Services and support for parents

Nhs services for new parents, registering your baby with a gp.

Register your baby with your GP as early as possible in case you need their help.

You can contact your GP at any time, whether it's for you or your child.

If you move, register with a new GP close to you as soon as possible.

If your baby is not yet registered with a GP but needs to see one, you can receive emergency treatment from any GP surgery.

How your health visitor can help

A health visitor will usually visit you at home for the first time around 10 days after your baby is born. Until then you'll be cared for by local midwives.

A health visitor is a qualified nurse or midwife who has had extra training. They're there to help you, your family and your new baby stay healthy.

Your health visitor can visit you at home, or you can see them at your child health clinic, GP surgery or health centre, depending on where they're based.

Talk to your health visitor if you’re struggling with your mental health. They can give you advice and suggest where to find help. Read more about feeling depressed after childbirth .

They may also be able to put you in touch with groups where you can meet other parents.

Child health clinics

Child health clinics are run by health visitors and GPs. They offer regular baby health and development reviews and vaccinations .

You can also talk about any problems to do with your child, but if your child is ill and likely to need treatment, see your GP.

Some child health clinics also run parent and baby, breastfeeding , and peer support groups.

Local authority services

Sure start children's centres.

Sure Start children's centres provide family health and support services, early learning, and full-day or temporary care for children from birth to 5 years.

They also provide advice and information for parents on a range of issues, from parenting to training and employment opportunities. Some have special services for young parents.

Family Information Service

Family Information Service (FIS) aims to help you support your children by providing information for parents.

Each FIS has close links with children's centres, Jobcentre Plus, schools, careers advisers, youth clubs and libraries.

They offer information about local childcare services and availability, and can help if you need childcare for a child with a disability or special needs.

You can find out if these services are available in your area by contacting your local council.

Local advice centres

Advice centres are non-profit agencies that give advice on issues such as benefits and housing.

You can search online for organisations such as:

  • Citizens Advice
  • community law centres
  • welfare rights offices
  • housing aid centres
  • neighbourhood centres
  • community projects

To help you get the most out of services:

  • write down what you want to talk about and what information you can give that will be helpful
  • tell the person you are talking to if you do not understand them – you could ask them to write down what they are saying

There may be support available if English is not your first language. Ask your health visitor what's available in your area.

Websites, helplines and support groups

Contact: for families with disabled children.

Support, advice and information for parents with disabled children.

  • helpline: 0808 808 3555
  • website: contact.org.uk

Family Lives

An organisation providing immediate help from volunteer parent support workers.

  • helpline: 0808 800 2222
  • website: www.familylives.org.uk

Family Rights Group

Support for parents and other family members whose children are involved with or need social care services.

  • helpline: 0808 801 0366
  • website: www.frg.org.uk

Gingerbread: single parents, equal families

Help and advice on the issues that matter to lone parents.

  • helpline: 0808 802 0925
  • website: www.gingerbread.org.uk

Parent and baby groups

To find out about local parent and baby groups:

  • ask your health visitor or GP
  • look on noticeboards and for leaflets at your local child health clinic, health centre, GP's waiting room, children's centre, library, advice centre, supermarket or newsagent
  • search on the internet, on social media or your local council’s website

In some areas, there are groups that offer support to parents who share the same background and culture.

Your health visitor may know whether there are any groups like these near you.

Video: What does a health visitor do?

In this video, a health visitor explains the role of health visitors and the support they offer to new parents.

Page last reviewed: 31 August 2022 Next review due: 31 August 2025

Validate your membership/access to the iHV Champion hub here to receive your password. Not a member? Join here .

Forgot Password

Health Visiting is…

Health visitors are registered nurses/midwives who have additional training in community public health nursing. They provide a professional public health service based on best evidence of what works for individuals, families, groups and communities; enhancing health and reducing health inequalities through a proactive, universal service for all children 0-5 years and for vulnerable populations targeted according to need. Health visiting is a proactive, universal service that provides a platform from which to reach out to individuals and vulnerable groups, taking into account their different dynamics and needs, and reducing inequalities in health.  Pre-school children and their families are a key focus.

How does it work?

Health visitors work with parents who have new babies, offering support and informed advice from the ante-natal period until the child starts school at 5 years.  They may work in teams or have sole responsibility for a caseload derived from the local area or a general practice list; they are usually based in children’s centres, surgeries, community or health centres. Health visitors visit parents through a minimum of 5 universal home visits from late pregnancy through to a developmental assessment at 2 years. These visits are usually in the home, but the health visitor may invite you to join groups, clinics and networks run by the health visiting team or colleagues who work with them such as: nursery nurses, children centre staff, voluntary organisations or community mothers.

Families from all walks of life may need support for specific issues that affect their children’s health and development, so the actual service provided to each particular family will vary according to a personalised assessment of their own needs and evidence of what will work for them.

View iHV Film – Health visiting in your community – December 2022

  • A short film which showcases the breadth of health visitors’ work and their critical role in supporting the health and wellbeing of thousands and thousands of families every week.
  • Please do share this film widely – you have our permission to include the links in your local resources.

health visitor second visit

Watch our short film – Health Visitors: for every family

The Institute of Health Visiting (iHV), working together with parents and Solent NHS Trust, is delighted to share a short film to highlight the value and breadth of the role of the health visitor in relation to family mental health and wellbeing outcomes.

It showcases the unique opportunity and skills that health visitors have to build relationships and the support that health visitors can offer where additional concerns about parental mental health or the parent-infant relationship are identified.

Infographics

One of the biggest challenges facing the health visiting profession is that many people do not know who health visitors are, or what their role entails. How can we expect the Government to invest in health visiting if this is not clear?

Across the four nations of the UK, there are also significant differences between the health visiting services offered in each nation – this is driven by different levels of prioritisation and investment by their respective governments. To support investment in health visiting in all nations, it is therefore imperative that the work of health visitors is made visible, and the benefits of an effective health visiting service are promoted. As a result, this infrastructure of support that health visitors provide is vulnerable to service cuts.

In our aim to make the work of the health visitor more visible, we launched two new infographics setting out  “Who are health visitors and what do they do?”  and  “It’s time to invest in health visiting because…”.

health visitor second visit

A film, by Birmingham Community Healthcare NHS Trust – “Health visiting in the spotlight”

Health visiting – every chance for every child, from birth to five. from BCHC COMMS on Vimeo .

  • Parent Leaflet for Sexual and Reproductive Health
  • **Parenting and the COVID-19 pandemic**
  • Ready Steady Mums
  • Getting to Know Your Baby
  • What is a Health Visitor
  • Childhood cancer: spotting the signs & symptoms
  • Respiratory Illnesses, Strep A and Flu – Tips for Parents
  • Online support

health visitor second visit

Institute of Health Visiting | c/o Royal Society for Public Health, John Snow House, 59 Mansell Street, London E1 8AN

Tel: +44 (0) 207 265 7352 | Email: [email protected]

  • © Institute of Health Visiting   |
  • FAQ   |
  • Privacy and cookies   |
  • Sitemap   |
  • Accessibility   |
  • Terms of use   |
  • Registered Charity Number 1149745

Website design by wave

Doctor Visits

Make the Most of Your Baby’s Visit to the Doctor (Ages 0 to 11 Months)

A smiling doctor helps a healthy baby sit up for an exam.

Take Action

Babies need to go to the doctor or nurse for a “well-baby visit” 6 times before their first birthday.

A well-baby visit is when you take your baby to the doctor to make sure they’re healthy and developing normally. This is different from other visits for sickness or injury.

At a well-baby visit, the doctor or nurse can help catch any problems early, when they may be easier to treat. You’ll also have a chance to ask any questions you have about caring for your baby.

Learn what to expect so you can make the most of each well-baby visit.

Well-Baby Visits

How often do i need to take my baby for well-baby visits.

Babies need to see the doctor or nurse 6 times before their first birthday. Your baby is growing and changing quickly, so regular visits are important.

The first well-baby visit is 2 to 3 days after coming home from the hospital, when the baby is about 3 to 5 days old. After that first visit, babies need to see the doctor or nurse when they’re:

  • 1 month old
  • 2 months old
  • 4 months old
  • 6 months old
  • 9 months old

If you’re worried about your baby’s health, don’t wait until the next scheduled visit — call the doctor or nurse right away.

Child Development

How do i know if my baby is growing and developing on schedule.

Your baby’s doctor or nurse can help you understand how your baby is developing and learning to do new things — like smile or turn their head to hear your voice. These are sometimes called “developmental milestones.”

At each visit, the doctor or nurse will ask you how you’re doing as a parent and what new things your baby is learning to do. 

By age 2 months, most babies:

  • Lift their head when lying on their stomach
  • Look at your face
  • Smile when you talk to them
  • React to loud sounds

See a complete list of milestones for kids age 2 months .

By age 4 months, most babies:

  • Bring their hands to their mouth
  • Make cooing sounds
  • Hold toys that you put in their hand
  • Turn their head to the sound of your voice
  • Make sounds when you talk to them

See a complete list of milestones for kids age 4 months .

By age 6 months, most babies:

  • Lean on their hands for support when sitting
  • Roll over from their stomach to their back
  • Show interest in and reach for objects
  • Recognize familiar people
  • Like to look at themselves in a mirror

See a complete list of milestones for kids age 6 months . 

By age 9 months, most babies:

  • Make different sounds like “mamamama” and “bababababa”
  • Smile or laugh when you play peek-a-boo
  • Look at you when you say their name
  • Sit without support

See a complete list of milestones for kids age 9 months . 

What if I'm worried about my baby's development? 

Remember, every baby develops a little differently. But if you’re concerned about your child’s growth and development, talk to your baby’s doctor or nurse. 

Learn more about newborn and infant development .

Take these steps to help you and your baby get the most out of well-baby visits.

Gather important information.

Take any medical records you have to the appointment, including a record of vaccines (shots) your baby has received and results from newborn screenings . Read about newborn screenings .

Make a list of any important changes in your baby’s life since the last doctor’s visit, like:

  • Falling or getting injured
  • Starting daycare or getting a new caregiver

Use this tool to  keep track of your baby’s family health history .

What about cost?

Under the Affordable Care Act, insurance plans must cover well-child visits. Depending on your insurance plan, you may be able to get well-child visits at no cost to you. Check with your insurance company to find out more.

Your child may also qualify for free or low-cost health insurance through Medicaid or the Children’s Health Insurance Program (CHIP). Learn about coverage options for your family.

If you don’t have insurance, you may still be able to get free or low-cost well-child visits. Find a health center near you and ask about well-child visits.

To learn more, check out these resources:

  • Free preventive care for children covered by the Affordable Care Act
  • How the Affordable Care Act protects you and your family
  • Understanding your health insurance and how to use it [PDF - 698 KB]

Ask Questions

Make a list of questions to ask the doctor..

Before the well-baby visit, write down 3 to 5 questions you have. Each well-baby visit is a great time to ask the doctor or nurse any questions about:

  • How your baby is growing and developing
  • How your baby is sleeping
  • Breastfeeding your baby
  • When and how to start giving your baby solid foods
  • What changes and behaviors to expect in the coming months
  • How to make sure your home is safe for a growing baby

Here are some questions you may want to ask:

  • Is my baby up to date on vaccines?
  • How can I make sure my baby is getting enough to eat?
  • Is my baby at a healthy weight?
  • How can I make sure my baby is sleeping safely — and getting enough sleep?
  • How can I help my baby develop speech and language skills?
  • Is it okay for my baby to have screen time?
  • How do I clean my baby's teeth?

Take a notepad, smartphone, or tablet and write down the answers so you can remember them later.

Ask what to do if your baby gets sick.

Make sure you know how to get in touch with a doctor or nurse when the office is closed. Ask how to reach the doctor on call, or if there's a nurse information service you can call at night or on the weekend.

