1. Health's Role in Multi-Agency Assessments
Working
together states

2. Norfolk Community Health and Care (NCH&C)
NCH&C provides community children’s services for children through:
The healthy child programme includes health visiting, school nursing and the Family Nurse Partnership. Plus four children's centres based in Kings Lynn, Thetford, Cromer and Mundesley, Bowthorpe in Norwich. There is also the Looked After Children team and a paediatric liaison nurse based at the NNUH.
Disability and additional specialist health includes learning disability teams, speech and language therapy, community paediatrics, specialist team for children with complex care needs (child development unit), occupational therapy and community psychology, ADHD team, community nursing for children with complex care needs and two residential units for children with complex care needs

3. Health’s contribution to multi-agency assessments
These professionals between them have contact with all children from pre-birth through to eighteen years of age. They have contact with the wider network of health services such as midwives, General Practitioners and Paediatricians as well as other agencies such as Children’s services, children’s centres and voluntary services.
These professionals will have knowledge and information about the children and families they work with. In particular they bring skills and training in child development. Understanding child development is crucial in ensuring best quality decision making (Brandon 2012).
They may also have a great deal of knowledge about the local area and resources.
There is a much wider health service provision through other Trusts such as hospitals and adult mental health as well as our GP colleagues.

4. Universal services
Health Visiting has a pivotal role in multi-agency assessments because of their contact with all pre-school children.
The healthy child core programme includes an ante natal contact, a new birth visit, a post natal visit around 6 weeks, a developmental assessment around 8-12 months and a two year developmental assessment.
Health visitors (along with the community nursery nurses and family support workers from the children’s centres) will offer additional services to those families identified as needing more support. For example babies born prematurely, low birth weight, vulnerable parents such as parental low mood, domestic abuse, socially isolated, parents with a learning disability, housing and debt needs etc
Those with safeguarding concerns are prioritised. Prior to any referral the health visitor may be the only professional gaining access to the home, especially with hard to reach families. Health visitors have to assess when the threshold has been reached to refer any safeguarding concerns. As we know sometimes there is a single event that triggers this but often it is a matter of collating the necessary evidence for such a referral.
NCH&C receives and responds to C39d’s either as a joint response (MASH) or may follow up as a single agency.

5. Health visiting developments in NCH&C
The health visitor early implementation site started in 2011
108 whole time equivalent Health Visitors including Team Leaders and Family Nurse Partnership (FNP)
Aim by March 2015
169 whole time equivalent Health Visitors including Team Leaders and expanded FNP

6. In 2012 we trained 35 Health Visitors, retaining 30 posts in NCH&C
This year (2013) we have 45 students about to qualify and hope to retain as many as possible
The whole time equivalent of 31 March 2013 was
We will see a reduction in the next few months (retirements etc)
Target for Health Visitors in post by March 2014 is and 169 by March 2015
We are on target to reach this

7. School Nursing Teams
School nurses see children at school but also undertake some home visits. They have a much larger cohort of children on their case loads so are usually involved in child protection when there is a specific health need such as enuresis, mental health or sexual health concerns.
School nursing teams provide universal health screening at school entry (height and weight/ hearing and vision plus height and weight at year 6).
They offer drop in clinics at high schools and will provide sessions on health and social development in schools when requested.
They attend case conferences as appropriate.

8. Examples of Developments in Training for Health Visitors
Ages and stages questionnaires provide a quick snap shot of a child’s development in key areas
ASQ-3 identifies a child strengths in respect of: fine motor, gross motor, communication, personal and social, problem solving skills
ASQ-SE identifies a child strengths in relation to social and emotional behaviours

9. What are the ages and stages Questionnaires (ASQ-3)
Not just another tool it will be the tool for developmental reviews.
Based on 30 years of research, five major revisions and on 3rd edition (ASQ-3)
Started in 1979 first edition in 1995, referenced in the HCP.
Similar in theory to health screening such as a quick hearing or vision screen
Identifies a family that needs further support, more intensive assessment or referral for a more specialist service.

10. Intentions Clinically?
To provide a parent education process/ strength based tool
To not provide a tick box approach
Support you in assessing, planning, empower, help teach families, evaluating and referencing.
Detection Rates:
NO TOOL
WITH A TOOL
30% developmental disabilities identified (Palfrey et al. JPEDS. 1994:111: )
70-80% developmental disabilities are identified (Squires et al. JDBP 1996:17: )
20% Mental Health problems identified (Lavigne et. al. Podiatry 1993: 91: )
80-90% Mental health problems identified (Sturner JDBP 19:51-64)

11. The Promotional Guide System
The promotional Guide system offers a structured and flexible manualised approach that promotes
The early development of babies
The transition of mothers and fathers to parenthood
Better informed professional and parent decisions about baby and family needs
Ref: Dr Crispin Day, South London & Maudsley NHS Foundation Trust

12. Structure of the Antenatal/Postnatal Promotional Guides
Five core themes underpin the Antenatal and Postnatal Guides:
the health, well-being and development of the baby, mother and father
family and social support
the couple relationship
parent-infant care and interaction
the development tasks of early parenthood and infancy
Ref: Dr Crispin Day, South London & Maudsley NHS Foundation Trust

13. FPM Antenatal Promotional Guide: Ten Topics
The mother and fathers feelings about their pregnancy
Expected family and other support
Anticipated changes in family life and relationships
Self perception of the pregnant mother
The pregnant mothers current perceptions and anticipation of her unborn child
The mothers and fathers anticipation of becoming parents
Anticipation of labour, delivery and birth
Anticipation of feeding, caring and looking after the baby
Current finances and housing
Life events
Ref: Dr Crispin Day, South London & Maudsley NHS Foundation Trust

14. Norfolk Family Nurse Partnership
6 Family Nurses, 1 Supervisor, with a maximum of 150 families
Intensive home visiting programme from early pregnancy till child aged 2 years
Safeguarding of children, young people and adults at heart of FNP – one of two programmes known to prevent child maltreatment (Lancet 2008)
Family Nurses enrich multi agency assessments