Implementing the Solihull Approach in Health Visiting to Improve Outcomes for Children and families

Picture20Health visitors build a consistent and trusting relationship with parents to help disclosure. The four levels of health visiting service give health visitors the opportunity to give targeted support where this is needed. Here’s one health visitor’s story of working with a family with a very specific need.

Parents may have difficulty expressing or disclosing very sensitive and personal information to professionals because of feelings they experience such as shame, guilt and anger. These feelings may be too painful and overwhelming to deal with alone. Health Visitors build a consistent and trusting relationship with parents to help disclosure. In this case study the name has been changed to protect client confidentiality.

The Health Visitor became aware of Rachel during a routine antenatal contact visit. She was in her early twenties and expecting her second child. She presented as withdrawn and sad, despite being six months pregnant. Rachel also had another child aged 4 who was due to start school. She described him as having behaviour problems (probably ADHD she suggested) and not ready to start school, as he was still in nappies. The Health Visitor offered her further support to help her prepare her older child for school and this was welcomed.

As Rachel developed a relationship with the Health Visitor she began to open up about her history. As a child, Rachel had witnessed parental domestic abuse and been subjected to physical and emotional abuse. This continued through her teenage years and ended when she left home to live with a friend. Rachel soon found herself pregnant and alone. Very soon after her first baby was born Rachel suffered post natal depression. Her baby suffered sub optimal growth, neglect in basic needs and eventually required hospitalisation. Child protection procedures were initiated.

Now six months pregnant with her second child it became clear that Rachel was afraid that history was going to repeat itself. Her partner was struggling to understand her too, he described her as becoming distant and disappointed since finding out about her pregnancy. Rachel said that she had never spoken to anyone about her underlying emotional and mental health needs.

A referral to children’s social care was discussed or if support could be gained through the local Children’s Centre or other services. Rachel would not consent to any of these suggestions as she was fearful of the outcome.

It became clear that Rachel had very low self esteem and no confidence in her own ability to parent. The Health Visitor enabled Rachel to talk about her pregnancy, how she felt about her baby and her expectations of being a mother. This increased Rachel’s ability to reflect on the needs of her baby and prepare for his arrival.

Following the birth, the Health Visitor visited regularly to give an opportunity to discuss feelings about her baby and emotional health. The Health Visitor explained how past events are not always remembered consciously but instead come back as feelings when under stress. By discussing how her baby’s cries made Rachel feel the Health visitor was able to explain how it was the old memories that made Rachel feel she could not cope. The Health Visitor talked about the neurological development of the baby and how the future could be different for a child if their emotional needs are met. Together they made a plan of things to do which would help Rachel to cope at difficult times and discussed her social support, as individuals with low self esteem and self efficacy benefit from just knowing there are others to turn to if needed.

Evidence of an improved relationship between Rachel and her baby began to manifest within the next few months. The interactions between them felt comfortable to observe and Rachel began to speak with love about her child. The Health visitor continued to visit during the times of the child’s developmental transitions such as weaning, toileting and sleeping as these are the stages which are known to be connected to a parents emotional functioning. As Rachel’s belief in herself increased so did her ability to cope with difficult emotions. Rachel was observed to be interacting more positively with her baby and feeling more confident about her parenting ability

Rachel was initially full of doubt and uncertainty about her pregnancy, yet a positive outcome was made for this family which avoided the costly involvement of safeguarding service. Having the Solihull model as a training resource and good supervision underpinning practice supported the Health Visitor to gain this outcome.

Rachel’s baby at two years old has reached his developmental milestones and is thriving and interactive; his speech is developing well, potty training has begun and he is accessing a 2 year funded nursery place. The areas of practice discussed in this case study support several of the high impact areas that now underpin health visiting practice, including the transition to parenthood, perinatal mental health and school readiness.

The author of this blog is a health visitor at Harrogate and District Foundation Trust

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