Abstract

Background: UK child health promotion guidelines expect health visitors to assess family needs before age 4 months and offer targeted care on that basis thereafter. We have used data from an intensive family support programme to assess how accurately family needs can be predicted at this stage.

Design: Population based cohort of 1202 families with new babies receiving 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.

Results: 302 families were rated high need at some point, but only 143 (47%) of these had been 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 2/3 of those with high contact rates and those 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 or strongest predictors of contact rates; 1003 (83%) families had one of these characteristics and/or lived in a highly deprived area and this included 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; a majority of families in deprived areas will need continued input if the most vulnerable families are to be reliably identified.