Health for All Children: Guidance on implementation in Scotland

The Health for All Children document (also known as “Hall 4”) offers guidance to support implementation of the recommendations of the Royal College of Paediatrics & Child Health’s fourth review of routine child health checks, screening and surveillance activity. The review examined the evidence for existing child health surveillance and screening activity, including the purpose, content and timing of interventions. It took into account the impact of social, economic and environmental factors on children's health. The guidance aims to promote effective and integrated provision of universal and tailored services for children and families, and describes the activity needed for implementation at national and local levels. 

Hall 4 guidance sets out a revised core programme of screening, surveillance and health promotion contacts which every child should receive. It highlights the need to tailor support and intervention, with tiered levels of support according to the assessed need of the child and their family. Hall 4 guidance recognises the need to work with other agencies to provide cohesive support for the child and the family, to ensure the right services are provided at the right time to meet the child’s mental, emotional and physical needs.

Health services have a key role in bringing partners together to meet potentially multiple and complex needs (especially for the target groups of pregnant women and children from 0-3 years) that play a determining factor in the whole outcome of the child including growth and development and affecting the ability to learn and participate in a successful future.

Service Review of Health for All Children (Hall 4) 

The review aimed to survey the implementation of the Scottish guidance from the perspective of a health visitor. The review gave the following key messages:

  • Leadership
  • NHS boards should identify a clinician, preferably an executive director, to lead and be accountable for the implementation of Health for All Children 4: Guidance on implementation in Scotland. Getting it right for Scotland’s children.
  • Specific guidance about what is to be delivered, when and where should be developed.
  • Assessment
  • A review of the wide range of assessment tools and frameworks that are currently in use in Scotland should be undertaken to identify whether a validated national tool can be created.
  • Consideration should be given to reviewing existing education and training programmes to ensure they enhance practitioners’ abilities in assessing risk and decision-making.
  • There is a clear need not only to assess children’s and families’ needs, but also to reassess them at appropriate intervals.
  • Pregnancy and postnatal period
  • Health visitors (HVs) and midwives should work together to improve information-sharing at key transitions including the need for communication with the midwife during antenatal care as required.

The Health Plan Indicator

Under Hall 4, all children are assigned to one of the models of continuing contact and support, on the basis of the assessed need of the family:

  • Core: the universal programme.
  • Additional: the universal programme plus structured additional support
  • Intensive: the universal programme plus intensive inter-agency support

The health professional maintains a record of the model of continuing contact and support the family has been assigned to, i.e. Core, Additional or Intensive. This is known as the Health Plan Indicator (HPI). 

  • The evidence emerging from a number of studies suggests that the universal programme should continue beyond eight weeks, and that some type of universal programme provision should continue for at least the first year of life.
  • There is a need to provide clearer guidance on the HPI and associated programmes; where possible, this should be evidence based.
  • A review of the current guidance on targeting and the time frame for allocation of the HPI should be undertaken to ensure that the needs of all children are met.
  • PHNs/HVs must remain aware of, and alert to, the needs of children in non-targeted groups to allow them to respond appropriately.

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