Re: Urgent help and info needed for Ed Select Committee on Wednesday

[Guest guest]

Thanks Ann

Best wishesMaggie

Urgent help and info needed for Ed Select Committee on Wednesday [1 Attachment]

[Attachment(s) from Maggie Fisher included below]

Dear All

I would really appreciate some help as I have now been given an idea today of the questions I will be asked by the Education Select Committee next Wednesday morning. This is a one off session on Health Visions and school readiness.

The first issue is quite contentious as the very wording school readiness is seen by many as a pedagogical swear word and I will be asked to give health’s perception on what we understand by this. I know Marmot, and Tickell all discuss school readiness in their reviews but I want to convey the essence of what we as HVs understand by this. I would really like other views on this

Apparently the committee will ask why the SE is so badly off for HVs and for spending least on child health. They have looked at the FPI reports on this and London and the SE ore in the top 10 and the DH figures reveal the SE and London being particularly poor. Any help with this would be welcome. They will also want to know why some children are not being picked up by either health or early years. What do HVs think of the suggested measures of life chance indicators that Field proposed at 3 years and do any HVs use these or do any of you have experience of using them, I know very few of us do any type of formal review at 3 years? See attached pages Annexe 1 pages 95-96

For the child: British Ability Scales (in particular the naming vocabulary and picture similarities sub-scales)

Bracken School Readiness Assessment

Strengths and Difficulties Questionnaire for three to four year olds

Height and weight to calculate BMI

For the parent: Home Learning Index from the Effective Provision of Pre-School Education (EPPE) study

Short Form 12 or Kessler 6 for maternal mental health

Pianta child-parent relationship scale Millennium Cohort Study authoritative parenting measures

Environment Early Childhood Environment Rating Scale (ECERS)

What are the professions views on the Tickell recommendations of an integrated review see below?

Graham recently published his recommendations for better, earlier, identification of those children who are most vulnerable to the effects of deprivation and dysfunction. Graham made a compelling case for investment in early intervention to prevent these children becoming adults struggling to participate in mainstream society. In his review on poverty and life chances, Field offered recommendations aimed at raising the status of the early years and intervening early to tackle issues at their roots. There are several points of agreement between our approaches, and I believe this early years summary of development will help early years and health professionals to work together more effectively. Only through professionals working together in this collaborative way, can the full benefits of early intervention be achieved. However, the full benefits of this way of working will only be realised when the Healthy Child Programme 2 year health and development review becomes 100% universal. At this point, I urge local commissioners to increase coverage of the Healthy Child Programme and I recommend strongly that the Government works with experts and services to test the feasibility of a single integrated review at age 2 to 2½.

For those children who are already in early years provision before their Healthy Child Programme health and development review, this review provides an excellent opportunity for early years practitioners to share with health visitors the picture they have formed, through ongoing regular observation, of children’s development. This is particularly relevant in the context of the Government’s free offer for disadvantaged 2-year-olds.Where a child may need extra help, early years practitioners are then well-placed to work with health visitors to intensify the support they provide to children as part of the Healthy Child Programme health and development review. Such early intervention should help to reduce significantly the proportion of children who are school unready.

22 Equipped for life, ready for school

3.14 There are other ways in which this information could be used to guide children’s ongoing development – for example, to support the transition between early years settings, such as between a childminder and a nursery class. For those children who haven’t been in early years care before, health visitors could, if needed, liaise with the early years setting to ensure appropriate support is provided. Where children move from one type of early years care to another, the rich information already gathered should be shared to provide smooth support for ongoing development. 3.15 Therefore, I recommend that the EYFS should include a requirement for practitioners, including childminders, to provide on request to parents and carers, at some point between the ages of 24 – 36 months, a short written early years summary of their child’s development in the prime areas. The purpose of this early years summary should be to inform parents and carers about their child’s level of development, and to support – if the timing is right – the Healthy Child Programme health and development review carried out by health visitors, as well as transition to nursery provision at age 3.The early years summary should be based around the overlap between the core areas of the 2 year health and development review and the prime areas I have set out above. It should capture the relevant professional knowledge that early years practitioners have developed about each child that they support. Parents and carers should be involved at all stages, and should have control over who the information contained in the early years summary is passed to

They will be asking about the 2 – 2,5 year review and thank you to all of those who have given me information on this already.

Final question on this how many of you have access to the validated tools that are used to support the 2 year review in Appendix A? Many of these are under licence and have to be purchased by the PCT so I know anecdotally that many practitioners are not able to use them because of this. I would love examples.

There will be question on children’s centres but I feel equipped to deal with this. (Brave last words)f

Best wishesMaggie

[Guest guest]

Can you give us clue about how it sheds light, please Ann?On 18 Jun 2011, at 10:15, ann ebeid wrote:Hi Maggie-re. Question3. my Ph.D thesis "explored the problems of hard to reach families and children in need and how they were supported by their helth visitors" (2008). It is freely available on line from Ethos at the British library and may throw some light to answer part of Q3. Kind regardsDr. Ann Ebeid ;@smtp140.mail.mud.From: mfisher2241@...Date: Thu, 16 Jun 2011 21:10:57 +0100Subject: Urgent help and info needed for Ed Select Committee on Wednesday [1 Attachment] [Attachment(s) from Maggie Fisher included below]Dear AllI would really appreciate some help as I have now been given an idea today of the questions I will be asked by the Education Select Committee next Wednesday morning. This is a one off session on Health Visions and school readiness.The first issue is quite contentious as the very wording school readiness is seen by many as a pedagogical swear word and I will be asked to give health’s perception on what we understand by this. I know Marmot, and Tickell all discuss school readiness in their reviews but I want to convey the essence of what we as HVs understand by this. I would really like other views on thisApparently the committee will ask why the SE is so badly off for HVs and for spending least on child health. They have looked at the FPI reports on this and London and the SE ore in the top 10 and the DH figures reveal the SE and London being particularly poor. Any help with this would be welcome.They will also want to know why some children are not being picked up by either health or early years.What do HVs think of the suggested measures of life chance indicators that Field proposed at 3 years and do any HVs use these or do any of you have experience of using them, I know very few of us do any type of formal review at 3 years? See attached pages Annexe 1 pages 95-96For the child: British Ability Scales (in particular the naming vocabulary and picture similarities sub-scales)Bracken School Readiness AssessmentStrengths and Difficulties Questionnaire for three to four year oldsHeight and weight to calculate BMIFor the parent: Home Learning Index from the Effective Provision of Pre-School Education (EPPE) studyShort Form 12 or Kessler 6 for maternal mental healthPianta child-parent relationship scale Millennium Cohort Study authoritative parenting measuresEnvironment Early Childhood Environment Rating Scale (ECERS)What are the professions views on the Tickell recommendations of an integrated review see below?Graham recently published his recommendations for better, earlier, identification of those children who are most vulnerable to the effects of deprivation and dysfunction. Graham made a compelling case for investment in early intervention to prevent these children becoming adults struggling to participate in mainstream society. In his review on poverty and life chances, Field offered recommendations aimed at raising the status of the early years and intervening early to tackle issues at their roots. There are several points of agreement between our approaches, and I believe this early years summary of development will help early years and health professionals to work together more effectively. Only through professionals working together in this collaborative way, can the full benefits of early intervention be achieved. However, the full benefits of this way of working will only be realised when the Healthy Child Programme 2 year health and development review becomes 100% universal. At this point, I urge local commissioners to increase coverage of the Healthy Child Programme and I recommend strongly that the Government works with experts and services to test the feasibility of a single integrated review at age 2 to 2½. For those children who are already in early years provision before their Healthy Child Programme health and development review, this review provides an excellent opportunity for early years practitioners to share with health visitors the picture they have formed, through ongoing regular observation, of children’s development. This is particularly relevant in the context of the Government’s free offer for disadvantaged 2-year-olds.Where a child may need extra help, early years practitioners are then well-placed to work with health visitors to intensify the support they provide to children as part of the Healthy Child Programme health and development review. Such early intervention should help to reduce significantly the proportion of children who are school unready. 22 Equipped for life, ready for school3.14 There are other ways in which this information could be used to guide children’s ongoing development – for example, to support the transition between early years settings, such as between a childminder and a nursery class. For those children who haven’t been in early years care before, health visitors could, if needed, liaise with the early years setting to ensure appropriate support is provided. Where children move from one type of early years care to another, the rich information already gathered should be shared to provide smooth support for ongoing development. 3.15 Therefore, I recommend that the EYFS should include a requirement for practitioners, including childminders, to provide on request to parents and carers, at some point between the ages of 24 – 36 months, a short written early years summary of their child’s development in the prime areas. The purpose of this early years summary should be to inform parents and carers about their child’s level of development, and to support – if the timing is right – the Healthy Child Programme health and development review carried out by health visitors, as well as transition to nursery provision at age 3.The early years summary should be based around the overlap between the core areas of the 2 year health and development review and the prime areas I have set out above. It should capture the relevant professional knowledge that early years practitioners have developed about each child that they support. Parents and carers should be involved at all stages, and should have control over who the information contained in the early years summary is passed toThey will be asking about the 2 – 2,5 year review and thank you to all of those who have given me information on this already.Final question on this how many of you have access to the validated tools that are used to support the 2 year review in Appendix A? Many of these are under licence and have to be purchased by the PCT so I know anecdotally that many practitioners are not able to use them because of this. I would love examples.There will be question on children’s centres but I feel equipped to deal with this. (Brave last words)fBest wishesMaggie Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn

[Guest guest]

Hi -briefly....

I had been a hv for over two decades in London and Surrey and was puzzled why some families I visited didn't seem to have benefitted from health visitor services in terms of health outcomes, quality of life and reducing health inequalities.

I decided to interview hard to reach mothers and chiildren in need and compare their stories with their health visitor's understanding of the situation.My research was mixed methods; narrative interpretation of case studies.

My findings pertinent to Maggie's Q3 below are:

I interviewed (through taped conversation, grounded theory analysis) mothers who were identified by their health visitors, in order to understand how they perceived their problems and needs and how they felt they had been supported by their health visitors. I used corresponding documentary evidence where possible. I validated my report with mother to make sure it accurately represented what she meant. I then interviewed their health visitor and validated my report with the health visitor to ascertainthat I accurately represented their view

I critically analysed/deconstructed mothers and health visitors narratives in biopschsocial frameworks, also analysing health visitors knowledge in use.

My findings were that in general health visitors did not link families into available community resources which would have promoted child health and improved health outcomes. In effect, I found little evidence of one of the four guiding principles of health visiting. (CETHV1977). Health visitors I interviewed did not have a good understanding of a public health approach in child health promotion, for example there was little evidence that health visitors linked vulnerable families into community initiatives such as Sure Start children's centres, Extended Schools breakfast and tea clubs. There was almost a scenario of 'paralysis by analysis' -when need was identified I could find little evidence of linkage to resources.

For me this is one main reasons why vulnerable children are not picked up.Unlike Early Year setting health visitors have unique access into homes and are aware of family situations.

I hope this brief view of my research is insightful to Maggie, in prepartation for next Wednesday's meeting. I am happy to give a full summary if needed.

Kind Regards,

Ann.

From: sarahcowley183@...Date: Sat, 18 Jun 2011 20:53:11 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

Can you give us clue about how it sheds light, please Ann?

On 18 Jun 2011, at 10:15, ann ebeid wrote:

Hi Maggie-re. Question3. my Ph.D thesis "explored the problems of hard to reach families and children in need and how they were supported by their helth visitors" (2008). It is freely available on line from Ethos at the British library and may throw some light to answer part of Q3. Kind regardsDr. Ann Ebeid

;@smtp140.mail.mud.From: mfisher2241@...Date: Thu, 16 Jun 2011 21:10:57 +0100Subject: Urgent help and info needed for Ed Select Committee on Wednesday [1 Attachment]

[Attachment(s) from Maggie Fisher included below]

Dear All

I would really appreciate some help as I have now been given an idea today of the questions I will be asked by the Education Select Committee next Wednesday morning. This is a one off session on Health Visions and school readiness.

The first issue is quite contentious as the very wording school readiness is seen by many as a pedagogical swear word and I will be asked to give health’s perception on what we understand by this. I know Marmot, and Tickell all discuss school readiness in their reviews but I want to convey the essence of what we as HVs understand by this. I would really like other views on this

Apparently the committee will ask why the SE is so badly off for HVs and for spending least on child health. They have looked at the FPI reports on this and London and the SE ore in the top 10 and the DH figures reveal the SE and London being particularly poor. Any help with this would be welcome.

They will also want to know why some children are not being picked up by either health or early years.

What do HVs think of the suggested measures of life chance indicators that Field proposed at 3 years and do any HVs use these or do any of you have experience of using them, I know very few of us do any type of formal review at 3 years? See attached pages Annexe 1 pages 95-96

For the child: British Ability Scales (in particular the naming vocabulary and picture similarities sub-scales)

Bracken School Readiness Assessment

Strengths and Difficulties Questionnaire for three to four year olds

Height and weight to calculate BMI

For the parent: Home Learning Index from the Effective Provision of Pre-School Education (EPPE) study

Short Form 12 or Kessler 6 for maternal mental health

Pianta child-parent relationship scale Millennium Cohort Study authoritative parenting measures

Environment Early Childhood Environment Rating Scale (ECERS)

What are the professions views on the Tickell recommendations of an integrated review see below?

Graham recently published his recommendations for better, earlier, identification of those children who are most vulnerable to the effects of deprivation and dysfunction. Graham made a compelling case for investment in early intervention to prevent these children becoming adults struggling to participate in mainstream society. In his review on poverty and life chances, Field offered recommendations aimed at raising the status of the early years and intervening early to tackle issues at their roots. There are several points of agreement between our approaches, and I believe this early years summary of development will help early years and health professionals to work together more effectively. Only through professionals working together in this collaborative way, can the full benefits of early intervention be achieved. However, the full benefits of this way of working will only be realised when the Healthy Child Programme 2 year health and development review becomes 100% universal. At this point, I urge local commissioners to increase coverage of the Healthy Child Programme and I recommend strongly that the Government works with experts and services to test the feasibility of a single integrated review at age 2 to 2½.

For those children who are already in early years provision before their Healthy Child Programme health and development review, this review provides an excellent opportunity for early years practitioners to share with health visitors the picture they have formed, through ongoing regular observation, of children’s development. This is particularly relevant in the context of the Government’s free offer for disadvantaged 2-year-olds.Where a child may need extra help, early years practitioners are then well-placed to work with health visitors to intensify the support they provide to children as part of the Healthy Child Programme health and development review. Such early intervention should help to reduce significantly the proportion of children who are school unready.

22 Equipped for life, ready for school

3.14 There are other ways in which this information could be used to guide children’s ongoing development – for example, to support the transition between early years settings, such as between a childminder and a nursery class. For those children who haven’t been in early years care before, health visitors could, if needed, liaise with the early years setting to ensure appropriate support is provided. Where children move from one type of early years care to another, the rich information already gathered should be shared to provide smooth support for ongoing development. 3.15 Therefore, I recommend that the EYFS should include a requirement for practitioners, including childminders, to provide on request to parents and carers, at some point between the ages of 24 – 36 months, a short written early years summary of their child’s development in the prime areas. The purpose of this early years summary should be to inform parents and carers about their child’s level of development, and to support – if the timing is right – the Healthy Child Programme health and development review carried out by health visitors, as well as transition to nursery provision at age 3.The early years summary should be based around the overlap between the core areas of the 2 year health and development review and the prime areas I have set out above. It should capture the relevant professional knowledge that early years practitioners have developed about each child that they support. Parents and carers should be involved at all stages, and should have control over who the information contained in the early years summary is passed to

They will be asking about the 2 – 2,5 year review and thank you to all of those who have given me information on this already.

