless of need.

• Enhanced – additional interventions based on the assessment and analysis of resilience and identification of additional need.

• Intensive – further interventions, built upon ongoing assessment and analysis of greater need.

At every contact, opportunities will be taken to ensure that key public health priorities are identified. Evidence based messages will be delivered in order to improve the health and well being of children and their families thereby contributing to the WG (2013) Building a Brighter Future: Early Years and Childcare Plan. The safety and wellbeing of the child will be the paramount consideration (Children Act 1998; 2004 Social Services & Well Being Act 2014). Where there are professional concerns regarding a child’s welfare or when a child is thought to be experiencing significant harm, SCPHN’s will refer to their Local Authority Social Services department using guidance contained in the All Wales Child Protection Procedures (AWCPP)(2008) Social Services & Well Being Act SSWBA (2014).

Overview of the Healthy Child Wales Programme

The intensity of intervention will depend upon an assessment of family resilience; which will be undertaken at key contacts. The following illustrates the different levels of provision offered:

Universal Core components of the Healthy Child Wales Programme available to all families with children under 7 years of age will include:

• Health and Development • Screening and physical examination • Immunisation • Key Public Health Messages • Smoking and Substance Misuse • Prevention of Sudden Infant Death Syndrome (SIDS)

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• Breastfeeding and healthy weaning • Nutrition • Obesity and physical activity • Baby safety • Home safety & accident prevention • Healthy relationships and domestic abuse • Dental health • Pet/Dog safety • Promotion of sensitive parenting • Secure infant attachment and bonding • Involvement of fathers • Perinatal Mental health • Preparation and support with transition to parenthood • Safeguarding

Enhanced Building on the Universal core components, the Enhanced service will include further interventions that will have been identified as required through either the assessments of resilience and development and will include;

• Emotional and psychological issues • Breastfeeding • Positive behaviour change (smoking, substance misuse, diet, dental health

etc.) • Parenting support programmes, including assessment and promotion of

parent-baby interaction • Child development & speech and language • Infants with health problems • Safeguarding concerns

Intensive This element will build upon the Universal and Enhanced core programmes and the decision to provide this further level of intervention be guided by the individual assessment of family resilience and identification of significant need and may include:

• Intensive structured home visiting programmes • Referral to specialist services • Safeguarding concerns

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Maternity

The Welsh Government’s Strategic Vision for Maternity Services in Wales (WG 2011) set the direction and the outcomes it expects for women and their babies during pregnancy and childbirth. The social and economic context within which the maternity services operate is constantly changing and given the high level of social inequality in Wales, the Strategic Vision focuses on reducing these inequalities to make sure that all families receive the best care possible. Tackling inequalities in terms of access to, and outcomes from maternity and Public Health Nursing services in Wales, is the cornerstone of this document. Ensuring every woman in Wales, irrespective of her location, social background, circumstances or ethnicity, has access to and receives safe high quality care, as close to home as possible. Outcome measures for the maternity services focus upon improving the health of pregnant women and their babies, by encouraging early access to a midwife, supporting healthy lifestyles and smoke free homes, improving immunisation uptakes in pregnancy, reducing unnecessary intervention and increasing breast feeding rates. Pregnancy is the beginning of the journey to parenthood and it is essential to identify the early need and support required. To facilitate a smooth transition between health professionals, the standardisation of both records and procedures for handover from Midwife to Health Visitor needs to be in place.

During the second trimester of pregnancy, Midwives will be expected to inform Health Visitors of any pregnant woman who is a first time mother or who may require additional support. This will enable Health Visitors to assess family resilience and participate in the care planning process. National Institute of Clinical Excellence (NICE) guidance on Pregnancy and Complex Social Factors (2010) refers to four main groups of women who may require additional multi-professional support:

• Women who misuse substances (alcohol and /or drugs) • Women who are recent migrants, asylum seekers or refugees, or who have

difficulty reading or speaking English • Young women aged under 20 • Women who experience Domestic Abuse

Midwife referral to Health Visitors during pregnancy

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Although the four factors highlighted by the guidance are not exhaustive they should be used to develop a process of formal communication between Midwife and Health Visitor. Other factors for referral may include:

• Parents with learning difficulties • Parents with pre - existing or current safeguarding concerns • Parent at higher risk of having emotional/mental health needs • An unborn baby who is known to have a medical condition

Postnatally, Midwives care for new mothers and their babiesforaminimumof10days,oraslongastheMidwifeconsidersnecessaryupto28days.AsHealthVisitorsmakeroutinevisitstonewfamiliesfrom10–14daysitisimportantthatthereisclearcommunicationbetweenMidwifeandHealthVisitor,particularlyifthefamilyhavebeenidentified,priortoorfollowingthebirthoftheirbaby,ashavingadditionalneeds. A standardised process for handover of families is key to providing family centred high quality services.

Midwife referral to Health Visitors in the postnatal period

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Health Visitor Antenatal Review

An assessment of family resilience for targeted mothers and their partners will commence from 28 weeks gestation using the FRAIT. Parental expectations and preparation for parenthood will be discussed and assessed to identify risk. For some families where English is not their first language the use of interpreter services will be considered. The assessment and evaluation of available information will determine the level of intervention necessary to support the family; this will be discussed with and agreed with the family.

The criteria will include the following:

• First time mothers • Parents expecting multiple pregnancies • Parents with learning difficulties • Parents with pre existing or current safeguarding concerns, including domestic

abuse • Parents at higher risk of having emotional/mental health needs • Unborn baby is known to have a medical condition

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Targeted Antenatal Review from 28 Weeks gestation

Key Interventions

Introduction from Maternity Services

Universal The Health Visitor will receive information on all pregnancies. Any parent requiring support can access the Health Visitor through their GP or Midwife.

Enhanced Any mother meeting the criteria for an ante natal review will be offered a face to face contact at home.

Intensive For families with additional and complex needs the AWCPP, SS&WBA, will be followed in order to agree a multi-agency plan of care ensuring adequate support for the family and unborn child.

Assessment of Family Needs

Universal

Targeted contact.

