A universal 30-month child health assessment focussed on social and emotional development

Abstract

Background: The Glasgow Parenting Support Framework was published in 2009 with a view to improving universal and targeted parenting support for families in the city of Glasgow. In order to provide structured support to families at all levels of need (i.e., either the whole population (universal) or those families with identified problems (targeted)), it was important to have a robust means of assessing the needs of families. To this end, two routine family visits by Health Visitors (community child nurses) were piloted in order to assess their utility in assessing need for parenting support. Both visits involved home assessments, one when the child reached 13 months of age and the other at 30 months. The utility of the 13 month visit is reported elsewhere ^[6]. We describe findings from the 30 month contact in this paper.

Aims: The present study aimed to assess the utility of a home visit at 30 months of age in assessing families’ need for parenting support. It describes (a) the level of need established and (b) the extent to which the home assessment influenced health visitors’ choice of subsequent action.

Methods: Health visitors were asked to arrange to see the principal carer (usually the mother) of the child at home with the child within a month of the child reaching 30 months of age. They collected data on: existing problems and service provision to families, including whether there were known developmental problems for the child or parental issues such as substance misuse or medical problems; parenting stress reported by the child’s principal carer using the Parenting Daily Hassles Scale; parent’s perception of their child’s language development using a two-item brief language screen and parent’s perception of the child’s behaviour using the Behaviour Screening Questionnaire. Using unique Community Health Index identification numbers, linked data from the Child Health Surveillance System, which allowed us to allocate a social deprivation score (using Scottish Index of Multiple Deprivation (SIMD)) to families, were incorporated into statistical models of service use.

Results: From a whole population of 819, data were obtained for 437 families of which 330 had a completed visit. The remaining families were not visited usually due to difficulties in securing an appointment or families not being home at the time of the planned appointment.  Parenting stress was generally low and behaviour problems commonly reported.  Scores on both parenting stress and behaviour measures were higher in families already identified to have higher levels of need and those living in more deprived areas.  Health visitors were more likely to intend to revisit or refer as parenting stress and behaviour scores increased, and where there was previously identified need and socio-economic deprivation.

Conclusions: Current service provision matches need to some extent but routine visits focused on children’s social and emotional development at 30 months may help to identify families needing support who would not otherwise have received it.