To not call the HV back?

[Lovemcgarrett]

After a couple of accidents and a couple of broken bones in the last fortnight, the HV has called for "a chat". This is the same HV who I made it very clear a couple of years ago after her "helpful comments" that I didn't want to see again.
Do I have to call her back? Any implications of I don't? They were genuine accidents to a very accident prone child (I know it sounds a lot!) but this HV is awful (she told me to shut my daughter in her room and just let her cry rather than cosleep as she was 4).

Yes I'm aware of that. What I mean is why would a SCR state a phone call from a HV after an a&e attendance saved a life? It's almost impossible to quantify that as it's nearly always part of a bigger picture.

It's not going to say it saved a life. No one can definitively say that. However, it's possible to make findings about the effect of various engagements with the various HCP's etc.

I have never read a SCR that says "following a follow up phone call from the HV, X occurred the rest of which improved the outcome for child X or prevented or lead to the prevention of x bad thing happening".

The times I have seen it, is as a result of when the HCP has seen the child face to face. Or, alternatively, turned up for a visit unannounced (as part of a child protection plan), been refused entry and then called the police.

Ok there is no legal obligation to engage with a health visitor this is exactly right. However if childrens services do become involved in a case from a referral from the hospital they will contact the health visitor. If this then proceeds to a child protection case conference the health visitor will attend. It is difficult if all she can say is that the family have not engaged with her as there is then no positive input from health. If this is an aggressive non engagement such as having been told to f off then this is an issue.

I disagree that it's a completely pointless exercise. When my baby bumped his head (accidentally!) and ended up in A&E I got a phone call from the HV afterwards. She asked the circumstances and repeatedly asked me if everything was alright at home. Yes, if they phoned and spoke to someone who had deliberately hurt their baby, that person would be unlikely to admit it. But if it was a person in an abusive relationship, they would potentially have more of a chance of asking for help during a follow up phone call than when attending A&E, possibly with the abusive partner. Or, if it's a family known to the HV the description given of the circumstances of the accident may allow them to assess whether there is a risk it was non accidental. I agree that in 99% of cases it's a box ticking exercise, but surely the point is that in the 1% of cases where it's not it can possibly help prevent a child being seriously harmed?

Although I have to say they must be kept busy if they ring after every trip to A&E - the day we took my son in there were three babies of around the same age there at the same time who had fat lips and eggs on their heads from toppling over when learning to crawl/walk.

I would phone back. Speaking from experience, they will just get you to recount what happened, say they are going to make unannounced home visits and then not bother. Your upset at the fact that someone could even think you MIGHT hurt your own child will quickly turn to disgust at how crap they are and feelings of 'no wonder real abuse victims slip though the net'.

you can't really fob them off with " it is an accident prone child" - that doesn't really explain anything, two accidents and two broken bones in two weeks warrants careful investigating, surely you are reassessing how well your child is supervised? You must be able to see that children's services will need to as well. Of course it could just be total coincidence, but there is more likely to be an underlying reason, isn't there. possibly a health reason?

I used to work with Health Visitors and one of my roles was A&E follow-up.

If I dad heard of a child having two accidents resulting in broken bones in a short time period then I would be concerned.

My level of concern would perhaps be less if it was a family I knew well so I had an idea of their set-up and would already whether anything about them as a family would worry me or not.

If that injured child belonged to a family that we hadn't had any real contact with and so we knew nothing about them it means I would be more worried simply because I had nothing to judge the injuries against.

Depending on the child's previous A&E attendances (if any) or any previous concerns then I would make a decision as to whether I would phone them or whether I would go and visit the family at home. This decision would be made in conjunction with the HV though, not mine alone.

If we were unable to get hold of the parents then we would probably escalate it to our manager and let them decide what to do.

I do think some areas are very lax when it comes to following up A&E injuries. My friend's 18 month old broke his arm by falling down the stairs and his HV didn't even call her to discuss the injury. It's worrying really.

A HV is not allowed to make unannounced home visits unless there is a protection plan in place, unless this has changed recently?

