The role of the health visitor in identifying and working with vulnerable families in relation to child protection: a review of the literature

Abstract

This paper presents an overview of the research surrounding the role of the health visitor in identifying and working with vulnerable families in relation to child protection. Only a limited number of empirical studies have been completed within the field of health visiting, so this review draws on most of the literature published over the last 15 years, which is mainly British in origin. No previous reviews have focused on this specific area of health visiting. Clearly with the recent increase in public and official recognition of child protection issues and the continuing debate of health visitor involvement within this area, this review takes a significant step forward in drawing together relevant research. The review focuses on research within three main areas. Firstly, the health visitor's role in working with vulnerable families in relation to child protection is explored. The clients' perceptions of this role are also explored. Secondly, the identification of vulnerable families by health visitors and non-health visitors is explored. Within this area a number of studies by non-health visitors investigating screening approaches to child abuse have been reviewed, because they play such a major role in the literature and appear to have influenced subsequent health visitor research. Thirdly, a review of health visitors' preventive work with vulnerable families is completed.

Health visitors’ assessments of parent–child relationships: A focus group study

“…There are however far fewer reports of how best to target the delivery of these interventions effectively towards those families who could gain most from them, and most of these have been based on simple demographics -for example Olds' seminal work on intensive home visitation was aimed at a target group of mothers who were in their teens, unmarried or living in deprived areas (Olds et al 1998b). Guidelines, such as those developed for children who may require statutory child protection measures, appear to offer a slightly more sophisticated approach -but they may have limited value in practice (Appleton et al 2004;Appleton 1994b). It is, moreover, unlikely that simple guidelines could ever form the sole basis of complex judgements about families who may benefit from more subtle types of intervention.…”

“…It is therefore surprising that there appears to be so little peer-reviewed literature on how HVs identify those families to which they potentially have most to offer.. While there are a number of reports on the role of health visitors in identifying children in need of statutory protection (Appleton 1994a;Appleton 1994b;Duncan 1992;Ling et al 2000) we have been unable to find any literature on how HVs identify, more subtle problems in the relationship between parents and children. This paper reports on how HVs in one large Scottish city identify difficulties in the early parent-child relationship…”

School nurses’ operational modes and ways of collaborating in caring for child abusing families in Finland

“…Luker & Chalmers (1990), Chalmers (1993) and Appleton (1994, 1996) have found that the tasks of gaining the confidence of families, of recognizing the clients’ real needs and of taking care of so‐called problem or high‐risk families are challenges in nursing. Nevertheless, the school nurse’s role in identifying child abusing families and in caring for them, instead of concentrating only on the child, is of central importance ( Appleton, 1994, 1996; Bekemeier, 1995). O’Toole et al .…”

Deconstructing the role of the public health nurse in child protection

“…It would appear that the increased visiting by the PHN in both of the above cases was of a ‘monitoring’ nature and explicit objectives in relation to the purpose of visiting outside of the prescribed times were not set out. Appleton (1994b) suggests that the reluctant monitoring role being played by the health visitor has come about as a result of the gap in the service. Given the extent of the remit of PHNs, the generalist nature of their work and their education and expertise in relation to tertiary child protection, the question must be asked as to what exactly the PHN can achieve in terms of meaningful intervention .…”