What to Expect

Know what to expect..

During each well-baby visit, the doctor or nurse will ask you about your baby and do a physical exam. The doctor or nurse will then update your baby’s medical history with all of this information.

The doctor or nurse will ask questions about your baby.

The doctor or nurse may ask about:

  • Behavior — Does your baby copy your movements and sounds?
  • Health — How many diapers does your baby wet each day? Does your baby spend time around people who are smoking or using e-cigarettes (vaping)?
  • Safety — If you live in an older home, has it been inspected for lead? Do you have a safe car seat for your baby?
  • Activities — Does your baby try to roll over? How often do you read to your baby?
  • Eating habits — How often does your baby eat each day? How are you feeding your baby?
  • Family — Do you have any worries about being a parent? Who can you count on to help you take care of your baby?

Your answers to questions like these will help the doctor or nurse make sure your baby is healthy, safe, and developing normally.

Physical Exam

The doctor or nurse will also check your baby’s body..

To check your baby’s body, the doctor or nurse will:

  • Measure height, weight, and the size of your baby’s head
  • Take your baby’s temperature
  • Check your baby’s eyes and hearing
  • Check your baby’s body parts (this is called a physical exam)
  • Give your baby shots they need

Learn more about your baby’s health care:

  • Read about what to expect at your baby’s first checkups
  • Find out how to get your baby’s shots on schedule

Content last updated March 30, 2023

Reviewer Information

This information on well-baby visits was adapted from materials from the Centers for Disease Control and Prevention and the National Institutes of Health.

Reviewed by: Sara Kinsman, M.D., Ph.D. Director, Division of Child, Adolescent, and Family Health Maternal and Child Health Bureau Health Resources and Services Administration

Bethany Miller, M.S.W. Chief, Adolescent Health Branch Maternal and Child Health Bureau Health Resources and Services Administration

Diane Pilkey, R.N., M.P.H. Nursing Consultant, Division of Child, Adolescent, and Family Health Maternal and Child Health Bureau Health Resources and Services Administration

September 2021

You may also be interested in:

health visitor second visit

Protect Yourself from Seasonal Flu

health visitor second visit

Breastfeed Your Baby

health visitor second visit

Eat Healthy During Pregnancy: Quick Tips

The office of disease prevention and health promotion (odphp) cannot attest to the accuracy of a non-federal website..

Linking to a non-federal website does not constitute an endorsement by ODPHP or any of its employees of the sponsors or the information and products presented on the website.

You will be subject to the destination website's privacy policy when you follow the link.

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • View all journals
  • Explore content
  • About the journal
  • Publish with us
  • Sign up for alerts
  • Published: 02 March 2021

Unintended consequences of restrictive visitation policies during the COVID-19 pandemic: implications for hospitalized children

  • Jean L. Raphael 1 ,
  • Woodie Kessel 2 &
  • Mona Patel 3  

Pediatric Research volume  89 ,  pages 1333–1335 ( 2021 ) Cite this article

5032 Accesses

18 Citations

3 Altmetric

Metrics details

The COVID-19 pandemic has resulted in devastating consequences worldwide with over 2,000,000 deaths. Although COVID-19 demonstrates less morbidity and mortality among children, 1 it has dramatically altered the health-care experience for children and families. This is particularly true for those cared for in inpatient settings. The competing priorities of safeguarding families and health-care personnel from a serious infection, stewardship of limited resources, ensuring family-centered care (FCC), and carrying out end-of-life care have led to tensions in how to effectively implement and execute necessary restrictive visitation policies. 2 While the Centers for Disease Control and Prevention (CDC) provides broad guidelines to health-care facilities on the management of visitors, hospitals must determine how to implement such guidelines. 3 Many children’s hospitals have instituted one-visitor policies with varying levels of restriction, such as allowing one parent at the bedside at any time or requiring families to choose a single parent to be allowed in the hospital for the entirety of the inpatient stay. Such visitation policies can have significant untoward consequences.

In this issue, Van Driest et al. 4 explored the consent rate for an observational study conducted in the early months of the COVID-19 pandemic after the implementation of a one-parent/visitor policy at an academic children’s hospital. They calculated the consent rate and enrollment rate for historical periods, the time immediately preceding the one-visitor policy, and during the one-visitor policy. The authors found a statistically significant reduction in the consent rate for the observational study in the early months of the COVID-19 pandemic and during the implementation of the one-visitor policy. In this commentary, we focus on the effects of restrictive visitation policies and strategies to mitigate against adverse impacts on children and families, both in research and the clinical setting.

Research implications

Researchers must consider the myriad of unintended consequences from restrictive visitation policies on children and families during a time of heightened anxiety related to the vulnerability and lethality of COVID-19 during the pandemic. Parents who feel isolated or distressed from being alone in the hospital during a pandemic may be less willing to participate in research. As another example, institutional review boards (IRBs) often require both parents to sign consent for important therapeutic trials in children or if studies are conducted on the fetus. If only one parent is allowed to visit and telephone consent is not allowed for the second parent, some children may not be able to participate in clinical trials. Van Driest et al. highlight the long-term consequences of the one-visitor policy on pediatric research identifying under enrollment, reduced sample sizes, and underrepresentation of key populations. Future pediatric research must adequately account for one-visitor policies in consent and enrollment procedures. 5

Impact on FCC

In addition to the conduct of research, COVID-19-related restrictive visitation policies have impacted how families and providers navigate the FCC model in the inpatient setting. In the FCC approach, health-care professionals work in partnership with families to facilitate parent–child closeness, open exchange of information, and shared decision-making regarding the child’s health-care management. 2 , 6 Endorsed by the American Academy of Pediatrics, the FCC has been demonstrated to improve outcomes for patients, families, and health-care providers while decreasing health-care expenditures. 2 , 6 By their very nature, restrictive visitation policies limit the extent to which families and health-care providers in hospitals can engage in FCC. The consequences may be especially deleterious in settings such as the neonatal intensive care unit (NICU) where 24-h parental presence with extended intimate contact of the newborn has both physiological and psychological benefits to the newborn and parents. 7 A recent study by Darcy Mahoney et al. 8 assessed the impact of restrictions on parental presence in the NICU before and during the COVID-19 pandemic. The cross-sectional survey of global NICUs identified a variety of visitation policies among 130 NICUs worldwide that restricted parental presence during the COVID-19 pandemic. Of these NICUs, 85% only allowed one parent at the bedside at any time, with a subset (25%) requiring families to choose a single parent to be allowed into the NICU for the entire hospitalization. Approximately 5% of NICUs excluded all parental presence. Such policies may have dramatic effects on kangaroo care or breastfeeding rates. This study also demonstrated dramatic shifts in parental engagement representative of FCC. The number of NICUs allowing 24-h parental presence decreased from 83 to 53% and parental participation in NICU rounds decreased from 71 to 32%. As health-care systems adapt their visitation policies to prevent the spread of COVID-19, they may unintentionally amplify the underlying stress and anxiety of parents about their children’s health during the pandemic, and impact engagement of families in supportive, shared decision-making with the health-care team.

Exacerbation of health inequities

Restrictive visitation policies in pediatric settings also have the potential to inadvertently exacerbate existing health-care inequities. Parents may weigh their physical presence in the hospital to engage in care and support of their child versus competing priorities such as work or caretaking of other children, which is especially challenging for marginalized populations during this global pandemic. If they choose to stay in the hospital, they may feel social isolation in combination with the stress of an ill child, without having shared family support during this time of crisis. If they remain at home, they forego the benefits of FCC and may feel the guilt of leaving a child alone in the hospital during a pandemic. They may also be subject to staff perceptions of being disengaged in their child’s care, which further contributes to implicit bias already experienced by people of color in medical settings. 9 For economically vulnerable populations, the weight of these decisions may be compounded by a lack of social supports and other child caretakers in addition to jobs with limited flexibility.

Vulnerable populations may also suffer if hospital’s policies are not adequately informed by ethical principles, stakeholder engagement, accessibility, transparency, and acknowledgment of diversity and equity of the populations served. In a study of COVID-19 visitor policies in Michigan, Weiner et al. 10 found that most policies lacked such elements, including stated ethical rationales and stakeholder engagement prior to implementation. Furthermore, many failed to delineate caregiver visitation exception request processes. Without such transparency, numerous institutional factors may lead to enforcement variation, and, consequently, confusion and inequity in visitation access and fair appeals processes. The consequence may be an amplification of already existing disparities as vulnerable populations may be less well-positioned to advocate for themselves. Inequities may also be engendered by the specification of which visitors are permitted, such as parents or immediate family. These assumptions of family structure may inadvertently exclude individuals important to the patient or those who have some level of decisional authority to the patient’s care. 10

Reduction in health-care utilization

There is also concern that visitor restriction policies may lead families to delay or defer care that requires a hospitalization. Those facing the added burden of restrictions on parental presence may avoid or defer medical procedures or surgeries that will ultimately improve their child’s health or well-being. Surgery, in normal times, is an anxiety-inducing experience for children and families. Family members and other social supports serve important roles in the preoperative decision-making, ensuring FCC throughout the hospitalization during recovery processes and in discharge planning. Visitor restrictions, made to stem the harm from the COVID-19 pandemic, may also negatively influence the postoperative experience. A recent study of adult postoperative experiences during COVID-19 by Zeh and co-workers 11 highlighted the psychosocial impacts of restrictive visitation policies. Patients under no-visitor policies were more likely to be dissatisfied with their hospital experience. A lack of visitors negatively affected patient’s psychosocial well-being. Patients under no-visitor policies were less likely to have their preferences adequately addressed at discharge. While no-visitor policies are unlikely to exist in pediatrics, even the limitation to one-visitor may adversely impact perioperative experiences. With consideration of these visitation restrictions, parents may opt to delay surgeries. This may impact the health of their children as well as the financial viability of hospitals already under financial strain during the pandemic.

Mitigating the challenges of visitor restrictions during the COVID-19 pandemic

As public health leaders, clinical experts, ethicists, and hospitals debate the merits of current visitation policies to stem the transmission of COVID-19, urgent efforts are needed to support families and mitigate against the unintended consequences of such restrictions on research, patient experience, and health equity. Researchers must modify policies and procedures while proactively working with IRBs to overcome challenges. Assuring that visitation policies are carried out in an ethically rigorous manner with transparency (e.g., clear appeals process), communication (e.g., public-facing website), and patient-centeredness (e.g., support mechanisms) is also essential. 2 , 3 , 7 , 10 This requires periodic modification of policies informed by epidemiological data, protective equipment availability, and stakeholder engagement. Specific engagement of vulnerable at-risk populations is critical in order to prevent exacerbation of health inequities. In addition to revising policies, hospitals must develop comprehensive measures to support parents during this or any infectious disease threat. Upon admission, inpatient clinical teams could provide families with a communication plan outlining their policy and specific measures by which they can experience FCC regardless of whether they are at the bedside or home. Parents should have a clear understanding of technologies, platforms, and interpreter services available to the patient and family for communication. Social work providers should be involved early in the hospitalization to describe available psychosocial resources for parents who may feel isolated or have concerns about competing priorities (e.g., employment, children at home). By leveraging the expertise of researchers, family engagement, and an emerging evidence base demonstrating the impact of visitation policies, it is possible to create an inpatient experience that preserves the ethical, legal, and public health principles of minimizing the spread of COVID-19 pandemic while continuing to conduct high-impact research, promote the FCC approach essential for quality pediatric care, and mitigate against health inequities.

Goyal, M. K. et al. Racial and/or ethnic and socioeconomic disparities of SARS-CoV-2 infection among children. Pediatrics 146 , e2020009951 (2020).

