Health visiting – taking the lead on reducing unintentional Injury in Hampshire’s Under-5s
The Department of Health’s Early Years Six High Impact Areas for Health Visiting include, as key public health priorities, the reduction of unintentional injury and the reduction of hospital admissions in the under-5s.
Amanda Whelan, Professional and Practice Lead for Health Visiting, Southern Health NHS Foundation Trust, Fellow of the Institute of Health Visiting and Ginny Taylor, Operational Services Lead, Southern Health NHS Foundation Trust outline the work they have been leading in Hampshire to address the issue.
Child injuries in Hampshire and priorities for action
Approximately 26,500 children under the age of 5 years are seen in Accident and Emergency departments annually; of these approximately 2,250 are admitted with an unintentional injury. Hampshire’s unintentional injury rates are above the national average for falls, poisonings and burns and close to the national average for choking, suffocation and drowning.
Public Health England’s guidance Reducing unintentional injuries in and around the home among children under five years, developed with the Child Accident Prevention Trust (CAPT) and the Royal Society for the Prevention of Accidents (RoSPA) made three recommendations for local authorities and their partners:
- Providing leadership and mobilising existing services prevents injuries
- The early years workforce needs support and training to strengthen its central role in helping reduce unintentional injuries
- That the focus should be on five kinds of unintentional injury in the under-5s; choking, suffocation and strangulation; falls; poisoning; burns and scalds; and drowning.
The guidance also highlighted the key role health visitors have to play in reducing unintentional injury. The report, supported by recommendations from NICE, calls for health visitors to be trained to lead on the delivery of programmes of prevention within their teams and with colleagues from children’s centres and Early Years settings to support and educate parents in a bid to reduce unintentional injury.
The Reducing Unintentional Injuries in Hampshire’s Under-5s Project was conceived against this backdrop and set about to train staff to affect real change in the incidence of unintentional injury through engagement with parents, education, support and integrated working. This project was supported by transformation of services funding from Southern Health’s commissioners.
Providing care that promotes and protects the health of the child including home and travel safety (reducing unintentional injury) is one of the Universal elements of the Healthy Child Programme. In addition, unintentional injuries are a major health inequality, with children having a 45% increased chance of injury in the most deprived areas. The challenge therefore, when planning the approach to reducing unintentional injuries was how to secure the best outcomes at all four of the levels of the Health Visiting service from Community to Universal Partnership Plus.
The five Universal health reviews provide the opportunity for relevant accident prevention messages and support for parents at key stages in a child’s development, however in addition to these it was important that staff in Hampshire were trained to enable them to provide opportunistic advice at all contacts with parents. For the most vulnerable families and those who were hard to engage in groups, a more tailored, individualised approach was needed.
Training for all staff in the Health Visiting teams was essential. Three phases were identified:
Phase one: identifying and training Health Visitor Champions to support the teams with education and the practical applications, including integrated working, following their training.
Phase two: training all the skill mix staff in the teams (Community Nursery Nurses and Staff Nurses) to be able them to engage parents in accident prevention and in basic first aid advice for choking, burns, cuts and abrasions and minor head injuries. The Trust commissioned a tailored, practical, one-day programme from The Child Accident Prevention Trust (CAPT) which was delivered to eight groups with Amanda Whelan, Professional and Practice Lead for Health Visiting present at each session to provide a steer for colleagues on local priorities and strategies.
Phase three: training all the Health Visitors in accident prevention – piloting a new iHV training pack which is being developed with the CAPT to enable Health Visitors to support the most vulnerable families.
At the time of writing, the first two phases have been completed and Health Visitors have been supporting their skill mix staff in engaging parents in accident prevention in a number of different ways including:
- Supporting their colleagues to develop strengths-based sessions on reducing unintentional injury that educate and inform in a supportive and blame-free ways. The sessions are being delivered as part of a package of post natal support in children’s centres with positive outcomes and feedback from parents
- Taking part in public events to raise the profile of accident prevention across the county. These events have been supported by children’s centre colleagues and our school mursing teams to maximise their reach
- Leading on the development of a model of intervention for reducing unintentional injury that can be used to support the most vulnerable families and those whose children are on a Child in Need or Child Protection Plan
There has been a marked increase in awareness of all members of the Health Visiting teams about reducing unintentional injury and this is being translated into practice both opportunistically as well as during the 5 Health Visiting reviews.
Health Visitor Champions have been liaising with children centre staff who have also been invited to attend training sessions with the skill mix staff to encourage a fully integrated approach and further sessions are planned to include colleagues from Early Years Settings.
Although the project is still rather in its infancy, it has shown the remarkable difference that skilled and educated interventions can make when delivering key public health messages. Investing in Health Visitors and their teams has already raised the profile of accident prevention with parents and with key partner agencies.
Across the country Health Visitors are ideally placed to strengthen the impact of this approach by expanding their work with families, children’s centres, A&E departments, Minor Injury Units, colleagues in General Practice and other key partners in Early Years’ provision to ensure consistent messages are given on reducing unintentional injury. The project has confirmed that Health Visitors are indeed ideally placed to affect real change through education, integrated working and the unique service that they provide to all families.