Universal Health Visiting Pathway in Scotland: pre-birth to pre-school

How I Grow up and Develop

Child Development

All domains with a focus on:

• Gross and fine motor
• Speech and language
• Social, emotional and behavioural

Child Nutrition and Growth

Nutrition and healthy eating (appropriate foods, portion size and milk volume)

Physical activity

Growth (note Body Mass Index (BMI) not appropriate for children <24 months)

Child Physical Health

Immunisations (ensure primary immunisations and 12 - 13 month boosters plus MMR completed, ensure selective immunisations - Bacillus Calmette-Guerin ( BCG), Hepatitis B, Influenza - completed if indicated

Dental health (encourage cup rather than bottle, tooth brushing, dental registration and attendance)

Unintentional injuries (especially home safety)

General physical health (especially testicular descent for boys and hips) - request assistance from General Practitioner if any concerns

What I Need From People Who Look After Me

Parenting and Family Relationships

Parenting capacity, enjoyment and stress

Parent-child relationship and attachment (sensitive and responsive parenting, appropriate boundaries, separation anxiety)

Wider family relationships (including domestic abuse)

Parental Health

Parental smoking - second hand smoke

Parental alcohol or drug misuse

Learning disabilities

Mental health

Physical health to include nutrition and diet and postnatal weight management support

My Wider World

Family Finances

Poverty and debt

Home Environment

Home safety

Play opportunities - ensure Play@home pre-school toddler book received

Books and reading (ensure Bookbug Baby Bag received)

Screen time

Sleep (bath, book, bed routine)

Early Learning and Childcare

Nursery/childminder/playgroup attendance

Wider environment

Play opportunities

Road safety

Sun Safety

Overall Need for Support

Health Plan Indicator

Demographic data

First name

Y

Surname / family name

Y

Home postcode

Y

Full postcode

Gender

Y

M/F

CHI

Y

Ethnicity

See code list

Is English first language at home

Y

Y/N

Is English the main language spoken at home?

Bilingual/multilingual

Y

Y/N

Is the child routinely exposed to more than one spoken language in their home and/or care environment?

Current Looked After Child ( LAC) status

See code list

Is the child currently looked after by the Local Authority for any reason?

Professional identifiers

Health visitor identifier

Y

Clinic identifier

Y

GP Practice identifier

Y

Information about review

Date of review

DDMMYY

If reviews are conducted over more than one appointment, please include the date the review was completed

Place of review

Home, GP Practice, community clinic, other

Tick all that apply

Professionals directly involved in delivering review

Health Visitor

Tick all that apply

Carer present with child at review

Primary carer, additional carer, other

Tick all that apply. Primary carer refers to the adult living (at least most of the time) with the child who provides most day to day care. Additional carer refers to a second adult (living with the child or not) who contributes to their day to day care. In most but not all cases, the primary and additional carers will be the child's mother and father.

Parental concerns

Concerns raised by carer

Feeding, growth/weight, sleep, development, physical health, other

Development

Ages & Stages Questionnaire results

Communication

Numerical score up to 60

Ages & Stages Questionnaires are available for children aged 12, 14 and 16 months

Gross motor

Numerical score up to 60

Fine motor

Numerical score up to 60

Problem solving

Numerical score up to 60

Personal-social

Numerical score up to 60

Overall assessment of child's development

Speech, language and communication

No concerns, concern newly suspected, concern/disorder previously identified

A concern about a child's development may be newly identified during their review through any/all of eliciting parental concerns, taking a developmental history, structured observation of the child, and/or the results of the Ages & Stages Questionnaire or other validated developmental assessment questionnaires. If concerns are newly identified, action would be expected to follow such as arrangement for early review, more detailed assessment, and/or wider parenting support. Developmental concerns, or specific disorders such as cerebral palsy, congenital deafness, etc, may have been identified prior to the child health review.