Article   Google Scholar  

Hart, J. L., Turnbull, A. E., Oppenheim, I. M. & Courtright, K. R. Family-centered care during the COVID-19 era. J. Pain Symptom Manag. 60 , e93–e97 (2020).

Virani, A. K. et al. Benefits and risks of visitor restrictions for hospitalized children during the COVID pandemic. Pediatrics 146 , e2020000786 (2020).

Van Driest, S. L. et al. Research consent rates before and during a COVID-19 one-visitor policy in a children’s hospital. Pediatr Res. 1–3. 2021. https://doi.org/10.1038/s41390-020-01303-7 . Online ahead of print.

Weiner, D. L., Balasubramaniam, V., Shah, S. I. & Javier, J. R., Pediatric Policy C. COVID-19 impact on research, lessons learned from COVID-19 research, implications for pediatric research. Pediatr. Res. 88 , 148–150 (2020).

Article   CAS   Google Scholar  

Meert, K. L., Clark, J. & Eggly, S. Family-centered care in the pediatric intensive care unit. Pediatr. Clin. N. Am. 60 , 761–772 (2013).

Murray, P. D. & Swanson, J. R. Visitation restrictions: is it right and how do we support families in the NICU during COVID-19? J. Perinatol. 40 , 1576–1581 (2020).

Darcy Mahoney, A. et al. Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019. J. Perinatol. 40 (Suppl. 1), 36–46 (2020).

Johnson, T. J. Intersection of bias, structural racism, and social determinants with health care inequities. Pediatrics . 146 , e2020003657 (2020).

Weiner, H. S. et al. Hospital visitation policies during the SARS-CoV-2 pandemic. Am. J. Infect. Control . S0196-6553(20)30887-7 (2020). https://doi.org/10.1016/j.ajic.2020.09.007 .

Zeh, R. D. et al. Impact of visitor restriction rules on the postoperative experience of COVID-19 negative patients undergoing surgery. Surgery 168 , 770–776 (2020).

Download references

Author information

Authors and affiliations.

Center for Child Health Policy and Advocacy, Baylor College of Medicine, Houston, TX, USA

Jean L. Raphael

Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA

Woodie Kessel

Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA, USA

You can also search for this author in PubMed   Google Scholar

Contributions

All authors have made substantial contributions to conception and design, drafting the article or revising it critically for important intellectual content, and final approval of the version to be published.

Corresponding author

Correspondence to Jean L. Raphael .

Ethics declarations

Competing interests.

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Cite this article.

Raphael, J.L., Kessel, W. & Patel, M. Unintended consequences of restrictive visitation policies during the COVID-19 pandemic: implications for hospitalized children. Pediatr Res 89 , 1333–1335 (2021). https://doi.org/10.1038/s41390-021-01439-0

Download citation

Received : 16 January 2021

Accepted : 25 January 2021

Published : 02 March 2021

Issue Date : May 2021

DOI : https://doi.org/10.1038/s41390-021-01439-0

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

This article is cited by

Supporting children and families in medical settings: insights from child life specialists during the covid-19 pandemic.

  • Carly Jenkins
  • Cheryl Geisthardt
  • Jack K. Day

Journal of Child and Family Studies (2023)

A qualitative descriptive study of the impact of the COVID-19 pandemic on staff in a Canadian intensive care unit

  • Jeanna Parsons Leigh
  • Sara J. Mizen
  • Sangeeta Mehta

Canadian Journal of Anesthesia/Journal canadien d'anesthésie (2023)

Visitors not Welcome: Hospital Visitation Restrictions and Institutional Betrayal

  • Suzanne Marmo
  • Jennifer Hirsch

Journal of Policy Practice and Research (2022)

Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review

  • Stephana J. Moss
  • Karla D. Krewulak
  • Kirsten M. Fiest

Critical Care (2021)

Quick links

  • Explore articles by subject
  • Guide to authors
  • Editorial policies

health visitor second visit

Advertisement

After a Night ‘on Fire,’ Biden Hits the Road to Make the Case for a Second Term

Pumped up by the reaction to his forceful address to Congress the evening before, the president sought to build on the momentum by opening his general election campaign with a trip to Pennsylvania.

  • Share full article

Biden Makes a Campaign Stop in Pennsylvania

President biden held a campaign rally outside philadelphia on friday to amplify his message from his state of the union address..

Our freedoms really are on the ballot this November. Donald Trump and the MAGA Republicans are trying to take away our freedoms. That’s not an exaggeration. Well, guess what? We will not let him. [cheering] We will not let him. I see a future where we defend democracy. Not diminish it. I see a future where we defend our freedom, not take them away. I see a future the middle class has a fair shot and the wealthy pay their fair share. I see a future for the planet — move from the climate crisis in our country, away from the gun violence that we have so much of. I see a future of America remains the beacon of the world.

Video player loading

By Peter Baker

Reporting from Wallingford, Pa.

  • March 7, 2024

President Biden took his bid for a second term on the road on Friday, effectively opening the general election campaign with a strongly populist pitch and an aggressive attack on his Republican challenger, former President Donald J. Trump.

Kicking off a monthlong set of barnstorming trips mainly to swing states, Mr. Biden reprised the themes of his State of the Union address at a rally in Wallingford, Pa., as he sought to capitalize on his robust nationally televised performance and galvanize Democrats who have been anxious about his age and poor poll numbers.

Mr. Biden made clear that his regular targets during this re-election bid would be billionaires, corporations, pharmaceutical companies, banks, credit card companies and even potato chip makers. All of them, in his telling, are out to gouge consumers and duck their fair share of taxes. But his favorite villain in his election-year narrative will still be Mr. Trump, his opponent from 2020 now in a rematch set by this week’s Super Tuesday primaries .

“Donald Trump and the MAGA Republicans are trying to take away our freedoms,” Mr. Biden told a crowd of cheering Democrats in a school gymnasium, this time not shying away from citing his challenger by name, unlike the night before. “That’s not an exaggeration. But guess what? We will not let him.”

Mr. Biden seemed delighted by the reviews of his State of the Union address, which allies hope will jump-start his campaign after months of Democratic uncertainty about his prospects. “I got my usual warm reception from Congresswoman Marjorie Taylor Greene,” he joked, referring to the Georgia Republican who had heckled and jeered him .

He was so pumped up after the speech, he said, that he stayed up until 2 a.m. and checked out the Fox News coverage. Unsurprisingly, he disagreed with the conservative network’s take that his economic policies would “ruin America,” as he summarized it. “We have the strongest economy in the world right now,” he said.

The president was introduced on Friday by his wife, Jill Biden, who seemed likewise charged up by the address to Congress. “Wasn’t he on fire?” she asked the crowd.

She too went after Mr. Trump directly, contrasting him with her husband. “He wakes up every morning thinking about how he can make the lives of Americans better,” she said of Mr. Biden. “Donald Trump wakes up every morning caring about one person and one person only: himself.”

The president’s travel schedule is about to pick up. After this stop in Pennsylvania, Mr. Biden will head to Georgia on Saturday, New Hampshire on Monday and Wisconsin and Michigan in the middle of next week. Vice President Kamala Harris will travel to Arizona and Nevada, meaning that between the two they will hit within a week all of the half-dozen swing states considered critical to the outcome in November.

The cabinet will join in the blitz as well, with the secretaries of the Treasury, interior, agriculture, labor, health and human services, education, energy and veterans affairs as well as various agency directors all taking to the road. The officials will talk about policy goals like protecting abortion rights and promote the administration’s accomplishments, such as strong job growth, rather than making formal campaign speeches, but it all fits into the broader effort. The president and his team got good news as they headed out when the Labor Department reported that U.S. employers had added 275,000 jobs last month.

Mr. Biden’s well-funded campaign announced that it would open the season with a $30 million advertising blitz . The campaign plans to hire 350 staff members and open 100 offices in battleground states over the next month, countering Democratic nervousness about its sluggish start.

After flying to Philadelphia on Friday, Mr. Biden stopped at a private home in Swarthmore to visit Jack and David Cunicelli, the owners of a local cafe. A member of their family is an old friend of Hunter Biden, the president’s son.

But one of the electoral challenges facing Mr. Biden as he seeks to reassemble his 2020 coalition manifested when he arrived at Strath Haven Middle School in Wallingford, where hundreds of protesters upset at his support for Israel’s war in Gaza were waiting. “Shame on you,” they chanted. They added, pointedly, “This November, we remember.”

Inside the gymnasium, Mr. Biden got a friendlier greeting from the crowd: “Four more years!”

Mr. Biden did not exhibit the same volume as he had the night before and stumbled over his words occasionally. But wearing a blue quarter-zip sweater and no tie, he appeared loose and in good spirits, engaging playfully with the crowd. At one point, he trotted out one of his regular lines, complaining that billionaires pay only 8 percent in taxes, a figure that fact checkers have said is misleading .

“I pay more than that,” a woman called out.

“You sure hell do!” he replied.

After his speech was over and Dr. Biden joined him onstage, the president interrupted the applause and made the campaign staff turn down the music so he could tell a well-worn story about how he had proposed to her. “I had to ask this woman five times to marry me!”

But he had a serious message about the choice he sees for the country between him and Mr. Trump, whom he blamed for threatening democracy and coarsening society.

“When you ride down the street, there’s a Trump banner with an F-U on it and a 6-year-old kid putting up his middle finger — did you ever think you’d hear people talk the way they do?” Mr. Biden asked. “Look, it demeans who we are. That’s not America.”

The president associated his challenger with dictators like President Vladimir V. Putin of Russia and autocrats like Prime Minister Viktor Orban of Hungary , essentially making the case that Mr. Trump shares their anti-democratic instincts.

“You know who he’s meeting with today down in Mar-a-Lago?” Mr. Biden asked the crowd. “Orban of Hungary, who stated flatly he doesn’t think democracy works, he’s looking for dictatorship.” He added, “That’s who he’s meeting with. I see a future where we defend democracy, not diminish it. I see a future where we defend our freedoms, not take them away.”

Peter Baker is the chief White House correspondent for The Times. He has covered the last five presidents and sometimes writes analytical pieces that place presidents and their administrations in a larger context and historical framework. More about Peter Baker

Our Coverage of the State of the Union

In a raucous state of the union address, president biden sought to reassure americans that at 81, he is ready for a second term..

Biden’s Performance: The president was feisty   and displayed a newly found solemnity and blunt combativeness . Republicans jeered  from their seats. And Democrats enthusiastically cheered their presidential nominee, even as a few aired their grievances about the war in Gaza .

A Contrast With Trump: In his speech, Biden launched a series of fiery attacks  against former President Donald Trump, a competitor whom he did not mention by name but made clear was a dire threat to American democracy  and to  stability in the world .

Middle East Crisis: During the State of the Union, the president announced the construction of a port to deliver aid to Gaza. That decision, as well as the  authorization of aid airdrops  on the territory, raised uncomfortable questions  about America’s role in the war.

Seeking a Tricky Balance: As he spoke to Congress, Biden tried to demonstrate that he could be tough on the border without demonizing immigrants .

A Rare Mention: Biden briefly referenced a topic  that he has often been reluctant to embrace: marijuana. His words could signal a move toward promoting the efforts he has made to liberalize cannabis policy.

Style Choices: Democratic women in suffragist white , Marjorie Taylor Greene in MAGA red. The sartorial statement-making on the congressional floor was clear .

health visitor second visit

Study record managers: refer to the Data Element Definitions if submitting registration or results information.