Enhanced The FRAIT will commence and a plan of contact and support will be agreed. Routine enquiry into domestic abuse will be completed. The Health Visitor will assess maternal mental health using NICE (2015) Mood questions.

Intensive

Work in partnership with maternity services, GP and partner agencies to address the identified needs in the care plan.

Planning for Parenthood

Universal

Targeted contact.

Enhanced The Health Visitor will promote a secure parental relationship with the unborn baby. Information on infant brain development, child development, feeding and safety will be promoted

Intensive

A multi- agency approach will be adopted to support families with an unborn infant with health or developmental problems.

Key Public Health Messages

Universal

Targeted contact.

Enhanced Public health issues that impact on maternal and family health will be identified and addressed.

Intensive

The Health Visitor will encourage attendance with specialist provision as indicated and where the child is at risk of experiencing significant harm a referral to the Local Authority Social Services will be undertaken.

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Family Health Review One to Six Weeks

A routine birth visit will be offered by the Health Visitor to all parents/carers between 10 to 14 days following the birth of their baby. Further home visits will be offered before the baby is 6 weeks old. Completing FRAIT will enable the Health Visitor to make a robust assessment and evaluation of parenting capacity to support identification of individual need. Through these contacts the Health Visitor will take the opportunity to influence family health and health behaviours that will impact upon long term health outcomes. This will include delivering on Tier 1 targets, for example; smoking cessation, increasing immunisation rates and supporting children and families to achieve a healthy weight. The Health Visitor will seek opportunities to promote secure attachment and bonding between the parent/carer and their baby, this is vital to ensure the baby`s optimal brain development. The knowledge gained will help parents understand the baby’s behaviour and enable them to build on their skills and knowledge. It is hoped that this will ensure that parents will be caring, confident and competent in their parenting.

The Health Visitor will emphasise the importance of parental emotional and physical wellbeing for family health. Support and advice will be offered to parents/carers about key health promotion messages, which will improve the family’s well being and also support parents/carers to become resilient to the challenges of parenting. The Health Visitor will discuss expected developmental milestones and the ongoing management of baby‘s well being, for example, the management of minor illnesses and the prevention of accidents, including Choose Well (NHS 2011).

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Family Health Review: One to Six Weeks

Key Interventions


Universal The FRAIT will be commenced/continued at the 10-14 day home visit, the Health Visitor will offer a further home visit within 6 weeks postnatally to complete the FRAIT. The routine enquiry screening for domestic abuse will also be completed within this time period.

Enhanced Assessment will identify those families needing extra support and a care plan will be developed and agreed in partnership with parents.

Intensive The Health Visitor will work with families and other services in a multiagency care plan of support.

Promotion of Secure Parent & Infant Relationship and Attachment

Universal

Parents will be offered support to develop secure parent and infant relationship and attachment. A discussion and demonstration of baby`s age appropriate behavioural development will be undertaken using Health Observation and Assessment of the Infant (HOAI). Information about crying, colic, and sleep patterns will be offered to encourage parental attunement with the new baby. Details of available Parenting Programmes for new parents either in groups or one to one will be provided.

Enhanced Baby massage, music, early talking and development can be offered in groups or at home.

Intensive

The Health Visitor will encourage Mothers/Fathers/Partners/Extended family to attend available local support services.

Promotion of Breast Feeding

Universal

All breastfeeding mothers will be offered bespoke advice and information to support the continuation of breastfeeding. This may include peer support and details of local groups in line with Baby Friendly Initiative (BFI).

Enhanced The Health Visitor will offer additional support and liaise as necessary with the local breastfeeding champion when difficulties have been identified.

Intensive

The Health Visitor will refer to specialist support when difficulties persist.

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Promotion of Safe Infant Feeding

Universal

Parents who use formula feeds will be given advice and support regarding safe infant formula feeding. Information on vitamins and healthy family nutrition will be offered including the benefits of delaying weaning with the safe introduction of solids at 6 months of age. Information on Healthy Start will be given to the parents who are eligible.

Enhanced

Review and monitor feeding difficulties following care plan.

Intensive

Bespoke parental support and advice regarding safe infant feeding and family nutrition will be given and/or referral to local appropriate services.

Promotion of Baby Safety

Universal Parents will be given advice about keeping the baby safe and providing a

safe environment. This will include home safety advice and information about safe handling and car seats. Safer sleeping and prevention of sudden infant death will be discussed and the infants sleeping area will be observed. The risk of parental smoking, smoke free homes and cars, substance misuse and also advice regarding the potential risks posed by animals including familiar pets will be discussed e.g. dogs.

Enhanced

Further information will be given and if necessary a referral to appropriate safety schemes e.g. fire service, safety equipment.

Intensive Referral to specific programmes e.g. Care of the Next Infant (CONI) Programme and/or multi agency support and plans of care.

Promotion of Growth and Development

Universal All parents will be offered an assessment of the baby’s growth and

development using HOAI. The baby`s weight and head circumference will be measured and interpreted for parents using the Growth Foundation Percentile Chart (WHO 2009).

Enhanced If required, there will be ongoing review and monitoring of the growth and development for those with health and/or developmental concerns, including prematurity and low birth weight. An early referral to specialist advice and support will be made as appropriate for those identified with growth and/or developmental concerns.

Intensive A bespoke package of care will be developed for those with complex needs, working within a multiagency context.

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Promotion of Maternal Emotional Health

Universal Mothers will be offered routine screening of their emotional health by the

Health Visitor at 10 - 14 days and at 4 -6 weeks postnatally using the “mood questions” (NICE 2015).

Enhanced Mothers identified as needing extra support for their emotional health, anxiety or mental illness will be offered an individualised plan of care. This may include support visits at home with the Health Visitor and/or referral to General Practitioner (GP) and local mother and baby support groups.

Intensive Mothers identified with perinatal mental health issues or mental illness should be referred to their GP and may be referred to specialist services.

Childhood Immunisations

Universal

Health Visitors will promote all recommended immunisations.

Enhanced As above. Intensive

As above.

