Guest guest Posted March 16, 2001 Report Share Posted March 16, 2001 Thak you for this digest . I misseed a great meeting (again). But still I am making soem progress with my proposal and hope it will be ready for submission next week! Best wishes Meeting 15th March RESEARCH SEMINAR 15TH MARCH 2001 27 people present 1. Key speaker: Sir Acheson outlined his now-familiar report about inequalities in health which was commissioned to outline the extent of inequalites and to make recommendations about effective measures that would reduce them Long-standing interest and concern in UK with many reports over decades, but it is near the bottom of the ‘league table’ in terms of inequalities in health in developed countries; only the US is worse. Distinguished between poverty and inequalities; both are significantly damaging to health and need alleviating. Inequalities can be mapped across a gradient; some of the most effective measures to tackle them need to be directed, not at the ‘worst-off’, but at the ‘least well-off’. Improving services/information overall can actually increase widen inequalities, because the better-off respond first to health promotion initiatives. Three of the report’s recommendations were based on particularly strong evidence, all of which are of significance to health visiting: 1. Smoking patterns reflect the ‘gradient effect’ and the way that the better off have responded to health promotion messages, whereas the poorer population (particularly women) continue to smoke in the same proportions as the 1960s, when the harm from smoking was first proven. The report recommended provision of nicotine patches free to help smoking cessation. Announcement on annual ‘no-smoking day’ (the day of the seminar) that the government has now made these available on prescription, so those who do not pay for prescriptions will get them free. 2. Education plays an important part in influencing inequalities in health. In particular, the effects of pre-school education is well evidenced, so the report recommended that children in disadvantaged areas should be able to access education early. The free provision of fruit to young children in school is another key initiative to enhance their health in the long term. 3. Home visiting to pregnant women and mothers of young children (first two years of life) provides an advantage well over and above the effect of seeing the same person in clinics or elsewhere. Very strong evidence, mainly from the US and Canada, of the positive benefits of this service; the report recommended that the role of health visitors should be strengthened in order to carry out this function. Health visitors are the only professionals mentioned anywhere in the report. This last point provoked much discussion, partly because Sir had been given the impression (elsewhere) that health visitors want to move away from the delivery of their service through home visiting. That view was not reflected in those present in the room, shown by a 'straw poll' of 23 to 1, with 3 abstentions, agreeing that frequent home visiting is a 'good thing'! Even so a number of practical difficulties and some solutions were identified: - The sense for practitioners of ‘drowning’ in caseloads if the workload is heavy, which is most likely in deprived areas - The expectation in a number of areas that practitioners should undertake a ‘norm’ of only one or two home visits following birth of a baby, using that level of contact to identify which families need more home visits, inviting the rest to clinic - This contrasts with the reportedly effective experiments where families are offered as many as 26 home visits in two years post-natally, in addition to ante-natal visits. In the successful experiments, visits were carried out by ‘specially trained professionals’. - There is no indication that resources are likely to be increased to enhance home visiting services across the board in the UK, except in Surestart areas which are due to encompass one third of all 0-4s by 2004. This may be sufficient to encompass the ‘worst off and the less well off’. - There is belief that combining home visiting with community development work and efforts directed at changing the environment in which families live may be at least as effective as home visiting: some evidence from evaluation of the US Headstart programme to support this, but no experimental evidence. - Changing roles and intra-organisational allegiances (public health, primary health care etc) as PCTs come on stream. A number of areas of research interest were also flagged up, particularly bearing in mind the current UK service and policy: - What is about home visiting that makes it effective? - What are the skills needed to deliver effective home visiting services? Relevance for education and skillmix teams - What level of home visiting (i.e. number of visits) is needed for it to be effective? - Is home visiting + community outreach more effective and/or cost-effective than home visiting alone?2. Business: research seminar group Discussion about the practicalities of the group and some volunteers to help carry things forward: i. Funding: No response yet from funding proposal sent in November to ESRC. Alternative possibilities to be explored: HDA (Ros Bryar offered to open discussions), PPP (Woody Caan will look out details) Foundation for Nursing Studies (Margaret Buttigieg will enquire). ii. Future meetings: need to arrange meetings ahead of time; next one planned for June/July; June has agreed in principle to be the key speaker ( Cowley to approach her and fix date; Toity Deave will try to arrange a room in Bristol). iii. Networking: would be enhanced if everyone posts a brief resume of their skills