Search for terms

ClinicalTrials.gov

  • Advanced Search
  • See Studies by Topic
  • See Studies on Map
  • How to Search
  • How to Use Search Results
  • How to Find Results of Studies
  • How to Read a Study Record

About Studies Menu

  • Learn About Studies
  • Other Sites About Studies
  • Glossary of Common Site Terms

Submit Studies Menu

  • Submit Studies to ClinicalTrials.gov PRS
  • Why Should I Register and Submit Results?
  • FDAAA 801 and the Final Rule
  • How to Apply for a PRS Account
  • How to Register Your Study
  • How to Edit Your Study Record
  • How to Submit Your Results
  • Frequently Asked Questions
  • Support Materials
  • Training Materials

Resources Menu

  • Selected Publications
  • Clinical Alerts and Advisories
  • Trends, Charts, and Maps
  • Downloading Content for Analysis

About Site Menu

  • ClinicalTrials.gov Background
  • About the Results Database
  • History, Policies, and Laws
  • ClinicalTrials.gov Modernization
  • Media/Press Resources
  • Linking to This Site
  • Terms and Conditions
  • Search Results
  • Study Record Detail

Maximum Saved Studies Reached

Double-blind, Placebo-controlled, Randomized Study of the Tolerability, Safety and Immunogenicity of an Inactivated Whole Virion Concentrated Purified Vaccine (CoviVac) Against Covid-19 of Children at the Age of 12-17 Years Inclusive"

  • Study Details
  • Tabular View
  • No Results Posted

sections

Recruitment of volunteers will be competitive. A maximum of 450 children aged 12 to 17 years inclusive will be screened in the study, of which it is planned to include and randomize 300 children who meet the criteria for inclusion in the study and do not have non-inclusion criteria, data on which will be used for subsequent safety and immunogenicity analysis.

Group 1 - 150 volunteers who will be vaccinated with the Nobivac vaccine twice with an interval of 21 days intramuscularly.

Group 2 - 150 volunteers who will receive a placebo twice with an interval of 21 days intramuscularly.

In case of withdrawal of volunteers from the study, their replacement is not provided.

health visitor second visit

Inclusion Criteria:

  • Volunteers must meet the following inclusion criteria:

Type of participants • Healthy volunteers.

Age at the time of signing the Informed Consent

• from 12 to 17 years inclusive (12 years 0 months 0 days - 17 years 11 months 30 days).

Paul • Male or female.

Reproductive characteristics

  • For girls with a history of mensis - a negative pregnancy test and consent to adhere to adequate methods of contraception (use of contraceptives within a month after the second vaccination). Girls should use methods of contraception with a reliability of more than 90% (cervical caps with spermicide, diaphragms with spermicide, condoms, intrauterine spirals).
  • For young men capable of conception - consent to adhere to adequate methods of contraception (use of contraceptives within a month after the second vaccination). Young men and their sexual partners should use methods of contraception with a reliability of more than 90% (cervical caps with spermicide, diaphragms with spermicide, condoms, intrauterine spirals).

Research procedures

  • Written Informed consent of a volunteer (14 years and older) and one of the parents to participate in a clinical trial.
  • Volunteers who are able to fulfill Protocol requirements (i.e. answer phone calls, fill out a Self-observation Diary, come to control visits).

Non-inclusion criteria:

  • Volunteers cannot be included in the study if any of the following criteria are present:

SARS-CoV-2 infection

  • A case of established COVID-19 disease confirmed by PCR and/or ELISA in the last 6 months.
  • History of contacts with confirmed or suspected cases of SARS-CoV-2 infection within 14 days prior to vaccination.
  • Positive IgM or IgG to SARS-CoV-2 detected on Screening.
  • Positive PCR test for SARS-CoV-2 at Screening / before vaccination.

Diseases or medical conditions

  • Serious post-vaccination reaction (temperature above 40 C, hyperemia or edema more than 8 cm in diameter) or complication (collapse or shock-like condition that developed within 48 hours after vaccination; convulsions, accompanied or not accompanied by a feverish state) to any previous vaccination.
  • Burdened allergic history (anaphylactic shock, Quincke's edema, polymorphic exudative eczema, serum sickness in the anamnesis, hypersensitivity or allergic reactions to the introduction of any vaccines in the anamnesis, known allergic reactions to vaccine components, etc.).
  • Guillain-Barre syndrome (acute polyradiculitis) in the anamnesis.
  • The axillary temperature at the time of vaccination is more than 37.0 ° C.
  • Positive blood test for HIV, syphilis, hepatitis B/C.
  • Acute infectious diseases (recovery earl

Exclusion Criteria:

- • Withdrawal of Informed consent by a volunteer and/or a parent of a volunteer;

  • The volunteer was included in violation of the inclusion/non-inclusion criteria of the Protocol;
  • Availability of inclusion/non-inclusion criteria before vaccination;
  • Any condition of a volunteer that requires, in the reasoned opinion of a medical researcher, the withdrawal of a volunteer from the study;
  • The established fact of pregnancy before the second vaccination;
  • Taking unauthorized medications (see section 6.2);
  • The volunteer's incompetence with the study procedures;
  • The volunteer refuses to cooperate or is undisciplined (for example, failure to attend a scheduled visit without warning the researcher and/or loss of communication with the volunteer), or dropped out of observation;
  • For administrative reasons (termination of the study by the Sponsor or regulatory authorities), as well as in case of gross violations of the protocol that may affect the results of the study.
  • For Patients and Families
  • For Researchers
  • For Study Record Managers
  • Customer Support
  • Accessibility
  • Viewers and Players
  • Freedom of Information Act
  • HHS Vulnerability Disclosure
  • U.S. National Library of Medicine
  • U.S. National Institutes of Health
  • U.S. Department of Health and Human Services

Cookies on GOV.UK

We use some essential cookies to make this website work.

We’d like to set additional cookies to understand how you use GOV.UK, remember your settings and improve government services.

We also use cookies set by other sites to help us deliver content from their services.

You have accepted additional cookies. You can change your cookie settings at any time.

You have rejected additional cookies. You can change your cookie settings at any time.

health visitor second visit

  • Parenting, childcare and children's services
  • Children's health and welfare
  • Children's health

Health Visitor Information Pack

The health visitor information pack describes the evidence-based approach of the work of health visitors and information on the transition of the service over the next 2 years and beyond.

Applies to England

health visitor second visit

Health visitor information pack

PDF , 652 KB , 8 pages

This file may not be suitable for users of assistive technology.

Other relevant resources

These resources and tools are aimed at health visitors and people who work with them to deliver the Healthy Child Programme for children aged 0 to 5 years old . They include professional pathways, guidance and education and training resources, as well as factsheets and questions and answers (Q and A).

The Health Visitor Programme Implementation Plan sets out the purpose, vision, programme of work, governance and accountability for the programme as well as information on those involved in the delivery.

Guidance for education commissioners, higher education institutions and lecturers  setting out the approach on aligning education with regard to provision of a transformed health visiting service. Also sets out a more detailed rationale and suggestions for aligning the ‘new service vision’ and meeting family expectations.

The Health Visitor Practice Teacher Framework pulls together all the published information around health visitor practice teachers.

Guidance on the health visiting career for commissioners, practice educators, line managers, service leads and newly qualified health visitors, including those who have responsibility for the skills, support and experiences of newly qualified health visitors.

Guidance for health visitors and midwives to help them deliver improved shared outcomes and greater integration of services.

The Health Visiting School Nursing Pathway provides a structured approach to addressing the common issues identified by both professionals associated with the transition of a family and child from health visiting to school nursing services. Builds on good practice and provides a systematic solution-focused approach on which to base future local practice.

The Maternal Mental Health Pathway guidance provides a structured approach on common issues associated with maternal mental health and wellbeing, from pregnancy through the early months after the birth. The maternal mental health pathway focuses on the role of the health visitor but also recognises the essential contributions of partners in midwifery, mental health, general practice and third sector, and also supports professional practice.

Health visiting factsheets and Q and As for local authority and GPs .

Answers to frequently asked questions about the Integrated review for children aged 2-2.5

Is this page useful?

  • Yes this page is useful
  • No this page is not useful

Help us improve GOV.UK

Don’t include personal or financial information like your National Insurance number or credit card details.

To help us improve GOV.UK, we’d like to know more about your visit today. We’ll send you a link to a feedback form. It will take only 2 minutes to fill in. Don’t worry we won’t send you spam or share your email address with anyone.

U.S. flag

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

  • Publications
  • Account settings
  • Advanced Search
  • Journal List
  • Pilot Feasibility Stud

Logo of pilotfs

‘Making the most of together time’: development of a Health Visitor–led intervention to support children’s early language and communication development at the 2–2½-year-old review

Cristina mckean.

1 Newcastle University, Newcastle upon Tyne, UK

Rose Watson

Jenna charlton, sue roulstone.

2 Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Southmead Hospital, Bristol, UK

3 University of West of England, Bristol, UK

Caitlin Holme

Victoria gilroy.

4 Institute of Health Visiting, London, UK

Associated Data

The datasets generated and/or analysed during the current study are not publicly available due to the ethical approvals in place making data sharing non-permissible. Participants did not give permission for data sharing. All qualitative data collection materials are available from the first corresponding author on reasonable request.

Early interventions to support young children’s language development through responsive parent–child interaction have proven efficacy but are not currently delivered universally. A potential universal delivery platform is the Health Visitor (HV)–led 2–2½-year-old review in England’s Healthy Child Programme. It is unclear if it is feasible to offer such interventions through this platform. We report an intervention development process, including extensive stakeholder consultation and co-design which aimed to develop an acceptable, feasible and equitable early language intervention for delivery in this context.

The study involved five phases including 13 stakeholder co-design workshops with 7 parents and 39 practitioners (HVs, early years practitioners and speech and language therapists): (1) Identification of existing intervention evidence, (2) qualitative review of intervention studies extracting candidate target behaviours for intervention and intervention techniques, (3) co-design workshops with parents and practitioners examining acceptability, barriers and enablers to those behaviours and techniques (particular attention was paid to diverse family circumstances and the range of barriers which might exist), (4) findings were analysed using COM-B and theoretical domains frameworks and a prototype intervention model designed, and (5) co-design workshops iteratively refined the proposed model.

Practitioners were committed to offering language intervention at the 2–2½-year-old review but were not sure precisely how to do so. Parents/caregivers wanted to be proactive and to have agency in supporting their own children and to do this as soon as possible. For equitable intervention, it must be proportionate , with higher ‘intensity’ for higher levels of disadvantage, and tailored, offering differing approaches considering the specific barriers and enablers, assets and challenges in each family. The importance and potential fragility of alliances between parent/caregiver and practitioner were identified as key, and so, strategies to engender successful collaborative partnership are also embedded in intervention design.

It is possible to develop a universal intervention which parents and practitioners judge would be acceptable, feasible and equitable for use at the 2–2½-year review to promote children’s language development. The result is one of the most explicitly developed universal interventions to promote children’s language development. Further development and piloting is required to develop materials to support successful widespread implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-00978-5.

Key messages regarding feasibility

  • Early interventions to support young children’s language development through responsive parent–child interaction have proven efficacy but are not currently delivered universally.
  • A potential universal delivery platform is the Health Visitor (HV)–led 2–2½-year-old review in England’s Healthy Child Programme.
  • It is unclear if it is feasible to offer such interventions through this platform.
  • It is possible to develop a universal intervention for use at the 2–2½-year review to promote children’s language development which practitioners and parents consider would be acceptable, feasible and equitable.
  • For equitable intervention, it must be proportionate , with higher ‘intensity’ for higher levels of disadvantage, and tailored, offering differing approaches considering the specific barriers and enablers, assets and challenges in each family.
  • The importance and potential fragility of alliances between parent/caregiver and practitioner were identified as key, and so, strategies to engender successful collaborative partnership are essential for success and must also be embedded in intervention design.
  • The intervention devised provides a protocol for delivery which participants felt would be acceptable, feasible and equitable; however, it is untested in practice.
  • Further work is also needed for ELIM-I to be accessible to families from a range of linguistic and cultural backgrounds.
  • Further work is required to develop and pilot a manualised programme with standardised intervention resources and guidance for local implementation and policy development.