Promotion of Speech, Language and Communication

Universal

Parents will be informed about the baby’s brain development in relation to their social skills and emotional growth and advised regarding the importance of play and stimulation. Information will be provided about the benefit of reading to the baby, local baby groups and appropriate local services and resources.

Enhanced Where lack of stimulation has been identified the Health Visitor will advise and monitor and if necessary refer to other professionals.

Intensive Some will require specialist services e.g. hearing impaired.


Universal Parents will be offered information and advice about key public health promotion messages. These will include family nutrition, how to achieve and sustain healthy weights, smoking cessation, oral health care, home safety and accident prevention. Emotional health and well being, contraception and sexual health will also be discussed.

Enhanced Parents and families identified as needing further advice and guidance will be offered referral to support services in relation to healthier lifestyle choices.

Intensive The Health Visitor will encourage engagement with specialist provision as indicated. Where the baby is at risk of significant harm a referral to Local Authority Social Services will be undertaken.

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Family Health Review at 8-16 weeks

The Health Visitor will encourage attendance and uptake of immunisations at Child Health Clinics when the baby is 8, 12 and 16 weeks. The Health Visitor will review the baby`s growth and developmental progress.

Where families are unable to access Child Health Clinics at these times or have not seen the Health Visitor, a home contact will be offered to assess and review growth and development. Key public health messages may be reinforced as appropriate at these contacts i.e. breastfeeding, dental health, healthy start vitamins, healthy nutrition and promoting baby development. The Health Visitor will discuss the baby’s developmental progress and age appropriate milestones. Advice will be offered regarding the management of baby and childhood minor ailments as stated in the previous review.

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Family Health Review: 8-16 Weeks

Key Interventions at 8 to 16 weeks


Universal If the Health Visitor is unable to see the baby in the Child Health Clinic for immunisations then a home visit will be offered.

Enhanced The Health Visitor will support families needing extra input with a care plan agreed in partnership with parents.

Intensive The Health Visitor will work alongside other agencies with a multi-agency plan of support to help build stronger and more resilient families.


Universal

If the Health Visitor is unable to see the baby in the Child Health Clinic for immunisations then a home visit will be offered.

Enhanced Families requiring extra help will be identified and supported with early referral to appropriate services with the aim of increasing parental attunement e.g. Baby massage in groups or on a one to one basis at home.

Intensive

Families identified with higher need will be referred to appropriate parenting support programmes. Family Information Services will hold a list of provision.

Promotion of Breastfeeding

Universal

Breastfeeding mothers will be offered bespoke advice and information to support the continuation of breastfeeding. This may include peer support and details of local groups in line with BFI guidance.

Enhanced

The Health Visitor will offer additional support and liaise as necessary with the local breastfeeding champion when difficulties have been identified.

Intensive

The Health Visitor will refer to specialist support when difficulties persist.

20

Promotion of Safe Infant Feeding

Universal

Parents who use formula feeds will be given advice and support regarding safe infant formula feeding which also promotes a close relationship with baby. Information on vitamins and healthy family nutrition will be offered including the benefits of delaying weaning with the safe introduction of solids at 6 months of age.

Enhanced This will include invitations to weaning parties/groups/one to one activity.

Intensive

Parental support and advice regarding safe infant feeding, family nutrition and achieving and sustaining a healthy weight will be given and/or referral to local appropriate services. Family Information Services will hold a list of provision.


Universal All parents will be given advice about keeping the baby safe and providing a

safe environment. Enhanced Further information will be given and if necessary a referral to appropriate

safety schemes e.g. fire service, safety equipment. Intensive Referral to specific programmes e.g. CONI Programme and/or multi agency

support and plans of care.


Universal

If the Health Visitor is unable to see the baby in the Child Health Clinic for immunisations then a home visit will be offered. Baby will be weighed at these contacts.

Enhanced Those identified as having health and/or developmental concerns will have closer monitoring. Some will need referrals to specialist advice and support services.

Intensive

A baby and family identified with complex needs will require a multiagency package of care.


Universal

All mothers will be observed for signs of emotional health issues throughout this period.

Enhanced

Mothers identified as needing extra support for their emotional health issues, will be offered further screening (NICE 2015) to inform an individualised plan of care This may then include support visits at home with the Health Visitor and/or referral to GP and local mother and baby support groups.

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Intensive

Mothers identified with perinatal mental health issues or mental illness should be referred to their General Practitioner (GP) and may be referred to specialist services.


Universal

Health Visitors will continue to promote all recommended immunisations.

Enhanced The Health Visitor will promote and reinforce those immunisations that may have been missed or are overdue for some children.

Intensive

The Health Visitor will advice on an alternative venue for immunisations for children who have repeatedly failed to attend.


Universal If the Health Visitor is unable to see the baby in the Child Health Clinic then

a home visit will be offered. Information will be provided about the benefit of reading to the baby.

Enhanced Where lack of stimulation has been identified the Health Visitor will advise and monitor and if necessary refer to other agencies.

Intensive Some will require specialist services e.g. hearing impaired or others with additional health needs.


Universal

All parents may be offered information and advice about key public health promotion messages where appropriate. These will include family nutrition, how to achieve and sustain healthy weights, smoking cessation, oral health care, home safety and accident prevention. Emotional health and well being, contraception and sexual health will also be discussed.

Enhanced Parents and families identified as needing further support may be offered referral to support services regarding making healthier lifestyle choices.

Intensive

The Health Visitor will encourage engagement with specialist provision as indicated. Where the baby is at risk of significant harm a referral to the Local Authority Social Services will be undertaken.