Final question on this how many of you have access to the validated tools that are used to support the 2 year review in Appendix A? Many of these are under licence and have to be purchased by the PCT so I know anecdotally that many practitioners are not able to use them because of this. I would love examples.

There will be question on children’s centres but I feel equipped to deal with this. (Brave last words)f

Best wishesMaggie

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

[Guest guest]

Hi Ann

That is very interesting and very helpful if rather alarming. A full summmary if you have one would be most useful. Time is not on my side as I have a day job to do!!!!!

What size caseloads did the HVs have and how often did the HVs visit?

I have registered with BL and Ethos but thesis's are not available to download immmediatley but take 30 days, so wil not be able to access before I give evidence

Best wishesMaggie

Urgent help and info needed for Ed Select Committee on Wednesday [1 Attachment]

[Attachment(s) from Maggie Fisher included below]

Dear All

I would really appreciate some help as I have now been given an idea today of the questions I will be asked by the Education Select Committee next Wednesday morning. This is a one off session on Health Visions and school readiness.

The first issue is quite contentious as the very wording school readiness is seen by many as a pedagogical swear word and I will be asked to give health’s perception on what we understand by this. I know Marmot, and Tickell all discuss school readiness in their reviews but I want to convey the essence of what we as HVs understand by this. I would really like other views on this Apparently the committee will ask why the SE is so badly off for HVs and for spending least on child health. They have looked at the FPI reports on this and London and the SE ore in the top 10 and the DH figures reveal the SE and London being particularly poor. Any help with this would be welcome. They will also want to know why some children are not being picked up by either health or early years. What do HVs think of the suggested measures of life chance indicators that Field proposed at 3 years and do any HVs use these or do any of you have experience of using them, I know very few of us do any type of formal review at 3 years? See attached pages Annexe 1 pages 95-96

For the child: British Ability Scales (in particular the naming vocabulary and picture similarities sub-scales)

Bracken School Readiness Assessment

Strengths and Difficulties Questionnaire for three to four year olds

Height and weight to calculate BMI

For the parent: Home Learning Index from the Effective Provision of Pre-School Education (EPPE) study

Short Form 12 or Kessler 6 for maternal mental health

Pianta child-parent relationship scale Millennium Cohort Study authoritative parenting measures

Environment Early Childhood Environment Rating Scale (ECERS)

What are the professions views on the Tickell recommendations of an integrated review see below?

Graham recently published his recommendations for better, earlier, identification of those children who are most vulnerable to the effects of deprivation and dysfunction. Graham made a compelling case for investment in early intervention to prevent these children becoming adults struggling to participate in mainstream society. In his review on poverty and life chances, Field offered recommendations aimed at raising the status of the early years and intervening early to tackle issues at their roots. There are several points of agreement between our approaches, and I believe this early years summary of development will help early years and health professionals to work together more effectively. Only through professionals working together in this collaborative way, can the full benefits of early intervention be achieved. However, the full benefits of this way of working will only be realised when the Healthy Child Programme 2 year health and development review becomes 100% universal. At this point, I urge local commissioners to increase coverage of the Healthy Child Programme and I recommend strongly that the Government works with experts and services to test the feasibility of a single integrated review at age 2 to 2½.

For those children who are already in early years provision before their Healthy Child Programme health and development review, this review provides an excellent opportunity for early years practitioners to share with health visitors the picture they have formed, through ongoing regular observation, of children’s development. This is particularly relevant in the context of the Government’s free offer for disadvantaged 2-year-olds.Where a child may need extra help, early years practitioners are then well-placed to work with health visitors to intensify the support they provide to children as part of the Healthy Child Programme health and development review. Such early intervention should help to reduce significantly the proportion of children who are school unready.

22 Equipped for life, ready for school

3.14 There are other ways in which this information could be used to guide children’s ongoing development – for example, to support the transition between early years settings, such as between a childminder and a nursery class. For those children who haven’t been in early years care before, health visitors could, if needed, liaise with the early years setting to ensure appropriate support is provided. Where children move from one type of early years care to another, the rich information already gathered should be shared to provide smooth support for ongoing development. 3.15 Therefore, I recommend that the EYFS should include a requirement for practitioners, including childminders, to provide on request to parents and carers, at some point between the ages of 24 – 36 months, a short written early years summary of their child’s development in the prime areas. The purpose of this early years summary should be to inform parents and carers about their child’s level of development, and to support – if the timing is right – the Healthy Child Programme health and development review carried out by health visitors, as well as transition to nursery provision at age 3.The early years summary should be based around the overlap between the core areas of the 2 year health and development review and the prime areas I have set out above. It should capture the relevant professional knowledge that early years practitioners have developed about each child that they support. Parents and carers should be involved at all stages, and should have control over who the information contained in the early years summary is passed to

They will be asking about the 2 – 2,5 year review and thank you to all of those who have given me information on this already.

Final question on this how many of you have access to the validated tools that are used to support the 2 year review in Appendix A? Many of these are under licence and have to be purchased by the PCT so I know anecdotally that many practitioners are not able to use them because of this. I would love examples.

There will be question on children’s centres but I feel equipped to deal with this. (Brave last words)f

Best wishesMaggie

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

[Guest guest]

That is very interesting Ann, if somewhat depressing. Thank you for sharing it with us. Have you written it up anywhere (sorry!)? Were the health visitors aware that they had not linked them into any community resources that might help, or did they not think about it? As I understand it, the government want health visitors to do the form of linking that you describe, which they describe as 'extending the health visiting rile.' I had thought it was what health visitors did anyway. but perhaps they don't do it any longer. I wonder how we can regain control of the education, and would that help? Or is it (as you suggest) to do with the whole emphasis on assessing needs, with no follow through? best wishesOn 19 Jun 2011, at 13:22, ann ebeid wrote:Hi -briefly.... I had been a hv for over two decades in London and Surrey and was puzzled why some families I visited didn't seem to have benefitted from health visitor services in terms of health outcomes, quality of life and reducing health inequalities. I decided to interview hard to reach mothers and chiildren in need and compare their stories with their health visitor's understanding of the situation.My research was mixed methods; narrative interpretation of case studies. My findings pertinent to Maggie's Q3 below are: I interviewed (through taped conversation, grounded theory analysis) mothers who were identified by their health visitors, in order to understand how they perceived their problems and needs and how they felt they had been supported by their health visitors. I used corresponding documentary evidence where possible. I validated my report with mother to make sure it accurately represented what she meant. I then interviewed their health visitor and validated my report with the health visitor to ascertainthat I accurately represented their view I critically analysed/deconstructed mothers and health visitors narratives in biopschsocial frameworks, also analysing health visitors knowledge in use. My findings were that in general health visitors did not link families into available community resources which would have promoted child health and improved health outcomes. In effect, I found little evidence of one of the four guiding principles of health visiting. (CETHV1977). Health visitors I interviewed did not have a good understanding of a public health approach in child health promotion, for example there was little evidence that health visitors linked vulnerable families into community initiatives such as Sure Start children's centres, Extended Schools breakfast and tea clubs. There was almost a scenario of 'paralysis by analysis' -when need was identified I could find little evidence of linkage to resources. For me this is one main reasons why vulnerable children are not picked up.Unlike Early Year setting health visitors have unique access into homes and are aware of family situations. I hope this brief view of my research is insightful to Maggie, in prepartation for next Wednesday's meeting. I am happy to give a full summary if needed. Kind Regards, Ann. From: sarahcowley183@...Date: Sat, 18 Jun 2011 20:53:11 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday Can you give us clue about how it sheds light, please Ann?On 18 Jun 2011, at 10:15, ann ebeid wrote:Hi Maggie-re. Question3. my Ph.D thesis "explored the problems of hard to reach families and children in need and how they were supported by their helth visitors" (2008). It is freely available on line from Ethos at the British library and may throw some light to answer part of Q3. Kind regardsDr. Ann Ebeid Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn

[Guest guest]

Hi Ann

I have managed to download it now. What a great link I had no idea this existed, thank you for sharing.

Best wishesMaggie

Urgent help and info needed for Ed Select Committee on Wednesday [1 Attachment]

[Attachment(s) from Maggie Fisher included below]

Dear All

I would really appreciate some help as I have now been given an idea today of the questions I will be asked by the Education Select Committee next Wednesday morning. This is a one off session on Health Visions and school readiness.

The first issue is quite contentious as the very wording school readiness is seen by many as a pedagogical swear word and I will be asked to give health’s perception on what we understand by this. I know Marmot, and Tickell all discuss school readiness in their reviews but I want to convey the essence of what we as HVs understand by this. I would really like other views on this Apparently the committee will ask why the SE is so badly off for HVs and for spending least on child health. They have looked at the FPI reports on this and London and the SE ore in the top 10 and the DH figures reveal the SE and London being particularly poor. Any help with this would be welcome. They will also want to know why some children are not being picked up by either health or early years. What do HVs think of the suggested measures of life chance indicators that Field proposed at 3 years and do any HVs use these or do any of you have experience of using them, I know very few of us do any type of formal review at 3 years? See attached pages Annexe 1 pages 95-96

For the child: British Ability Scales (in particular the naming vocabulary and picture similarities sub-scales)

Bracken School Readiness Assessment

Strengths and Difficulties Questionnaire for three to four year olds

Height and weight to calculate BMI

For the parent: Home Learning Index from the Effective Provision of Pre-School Education (EPPE) study

Short Form 12 or Kessler 6 for maternal mental health

Pianta child-parent relationship scale Millennium Cohort Study authoritative parenting measures

Environment Early Childhood Environment Rating Scale (ECERS)

What are the professions views on the Tickell recommendations of an integrated review see below?

Graham recently published his recommendations for better, earlier, identification of those children who are most vulnerable to the effects of deprivation and dysfunction. Graham made a compelling case for investment in early intervention to prevent these children becoming adults struggling to participate in mainstream society. In his review on poverty and life chances, Field offered recommendations aimed at raising the status of the early years and intervening early to tackle issues at their roots. There are several points of agreement between our approaches, and I believe this early years summary of development will help early years and health professionals to work together more effectively. Only through professionals working together in this collaborative way, can the full benefits of early intervention be achieved. However, the full benefits of this way of working will only be realised when the Healthy Child Programme 2 year health and development review becomes 100% universal. At this point, I urge local commissioners to increase coverage of the Healthy Child Programme and I recommend strongly that the Government works with experts and services to test the feasibility of a single integrated review at age 2 to 2½.

For those children who are already in early years provision before their Healthy Child Programme health and development review, this review provides an excellent opportunity for early years practitioners to share with health visitors the picture they have formed, through ongoing regular observation, of children’s development. This is particularly relevant in the context of the Government’s free offer for disadvantaged 2-year-olds.Where a child may need extra help, early years practitioners are then well-placed to work with health visitors to intensify the support they provide to children as part of the Healthy Child Programme health and development review. Such early intervention should help to reduce significantly the proportion of children who are school unready.

22 Equipped for life, ready for school

3.14 There are other ways in which this information could be used to guide children’s ongoing development – for example, to support the transition between early years settings, such as between a childminder and a nursery class. For those children who haven’t been in early years care before, health visitors could, if needed, liaise with the early years setting to ensure appropriate support is provided. Where children move from one type of early years care to another, the rich information already gathered should be shared to provide smooth support for ongoing development. 3.15 Therefore, I recommend that the EYFS should include a requirement for practitioners, including childminders, to provide on request to parents and carers, at some point between the ages of 24 – 36 months, a short written early years summary of their child’s development in the prime areas. The purpose of this early years summary should be to inform parents and carers about their child’s level of development, and to support – if the timing is right – the Healthy Child Programme health and development review carried out by health visitors, as well as transition to nursery provision at age 3.The early years summary should be based around the overlap between the core areas of the 2 year health and development review and the prime areas I have set out above. It should capture the relevant professional knowledge that early years practitioners have developed about each child that they support. Parents and carers should be involved at all stages, and should have control over who the information contained in the early years summary is passed to

They will be asking about the 2 – 2,5 year review and thank you to all of those who have given me information on this already.

Final question on this how many of you have access to the validated tools that are used to support the 2 year review in Appendix A? Many of these are under licence and have to be purchased by the PCT so I know anecdotally that many practitioners are not able to use them because of this. I would love examples.

There will be question on children’s centres but I feel equipped to deal with this. (Brave last words)f

Best wishesMaggie

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

[Guest guest]

Hi

in my research some health visitors were not aware of the community resources available to promote children's and family health, similiar to Jane Appleton's study (?)and an earlier study in Wales by June e and Magaret Buttegieg, Which translated into a lot of missed opportunities to improve the health, welfare and life chances of children in need and their families.

June e's (2000?)study found rhetoric rather than a real public health approach in the hv/sn practices that she observed.

In my study health visitors felt they were assessing family health needs and there was good evidence that a few health visitors actually did and made a difference to family health . But equally there was evidence that some health visitors didn't recognise/analyse problems and needs and didn't link the family into appropriate services.Some health visitors lacked a focus on outcomes.

My exploratory research indicated that hv education and training needs were needed 'on the job' -that is more reflective learning from practice was needed - experiential learning from experienced health visitors who are able to critically deconstuct situations and needs in terms of embedded theories/policy AND practical support that health visitors can link in, to help vulnerable families. For me that is a huge challenge because it requires a new way of training future health visitors with equal emphasis not only on the biological, psychological and social deteminants of health but also on health visitors practical know how and experiential knowledge.

Best wishes, Ann.

From: sarahcowley183@...Date: Sun, 19 Jun 2011 19:29:47 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

That is very interesting Ann, if somewhat depressing. Thank you for sharing it with us. Have you written it up anywhere (sorry!)? Were the health visitors aware that they had not linked them into any community resources that might help, or did they not think about it?

As I understand it, the government want health visitors to do the form of linking that you describe, which they describe as 'extending the health visiting rile.' I had thought it was what health visitors did anyway. but perhaps they don't do it any longer. I wonder how we can regain control of the education, and would that help? Or is it (as you suggest) to do with the whole emphasis on assessing needs, with no follow through?

best wishes

On 19 Jun 2011, at 13:22, ann ebeid wrote:

Hi -briefly.... I had been a hv for over two decades in London and Surrey and was puzzled why some families I visited didn't seem to have benefitted from health visitor services in terms of health outcomes, quality of life and reducing health inequalities. I decided to interview hard to reach mothers and chiildren in need and compare their stories with their health visitor's understanding of the situation.My research was mixed methods; narrative interpretation of case studies. My findings pertinent to Maggie's Q3 below are: I interviewed (through taped conversation, grounded theory analysis) mothers who were identified by their health visitors, in order to understand how they perceived their problems and needs and how they felt they had been supported by their health visitors. I used corresponding documentary evidence where possible. I validated my report with mother to make sure it accurately represented what she meant. I then interviewed their health visitor and validated my report with the health visitor to ascertainthat I accurately represented their view I critically analysed/deconstructed mothers and health visitors narratives in biopschsocial frameworks, also analysing health visitors knowledge in use. My findings were that in general health visitors did not link families into available community resources which would have promoted child health and improved health outcomes. In effect, I found little evidence of one of the four guiding principles of health visiting. (CETHV1977). Health visitors I interviewed did not have a good understanding of a public health approach in child health promotion, for example there was little evidence that health visitors linked vulnerable families into community initiatives such as Sure Start children's centres, Extended Schools breakfast and tea clubs. There was almost a scenario of 'paralysis by analysis' -when need was identified I could find little evidence of linkage to resources. For me this is one main reasons why vulnerable children are not picked up.Unlike Early Year setting health visitors have unique access into homes and are aware of family situations. I hope this brief view of my research is insightful to Maggie, in prepartation for next Wednesday's meeting. I am happy to give a full summary if needed. Kind Regards, Ann.

