+

Evaluation of Health Visiting Practice

How should we go forward?

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’

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?

+Public Health outcomes Framework

+Putting the family first

The families and children must be the first priority in all of what

the health visitors do. Within available resources, they must

receive effective services from caring, compassionate and

committed staff, working within a common culture, and they

must be protected from avoidable harm and any deprivation of

their basic rights.

Enhanced quality standards to promote improvement

Public engagement and partnership

Strong leadership in health visiting and other professions

+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.

+ 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?

+Improvement Science

What is improvement science?

The overriding goal of improvement

science is to ensure that quality

improvement efforts are based as much

on evidence as the best practices they

seek to implement

Shojania KG, Grimshaw JM. Evidence-based

quality improvement: the state of the science.

Health Aff (Millwood) 2005; 24(1):138-50.Improvement science aims to

create practical learning that can

make a timely difference to

patient care. It is characterised by

its large domain of interest, its applied nature,

and its commitment to generation of practical

learning that can be applied in real-life situations.

Improvement science recognises and integrates many

contributions, similar to the way that engineering science

uses scientific knowledge and theories to address real-life problems

Marshall et 2013 www.thelancet.com

+ 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,

+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

+One place to build and share

evidence for practice

+Future possibilities

To achieve real quality improvements in health and health care

should promote, build on and invest in evaluation research that

draws on Improvement Science

Working with networks such as the the iHV , CLAHRCs, eCoP

enhances opportunities to work more closely with NHS, public

health and social care partners on a larger scale

We have an opportunity to grow a national and international

reputation if we start to build on current work now