The early years of a child’s life lay the foundation for their health, education and wellbeing across the life course [ 1 , 2 ]. A child’s language development in these early years is a key component of that foundation and is now widely recognised as a crucial indicator of an individual’s ‘life chances’ [ 3 ]. Children who enter school (aged 5–6 years) with language difficulties are at risk of poorer long-term outcomes with respect to adolescent educational attainment and social–emotional wellbeing [ 4 ], adult literacy, mental health, employment [ 5 , 6 ], health literacy [ 7 ], social anxiety and isolation [ 8 ]. Given that prevalence estimates suggest that, on average, every primary school classroom in England contains two children with significant language difficulties [ 9 ], reaching up to 40% in the most disadvantaged communities [ 10 ], this is a substantial challenge for educational, social and health services.

Many social and educational policies around the world make robust early language development a key objective [ 11 – 13 ]. A great deal is known about the aspects of a child’s early learning environment which can be harnessed to promote positive language outcomes in the pre-school period due to several systematic reviews and efficacy and epidemiological studies [ 14 – 22 ]. Despite this, the development of an intervention, which can be delivered universally, affordably and effectively for children under the age of 3 years, has remained elusive. Recently, the case has been made that early language and communication needs should be tackled through public health preventive models of intervention [ 23 ]. In the UK, the Healthy Child Programme provides support from 0 to 19 years of age and is led by Public Health England (PHE) aiming to ‘improve the health of babies, children and their families to enable a happy healthy childhood and provide the foundations of good health into adult life’ [ 24 – 26 ]. In the 0–5-year period, this programme of work is led by Health Visiting Teams. HVs are specialist nurses, and their teams often include trained early years educators. The teams are separate from but closely linked to family doctors and paediatric services and provide families with a programme of screening, immunisation and health and development reviews, supplemented by advice around health, wellbeing and parenting. In 2018, PHE identified early language development as one of six ‘high impact’ areas where HV services can make the greatest difference [ 27 ]. Whilst such ambitions and their rationale are clearly stated in policy, precisely how to ensure all children are supported to achieve positive language outcomes is less well specified. Furthermore, whilst the HV 2–2½-year-old review has been the focus of timely identification of speech, language and communication needs (SLCN) using the Ages and Stages Questionnaire (ASQ-3) nationally mandated pre-assessment tool [ 28 ], the mode, content and delivery of this contact is variable, and interventions commonly lack conceptual and practical detail. In recognition of this, the Department for Education (DfE) commissioned a programme of training and research to develop a national approach to support the development of children’s early language and led by PHE [ 29 ]. This research strand developed a novel tool for HV teams to identify children at risk of poor language development and a linked intervention: the Early Language Identification Measure and Intervention (ELIM-I) [ 30 , 31 ]. Here, we focus on the development of the intervention component of the ELIM-I, whilst a description of the development of the identification measure is reported elsewhere [ 32 ].

This paper outlines the development of a universal intervention to offer to families at the HV 2–2½-year-old review to promote robust language development for all children. Our aim was to develop an intervention which aligns with the aims, principles and structure of the modernised HCP [ 33 ]. That is, an approach with ‘universal reach and a personalised response’ to be led by HV teams in England, and which focusses, in the first instance, on the universal 2–2½-year-old review and draws on the wider children’s workforce, as necessary. Following guidance on the development of complex and public health interventions, we sought to develop an intervention which is acceptable, equitable, practicable, can be delivered at scale, and which is based on current best evidence and underpinned by relevant theory [ 34 – 36 ].

As with any public health intervention, there is a risk that universal approaches can inadvertently widen rather than narrow inequalities if the necessary attention is not paid to structural factors which influence a family’s ability to engage in a given health-promoting behaviour [ 37 ]. There is evidence to suggest this is a real risk for early language interventions [ 38 , 39 ]. An alternative is to apply ‘proportionate universalism’ where intensity of action is proportionate to the level of disadvantage [ 40 ]. However, intensity is not the only characteristic which can and should be tailored to the individual circumstances of a family. Much of the existing evidence regarding pre-school language interventions focusses on building capacity in parents/caregivers: their knowledge and skills as to how to create a language enriching environment for their child. Insufficient attention has been paid to other factors associated with structural inequalities such as families’ opportunities and resources as well as affective factors such as their optimism and belief about their capabilities [ 41 , 42 ]. For an equitable intervention to be designed, we must not only create a proportionate model (i.e. with higher ‘intensity’ for higher levels of disadvantage need [ 40 ]) but also a tailored one, offering differing approaches considering the specific barriers and enablers, assets and challenges in each family [ 43 ].

In conclusion, the aim was to develop an intervention that is

  • Acceptable, practicable and can be delivered at scale;
  • Based on current best evidence and underpinned by relevant theory;
  • Proportionate to the assets and challenges of individual families;
  • Tailored to the barriers and enablers present for individual families; and
  • Well specified in its methods to enable fidelity in delivery.

Overarching methodology

The Medical Research Council’s guidance for the development and evaluation of complex interventions emphasises the importance of rigorous intervention development [ 34 ]. However, it is only relatively recently that detailed, systematic and replicable methods for this first phase of intervention research have been specified [ 41 , 44 ]. Our methods align with the most recent guidance by O’Caithan and colleagues published in 2019 [ 35 ], and are an adaptation of those described by O’Brien et al. [ 44 ]. This iterative and sequential method is designed to enable the integration of published scientific evidence, expert knowledge and experience and detailed consideration of stakeholder knowledge and views. We remained open to change, and processes were developed and adapted as necessary in response to outcomes at each stage. We made use of the expertise of the research team at several stages to challenge, develop and contextualise intervention development. The team comprised researchers with backgrounds in Speech and Language Therapy, General Practice, Health Visiting (practice and policy), Psychology, Medical Sociology and Linguistics. In addition, reflections from a parallel study regarding the acceptability of the ELIM/developmental review were used to challenge interpretations/analyses (Holme C, et al. Parental experiences and perspectives of the 2–2½ year developmental review process for identifying speech, language and communication needs. Under review). Furthermore, we report the intervention development following recognised reporting guidance (GUIDED) [ 45 ].

Theoretical perspective

We drew on existing theory in several ways. First, with respect to child language development, we were informed by socio-cognitive theories [ 46 – 48 ] which emphasise the importance of responsive interactions with caregivers for robust language development. A number of infant socio-cognitive skills are also crucial to early language development: the ability to share attention with adults, understand their communicative intentions and take turns in conversations [ 49 ]. Language is learned best in responsive social interactions between caregiver and infant where the language used by the adult is contingent on the child’s attention and where the child is deploying these socio-cognitive abilities to infer meaning and maintain the interaction [ 19 , 21 , 22 , 49 ]. Importantly, caregiver-responsive contingent interactions also facilitate the development of these socio-cognitive abilities and so are critical to robust language and communication development from the very earliest days of a child’s life [ 50 ]. Second, we planned to apply Behaviour Change Theory to the intervention development drawing on the Behaviour Change Wheel [ 41 ] and the Theoretical Domains Framework (TDF) [ 42 ]. Third, the Theoretical Framework of Acceptability (TFA) [ 51 ] informed the development of stakeholder co-design workshop materials.

As data were collected and analysed, it became clear that consideration of the socio-relational aspects of the intervention was essential and must inform intervention design if an effective and acceptable approach was to be developed. Additional theory relating to principles of shared decision-making, therapeutic alliance, trust and engagement was therefore also consulted [ 36 , 52 – 59 ].

When attending to future implementation, normalisation process theory (NPT) was also considered [ 60 ]. Embedding health care innovations into routine practice is not straightforward and requires explicit planning. NPT suggests that four kinds of work need to occur for an innovation to become ‘normalised’ practice: coherence work (or sense-making), participation work (or engagement), enacting work (action to enable the intervention to happen) and appraisal work (reflection and monitoring of the benefits and costs) [ 61 ]. When designing the intervention, where HV teams were on the ‘journey’ towards normalisation of support for children’s language development was considered to ensure the approach devised takes the necessary next steps. Future implementation was also considered through the lens of acceptability and considering APEASE criteria (Affordability Practicability, Effectiveness and cost-effectiveness, Acceptability, Safety and Equity) throughout the stages of development [ 41 , 51 ].

All relevant details about the project were submitted to the West Midlands–Black Country NHS Research Ethics Committee (REC), and a favourable ethical opinion was received on the 7th of May 2019 (REC reference 19/WM/0114 project # 261205). Research and development (R&D) management approvals were then received from the five sites involved in the study. Participants gave fully informed consent before each workshop/data collection episode.

An iterative design process was followed through which evidence was gathered and appraised, relevant theory identified and applied, and intervention models and materials generated, tested and analysed. There were four stages, each stage providing results which then formed the basis of the design of the next phase (Fig. ​ (Fig.1). 1 ). Stages 3 and 4 comprised co-design workshops with parents and practitioners. A total of 13 stakeholder co-design workshops were completed: seven in Stage 3 and six in Stage 4. Members of the research team reflected on and discussed processes and outputs over the course of the study. A number of Public Patient Involvement (PPI) workshops also contributed to knowledge of the context of the interventions.

An external file that holds a picture, illustration, etc.
Object name is 40814_2022_978_Fig1_HTML.jpg

Overview of the intervention stages, outputs and their linkage

PHE led a selection process to identify 5 sites to host the ELIM-I study based on prevalence of speech, language and communication needs (SLCN) (as indicated by school readiness), prevalence of risk factors associated with SLCN (including free school meal eligibility as a proxy for socio-economic status and English as an additional language) and the availability of site data. The sites included a mix of urban, rural, northern and southern geographies and a range of service delivery models [ 32 ]. Table ​ Table1 1 presents a summary of the demographic detail for the local authority areas of the 5 sites drawing on data from the Office of National Statistics [ 62 , 63 ].

Summary on demographic detail for the local authority areas of the 5 sites

a Data source: https://www.ons.gov.uk/visualisations/dvc1371/#/E09000023

b Data source: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/populationcharacteristicsresearchtables

c BAME Black Asian and Minority Ethnic groups including White non-British groups

Participants

Study contacts at each site provided meeting facilities and acted as gatekeepers to participant recruitment. For practitioners, study contacts were asked to invite members of the HV team (HVs and community nursery nurses (CNN)) and relevant members of the Speech and Language Therapy (SLT) team. For parents/caregivers, they were asked to invite parents of children aged 3–6 years currently receiving support for their SLCN (Table ​ (Table2). 2 ). This was to allow us to engage with the experiences of families with recent experience of the pathway from identification to receipt of support. Seven parents were involved across the workshops. Two parents attended two co-design workshops, and five attended one. Parents were given shopping vouchers as a token of appreciation for their time, and their travel expenses were reimbursed.

Stakeholder workshops and participant characteristics

Stage 5 parent/caregiver workshops in Site 5 was cancelled due to COVID-19 restrictions on travel and were offered in Sites 2 and 4 but not attended by any parents; all CNNs were part of HV teams. Codes are used when reporting quotes from workshops in the Results section

Key: HV Health visitor, CNN Community nursery nurse, SLT Speech and language therapist, SLTA Speech and language therapy assistant, Prac Practitioner, P-C Parent/caregiver, WS Workshop

Thirty-nine different practitioners were involved across the workshops. A range of practitioner roles were represented with the substantial majority being HVs or community nursery nurses working within the HV team. This allowed for issues of acceptability, practicability, implementation and equity to be explored. SLTs were also represented to draw on their knowledge of local SLCN pathways and of successful language intervention models and techniques. A total of seven different parents/caregivers participated, one of whom spoke English as an additional language, and 36 different practitioners (18 HVs, 6 community nursery nurses, 2 student HVs, 1 family nurse, 1 student nurse, 6 speech and language therapists, 2 speech and language therapy assistants). Parent/caregiver participant recruitment was affected by the government restrictions associated with COVID-19. Attendance at offered workshops in Sites 4 and 2 were probably affected by the growing anxiety at that time, and a final planned workshop in Site 5 with twelve families recruited had to be cancelled due to travel restrictions immediately prior to the first UK lockdown.