From: sarahcowley183@...Date: Sat, 18 Jun 2011 20:53:11 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

Can you give us clue about how it sheds light, please Ann?

On 18 Jun 2011, at 10:15, ann ebeid wrote:

Hi Maggie-re. Question3. my Ph.D thesis "explored the problems of hard to reach families and children in need and how they were supported by their helth visitors" (2008). It is freely available on line from Ethos at the British library and may throw some light to answer part of Q3. Kind regardsDr. Ann Ebeid

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

[Guest guest]

I am so pleased. Thank you for telling me. Best wishes for Wednesday.

Ann

From: mfisher2241@...Date: Sun, 19 Jun 2011 19:34:52 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

Hi Ann

I have managed to download it now. What a great link I had no idea this existed, thank you for sharing.

Best wishesMaggie

Urgent help and info needed for Ed Select Committee on Wednesday [1 Attachment]

[Attachment(s) from Maggie Fisher included below]

Dear All

I would really appreciate some help as I have now been given an idea today of the questions I will be asked by the Education Select Committee next Wednesday morning. This is a one off session on Health Visions and school readiness.

The first issue is quite contentious as the very wording school readiness is seen by many as a pedagogical swear word and I will be asked to give health’s perception on what we understand by this. I know Marmot, and Tickell all discuss school readiness in their reviews but I want to convey the essence of what we as HVs understand by this. I would really like other views on this Apparently the committee will ask why the SE is so badly off for HVs and for spending least on child health. They have looked at the FPI reports on this and London and the SE ore in the top 10 and the DH figures reveal the SE and London being particularly poor. Any help with this would be welcome. They will also want to know why some children are not being picked up by either health or early years. What do HVs think of the suggested measures of life chance indicators that Field proposed at 3 years and do any HVs use these or do any of you have experience of using them, I know very few of us do any type of formal review at 3 years? See attached pages Annexe 1 pages 95-96

For the child: British Ability Scales (in particular the naming vocabulary and picture similarities sub-scales)

Bracken School Readiness Assessment

Strengths and Difficulties Questionnaire for three to four year olds

Height and weight to calculate BMI

For the parent: Home Learning Index from the Effective Provision of Pre-School Education (EPPE) study

Short Form 12 or Kessler 6 for maternal mental health

Pianta child-parent relationship scale Millennium Cohort Study authoritative parenting measures

Environment Early Childhood Environment Rating Scale (ECERS)

What are the professions views on the Tickell recommendations of an integrated review see below?

Graham recently published his recommendations for better, earlier, identification of those children who are most vulnerable to the effects of deprivation and dysfunction. Graham made a compelling case for investment in early intervention to prevent these children becoming adults struggling to participate in mainstream society. In his review on poverty and life chances, Field offered recommendations aimed at raising the status of the early years and intervening early to tackle issues at their roots. There are several points of agreement between our approaches, and I believe this early years summary of development will help early years and health professionals to work together more effectively. Only through professionals working together in this collaborative way, can the full benefits of early intervention be achieved. However, the full benefits of this way of working will only be realised when the Healthy Child Programme 2 year health and development review becomes 100% universal. At this point, I urge local commissioners to increase coverage of the Healthy Child Programme and I recommend strongly that the Government works with experts and services to test the feasibility of a single integrated review at age 2 to 2½.

For those children who are already in early years provision before their Healthy Child Programme health and development review, this review provides an excellent opportunity for early years practitioners to share with health visitors the picture they have formed, through ongoing regular observation, of children’s development. This is particularly relevant in the context of the Government’s free offer for disadvantaged 2-year-olds.Where a child may need extra help, early years practitioners are then well-placed to work with health visitors to intensify the support they provide to children as part of the Healthy Child Programme health and development review. Such early intervention should help to reduce significantly the proportion of children who are school unready.

22 Equipped for life, ready for school

3.14 There are other ways in which this information could be used to guide children’s ongoing development – for example, to support the transition between early years settings, such as between a childminder and a nursery class. For those children who haven’t been in early years care before, health visitors could, if needed, liaise with the early years setting to ensure appropriate support is provided. Where children move from one type of early years care to another, the rich information already gathered should be shared to provide smooth support for ongoing development. 3.15 Therefore, I recommend that the EYFS should include a requirement for practitioners, including childminders, to provide on request to parents and carers, at some point between the ages of 24 – 36 months, a short written early years summary of their child’s development in the prime areas. The purpose of this early years summary should be to inform parents and carers about their child’s level of development, and to support – if the timing is right – the Healthy Child Programme health and development review carried out by health visitors, as well as transition to nursery provision at age 3.The early years summary should be based around the overlap between the core areas of the 2 year health and development review and the prime areas I have set out above. It should capture the relevant professional knowledge that early years practitioners have developed about each child that they support. Parents and carers should be involved at all stages, and should have control over who the information contained in the early years summary is passed to

They will be asking about the 2 – 2,5 year review and thank you to all of those who have given me information on this already.

Final question on this how many of you have access to the validated tools that are used to support the 2 year review in Appendix A? Many of these are under licence and have to be purchased by the PCT so I know anecdotally that many practitioners are not able to use them because of this. I would love examples.

There will be question on children’s centres but I feel equipped to deal with this. (Brave last words)f

Best wishesMaggie

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

[Guest guest]

Ann,

Amongst GP Trainers and within Pharmacy Practice there is a growing recognition that " signposting " patients and families to appropriate services is an important but neglected area practice.

It seems to me that shared Health Visitor , GP and Pharmacy " in service " reflective practice should be considered .

The Library Service is now going to be offering " Zero to 5 on-line learning opportunities " so the Library Service must also be involved . In some places at least I know that " Library - Health " partnerships are already beginning

to develop . Could HVs help to drive this development?

Best wishes

Malcolm

From: [ ] On Behalf Of ann ebeid [annebeid@...]

Sent: 19 June 2011 21:51

senate hvsn

Subject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Hi

in my research some health visitors were not aware of the community resources available to promote children's and family health, similiar to Jane Appleton's study (?)and an earlier study in Wales by June e and Magaret Buttegieg, Which translated into

a lot of missed opportunities to improve the health, welfare and life chances of children in need and their families.

June e's (2000?)study found rhetoric rather than a real public health approach in the hv/sn practices that she observed.

In my study health visitors felt they were assessing family health needs and there was good evidence that a few health visitors actually did and made a difference to family health . But equally there was evidence that some health visitors didn't recognise/analyse

problems and needs and didn't link the family into appropriate services.Some health visitors lacked a focus on outcomes.

My exploratory research indicated that hv education and training needs were needed 'on the job' -that is more reflective learning from practice was needed - experiential learning from experienced health visitors who are able to critically deconstuct situations

and needs in terms of embedded theories/policy AND practical support that health visitors can link in, to help vulnerable families. For me that is a huge challenge because it requires a new way of training future health visitors with equal emphasis not only

on the biological, psychological and social deteminants of health but also on health visitors practical know how and experiential knowledge.

Best wishes, Ann.

From: sarahcowley183@...

Date: Sun, 19 Jun 2011 19:29:47 +0100

Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

That is very interesting Ann, if somewhat depressing. Thank you for sharing it with us. Have you written it up anywhere (sorry!)? Were the health visitors aware that they had not linked them into any community resources that might help,

or did they not think about it?

As I understand it, the government want health visitors to do the form of linking that you describe, which they describe as 'extending the health visiting rile.' I had thought it was what health visitors did anyway. but perhaps they don't do it any longer.

I wonder how we can regain control of the education, and would that help? Or is it (as you suggest) to do with the whole emphasis on assessing needs, with no follow through?

best wishes

On 19 Jun 2011, at 13:22, ann ebeid wrote:

Hi -briefly....

I had been a hv for over two decades in London and Surrey and was puzzled why some families I visited didn't seem to have benefitted from health visitor services in terms of health outcomes, quality of life and reducing health inequalities.

I decided to interview hard to reach mothers and chiildren in need and compare their stories with their health visitor's understanding of the situation.My research was mixed methods; narrative interpretation of case studies.

My findings pertinent to Maggie's Q3 below are:

I interviewed (through taped conversation, grounded theory analysis) mothers who were identified by their health visitors, in order to understand how they perceived their problems and needs and how they felt they had been supported by their health visitors. I

used corresponding documentary evidence where possible. I validated my report with mother to make sure it accurately represented what she meant. I then interviewed their health visitor and validated my report with the health visitor to ascertainthat I accurately

represented their view

I critically analysed/deconstructed mothers and health visitors narratives in biopschsocial frameworks, also analysing health visitors knowledge in use.

My findings were that in general health visitors did not link families into available community resources which would have promoted child health and improved health outcomes. In effect, I found little evidence of one of the four guiding principles of health

visiting. (CETHV1977). Health visitors I interviewed did not have a good understanding of a public health approach in child health promotion, for example there was little evidence that health visitors linked vulnerable families into community in! ! itiatives

such as Sure Start children's centres, Extended Schools breakfast and tea clubs. There was almost a scenario of 'paralysis by analysis' -when need was identified I could find little evidence of linkage to resources.

For me this is one main reasons why vulnerable children are not picked up.Unlike Early Year setting health visitors have unique access into homes and are aware of family situations.

I hope this brief view of my research is insightful to Maggie, in prepartation for next Wednesday's meeting. I am happy to give a full summary if needed.

Kind Regards,

Ann.

From: sarahcowley183@...

Date: Sat, 18 Jun 2011 20:53:11 +0100

Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

Can you give us clue about how it sheds light, please Ann?

On 18 Jun 2011, at 10:15, ann ebeid wrote:

Hi Maggie-re. Question3.

my Ph.D thesis " explored the problems of hard to reach families and children in need and how they were supported by their helth visitors " (2008). It is freely available on line from Ethos at the British library and may throw some light to answer part of Q3.

Kind regards

Dr. Ann Ebeid

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

********************************************************************************************************************

This message may contain confidential information. If you are not the intended recipient please inform the

sender that you have received the message in error before deleting it.

Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents:

to do so is strictly prohibited and may be unlawful.

Thank you for your co-operation.

NHSmail is the secure email and directory service available for all NHS staff in England and Scotland

NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipients

NHSmail provides an email address for your career in the NHS and can be accessed anywhere

For more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail

********************************************************************************************************************

[Guest guest]

Dear Macolm,

Back in the reign of Hewitt, there was a whole day 'consultation'

event near Covent Garden on her policy Our Health Our Care Our Say. I was

among the child health enthusiasts, and in a rather perfunctory day there was

one outstanding contribution (Maggie Barker was in the chair, and may have a

clearer memory of this, as she entered into a full-and-frank discussion with

the reluctant young civil servants present, who did even record this idea,

initially, because it did not fit with the answers Ms. Hewitt wanted). The

critical issue under discussion was the health needs of children in

ethnically diverse and multi-lingual areas like Newham. A small group of

voluntary sector participants (led I think by Barnardos'?) came up with a

plan for signposting families through the inter-professional maze of PCT and

Social Care services, but as well as inter-professional training they had

evidence that the most socially excluded residents would be 'navigated'

through the maze by an alliance of networked voluntary agencies across

London, with better " local " intelligence than the PCTs. For many service

users, interpretation or advocacy were needed, as well as signposting, and

they wanted their network to become the first point of contact for many

community health needs. This idea to address health inequalities gained very

widespread and vocal support from the floor. Needless to say, in spite of

Prof. Barker's good efforts, it did not figure in the consultation Report.

Any thoughts on joint training with Health Visitors, GPs, Pharmacists and

Community Agencies? The one time I tried this, with Young Minds, it seemed to

go well....

Woody.

________________________________

From: on behalf of Rigler Malcolm (SWINDON PCT)

Sent: Mon 20/06/2011 07:24

Subject: RE: Urgent help and info needed for Ed Select

Committee on Wednesday

Ann,

Amongst GP Trainers and within Pharmacy Practice there is a growing

recognition that " signposting " patients and families to appropriate services

is an important but neglected area practice.

It seems to me that shared Health Visitor , GP and Pharmacy " in service "

reflective practice should be considered .

The Library Service is now going to be offering " Zero to 5 on-line learning

opportunities " so the Library Service must also be involved . In some places

at least I know that " Library - Health " partnerships are already beginning to

develop . Could HVs help to drive this development?

Best wishes

Malcolm

________________________________

From: [ ] On Behalf Of

ann ebeid [annebeid@...]

Sent: 19 June 2011 21:51

senate hvsn

Subject: RE: Urgent help and info needed for Ed Select

Committee on Wednesday

Hi

in my research some health visitors were not aware of the community resources

available to promote children's and family health, similiar to Jane

Appleton's study (?)and an earlier study in Wales by June e and Magaret

Buttegieg, Which translated into a lot of missed opportunities to improve

the health, welfare and life chances of children in need and their families.

June e's (2000?)study found rhetoric rather than a real public health

approach in the hv/sn practices that she observed.

In my study health visitors felt they were assessing family health needs and

there was good evidence that a few health visitors actually did and made a

difference to family health . But equally there was evidence that some health

visitors didn't recognise/analyse problems and needs and didn't link the

family into appropriate services.Some health visitors lacked a focus on

outcomes.

My exploratory research indicated that hv education and training needs were

needed 'on the job' -that is more reflective learning from practice was

needed - experiential learning from experienced health visitors who are able

to critically deconstuct situations and needs in terms of embedded

theories/policy AND practical support that health visitors can link in, to

help vulnerable families. For me that is a huge challenge because it requires

a new way of training future health visitors with equal emphasis not only on

the biological, psychological and social deteminants of health but also on

health visitors practical know how and experiential knowledge.

Best wishes, Ann.

________________________________

From: sarahcowley183@...

Date: Sun, 19 Jun 2011 19:29:47 +0100

Subject: Re: Urgent help and info needed for Ed Select

Committee on Wednesday

That is very interesting Ann, if somewhat depressing. Thank you for sharing

it with us. Have you written it up anywhere (sorry!)? Were the health

visitors aware that they had not linked them into any community resources

that might help, or did they not think about it?

As I understand it, the government want health visitors to do the form of

linking that you describe, which they describe as 'extending the health

visiting rile.' I had thought it was what health visitors did anyway. but

perhaps they don't do it any longer. I wonder how we can regain control of

the education, and would that help? Or is it (as you suggest) to do with the

whole emphasis on assessing needs, with no follow through?

best wishes

On 19 Jun 2011, at 13:22, ann ebeid wrote:

Hi -briefly....

I had been a hv for over two decades in London and Surrey and was

puzzled why some families I visited didn't seem to have benefitted from

health visitor services in terms of health outcomes, quality of life and

reducing health inequalities.

I decided to interview hard to reach mothers and chiildren in need

and compare their stories with their health visitor's understanding of the

situation.My research was mixed methods; narrative interpretation of case

studies.