Presumably the HV will ask what happened, you recount it over the phone, assure her that everything is fine and then get back on with thwacking your child in private if you are of that persuasion

Just to clarify: we wouldn't turn up unannounced, we would send them a letter with an appointment time.

ooh let me list dd's a&e attendance.

1. as a baby when a cardboard box hit her in the eye and i wanted to make sure there was no damage to cornea.
2. at about 2yo where she put her hand on a lightbulb needed dressing.
3. nearly bit her tongue off.
4. toenail came off big toe weeks after being trod on by horse. (not a&e practice nurse)

visits/phone call from hv = 0

all of the above raised a comment from practice nurse as dd hardly ever gets sick so only notes on her records were injuries. more of an ooopsie shes a bit accident prone type comment. no concerns.

so i guess not all hospitals call the hv or was mine just crap?

In the 2.5 years that I worked with the HV the hospital only phoned once and that was because it was a serious injury, the family were already known to SS and there were lots of mitigating issues.

What happened in our base is that every week we had a member of staff go to our three local Peadiatric A&E departments and collect all the records of the under 5's who had attended that week. The details included the nature of the injury, the nature of the way they present to A&E, what investigations were done and what treatment was given. Sometimes there would also be a comment written by the doctor to say they specifically wanted the HV to contact the family.

When the staff member returned with the A&E paperwork (usually 20 a week minimum) we would go through them one by one and decide what action, if any, to take.

My DM always marvels at this. She was shocked in an opposite circumstance. DSis had a very nasty accident at home that resulted in a stay in hospital of nearly two weeks. And it could have been way worse than it was only for the extremely quick reactions of both my parents.

Not once did my Mum see an SW or and HV or anyone ask her any questions about it beyond the initial questions of the staff in A&E. But we were a naice professional family living in a naice part of London. Mum says she was horrified and wondered what cases of neglect/abuse were getting missed.

This was nearly 30 years ago mind.

Having been the victim of some spectacularly stupid HV comments OP, I get where you're coming from. But it's probably easier to let her in just this once and then move on.

I myself have taken my DS to A&E about four times and have been contacted by my HV on three of those occasions

jaffa - I agree with you. Hit there is a big difference between parents politely declining the services of an advisory service and telling HVs to fuck off.

In the absence of other concerns, that should not be a red flag. And, actually, telling someone to "fuck off" is very rude but in and of itself shouldn't be a red flag.

Seeing a HV is not mandatory (except under certain circumstances) so previous posts alluding to that causing concerns of itself is exactly what makes the tin foil hat brigade run around shouting that it's all a big conspiracy and an attempt by the government to get into your house by stealth. But more worryingly, it can scare vulnerable people who would really benefit from engagement but don't trust the HV as they feel they are not being told the truth about why they need to see them and what choices they have

*writer - your posts are really interesting and informative re: what happens in action

I think I still feel the same that there needs to be (if possible) more targeted assessment - ideally from birth - re: who is most in need of services.

I don't like a one size fits all approach of there has been a recommendation in a SCR (of, what, over 10 years ago) saying we must phone everyone. Therefore, we will phone. We can now tick box.

Who is assessing the effectiveness of that approach and whether it is still fit for purpose today?

They're obviously very lax here. DD broke her wrist at 23 months old, while in the house with just me. Didn't take her to a&e until the next day (thought I'd "see how it is in the morning") and we never had one call or visit about it.

I was worried for a good few weeks I would be getting SS knocking!

My sin drank perfume so we ended up in A&E on the advice of 111.

I'm fairly certain my (nice but fairly useless) HV knows nothing about it.

I completely agree that not everyone requires a phone call, it is a waste of HV time and also a way to alienate the families against the HV team as unnecessary contact can be viewed as simply interfering.

We had four options when dealing with A&E attendances:

1. No contact, just record it in their notes.
2. A letter to the home to acknowledge the attendance and to just call us if they need any advice or support.
3. A courtesy telephone call to check the child is ok.
4. A home visit.

A lot of factors would be taken into account when making the decision: age of the child, the nature and severity of the injury, social concerns, previous attendances and whether we had concerns about the family set-up. Judgement calls were what led our chosen path of action.

