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Making a difference for children and young people (5-19) – the 4-5-6 model and high impact areas by Wendy Nicholson

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Wendy Nicholson finalDuring this week of week of action (#health5-19), we will be focussing on the key issues relating to the health and wellbeing of children and young people aged 5 to 19. This stage of the life course poses many challenges and indeed opportunities with can affect health, wellbeing and more long term life chances. We know school nurses as leaders of the healthy child programme can and do make a difference to health and wellbeing to school-aged children, we also know their role is complex and covers so many inter-related issues. School nurses often tell us they are stretched and pulled in many directions, so building on the health visitor high impact areas we have worked with school nurses and key partners to develop an integrated 4-5-6 model spanning 0-19 years and specifically identifying 6 High Impact Areas to focus on for school-aged children.

The high impact areas provide an opportunity for school nurses to focus their efforts on the areas where they can make the biggest difference and include:

  • Resilience and wellbeing
  • Keeping safe
  • Healthy lifestyles
  • Learning and achieving
  • Supporting complex and additional health needs
  • transition

School nurses have been central to the development of the high impact areas. Jane and Maggie as our PHE school nurse advisers were very involved in the development process and offer their thoughts.

Jane Levers, Professional Lead for School Nursing Southern Health NHS Foundation Trust

The 6 School-aged High Impact areas complement the existing Health Visiting High Impact Areas and will help School Nurses deliver the Healthy Child Programme 5-19.

They will enable School Nurses and commissioners to focus on health priorities that will make a difference to children and young people and on evidence driven interventions to improve outcomes.



Maggie Clarke, Assistant Director Healthy Child Programme Compass

The HIA will keep the school nurse team focused on what to deliver and when, giving clarity and purpose. Helping to concentrate on where our energies are best applied.

They will help to clearly articulate our offer to partners and other stakeholders. They are a simple way to explain what we are trying to achieve and opportunities for joined up working; which is vital to improve outcomes for our children and young people with limited resources.

They will help school nurses deliver best and most appropriate practice and assist teams with resource allocation. I am really proud and happy to have played a small part in their creation and know that the school nurses will find them a positive addition to their toolbox.


During this week of action we are taking the opportunity to focus on the high impact areas, highlighting how school nurses and key partners including education, social care, voluntary sector and importantly children, young people and families can work together to improve health and wellbeing. We will be publishing a number of new resources and tools during the week – many of which have been co-produced with young people so do look out for them and take the time to see how you could use these in your role.

Developing the new 6 High Impact Areas for school-aged children, also provided an opportunity to refresh the early years high impact areas and to develop an infographic illustrating the role of health visitors and school nurses in providing seamless support 0-19yrs.


Access the 456 model as a pdf

Partnership working is crucial to seamless support and effective local delivery, so we will be featuring a number of guest blogs; all of which will relate to the high impact areas and provide an insight into how we can make a difference and understand each other’s world - a real chance to explore challenges and opportunities together.

We hope you are able to join the week and share your experience and ideas – you can tweet using #Health5to19 and join our Twitter chat on Tuesday evening at 8pm.  Watch out for exciting blogs, new published resources and wise words from young people to help guide us.  Enjoy!

Wendy Nicholson, Lead Nurse for Children and Young People, Public Health England

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