My findings pertinent to Maggie's Q3 below are:

I interviewed (through taped conversation, grounded theory analysis)

mothers who were identified by their health visitors, in order to understand

how they perceived their problems and needs and how they felt they had been

supported by their health visitors. I used corresponding documentary evidence

where possible. I validated my report with mother to make sure it accurately

represented what she meant. I then interviewed their health visitor and

validated my report with the health visitor to ascertainthat I accurately

represented their view

I critically analysed/deconstructed mothers and health visitors

narratives in biopschsocial frameworks, also analysing health visitors

knowledge in use.

My findings were that in general health visitors did not link

families into available community resources which would have promoted child

health and improved health outcomes. In effect, I found little evidence of

one of the four guiding principles of health visiting. (CETHV1977). Health

visitors I interviewed did not have a good understanding of a public health

approach in child health promotion, for example there was little evidence

that health visitors linked vulnerable families into community in! !

itiatives such as Sure Start children's centres, Extended Schools breakfast

and tea clubs. There was almost a scenario of 'paralysis by analysis' -when

need was identified I could find little evidence of linkage to resources.

For me this is one main reasons why vulnerable children are not

picked up.Unlike Early Year setting health visitors have unique access into

homes and are aware of family situations.

I hope this brief view of my research is insightful to Maggie, in

prepartation for next Wednesday's meeting. I am happy to give a full summary

if needed.

Kind Regards,

Ann.

________________________________

From: sarahcowley183@...

Date: Sat, 18 Jun 2011 20:53:11 +0100

Subject: Re: Urgent help and info needed for Ed Select

Committee on Wednesday

Can you give us clue about how it sheds light, please Ann?

On 18 Jun 2011, at 10:15, ann ebeid wrote:

Hi Maggie-re. Question3.

my Ph.D thesis " explored the problems of hard to reach

families and children in need and how they were supported by their helth

visitors " (2008). It is freely available on line from Ethos at the British

library and may throw some light to answer part of Q3. Kind regards

Dr. Ann Ebeid

________________________________

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

*****************************************************************************

***************************************

This message may contain confidential information. If you are not the

intended recipient please inform the

sender that you have received the message in error before deleting it.

Please do not disclose, copy or distribute information in this e-mail or take

any action in reliance on its contents:

to do so is strictly prohibited and may be unlawful.

Thank you for your co-operation.

NHSmail is the secure email and directory service available for all NHS staff

in England and Scotland

NHSmail is approved for exchanging patient data and other sensitive

information with NHSmail and GSi recipients

NHSmail provides an email address for your career in the NHS and can be

accessed anywhere

For more information and to find out how you can switch, visit

www.connectingforhealth.nhs.uk/nhsmail

*****************************************************************************

***************************************

Email has been scanned for viruses by Altman Technologies' email management

service <http://www.altman.co.uk/emailsystems>

~--

EMERGING EXCELLENCE: In the Research Assessment Exercise (RAE) 2008,

more than 30% of our submissions were rated as 'Internationally

Excellent' or 'World-leading'. Among the academic disciplines now rated

'World-leading' are Allied Health Professions & Studies; Art & Design;

English Language & Literature; Geography & Environmental Studies;

History; Music; Psychology; and Social Work & Social Policy &

Administration. Visit www.anglia.ac.uk/rae for more information.

This e-mail and any attachments are intended for the above named

recipient(s)only and may be privileged. If they have come to you in

error you must take no action based on them, nor must you copy or show

them to anyone please reply to this e-mail to highlight the error and

then immediately delete the e-mail from your system. Any opinions

expressed are solely those of the author and do not necessarily

represent the views or opinions of Anglia Ruskin University. Although

measures have been taken to ensure that this e-mail and attachments are

free from any virus we advise that, in keeping with good computing

practice, the recipient should ensure they are actually virus free.

Please note that this message has been sent over public networks which

may not be a 100% secure communications

Email has been scanned for viruses by Altman Technologies' email

management service - www.altman.co.uk/emailsystems

[Guest guest]

Dear Malcom,

An inter-professional forum for health, social care,education/early ears and community services was wonderful in Greenwhich between 1997-1999 for just that sort of information sharing. Sadly such initiatives seem to have disappeared since the the NHS (1997) reforms, ironic given its focus on tackling root causes of health inequalities and its emphasis on sharing of information re-inforced in Every Child Matters (2004) policy .

The zero to 5 online learning service sounds excellent but might not reach vulnerable families where health visiting has a clear role by referring families on to the wonderful play and learn activities at every children's centre.

Where I work as a health visitor we have started child protection (cp) meetings with the GP lead for child protection and for us it works well for us. My research illuminated child protection supervision focused on medical aspects, such as the child's immunisation status rather than holistic family and child health and welfare needs.

Best wishes-are you still working in South Wales?

Ann.

From: m.rigler@...Date: Mon, 20 Jun 2011 07:24:35 +0100Subject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Ann,

Amongst GP Trainers and within Pharmacy Practice there is a growing recognition that "signposting" patients and families to appropriate services is an important but neglected area practice.

It seems to me that shared Health Visitor , GP and Pharmacy "in service" reflective practice should be considered .

The Library Service is now going to be offering "Zero to 5 on-line learning opportunities" so the Library Service must also be involved . In some places at least I know that "Library - Health" partnerships are already beginning to develop . Could HVs help to drive this development?

Best wishes

Malcolm

From: [ ] On Behalf Of ann ebeid [annebeid@...]Sent: 19 June 2011 21:51senate hvsnSubject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Hi in my research some health visitors were not aware of the community resources available to promote children's and family health, similiar to Jane Appleton's study (?)and an earlier study in Wales by June e and Magaret Buttegieg, Which translated into a lot of missed opportunities to improve the health, welfare and life chances of children in need and their families. June e's (2000?)study found rhetoric rather than a real public health approach in the hv/sn practices that she observed. In my study health visitors felt they were assessing family health needs and there was good evidence that a few health visitors actually did and made a difference to family health . But equally there was evidence that some health visitors didn't recognise/analyse problems and needs and didn't link the family into appropriate services.Some health visitors lacked a focus on outcomes. My exploratory research indicated that hv education and training needs were needed 'on the job' -that is more reflective learning from practice was needed - experiential learning from experienced health visitors who are able to critically deconstuct situations and needs in terms of embedded theories/policy AND practical support that health visitors can link in, to help vulnerable families. For me that is a huge challenge because it requires a new way of training future health visitors with equal emphasis not only on the biological, psychological and social deteminants of health but also on health visitors practical know how and experiential knowledge. Best wishes, Ann.

From: sarahcowley183@...Date: Sun, 19 Jun 2011 19:29:47 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

That is very interesting Ann, if somewhat depressing. Thank you for sharing it with us. Have you written it up anywhere (sorry!)? Were the health visitors aware that they had not linked them into any community resources that might help, or did they not think about it?

As I understand it, the government want health visitors to do the form of linking that you describe, which they describe as 'extending the health visiting rile.' I had thought it was what health visitors did anyway. but perhaps they don't do it any longer. I wonder how we can regain control of the education, and would that help? Or is it (as you suggest) to do with the whole emphasis on assessing needs, with no follow through?

best wishes

On 19 Jun 2011, at 13:22, ann ebeid wrote:

Hi -briefly.... I had been a hv for over two decades in London and Surrey and was puzzled why some families I visited didn't seem to have benefitted from health visitor services in terms of health outcomes, quality of life and reducing health inequalities. I decided to interview hard to reach mothers and chiildren in need and compare their stories with their health visitor's understanding of the situation.My research was mixed methods; narrative interpretation of case studies. My findings pertinent to Maggie's Q3 below are: I interviewed (through taped conversation, grounded theory analysis) mothers who were identified by their health visitors, in order to understand how they perceived their problems and needs and how they felt they had been supported by their health visitors. I used corresponding documentary evidence where possible. I validated my report with mother to make sure it accurately represented what she meant. I then interviewed their health visitor and validated my report with the health visitor to ascertainthat I accurately represented their view I critically analysed/deconstructed mothers and health visitors narratives in biopschsocial frameworks, also analysing health visitors knowledge in use. My findings were that in general health visitors did not link families into available community resources which would have promoted child health and improved health outcomes. In effect, I found little evidence of one of the four guiding principles of health visiting. (CETHV1977). Health visitors I interviewed did not have a good understanding of a public health approach in child health promotion, for example there was little evidence that health visitors linked vulnerable families into community in! ! itiatives such as Sure Start children's centres, Extended Schools breakfast and tea clubs. There was almost a scenario of 'paralysis by analysis' -when need was identified I could find little evidence of linkage to resources. For me this is one main reasons why vulnerable children are not picked up.Unlike Early Year setting health visitors have unique access into homes and are aware of family situations. I hope this brief view of my research is insightful to Maggie, in prepartation for next Wednesday's meeting. I am happy to give a full summary if needed. Kind Regards, Ann.

From: sarahcowley183@...Date: Sat, 18 Jun 2011 20:53:11 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

Can you give us clue about how it sheds light, please Ann?

On 18 Jun 2011, at 10:15, ann ebeid wrote:

Hi Maggie-re. Question3. my Ph.D thesis "explored the problems of hard to reach families and children in need and how they were supported by their helth visitors" (2008). It is freely available on line from Ethos at the British library and may throw some light to answer part of Q3. Kind regardsDr. Ann Ebeid

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

********************************************************************************************************************This message may contain confidential information. If you are not the intended recipient please inform thesender that you have received the message in error before deleting it.Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents:to do so is strictly prohibited and may be unlawful.Thank you for your co-operation.NHSmail is the secure email and directory service available for all NHS staff in England and ScotlandNHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipientsNHSmail provides an email address for your career in the NHS and can be accessed anywhereFor more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail********************************************************************************************************************

[Guest guest]

Dear Ann,

I've crossed the Bristol Channel and now work in Weston Super MAre.

Here in the SOuth West the Regional Development manager for Libraries in the SOuth West has decided to create a " Libraries - Health " partnership so your work in Greenwich would be of great interest . Are there any reports or

documents that I can share with Jon about the work you mention?

Of course libraries are also keen to reach vulnerable families as well both with books and information - which would include video clips for folk who cannot or prefer not to read.

In the document " Leading the Future " from the CPHVA some years ago it was suggested that each HV Team should work with a group of " volunteers " which I have termed " health promotion helpers " . This development of volunteers

linked to HVs has not yet happened due to lack of funded HV posts . HOwever, the library service has lots of experiance of working with volunteers so working together we may get further faster.

I anyone has any other good stories of past multi agency - interprofessional projects that involved HVs please let me know - especially if the library service was involved.

Best wishes

Malcolm

Dr Malcolm Rigler

Mobile 07771 983580

From: [ ] On Behalf Of ann ebeid [annebeid@...]

Sent: 20 June 2011 15:31

senate hvsn

Subject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Dear Malcom,

An inter-professional forum for health, social care,education/early ears and community services was wonderful in Greenwhich between 1997-1999 for just that sort of information sharing. Sadly such initiatives seem to have disappeared since the the NHS (1997)

reforms, ironic given its focus on tackling root causes of health inequalities and its emphasis on sharing of information re-inforced in Every Child Matters (2004) policy .

The zero to 5 online learning service sounds excellent but might not reach vulnerable families where health visiting has a clear role by referring families on to the wonderful play and learn activities at every children's centre.

Where I work as a health visitor we have started child protection (cp) meetings with the GP lead for child protection and for us it works well for us. My research illuminated child protection supervision focused on medical aspects, such as the child's immunisation

status rather than holistic family and child health and welfare needs.

Best wishes-are you still working in South Wales?

Ann.

From: m.rigler@...

Date: Mon, 20 Jun 2011 07:24:35 +0100

Subject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Ann,

Amongst GP Trainers and within Pharmacy Practice there is a growing recognition that " signposting " patients and families to appropriate services is an important but neglected area practice.

It seems to me that shared Health Visitor , GP and Pharmacy " in service " reflective practice should be considered .

The Library Service is now going to be offering " Zero to 5 on-line learning opportunities " so the Library Service must also be involved . In some places at least I know that " Library - Health " partnerships are already beginning

to develop . Could HVs help to drive this development?

Best wishes

Malcolm

From: [ ] On Behalf Of ann ebeid [annebeid@...]

Sent: 19 June 2011 21:51

senate hvsn

Subject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Hi

in my research some health visitors were not aware of the community resources available to promote children's and family health, similiar to Jane Appleton's study (?)and an earlier study in Wales by June e and Magaret Buttegieg, Which translated into

a lot of missed opportunities to improve the health, welfare and life chances of children in need and their families.

June e's (2000?)study found rhetoric rather than a real public health approach in the hv/sn practices that she observed.

In my study health visitors felt they were assessing family health needs and there was good evidence that a few health visitors actually did and made a difference to family health . But equally there was evidence that some health visitors didn't recognise/analyse

problems and needs and didn't link the family into appropriate services.Some health visitors lacked a focus on outcomes.

My exploratory research indicated that hv education and training needs were needed 'on the job' -that is more reflective learning from practice was needed - experiential learning from experienced health visitors who are able to critically deconstuct situations

and needs in terms of embedded theories/policy AND practical support that health visitors can link in, to help vulnerable families. For me that is a huge challenge because it requires a new way of training future health visitors with equal emphasis not only

on the biological, psychological and social deteminants of health but also on health visitors practical know how and experiential knowledge.

Best wishes, Ann.

From: sarahcowley183@...

Date: Sun, 19 Jun 2011 19:29:47 +0100

Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

That is very interesting Ann, if somewhat depressing. Thank you for sharing it with us. Have you written it up anywhere (sorry!)? Were the health visitors aware that they had not linked them into any community resources that might help,

or did they not think about it?

As I understand it, the government want health visitors to do the form of linking that you describe, which they describe as 'extending the health visiting rile.' I had thought it was what health visitors did anyway. but perhaps they don't do it any longer.

I wonder how we can regain control of the education, and would that help? Or is it (as you suggest) to do with the whole emphasis on assessing needs, with no follow through?

best wishes

On 19 Jun 2011, at 13:22, ann ebeid wrote:

Hi -briefly....

I had been a hv for over two decades in London and Surrey and was puzzled why some families I visited didn't seem to have benefitted from health visitor services in terms of health outcomes, quality of life and reducing health inequalities.

I decided to interview hard to reach mothers and chiildren in need and compare their stories with their health visitor's understanding of the situation.My research was mixed methods; narrative interpretation of case studies.

My findings pertinent to Maggie's Q3 below are:

I interviewed (through taped conversation, grounded theory analysis) mothers who were identified by their health visitors, in order to understand how they perceived their problems and needs and how they felt they had been supported by their health visitors. I

used corresponding documentary evidence where possible. I validated my report with mother to make sure it accurately represented what she meant. I then interviewed their health visitor and validated my report with the health visitor to ascertainthat I accurately

represented their view

I critically analysed/deconstructed mothers and health visitors narratives in biopschsocial frameworks, also analysing health visitors knowledge in use.

My findings were that in general health visitors did not link families into available community resources which would have promoted child health and improved health outcomes. In effect, I found little evidence of one of the four guiding principles of health

visiting. (CETHV1977). Health visitors I interviewed did not have a good understanding of a public health approach in child health promotion, for example there was little evidence that health visitors linked vulnerable families into community in! ! ! ! itiatives

such as Sure Start children's centres, Extended Schools breakfast and tea clubs. There was almost a scenario of 'paralysis by analysis' -when need was identified I could find little evidence of linkage to resources.