The only criteria was that I would definitely carry out home visits for burns, ingestion/poisoning, household injuries that make us question safety/supervision and dog bites.

In the OPs case of two broken bones, depending on the given causes of the injuries, we would either make a phone-call or visit the family. I suspect the latter would be done though.

In our base the HV's would carry out home visits (optional) to the families before the babies were even born. They were called pre-natal visits and were being introduced to the service in 2012-13. The theory behind it was that prior to the baby being born the HV's could get to know the family and identify who could be in need of more support.

In our case loaf of 1'200 children we covered a vast area, going from families in quite a deprived area to those in an affluent area. Where the child lived was never a factor in our decision on what action to take following an A&E attendance. Our approach was pretty blanketed across the entire case load.

In the 2.5 years I worked there I never had a family refuse me entry or say that didn't want a visit after an A&E attendance. In general they understood why it had to be done and because they never had anything to hide they had no issues with me going round.

I did once get the phone slammed down on me though after being called a nosy, interfering cow

writer - that's good to hear that the vast majority don't refuse entry. Simply because it shows how well the service is engaging in that area

And - also - it's very reassuring to see that there is actual consideration given to the approach to take. I think that makes service users feel much more confident that their own personal circumstances are being considered rather than the "guilty until proven innocent" ethos that some non-engagers give as the reason they don't want input.

My DCs are 15 and 11, and we've never had any follow up calls.

DD ended up in our minor injuries unit due to trapping her toe under the door and ripping the nail, and we also took her after she banged her ear on a roller coaster ride resulting in a rather odd looking bruise.

DS ended up there after DD managed to trap his finger in a door jamb, and we went into a minor injuries unit on holiday a couple of years ago when he complained about a pain in his groin area, which the nurse said was probably a strain. They took all our details there, including his school details, and I guess must have checked against our local HV details and decided no cause for concern.

But we had good HVs in my area when my DCs were babies (don't know what they're like now) so personally I'd have no concerns. I suppose it might be different if we'd had HVs who were not so good.

I don't see a HV but in these circumstances I'd ring.

Our Health Visitor put ds2, (aged 6 weeks), in hospital with chemical burns after she overtreated an umbilical granuloma. Despite the somewhat difficult situation I still had good follow up support from the team, albeit from a different HV.

All the other times my children have ended up in A&E we got a phone call (if it was an injury) or nothing (anaphaxis/croup/dehydration).

We did have quite good links to our families really, there weren't many families that we didn't know relatively well.

We had as much contact with them as we could in the early days: the health visitors would do the pre-natal visits and the new birth visit and then I would go out at 4 weeks and 6 weeks just to see how mom and baby were doing. The HV would also go out at 6 weeks to do the mother's post natal depression assessment.

As I was leaving that job they were also starting to introduce a routine home visit at 4/5 months of age too in order to check all is going ok and give advice on weaning if needed.

We ran two breast feeding clinics a week and also six general baby clinics a week and attendance rates were really good. At some of our busiest clinics we would have 30+ mothers attend each week.

When we had new families move to the area I would go and carry out a home visit so I could introduce our services and put the children on our records. Doing those visits was a fantastic opportunity to identify families in need - I can't count how many visits I have walked away from and been thinking about what support that family or the child needs and how we can help them. If I have any serious concerns about the family (which I've had a few) then I go back to base, contact their previous HV and then discuss with their assigned HV in my base as to whether any action needs to be taken.

We were based in a really lovely Sure Start centre so we had instant access to nursery and pre- school staff who could contact us if they had any concerns. Within our centre we had Family Support Workers, Nursery nurses, midwives, GPs, paediatricians, SALT workers and weekly visits from a company who dealt with employment issues, benefit issues, housing issues etc who ran a drop in clinic for any families who needed support.

I think the fact that we ran such a well jointed and accessible service is what made families so happy to engage with us.

Within our office we had 6 HV's, a nursery nurse and myself. I think one of the main reasons for why things worked so smoothly was because the HV's were absolutely fantastic, no airs and graces, just really down to earth and non-judgemental about the families they came across. They were a lovely team to work with.