Identifying approaches to meet assessed needs in health visiting

An action research project, based in a single fundholding practice on the s outh coast of England, aimed to identify the health needs of families with resident children, then use the contracting system to redirect health visit ing services to meet those needs. After assessing the health needs, it was necessary to assess the potential of a range of health visiting approaches that might be proposed to meet tho se needs. This paper explains how the approaches were assessed for use in the local a rea and why funding for two additional, innovative posts was deemed necessa ry. Despite the unsophisticated evidence base for health visiting interventions , a case can be made for commissioning particular service approaches by usi ng a combination of survey data and results from controlled and uncontrolle d service evaluations. The supportive focus of health visitor home visiting remains an appropriate use of existing resources, but the usual intensity of visiting may be insu fficient for full effectiveness. To rationalize such services by targeting them only at individuals with established needs risks an exacerbation of de teriorating health trends across an area. Alternatively, augmenting home visiting with a community development approa ch to improve the adverse social environments in which families live may he lp to change the underlying factors that contribute to ill-health and prove more widely cost-effective.