A Pathway of Care for Vulnerable Families (0-3)

1. Introduction

All children and young people have the right to be cared for, protected from harm and abuse and to grow up in a safe environment in which their rights are respected and their needs met. A large number of children in Scotland, however, are born into, and live within, families that can be considered "vulnerable".

Twenty-one per cent of all children in Scotland live below the poverty threshold, which can affect not only their material well-being, but also their physical and emotional well-being. By the age of 3, a disadvantaged child's development is already up to a year behind that of their peers. ¹ There is also evidence that pregnancy and the first years of life have a huge influence on the future mental health of the child. In one long-term follow up of children suffering abuse in the first years of life, 90% had at least one psychiatric diagnosis by age 17. And it is widely recognised that the teenage pregnancy rate in those under 16 years in the most deprived areas of Scotland is more than four times that found in the least deprived. ²

Disadvantage takes many forms and is not just measured in socioeconomic terms. It can arise as a result of many causes, including parental substance misuse. Between 41,000 and 59,000 children in Scotland have at least one parent who is a problem drug user and around 70,000 have at least one parent who is a problem drinker. ¹

The Scottish Government's overarching purpose is to create a more successful country with opportunities for all of Scotland to flourish, ³ and it has committed to strengthen support for vulnerable children and families.

Improving outcomes for children and young people is a fundamental objective for all services and organisations. Ensuring that they and their families get the help they need, when they need it, will give all children and young people the opportunity to flourish. Agencies can improve outcomes for Scotland's most vulnerable by adopting common frameworks for assessment, planning and action that help them to identify needs and risks and work together to address them appropriately. ³

A continuum of support from universal provision (the universal pathway) through to specialist targeted provision most effectively meets the needs of children and families at different ages and stages across the life course. A variety of different services and interventions are required to address the often very different needs of families and the multiple risk factors that impact on children's outcomes. The ultimate aim for services is to support children and families to remain within the universal pathway whenever possible, bringing in targeted or specialist provision where appropriate.

1.1 What children and families can expect from health care services

Every child and adult is entitled to register with a local general practitioner to access primary health care services. They will also have access to support from a midwife in the antenatal period and a public health nurse/health visitor in the early years of a child's life. Secondary and tertiary support from health services, following identification of need, is coordinated and provided by a range of health care practitioners.

The Healthcare Quality Strategy for NHSScotland⁴ has been built around what people in Scotland said they wanted from health care services, which was:

• caring and compassionate staff and services
• clear, effective communication and explanation about conditions and treatment
• effective collaboration between clinicians, patients and others
• a clean and safe environment
• continuity of care
• clinical excellence.

The Quality Strategy sets out the internationally recognised six dimensions of health care quality - health care that is: person-centred, safe, effective, efficient, equitable and timely. The three Quality Ambitions set out in the strategy to which all NHSScotland staff and its partners are aligned are:

• person centredness - mutually beneficial partnerships between patients, their families and those delivering health care services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making
• safety - there will be no avoidable injury or harm to people from the health care they receive, and an appropriate, clean and safe environment will be provided for the delivery of health care services at all times
• effective - the most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.

These Ambitions are relevant to the delivery of care to children and their families in the early years. They describe the care they should receive as being safe, relevant and delivered in partnership with children and their families.