+

Evaluation of Health Visiting Practice

How should we go forward?

Dr Karen Whittaker, Senior Lecturer, University of Central Lancashire. Fellow iHV

Thanks to Prof. Sally Kendall, Associate Dean Research and Director, CRIPACC, University of

Hertfordshire

Trustee iHV

+Current Policy: Why health visiting matters

In 2011 the Department of Health for England launched the

‘Health Visiting Implementation Plan’

Updated as ‘The Plan’ (2013)

The Government believes that strong and stable

families are the bedrock of a strong and stable

society.

+The Healthy Child Programme

The Healthy Child Programme (HCP) is led by

Health Visitors and consists of a programme of

evidence based activities across the pregnancy

and 0-5 year period

+Effective HCP should lead to…..

strong parent–child attachment and positive parenting, resulting in better social and emotional wellbeing among children;

care that helps to keep children healthy and safe;

healthy eating and increased activity, leading to a reduction in obesity; prevention of some serious and communicable diseases;

increased rates of initiation and continuation of breastfeeding;

readiness for school and improved learning; early recognition of growth disorders and risk factors for obesity;

early detection of – and action to address – developmental delay, abnormalities and ill health, and concerns about safety; • identification of factors that could influence health and wellbeing in families; and

better short- and long-term outcomes for children who are at risk of social exclusion.

How do we evaluate effectiveness?

Six High Impact Areas for Health Visiting

+Public Health Outcomes Framework:

What is it?

https://www.gov.uk/government/publications/healthy-lives-healthy-people-improving-outcomes-and-supporting-transparency

+Public Health outcomes Framework

http://www.phoutcomes.info/

Travelling on a journey with a family

+ Enhancing quality standards through evaluation

Evaluation

What? Intervention or change in practice

Who? Family, child, parents, community

How? What is involved? Break it down to component parts

When? At what stage, time, level

Where? What is the context, home, community, clinic

Measures? Do they already exist? Where can they be found?

Changes? Can the change be associated with the intervention or practice development?

Dissemination and communication?

+Ask Questions, Be Curious

“Be vigilant, curious and ask the ‘why’questions, because it’s when you stop asking

questions that things start to go wrong.”

Mary Mumvuri, Head of Nursing and Patient Safety at

Hertfordshire Partnership University NHS Foundation

Trust (HPFT), told nursing students at the University of

Hertfordshire.

Improvement Science

What is improvement science?

Improvement Science is a body of knowledge that

describes how to improve safely and consistently.

Improvement Science is not the same as

Research. Research is designed to find out what

is possible. Improvement Science is not the same

as Audit. Audit is designed to find out what is

actual. Improvement Science describes how to

reduce the gap between what is actual and what

is possible.

• The overriding goal…. to ensure that quality improvement efforts are based as much on evidence as

the best practices they seek to implementShojania & Grimshaw (2005) Health Affairs 24(1):138-50.

• It aims to create practical learning that can be applied in real-life situations.

• Concerns how to make quality improvement. Marshall et al (2013); The Lancet

+ Terms used for improvement science

implementation science

science of improvement

translational research

translational science

measurement for improvement

quality improvement methods

quality improvement science

science of quality improvement

evidence-based practice

knowledge translation

research utilisation

+Evaluation approaches

Kirkpatrick (1988) Framework for Evaluation 4 stages

Reaction – how do people react, feel, behave in relation to the

process?

Learning – what have people learned from it and what would they do

differently?

Impact – what has been the impact on their lives, behaviour,

relationships,

Results – what change has occurred, is it measurable?

+How would you do this?

Posing the question

E.g How effective has my breastfeeding support group been in

enabling breastfeeding to continue?

Reaction

How did you feel about the breastfeeding support group? What made

you want to continue with it?

What was challenging?

Learning

What have you learned from the group?

What supported your learning?

What would you want to do differently?

+How would you do this?

Posing the question

E.g How effective has my breastfeeding support group been in

enabling breastfeeding to continue?

Impact - What difference has attending the group made to your

experience of breastfeeding?

How has it affected your family’s approach to breastfeeding?

How confident are you about continuing to breastfeed?

Results – what has changed as a a result of the programme?

Before and after measures – breastfeeding rates, confidence, self-

efficacy, attachment,

Programme Logic Model

Programme objective

• Are programme objectives clearly defined?

• e.g. reduce child speech and language referrals; increase breastfeeding initiation and duration

Population

• Describe characteristics of target population

• Classify needs levels, risks, strengths

Theory of change

• Is there a programme theory of change? E.g. social learning theory

• Is it based on an understanding of vulnerabilities (& strengths) in the population and mechanisms to interrupt and achieve desired outcomes?

Programme components

• As designed, does it reflect the theory of change?

• As implemented, does it reflect design? Is it adequately resourced? If there a QA process?

Success

• Consider carefully how to define programme success

• Is there a process to monitor progress and incorporate feedback in programme redesign

Segal et al. (2012). A Systematic Review. Milbank Quarterly, 90, 47-106.

+How can you contribute?

By being curious about health visiting practice, what makes a difference and why?

Be systematic and methodical!

Through engagement with NHS and public health organisations and identifying areas of local and national concern

By considering how to implement what is already known and identifying gaps in knowledge

Taking part in research events such as master-classes, seminars and conferences – getting ‘out there’

Engaging with families and the public – how can improvement science address their concerns?

Building experience and knowledge through professional development (Masters, PhDs) and working with teams

Disseminating your work in good quality journals, conferences and the e-Community of Practice

Applying for grants that will stimulate and grow new areas

+Disseminate your findings

Write for a journal

or local newsletter

Conference or seminars

Blogs, twitter, facebook – use social media!

Use the e-Community of Practice for Health Visitors

+On-line Community of Practice

The CoP is built around the 6 high impact areas, enabling HVs to build and

share evidence and knowledge in each of the 6 areas within an

on-line community

+Future possibilities

+The challenge

Shonkoff 2014

The time has now come for a different approach to early childhood

investment that catalyzes innovation, seeks far greater impacts, and views

best practices as a baseline, not a solution.

Evidence for parental change is not enough – we need evidence of the

actual impact on children – their outcomes and achievements.

+Pride