For me this is one main reasons why vulnerable children are not picked up.Unlike Early Year setting health visitors have unique access into homes and are aware of family situations.

I hope this brief view of my research is insightful to Maggie, in prepartation for next Wednesday's meeting. I am happy to give a full summary if needed.

Kind Regards,

Ann.

From: sarahcowley183@...

Date: Sat, 18 Jun 2011 20:53:11 +0100

Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

Can you give us clue about how it sheds light, please Ann?

On 18 Jun 2011, at 10:15, ann ebeid wrote:

Hi Maggie-re. Question3.

my Ph.D thesis " explored the problems of hard to reach families and children in need and how they were supported by their helth visitors " (2008). It is freely available on line from Ethos at the British library and may throw some light to answer part of Q3.

Kind regards

Dr. Ann Ebeid

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

********************************************************************************************************************

This message may contain confidential information. If you are not the intended recipient please inform the

sender that you have received the message in error before deleting it.

Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents:

to do so is strictly prohibited and may be unlawful.

Thank you for your co-operation.

NHSmail is the secure email and directory service available for all NHS staff in England and Scotland

NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipients

NHSmail provides an email address for your career in the NHS and can be accessed anywhere

For more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail

********************************************************************************************************************

********************************************************************************************************************

This message may contain confidential information. If you are not the intended recipient please inform the

sender that you have received the message in error before deleting it.

Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents:

to do so is strictly prohibited and may be unlawful.

Thank you for your co-operation.

NHSmail is the secure email and directory service available for all NHS staff in England and Scotland

NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipients

NHSmail provides an email address for your career in the NHS and can be accessed anywhere

For more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail

********************************************************************************************************************

[Guest guest]

Dear Woody,

Thank you for this . Good to hear that Barnardos was involved. I am in a way a Barnardos child.

From my various contacts within pharmacy I know that both Lloydspharmacy and Boots

know that they ought to be better at " signposting " through pharmacy than they are at present.

If any academic body working in the SOuth West could devote some time to working up a " pilot multi agency project on signposting for health and well being through pharmacy " I would be keen to help to ensure that possible key

players actually got to meet with each other. Such a project would of course need both advocacy and interpretation support.

Any takers?

Malcolm

From: [ ] On Behalf Of Caan, Woody [Woody.Caan@...]

Sent: 20 June 2011 09:47

Subject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Dear Macolm,

Back in the reign of Hewitt, there was a whole day 'consultation' event near Covent Garden on her policy Our Health Our Care Our Say. I was among the child health enthusiasts, and in a rather

perfunctory day there was one outstanding contribution (Maggie Barker was in the chair, and may have a clearer memory of this, as she entered into a full-and-frank discussion with the reluctant young civil servants present, who did even record this idea, initially,

because it did not fit with the answers Ms. Hewitt wanted). The critical issue under discussion was the health needs of children in ethnically diverse and multi-lingual areas like Newham. A small group of voluntary sector participants (led I think by Barnardos'?)

came up with a plan for signposting families through the inter-professional maze of PCT and Social Care services, but as well as inter-professional training they had evidence that the most socially excluded residents would be 'navigated' through the maze by

an alliance of networked voluntary agencies across London, with better " local " intelligence than the PCTs. For many service users, interpretation or advocacy were needed, as well as signposting, and they wanted their network to become the first point of contact

for many community health needs. This idea to address health inequalities gained very widespread and vocal support from the floor. Needless to say, in spite of Prof. Barker's good efforts, it did not figure in the consultation Report.

Any thoughts on joint training with Health Visitors, GPs, Pharmacists and Community Agencies? The one time I tried this, with Young Minds, it seemed to go well....

Woody.

From: on behalf of Rigler Malcolm (SWINDON PCT)

Sent: Mon 20/06/2011 07:24

Subject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Ann,

Amongst GP Trainers and within Pharmacy Practice there is a growing recognition that " signposting " patients and families to appropriate services is an important but neglected area practice.

It seems to me that shared Health Visitor , GP and Pharmacy " in service " reflective practice should be considered .

The Library Service is now going to be offering " Zero to 5 on-line learning opportunities " so the Library Service must also be involved . In some places at least I know that " Library - Health " partnerships are already beginning

to develop . Could HVs help to drive this development?

Best wishes

Malcolm

From: [ ] On Behalf Of ann ebeid [annebeid@...]

Sent: 19 June 2011 21:51

senate hvsn

Subject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Hi

in my research some health visitors were not aware of the community resources available to promote children's and family health, similiar to Jane Appleton's study (?)and an earlier study in Wales by June e and Magaret Buttegieg, Which translated into

a lot of missed opportunities to improve the health, welfare and life chances of children in need and their families.

June e's (2000?)study found rhetoric rather than a real public health approach in the hv/sn practices that she observed.

In my study health visitors felt they were assessing family health needs and there was good evidence that a few health visitors actually did and made a difference to family health . But equally there was evidence that some health visitors didn't recognise/analyse

problems and needs and didn't link the family into appropriate services.Some health visitors lacked a focus on outcomes.

My exploratory research indicated that hv education and training needs were needed 'on the job' -that is more reflective learning from practice was needed - experiential learning from experienced health visitors who are able to critically deconstuct situations

and needs in terms of embedded theories/policy AND practical support that health visitors can link in, to help vulnerable families. For me that is a huge challenge because it requires a new way of training future health visitors with equal emphasis not only

on the biological, psychological and social deteminants of health but also on health visitors practical know how and experiential knowledge.

Best wishes, Ann.

From: sarahcowley183@...

Date: Sun, 19 Jun 2011 19:29:47 +0100

Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

That is very interesting Ann, if somewhat depressing. Thank you for sharing it with us. Have you written it up anywhere (sorry!)? Were the health visitors aware that they had not linked them into any community resources that might help,

or did they not think about it?

As I understand it, the government want health visitors to do the form of linking that you describe, which they describe as 'extending the health visiting rile.' I had thought it was what health visitors did anyway. but perhaps they don't do it any longer.

I wonder how we can regain control of the education, and would that help? Or is it (as you suggest) to do with the whole emphasis on assessing needs, with no follow through?

best wishes

On 19 Jun 2011, at 13:22, ann ebeid wrote:

Hi -briefly....

I had been a hv for over two decades in London and Surrey and was puzzled why some families I visited didn't seem to have benefitted from health visitor services in terms of health outcomes, quality of life and reducing health inequalities.

I decided to interview hard to reach mothers and chiildren in need and compare their stories with their health visitor's understanding of the situation.My research was mixed methods; narrative interpretation of case studies.

My findings pertinent to Maggie's Q3 below are:

I interviewed (through taped conversation, grounded theory analysis) mothers who were identified by their health visitors, in order to understand how they perceived their problems and needs and how they felt they had been supported by their health visitors. I

used corresponding documentary evidence where possible. I validated my report with mother to make sure it accurately represented what she meant. I then interviewed their health visitor and validated my report with the health visitor to ascertainthat I accurately

represented their view

I critically analysed/deconstructed mothers and health visitors narratives in biopschsocial frameworks, also analysing health visitors knowledge in use.

My findings were that in general health visitors did not link families into available community resources which would have promoted child health and improved health outcomes. In effect, I found little evidence of one of the four guiding principles of health

visiting. (CETHV1977). Health visitors I interviewed did not have a good understanding of a public health approach in child health promotion, for example there was little evidence that health visitors linked vulnerable families into community in! ! itiatives

such as Sure Start children's centres, Extended Schools breakfast and tea clubs. There was almost a scenario of 'paralysis by analysis' -when need was identified I could find little evidence of linkage to resources.

For me this is one main reasons why vulnerable children are not picked up.Unlike Early Year setting health visitors have unique access into homes and are aware of family situations.

I hope this brief view of my research is insightful to Maggie, in prepartation for next Wednesday's meeting. I am happy to give a full summary if needed.

Kind Regards,

Ann.

From: sarahcowley183@...

Date: Sat, 18 Jun 2011 20:53:11 +0100

Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

Can you give us clue about how it sheds light, please Ann?

On 18 Jun 2011, at 10:15, ann ebeid wrote:

Hi Maggie-re. Question3.

my Ph.D thesis " explored the problems of hard to reach families and children in need and how they were supported by their helth visitors " (2008). It is freely available on line from Ethos at the British library and may throw some light to answer part of Q3.

Kind regards

Dr. Ann Ebeid

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

********************************************************************************************************************

This message may contain confidential information. If you are not the intended recipient please inform the

sender that you have received the message in error before deleting it.

Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents:

to do so is strictly prohibited and may be unlawful.

Thank you for your co-operation.

NHSmail is the secure email and directory service available for all NHS staff in England and Scotland

NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipients

NHSmail provides an email address for your career in the NHS and can be accessed anywhere

For more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail

********************************************************************************************************************

Email has been scanned for viruses by Altman Technologies' email management service

********************************************************************************************************************

This message may contain confidential information. If you are not the intended recipient please inform the

sender that you have received the message in error before deleting it.

Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents:

to do so is strictly prohibited and may be unlawful.

Thank you for your co-operation.

NHSmail is the secure email and directory service available for all NHS staff in England and Scotland

NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipients

NHSmail provides an email address for your career in the NHS and can be accessed anywhere

For more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail

********************************************************************************************************************

[Guest guest]

dear MalcomI published 2 papers in the CPHVA in September 1999 (Managing change in community nursing (health visiting) and Skill mix development (in July 2000) about my development work in health visiting in Greenwhich although not in any detail about inter-professional learning/ forums.My 2008 thesis considered health visitors professional development using Dreyfus' skill acquisition model as a framwork and reflective learning models to aid super vision. Inter-professional learning at undergraduate and postgraduate levels, reflective learning groups, training in social science methods, training on the job with experienced, skilled health visitors and evidenced-based practice seem to me to be the way forward for effective health visiting. best wishes,Ann

From: m.rigler@...Date: Mon, 20 Jun 2011 17:08:42 +0100Subject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Dear Ann,

I've crossed the Bristol Channel and now work in Weston Super MAre.

Here in the SOuth West the Regional Development manager for Libraries in the SOuth West has decided to create a "Libraries - Health" partnership so your work in Greenwich would be of great interest . Are there any reports or documents that I can share with Jon about the work you mention?

Of course libraries are also keen to reach vulnerable families as well both with books and information - which would include video clips for folk who cannot or prefer not to read.

In the document "Leading the Future" from the CPHVA some years ago it was suggested that each HV Team should work with a group of "volunteers" which I have termed "health promotion helpers" . This development of volunteers linked to HVs has not yet happened due to lack of funded HV posts . HOwever, the library service has lots of experiance of working with volunteers so working together we may get further faster.

I anyone has any other good stories of past multi agency - interprofessional projects that involved HVs please let me know - especially if the library service was involved.

Best wishes

Malcolm

Dr Malcolm Rigler

Mobile 07771 983580

From: [ ] On Behalf Of ann ebeid [annebeid@...]Sent: 20 June 2011 15:31senate hvsnSubject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Dear Malcom, An inter-professional forum for health, social care,education/early ears and community services was wonderful in Greenwhich between 1997-1999 for just that sort of information sharing. Sadly such initiatives seem to have disappeared since the the NHS (1997) reforms, ironic given its focus on tackling root causes of health inequalities and its emphasis on sharing of information re-inforced in Every Child Matters (2004) policy . The zero to 5 online learning service sounds excellent but might not reach vulnerable families where health visiting has a clear role by referring families on to the wonderful play and learn activities at every children's centre. Where I work as a health visitor we have started child protection (cp) meetings with the GP lead for child protection and for us it works well for us. My research illuminated child protection supervision focused on medical aspects, such as the child's immunisation status rather than holistic family and child health and welfare needs.Best wishes-are you still working in South Wales?Ann.

From: m.rigler@...Date: Mon, 20 Jun 2011 07:24:35 +0100Subject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Ann,

Amongst GP Trainers and within Pharmacy Practice there is a growing recognition that "signposting" patients and families to appropriate services is an important but neglected area practice.

It seems to me that shared Health Visitor , GP and Pharmacy "in service" reflective practice should be considered .

The Library Service is now going to be offering "Zero to 5 on-line learning opportunities" so the Library Service must also be involved . In some places at least I know that "Library - Health" partnerships are already beginning to develop . Could HVs help to drive this development?

Best wishes

Malcolm

From: [ ] On Behalf Of ann ebeid [annebeid@...]Sent: 19 June 2011 21:51senate hvsnSubject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Hi in my research some health visitors were not aware of the community resources available to promote children's and family health, similiar to Jane Appleton's study (?)and an earlier study in Wales by June e and Magaret Buttegieg, Which translated into a lot of missed opportunities to improve the health, welfare and life chances of children in need and their families. June e's (2000?)study found rhetoric rather than a real public health approach in the hv/sn practices that she observed. In my study health visitors felt they were assessing family health needs and there was good evidence that a few health visitors actually did and made a difference to family health . But equally there was evidence that some health visitors didn't recognise/analyse problems and needs and didn't link the family into appropriate services.Some health visitors lacked a focus on outcomes. My exploratory research indicated that hv education and training needs were needed 'on the job' -that is more reflective learning from practice was needed - experiential learning from experienced health visitors who are able to critically deconstuct situations and needs in terms of embedded theories/policy AND practical support that health visitors can link in, to help vulnerable families. For me that is a huge challenge because it requires a new way of training future health visitors with equal emphasis not only on the biological, psychological and social deteminants of health but also on health visitors practical know how and experiential knowledge. Best wishes, Ann.

From: sarahcowley183@...Date: Sun, 19 Jun 2011 19:29:47 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

That is very interesting Ann, if somewhat depressing. Thank you for sharing it with us. Have you written it up anywhere (sorry!)? Were the health visitors aware that they had not linked them into any community resources that might help, or did they not think about it?

As I understand it, the government want health visitors to do the form of linking that you describe, which they describe as 'extending the health visiting rile.' I had thought it was what health visitors did anyway. but perhaps they don't do it any longer. I wonder how we can regain control of the education, and would that help? Or is it (as you suggest) to do with the whole emphasis on assessing needs, with no follow through?

best wishes

On 19 Jun 2011, at 13:22, ann ebeid wrote:

Hi -briefly.... I had been a hv for over two decades in London and Surrey and was puzzled why some families I visited didn't seem to have benefitted from health visitor services in terms of health outcomes, quality of life and reducing health inequalities. I decided to interview hard to reach mothers and chiildren in need and compare their stories with their health visitor's understanding of the situation.My research was mixed methods; narrative interpretation of case studies. My findings pertinent to Maggie's Q3 below are: I interviewed (through taped conversation, grounded theory analysis) mothers who were identified by their health visitors, in order to understand how they perceived their problems and needs and how they felt they had been supported by their health visitors. I used corresponding documentary evidence where possible. I validated my report with mother to make sure it accurately represented what she meant. I then interviewed their health visitor and validated my report with the health visitor to ascertainthat I accurately represented their view I critically analysed/deconstructed mothers and health visitors narratives in biopschsocial frameworks, also analysing health visitors knowledge in use. My findings were that in general health visitors did not link families into available community resources which would have promoted child health and improved health outcomes. In effect, I found little evidence of one of the four guiding principles of health visiting. (CETHV1977). Health visitors I interviewed did not have a good understanding of a public health approach in child health promotion, for example there was little evidence that health visitors linked vulnerable families into community in! ! ! ! itiatives such as Sure Start children's centres, Extended Schools breakfast and tea clubs. There was almost a scenario of 'paralysis by analysis' -when need was identified I could find little evidence of linkage to resources. For me this is one main reasons why vulnerable children are not picked up.Unlike Early Year setting health visitors have unique access into homes and are aware of family situations. I hope this brief view of my research is insightful to Maggie, in prepartation for next Wednesday's meeting. I am happy to give a full summary if needed. Kind Regards, Ann.