and interests on the web/email group. Toity Deave will develop a template to help this. A database of expertise could be used as a resource, e.g. for peer review of proposals, and/or mentoring new researchers. Need to liaise with, e.g. Anne Marie Rafferty and the task-force developing a strategy for nursing, midwifery and health visiting research, with RCN primary care nursing research egroup and with CPHVA research strategy. iv. Web-based developments: ‘’ have the advantage of being free, but the web page is not ‘user-friendly’ and would not be easily identified by an electronic search seeking support for health visiting research. Redsell and Woods will liaise with Marjorie Talbot (who had previously expressed interest in this) to see what developments are feasible/possible. Please will others present comment/correct and add anything if I have missed out? Best wishes Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2001 Report Share Posted March 16, 2001 Thank you for that focused resume , just wanted to add my shock at Sir 's comment that he had not been warmly received by health visitors at a previous encounter, he said he thought it was the professional organisation's annual meeting that he had attended and was left with the impression that health visitors are against home visiting. I keep thinking I must have misheard but if I didn't how brave of him to return to the lions den for a second time! Houston >From: Cowley <sarah@...> >Reply- > " " < > >Subject: Meeting 15th March >Date: Fri, 16 Mar 2001 12:56:21 +0100 > > RESEARCH SEMINAR 15TH MARCH 2001 > >27 people present > >1. Key speaker: > >Sir Acheson outlined his now-familiar report about inequalities >in health which was commissioned to outline the extent of inequalites >and to make recommendations about effective measures that would reduce >them > > > * Long-standing interest and concern in UK with many reports over > decades, but it is near the bottom of the ëleague tableí in terms > of inequalities in health in developed countries; only the US is > worse. > * Distinguished between poverty and inequalities; both are > significantly damaging to health and need alleviating. > Inequalities can be mapped across a gradient; some of the most > effective measures to tackle them need to be directed, not at the > ëworst-offí, but at the ëleast well-offí. > * Improving services/information overall can actually increase widen > inequalities, because the better-off respond first to health > promotion initiatives. > >Three of the reportís recommendations were based on particularly strong >evidence, all of which are of significance to health visiting: > > 1. 1. Smoking patterns reflect the ëgradient effectí and the way that > the better off have responded to health promotion messages, whereas > the poorer population (particularly women) continue to smoke in the > same proportions as the 1960s, when the harm from smoking was first > proven. The report recommended provision of nicotine patches free > to help smoking cessation. Announcement on annual ëno-smoking dayí > (the day of the seminar) that the government has now made these > available on prescription, so those who do not pay for > prescriptions will get them free. > > 1. 2. Education plays an important part in influencing inequalities in > health. In particular, the effects of pre-school education is well > evidenced, so the report recommended that children in disadvantaged > areas should be able to access education early. The free provision > of fruit to young children in school is another key initiative to > enhance their health in the long term. > 2. 3. Home visiting to pregnant women and mothers of young children > (first two years of life) provides an advantage well over and above > the effect of seeing the same person in clinics or elsewhere. Very > strong evidence, mainly from the US and Canada, of the positive > benefits of this service; the report recommended that the role of > health visitors should be strengthened in order to carry out this > function. Health visitors are the only professionals mentioned > anywhere in the report. > >This last point provoked much discussion, partly because Sir had >been given the impression (elsewhere) that health visitors want to move >away from the delivery of their service through home visiting. That >view was not reflected in those present in the room, shown by a 'straw >poll' of 23 to 1, with 3 abstentions, agreeing that frequent home >visiting is a 'good thing'! Even so a number of practical difficulties >and some solutions were identified: > > > - The sense for practitioners of ëdrowningí in caseloads if > the workload is heavy, which is most likely in deprived areas > - The expectation in a number of areas that practitioners > should undertake a ënormí of only one or two home visits > following birth of a baby, using that level of contact to > identify which families need more home visits, inviting the > rest to clinic > - This contrasts with the reportedly effective experiments > where families are offered as many as 26 home visits in two > years post-natally, in addition to ante-natal visits. In the > successful experiments, visits were carried out by ëspecially > trained professionalsí. > - There is no indication that resources are likely to be > increased to enhance home visiting services across the board > in the UK, except in Surestart areas which are due to > encompass one third of all 0-4s by 2004. This may be > sufficient to encompass the ëworst off and the less well offí. > > - There is belief that combining home visiting with community > development work and efforts directed at changing the > environment in which families live may be at least as > effective