What makes health visiting successful—or not? 2. The service journey

Cowley, Sarah; Malone, Mary; Whittaker, Karen; Donetto, Sara; Grigulis, Astrida; Maben, Jill

doi:10.12968/johv.2018.6.8.404

Cited by 10 publications

(5 citation statements)

References 28 publications

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“…Moreover, the quantitative data showed almost 75% of the HVs in both areas perceived a lack of contacts in the home was a major barrier to identifying women's PNMH problems. Interview data suggested that HVs felt home contacts facilitated the building of relationships, and that the home environment was perceived to engender feelings of security and confidence for women thereby facilitating disclosure of pre-existing/current PNMH problems, these findings are reinforced in the literature (34). Home visits were also perceived to be beneficial to HVs as they fostered a holistic approach to their assessment of women, enabling HVs to observe women and assess how they were coping and/or observe women's parenting.…”

Section: Discussionmentioning

confidence: 83%

A mixed methods study to understand perinatal mental healthcare referral decisions among midwives and health visitors in the UK

et al. 2023

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BackgroundIn the UK approximately half of women requiring perinatal mental health (PNMH) care do not receive treatment despite having routine contact with midwives (MWs) and health visitors (HVs). Limited research has been undertaken regarding MWs’/HVs’ decision-making around referring women for secondary PNMH care. In particular, the impact that the level of local secondary PNMH services may have on MWs’/HVs’ referral decisions is unexplored.AimTo understand MWs’/HVs’ decision-making in relation to referring women with identified PNMH problems, to identify barriers and facilitators to effective and timely referrals including any impact of the local secondary PNMH service provision.MethodsParticipants were recruited from four National Health Service (NHS) Trusts in England, located across two geographical areas, that provided different types of PNMH services. One area had PNMH services that met National Institute for Health and Care Excellence (NICE) guidelines; the other area had no secondary PNMH services. A sequential mixed methods design was used: In-depth semi-structured interviews with practising MWs/HVs (n = 24) to explore their approach to PNMH referral decision-making, analysed using thematic analysis; Questionnaire offered to all practising MWs/HVs in the two geographical areas to measure factors that may impact on PNMH referral decision-making allowing for statistical comparisons to be made between the professional groups/geographical areas.FindingsThree themes were identified from the interviews that impacted on MWs’/HVs’ PNMH referral decision-making: identifying need; education, skills and experience; and referral pathways.Questionnaire response rate 13.1% (n = 99). The most reported facilitators to referral decision-making were a trusted relationship between MWs/HVs and women and routine enquiry about women’s mental health; the most reported barriers were stigma associated with mental ill-health and women’s perceived fear of child removal.ConclusionFundamental to MWs’/HVs’ decision-making was their perceived relationship between themselves and women. Although PNMH service provision is important for women to ensure they receive appropriate PNMH care, service provision appeared less important to MWs’/HVs’ referral decision-making than how maternity/health visiting services were delivered. Further important factors to MWs/HVs were to the ability to provide continuity of carer with women allowing MWs/HVs to identify women who would benefit from referral for secondary PNMH care.

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Section: Discussionmentioning

confidence: 83%

A mixed methods study to understand perinatal mental healthcare referral decisions among midwives and health visitors in the UK

et al. 2023

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“…Analysis of serious case reviews found that thresholds for CSC intervention may be high because of pressures on the system and heavy workloads (Social Care Institute for Excellence, 2016b). If thresholds are not met, an HV may become the sole worker involved with high‐risk families, which can cause anxiety and concern both for the families who are not receiving adequate social care, and other families for whom the HV is responsible, who may be receiving less support as a result (Cowley et al, 2013). Possible solutions include the introduction of ‘threshold moderation meetings’, double screening of referrals, feedback on referrals, training and support for professionals making referrals and encouraging professionals to challenge decisions and escalate concerns where necessary (Social Care Institute for Excellence, 2016b).…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Clinicians', Health Visitors' and Social Workers' Professional Judgements, Decision‐Making and Multidisciplinary Collaboration When Safeguarding Children with Burn Injuries: A Qualitative Study

Cowley,

Bennett,

Quinn‐Scoggins

et al. 2024

Child Abuse Review

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Burns are a common injury to young children, sometimes related to neglect or physical abuse. Emergency department (ED) clinicians, health visitors and social workers must work collaboratively when safeguarding children with burns; however, little is known about the factors influencing their professional judgements, decision‐making and multidisciplinary collaboration. Objective was to explore factors affecting ED clinicians', health visitors' and social workers' professional judgements and decision‐making when children present to the ED with burns, and experiences of multidisciplinary collaboration, to identify areas for improvement. This was a qualitative semi‐structured interview study using purposive and snowball sampling to recruit participants. Data were analysed using ‘codebook’ thematic analysis. Four themes were identified: ‘perceived roles and responsibilities when safeguarding children with burn injuries’, ‘factors influencing judgment of risk and decision‐making’, ‘information sharing’ and ‘barriers and facilitators to successful multidisciplinary collaboration’. There is limited understanding between the groups about each other's roles. Each agency is dependent on one another to understand the full picture; however, information sharing is lacking in detail and context and hindered by organisational and resource constraints. Formal opportunities for multiagency team working such as strategy meetings can be facilitators of more successful collaborations. Professionals may benefit from multiagency training to improve understanding of one another's roles. Greater detail and context are needed when notifying health visitors of burn injuries in children or making a referral to children's services.

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“…As health visitor academics and researchers, we were aware from anecdotal evidence of differences in caseload and team organisation. This includes health visitors working within integrated teams with early years providers and with various caseload models, reflecting the team/caseload arrangements described by Cowley et al (2018). What is more, this appears to be a rapidly changing picture.…”

Section: Methodsmentioning

confidence: 99%

Organising health visiting services in the UK: Frontline perspectives

Whittaker

Appleton

Peckover

et al. 2021

Journal of Health Visiting

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The organisation of health visitor work is an important part of service design, which can have an impact on when and where services are provided and who gains access. This article reports a 2018 survey of UK health visitors conducted to provide an overview of the range of ways in which health visitor cases and workloads are organised. The 584 respondents confirmed the operation of three broad types of health visitor service delivery models; namely, the individual case, the corporate case and the combination model. Themes that emerged from practitioners' experiences of working with the different models reflected concerns about continuity and staffing, accommodating different needs and different services in different places. Overall, the data indicated a lack of consistency in health visitor service across the UK. The advantages and disadvantages of each workload model are detailed and considered with respect to markers of a quality service, including achieving relationships with clients and sufficient communication within and across teams.

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What makes health visiting successful—or not? 2. The service journey

Cited by 10 publications

References 28 publications

A mixed methods study to understand perinatal mental healthcare referral decisions among midwives and health visitors in the UK

A mixed methods study to understand perinatal mental healthcare referral decisions among midwives and health visitors in the UK

Factors Influencing Clinicians', Health Visitors' and Social Workers' Professional Judgements, Decision‐Making and Multidisciplinary Collaboration When Safeguarding Children with Burn Injuries: A Qualitative Study

Organising health visiting services in the UK: Frontline perspectives

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