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Family Health Review at 6 months

A home visit will be offered by the Health Visitor to all parents/carers at 6 months. Completing FRAIT will enable the Health Visitor to make a robust assessment and evaluation of parenting capacity to support identification of individual need. The Health Visitor will use this contact as an opportunity to promote secure attachment between a parent/carer and their growing baby which is vital for the baby’s optimal brain development and the baby`s social and emotional wellbeing. This will assist parents to build on their own skills and knowledge of their baby’s ever expanding capabilities to encourage caring, confident and competent parenting. The Health Visitor will emphasise the importance of parental emotional and physical wellbeing and include an assessment of maternal emotional health and well being using the NICE questions. The Health Visitor will support and advise parents/carers about key public health messages which improve family well being and also support parents/carers to become resilient to the challenges of parenting. Public health priorities will be met by the provision of support and advice on various key areas including baby and home safety, breastfeeding, weaning, healthy food choices, reading and play, pet safety, dental care and dental registration, immunisation programmes, smoking cessation and promoting smoke free environments.

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Family Health Review: 6 Months

Key Interventions at 6 Months


Universal The FRAIT will be completed.

Enhanced The Health Visitor will support families needing extra input with a care plan

agreed in partnership with parents.

Intensive The Health visitor will work with other agencies in a multi-agency plan of support to help build stronger and more resilient families.


Universal Parents will be offered support and information about the baby’s

development to raise awareness of key developmental stages and promote activities that both parents and babies can enjoy together e.g. swimming, music, groups.

Enhanced Families requiring extra help will be identified and supported with early referral to appropriate services with the aim of increasing parental attunement e.g. baby massage in groups or on a one to one basis.

Intensive Families identified with higher need will be referred to appropriate parenting support programmes. Family Information Services will hold a list of provision.

Promotion of Breastfeeding

Universal Breastfeeding mothers will be offered bespoke advice and information to

support the continuation of breastfeeding. This may include peer support and details of local groups in line with BFI guidance. Babieswho arebreast fed should be given vitamin D supplement from 6 months of age.

Enhanced The Health Visitor will offer additional support and liaise as necessary with the local breastfeeding champion when difficulties have been identified.

Intensive The Health Visitor will refer to specialist support when difficulties persist.

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Promotion of Infant Feeding and Nutrition

Universal Parents who formula feed their baby will be given appropriate tailored

information. Parents will be given further information about progressing with the introduction of solid foods and information on further stages of weaning. Babies should be given vitamin D from 6 months, if having less than 500ml of formula a day. Information on Healthy Start will be given to the parents who are eligible.

Enhanced This will include invitations to weaning parties/groups and one to one activity.

Intensive Parental support and advice regarding safe infant feeding, family nutrition and achieving and sustaining a healthy weight will be given and/or referral to appropriate services.


Universal Parents will be given advice about keeping the baby safe and providing a

safe environment. This will include home safety advice and information about, safe handling, car seats, safer sleeping and sudden infant death. The risk of parental smoking, smoke free homes and cars, substance misuse and advice regarding the potential risks posed by animals including familiar pets e.g. dogs.

Enhanced Further information will be given and if necessary a referral to appropriate safety schemes e.g. fire service, safety equipment.

Intensive Referral to specific programmes and/or multi agency support and plans of care.


Universal Although no formal assessment of development is scheduled at this contact,

growth and development will be reviewed with parents. Parents will be advised on healthy choices including diet, play and activities which promote healthy development.

Enhanced Those identified as having health and/or developmental concerns will have closer monitoring. Some will need referrals to specialist advice and support services.

Intensive A baby and family with complex needs will require a multi-agency package of care. Family Information Services will hold a list of provision.

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Universal

Mothers will be offered routine screening of their emotional health by the Health Visitor using the “mood questions” (NICE 2015).

Enhanced Mothers identified as needing extra support for their emotional health, anxiety or mental illness will be offered an individualised plan of care which may include support visits at home with the Health Visitor and/or referral to GP and local mother and baby support groups.

Intensive

Mothers identified with perinatal mental health issues or mental illness should be referred to their GP and/or other specialist services.


Universal



Intensive

The Health Visitor will advise on an alternative venue for immunisations are offered for babies who have repeatedly not been presented.


Universal

Parents will be informed about the baby`s brain development in relation to their social skills and emotional growth and advised regarding the importance of play and stimulation. Information will be provided about the benefit of reading to the baby, local baby groups and appropriate local services and resources. Provide “Bookstart” resources.

Enhanced

The Health Visitor will advise and monitor and if necessary refer to other professionals.

Intensive

Some will require specialist services e.g. hearing impaired or others with additional health needs. Family Information Services will hold a list of provision.

Promotion of Dental Health

Universal

Parents to be offered advice, support and information in relation to good oral dental health care.

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Enhanced

Some parents will need extra support and advice with the promotion and implementation of good oral dental health care for their baby. The Health Visitor can offer referral to dentist and further dental services, and can access free toothbrushes, toothpaste and cups for some families who need it.

Intensive

Families with concerns in relation dental health, will be offered referrals and ongoing advice from specialist dental services


Universal

Parents will be offered information and advice about key public health promotion messages. These will include family nutrition, how to achieve and sustain healthy weights, smoking cessation, oral health care, home safety and accident prevention. Emotional health and well being, contraception and sexual health will also be discussed.

Enhanced

Parents and families identified as needing further advice and guidance will be offered referral to support services in relation to healthier lifestyle choices.

Intensive

The Health Visitor will encourage engagement with specialist provision as indicated. Where the baby is at risk of significant harm a referral to Local Authority Social Services will be undertaken.

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A home visit will be offered by the Health Visitor to all parents/carers when their child is 15 months of age. Completing FRAIT will enable the Health Visitor to make a robust assessment and evaluation of parenting capacity to support identification of individual need.

This is another opportunity for the Health Visitor to support the family and assess the child’s health and development and to discuss any concerns or support needed in order to assist families to help their child reach their full potential.

Children not walking should be observed and followed up at 18 months of age.

This contact will have specific focus on the development of speech and language skills.

Public health priorities will be met by the provision of support and advice on various key areas including: promotion of safety in the home and the community, dietary advice, stimulation of development through play and reading, dental health, smoking cessation and the childhood immunisation programme

Family Health Review: 15 months

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Universal The FRAIT will be completed.



Intensive The Health visitor will work with other agencies in a multi-agency plan of support to help build stronger and more resilient families.

