Universal Health Visiting Pathway evaluation - phase 1: main report - primary research with health visitors and parents and case note review

Appendix 2 Revised Logic Model – Universal Health Visiting Pathway

Inputs

• Universal pathway home visits by HVs (0-5yrs)
• Funding for additional HVs
• HB’s employ sufficient HV’s to deliver the universal pathway
• Resources for training and continuous workforce development
• Workforce planning and caseload weighting tool
• Evidence informed national and local guidance, resources and tools

Outputs/Activities

• All families offered all core visits, additional visits provided if required.
• Build and maintain strong relationships with families from pregnancy onwards, providing information on the role of the HV to enable better understanding among families
• Early assessment of family wellbeing and strengths identification of current/potential needs and care planning
• Ensure continuous, consistent use of GIRFEC National practice model to assess, evaluate ,analyse and plan for the child with a focus on outcomes
• Ensure continuous, consistent and effective assessment of families strengths and concerns (e.g. finance, mental health, domestic abuse, learning difficulties) using open and inclusive routine enquiry.
• Ensure continuous, consistent and effected assessment of child and family relationships
• Where necessary deliver/promote timely tailored interventions advice signposting and support for children and families using a strengths bases model (e.g. positive attachment, child development and behaviour, in fact nutrition, oral health smoking, child safety).
• Children assessed as having additional needs (HPI-A) receive support and interventions over and above the minimum core visits by either HV or referral to appropriate agencies
• Facilitate and/or contribute to multi-agency support for children and families (e.g. child protection, wellbeing) where required.
• Develop and apply appropriate protocol for collecting and sharing information with multiple agencies.
• Continuous professional development, including provision of clinical supervision and education, training opportunities and evidence based resources.
• Develop and implement a sustainable national workforce plan to meet national and professional guidance.

Process outcomes

• Families receive core visits and additional visits by HV as required
• Improve continuity of care and partnership working between HV and families
• Early identification of family strengths and concerns
• Early identification of child strengths and concerns (e.g. HPI-A, child development, neglect)
• Improve families understanding of children's development, wellbeing and safety
• Improve family understanding of healthy lifestyle and behaviour choices (e.g. smoke free home, breastfeeding, oral health
• Provision of timely and proportionate support to families by HV
• Appropriate and timely referrals to other agencies/disciplines
• Effective multi-agency working and information sharing with other agencies/disciplines
• Increased strength based/outcome focused working
• HVs feel well supported (e.g. Caseload management) and valued in their role
• HVs are competent and skilled with appropriate training and resources
• HV participate in clinical supervision, education and training
• HV have knowledge and awareness of community assets, care and referral
• pathways
• HVs are equipped to deliver appropriate interventions to children and families

Intermediate Outcomes

• Positive and trusting relationships between families and HV
• Families feel well supported by HV and able to access relevant other support options if required
• Improved family confidence in, and knowledge and application of, good parenting techniques
• Improved family understanding of attachment and its impact on child's brain development, resulting in secure attachment
• Improved family home learning environment, (e.g. play, reading)
• Increase in number of secure family/child relationships
• Improved wellbeing and safety practices by families
• Improved health behaviours within families (e.g. smoke free homes, breastfeeding, weaning and early diet, oral health).
• Appropriate use of health services for children (e.g. A&E attendance, out of hours)
• Sustained engagement with universal and wider support groups/services, including increased engagement with services referred to.
• Appropriate HV support provided regarding strengths and concerns identified and/or referral to appropriate agency.
• Increased family awareness and uptake of local groups/services
• Increase in HV job satisfaction
• Decrease in HV sickness, absenteeism, staff turnover
• Sustained effective multi-agency partnership working and information sharing with other agencies/disciplines

Longer Term Outcomes

• Improved confidence and resilience among children and families
• Earlier intervention and prevention for children and families
• Reduced inequalities in outcomes and reduced impact of wider inequalities (e.g.
• changing parents approach to parenting despite inequalities)
• Improved child development and school readiness
• Improved child safety and protection
• Improved health outcomes for children and families (e.g. healthy child weight,
• reduced hospital admissions for serious injuries, maternal mental health, reduced substance misuse)
• HVs and other agencies contribute to effective multi-agency partnership working
• HV workforce retention and satisfaction of staff