Health Visiting

List of Contributors ix Introduction 1 Karen A. Luker, Gretl A. McHugh and Rosamund M. Bryar Prevention, public health, and health visiting 2 Health visiting: preparation for practice 4 1 Managing Knowledge in Health Visiting 8 Kate Robinson Introduction 8 Defining health visiting practice 10 What do health visitors do ± and where do they do it? 13 Evidence-based practice 16 The current landscape of EBP 21 Managing knowledge and evidence in practice 26 Case study 1.1: Introducing new technology 26 Case study 1.2: Creating guidelines in primary care 27 Case study 1.3: Protocol-based decision making in nursing 29 Case study 1.4: Knowledge management in primary care 30 Communities of practice 35 Reflective practice 37 Clients: what do they know and how do they know it? 40 Social networking and the media 41 The debate 44 Summary 45 References 46 Activities 50 2 Health Visiting: Context and Public Health Practice 53 Martin Smith Introduction 53 Public health 56 Defining 'public' 56 Defining 'health' 57 Defining 'public health' 59 Human rights and public health 60 The principles of health visiting 63 The search for health needs 65 The stimulation of an awareness of health needs 65 The influence on policies affecting health 66 The facilitation of health-enhancing activities 67 Summary 68 Health inequalities 69 Summary 76 References 77 Activities 82 3 The Community Dimension 85 Rosamund M. Bryar Introduction 85 Public health and communities 87 Defining 'community' 89 Impact of communities on health 91 The role of health visitors in working with communities 96 Gaining an understanding of the health of your local community 100 Windshield survey 101 Public health walk 101 Health needs assessment 102 Building community capacity 110 Using health promotion models to support community working 113 Summary 116 References 118 Activities 124 4 Approaches to Supporting Families 127 Karen I. Chalmers and Karen A. Whittaker Introduction 127 Models of intervention in family life 128 Three models relevant to health visiting practice in families with young children 129 Application of the models in practice 132 Policies 133 Evidence for interventions to support families 136 Characteristics of services and programmes to support families with young children 137 Early home visiting programmes 138 First Parent Health Visiting Programme 138 Community Mothers Programme (CMP) 139 Current home visiting programmes 140 Family Nurse Partnership (FNP) Programme 140 Flying Start ± Wales 143 The Triple-P (Positive Parenting Programme) 144 Maternal Early Childhood Sustained Home Visiting (MECSH) 145 Sure Start programmes 146 Summary 148 Working with families 148 Empirical evidence on relationship development 152 Challenges 154 Public health agenda 154 Level of evidence 155 Adhering to the programme criteria 155 High-needs families 156 Practice specialisation 157 Concerns about child safety 157 Adequate resources 157 Summary 158 Note 158 References 158 Activities 167 5 Safeguarding Children: Debates and Dilemmas for Health Visitors 170 Julianne Harlow and Martin Smith Introduction 170 The key concepts 172 Defining 'child' 172 Defining 'childhood' 174 Defining 'safeguarding' 175 Defining 'child abuse' 180 Defining 'significant harm' 187 Incidence and prevalence of child abuse 193 Assessment of vulnerable children 197 Assessment of children in need and their families 198 Common Assessment Framework (CAF) 200 Graded Care Profile (GCP) 202 Working together 203 Confidentiality and information sharing 205 Supervision 206 Summary 210 References 211 Activities 217 6 Working with Diverse Communities 220 Sharin Baldwin and Mark R.D. Johnson Introduction 220 Culture and migration 221 Cultural sensitivity and competence 222 Some useful tips for developing cultural competence 225 Institutional discrimination and organisational cultural competence 225 Understanding different cultural practices 226 Pregnancy 226 Birth customs 228 Confinement following birth 231 Breastfeeding 231 Diet, weaning, and feeding practices 232 Maternal mental health 235 Safeguarding, domestic violence, and abuse 237 Communication 239 Other communities 240 Case studies 241 Case study 6.1: Breastfeeding support project for Somali mothers in Harrow 241 Case study 6.2: New ways of delivering health visiting services for Orthodox Jewish community in Hackney 242 Summary 244 References 244 Activities 250 7 Evaluating Practice 252 Karen A. Luker and Gretl A. McHugh Introduction 252 Sources of evidence for practice 253 Evaluation ± the problem of definition 257 Conceptualising evaluation 259 Example: tackling childhood obesity 261 Evaluation and evaluative research 263 Evaluation of health care 263 Structure, process, and outcome evaluation 266 Structure evaluation 266 Process evaluation 268 Outcome evaluation 270 Summary 272 The care planning process 272 Actual and potential problems 274 Problem solving 275 Additional issues in evaluating the practice of health visiting 275 Summary 280 References 281 Activities for Chapter 7 287 Index 291