Promotion of Child and Family Nutrition

Universal The Health Visitor will offer advice and information on nutrition, healthy

eating, portion sizes, meal time routines and physical activity. The Health Visitor will recommend the use of Healthy Start vitamins in line with current guidelines.

Enhanced The Health Visitor will discuss any identified feeding problems and provide advice and support on management.

Intensive Referral will be made as necessary to appropriate specialist services e.g. dietician. Family Information Services will hold a list of provision.

Promotion of Child Safety

Universal Parents will be given advice about keeping their child safe in relation to their

age and stage of development. All parents will be given advice about correct use of basic safety equipment. The risk of parental smoking, smoke free homes and cars, substance misuse and advice regarding the potential risks posed by animals including familiar pets e.g. dogs.

Enhanced Some parents will require extra support to help them keep their child safe and implement safety precautions in and outside of the home.

Intensive For those families with concerns identified relating to maintaining their child’s safety, one to one support and referral to further services may be necessary. Family Information Services will hold a list of provision.

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Universal The Health Visitor will review with the parents their child’s development

using the 15 month Development Review. Every child will be offered measurement of their length and weight and parents will be provided with a clear explanation of the assessment.

Enhanced Where a delay or concern in the child`s development is identified, the Schedule of Growing Skills (SOGS) assessment will be undertaken and the child reviewed at 18 months of age.

Intensive Children and families with complex needs will require a multi agency care plan of intensive support and ongoing review.

Promotion of Childhood Immunisations

Universal



Intensive

The Health Visitor will advise on an alternative venue for immunisations are offered for children who have repeatedly not been presented


Universal

Health Visitors will undertake an assessment of speech using the 15 month Development Review and provide advice. Parents will receive information about promoting their child’s language development through early talking, book sharing and invitations to groups i.e. music and interactive activities.

Enhanced

If there are concerns relating to any child’s social or language development an early referral to a specialist team will be considered. A child with identified language delay can be offered support through language and development schemes. Family Information Services will hold a list of provision.

Intensive

Children and families with complex needs should be offered early intensive support e.g. Speech and Language Therapy, Play Therapists.


Universal

Parents to be offered advice, support and information regarding good oral / dental health care.

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Enhanced

Some parents need extra support and advice with the promotion and implementation of good oral dental health care for their child. The Health Visitor can offer support and referrals to dentist and further dental services

Intensive

For those families with concerns regarding dental health referrals and ongoing advice from specialist dental services is available

Promotion of Positive Child Behaviour

Universal Parents will be offered advice regarding establishing routines including

management of sleep.

Enhanced Some parents may require additional support where individual packages of care may be delivered. Family Information Services will hold a list of provision that can offer parenting support.

Intensive Children with additional or complex needs around behaviour may require a more intensive or specialist provision.


Universal


Enhanced


Intensive

The Health Visitor will encourage engagement with specialist provision as indicated. Where the child is at risk of significant harm a referral to the Local Authority Social Services will be undertaken.

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Health Visitor Child and Family Health Review – 27 months

A home visit will be offered by the Health Visitor to all parents/carers at 27 months. Completing FRAIT will enable the Health Visitor to make a robust assessment of and evaluation of parenting capacity to support identification of individual need. The purpose of this contact is for the Health Visitor to assess growth and developmental progress of the child and provides an opportunity to review family resilience.

Public health priorities will be met by the provision of support and advice on various key areas including: dietary advice, smoking cessation, dental health, play, vision, childhood immunisation programme, preparation of school readiness and promotion of safety in the home and the community

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Universal FRAIT will be completed.



Intensive For families with greatest need the Health Visitor may refer to local intensive programmes and work with a multi-agency plan of care to support families and help prevent crisis.




Enhanced The Health Visitor will discuss any identified feeding problems and provide advice and support on management.



Universal All parents will be given advice about keeping their child safe in relation to

their age and stage of development. All parents will be given advice about correct use of basic safety equipment.

Enhanced Some parents will require extra support to help them keep their child safe and implement safety precautions in and outside of the home.

Intensive Referral to specific programme and/or multi- agency support and plans of care.

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Universal The Health Visitor will review with the parents their child’s development

using the 27 month Developmental Review. They will be offered measurement of their height and weight if there are any concerns and parents will be provided with a clear explanation of the assessment.

Enhanced For those children where there is concern regarding their development the SOGS will be used. For these children an individualised care plan may be required.

Intensive Children with additional and or complex needs will be referred to appropriate services for a multi- agency plan of care.


Universal



Intensive

The Health Visitor will advise on an alternative venue for immunisations are offered for children who have repeatedly not been presented


Universal

Health Visitors will undertake an assessment of speech using the 27 month Developmental Review and provide advice and support regarding promotion of speech development. Provide “Bookstart” resources.

Enhanced

If there are concerns an early referral will be considered. Health Visitors will ensure that parents are offered advice regarding local provision and support to encourage speech and language development.

Intensive

Children with additional and complex communication difficulties can be offered a programme of intensive support.


Universal

Health Visitors will offer advice, support and information around good oral dental health care and review dental registration.

Enhanced

For children and families requiring additional support the appropriate referrals will be made.

Intensive

For children with additional and complex needs more specialist dental services may be required.

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Universal

Parents will be offered advice regarding establishing routines including management of sleep and toilet training.

Enhanced

Some parents may require additional support where individual packages of care may be delivered. Family Information Services will hold a list of provision that can offer parenting support.

Intensive

Children with additional or complex needs around behaviour may require a more intensive or specialist provision.

Toilet Training Universal The Health Visitor will discuss toilet training and provide relevant advice.

Enhanced As above Intensive As above


Universal


Enhanced


Intensive


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Health Visiting Child and Family Health Review at

3 ½ Years Old.

A home visit will be offered by the Health Visitor to all parents/carers when their child is 3 ½ years old. Completing FRAIT will inform a robust assessment and evaluation of parenting capacity to support identification of individual need. Those children who will require a full handover to the School Health Nurse will be identified. Public health priorities will be met by the provision of support and advice on various key areas including: dietary advice, smoking cessation, dental health, play, vision, childhood immunisation programme, preparation of school readiness and promotion of safety in the home and the community.