From: sarahcowley183@...Date: Sat, 18 Jun 2011 20:53:11 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

Can you give us clue about how it sheds light, please Ann?

On 18 Jun 2011, at 10:15, ann ebeid wrote:

Hi Maggie-re. Question3. my Ph.D thesis "explored the problems of hard to reach families and children in need and how they were supported by their helth visitors" (2008). It is freely available on line from Ethos at the British library and may throw some light to answer part of Q3. Kind regardsDr. Ann Ebeid

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

********************************************************************************************************************This message may contain confidential information. If you are not the intended recipient please inform thesender that you have received the message in error before deleting it.Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents:to do so is strictly prohibited and may be unlawful.Thank you for your co-operation.NHSmail is the secure email and directory service available for all NHS staff in England and ScotlandNHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipientsNHSmail provides an email address for your career in the NHS and can be accessed anywhereFor more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail********************************************************************************************************************

********************************************************************************************************************This message may contain confidential information. If you are not the intended recipient please inform thesender that you have received the message in error before deleting it.Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents:to do so is strictly prohibited and may be unlawful.Thank you for your co-operation.NHSmail is the secure email and directory service available for all NHS staff in England and ScotlandNHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipientsNHSmail provides an email address for your career in the NHS and can be accessed anywhereFor more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail********************************************************************************************************************

[Guest guest]

Yes, Maggie. You will be excellent. is right.

Will be thinking of you,

Diane

Re: Urgent help and info needed for Ed Select Committee on Wednesday

HI Maggie

I am very sorry to respond so late to your request for information, particularly question 2 below. The D-SCOVOR survey that we carried out in 2005 showed enormous variation in service delivery, with some areas providing a comprehensive health visiting service and some a very restricted one, but there was no information in the survey to indicate why there was that variation. In 2008, the Burdett Trust funded a small piece of follow up work, so we could re-analyse the D-SCOVOR data in conjunction with that gathered by the FPI about caseloads, and also analyse some of the first Children and Young People's Plans (CYPPs). This allowed us to consider three popular 'explanations' for the cutbacks that were circulating at the time:

1. That health visitors were spending more time with affluent parents than needy ones: this excuse was being used to reduce service in many supposedly middle class areas. What we found was that individual health visitors were tending to focus where the greatest need exists, both in terms of geography and specific vulnerable groups (e.g. by liaising with Sure Start more, visiting more teenage mothers, or carrying out more home visits).

2. For some people, the idea of the 'north-south' divide still exists, and many remain convinced that London and the South East have little poverty or health need, despite clear evidence of very dense areas of profound deprivation. Our analysis showed no statistical connection between areas of deprivation and the frequency of planned home visits or of caseload size at the time the data were collected.

3. The view that the service provision is there by another name, children's services were expanding to fill the gap etc. The CYPPs that we analysed gave no indication that this was the case, indeed children under three years (or the kind of services they might need) were barely mentioned in some of the Plans, except in terms of childcare. Professionals were rarely mentioned by any name, although teachers were named most.

We were left with no clear explanation as to why the services varied so noticeably, so I can only offer another set of untested speculations, based more on anecdote than on any evidence:

1. Where there is a service manager or commissioner who is strongly committed to health visiting, the services seem to do better than where there is not: the leadership issue

2. The converse appears to happen as well; where there is a service manager or commissioner who is unconvinced of the value of health visiting, or even hostile to it, disinvestments occur, because there were no safeguards to prevent it: the 'because we can' issue

(I heard a couple of weeks ago that, in a meeting of commissioners, someone said they were not going to expand their health visiting service as expected by the government. When asked 'are you allowed to ignore the operating framework then,' the commissioner replied that yes, they could choose)

3. The only thing that might be worth investigating, is senior staff mobility in areas where the services are seriously cut back. It would be hard to unravel cause and effect, but where mobility is high, it seems more likely that the 'highly committed' managers with local knowledge are likely to move on. It might be that are some somewhere that folk wish would move on, of course! I think population mobility is highest in London and South East, although it is pretty high in other major conurbations like Birmingham and Manchester: whre there are also very poor ratios health visitors to pre-school children

I guess those three issues might be relevant to school health as well.

Good luck with your evidence Maggie, I am sure you will be excellent

kind regards

Refs:

Cowley S, Caan, W, Dowling S, Weir, H (2007) What do health visitors do? A national survey of activities and service organisation. Public Health. 21: 11, 869-879

Cowley S, Dowling, S, Caan W, (2009) Too little for early interventions? Examining the policy-practice gap in English health visiting services and organisation. Primary Health Care Research and Development. 10: 130–142

On 16 Jun 2011, at 21:10, Maggie Fisher wrote:

[Attachment(s) from Maggie Fisher included below]

Dear All

I would really appreciate some help as I have now been given an idea today of the questions I will be asked by the Education Select Committee next Wednesday morning. This is a one off session on Health Visions and school readiness.

The first issue is quite contentious as the very wording school readiness is seen by many as a pedagogical swear word and I will be asked to give health’s perception on what we understand by this. I know Marmot, and Tickell all discuss school readiness in their reviews but I want to convey the essence of what we as HVs understand by this. I would really like other views on this

Apparently the committee will ask why the SE is so badly off for HVs and for spending least on child health. They have looked at the FPI reports on this and London and the SE ore in the top 10 and the DH figures reveal the SE and London being particularly poor. Any help with this would be welcome.

They will also want to know why some children are not being picked up by either health or early years.

What do HVs think of the suggested measures of life chance indicators that Field proposed at 3 years and do any HVs use these or do any of you have experience of using them, I know very few of us do any type of formal review at 3 years? See attached pages Annexe 1 pages 95-96

For the child: British Ability Scales (in particular the naming vocabulary and picture similarities sub-scales)

Bracken School Readiness Assessment

Strengths and Difficulties Questionnaire for three to four year olds

Height and weight to calculate BMI

For the parent: Home Learning Index from the Effective Provision of Pre-School Education (EPPE) study

Short Form 12 or Kessler 6 for maternal mental health

Pianta child-parent relationship scale Millennium Cohort Study authoritative parenting measures

Environment Early Childhood Environment Rating Scale (ECERS)

What are the professions views on the Tickell recommendations of an integrated review see below?

Graham recently published his recommendations for better, earlier, identification of those children who are most vulnerable to the effects of deprivation and dysfunction. Graham made a compelling case for investment in early intervention to prevent these children becoming adults struggling to participate in mainstream society. In his review on poverty and life chances, Field offered recommendations aimed at raising the status of the early years and intervening early to tackle issues at their roots. There are several points of agreement between our approaches, and I believe this early years summary of development will help early years and health professionals to work together more effectively. Only through professionals working together in this collaborative way, can the full benefits of early intervention be achieved. However, the full benefits of this way of working will only be realised when the Healthy Child Programme 2 year health and development review becomes 100% universal. At this point, I urge local commissioners to increase coverage of the Healthy Child Programme and I recommend strongly that the Government works with experts and services to test the feasibility of a single integrated review at age 2 to 2½.

For those children who are already in early years provision before their Healthy Child Programme health and development review, this review provides an excellent opportunity for early years practitioners to share with health visitors the picture they have formed, through ongoing regular observation, of children’s development. This is particularly relevant in the context of the Government’s free offer for disadvantaged 2-year-olds.Where a child may need extra help, early years practitioners are then well-placed to work with health visitors to intensify the support they provide to children as part of the Healthy Child Programme health and development review. Such early intervention should help to reduce significantly the proportion of children who are school unready.

22 Equipped for life, ready for school

3.14 There are other ways in which this information could be used to guide children’s ongoing development – for example, to support the transition between early years settings, such as between a childminder and a nursery class. For those children who haven’t been in early years care before, health visitors could, if needed, liaise with the early years setting to ensure appropriate support is provided. Where children move from one type of early years care to another, the rich information already gathered should be shared to provide smooth support for ongoing development. 3.15 Therefore, I recommend that the EYFS should include a requirement for practitioners, including childminders, to provide on request to parents and carers, at some point between the ages of 24 – 36 months, a short written early years summary of their child’s development in the prime areas. The purpose of this early years summary should be to inform parents and carers about their child’s level of development, and to support – if the timing is right – the Healthy Child Programme health and development review carried out by health visitors, as well as transition to nursery provision at age 3.The early years summary should be based around the overlap between the core areas of the 2 year health and development review and the prime areas I have set out above. It should capture the relevant professional knowledge that early years practitioners have developed about each child that they support. Parents and carers should be involved at all stages, and should have control over who the information contained in the early years summary is passed to

They will be asking about the 2 – 2,5 year review and thank you to all of those who have given me information on this already.

Final question on this how many of you have access to the validated tools that are used to support the 2 year review in Appendix A? Many of these are under licence and have to be purchased by the PCT so I know anecdotally that many practitioners are not able to use them because of this. I would love examples.

There will be question on children’s centres but I feel equipped to deal with this. (Brave last words)f

Best wishes

Maggie

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

[Guest guest]

Dear

Thank you so much for this it is very welcome

Best wishesMaggie

Re: Urgent help and info needed for Ed Select Committee on Wednesday

HI Maggie

I am very sorry to respond so late to your request for information, particularly question 2 below. The D-SCOVOR survey that we carried out in 2005 showed enormous variation in service delivery, with some areas providing a comprehensive health visiting service and some a very restricted one, but there was no information in the survey to indicate why there was that variation. In 2008, the Burdett Trust funded a small piece of follow up work, so we could re-analyse the D-SCOVOR data in conjunction with that gathered by the FPI about caseloads, and also analyse some of the first Children and Young People's Plans (CYPPs). This allowed us to consider three popular 'explanations' for the cutbacks that were circulating at the time:

1. That health visitors were spending more time with affluent parents than needy ones: this excuse was being used to reduce service in many supposedly middle class areas. What we found was that individual health visitors were tending to focus where the greatest need exists, both in terms of geography and specific vulnerable groups (e.g. by liaising with Sure Start more, visiting more teenage mothers, or carrying out more home visits).

2. For some people, the idea of the 'north-south' divide still exists, and many remain convinced that London and the South East have little poverty or health need, despite clear evidence of very dense areas of profound deprivation. Our analysis showed no statistical connection between areas of deprivation and the frequency of planned home visits or of caseload size at the time the data were collected.

3. The view that the service provision is there by another name, children's services were expanding to fill the gap etc. The CYPPs that we analysed gave no indication that this was the case, indeed children under three years (or the kind of services they might need) were barely mentioned in some of the Plans, except in terms of childcare. Professionals were rarely mentioned by any name, although teachers were named most.

We were left with no clear explanation as to why the services varied so noticeably, so I can only offer another set of untested speculations, based more on anecdote than on any evidence:

1. Where there is a service manager or commissioner who is strongly committed to health visiting, the services seem to do better than where there is not: the leadership issue

2. The converse appears to happen as well; where there is a service manager or commissioner who is unconvinced of the value of health visiting, or even hostile to it, disinvestments occur, because there were no safeguards to prevent it: the 'because we can' issue

(I heard a couple of weeks ago that, in a meeting of commissioners, someone said they were not going to expand their health visiting service as expected by the government. When asked 'are you allowed to ignore the operating framework then,' the commissioner replied that yes, they could choose)

3. The only thing that might be worth investigating, is senior staff mobility in areas where the services are seriously cut back. It would be hard to unravel cause and effect, but where mobility is high, it seems more likely that the 'highly committed' managers with local knowledge are likely to move on. It might be that are some somewhere that folk wish would move on, of course! I think population mobility is highest in London and South East, although it is pretty high in other major conurbations like Birmingham and Manchester: whre there are also very poor ratios health visitors to pre-school children

I guess those three issues might be relevant to school health as well.

Good luck with your evidence Maggie, I am sure you will be excellent

kind regards

Refs:

Cowley S, Caan, W, Dowling S, Weir, H (2007) What do health visitors do? A national survey of activities and service organisation. Public Health. 21: 11, 869-879

Cowley S, Dowling, S, Caan W, (2009) Too little for early interventions? Examining the policy-practice gap in English health visiting services and organisation. Primary Health Care Research and Development. 10: 130–142

On 16 Jun 2011, at 21:10, Maggie Fisher wrote:

[Attachment(s) from Maggie Fisher included below]

Dear All

I would really appreciate some help as I have now been given an idea today of the questions I will be asked by the Education Select Committee next Wednesday morning. This is a one off session on Health Visions and school readiness.

The first issue is quite contentious as the very wording school readiness is seen by many as a pedagogical swear word and I will be asked to give health’s perception on what we understand by this. I know Marmot, and Tickell all discuss school readiness in their reviews but I want to convey the essence of what we as HVs understand by this. I would really like other views on this

Apparently the committee will ask why the SE is so badly off for HVs and for spending least on child health. They have looked at the FPI reports on this and London and the SE ore in the top 10 and the DH figures reveal the SE and London being particularly poor. Any help with this would be welcome.

They will also want to know why some children are not being picked up by either health or early years.

What do HVs think of the suggested measures of life chance indicators that Field proposed at 3 years and do any HVs use these or do any of you have experience of using them, I know very few of us do any type of formal review at 3 years? See attached pages Annexe 1 pages 95-96

For the child: British Ability Scales (in particular the naming vocabulary and picture similarities sub-scales)

Bracken School Readiness Assessment

Strengths and Difficulties Questionnaire for three to four year olds

Height and weight to calculate BMI

For the parent: Home Learning Index from the Effective Provision of Pre-School Education (EPPE) study

Short Form 12 or Kessler 6 for maternal mental health

Pianta child-parent relationship scale Millennium Cohort Study authoritative parenting measures

Environment Early Childhood Environment Rating Scale (ECERS)

What are the professions views on the Tickell recommendations of an integrated review see below?

Graham recently published his recommendations for better, earlier, identification of those children who are most vulnerable to the effects of deprivation and dysfunction. Graham made a compelling case for investment in early intervention to prevent these children becoming adults struggling to participate in mainstream society. In his review on poverty and life chances, Field offered recommendations aimed at raising the status of the early years and intervening early to tackle issues at their roots. There are several points of agreement between our approaches, and I believe this early years summary of development will help early years and health professionals to work together more effectively. Only through professionals working together in this collaborative way, can the full benefits of early intervention be achieved. However, the full benefits of this way of working will only be realised when the Healthy Child Programme 2 year health and development review becomes 100% universal. At this point, I urge local commissioners to increase coverage of the Healthy Child Programme and I recommend strongly that the Government works with experts and services to test the feasibility of a single integrated review at age 2 to 2½.

For those children who are already in early years provision before their Healthy Child Programme health and development review, this review provides an excellent opportunity for early years practitioners to share with health visitors the picture they have formed, through ongoing regular observation, of children’s development. This is particularly relevant in the context of the Government’s free offer for disadvantaged 2-year-olds.Where a child may need extra help, early years practitioners are then well-placed to work with health visitors to intensify the support they provide to children as part of the Healthy Child Programme health and development review. Such early intervention should help to reduce significantly the proportion of children who are school unready.

