Quality statement 1: Identifying risk

Quality statement

Parents and carers of children under 5 have a discussion during each of the 5 key contacts about factors that may pose a risk to their child's social and emotional wellbeing.

Rationale

If factors that may pose a risk to a child's social and emotional wellbeing are identified during these key face-to-face contacts, early action can be taken to prevent or reduce the potential impact on the child. Factors that may pose a risk can be identified by using a validated tool.

Poor social and emotional wellbeing in young children can lead to behaviour and developmental problems and, later in childhood, severe depression, anxiety, self‑harm and other poor mental health outcomes.

Quality measures

Structure

Evidence of local arrangements to ensure that parents of children under 5 have a discussion during each of the 5 key contacts about factors that may pose a risk to their child's social and emotional wellbeing.

Data source: Local data collection. This can include the NHS England Health visitors service delivery metrics.

Process

a) Proportion of parents and carers who have a discussion at the antenatal health visitor appointment about factors that may pose a risk to their child's social and emotional wellbeing.

Numerator – The number in the denominator who have a discussion about factors that may pose a risk to their child's social and emotional wellbeing.

Denominator – The number of parents and carers who are eligible to attend the antenatal health visitor appointment.

Data source: Local data collection and the NHS England Health visitors service delivery metrics.

b) Proportion of parents and carers who have a discussion at the new baby health visitor appointment about factors that may pose a risk to their child's social and emotional wellbeing.

Numerator – The number in the denominator who have a discussion about factors that may pose a risk to their child's social and emotional wellbeing.

Denominator – The number of parents and carers who are eligible to attend the new baby health visitor appointment.

Data source: Local data collection and the NHS England Health visitors service delivery metrics.

c) Proportion of parents and carers who have a discussion at the 6–8 week health visitor appointment about factors that may pose a risk to their child's social and emotional wellbeing.

Numerator – The number in the denominator who have a discussion about factors that may pose a risk to their child's social and emotional wellbeing.

Denominator – The number of parents and carers who are eligible to attend the 6–8 week health visitor appointment.

Data source: Local data collection.

d) Proportion of parents and carers who have a discussion at the 9–12 month developmental review about factors that may pose a risk to their child's social and emotional wellbeing.

Numerator – The number in the denominator who have a discussion about factors that may pose a risk to their child's social and emotional wellbeing.

Denominator – The number of parents and carers who are eligible to attend the 9–12 month developmental review.

Data source: Local data collection and the NHS England Health visitors service delivery metrics.

e) Proportion of parents and carers who have a discussion at the 2–2½ year integrated review about factors that may pose a risk to their child's social and emotional wellbeing.

Numerator – The number in the denominator who have a discussion about factors that may pose a risk to their child's social and emotional wellbeing.

Denominator – The number of parents and carers who are eligible to attend the 2–2½ year integrated review.

Data source: Local data collection and the NHS England Health visitors service delivery metrics.

Outcome

a) Behaviour and developmental difficulties.

Data source: Local data collection.

b) Depression, anxiety, self-harm and other poor mental health outcomes later in childhood.

Data source: Local data collection.

What the quality statement means for service providers, health, public health and social care practitioners, and commissioners

Service providers (such as health visiting services, early years providers and other services involved in providing the 5 key contacts) ensure that local protocols are in place for parents and carers to discuss the factors that pose a risk to their child's social and emotional wellbeing. This offer is made during each of the 5 key contacts.

Health and social care practitioners (such as health visitors, early years practitioners and other practitioners involved in providing the 5 key contacts) ensure that during each of the 5 key contacts they discuss the factors that pose a risk to a child's social and emotional wellbeing with parents and carers.

Commissioners (such as NHS England, clinical commissioning groups and local authorities) ensure that they commission services with local protocols to discuss the factors that pose a risk to a child's social and emotional wellbeing with parents and carers. This offer is made during each of the 5 key contacts.

What the quality statement means for patients, service users and carers

Parents and carers of children aged under 5 can discuss any difficulties they have that could affect their child's development. They have at least 5 appointments with their child's health visiting team when they can talk about this. (In some cases the early years service will be involved in the fifth appointment.) At these appointments the child is also assessed to check their progress.

Source guidance

Definitions of terms used in this quality statement

Discussing factors that may pose a risk

The discussion should be carried out in accordance with local protocols. Use a validated tool, for example, Early Help Assessment or Outcome Star, to identify what help a child and family may need. It could include an interagency assessment to determine if a child has needs that are not being met by universal services, and, if so, deciding how those needs should be met. The discussion should cover the whole family, not just the child, to reduce the need for multiple assessments. Practitioners should work together to assess, plan and support families to prevent problems escalating to the point where statutory intervention becomes necessary.

[Expert opinion]

5 key contacts

These face-to-face contacts are part of the 0–5 Healthy Child Programme. They are carried out by health visitors, but other practitioners may be involved if necessary. Sometimes the last key contact also involves early years practitioners. The contacts are at the following stages:

  • antenatal (around 28 weeks into pregnancy)

  • new baby (10–14 days after the baby's birth)

  • 6–8 weeks

  • 9–12 months developmental review

  • 2–2½ year integrated review.

[Adapted from The universal health reviews – 5 key visits NHS England and expert opinion]

Risks to a child's social and emotional wellbeing

This includes factors that could affect the carers' capacity to provide a loving and nurturing environment. For example, problems with mental health, drug or alcohol misuse and family relationships, or lack of support networks. Signs of problems could include the parent or carer being indifferent, insensitive or harsh towards the child. The child could be withdrawn or unresponsive, showing signs of behavioural problems, delayed speech or poor language and communication skills.

[Adapted from Social and emotional wellbeing: early years (2012) NICE guideline PH40, recommendation 2]

Social wellbeing

A child has good relationships with others and does not have behavioural problems that is, they are not disruptive, violent or a bully.

[Social and emotional wellbeing: early years (2012) NICE guideline PH40, glossary]

Emotional wellbeing

This includes the child being happy and confident, not anxious or depressed and ready for, and able to function well at, school.

[Social and emotional wellbeing: early years (2012) NICE guideline PH40, glossary and expert opinion]

Equality and diversity considerations

There is a risk of stigmatisation when identifying vulnerable children. It is important that practitioners take a non‑judgemental approach when discussing with parents and carers any factors that may pose a risk to their child's social and emotional wellbeing.

Practitioners and local services should ensure that groups who are underserved by, or not in regular contact with, services are contacted and encouraged to attend these 5 key contacts meetings. This could include arranging appointments at children's centres or at home if they feel uncomfortable about, or have difficulty attending clinics.

Practitioners should take into account cultural factors, educational attainment levels and whether English is the child or family's first language when discussing risks with the child's parents and carers, to ensure they understand.