Section 3

Pathways

The emphasis on partnership working within the delivery of the HCP is been based on the premise that the best outcomes for children and families often rely on a multi-professional/organisational approach to care and support. This is supported by the evidence from the Collaborative Children’s Workforce showing that there is no single profession or organisation that can ensure the best outcomes for children and families.

As part of the National Health Visiting programme specific pathway work has been undertaken which covers two partnership pathways to strengthen consistent, seamless support and care for children and families. These pathways cover:

  • Midwives and health visitors working together in pregnancy and early infancy.
  • Health Visiting and the transition of a child and family to school nursing services.

Whilst not the only interface between professional groups and services, this project has also identified these as key partnership interfaces in the child and families lives. Additionally, the interface with Children’s Centre’s across these pathways is a fundamental component of delivering an integrated HCP. Therefore the pathways at these interfaces have been developed to ensure continuity of care and service provision. Figure 4 below provides a diagrammatic view of how the pathway provides this.

Figure 4
Figure 4

Formation of the Pathways

Throughout the development of the Best Practice Pathways the workstreams involved in the project have been clear that the focus is on “What should be done” not what is currently being delivered within the individual provider areas. To this end they have focused on:

  • What evidence exists to support the delivery of particular interventions, programmes or groups.
  • What learning can we take from the HV Early Implementer Sites operating in the East of England and other best practice both locally and nationally.

From this basis the Best Practice Pathways section of the product has delivered the following key areas:

The identification of the specific pathways required to meet the varying needs of children and families reflecting the 3 key components of the HCP model; Universal, Universal Plus, Universal Partnership Plus. Within this work it has been essential that the service offer is described at Universal, Universal Plus and Universal Partnership Plus at the lowest or most specific level possible to reflect the particular needs of the child/family.

In order to achieve this, the project group has developed:

  • A single Universal Pathway covering preconception to 5 years of age and delivers the core elements of the HCP.
  • Eight Universal Plus Pathways & Universal Partnership Plus Pathways
    • Antenatal (Covering the period from Notification of pregnancy to New Birth)
    • Nutritional Healthy Start
    • Parental Mental Health
    • Infant Mental Health
    • Parenting Support
    • Early Childhood Development
    • Vulnerable Families
    • Safeguarding (Remaining 7 covering the period from New Birth to 5 Years old)
Figure 5
Figure 5

Pathway Structure

Having identified the above pathways the range of services/interventions appropriate within each pathway has been mapped according to:

  • The ages and stages identified within the HCP (see figure 6 below)
  • Within the above, and where appropriate, the exact timescales relating to a specific intervention/service delivery.
  • The profession or professions responsible for undertaking/delivering each intervention/service
Figure 6
Figure 6

Note: Within each of the pathway ages and stages, identified above, work has also been undertaken to identify where current Key Performance Indicators (KPI’S) are available and areas where additional KPI’s have been recommended (see Outcomes & Key Performance Indicators section for further detail).

Pathway Use

Each specific pathway builds on, and is additional to, the contents of the universal pathway. The remaining eight pathways have been specifically designed from the themes outlines within the HCP.

It is important to recognise that children’s centres have been commissioned to deliver against a nationally agreed core purpose (see below). In addition there is a clear requirement that the development of services or partnerships within an individual Children’s Centre should be driven by the needs of the local population they serve. Therefore, whilst the following pathways provide a clear indication of the services that are evidence based, the extent to which they are available within a local children’s centre will be dictated by the needs of the local population.

Core purpose of Children’s Centres

  1. Child development & School Readiness
    Supporting personal, social and emotional development, physical development and communication and language from pre-birth to age 5, so children develop as confident and curious learners and are able to take full advantage of the learning opportunities presented to them in school.
  2. Parenting Aspirations and parenting skills
    Building on strengths and supporting aspirations, so that parents and carers are able to give their child the best start in life
  3. Child and family health and life chances
    Promoting good physical health for both children and their family; safeguarding; supporting parents to improve the skills that enable them to access education, training and employment, and addressing risk factors so that children and their families are safe, free from poverty and able to improve their immediate wellbeing and their future life chances.

Implicit within the above is the expectation that, in addition to the provision of services, Children’s centres will provide a local focus and facilities for the delivery of both multi-professional and uni-professional services.

In order to ensure this core purpose is reflected within the pathways all reference to services or interventions related to Children’s centres are followed by a reference back to the above core purpose (i.e. 1, 2 or 3).

Assessment Criteria

Assessing Need

It is important that an integrated system of delivery is supported by a consistent and comprehensive means of identifying the needs of children and families.

The following broad assessment framework follows the ‘Framework for Children in need Assessment Triangle Model’ (DH 2000) and is provided as a guide to the areas for consideration when assessing the needs of children and families.

The three bands within the assessment tool are intended to provide the practitioner with an indication of the level of service, Universal, Universal Plus or Universal Partnership Plus, likely to be required to support the individual child or family.

It should be stressed that the final decision regarding the type and level of intervention required rests with the practitioner using up-to-date information and professional judgement.