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Targeting health visitor care: lessons from Starting Well
  1. C M Wright1,
  2. S K Jeffrey1,
  3. M K Ross2,
  4. L Wallis2,
  5. R Wood3
  1. 1
    PEACH Unit, Faculty of Medicine, University of Glasgow, Glasgow, UK
  2. 2
    Starting Well Health Demonstration Project, Greater Glasgow NHS Board, Glasgow, UK
  3. 3
    Public Health Sciences, University of Edinburgh, Edinburgh, UK
  1. Professor Charlotte M Wright, Community Child Health, PEACH Unit, QMH Tower, Yorkhill Hospitals, Glasgow G3 8SJ, UK; charlotte.wright{at}


Background: UK child health promotion guidelines expect health visitors to assess family needs before new babies are aged 4 months and offer targeted care on that basis thereafter. Data from an intensive family support programme were used to assess how accurately family needs can be predicted at this stage.

Design: A population based cohort of 1202 families with new babies receiving an intensive health visiting programme. Analysis of routinely recorded data.

Setting: Starting Well project, Glasgow, UK.

Predictors: Health visitor rating of family needs.

Main outcome measures: Families receiving high visiting rates or referred to social work services.

Results: Of 302 families rated high need, only 143 (47%) were identified by age 4 months. Visiting rates in the first year for those initially rated high need were nearly double those for the remainder, but around two thirds of those with high contact rates/referred to social work were not initially rated high need. Six family characteristics (no income, baby born preterm, multiple pregnancy, South Asian, prior social work/criminal justice involvement, either parent in care as a child) were identified as the commonest/strongest predictors of contact rates; 1003 (83%) families had one such characteristics and/or lived in a highly deprived area, including 228 (93%) of those with high contact rates and 157 (96%) of those referred to social work.

Conclusions: Most families at risk will not be identified on an individual basis in the early weeks. Most families in deprived areas need continued input if the most vulnerable families are to be reliably identified.

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  • Funding: This analysis was supported by the Starting Well Programme, funded by the Scottish Executive and commissioned through NHS Health Scotland. RW is currently funded by the Chief Scientist Office of the Scottish Government Health Directorate to undertake an evaluation of the implementation of Health for All Children 4 in Scotland (Fellowship reference CAF/06/05).

  • Competing interests: The researchers were independent from funders at all times with regard to study design, analysis and interpretation of data, deciding to submit the results for publication and writing the paper.