as home visiting: some evidence from evaluation of > the US Headstart programme to support this, but no > experimental evidence. > - Changing roles and intra-organisational allegiances (public > health, primary health care etc) as PCTs come on stream. > >A number of areas of research interest were also flagged up, >particularly bearing in mind the current UK service and policy: > > - What is about home visiting that makes it effective? > - What are the skills needed to deliver effective home > visiting services? Relevance for education and skillmix teams > > - What level of home visiting (i.e. number of visits) is > needed for it to be effective? > - Is home visiting + community outreach more effective and/or > cost-effective than home visiting alone? > >2. Business: research seminar group > >Discussion about the practicalities of the group and some volunteers to >help carry things forward: > >i. Funding: No response yet from funding proposal sent in November to >ESRC. Alternative possibilities to be explored: HDA (Ros Bryar offered >to open discussions), PPP (Woody Caan will look out details) Foundation >for Nursing Studies (Margaret Buttigieg will enquire). >ii. Future meetings: need to arrange meetings ahead of time; next one >planned for June/July; June has agreed in principle to be the key >speaker ( Cowley to approach her and fix date; Toity Deave will >try to arrange a room in Bristol). >iii. Networking: would be enhanced if everyone posts a brief resume of >their skills and interests on the web/email group. Toity Deave will >develop a template to help this. A database of expertise could be used >as a resource, e.g. for peer review of proposals, and/or mentoring new >researchers. Need to liaise with, e.g. Anne Marie Rafferty and the >task-force developing a strategy for nursing, midwifery and health >visiting research, with RCN primary care nursing research egroup and >with CPHVA research strategy. >iv. Web-based developments: ëí have the advantage of being >free, but the web page is not ëuser-friendlyí and would not be easily >identified by an electronic search seeking support for health visiting >research. Redsell and Woods will liaise with Marjorie >Talbot (who had previously expressed interest in this) to see what >developments are feasible/possible. > >Please will others present comment/correct and add anything if I have >missed out? > >Best wishes > > > _________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2001 Report Share Posted March 16, 2001 maybe he thought we were an enlightened lot!!!!!! Thank you for the resume , what a quick turn around! Toity PS The Walk-in Centre has a meeting room for charities etc to use free of charge and they charge normal rated to businesses. If we are a fairly small group. or if you are arranging a meeting for yourselves then you might well find that your local Walk-in Centre has space - to use free of charge. Toity ---------------------- Dr Toity Deave Division of Primary Care University of Bristol Canynge Hall Whiteladies Road Bristol BS8 2PR Tel: 0117 9287215 Fax: 0117 9287340 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2001 Report Share Posted March 16, 2001 Thank you , I really enjoyed the meeting which I thought to be most stimulating. It is great that you are able to offer a resume so quickly after the event. Although I agreed that home visiting is of importance I equally feel that the building of community support networks is of great importance and is as necessary as one to one work in the home. Somehow a balance has to be struck. I know that there is research that shows that the lack of community support and therefore social isolation is bad for health in general but is there research that shows that social support is beneficial? I think that it is significant that the research that Hilton has done shows the benefits of good one-to-one work but the down side was that parents remained socially isolated. When I established a sleep clinic in my previous practice I met with parents and children on a one-to-one basis but once a month all those parents I was seeing individually met together to discuss their similar problems and to encourage each other. There was a great deal of benefit in doing this both for those just starting out on a sleep programme and those who had mastered their problems in terms of building their confidence and self-esteem. They supported each other. I believe that as a health visitor matures in practice she becomes aware of the problems parents are faced with day after day and then seeks to help the community to address these problems by helping them to help themselves. Does that sound a bit trite? Perhaps, but it is not as easy as it sounds as those of you who have tried it know, especially in the light of ever dwindling health visitor numbers. I was sorry that Sir could not see this yesterday and that I could not quote any relevant research to make him think differently. Will there be any relevant research in the 'Sure Start' evaluation to show the benefits of 'strengthening communities' which is one of the 'Sure Start' targets? Perhaps this is something that our members with research expertise can put their minds to. Perhaps too it illustrates the need for research and practice to be linked not only for practitioners needing to implement evidence-based practice but so that we can demonstrate what we feel intuitively is true, is empirically so. I know the trend is to take us off now to do lots of group work but without that one-to-one input there will not be any groups. It is not easy to set up a group and the very best way is through that one-to-one work first. 