The development of community service for young children in the New Forest : joint work by a child guidance clinic with health visitors

This work was developed from a child guidance clinic in the New Forest over a period of 15 years from 1984-99. This service was developed with the aim of devolving and disseminating knowledge to allow interventions to take place at the lowest possible level in the system. A strategy to realise these aims was developed and data was collected to monitor progress. This thesis will describe the strategic approach adopted, in order to develop the service: 1. A review of the background literature relevant to the work proposed. 2. A needs' assessment of behaviour problems young preschool children in our district in order to establish what kind of service should be offered. This was a community survey of a total birth cohort of children at age 3 years at the time of their developmental screen. Questionnaires were sent 10 out to families with their invitation to their child's developmental check. This established that the prevalence of behaviour problems found in three year old children in this urban/rural area (14.2%) was similar to the findings of the urban community study of three year old children carried out by Richman, Stevenson & Graham, (1982). 3. The development of ongoing training and support for health visitors in order that they would be able to assess families with young children, screen for problems and institute treatment methods. 4. The development of behaviour programmes that would work within a community setting. An evaluation of the efficacy of treatment of sleep problems by a specialised health visitor in the community was undertaken with a Grant from the South and South West Regional Health Authority. This Trial was a randomised- controlled trial of the delivery of a manualised sleep programme for non-sleeping 2-4 year olds (Douglas & Richman, 1982) delivered by a specialised health visitor over a eight week period at the family's home. The results were clinically significant although just without statistical significance (p=.05 CI -.005 to 5.8). 5. The development of a clinic for young children within the Child Guidance Service in order to encourage appropriate referrals and encourage joint working with the health visitors. 6. Outcome measures were developed to evaluate the clinic work including a tool to assess families' satisfaction. Outcome was measured by the family and clinic independently using a 6-point, unanchored, Likert Scale filled in at assessment and on discharge. Results found that both families and the clinic staff indicated improvement and there was agreement by families and clinicians as to whom had improved. 7. An evaluation of work at Tier I, 11 and 111. Can liaison nurses work within the community, from a base within the child guidance service. A comparison of results from a clinic based service and a community based service indicated that the results for staff working in the community by themselves, were as good as two or more staff working in the clinic but at half the cost. Better liaison with primary care was achieved while working in localities. (Abstract shortened by ProQuest.).