22 Equipped for life, ready for school

3.14 There are other ways in which this information could be used to guide children’s ongoing development – for example, to support the transition between early years settings, such as between a childminder and a nursery class. For those children who haven’t been in early years care before, health visitors could, if needed, liaise with the early years setting to ensure appropriate support is provided. Where children move from one type of early years care to another, the rich information already gathered should be shared to provide smooth support for ongoing development. 3.15 Therefore, I recommend that the EYFS should include a requirement for practitioners, including childminders, to provide on request to parents and carers, at some point between the ages of 24 – 36 months, a short written early years summary of their child’s development in the prime areas. The purpose of this early years summary should be to inform parents and carers about their child’s level of development, and to support – if the timing is right – the Healthy Child Programme health and development review carried out by health visitors, as well as transition to nursery provision at age 3.The early years summary should be based around the overlap between the core areas of the 2 year health and development review and the prime areas I have set out above. It should capture the relevant professional knowledge that early years practitioners have developed about each child that they support. Parents and carers should be involved at all stages, and should have control over who the information contained in the early years summary is passed to

They will be asking about the 2 – 2,5 year review and thank you to all of those who have given me information on this already.

Final question on this how many of you have access to the validated tools that are used to support the 2 year review in Appendix A? Many of these are under licence and have to be purchased by the PCT so I know anecdotally that many practitioners are not able to use them because of this. I would love examples.

There will be question on children’s centres but I feel equipped to deal with this. (Brave last words)f

Best wishesMaggie

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

[Guest guest]

Dear ,

I tend to agree with your speculations.

Good luck Maggie !

Kind regards,

Jane.

[Attachment(s) from Maggie Fisher included below]

Dear All

I would really appreciate some help as I have now been given an idea today of the questions I will be asked by the Education Select Committee next Wednesday morning. This is a one off session on Health Visions and school readiness.

The first issue is quite contentious as the very wording school readiness is seen by many as a pedagogical swear word and I will be asked to give health’s perception on what we understand by this. I know Marmot, and Tickell all discuss school readiness in their reviews but I want to convey the essence of what we as HVs understand by this. I would really like other views on this

Apparently the committee will ask why the SE is so badly off for HVs and for spending least on child health. They have looked at the FPI reports on this and London and the SE ore in the top 10 and the DH figures reveal the SE and London being particularly poor. Any help with this would be welcome.

They will also want to know why some children are not being picked up by either health or early years.

What do HVs think of the suggested measures of life chance indicators that Field proposed at 3 years and do any HVs use these or do any of you have experience of using them, I know very few of us do any type of formal review at 3 years? See attached pages Annexe 1 pages 95-96

For the child: British Ability Scales (in particular the naming vocabulary and picture similarities sub-scales)

Bracken School Readiness Assessment

Strengths and Difficulties Questionnaire for three to four year olds

Height and weight to calculate BMI

For the parent: Home Learning Index from the Effective Provision of Pre-School Education (EPPE) study

Short Form 12 or Kessler 6 for maternal mental health

Pianta child-parent relationship scale Millennium Cohort Study authoritative parenting measures

Environment Early Childhood Environment Rating Scale (ECERS)

What are the professions views on the Tickell recommendations of an integrated review see below?

Graham recently published his recommendations for better, earlier, identification of those children who are most vulnerable to the effects of deprivation and dysfunction. Graham made a compelling case for investment in early intervention to prevent these children becoming adults struggling to participate in mainstream society. In his review on poverty and life chances, Field offered recommendations aimed at raising the status of the early years and intervening early to tackle issues at their roots. There are several points of agreement between our approaches, and I believe this early years summary of development will help early years and health professionals to work together more effectively. Only through professionals working together in this collaborative way, can the full benefits of early intervention be achieved. However, the full benefits of this way

of working will only be realised when the Healthy Child Programme 2 year health and development review becomes 100% universal. At this point, I urge local commissioners to increase coverage of the Healthy Child Programme and I recommend strongly that the Government works with experts and services to test the feasibility of a single integrated review at age 2 to 2½.

For those children who are already in early years provision before their Healthy Child Programme health and development review, this review provides an excellent opportunity for early years practitioners to share with health visitors the picture they have formed, through ongoing regular observation, of children’s development. This is particularly relevant in the context of the Government’s free offer for disadvantaged 2-year-olds.Where a child may need extra help, early years practitioners are then well-placed to work with health visitors to intensify the support they provide to children as part of the Healthy Child Programme health and development review. Such early intervention should help to reduce significantly the proportion of children who are school unready.

22 Equipped for life, ready for school

3.14 There are other ways in which this information could be used to guide children’s ongoing development – for example, to support the transition between early years settings, such as between a childminder and a nursery class. For those children who haven’t been in early years care before, health visitors could, if needed, liaise with the early years setting to ensure appropriate support is provided. Where children move from one type of early years care to another, the rich information already gathered should be shared to provide smooth support for ongoing development. 3.15 Therefore, I recommend that the EYFS should include a requirement for practitioners, including childminders, to provide on request to parents and carers, at some point between the ages of 24 – 36 months, a short written

early years summary of their child’s development in the prime areas. The purpose of this early years summary should be to inform parents and carers about their child’s level of development, and to support – if the timing is right – the Healthy Child Programme health and development review carried out by health visitors, as well as transition to nursery provision at age 3.The early years summary should be based around the overlap between the core areas of the 2 year health and development review and the prime areas I have set out above. It should capture the relevant professional knowledge that early years practitioners have developed about each child that they support. Parents and carers should be involved at all stages, and should have control over who the information contained in the early years summary is passed to

They will be asking about the 2 – 2,5 year review and thank you to all of those who have given me information on this already.

Final question on this how many of you have access to the validated tools that are used to support the 2 year review in Appendix A? Many of these are under licence and have to be purchased by the PCT so I know anecdotally that many practitioners are not able to use them because of this. I would love examples.

There will be question on children’s centres but I feel equipped to deal with this. (Brave last words)f

Best wishesMaggie

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

[Guest guest]

thanks jane-Ann

From: jvappleton@...Date: Tue, 21 Jun 2011 09:25:08 +0100Subject: Re: Fwd: Urgent help and info needed for Ed Select Committee on Wednesday

Dear Ann,

Sorry I noted that you said something about my PhD study which is incorrect. In fact in my study which examined health visitors judgments in identifying and working with families requiring extra health visiting, ‘knowing the local community’ had an impact on assessment processes. HVs continually described the importance of developing a good knowledge of the local community in order to make accurate assessments and initiate appropriate referrals to other agencies and services. Many clients also regarded referral and as an important aspect of the HV role, with HVs in this study referring clients for a range of services. Kind regards, Jane.

From: ann ebeid <annebeid@...>Date: 19 June 2011 21:51:07 GMT+01:00senate hvsn < >Subject: RE: Urgent help and info needed for Ed Select Committee on WednesdayReply-

Hi in my research some health visitors were not aware of the community resources available to promote children's and family health, similiar to Jane Appleton's study (?)and an earlier study in Wales by June e and Magaret Buttegieg, Which translated into a lot of missed opportunities to improve the health, welfare and life chances of children in need and their families. June e's (2000?)study found rhetoric rather than a real public health approach in the hv/sn practices that she observed. In my study health visitors felt they were assessing family health needs and there was good evidence that a few health visitors actually did and made a difference to family health . But equally there was evidence that some health visitors didn't recognise/analyse problems and needs and didn't link the family into appropriate services.Some health visitors lacked a focus on outcomes. My exploratory research indicated that hv education and training needs were needed 'on the job' -that is more reflective learning from practice was needed - experiential learning from experienced health visitors who are able to critically deconstuct situations and needs in terms of embedded theories/policy AND practical support that health visitors can link in, to help vulnerable families. For me that is a huge challenge because it requires a new way of training future health visitors with equal emphasis not only on the biological, psychological and social deteminants of health but also on health visitors practical know how and experiential knowledge. Best wishes, Ann.

From: sarahcowley183@...Date: Sun, 19 Jun 2011 19:29:47 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

That is very interesting Ann, if somewhat depressing. Thank you for sharing it with us. Have you written it up anywhere (sorry!)? Were the health visitors aware that they had not linked them into any community resources that might help, or did they not think about it?

As I understand it, the government want health visitors to do the form of linking that you describe, which they describe as 'extending the health visiting rile.' I had thought it was what health visitors did anyway. but perhaps they don't do it any longer. I wonder how we can regain control of the education, and would that help? Or is it (as you suggest) to do with the whole emphasis on assessing needs, with no follow through?

best wishes

On 19 Jun 2011, at 13:22, ann ebeid wrote:

Hi -briefly.... I had been a hv for over two decades in London and Surrey and was puzzled why some families I visited didn't seem to have benefitted from health visitor services in terms of health outcomes, quality of life and reducing health inequalities. I decided to interview hard to reach mothers and chiildren in need and compare their stories with their health visitor's understanding of the situation.My research was mixed methods; narrative interpretation of case studies. My findings pertinent to Maggie's Q3 below are: I interviewed (through taped conversation, grounded theory analysis) mothers who were identified by their health visitors, in order to understand how they perceived their problems and needs and how they felt they had been supported by their health visitors. I used corresponding documentary evidence where possible. I validated my report with mother to make sure it accurately represented what she meant. I then interviewed their health visitor and validated my report with the health visitor to ascertainthat I accurately represented their view I critically analysed/deconstructed mothers and health visitors narratives in biopschsocial frameworks, also analysing health visitors knowledge in use. My findings were that in general health visitors did not link families into available community resources which would have promoted child health and improved health outcomes. In effect, I found little evidence of one of the four guiding principles of health visiting. (CETHV1977). Health visitors I interviewed did not have a good understanding of a public health approach in child health promotion, for example there was little evidence that health visitors linked vulnerable families into community initiatives such as Sure Start children's centres, Extended Schools breakfast and tea clubs. There was almost a scenario of 'paralysis by analysis' -when need was identified I could find little evidence of linkage to resources. For me this is one main reasons why vulnerable children are not picked up.Unlike Early Year setting health visitors have unique access into homes and are aware of family situations. I hope this brief view of my research is insightful to Maggie, in prepartation for next Wednesday's meeting. I am happy to give a full summary if needed. Kind Regards, Ann.

From: sarahcowley183@...Date: Sat, 18 Jun 2011 20:53:11 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

Can you give us clue about how it sheds light, please Ann?

On 18 Jun 2011, at 10:15, ann ebeid wrote:

Hi Maggie-re. Question3. my Ph.D thesis "explored the problems of hard to reach families and children in need and how they were supported by their helth visitors" (2008). It is freely available on line from Ethos at the British library and may throw some light to answer part of Q3. Kind regardsDr. Ann Ebeid

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

[Guest guest]

dear Jane

I referred to your 1996 paper-Working with vulnerable families- which found half of the hvs in the study were not aware of local services (ref below).i am sorry I was unclear about the date of the source in an earlier email because I am on annual leave and in the middle of redecorating!

Drennan and ph's study (2005) found all 13 hv participants working with refugee and asylum seekers "lacked knowledge of local services" (ref below).

The purose of my 2007 Ph.D research was to search for evidence of hvs contributions to better health outcomes for the most at risk groups of children and families.In my study several HVs lacked of knowledge of local services such as Sure Start children's services, Benefits Advisors, Community outreach support services, Languagr Line interpreters and consequently did not of refer families on to these services, which had a negative impact on health and welfare outcomes for the families. As previously stated there were some examples of excellent work done, but this wasn't the norm.

Appleton J 1996 Working with Vulnerable families:a hv perspective.Journal of Advanced Nursing 23 (5) 912-918.

Drennan,V.ph,J.2005.Health Visiting and Refugee families:issues in professional practice Journal of advanced Nursing 49(2)155-163.

Ebeid, A. 2007.Exploring the problems and needs of hard to reach families and children in need and the support they received from their health visitors. Available free, on line at ethos.bl.uk-just key in significant words such as problems, needs,hard to reach.

Best wishes Maggie

Ann.

From: annebeid@...Date: Tue, 21 Jun 2011 09:32:16 +0000Subject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

thanks jane-Ann

From: jvappleton@...Date: Tue, 21 Jun 2011 09:25:08 +0100Subject: Re: Fwd: Urgent help and info needed for Ed Select Committee on Wednesday

Dear Ann,

Sorry I noted that you said something about my PhD study which is incorrect. In fact in my study which examined health visitors judgments in identifying and working with families requiring extra health visiting, ‘knowing the local community’ had an impact on assessment processes. HVs continually described the importance of developing a good knowledge of the local community in order to make accurate assessments and initiate appropriate referrals to other agencies and services. Many clients also regarded referral and as an important aspect of the HV role, with HVs in this study referring clients for a range of services. Kind regards, Jane.

From: ann ebeid <annebeid@...>Date: 19 June 2011 21:51:07 GMT+01:00senate hvsn < >Subject: RE: Urgent help and info needed for Ed Select Committee on WednesdayReply-

Hi in my research some health visitors were not aware of the community resources available to promote children's and family health, similiar to Jane Appleton's study (?)and an earlier study in Wales by June e and Magaret Buttegieg, Which translated into a lot of missed opportunities to improve the health, welfare and life chances of children in need and their families. June e's (2000?)study found rhetoric rather than a real public health approach in the hv/sn practices that she observed. In my study health visitors felt they were assessing family health needs and there was good evidence that a few health visitors actually did and made a difference to family health . But equally there was evidence that some health visitors didn't recognise/analyse problems and needs and didn't link the family into appropriate services.Some health visitors lacked a focus on outcomes. My exploratory research indicated that hv education and training needs were needed 'on the job' -that is more reflective learning from practice was needed - experiential learning from experienced health visitors who are able to critically deconstuct situations and needs in terms of embedded theories/policy AND practical support that health visitors can link in, to help vulnerable families. For me that is a huge challenge because it requires a new way of training future health visitors with equal emphasis not only on the biological, psychological and social deteminants of health but also on health visitors practical know how and experiential knowledge. Best wishes, Ann.

From: sarahcowley183@...Date: Sun, 19 Jun 2011 19:29:47 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

That is very interesting Ann, if somewhat depressing. Thank you for sharing it with us. Have you written it up anywhere (sorry!)? Were the health visitors aware that they had not linked them into any community resources that might help, or did they not think about it?

As I understand it, the government want health visitors to do the form of linking that you describe, which they describe as 'extending the health visiting rile.' I had thought it was what health visitors did anyway. but perhaps they don't do it any longer. I wonder how we can regain control of the education, and would that help? Or is it (as you suggest) to do with the whole emphasis on assessing needs, with no follow through?

best wishes

On 19 Jun 2011, at 13:22, ann ebeid wrote:

Hi -briefly.... I had been a hv for over two decades in London and Surrey and was puzzled why some families I visited didn't seem to have benefitted from health visitor services in terms of health outcomes, quality of life and reducing health inequalities. I decided to interview hard to reach mothers and chiildren in need and compare their stories with their health visitor's understanding of the situation.My research was mixed methods; narrative interpretation of case studies. My findings pertinent to Maggie's Q3 below are: I interviewed (through taped conversation, grounded theory analysis) mothers who were identified by their health visitors, in order to understand how they perceived their problems and needs and how they felt they had been supported by their health visitors. I used corresponding documentary evidence where possible. I validated my report with mother to make sure it accurately represented what she meant. I then interviewed their health visitor and validated my report with the health visitor to ascertainthat I accurately represented their view I critically analysed/deconstructed mothers and health visitors narratives in biopschsocial frameworks, also analysing health visitors knowledge in use. My findings were that in general health visitors did not link families into available community resources which would have promoted child health and improved health outcomes. In effect, I found little evidence of one of the four guiding principles of health visiting. (CETHV1977). Health visitors I interviewed did not have a good understanding of a public health approach in child health promotion, for example there was little evidence that health visitors linked vulnerable families into community initiatives such as Sure Start children's centres, Extended Schools breakfast and tea clubs. There was almost a scenario of 'paralysis by analysis' -when need was identified I could find little evidence of linkage to resources. For me this is one main reasons why vulnerable children are not picked up.Unlike Early Year setting health visitors have unique access into homes and are aware of family situations. I hope this brief view of my research is insightful to Maggie, in prepartation for next Wednesday's meeting. I am happy to give a full summary if needed. Kind Regards, Ann.

