Supporting the case for ‘progressive universalism’ in health visiting: Scottish mothers and health visitors’ perspectives on targeting and rationing health visiting services, with a focus on the Lothian Child Concern Model

Abstract

To explore parents and professionals' experience of family assessment in health visiting (public health nursing), with a focus on the Lothian Child Concern Model. Health visitors currently assess families as requiring core, additional or intensive support, and offer support at a corresponding level. The majority of families are assessed as core and receive no pro-active support beyond the early days. Previous assessment tools, consisting of checklists, have been criticised as being ineffective in identifying a range of health needs and unacceptable to parents and health visitors. The Lothian Child Concern Model was developed and introduced in the study area to promote a partnership approach with parents and assess strengths as well as difficulties in parents' capacity to care for their child. Qualitative methods were used. Ten mothers and 12 health visitors took part in individual semi-structured interviews. Most mothers were aware of the assessment process but some felt that they were not involved in the decision-making process. Explaining the assessment process to parents is problematic and not all health visitors do so. The assessment process was stressful for some mothers. Health visitors find the model useful for structuring and documenting the assessment process. Many believe that most families benefit from some support, using public health approaches. Health visitors said that families are often assessed as core because there are insufficient resources to support all those who meet the criteria of the additional category and that managers assess caseloads in terms of families with child protection concerns. The study findings significant the concept of 'progressive universalism' that provides a continuum that intensity of support to families, depending on need. Mothers would like better partnership working with health visitors. The study endorses proposed policy changes to re-establish the public health role of health visitors and to lower the threshold for families to qualify for support.