Methods and results

Due to the iterative and interconnected nature of the study design, the following presents the methods and results for the four stages in turn. Figure ​ Figure1 1 summarises the methods, objectives and results of each stage and their linkage.

Stage 1 methods

To identify evidence-based interventions in a parsimonious fashion, the starting point for Stage 1 was previous systematic and scoping reviews [ 15 , 16 , 64 – 67 ]. This ensured a level of quality assurance and relevance without the need for full systematic reviewing of the intervention literature. The knowledge and expertise of the team was utilised within a workshop to review and analyse identified intervention studies to determine their quality and relevance to the HV check (see Supplementary materials 1 for additional detail) and to make explicit key relevant components of the interventions.

Stage 1 results

A final set of 16 papers was identified detailing effective interventions of relevance to the HV assessment (see Supplementary materials 1 ). A simple preliminary logic model of the intervention was designed based on initial review of the interventions and workshop discussions (Fig. ​ (Fig.2 2 ).

An external file that holds a picture, illustration, etc.
Object name is 40814_2022_978_Fig2_HTML.jpg

Simple Logic Model to guide intervention development

Stage 2 methods

The intervention papers identified in Stage 1 were examined and the target behaviours of the effective interventions and the intervention techniques extracted.

‘Personae’ were developed for use in practitioner workshops at Stage 3 to explore how any intervention would need to be tailored for different families to ensure equity and proportionality [ 68 ]. These personae described families with whom the practitioner might work which vary according to characteristics that may affect a family’s ability to engage with an intervention and/or the target health-promoting behaviour. Their use in our data collection methods aimed to make explicit expert practitioner knowledge and clinical decision-making, which can often be tacit or implicit [ 69 ]. To develop persona in an objective, empirically based manner and avoid the danger of pejorative or reductive stereotypes, we searched for epidemiological studies which consider how potential barriers and enablers to positive language outcomes cluster within families. The resulting personae were based on work by Christensen and colleagues using latent class methods, which identified, six distinct clusters of family risks associated with differing vocabulary growth trajectories in a representative sample of 4000 Australian children [ 70 ]. ‘Pen portraits’ of families representing each of the risk clusters described by Christenson et al. were developed using gender neutral names from a range of cultural heritages. Personae were developed only for use with practitioners; parents/caregivers were asked instead to reflect on their own experiences to maintain the validity of the insights gained as emerging from their own lived experience rather than any assumptions or generalisations about other family circumstances.

Workshop materials were designed using the findings above and drawing on behaviour change and acceptability theoretical frameworks [ 41 , 51 ]. They aimed to elicit parent/caregiver and practitioner opinions regarding the acceptability of intervention target behaviours and techniques, and barriers and enablers for families with differing assets and challenges.

Stage 2 results

Table ​ Table3 3 lists the target behaviours and intervention techniques extracted from the list of intervention papers. Multiple goals were targeted within complex interventions falling broadly into three categories: responsive contingent interaction, shared book reading and focussed stimulation. Several intervention techniques were used including video feedback; multiple techniques were identified including video coaching, diary completion, environmental prompts (e.g. fridge magnet reminders), etc.. The persona ‘pen portraits’ are presented in Table ​ Table4. 4 . Workshop materials are available on request from the authors.

Workshop descriptors of the behaviours targeted and intervention techniques used in the research literature

Descriptions of family ‘persona’ used to elicit practitioners implicit decision-making processes

Stage 3 methods

Seven co-design workshops with 22 participants were facilitated by two members of the study team at each workshop (CM and either RW or SR). Practitioner workshops began with questions to understand the local pathway for children with speech, language and communication (SLC) needs. Parent/caregiver workshops began with an exploration of the participants’ motivation for attendance which also uncovered their experiences of the local pathway. A co-design activity was then completed which involved participants being presented in turn with the candidate target behaviours (e.g. shared book reading) and intervention techniques (e.g. diary completion) identified in Stage 2 (Table ​ (Table3). 3 ). Barriers and enablers to and acceptability of adopting the target behaviour or implementing the intervention technique were then explored. Paper-based workshop materials were used to stimulate discussions and helped to scaffold and steer the topics covered. These materials were manipulated and annotated during discussions by the study team and participants. All workshops were audio recorded. The above yielded the raw data for analysis: verbatim transcriptions of the workshops, annotated workshop materials, field notes and team reflections.

Methods for intervention development, described by Michie and colleagues and often referred to as the Behaviour Change Wheel and Capability, Opportunity, Motivation, Behaviour (COM-B) models, were followed [ 41 , 71 ]. These methods ensure a systematic, theory-driven approach to intervention design providing methods and frameworks for (1) a thorough assessment of the behaviour to be targeted (the Behaviour in the COM-B model); (2) precise and detailed analysis of what is needed for individuals to change that behaviour (Capability, Opportunity and Motivation factors); (3) identification of the types of intervention functions and techniques which have proven efficacy in bringing those specific types of change about (Theoretical Domains Framework and Intervention Functions); and (4) determination of the best methods to implement those intervention functions and techniques, whether that be through service provision, communication and marketing, fiscal measures, regulation, and so on (the Policy categories section of the Behaviour Change Wheel). A four-step deductive analysis was completed to (1) map identified barriers and enablers and intervention techniques identified in the workshops and the research papers to the Theoretical Domains Framework (TDF) (e.g. Physical skills, Knowledge, Memory, Attention and Decision processes); (2) map the identified theoretical domains to candidate intervention functions (e.g. Training, Education, Environmental Restructuring); (3) map the intervention function to candidate ‘policy categories’, that are the candidate platforms through which a specific intervention function can be delivered effectively (for example, ‘Fiscal Measures’ may be appropriate for environmental restructuring function to reduce alcohol intake, ‘Communications and Marketing’ may be appropriate for Education to reduce smoking, and ‘Service Provision’ may be needed for training to increase physical activity); and (4) intervention functions identified as relevant to the TDF and barriers/enablers but judged not to be appropriate to the intervention context were discarded (e.g. Restriction, Coercion).

Field notes and team reflections identified that several qualitative, socio-relational aspects of intervention delivery were being identified by participants as crucial to intervention success. Inductive analysis was therefore also completed to analyse the verbatim transcripts to identify themes which were not determined a priori, which emerged as important to intervention design.

Finally, a paper model of a proposed intervention was developed based on the identified intervention functions and policy categories. Judgement was used to determine which were the most relevant to the intervention. This judgement was informed by comments on acceptability from the co-design workshops at Stage 3, discussion with the wider team, knowledge gained of the contextual factors of importance through PPI, and themes of acceptability from the parallel study regarding parent/caregiver perspectives on the ELIM/developmental review.

Stage 3 results

Table ​ Table5 5 presents the results of the deductive analysis mapping the barriers, enablers and techniques to the theoretical domains framework; the theoretical domains framework to the intervention functions; and the intervention functions to the ‘policy categories’. Table ​ Table6 6 presents the key finding from the deductive and inductive analyses and previous methodological stages which informed the development of a prototype intervention for further development and evaluation in Stage 5. These were

  • Identified target behaviours for the intervention;
  • Appropriate intervention contexts;
  • Barriers and enablers to the targeted behaviour change which may exist across families;
  • Candidate intervention functions;
  • Candidate intervention delivery level/ policy categories;
  • Factors for equitable, acceptable and practicable intervention delivery.

Mapping data to the Theoretical Domains Framework, intervention functions and policy categories

Analysis is based on guidance and resources in Michie, S., L. Atkins, and R. West’s, The behaviour change wheel: a guide to designing interventions. 2014, Surrey: England: Silverback Publishing. Strike through (i.e. Incentivisation) indicates an intervention function identified as relevant to the TDF and barrier/enabler but judged not to be appropriate to the intervention context

Summary of key results feeding forward to final intervention design

a Of specific relevance to families where there is a need to tackle barriers with respect to physical and social opportunities

A paper prototype intervention was developed instantiating these features into a proposed model for workshop purposes.

Stage 4 methods

Six co-design workshops were conducted with 33 participants, facilitated by two members of the study team. Workshops at this stage involved a ‘walk through’ of the phases of the proposed intervention with paper ‘mock-ups’ and descriptors of materials and processes. Workshop resources included triggers to comment on the acceptability and feasibility of the proposed model eliciting suggestions as to how the phases should be presented and what materials should be used. The intervention model was refined and improved iteratively between workshops with modified materials presented at each site in light of previous workshop findings. Discussions were audio recorded, and participants manipulated and annotated paper materials during discussions. Verbatim transcripts of discussions were subjected to a content analysis to check and challenge the final model produced. The model was also ‘walked through’ with a subgroup of the study team part way through the participant data collection (CM, JL, VG, SR). Verbatim transcriptions were also analysed inductively to supplement the previous analysis regarding the qualitative aspects of intervention delivery which would be crucial to intervention success.

Stage 4 results

The following presents key learning from the phased methodology and a final intervention model derived through the synthesis of the evidence, and views of stakeholder and expert practitioners. We first report the finding of the inductive data analysis relating to two key themes: (1) Parent and practitioner views on the need for an intervention and (2) Key characteristics required for acceptable, equitable and practicable intervention delivery. We then present the final conclusions from the deductive analysis identifying (3) the acceptable target behaviours, contexts and intervention techniques; (4) the barriers and enablers to the identified behaviours across families and (5) the identified acceptable intervention functions and policy categories. Finally, we synthesise the above findings into (6) the final intervention model for practice and implementation.

Parent and practitioner views on the need for an intervention

Using NPT, the data from practitioners suggested that the PHE SLC ‘train the trainer’ programme was supporting practitioners to do the work of coherence/sense-making and participation/engagement which is required to embed speech, language and communication interventions into practices at the 2–2½-year-old review. That is, practitioners had an appetite and indeed an enthusiasm to complete this work, see it is aligning with their role and skills and had ‘bought in’ to delivering interventions to support child language development. However, we found that the next step of enacting the intervention was difficult for practitioners. They were not sure precisely how to deliver support to families and discussions of the potential provision of concrete resources was welcomed.

Prac-WS7: “except we don’t have anything specific do we to show, that’s the thing. There’s nothing that I’m going to go back and I’m going to go in and I’m going to show this because that is what we do. There’s nothing set in stone that that’s what we use, is there? I think that’s probably a big problem because people are going back in, there’s not a definite this is a route we need to follow, is there really?”

Parents also articulated a desire to ‘get started’ to take action that would help their child. They expressed feelings of helplessness, frustration and anger if they felt that nothing was happening, and their concerns were going unheard.

P-C-WS5: “because…you feel like something is happening which psychologically is good rather than, “We’ll wait a year and she’ll probably start speaking….You can be proactive and do things.”
P-C-WS2 : “When they did his two year one, they didn’t say, “Come back in four weeks or two weeks,” it was eight months so in that eight months we could have got something started rather than making us just leave it this late”.

They emphasised however that provision of this intervention must not introduce delays in referring children with severe difficulties and/or broader developmental concerns to SLTs and/or paediatricians/psychologists/audiologists. Rather, it should allow those families to begin supporting their child immediately whilst waiting for specialist assessment if that were the appropriate next step.

P-C-W5:” As long as it’s made perfectly clear to them that they just can’t be left flailing around for two or three years like they have been……And listen to parents because they know if something is wrong.”

Key intervention characteristics necessary for success

Practitioner language and communication.