From: sarahcowley183@...Date: Sat, 18 Jun 2011 20:53:11 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

Can you give us clue about how it sheds light, please Ann?

On 18 Jun 2011, at 10:15, ann ebeid wrote:

Hi Maggie-re. Question3. my Ph.D thesis "explored the problems of hard to reach families and children in need and how they were supported by their helth visitors" (2008). It is freely available on line from Ethos at the British library and may throw some light to answer part of Q3. Kind regardsDr. Ann Ebeid

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

[Guest guest]



Thanks Jane.

Best wishesMaggie

Re: Urgent help and info needed for Ed Select Committee on Wednesday

Dear , I tend to agree with your speculations. Good luck Maggie ! Kind regards, Jane.

[Attachment(s) from Maggie Fisher included below]

Dear All

I would really appreciate some help as I have now been given an idea today of the questions I will be asked by the Education Select Committee next Wednesday morning. This is a one off session on Health Visions and school readiness.

The first issue is quite contentious as the very wording school readiness is seen by many as a pedagogical swear word and I will be asked to give health’s perception on what we understand by this. I know Marmot, and Tickell all discuss school readiness in their reviews but I want to convey the essence of what we as HVs understand by this. I would really like other views on this Apparently the committee will ask why the SE is so badly off for HVs and for spending least on child health. They have looked at the FPI reports on this and London and the SE ore in the top 10 and the DH figures reveal the SE and London being particularly poor. Any help with this would be welcome. They will also want to know why some children are not being picked up by either health or early years. What do HVs think of the suggested measures of life chance indicators that Field proposed at 3 years and do any HVs use these or do any of you have experience of using them, I know very few of us do any type of formal review at 3 years? See attached pages Annexe 1 pages 95-96

For the child: British Ability Scales (in particular the naming vocabulary and picture similarities sub-scales)

Bracken School Readiness Assessment

Strengths and Difficulties Questionnaire for three to four year olds

Height and weight to calculate BMI

For the parent: Home Learning Index from the Effective Provision of Pre-School Education (EPPE) study

Short Form 12 or Kessler 6 for maternal mental health

Pianta child-parent relationship scale Millennium Cohort Study authoritative parenting measures

Environment Early Childhood Environment Rating Scale (ECERS)

What are the professions views on the Tickell recommendations of an integrated review see below?

Graham recently published his recommendations for better, earlier, identification of those children who are most vulnerable to the effects of deprivation and dysfunction. Graham made a compelling case for investment in early intervention to prevent these children becoming adults struggling to participate in mainstream society. In his review on poverty and life chances, Field offered recommendations aimed at raising the status of the early years and intervening early to tackle issues at their roots. There are several points of agreement between our approaches, and I believe this early years summary of development will help early years and health professionals to work together more effectively. Only through professionals working together in this collaborative way, can the full benefits of early intervention be achieved. However, the full benefits of this way of working will only be realised when the Healthy Child Programme 2 year health and development review becomes 100% universal. At this point, I urge local commissioners to increase coverage of the Healthy Child Programme and I recommend strongly that the Government works with experts and services to test the feasibility of a single integrated review at age 2 to 2½. For those children who are already in early years provision before their Healthy Child Programme health and development review, this review provides an excellent opportunity for early years practitioners to share with health visitors the picture they have formed, through ongoing regular observation, of children’s development. This is particularly relevant in the context of the Government’s free offer for disadvantaged 2-year-olds.Where a child may need extra help, early years practitioners are then well-placed to work with health visitors to intensify the support they provide to children as part of the Healthy Child Programme health and development review. Such early intervention should help to reduce significantly the proportion of children who are school unready. 22 Equipped for life, ready for school 3.14 There are other ways in which this information could be used to guide children’s ongoing development – for example, to support the transition between early years settings, such as between a childminder and a nursery class. For those children who haven’t been in early years care before, health visitors could, if needed, liaise with the early years setting to ensure appropriate support is provided. Where children move from one type of early years care to another, the rich information already gathered should be shared to provide smooth support for ongoing development. 3.15 Therefore, I recommend that the EYFS should include a requirement for practitioners, including childminders, to provide on request to parents and carers, at some point between the ages of 24 – 36 months, a short written early years summary of their child’s development in the prime areas. The purpose of this early years summary should be to inform parents and carers about their child’s level of development, and to support – if the timing is right – the Healthy Child Programme health and development review carried out by health visitors, as well as transition to nursery provision at age 3.The early years summary should be based around the overlap between the core areas of the 2 year health and development review and the prime areas I have set out above. It should capture the relevant professional knowledge that early years practitioners have developed about each child that they support. Parents and carers should be involved at all stages, and should have control over who the information contained in the early years summary is passed to They will be asking about the 2 – 2,5 year review and thank you to all of those who have given me information on this already. Final question on this how many of you have access to the validated tools that are used to support the 2 year review in Appendix A? Many of these are under licence and have to be purchased by the PCT so I know anecdotally that many practitioners are not able to use them because of this. I would love examples. There will be question on children’s centres but I feel equipped to deal with this. (Brave last words)f Best wishesMaggie

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

[Guest guest]

Hi

any advice about where to publish papers from my thesis. Thank you Ann Ann Ebeid

From: sarahcowley183@...Date: Sun, 19 Jun 2011 19:29:47 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

That is very interesting Ann, if somewhat depressing. Thank you for sharing it with us. Have you written it up anywhere (sorry!)? Were the health visitors aware that they had not linked them into any community resources that might help, or did they not think about it?

As I understand it, the government want health visitors to do the form of linking that you describe, which they describe as 'extending the health visiting rile.' I had thought it was what health visitors did anyway. but perhaps they don't do it any longer. I wonder how we can regain control of the education, and would that help? Or is it (as you suggest) to do with the whole emphasis on assessing needs, with no follow through?

best wishes

On 19 Jun 2011, at 13:22, ann ebeid wrote:

Hi -briefly.... I had been a hv for over two decades in London and Surrey and was puzzled why some families I visited didn't seem to have benefitted from health visitor services in terms of health outcomes, quality of life and reducing health inequalities. I decided to interview hard to reach mothers and chiildren in need and compare their stories with their health visitor's understanding of the situation.My research was mixed methods; narrative interpretation of case studies. My findings pertinent to Maggie's Q3 below are: I interviewed (through taped conversation, grounded theory analysis) mothers who were identified by their health visitors, in order to understand how they perceived their problems and needs and how they felt they had been supported by their health visitors. I used corresponding documentary evidence where possible. I validated my report with mother to make sure it accurately represented what she meant. I then interviewed their health visitor and validated my report with the health visitor to ascertainthat I accurately represented their view I critically analysed/deconstructed mothers and health visitors narratives in biopschsocial frameworks, also analysing health visitors knowledge in use. My findings were that in general health visitors did not link families into available community resources which would have promoted child health and improved health outcomes. In effect, I found little evidence of one of the four guiding principles of health visiting. (CETHV1977). Health visitors I interviewed did not have a good understanding of a public health approach in child health promotion, for example there was little evidence that health visitors linked vulnerable families into community initiatives such as Sure Start children's centres, Extended Schools breakfast and tea clubs. There was almost a scenario of 'paralysis by analysis' -when need was identified I could find little evidence of linkage to resources. For me this is one main reasons why vulnerable children are not picked up.Unlike Early Year setting health visitors have unique access into homes and are aware of family situations. I hope this brief view of my research is insightful to Maggie, in prepartation for next Wednesday's meeting. I am happy to give a full summary if needed. Kind Regards, Ann.

From: sarahcowley183@...Date: Sat, 18 Jun 2011 20:53:11 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

Can you give us clue about how it sheds light, please Ann?

On 18 Jun 2011, at 10:15, ann ebeid wrote:

Hi Maggie-re. Question3. my Ph.D thesis "explored the problems of hard to reach families and children in need and how they were supported by their helth visitors" (2008). It is freely available on line from Ethos at the British library and may throw some light to answer part of Q3. Kind regardsDr. Ann Ebeid

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

[Guest guest]

Dear Ann,

If there is an element of mental health promotion in your thesis, consider sending it to the Journal of Public Mental Health perhaps?

Woody.

From: [mailto: ] On Behalf Of ann ebeidSent: 22 June 2011 09:50senate hvsnSubject: RE: Urgent help and info needed for Ed Select Committee on Wednesday

Hi any advice about where to publish papers from my thesis. Thank you Ann Ann Ebeid

From: sarahcowley183@...Date: Sun, 19 Jun 2011 19:29:47 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

That is very interesting Ann, if somewhat depressing. Thank you for sharing it with us. Have you written it up anywhere (sorry!)? Were the health visitors aware that they had not linked them into any community resources that might help, or did they not think about it?

As I understand it, the government want health visitors to do the form of linking that you describe, which they describe as 'extending the health visiting rile.' I had thought it was what health visitors did anyway. but perhaps they don't do it any longer. I wonder how we can regain control of the education, and would that help? Or is it (as you suggest) to do with the whole emphasis on assessing needs, with no follow through?

best wishes

On 19 Jun 2011, at 13:22, ann ebeid wrote:

Hi -briefly.... I had been a hv for over two decades in London and Surrey and was puzzled why some families I visited didn't seem to have benefitted from health visitor services in terms of health outcomes, quality of life and reducing health inequalities. I decided to interview hard to reach mothers and chiildren in need and compare their stories with their health visitor's understanding of the situation.My research was mixed methods; narrative interpretation of case studies. My findings pertinent to Maggie's Q3 below are: I interviewed (through taped conversation, grounded theory analysis) mothers who were identified by their health visitors, in order to understand how they perceived their problems and needs and how they felt they had been supported by their health visitors. I used corresponding documentary evidence where possible. I validated my report with mother to make sure it accurately represented what she meant. I then interviewed their health visitor and validated my report with the health visitor to ascertainthat I accurately represented their view I critically analysed/deconstructed mothers and health visitors narratives in biopschsocial frameworks, also analysing health visitors knowledge in use. My findings were that in general health visitors did not link families into available community resources which would have promoted child health and improved health outcomes. In effect, I found little evidence of one of the four guiding principles of health visiting. (CETHV1977). Health visitors I interviewed did not have a good understanding of a public health approach in child health promotion, for example there was little evidence that health visitors linked vulnerable families into community initiatives such as Sure Start children's centres, Extended Schools breakfast and tea clubs. There was almost a scenario of 'paralysis by analysis' -when need was identified I could find little evidence of linkage to resources. For me this is one main reasons why vulnerable children are not picked up.Unlike Early Year setting health visitors have unique access into homes and are aware of family situations. I hope this brief view of my research is insightful to Maggie, in prepartation for next Wednesday's meeting. I am happy to give a full summary if needed. Kind Regards, Ann.

From: sarahcowley183@...Date: Sat, 18 Jun 2011 20:53:11 +0100Subject: Re: Urgent help and info needed for Ed Select Committee on Wednesday

Can you give us clue about how it sheds light, please Ann?

On 18 Jun 2011, at 10:15, ann ebeid wrote:

Hi Maggie-re. Question3. my Ph.D thesis "explored the problems of hard to reach families and children in need and how they were supported by their helth visitors" (2008). It is freely available on line from Ethos at the British library and may throw some light to answer part of Q3. Kind regardsDr. Ann Ebeid

Cowley

sarahcowley183@...

http://myprofile.cos.com/S124021COn

Email has been scanned for viruses by Altman Technologies' email management service~EMERGING EXCELLENCE: In the Research Assessment Exercise (RAE) 2008, more than 30% of our submissions were ratedas 'Internationally Excellent' or 'World-leading'.Among the academic disciplines now rated 'World-leading' are Allied Health Professions Studies; Art Design; English Language Literature; Geography Environmental Studies;History; Music; Psychology; and Social Work Social Policy Administration.Visit www.anglia.ac.uk/rae for more information.This e-mail and any attachments are intended for the above named recipient(s) only and may be privileged. If they have come to you in error you must take no action based on them, nor must you copy or show them to anyone: please reply to this e-mail to highlight the error and then immediately delete the e-mail from your system.Any opinions expressed are solely those of the author and do not necessarily represent the views or opinions of Anglia Ruskin University.Although measures have been taken to ensure that this e-mail and attachments are free from any virus we advise that, in keeping with good computing practice, the recipient should ensure they are actually virus free. Please note that this message has been sent over public networks which may not be a 100% secure communicationsEmail has beenscanned for viruses by Altman Technologies' email management service

[Guest guest]

What a star! Maggie was fantastic, overall proceeding very

interesting and can be watched on:

http://www.parliamentlive.tv/Main/Player.aspx?meetingId=8673

[Guest guest]

Maggie

Your passion comes through loud and strong

– you delivered a coherent and clear message. Very well done. We

are fortunate to have you represent us.

Thank you for your such hard work

From:

[mailto: ] On Behalf Of Cowley

Sent: 22 June 2011 11:41

Subject: Re: Urgent

help and info needed for Ed Select Committee on Wednesday

What a star! Maggie was fantastic, overall proceeding very

interesting and can be watched on:

http://www.parliamentlive.tv/Main/Player.aspx?meetingId=8673

size=1 width="100%" noshade color="#a0a0a0"

align=center>

No virus found in this message.

Checked by AVG - www.avg.com

Version: 10.0.1382 / Virus Database: 1513/3719 - Release Date: 06/22/11

[Guest guest]

Thank you and for your kind words, I feel exhausted and drained and wish I could have done some things much better.It is so hard when you are sitting there. My brain was whirling like a top. Liz was great and we agreed which is always helpful. Both Nicola and ine supported the HV case so that was positive as wellIt went on much longer than I anticipated. You can always think of the things you should have said instead.Thank you very much to Senate members for all your help, support and kind words of encouragementBest wishesMaggieSent from my BlackBerry® wireless deviceFrom: " Whittaker" <kwhittaker1@...>Sender: Date: Wed, 22 Jun 2011 12:17:38 +0100< >Reply Subject: RE: Urgent help and info needed for Ed Select Committee on Wednesday Maggie Your passion comes through loud and strong– you delivered a coherent and clear message. Very well done. Weare fortunate to have you represent us.Thank you for your such hard work From: [mailto: ] On Behalf Of CowleySent: 22 June 2011 11:41 Subject: Re: Urgenthelp and info needed for Ed Select Committee on Wednesday What a star! Maggie was fantastic, overall proceeding very interesting and can be watched on:http://www.parliamentlive.tv/Main/Player.aspx?meetingId=8673 size=1 width="100%" noshade color="#a0a0a0"align=center>No virus found in this message.Checked by AVG - www.avg.comVersion: 10.0.1382 / Virus Database: 1513/3719 - Release Date: 06/22/11