'Newpin' utilises the skills of parents who have been through their programme to reach out to other mothers to bring them into the centre and into groups and this has been shown to be very effective in engaging women who may be depressed and in difficult circumstances. Sorry I've been going on a bit now but was really stimulated by the seminar yesterday. Thank you, for organising it all. Meeting 15th March RESEARCH SEMINAR 15TH MARCH 2001 27 people present 1. Key speaker: Sir Acheson outlined his now-familiar report about inequalities in health which was commissioned to outline the extent of inequalites and to make recommendations about effective measures that would reduce them Long-standing interest and concern in UK with many reports over decades, but it is near the bottom of the ‘league table’ in terms of inequalities in health in developed countries; only the US is worse. Distinguished between poverty and inequalities; both are significantly damaging to health and need alleviating. Inequalities can be mapped across a gradient; some of the most effective measures to tackle them need to be directed, not at the ‘worst-off’, but at the ‘least well-off’. Improving services/information overall can actually increase widen inequalities, because the better-off respond first to health promotion initiatives. Three of the report’s recommendations were based on particularly strong evidence, all of which are of significance to health visiting: 1. Smoking patterns reflect the ‘gradient effect’ and the way that the better off have responded to health promotion messages, whereas the poorer population (particularly women) continue to smoke in the same proportions as the 1960s, when the harm from smoking was first proven. The report recommended provision of nicotine patches free to help smoking cessation. Announcement on annual ‘no-smoking day’ (the day of the seminar) that the government has now made these available on prescription, so those who do not pay for prescriptions will get them free. 2. Education plays an important part in influencing inequalities in health. In particular, the effects of pre-school education is well evidenced, so the report recommended that children in disadvantaged areas should be able to access education early. The free provision of fruit to young children in school is another key initiative to enhance their health in the long term. 3. Home visiting to pregnant women and mothers of young children (first two years of life) provides an advantage well over and above the effect of seeing the same person in clinics or elsewhere. Very strong evidence, mainly from the US and Canada, of the positive benefits of this service; the report recommended that the role of health visitors should be strengthened in order to carry out this function. Health visitors are the only professionals mentioned anywhere in the report. This last point provoked much discussion, partly because Sir had been given the impression (elsewhere) that health visitors want to move away from the delivery of their service through home visiting. That view was not reflected in those present in the room, shown by a 'straw poll' of 23 to 1, with 3 abstentions, agreeing that frequent home visiting is a 'good thing'! Even so a number of practical difficulties and some solutions were identified: - The sense for practitioners of ‘drowning’ in caseloads if the workload is heavy, which is most likely in deprived areas - The expectation in a number of areas that practitioners should undertake a ‘norm’ of only one or two home visits following birth of a baby, using that level of contact to identify which families need more home visits, inviting the rest to clinic - This contrasts with the reportedly effective experiments where families are offered as many as 26 home visits in two years post-natally, in addition to ante-natal visits. In the successful experiments, visits were carried out by ‘specially trained professionals’. - There is no indication that resources are likely to be increased to enhance home visiting services across the board in the UK, except in Surestart areas which are due to encompass one third of all 0-4s by 2004. This may be sufficient to encompass the ‘worst off and the less well off’. - There is belief that combining home visiting with community development work and efforts directed at changing the environment in which families live may be at least as effective as home visiting: some evidence from evaluation of the US Headstart programme to support this, but no experimental evidence. - Changing roles and intra-organisational allegiances (public health, primary health care etc) as PCTs come on stream. A number of areas of research interest were also flagged up, particularly bearing in mind the current UK service and policy: - What is about home visiting that makes it effective? - What are the skills needed to deliver effective home visiting services? Relevance for education and skillmix teams - What level of home visiting (i.e. number of visits) is needed for it to be effective? - Is home visiting + community outreach more effective and/or cost-effective than home visiting alone?2. Business: research seminar group Discussion about the practicalities of the group and some volunteers to help carry things forward: i. Funding: No response yet from funding proposal sent in November to ESRC. Alternative possibilities to be explored: HDA (Ros Bryar offered to open discussions), PPP (Woody Caan will look out details) Foundation for Nursing Studies (Margaret Buttigieg will enquire). ii. Future meetings: need to arrange meetings ahead of time; next one planned for June/July; June has agreed in principle to be the key speaker ( Cowley to approach her and fix date; Toity Deave will try to arrange a room in Bristol). iii. Networking: would be enhanced if everyone posts a brief resume of their skills and interests on the web/email group. Toity Deave will develop a template to help this. A database of expertise could be used as a resource, e.g. for peer review of proposals, and/or mentoring new researchers. Need to liaise with, e.g. Anne Marie Rafferty and the task-force developing a strategy for nursing, midwifery and health visiting research, with RCN primary care nursing research egroup and with CPHVA research strategy. iv. Web-based developments: ‘’ have the advantage of being free, but the web page is not ‘user-friendly’ and would not be easily identified by an electronic search seeking support for health visiting research. Redsell and Woods will liaise with Marjorie Talbot (who had previously expressed interest in this) to see what developments are feasible/possible. Please will others present comment/correct and add anything if I have missed out? Best wishes Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2001 Report Share Posted March 16, 2001 Thanks ; I enjoyed the afternoon as well. All that you have said rings bells with me. I don't think Sir was intending to be 'unconvinced' about the value of group and community based work; but he is clearly frustrated at what he understood to be a rejection of activities with a very strong evidence base: ie, home visiting. Yes, the US research points to specially trained visitors: either nurses with additional training or child psychologists with additional training. Very little comparative work exists to show if lay visitors could do as well, but what there is suggests they are not so successful. So, thinking of Maureen's quest for 'what skills' for future health visitors; certainly home visiting skills and all that that encompasses: so much more than listening and advising, although those are essential too. Like you, I am pretty certain that we will never win the battle against inequalities and deprivation by doing one-to-one work only; we must be able to do something about the situation in which families live, the structural causes of disadvantage as well and that means some kind fo community outreach work. Yet more skills needed. Can anyone unravel those for Maureen too? But, like Sir , I think we have to have enough scepticism to recognise that this combination home visiting/community outreach has not been evaluated at all, yet alone against home visiting alone or against nothing. That would be a fascinating and important study to undertake. Oh yes, like , I think health visitors need research skills, including statistics even though I can't do them. But how can we fit all of that into 32 weeks? Of course, we are future-gazing, so let us try and think of all the outcomes needed. Sorry, I'm replying to about a dozen messages at once and will confuse the 'threads through! Best wishes Bidmead wrote: Thank you ,I really enjoyed the meeting which I thought to be most stimulating. It is great that you are able to offer a resume so quickly after the event. Although I agreed that home visiting is of importance I equally feel that the building of community support networks is of great importance and is as necessary as one to one work in the home. Somehow a balance has to be struck. I know that there is research that shows that the lack of community support and therefore social isolation is bad for health in general but is there research that shows that social support is beneficial? I think that it is significant that the research that Hilton has done shows the benefits of good one-to-one work but the down side was that parents remained socially isolated. When I established a sleep clinic in my previous practice I met with parents and children on a one-to-one basis but once a month all those parents I was seeing individually met together to discuss their similar problems and to encourage each other. There was a great deal of benefit in doing this both for those just starting out on a sleep programme and those who had mastered their problems in terms of building their confidence and self-esteem. They supported each other. I believe that as a health visitor matures in practice she becomes aware of the problems parents are faced with day after day and then seeks to help the community to address these problems by helping them to help themselves. Does that sound a bit trite? Perhaps, but it is not as easy as it sounds as those of you who have tried it know, especially in the light of ever dwindling health visitor numbers. I was sorry that Sir could not see this yesterday and that I could not quote any relevant research to make him think differently. Will there be any relevant research in the 'Sure Start' evaluation to show the benefits of 'strengthening communities' which is one of the 'Sure Start' targets? Perhaps this is something that our members with research expertise can put their minds to. Perhaps too it illustrates the need for research and practice to be linked not only for practitioners needing to implement evidence-based practice but so that we can demonstrate what we feel intuitively is true, is empirically so. I know the trend is to take us off now to do lots of group work but without that one-to-one input there will not be any groups. It is not easy to set up a group and the very best way is through that one-to-one work first. 