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Family Health Review: 3 ½ Years Old.

Key Interventions at 3 ½ years old


Universal FRAIT will be completed. Enhanced The Health Visitor will provide additional support and advice as relevant to

need.

Intensive The Health Visitor will refer to specialist services as appropriate to need.




Enhanced The Health Visitor will discuss any identified problems and provide advice and support on management.



Universal The Health Visitor will identify any potential concerns and support the family

to make appropriate changes to the environment.

Enhanced Some parents will require extra support from Health Visitors to help them keep their child safe and implement safety precautions in and outside of the home.

Intensive Referral to specific programme and/or multi agency support and plans of care.


Universal Although no formal assessment of development is scheduled at this contact,

growth and development will be reviewed with parents.

Enhanced Children identified with concerns about their growth and development and where there is parental or professional concern the Health Visitor will provide advice and support.

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Intensive Those children identified with growth or development needs may be offered a multi-disciplinary plan of care.


Universal

The Health Visitor will review immunisation status ensuring all recommended immunisations are complete prior to school entry.


Intensive

The Health Visitor will advise on an alternative venue for immunisations for children who have repeatedly not been presented


Universal

The Health Visitor will provide advice and support regarding age appropriate speech and language development.

Enhanced

Those children identified with concerns will be offered individualised support.

Intensive

Those children with complex and or additional needs will be offered intensive support within a multi disciplinary plan of care.


Universal

The Health Visitor will provide advice and information with regard to dental care.

Enhanced

Those children identified with dental concerns will be encouraged to attend local dental services.

Intensive

Those children with identified additional and complex concerns will be referred to specialist services.


Universal

The Health Visitor will discuss with families any concerns regarding children’s behaviour and encourage preschool/nursery attendance. This will promote school readiness.

Enhanced

Children with identified behaviour difficulties will be offered individualised intervention. Family Information Services will hold a list of family support provision.

Intensive

Children with additional and or complex needs will be offered multi agency provision.

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Toilet Training

Universal

The Health Visitor will discuss progress with toilet training and provide the relevant advice to promote the child being dry by day.

Enhanced

The Health Visitor will encourage GP attendance to exclude medical or anatomical cause.

Intensive

Those children with complex needs will be offered intensive support within a multi agency care plan.


Universal

Parents will be offered information and advice about key public health promotion messages. These will include family nutrition, how to achieve and sustain healthy weights, smoking cessation, oral health care, home safety and accident prevention. Emotional health and well being, contraception and sexual health will also be discussed. Additionally, introduction to the School Health Nursing Service.

Enhanced


Intensive


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School Health Nurse Review - Reception Class Age 4-5 years

The purpose of the school entry review is to assess the child’s health needs, promote health and wellbeing and to support and enable children to achieve their full potential. A formal handover from the Health Visitor to the School Nurse will not be necessary for every child. For those where it is appropriate, locally agreed processes should be in place and all relevant documentation, hard copy & electronic, should be transferred to the School Nursing Service. Each school has a named School Nurse who is usually based outside of school premises and can be contacted for advice and support. The School Nurse will support children and young people in school through the promotion of positive health education and health promoting information as well as targeted involvement as necessary. During the year that a child enters full time education the School Nurse will provide all reception class pupil’s parents/carers with the information listed below. Local protocols should be in place to ensure similar appropriate information and signposting is provided to parents of children who are electively home educated. • Information introducing the School Nursing Service • Contact details for their child’s named School Nurse • A questionnaire to be completed by the parent/carer regarding the child’s

current health, including their immunisation status. • Information on the hearing impairment screening programme • Information on the national vision screening programme • Information on the Child Measurement Programme

.

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Healthy Child Wales Programme: School Health Nurse Review: Reception Class age 4-5 years

Key Interventions at Reception Class age 4-5 years

School Nurse Assessment of Need

Universal The School Nurse will review the completed questionnaire, any

documentation transferred by the Health Visitor and all relevant information hard copy & electronic relating to the child. Advice and support will be offered if concerns are reported or identified, including immunisation status.

Enhanced A health assessment will be undertaken by the School Nurse as appropriate. Children identified with a development delay or health concern will be offered further support and referrals to specialist services as appropriate and necessary.

Intensive The School Nurse will work alongside other agencies in line with the All Wales Child Protection Procedures when ongoing care is handed over from the Health Visitor or new concerns are identified.

Screening programmes

Universal Information will be provided to parents on the growth screening

programme. Information will be provided to parents on the national vision screening programme. The information will include detail of how to exercise the option to opt out of the programmes. Results will be advised to parents via local protocols.

Enhanced Parents will be notified and advice and support will be offered for children identified as falling outside the agreed parameters.

Intensive Children identified with abnormal growth or vision will be referred in line with the relevant pathway

Surveillance programme

Universal Utilising the National Standards parents will be provided with information on

the Child Measurement Programme. The information will include detail of how to exercise the option to opt out of the programme.

Enhanced N/A as this is a surveillance programme.

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Intensive N/A as this is a surveillance programme.

Immunisations

Universal The School Nurse will review immunisation status to ensure the routine

childhood immunisation programme has been completed. The Nasal Flu immunisation will be offered in line with the national programme.

Enhanced The School Nurse will promote and reinforce any immunisations that have been missed or are overdue.

Intensive The School Nurse will ensure alternative venue immunisations are advised/offered to children who are not fully immunised, including children who do not attend school.

Key Public Health Promotion Messages

Universal The School Nurse will support each child’s school by delivering

positive health promotion messages and locally agreed class room sessions.

Enhanced The School Nurse will offer further support for children where there are identified concerns.

Intensive The School Nurse will ensure that all Wales Child Protection procedures and local policies are adhered to and will encourage attendance at specialist provision as indicated.

