What works to enhance the effectiveness of the Healthy Child Programme

As well as assessing the evidence for a range of common approaches and practices, the report draws a set of wider conclusions that pertain to the Healthy Child Programme and maternity and infant support in the UK.

1. The evidence base is growing: Our knowledge of what does and does not work continues to grow at a rapid pace.
2. Not all problems are preventable: Prevention of modifiable risks and promotion of positive protective factors is a vital role of health visiting universal services. However, not all problems are preventable through maternity and health visiting services.
3. There are few magic bullets or quick wins: The majority of effective interventions identified in this review are relatively intensive – that is, taking place for three months or longer through multiple family visits. However, it does also identify a number of ‘quick wins’: relatively short interventions with evidence of improving child and parent outcomes in the short and long term for large sections of the general population.
4. The Healthy Child Programme is a good delivery mechanism for many of the interventions described in this report: The vast majority of interventions and practices identified in this report were developed specifically to be delivered or coordinated by health professionals, including midwives, nurses and health visitors. With minimal additional training in the programme delivery models, it is highly likely that the majority of interventions could be successfully delivered as part of the Healthy Child Programme.
5. Good systems are required to identify need and refer families on to additional support as and when needed: While a wide variety of the interventions described in this report can be successfully delivered through routine midwifery and health visiting care, some require delivery by specialist teams. Some of the more intensive interventions also require good referral systems between midwifery, health visiting, adult mental health and social work teams in order to be successful.
6. Evidence of effectiveness is not a replacement for ongoing evaluation: The fact that an intervention has evidence from a rigorous evaluation conducted at one time and place does not mean that it will be effective again. The evidence described in this report is therefore not a replacement for good monitoring and evaluation systems as interventions are set up and delivered.
7. Evidence that an intervention is effective for parents does not necessarily mean that children will also benefit: Many of the interventions and activities identified in this report have evidence of improving outcomes for parents, but not their children. It is not sufficient to assume that children will automatically benefit from interventions that only have evidence of meeting parents’ needs.
8. There is a lack of evidence about when and how to intervene when parents misuse drugs and alcohol: The lack of evidence involving interventions for parents who misuse drugs and alcohol represents a serious gap in the evidence base. More high-quality research is therefore urgently required to understand the extent to which substance misuse interventions improve parenting behaviours and child outcomes.