'Newpin' utilises the skills of parents who have been through their programme to reach out to other mothers to bring them into the centre and into groups and this has been shown to be very effective in engaging women who may be depressed and in difficult circumstances. Sorry I've been going on a bit now but was really stimulated by the seminar yesterday. Thank you, for organising it all. ----- Original Message ----- From: Cowley Sent: Friday, March 16, 2001 11:56 AM Subject: Meeting 15th March RESEARCH SEMINAR 15TH MARCH 2001 27 people present 1. Key speaker: Sir Acheson outlined his now-familiar report about inequalities in health which was commissioned to outline the extent of inequalites and to make recommendations about effective measures that would reduce them Long-standing interest and concern in UK with many reports over decades, but it is near the bottom of the ‘league table’ in terms of inequalities in health in developed countries; only the US is worse. Distinguished between poverty and inequalities; both are significantly damaging to health and need alleviating. Inequalities can be mapped across a gradient; some of the most effective measures to tackle them need to be directed, not at the ‘worst-off’, but at the ‘least well-off’. Improving services/information overall can actually increase widen inequalities, because the better-off respond first to health promotion initiatives. Three of the report’s recommendations were based on particularly strong evidence, all of which are of significance to health visiting: 1. Smoking patterns reflect the ‘gradient effect’ and the way that the better off have responded to health promotion messages, whereas the poorer population (particularly women) continue to smoke in the same proportions as the 1960s, when the harm from smoking was first proven. The report recommended provision of nicotine patches free to help smoking cessation. Announcement on annual ‘no-smoking day’ (the day of the seminar) that the government has now made these available on prescription, so those who do not pay for prescriptions will get them free. 2. Education plays an important part in influencing inequalities in health. In particular, the effects of pre-school education is well evidenced, so the report recommended that children in disadvantaged areas should be able to access education early. The free provision of fruit to young children in school is another key initiative to enhance their health in the long term. 3. Home visiting to pregnant women and mothers of young children (first two years of life) provides an advantage well over and above the effect of seeing the same person in clinics or elsewhere. Very strong evidence, mainly from the US and Canada, of the positive benefits of this service; the report recommended that the role of health visitors should be strengthened in order to carry out this function. Health visitors are the only professionals mentioned anywhere in the report. This last point provoked much discussion, partly because Sir had been given the impression (elsewhere) that health visitors want to move away from the delivery of their service through home visiting. That view was not reflected in those present in the room, shown by a 'straw poll' of 23 to 1, with 3 abstentions, agreeing that frequent home visiting is a 'good thing'! Even so a number of practical difficulties and some solutions were identified: - The sense for practitioners of ‘drowning’ in caseloads if the workload is heavy, which is most likely in deprived areas - The expectation in a number of areas that practitioners should undertake a ‘norm’ of only one or two home visits following birth of a baby, using that level of contact to identify which families need more home visits, inviting the rest to clinic - This contrasts with the reportedly effective experiments where families are offered as many as 26 home visits in two years post-natally, in addition to ante-natal visits. In the successful experiments, visits were carried out by ‘specially trained professionals’. - There is no indication that resources are likely to be increased to enhance home visiting services across the board in the UK, except in Surestart areas which are due to encompass one third of all 0-4s by 2004. This may be sufficient to encompass the ‘worst off and the less well off’. - There is belief that combining home visiting with community development work and efforts directed at changing the environment in which families live may be at least as effective as home visiting: some evidence from evaluation of the US Headstart programme to support this, but no experimental evidence. - Changing roles and intra-organisational allegiances (public health, primary health care etc) as PCTs come on stream. A number of areas of research interest were also flagged up, particularly bearing in mind the current UK service and policy: - What is about home visiting that makes it effective? - What are the skills needed to deliver effective home visiting services? Relevance for education and skillmix teams - What level of home visiting (i.e. number of visits) is needed for it to be effective? - Is home visiting + community outreach more effective and/or cost-effective than home visiting alone? 2. Business: research seminar group Discussion about the practicalities of the group and some volunteers to help carry things forward: i. Funding: No response yet from funding proposal sent in November to ESRC. Alternative possibilities to be explored: HDA (Ros Bryar offered to open discussions), PPP (Woody Caan will look out details) Foundation for Nursing Studies (Margaret Buttigieg will enquire). ii. Future meetings: need to arrange meetings ahead of time; next one planned for June/July; June has agreed in principle to be the key speaker ( Cowley to approach her and fix date; Toity Deave will try to arrange a room in Bristol). iii. Networking: would be enhanced if everyone posts a brief resume of their skills and interests on the web/email group. Toity Deave will develop a template to help this. A database of expertise could be used as a resource, e.g. for