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Four levels of health visiting service: Dealing with deprivation and domestic abuse, Stockport

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The new health visiting service model offers both universal support and more targeted support, depending on the needs of the family. In cases of domestic abuse, health visitors often help give targeted services to families, and can be a key link between the family and other services. Below is one such anonymised story from Stockport.

One mother first met a health visitor 11 days after the birth of her first child in February 2012. As well as the new birth visit, the family received brief some support for feeding, 6 – 8 week check, weaning contact, 4 month contact and finally the 8 – 12 month contact. At all of these contacts, there were no concerns – the parents’ engagement was good and the child’s development seemed fine. On the surface this family were meeting the needs of their child and so there was no reason for further input at this time.

The arrival of the couple’s second child in March 2013 instigated our involvement with the family once again. A new birth visit was conducted on day 12 and again, all seemed well. The parents seemed tired but this was to be expected as the children were only 13 months apart in age. Following this visit the family were seen a further two times at home and there were no concerns regarding health or wellbeing.

In October 2013 (4 months after the last home visit) a referral came through via the police domestic violence unit. They had attended the property the day before and felt that mum was struggling with the children. She was unable to leave the house and after this referral, was assigned a new health visitor. This referral and the concerns that were to precede it highlight the imperativeness or effective interagency working. When I went to the property four days after the referral it was clear that there was a multitude of concerns and the situation in the household had deteriorated substantially since previous visits.

The elder child was showing signs of developmental delay especially regarding his speech and language. He was also walking on his tip toes and demonstrating behaviours such as head butting the walls.

Mum was suffering from a server anxiety disorder and was unable to carry out normal daily activities which were in turn impacting on the children’s emotional wellbeing. Mum was constantly in a heightened state and would raise her voice and swear in front of the children. She disclosed that she had issues from her past and had had difficulties with her own mother who was a heroin addict (and she was living on the estate where her mum used to buy drugs) meaning she had been unofficially adopted by a neighbour. As a result she was very suspicious of agency involvement.

The younger child was in general well but noted to be confined to her car seat a lot of the time and even when mum was in a highly emotional state the baby didn’t react or get distressed by this.

Dad confessed that he was a heavy cannabis user. His habit was affecting his mental health and he felt he was paranoid at times. He too had a difficult childhood and was now unemployed but wanted to return to work.

The family had very little support from family or friends.

They began a family Common Assessment Framework with a range of planned interventions with full engagement from both parents despite their initial reservations.

Three months into this process there was a domestic violence incident at home. Dad had smashed up the property and was threatening harm towards the mum. This happened whilst the inspire worker was present. She was very fearful and rightfully called the police due the serious nature of the incident. The children didn’t react to the shouting and weren’t upset or frightened leading to concerns that they were well adapted to living in a chaotic household.

The children were taken into care for 6 months and during this time were seen by a health visitor and the early attachment service. I ensured that health needs were met especially with the older child. The younger child’s development was also assessed and was age appropriate. The children were settled in their placement and had contact four times a week with their parents. Both parents engaged fully with the process and sought the help they both required.

The children returned to the family home in September 2014 on a child protection plan under the category of neglect. Work began with the family and has been heavily focusing on attachment. Maureen (specialist attachment service) is working with the whole family rather than concentrating on one specific relationship. The children came off a plan in February and continue to receive support.

The family have made significant progress and the work that has been done has significantly improved the outcomes for all of them. The life story for the two children would have been very different without intervention and this is the difference health visitors can make when they work in partnership with other parts of the system.

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