It is difficult to overstate the importance of the specific language used by practitioners to talk about children’s difficulties, and what parents/caregivers could do to help support their child. Language must be avoided which implies blame and judgement. If not carefully presented, advice can elicit strong negative feelings.

P-C WS3 : “might have thrown something at her to be honest”
P-C WS3: “you’ve done everything and you’ve read every book, every audio book and every study you can find online and someone says, “Have you tried talking to your child?” you just go, “I’m either going to breathe or lose it so I’m just going to go.”

Communication should invite the parent/caregiver in as an equal in a process of shared decision-making, setting goals appropriate to the specific family . Experienced and skilled practitioners invite parent/caregivers to express preferences, try new behaviours and feedback and problem solve together.

Prac-WS7: “it’s very much like they feel that you’re going in there to tell them they’re doing it wrong. It’s not about that. It’s about them learning the best way for them to do it themselves, isn’t it really .”
P-C-WS3: I think if she’d said, “I’m sure you’re doing a brilliant job but here’s a couple of things you might not have thought about. You could just have a look at this list, it might give you a couple of pointers,” rather than, “Right, well this is what you’ve got to be doing to make your child speak. Do you speak to your child?”
P-C-WS3: “I think a dialogue rather than just being told. A dialogue is good”

Alliance and trust between parent/caregiver and practitioner

Relationships of trust between practitioner and parent/caregiver were vital and, if not built at this stage, then continued engagement with the intervention and therefore its success are extremely unlikely. Facilitators of alliance and trust included demonstrating interest, engagement and expertise in interaction with the child at the review; a communication style which invites partnership, dialogue, and shared decision-making; and continuity of support from the same practitioner over an extended period.

P-C-WS5: “because the number of times I’ve told my daughter’s story”

Continuity was also seen as being important in supporting practitioners to make correct judgements as to the barriers and enablers which might exist for a family’s ability to engage in responsive interaction and so to choose the level of support required.

The role of modelling responsive interaction by the practitioner with the child was identified by both practitioners and parents. This modelling seems to fulfil several functions:

P-C-WS3: Well I found it useful being shown, not being dictated to but being shown and not in, “I’m now going to show you how to talk to your child,” but more just doing it naturally. You think, “Oh.” I found that really useful… I think when you’re being told this is what you’ve got to do but when you see it and you see the way the child engages with it, you see how it works, whereas when you’re just being told, “Do this, do this,” I don’t know, you’re butting your head against it a bit and you’re feeling a bit just shouted at.
Prac-WS7: “We model a lot of those kind of behaviours in the visit with the parents themselves but also with the children and then they see the child responding. Then they’re building their confidence up to do that themselves as well.”
P-C-WS3: But I think what was an amazing light bulb moment for me is when I saw the speech and language person speaking to Gemma 1 , engaging and doing things and she was engaging back. It was amazing,”
  • Promoting the parent/caregiver’s trust in the practitioner

Modelling promoted trust as it demonstrated the practitioner’s skills in engaging with the child; ensured any advice given was informed by the individual child’s temperament, developmental level and needs; and facilitated joint and individualised problem solving.

Attractive and motivating resources

The number of information sources and media which compete for parents’ attention was mentioned several times. Practitioners identified the need therefore to design any messaging and intervention resources in a way which would capture the attention of parents and motivate them to engage.

Inclusiveness and accessibility

Practitioners commented on how effective they found visual resources in other aspects of their practice. These included the use of video, attractive visual resources, ‘cue cards’ and visual reminders. For inclusive and accessible practice, they emphasised that any physical resources must be ‘relatable’ and represent the range of families served by HV teams in England, require minimal literacy levels, be readily adapted to languages other than English and be designed to take account of the range of digital inequalities.

There was substantial variation across sites as to the accessibility of sources of social support for families, such as parent and toddler groups, and opportunities for early childhood education and care (ECEC). Barriers to access included transport in more rural communities, recent reduction in local authority provision and confidence to attend, particularly for more socially disadvantaged families, families who had concerns about their child’s behaviour and those from minority ethnic groups. The financial support for paid childcare hours is also often difficult for families to navigate with some not being sure of how to access this.

Fit with current services

For the intervention to be practicable and acceptable, it would need to fit into current service provision in terms of HV team models of care, early childhood education and care provision and also local onward referral pathways.

If the intervention is not tailored to the individual family and child, there is a substantial risk of it not being manageable for the family and of making them feel judged, patronised and/or set up to fail. The following explains how key components of the intervention (behaviours, contexts and intervention techniques) need to be tailored to the individual family’s context and preferences for them to engage with the intervention.

Acceptable target behaviours, contexts and intervention techniques

Parents/caregivers and practitioners preferred an approach which would allow them to integrate any new behaviours into their everyday routine, rather than as an additional activity. Practitioners felt that the contingent responsive interaction behaviours (Table ​ (Table4) 4 ) aligned well with their current practice, underlying philosophy and the messages which they provide at other reviews.

Prac-WS4: “It has to come with their own life and the way they are and how is that going to integrate into to their lifestyle so they can make the changes”
Prac-WS1: “it because part of your flow of conversation rather than being told what to do. We talk about responsive feeding, we talk about responsive parenting. That word responsive comes in”

There were substantial differences across parents in which responsive behaviours they felt they needed/wanted to try to do more frequently. It was also important that any goal was perceived to be focussed and manageable.

Prac-WS4: I think it feels big….it needs to be broken down
Prac-WS4: “But it’s about choosing one or two things and not too many things…I think giving them too much and bombarding them with too many things…”
Prac-WS1: “it’s something they already do, and you’re not asking them to do too much. They’re not overwhelmed.”

Importantly, jumping too quickly to a specific context within which to practise these behaviours risked alienating families. For example, when considering shared book-reading interventions, families reported multiple ways in which this context could cause problems. This included parent/caregivers’ perception that it suggested that they might not know book reading was a good idea, which felt patronising, or that they did not do enough book reading, which felt judgemental.

P-CWS1: “I’d be quite offended because I read a lot with my kids. We had this and they said, “Mum, you need to read with them.” I read with them quite a lot. I do at least four books on a night …. Then they’re saying, “Read with them. That’s why he doesn’t, you just have to read…. Yes, like it’s our fault”

Furthermore, if book reading felt too difficult for the parent/carer either because the child was not ready or they themselves had some literacy difficulties, this would likely feel too difficult and that it was setting them up to fail.

P-C-WS1: “Everything needs to be the way Danny likes. If I want to read a book to Danny, no, because he wants another book. If you’re reading a book to Danny, he’s like, “That’s enough.” He has enough with the book so it’s just like…I don’t want to be shouting all the time, “Danny Sit down, Danny.” I’m like, “You know what? I’m just going to let Danny when he wants it,” because I don’t want to frustrate him”
P-C-WS1: “So to be honest, I’m not very good at reading books but my husband has a little bit more patience with the language because it’s not my language so for me to read, I need to take… a lot of times.”

Other parents would very much welcome support with how to share books with their child:

P-C-WS2: “I’m not so creative so maybe if we got a sheet with questions on it, that would help a bit more.”

It was clear that different families needed and preferred different contexts to practice the chosen intervention behaviours.

P-C-WS5: “ I just built it into my day all the time really at the moment, when we had a moment….I just worked it in wherever we were.”
“On the flip side, for me, having multiple children I wouldn’t be able to work it into my daily because it’s just mental sometimes….but for me, this would be brilliant because I would go, “Actually yes, I do need to find a time in my day to focus and that will be my time. That will be when the others are in the bath, dad is bathing them. He can bath Ella and Jack and I will sit on the sofa with Archie.”
Prac-WS4: “I think it’s the time when they are together that is the critical time. It’s making the most of that together time”

Intervention techniques

In terms of intervention techniques extracted from previous research and discussed in the workshops (Table ​ (Table4), 4 ), most were felt to be acceptable if their implementation could be adjusted to the family’s context, if explained appropriately, and if delivered in the context of a relationship of trust between the parent/caregiver and the practitioner. The exceptions (techniques which were considered not acceptable) included the parent/caregiver being videoed by the practitioner; the use of a ‘language fit bit’ which records how much the parent says to the child and gives a daily report; and teaching another family member how to be a responsive communicator. The former two bringing with them a power dynamic which was not welcomed by many families and a sense of being ‘surveilled’ and the latter raising significant difficulties with respect to family dynamics and difference of opinion as to how best to parent between partners and across generations.

Barriers and enablers

The work above identified the target behaviour for the intervention: parents/caregivers increasing the frequency of use of one or more of set of responsive interaction behaviors. The barriers and enablers to the use of responsive interaction language-promoting behaviours in the home identified in Stage 3 are synthesised and summarised in Table ​ Table7 7 .

Enablers identified as needing to be in place to engage in the target behaviour change (increase frequency of responsive interaction behaviour) organised with respect to the COM-B components and the TDF domains)

Intervention functions and ‘policy categories’

We further examined the barriers and enablers identified above together with the intervention techniques drawn from the literature which participants judged to be acceptable and feasible to identify the most relevant intervention functions and policy categories to be used in the intervention (see Table ​ Table5). 5 ). These were mapped to relevant intervention functions, and Training, Enablement, Modelling, and Persuasion were identified as the most relevant functions. The main policy categories/platforms for delivery identified as relevant to our shortlist of intervention functions and theoretical domains were Service delivery and Communications and Marketing suggesting a combination of implementation approaches across health/educational services and marketing would be beneficial (Table ​ (Table5 5 ).

The proposed intervention

The proposed intervention aims to empower families to act to support their child as soon as the risk of SLCN is identified, applying current best evidence in a timely manner. It aims to ensure equity of access for all children and families through tailored guidance and support (Fig. ​ (Fig.3). 3 ). The intervention does not replace local SLCN pathways but rather is designed to become coordinated with and integrated into them. It is essential that children continue to be referred for support by SLTs and other professionals where they meet local criteria for referral and receive enhanced support in their early years settings as appropriate.

An external file that holds a picture, illustration, etc.
Object name is 40814_2022_978_Fig3_HTML.jpg

The proposed intervention model

The steps in intervention delivery are as follow :

  • Step 1: Preparation
  • Step 2: Decide on the need for intervention and/or onward referral
  • Step 3: Choose intervention level
  • Step 4: Choose a responsive behaviour to do more often
  • Step 5: Choose the context in which to practice the behaviour for 10–15 min daily
  • Step 6: Deliver tailored support
  • Step 7: Offer optional additional support

Step 1 focusses on the preparation, which is necessary for successful shared decision-making and engagement [ 53 , 72 ]. In order to address power imbalances in the practitioner–parent/caregiver relationship [ 18 ] and ‘activate’ the parent/caregiver [ 73 ], preparatory materials are needed which welcome and value the parent/caregiver’s knowledge about their child, establish the focus of the review [ 72 ] and encourage the parent/caregiver to arrive with questions and reflections. Step 2 is essential in mobilising and motivating action by the parent/caregiver and creating practitioner–parent/caregiver alliance [ 36 ]. Steps 3–5 focus on shared decision-making and goal setting. Steps 6 and 7 relate to intervention delivery. The proposed procedures, content and materials of each intervention stage including recommendations regarding the language to use and methods of presentation are described in detail in Supplementary Materials 2 .

The intervention model and its components

The goal of the intervention is to increase parents/caregivers’ use of specific responsive interaction behaviours for 10–15 min per day in a specific context, which suits the family’s resources and constraints and is part of their usual daily routine.

