Protecting, promoting and supporting health in families and communities - presentation at the Faculty of Public Health annual conference 2016

1. PUBLIC HEALTH NURSING
PROTECTING, PROMOTING AND SUPPORTING
HEALTH, IN FAMILIES AND COMMUNITIES

2.  Star Babies:
Supporting First Time
Parents (Pamela McBride,
Lead Nurse)
 A Weight Management
Pathway for School
Nursing (Clare McKeown,
Children’s Health Coordinator)

3. Healthy Child, Healthy Future:
Child Health Promotion
Programme (NI)
 Antenatal
 10 – 14 days
 6 -8 weeks
 14 -16 weeks
 6 -9 months
 1 year
 2 year
Child and
family
Assess child
development
Promote
emotional
health/well
being
Screening
Immunisations
Promote
physical health
prevent illness
Support
parenting
Identify risk
factors

4. The World of Parenting

5. Children on the Child Protection
Register NI
Neglect = 28%
Physical Abuse = 29%
Average
number of
children on the
child
protection
register = 2000
39% are
between the
age of 0-4
years

6. without being magic
“1000 Health Visitors more effective
than 1000 Police Officers”
“The nearest thing to magic”

7. More contact with health visiting teams.
Share additional information, helplines,
websites, leaflets not enough.
Focus on nurturing of
mums.
Include Dads.
Practical help and networks of support.
Sleep management, stress management.
More focus on mental health: ante/post
natal depression.
Lack of
role
models
Lost the
skills of
parenting
Parents Views

8. Star Babies
 Structured around delivery of the ‘Healthy Child,
Healthy Future’ framework of contacts with a focus
on prevention and early intervention.
 Attachment based enhanced home visiting for first
time parents with babies from birth to one year.
 A package of parenting support will be delivered
with the aim of improving the social and emotional
wellbeing of babies and parents and strengthening
relationships.
 Every month, visits track the journey of a child from
the perinatal period through the first twelve months
of life.

9. Responsive Parenting
 ‘Ethan actively engages with his
parents. Not only can he see, he
can copy facial expressions,
and he can both hear and
recognise the sound of his
mother’s voice...’
 Promotes baby-centered care. It
uses images to show the
subtleties and significance of
infant behaviour.

10. Themes
Play
Infant Massage

11. Loving Care = 98%
Baby Cues = 98%
Talking to Baby = 97%
Bonding and Attachment = 97%
Outcomes
Since the start of
Star Babies in
2013:
• 1098 babies
have completed
• 769 babies are
ongoing

12. Feedback
Parents
“Star Babies is
so important for
new parents to
reassure them
of their baby’s
individual
needs”
“I was sad when
the service
ended at twelve
months. It was
such a great
help”
“Everything was
well thought out
and useful and
reassuring as a
first time mum”
“Excellent staff-
warm caring and
professional.
Keep the
service
available”
Staff
“Has re-focused
my direction as a
Health Visitor”
“Has enabled me
to become a
more reflective
practitioner”
“I have a clearer
vision for the
longer life-time
impact on the
child and family”
“The quality of
my visits are
richer now”

13. Seth’s Star Babies Journey

14. A Weight Management
Pathway for School Nursing
Appraisal Assessment Discussion Self-Care Plan

15. Childhood Obesity
25%
of 2-15 year olds in
Northern Ireland are obese
or overweight
(DHSSPS, 2014)
1:4 children in Northern
Ireland is obese by 11yrs
(The Millennium Cohort Study, 2014)
9
10.5
11
15
16.5
19
10
16
12
14
0
2
4
6
8
10
12
14
16
18
20
2013/14 2014/15 NI Average2014/15

16. School health appraisal
Primary 1
Post Primary Year 8
Targeted reviews
Primary 2-7
Post Primary Year 9-14
Immunisation
Child,
Young
Person and
Family
Individual
health
assessment
Mental,
emotional
health issues
Health
protection
screening
immunisation
Transitions
Personal
Development
RSE
Safeguarding
Conditions
management

17. Public
Perception
“Finding out early about how parents view their children’s
weight, and their own size and shape, is conducive to
building partnerships for the management of obesity. This
will be easier to do if a child’s overweight is the reason for
the consultation. This can’t be ducked but it can be done
better”.
• Ball, 2012, British Psychological Society

18. The Pathway
 Increase parental
awareness
 Provide information
about children’s weight in
the context of healthy
lifestyles
 Take a self-care approach
to behaviour change
 Offer nurse-led support
and review
 Support parents in talking
to their children about
weight

19. Features
 Proactive telephone feedback
 Parents’ /staff views
 Individual assessment
 Mental/emotional health factors
 Supporting parents in talking to their
child about weight
 Information about practical behaviour
change strategies
 Agree lifestyle changes and goals

20. Starting the conversation
 ‘Parent very irate regarding phone call.
Disputes child’s BMI could be as high, as child
exercises. Mum stated that weight was a
private matter and didn’t wish to discuss the
issue any further’.
 Dad reports that she is ‘a big, strong girl’; farm
work will increase over next 7 months and the
weight will drop off’
 ‘Mum reported that her daughter was not
overweight’
 ‘Mum says his father is a larger man and she
has no concerns. He has a lot of growing to
do’
•Anticipate the range of
responses you might
encounter, use sensitive,
guided discussion
When to
initiate
discussion
•“We completed your child’s
Year 8 health appraisal. We
look at the relationship of
weight to their height and
stage of development.”
Starting the
conversation
•“Have you noticed any
changes in development or
concerns about weight?”
Raising the
issue of
overweight

21. Feedback
‘Cold calling before
(the pathway) was
very divisive and you
got strong reactions
from families”’
‘There were no
angry, defensive, or
abusive phone calls
this year’
‘There was less
hostility, better
engagement. Staff
felt better able to
guide discussion’
‘Parent very
appreciative of call’
‘Parent very
responsive to
information’
Mum commends the
school nursing team
- they provide an
excellent service

22. School Nurses and the Self-
Care Model

23. Journey Through the Pathway
SN conducts school HA with child
Growth measurement undertaken
Child identified as BMI centile overweight range
Telephone contact and guided discussion with child’s mother
Telephone Contact
Mum is very concerned about son’s weight and feels like fighting losing battle. Says partner not supportive and
buys fizzy drinks/junk food. SN advised mum on how to address the issue sensitively. Self-care plan agreed with SN
telephone and clinic review at 3-4 months. Mum requested all pathway resources and ‘Talking to Your Child About
Weight’
Self-care telephone review at 3 months
• Mum reports has been trying very well, cutting down on portion size and making healthier choices. Mum says
that son has increased physical activity and has lost half a stone.’
Drop-In Clinic at 6 months
Son is very aware of which foods to eat and which to avoid. Discussed diet and very healthy diet is taken. Mum
reports healthy breaks, lunches and dinners at home and she has stopped buying sugary foods. Son has cut down
at home and now goes for the healthy option. Mum is happy to contact SN for further input if required. Lots of
praise given today.’

24. Outcomes
 81% telephone contact/discussion
 1% negative response to information
 4% experiencing weight related mental/emotional health issues
 579 self-care plans/reviews agreed
 76% reported healthier eating and meal patterns
 43% reported child had decreased weight or weight centile
 61% reported that their child had taken up a new form of exercise or
increased physical activity levels