HCHS Children’s Universal Services delivering health care through Children’s Centres & Extended Schools

• National Policy Context• HCHS strategic direction• CHPP – Healthy Child Programme

• Current delivery – practice examples demonstrating increased access to universal services, service integration across CC & ESC, increasing capacity & supporting vulnerable children.

• Areas for improvement

National Policy Context

• Section 4 Childcare Act 2006 • Delivering health services through Sure Start Children’s

Centres (DH) 2007• The delivery of key components of the National Service

Framework for Children Young People and Maternity Services such as CHPP (Healthy Child Programme)

• Healthy Lives Brighter Futures• CYPP 2009/11 HCTP• Transforming Community Services

HCHS strategic direction for Children’s Universal Services

• ALTO to PCT• Provider service• Community Foundation Trust• Service realignment to CC & ESC• Service Specifications for HV & SN• Awaiting the Healthy Child commissioning intentions• Increasing partnership working• Integrated Practice (DCTP, MAST, CAF TAC)• Public health targets• SLT – clearly linked to CC

CHPP (Healthy Child Programme)• An effective & high quality preventive programme 0-5 (school aged

programme awaited)• CHPP team led by health visitors, delivered by a range of

practitioners across health & the wider children’s workforce • Progressive universalism (universal – additional services for those

with specific needs & risks)• Screening, early detection & action • Immunisations• Developmental reviews • Parent – child attachment• Positive parenting• Healthy eating• Breastfeeding• Engagement with fathers• Maternal mental health• Readiness for school

Service delivery overview Health Visiting (CC)• Where space provided & dependent on current service configuration

– well baby & drop in clinics for parents.• Facilitate access to CC• Developmental assessments• Breastfeeding expertise & support networks• Antenatal work project focussing on depression• Post natal depression (joint funded & increases capacity)• Parenting support (wonderful ones & twos led by CNN)• Infant massage (targeted)• Post natal groups• Young parents• Weaning & healthy eating• HV access at targeted stay & play • Recruitment

Vignette

• Vulnerable parents – identified learning difficulties, physical disabilities and mental health issues.

• First baby

• Limited family support.

• Extensive support & interventions required to ensure parenting standards are available to meet the changing needs of the baby. CSF & health involved in antenatal period & assessment work carried out regarding capacity to parent.

• Concerns – safe & effective parenting, hygiene, feeding, interactions & responses to baby’s needs, accident prevention.

• Family Together package provided for CSF – input into family large % of the day, increased following failure to thrive and feeding problems.

• Families Together completed their work & replaced by a professional assistant for ongoing support, health input ongoing & Homestart.

• Accessing CC groups rather than outreach worker as keen to normalise routines. Socialising baby & parents, accessing Jo Jingles, building on parenting skills.

Service delivery overview School Nursing (ESC)

• CAF Coordinators/ESCO’s/support workers & SN working in partnership to deliver CAF process, interventions and support, accessing funding and arranging activities for children to support emotional and mental health.

• SN – steering groups to input into service development.

• Crucial Crew – multi agency.

• Fruit Bar – whole school education to prepare & taste fruits, understanding nutritional values and how it fits into the balanced diet.

• Sexual health services & chlamydia screening

• Anger management .

• Parenting programmes – organised by ESCO, SN form part of the referral pathway for identified parents.

• Art project.

• Regular meeting with pupil support workers to ensure properly scoped, managed by the right person at the right time.

• Royston considering as a joint Health ESC project – MEND - whole family approach to managing a healthy weight.

Vignette• Partnership approach to anger management issues – co-ordinated

approach, previously disjointed and duplicated.

• Service pathway developed in partnership - School Nurses & Emotional Health & Wellbeing Advisor (health) and ESC.

• Pathway - Identified child with anger management referred to School Nurse for a 4 week programme, identifies sources of anger & strategies to manage this response. The programme is linked into the classroom management strategies , allowing the child to leave classroom if needed. This is sometimes supported by drama therapy.

• If the child is at risk of school exclusion for any length of time then referred the BST.

• If initial strategies not worked – SDQ assessment & referral to CAMHS• Regular meeting with pupil support workers to ensure properly

scoped, managed by the right person at the right time.

Areas for improvement

• Clarity of vision moving forward • Multiple partners - communication• Joint service planning• Roles & responsibilities• Information sharing• Outcome measurement• Commissioning• Identifying need• Areas functioning on critical impact