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Annex 1 Programmes in the Community that Tackle Health Inequalities The Families First, Flying Start and Communities First are key programmes in the Welsh Government’s response to tackling child poverty and improving health and education outcomes of children living in low income households. All three programmes recognise the importance of tackling health inequalities and provide support for children, families and communities in order to do so. Flying Start Flying Start is the Welsh Government’s targeted Early Years programme for families with children under four years of age. It is a key programme in delivering the Welsh Government’s commitment to reduce inequalities that exist in health, education and economic outcomes for children and families living in low income households. Flying Start offers additional support to families which will give their children the best possible start in life and bring about improved outcomes in language, cognitive, social and emotional development and physical health. It offers families access to intensive health support; quality part-time childcare for two to three year olds; parenting support; and support for the development of speech ,language and communication. These four core entitlements work holistically to identify and meet the needs of the child and their family. Flying Start is targeted at defined geographical areas within each Local Authority where there are the highest concentrations of households in receipt of income benefit. Flying Start is offered universally within these areas. Improving the health outcomes for children and their families is a key aim of Flying Start. Flying Start health support services are delivered by a dedicated health workforce. At the heart of Flying Start health support services are Health Visitors who are allocated a significantly reduced caseload of 1:110 .This enables them to provide additional support and to be able to have more regular and intensive contact with families. The Flying Start health workforce also comprises a range of other professionals that may include midwives, speech and language therapists, child psychologists, educational psychologists, psychotherapists, nursery nurses and dieticians. The caseload of children who live in the designated Flying Start areas has been transferred from generic health visiting services to Flying Start. All members of the Flying Start health skill mix team should work in collaboration with generic health services to ensure the best possible support is made available to children and their families. Flying Start health support services are offered to all families living in a Flying Start area. All Flying Start children and families are entitled to additional contacts and support to that which would otherwise be offered by generic services. The support and interventions offered to children and families are related to their assessed level of need/risk.

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The Flying Start Programme has developed a specific focus on health improvement. The Flying Start Health Support Services guidance document outlines the schedule of contacts, support and interventions that should be offered to children and families within the Programme. This guidance builds upon the core programme of contacts; support and intervention set down in the HCW Programme and should be viewed as being an extension to it. Support provided through Flying Start, like the HCW programme, is based on the premise of providing tailored support depending on the level of risk which should be assessed using a Family Resilience Assessment Tool. The Flying Start Health Visitor has an important role to play in coordinating the support offered by not only the other health professionals within the Flying Start health skill mix team and but also those of the wider Flying Start team. They have a responsibility to promote the childcare, support for parenting and speech, language and communication development entitlements to families and encourage them to take up their full entitlement. Families First Programme The aim of Families First is to improve outcomes for children, young people and families. The emphasis is on prevention and early intervention and on the need for agencies to work together to offer a coherent package of support and interventions. The programme aims to stop families from developing more complex needs, requiring more intensive and costly interventions. Health services have an important role in helping to identify families who could benefit from the support of Families First through making referrals into the programme and playing a key role in the design and delivery of Team around the Family models. Families First comprise five main elements:

1. A Joint Assessment Framework for Families (JAFF) to provide a comprehensive evaluation of families’ needs. The JAFF assesses the families’ strengths and needs in a number of areas and is used to design a tailored plan of interventions to help families overcome the problems they face.

2. A Team around the Family approach to working with families (TAF). The TAF model brings together a wide range of professionals to work together with a family in order to help them address the breadth of challenges they are facing. This approach is intended to ensure there is a holistic and seamless package of support provided to the family and local health services will often be a key partner in a TAF.

3. A strategic approach to commissioning family support services. A key principle of

the programme is that local services should be commissioned and designed based on an assessment of local needs. This may include programmes and projects which seek to address health issues and inequalities and some projects are delivered in partnership with Local Health Boards.

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4. A ring-fenced sum to be spent on innovative ways of improving services for families affected by disability Local Health Boards may be involved in the development and delivery of these services.

5. An action learning element to ensure that local level learning is shared at local,

regional and national levels. Partners from the health sector can play a role in helping to identify key learning actions which can be taken forward to improve service delivery for families.

Communities First Programme The Welsh Government’s Communities First programme aims to narrow the economic, education/skills and health gaps between our most deprived and more affluent areas. It operates in 52 areas across Wales known as Communities First Clusters and has three strategic objectives:

• Prosperous Communities • Learning Communities • Healthier Communities

Each Cluster produces a delivery plan detailing how it will work towards its three strategic objectives, offering a range of activities to residents which might include things like the support to make healthy lifestyle choices, help to enable a person to become work-ready and move into employment, information which will enable a person to maximise their income manage on a limited budget or help to gain the skills and qualifications they need to get a job. The range of activities offered within each Cluster will vary, but, if you are looking for sources of support for someone living in a Communities First Cluster area, the Cluster team may well be able to help. The following link to the Welsh Government’s website will enable you to find out whether a person lives within a Communities First Cluster area and provides a list of contacts. http://gov.wales/topics/people-and-communities/communities/communitiesfirst/clusters/?lang=en There are many interventions offered locally through different providers and funding streams. For details of your local services talk to your local Family Information Service (FIS), using the Welsh Government website link for their details: http://tinyurl.com/fiswales1 You can also ring the national FIS helpline on: 0300 123 77 77.

http://gov.wales/topics/people-and-communities/communities/communitiesfirst/clusters/?lang=en


http://tinyurl.com/fiswales1

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References Acheson, D. (1998) Independent Inquiry into Inequalities in Health Report

All Wales Child Protection Procedures Group on behalf of the Local Safeguarding Children Boards (2008) All Wales Child Protection Procedures

Bedford, H et al. (2013) Measures of Child Development: A review Centre for Paediatric Epidemiology and Biostatistics UCL Institute of Child Health Children’s Commissioner of Wales (2014) Annual Report Department of Education (1998, 2004) Children Act The Stationary Office London

Department of Health (DoH) (2001) United Nations International Children Emergency Fund. Baby Friendly Initiative Breast Feeding

Department of Health (DoH) (2013) Weaning Guidelines The Stationary Office London

Department of Health (DoH) (2012) Baby Friendly Initiative Guidelines Infant Feeding Guidelines The Stationary Office London