Gross motor

No concerns, concern newly suspected, concern/disorder previously identified

Fine motor

No concerns, concern newly suspected, concern/disorder previously identified

Problem solving, cognitive

No concerns, concern newly suspected, concern/disorder previously identified

Personal-social

No concerns, concern newly suspected, concern/disorder previously identified

Emotional, behavioural, attention

No concerns, concern newly suspected, concern/disorder previously identified

Vision

No concerns, concern newly suspected, concern/disorder previously identified

Hearing

No concerns, concern newly suspected, concern/disorder previously identified

Tools used during the review to support developmental assessment

List up to 4 - see code list

Infant feeding

Ever breastfed

Y

Y/N

Has the baby ever been put to the breast to feed or been given expressed breast milk?

Current milk feeding (previous 24 hours)

Breast milk only, formula milk only, mixed breast and formula milk, other

This variable refers to the feeding that the baby has received over the 24 hours prior to the child health review. 'Breast milk only' includes either feeding at the breast or being fed expressed breast milk. 'Other' would include babies with special nutritional needs receiving non milk feeding.

Child's age when breastfeeding stopped

Y

Age in completed months (if stopped after 6-8 week review)

Child's age when weaning foods introduced

Age in completed months

Growth

Weight

Weight in kg to one decimal place

Length

Length in cm to one decimal place

Date measured

DDMMYY

Complete if different to date of review.

Immunisations

Universal immunisations complete for age

Y (from SIRS)

Y/N

Diphtheria, Tetanus, Pertussis, Polio, Haemophilus Influenzae Type b (Hib), Meningitis C, Pneumococcal Conjugate Vaccine ( PCV), Rotavirus, Measles, Mumps & Rubella ( MMR)

Tuberculosis risk status

Y

Free text - list country of birth of parents and grandparents

Bacillus Calmette-Guerin ( BCG) given

Y

Y/N

Is Hepatitis B immunisation indicated

Y

Y/N

Hepititus B immunisation completed

Y

Y/N

Influenza vaccination given

Y

Y/N

Dental Health

Childsmile requested at 6-8 weeks

Y

Yes, no, refused

Was the child referred to Childsmile following their 6-8 week child health review?

Toothbrushing twice daily

Y/N

Is the child having their teeth brushed with fluoride toothpaste at least twice daily?

Registered with dentist

May be available for pre-printing as part of the national Childsmile data linkage project - otherwise Health Visitors to complete

Y/N

Is the child currently registered with a dentist?

Ever attended dentist

Y/N

Has the child ever attended a dentist?

Second hand smoke

Primary carer current smoker?

Y/N

Is the child's primary carer a current smoker? Primary carer refers to the adult living (at least most of the time) with the child who provides most day to day care.

Child exposed to second hand smoke?

Y/N

Is child regularly exposed to second hand smoke within their home, car, and/or care environment from any source? Exposure in the home means anyone smoking anywhere inside the house or on the doorstep with the door open. Regularly means once a week or more frequently.

Issues

Issues likely to be relevant to the child's ongoing health, development or wellbeing

Y

List up to 4 issues. Free text subsequently Read coded

All medical diagnoses (including congenital anomalies) and social/environmental issues likely to impact of the child's ongoing health, development, or wellbeing should be recorded in line with the national guidance on recording of issues.

Future action

Recall to Health Visitor

Interval to next appointment in weeks if child to be reviewed by Health Visitor

Length of recall appointment

S, M, L

Reason for recall appointment

Free text

GP

Provide, signposted to, discuss with, refer to/request assistance from, refused

Provide indicates that the Health Visitor and/or associated skill mix team will directly provide the specified additional support e.g. parenting support (only relevant for some options).

Parenting support

Signposted to indicates that parents have been given details of specified local services and how to access them.

Audiology

Discuss with indicates that the HV will formally discuss the child/family with the specified service to inform future management plans.

Speech and language therapy

Refer to/request assistance from indicates that the Health Visitor will formally refer the child/family to the specified service, whilst retaining responsibility for overall monitoring of the child's wellbeing and outcomes as their GIRFEC Named Person.

Community paediatrics

Refused indicates that the carer has been offered provision/signposting/discussion/referral to the specified service but has refused this.