peer review of proposals, and/or mentoring new researchers. Need to liaise with, e.g. Anne Marie Rafferty and the task-force developing a strategy for nursing, midwifery and health visiting research, with RCN primary care nursing research egroup and with CPHVA research strategy. iv. Web-based developments: ‘’ have the advantage of being free, but the web page is not ‘user-friendly’ and would not be easily identified by an electronic search seeking support for health visiting research. Redsell and Woods will liaise with Marjorie Talbot (who had previously expressed interest in this) to see what developments are feasible/possible. Please will others present comment/correct and add anything if I have missed out? Best wishes Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2001 Report Share Posted March 16, 2001 Dear , The swan song of the HEA was the 1999 report 'The influence of social support and social capital on health' - social support really can improve health, although the mechanism of this was unknown in 1999. This morning I went to a talk by UCL research fellow Mai Stafford on her HDA project trying to identify what are the key aspects of community support for health: fascinating project in 250 electoral wards around the UK (mainly London & SE). I think the HDA are also supporting to do a related social capital project at Kings - with several techniques chipping away at this problem I anticipate real progress soon. Best wishes, Woody. > Thank you , > I really enjoyed the meeting which I thought to be most stimulating. It is great that you are able to offer a resume so quickly after the event. > > Although I agreed that home visiting is of importance I equally feel that the building of community support networks is of great importance and is as necessary as one to one work in the home. Somehow a balance has to be struck. I know that there is research that shows that the lack of community support and therefore social isolation is bad for health in general but is there research that shows that social support is beneficial? I think that it is significant that the research that Hilton has done shows the benefits of good one-to-one work but the down side was that parents remained socially isolated. When I established a sleep clinic in my previous practice I met with parents and children on a one-to-one basis but once a month all those parents I was seeing individually met together to discuss their similar problems and to encourage each other. There was a great deal of benefit in doing this both for those just starting out on a sleep programme and those who had mastered their problems in terms of building their confidence and self-esteem. They supported each other. > > I believe that as a health visitor matures in practice she becomes aware of the problems parents are faced with day after day and then seeks to help the community to address these problems by helping them to help themselves. Does that sound a bit trite? Perhaps, but it is not as easy as it sounds as those of you who have tried it know, especially in the light of ever dwindling health visitor numbers. I was sorry that Sir could not see this yesterday and that I could not quote any relevant research to make him think differently. Will there be any relevant research in the 'Sure Start' evaluation to show the benefits of 'strengthening communities' which is one of the 'Sure Start' targets? > > Perhaps this is something that our members with research expertise can put their minds to. Perhaps too it illustrates the need for research and practice to be linked not only for practitioners needing to implement evidence-based practice but so that we can demonstrate what we feel intuitively is true, is empirically so. > > I know the trend is to take us off now to do lots of group work but without that one-to-one input there will not be any groups. It is not easy to set up a group and the very best way is through that one-to-one work first. 'Newpin' utilises the skills of parents who have been through their programme to reach out to other mothers to bring them into the centre and into groups and this has been shown to be very effective in engaging women who may be depressed and in difficult circumstances. > > Sorry I've been going on a bit now but was really stimulated by the seminar yesterday. Thank you, for organising it all. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2001 Report Share Posted March 16, 2001 Meeting 15th March thank you , seems to have been a productive meeting. I appreciate your prompt summaryand shall glady contribute to the website development, Sara Sedsell has been in touch already best wishes Marjorie Marjorie Talbot PhD studentship, informatics School of Health Science University of Wales Swansea RESEARCH SEMINAR 15TH MARCH 2001 27 people present 1. Key speaker: Sir Acheson outlined his now-familiar report about inequalities in health which was commissioned to outline the extent of inequalites and to make recommendations about effective measures that would reduce them Long-standing interest and concern in UK with many reports over decades, but it is near the bottom of the ‘league table’ in terms of inequalities in health in developed countries; only the US is worse. Distinguished between poverty and inequalities; both are significantly damaging to health and need alleviating. Inequalities can be mapped across a gradient; some of the most effective measures to tackle them need to be directed, not at the ‘worst-off’, but at the ‘least well-off’. Improving services/information overall can actually increase widen inequalities, because the better-off respond first to health promotion initiatives. Three of the report’s recommendations were based