The Scottish Child Health Programme: Guidance on the 27-30 month child health review

Executive Summary

• The Scottish Child Health Programme provides proactive care and support to all children to help them attain their health and development potential. Overall policy on the Child Health Programme was set out in 2005 in Health for All Children 4: Guidance on Implementation in Scotland http://www.scotland.gov.uk/Resource/Doc/37432/0011167.pdf.
• The universal child health reviews are a core element of the Child Health Programme. The reviews provide an opportunity to work with parents to assess children's wellbeing, provide age appropriate health promotion advice, build parenting capacity, identify needs for support, and facilitate early access to effective interventions. The Scottish Government indicated in a 2010 Chief Executive letter (http://www.sehd.scot.nhs.uk/mels/CEL2010_15.pdf) and subsequent policy update (http://www.scotland.gov.uk/Resource/Doc/337318/0110676.pdf) that a new child health review for children aged 24-30 months should be added to the Scottish Child Health Programme.
• The Scottish Government set up a short-life working group in late 2011 to produce national guidance on the content and delivery of the 24-30 month review: the group's guidance is provided in this report. The guidance is primarily aimed at front line health staff involved in delivery of the review, in particular Public Health Nurses - Health Visitors (PHN-HVs) and their managers.
• The significance of findings may be less clear at the 24 month point due to the relatively high degree of variability in younger children's development, potentially leading to a high number of re-assessments being offered. The guidance recommends that the CHSP-PS system will issue the first invitation for the review when children attain 27 months, therefore the review will now be known as the 27-30 month review. NHS Boards should aim to ensure that reviews are completed by the time children attain 30 months.
• The 27-30 month review should be offered to all children, regardless of their circumstances. Achieving high uptake of the review can be challenging but is critically important to ensuring that the review makes the greatest possible contribution to improving children's outcomes and reducing inequalities. The review should be face-to-face with the child present. Provision of the review should be in line with asset based approaches to health promotion.
• The overall priorities of the review should be the promotion of strong early child development (particularly social/emotional and language/cognitive development) within a context of helpful parenting and wider family wellbeing, and the promotion of child healthy weight. Guidance is provided on the core issues that should be considered for all children attending 27-30 month reviews.
• The Getting It Right for Every Child approach provides an overall framework for the 27-30 month review (http://www.scotland.gov.uk/Topics/People/Young-People/gettingitright). How the GIRFEC national practice model supports assessing and addressing children's needs is outlined. Additional guidance is provided on assessing children's development and their nutrition and growth.
• Information is provided on current health promotion resources that can be used to facilitate discussions with families, and relevant evidence summaries that support professional practice.
• A national minimum dataset that should be returned on all completed reviews is provided. The resulting data will allow robust monitoring of delivery of the 27-30 month review and of young children's health and development.
• Further actions that will be required to ensure successful delivery of 27-30 month reviews in line with this guidance include:
  • NHS Boards, the Modernising Nursing in the Community education sub-group, and NHS Education for Scotland working together to explore solutions to address any staff training needs.
  • NHS Boards developing clear local clinical pathways for children found during the course of their review to need additional support, and ensuring that relevant services, such as parenting support, developmental paediatrics, etc have adequate capacity to meet anticipated need.
  • The Child Health Surveillance Programme - Pre School information system national user group ensuring that the system modifications required for the review are made.
  • The Scottish Government and NHS Health Scotland working together to ensure that relevant resources, such as the 'Red Book', are updated to reflect the new 27-30 month review.
• It is expected that all NHS Boards will be providing reviews in line with this guidance, and returning the national dataset on completed reviews, from April 2013.