Child and Adolescent Mental Health Service

Childsmile

Smoking cessation

Child healthy weight intervention

Early learning and childcare

Financial Advice Services

Social Work

Physiotherapy/Occupational Therapy

Other service

Specify

Support Needs Status

Y

Not active on Support Needs Status, active - not yet notified to doctor, active - not yet assessed, active - being assessed, previously on Support Needs Status

Summary and data sharing

Summary comment

Free text

Parental consent to share information from this review

Provided, refused, not sought. Specify with whom the results will be shared.

Health Plan Indicator

Current Health Plan Indicator

Y

Core, additional

This is last HPI entered into Child Health Surveillance Programme - Pre-School ( CHSP- PS) prior to the current review

Updated Health Plan Indicator

Core, additional

This is the Health Plan Indicator assigned on completion of the review.
An additional Health Plan Indicator indicates that the child (and/or their carer) requires sustained (>3 months) additional input from professional services to help them attain their health or development potential. Any services may be required such as additional Health Visitor support, parenting support, enhanced early learning and childcare, specialist medical input, etc.

Group A - White

Group D - African

1A

Scottish

4D

African, African Scottish or African British

1B

Other British

4Y

Other African

1C

Irish

Group E - Caribbean or Black

1K

Gypsy/Traveller

5C

Caribbean, Caribbean Scottish or Caribbean British

1L

Polish

5D

Black, Black Scottish or Black British

1Z

Other white ethnic group

5Y

Other Caribbean or Black

Group B - Mixed or multiple ethnic groups

Group F - Other ethnic group

2A

Any mixed or multiple ethnic groups

6A

Arab, Arab Scottish or Arab British

Group C - Asian, Asian Scottish or Asian British

6Z

Other ethnic group

3F

Pakistani, Pakistani Scottish or Pakistani British

Group G - Refused/Not provided by patient

3G

Indian, Indian Scottish or Indian British

98

Refused/Not provided by patient

3H

Bangladeshi, Bangladeshi Scottish or Bangladeshi British

Group H - Not Known

3J

Chinese, Chinese Scottish or Chinese British

99

Not Known ( i.e. individual was not asked)

3Z

Other Asian, Asian Scottish or Asian British

01

No, not currently looked after by local authority

02

Yes, looked after at home

03

Yes, looked after with friends/relatives (placed with friends or relatives who are not approved foster carers)

04

Yes, looked after with foster carers (placed with approved foster carers provided by or purchased by the Local Authority)

05

Yes, looked after with prospective adopters

06

Yes, looked after in other community placement ( e.g. supported accommodation, hospital)

07

Yes, looked after in residential care (any form of residential care e.g. local authority or voluntary children's home or crisis care refuge)

The nationally agreed core list of recommended additional questionnaires (in addition to the Ages & Stages Questionnaire - ASQ:3) is:

Parents Evaluation of Developmental Status (PEDS)

Parents Evaluation of Developmental Status: Developmental Milestones Questionnaire ( PEDS:DM)

Ages & Stage Questionnaire: Social-Emotional ( ASQ:SE 2)

Strengths & Difficulties Questionnaire ( SDQ)

The Sure Start Language Measure ( SSLM)

Modified Checklist for Autism in Toddlers ( M-CHAT)

Note that the Eyberg Child Behaviour Inventory was also listed in the 27-30 month guidance but this has been removed as in practice it has been little used in Scotland Furthermore, the Schedule of Growing Skills ( SOGS) II has also been removed from the list as this serves the same function as the Ages & Stages Questionnaire ( ASQ:3) ( i.e. holistic assessment of all developmental domains) hence with the move to universal use of the Ages & Stages Questionnaire ( ASQ:3) this is now redundant Health Visitors can record the use of 'other' specific questionnaires on the relevant Child Health Surveillance Programme - Pre-School ( CHSP- PS) forms. Use of other questionnaires is a matter for Health Visitors' professional judgement however in general it is expected that use of other questionnaires will be uncommon.