Department of Health (DoH) (2015) The Complete Routine Immunisation Schedule

Department of Health and Social services (DHSS) (1980) Inequalities in Health, Report of a Research Working Group (The Black Report) The Stationary Office London

Hall, D. And Elliman, D. (2006) (revised 4th.edition) Health for all Children Oxford University Press Oxford

Kendall, S et al. (2014) Evaluating the use of a population measure of child development in the Healthy Child Programme Two Year Review UCL Institute of Child Health Marmot, M. (2010) The Marmot Review Fair Society, Healthy Lives _ Strategic Review of Health Inequalities in England Post 2010: University College London Department of Epidemiology and Public Health

NFER-NELSON (2008) Schedule of Growing Skills (SOGS) Health and Social Care United Kingdom

National Health Service Wales (2011) Choose Well www.choosewellwales.org.uk

National Institute for Health and Care Excellence (NICE 2006) Public Health 1Brief Interventions and Referral for smoking cessation in primary care and other settings

National Institute of Health and Care Excellence (NICE 2010) Pregnancy and Complex Social Factors

National Institute of Health and Care Excellence (NICE Reviewed 2015) Clinical Guideline 192 Ante Natal and Post Natal Mental Health

Public Health Wales (2012) Child Measurement Report Public Health Wales

http://www.choosewellwales.org.uk

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Public Health Wales NHS Trust (2014) Bump Baby and Beyond WG Cardiff

Public Health Wales NHS Trust (2015) Stop Smoking Wales

Royal College of Paediatrics and Child Health (RCPCH) Personal Child Health Record

UNICEF (1989) United Nations Convention on the Rights of the Child www.unicef.org.uk

Wallace, C., Pontin, D., Jones, G.H., O’Kane, J. Wilson, L., Thomas, M., Dale F., and Thomas, S. (2016) Family Resilience Assessment Instrument Tool (FRAIT) University of South Wales Glynn Taff

Welsh Government (WG) (2004) National Framework for Children Young People and Maternity Services WG Cardiff

Welsh Government (WG) (2011) A Strategic Vision for Maternity Services in Wales W.G. Cardiff

Welsh Government (WG) (2011b) The Healthy Start and Welfare Food Scheme Regulation WG Cardiff

Welsh Government (WG) (2012) A Vision for Health Visiting WG Cardiff

Welsh Government (WG) (2012) Flying Start Strategic Guidance WG Cardiff

Welsh Government (WG) (2013) Building a Brighter Future Early Years and Childcare Plan WG Cardiff

Welsh Government (WG) (2014) Funding for training and resources for assessing the development of the pre-school child WG Cardiff

Welsh Government (WG) (2014a) Social Services and Well Being Act WG Cardiff

Welsh Government (WG) (2015) Flying Start Annex Health Support Services WG Cardiff

National Breastfeeding helplines-03001000212/La Leche-08451202918/NCT-03003300771

http://www.unicef.org.uk

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Links http://incredibleyears.com http://positiveparenting.com www.solihullapproachparenting.com/ http://unicef https://www.familylinks.org.uk https://www.lullabytrust.org.uk/ http://www.nice.org.uk/nicemedia/live/13274/51669/51669.pdf http://www.unicef.org.uk/babyfriendly/ http://www.unicef.org.uk/UNICEFs-Work/UN-Convention/10

www.afasiccymru.org.uk

www.bookstart.co.uk www.Change4lifeWales.co.uk

www.communicationtrust.org.uk

www.designtosmile.co.uk http://gov.wales/topics/people-and-communities/communities/communitiesfirst/clusters/?lang=en

www.ican.org.uk

www.talktoyourbaby.org.uk

http://incredibleyears.com

http://positiveparenting.com

http://www.solihullapproachparenting.com/

http://unicef

https://www.familylinks.org.uk

https://www.lullabytrust.org.uk/

http://www.nice.org.uk/nicemedia/live/13274/51669/51669.pdf

http://www.unicef.org.uk/babyfriendly/

http://www.afasiccymru.org.uk

http://www.bookstart.co.uk

http://www.Change4lifeWales.co.uk

http://www.communicationtrust.org.uk

http://www.designtosmile.co.uk



http://www.ican.org.uk

http://www.talktoyourbaby.org.uk

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Contributions to the Healthy Child Wales Programme

Aneurin Bevan University Health Board

Gail Powell – Senior Nurse -Professional Head, Health Visiting

ABM University Health Board

Jane O’Kane - Professional Head of Health Visiting

Susan Jones MBE - Lead Nurse School Health Nursing

BC University Health Board

Helen Owen- Service Manager

Mary Cottrill- Service Manager

Sue Aston- Service Manager

Cardiff and Vale University Health Board

Wendy Herbert

Sandra Dredge-Senior Nurse for Community Child Health

Cwm Taf University Health Board

Lynne Hannington- Senior Nurse Health Visiting and School Nursing

Allyson Allman – Senior Nurse Health Visiting

Hywel Dda University Health Board

Isobel Hall Directorate Nurse Child & Adolescent Health Services

Jenny Israel- Service Delivery Manager/Senior Nurse Childrens Public Health and Partnerships

Lesley Hill -Senior Nurse Quality Assurance/Public Health & Children's Partnership

Powys Teaching Health Board

Helen James- Head of Children’s Public Health Nursing and Paediatric Services

ABM University Health Board

Pamela Josty – Information and Communication Lead

Welsh Government

Dr Heather Payne - Senior Medical Officer

Alison Strode - Therapies Advisor for Wales

Debbie Tynen - Head of Family Support Policy

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Edward Rees - Head of Children's Health

Polly Ferguson - Nursing Officer

Tania Jeynes – Healthy Child Wales Programme Implementation Officer, Welsh Government

Cardiff University

Dr Nia John - Consultant Paediatrician

Dr Shantini Paranjothys – Public Health Wales

Public Heath Wales

Rhiannon Beaumont-Wood – Public Health Wales

Caerphilly CBC

Sarah Mutch - Early Years Manager Flying Start Caerphilly

Public and public representative

Rebecca Hill

rhaglen plant iach cymru healthy child wales...

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