on particularly strong evidence, all of which are of significance to health visiting: 1. Smoking patterns reflect the ‘gradient effect’ and the way that the better off have responded to health promotion messages, whereas the poorer population (particularly women) continue to smoke in the same proportions as the 1960s, when the harm from smoking was first proven. The report recommended provision of nicotine patches free to help smoking cessation. Announcement on annual ‘no-smoking day’ (the day of the seminar) that the government has now made these available on prescription, so those who do not pay for prescriptions will get them free. 2. Education plays an important part in influencing inequalities in health. In particular, the effects of pre-school education is well evidenced, so the report recommended that children in disadvantaged areas should be able to access education early. The free provision of fruit to young children in school is another key initiative to enhance their health in the long term. 3. Home visiting to pregnant women and mothers of young children (first two years of life) provides an advantage well over and above the effect of seeing the same person in clinics or elsewhere. Very strong evidence, mainly from the US and Canada, of the positive benefits of this service; the report recommended that the role of health visitors should be strengthened in order to carry out this function. Health visitors are the only professionals mentioned anywhere in the report. This last point provoked much discussion, partly because Sir had been given the impression (elsewhere) that health visitors want to move away from the delivery of their service through home visiting. That view was not reflected in those present in the room, shown by a 'straw poll' of 23 to 1, with 3 abstentions, agreeing that frequent home visiting is a 'good thing'! Even so a number of practical difficulties and some solutions were identified: - The sense for practitioners of ‘drowning’ in caseloads if the workload is heavy, which is most likely in deprived areas - The expectation in a number of areas that practitioners should undertake a ‘norm’ of only one or two home visits following birth of a baby, using that level of contact to identify which families need more home visits, inviting the rest to clinic - This contrasts with the reportedly effective experiments where families are offered as many as 26 home visits in two years post-natally, in addition to ante-natal visits. In the successful experiments, visits were carried out by ‘specially trained professionals’. - There is no indication that resources are likely to be increased to enhance home visiting services across the board in the UK, except in Surestart areas which are due to encompass one third of all 0-4s by 2004. This may be sufficient to encompass the ‘worst off and the less well off’. - There is belief that combining home visiting with community development work and efforts directed at changing the environment in which families live may be at least as effective as home visiting: some evidence from evaluation of the US Headstart programme to support this, but no experimental evidence. - Changing roles and intra-organisational allegiances (public health, primary health care etc) as PCTs come on stream. A number of areas of research interest were also flagged up, particularly bearing in mind the current UK service and policy: - What is about home visiting that makes it effective? - What are the skills needed to deliver effective home visiting services? Relevance for education and skillmix teams - What level of home visiting (i.e. number of visits) is needed for it to be effective? - Is home visiting + community outreach more effective and/or cost-effective than home visiting alone?2. Business: research seminar group Discussion about the practicalities of the group and some volunteers to help carry things forward: i. Funding: No response yet from funding proposal sent in November to ESRC. Alternative possibilities to be explored: HDA (Ros Bryar offered to open discussions), PPP (Woody Caan will look out details) Foundation for Nursing Studies (Margaret Buttigieg will enquire). ii. Future meetings: need to arrange meetings ahead of time; next one planned for June/July; June has agreed in principle to be the key speaker ( Cowley to approach her and fix date; Toity Deave will try to arrange a room in Bristol). iii. Networking: would be enhanced if everyone posts a brief resume of their skills and interests on the web/email group. Toity Deave will develop a template to help this. A database of expertise could be used as a resource, e.g. for peer review of proposals, and/or mentoring new researchers. Need to liaise with, e.g. Anne Marie Rafferty and the task-force developing a strategy for nursing, midwifery and health visiting research, with RCN primary care nursing research egroup and with CPHVA research strategy. iv. Web-based developments: ‘’ have the advantage of being free, but the web page is not ‘user-friendly’ and would not be easily identified by an electronic search seeking support for health visiting research. Redsell and Woods will liaise with Marjorie Talbot (who had previously expressed interest in this) to see what developments are feasible/possible. Please will others present comment/correct and add anything if I have missed out? Best wishes Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 17, 2001 Report Share Posted March 17, 2001 , thanks for your prompt and comprehensive report - the meeting sounded most interesting and I'm sorry I missed it. Regards, June Quote Link to comment Share on other sites More sharing options...
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