The intervention delivery platforms draw on the identified relevant policy categories of Service Delivery and Communications and Marketing. All families receive one of three levels of support through HV services (Service Delivery) and links to a universal media and social media campaign (Communications and Marketing) (i.e. resources already published or under development by the Best Start in Life program: ‘Hungry Little Minds’ [ 74 ] and ‘Tiny Happy People’ [ 75 ]). Two optional additional support packages may also be offered (see Fig. ​ Fig.3). 3 ). Which level families receive and whether the optional additional support is offered is determined by the outcome from the ELIM-I measure (developed as part of this study and reported elsewhere) and also practitioner judgement as to the assets and challenges for the family and the barriers and enablers to accessing the intervention—a judgement which is guided by resources and training based on the COM-B model and Theoretical Domains Frameworks [ 41 , 42 ] (see below).

Level 1: children with no identified risk

We recommend the framing of this review as a time to talk about setting the foundations for the child’s learning and ensuring all children reach their full potential [ 24 , 76 ]. As such, all families should be signposted to available resources which provide guidance as to how to support children’s language development. This universal provision of accessible information potentially brings three key benefits. First, we know that trajectories of language development can be unstable and unpredictable between 2 and 4 years of age, and some children who appear to be developing well at 2 years may develop language difficulties later [ 32 ]. By ensuring all families are provided with appropriate resources to support them to provide an enriching language environment, we provide a ‘safety net’ for those who may not be identified at this review. Second, parents/caregivers’ perception of the value of the 2–2½-year review and their subsequent engagement with services is partly influenced by whether they learn something new at that appointment [ 32 ]; guidance on child language development could meet these preferences. Third, taking a universal rather than targeted approach brings an additional advantage of reducing the potential for stigmatisation which can be inherent in some targeted interventions. Targeted selective approaches offer intervention to groups who are more likely than others to develop a particular condition. In the case of language interventions, this is usually families living with social disadvantage. Such approaches carry the risk of unintentional stigmatisation and consequential disengagement of targeted groups [ 77 ]. This can be avoided where families see that the support is universally offered albeit with varying intensity according to need.

Level 2: children with identified risk—self-directed approach

This level of support is for children identified as being at risk of SLCN using the ELIM and where practitioners judge there are few barriers to the targeted behaviour change. Where barriers do exist, the practitioner judges they mainly relate to the Capabilities category of the C OM-B model (Table ​ (Table7). 7 ). If the child meets the criteria for SLT referral for the local pathway then this should be actioned. Practitioners discuss the need to support their child’s language development and the nature of responsive interaction. Language is carefully chosen which promotes the building of trust and engagement and avoids implications of blame or judgement (see Supplementary Materials 2 ). Using a shared decision-making tool, practitioners support families to choose a responsive interaction behaviour which they would like to try to do more often and identify the context and times in the day when they will be able to try this—their ‘Together Time’.

Detailed guidance is provided for the practitioner about each step (see Supplementary materials ). This includes suggestions for how to support parents to sustain and adjust their interactions including review and reflection techniques, recording and aide memoire strategies (see Supplementary materials 2 for more detail).

Level 3: children with identified risk—coaching approach with additional practitioner support

This pathway is for children identified as potentially being at risk of SLCN using the ELIM and where practitioners judge there are a number of barriers to the targeted behaviour change, particularly in the Motivation and/or Opportunity categories of the COM-B model (see Table ​ Table7). 7 ). This level uses similar approaches as level 2 above but with additional face-to-face support from the practitioner to tackle motivation and opportunity barriers to change and offer more support for knowledge and skills development. This support takes the form of coaching through modelling, practice and supported reflection and goal setting, with the practitioner offering regular visits until the parent/caregiver is confident they can integrate the behaviour into their daily routines (see Supplementary materials 2 for more detail).

Optional additional support package 1—access to early years settings/social support

An optional additional support package should be offered to families with barriers to behaviour change identified with respect to social opportunities and physical resources necessary for those social opportunities (see Table ​ Table6). 6 ). Design and delivery of a support package to facilitate access to social opportunities will require knowledge regarding local provision and the community assets and resources, that can be mobilised. Action by the practitioner alone is not sufficient if local provision is not accessible to all families.

Optional additional support package 2—access to age-appropriate books and play materials

The responsive interaction behaviours targeted in this intervention do not require the provision of any specific play materials or toys. Indeed, the goal of the intervention is to support families to integrate responsive interaction into their usual daily routines. In general, no additional toys or children’s books are likely to be required. However, in some cases, where the family identifies ‘playing with toys’ or ‘sharing books’ as their preferred ‘together time’ and where the family resources are extremely limited, practitioners should consider a support package to address access to toys and books. This may involve support to access toy libraries and the local library. As in the case of ECEC provision, many barriers to access to these resources exist.

We recommend local co-design of both support packages to identify barriers and enable access to parents and toddler groups, playgroups, local libraries and toy libraries for families who need this support: those with social and physical opportunity barriers (see Table ​ Table6). 6 ). Co-design work should involve all agencies involved with early years provision, those practitioners who signpost families to them and parents/caregivers and may include the development of resources to support families to use everyday materials available at home to develop play and language.

Media and social media campaign

Our analyses identified that in addition to the service delivery approaches we have described above, that the policy category ‘Communications and Marketing’ was also a relevant platform for delivery of support. Existing social media resources from the ‘Hungry Little Minds’ and ‘Tiny Happy People’ [ 33 , 75 ] campaigns align closely to this intervention model. There was, however, a sense of being overwhelmed from some practitioners we spoke to in terms of the range and sheer volume of materials whilst others were not aware of the ‘Tiny Happy People’ campaign. There was an identified need from practitioners for help to navigate the resources and identify which might be best for which purposes. Both parents and practitioners suggested many families will not seek this information out and, in some cases, may be uncomfortable with a perceived ‘educational’ tone. The use of a range of social media platforms and active campaigns were suggested as being necessary if these messages are to reach all families of young children. We therefore recommend ‘joining up’ of this intervention with existing resources and social media campaigns so that the materials developed in this intervention clearly signpost to the high-quality resources being developed.

Skill-mix, delivery and normalisation

Steps 1–5 of this model (encompassing preparation, identification, tailoring and shared goal-setting) require a holistic approach to both child and parent health and wellbeing and knowledge of the family and so we recommend that the HV take the lead at these stages. The provision of tailored support and additional support packages (Steps 6 and 7) could involve a more mixed model with skill mix in HV teams or Early Years Practitioners in early years settings delivering the tailored support and/or the optional additional support packages in consultation with the HV team. For those families where coaching and additional support packages are required (Level 3) Speech and Language Therapy services could also be involved either directly or as advisors to the practitioners delivering the coaching model, depending on the configuration of the local SLCN pathway. This should be negotiated and discussed as part of the local co-design work we recommend above which will be required to develop implementation and sustainability plans for integration into local service delivery context. We recommend that for implementation and maintenance of this programme of work that an integrated team of HVs, SLTs and Early Years leads is convened and maintained to steer its introduction and safeguard its sustainability [ 60 , 61 ].

This paper presents the findings of a rigorous intervention development methodology to design a universal intervention to promote children’s language development to be delivered at the HV 2½-year review. The study applied the most recent guidance on best practice in intervention design and co-design [ 34 , 35 , 44 , 45 ] and was informed by relevant theory with respect to early language development and disorders [ 22 , 46 ], behaviour change [ 41 ], shared decision-making [ 53 , 55 ], engagement [ 36 ], acceptability [ 41 , 51 ] and implementation [ 35 , 61 ].

The resulting intervention (ELIM-I) focusses on supporting families to increase their use of responsive interaction behaviours [ 22 , 46 ] within their daily routines and in contexts tailored to individual family circumstances [ 53 , 55 ]. The risks of universal interventions widening rather than narrowing inequalities was addressed through consideration of the differing barriers and enablers which may be present for families [ 41 ]. The intervention was therefore designed to offer families a proportionate and tailored response—proportionate in that the intensity of support can increase or decrease depending on the family’s needs—and tailored such that the goals and intervention approaches are modified considering the specific assets and challenges in each family. The resulting intervention therefore meets a core principle of the modernised Healthy Child Programme—Best Start in Life: ‘universal reach and a personalised response’ [ 33 ]. Families differed significantly as to where the barriers lay to changing the targeted behaviour and in their daily routines and demands on parent/caregiver time. Many published interventions focus on specific behaviours (e.g. shared book reading) [ 16 ] or on the development of knowledge and skills, and do not consider factors of motivation (such as feelings of self-efficacy and confidence to succeed) or social or physical opportunities [ 19 , 78 ]. Interventions which are not tailored to the specific barriers and enablers present for each are likely not only to be ineffective, but also risk alienating families and damaging the potential for engagement with services [ 36 ]. Inappropriate advice risks families feeling blamed, judged, patronised, or set up to fail [ 79 ]: how an intervention is delivered can ‘make or break’ its success. This intervention therefore draws on theories of shared decision making, patient activation and engagement and partnership, to embed strategies which engender successful collaborative partnership in its design [ 53 , 55 ]. Although these characteristics are often viewed as core to HV practice [ 80 ], our findings suggest families do not always experience them and, as a result, sometimes relationships break down.

Perhaps most important to this alliance is the language used by practitioners to talk about children’s difficulties, and what parents/carers could do to help support their child. Concrete, shared decision-making tools can scaffold practitioner–patient conversations to enable communication which addresses power imbalances, acknowledges families’ strengths and invites equal participation [ 55 , 80 ]. Implementation will likely also require training in the use of the tools advocated here [ 59 ]. We also recommend the use of preparatory materials for ‘patient activation’ prior to attendance at the review appointment which can go some way to addressing power imbalance and hence promote dialogue [ 53 , 73 ]. Particular care must be taken that discussions with parents/carers do not imply that their interaction style or the time they spend interacting with their child has caused the language difficulties they are experiencing. It can be difficult to understand and to explain that although changing your interaction style can improve your child’s language development that your interaction style has not caused their language difficulties [ 81 , 82 ].

The views of both practitioners and parents suggest any intervention must maintain their sense of agency, enabling practitioners to provide a responsive service and for parents to begin to address the needs of their children. It was very clear that any such support for the family must not create a delay to access to more specialist Speech and Language Therapy Support for children with more severe difficulties and/or signs of broader developmental concerns. The degree to which SLT and HV services are ‘joined up’ and have agreed and clear co-working and referral pathways varies substantially across the UK. To deliver ELIM-I and support all children’s language development in a given locality, it is clear that collaboration between these services is vital. Further ‘joining up’ is required to tackle the identified barriers of physical and social opportunity, which are best addressed through access to Early Childhood Education and Care Settings, particularly those which focus on the provision of support for the family as whole. Again, access to these varied across our sites, a picture mirrored across the UK reflecting the reduction in spending on early preventative services in 2010 and the move away from universal provision to more targeted approaches [ 83 ]. Successful delivery of the ELIM-I intervention would necessarily require commissioning and service delivery to be integrated across all the different professionals involved—health visitors and their teams, speech and language therapists and early years practitioners. This integration work also fulfils the NPT process of enacting wherein the innovation becomes material practice through practitioners’ operationalising the innovation into their own specific context, increasing the potential for it to become normalised practice [ 60 ].

Strengths and limitations

This study followed recent guidance for successful intervention development. The iterative methodology served to integrate current best evidence with stakeholder preferences and rich contextual information regarding the context within which the intervention would be delivered. Extensive stakeholder engagement and co-design workshops across a diverse range of sites served to inform the final intervention design. The advent of COVID-19 restrictions in the last phase of data collection meant that our parent/caregiver participant sample was not as diverse, in terms of linguistic and cultural backgrounds as we would have hoped. In the next phase of piloting and implementation of the ELIM-I, it will be essential to ensure the views and experiences of a broad demographic of families are solicited.

This study delivered detailed guidelines for the delivery of the ELIM-I intervention. Superficially, the ELIM-I intervention is a simple one: supporting parents/caregivers of children at risk of speech language or communication needs to increase their use of responsive interaction behaviours with their child. However, the need for proportionality, tailoring and collaborative partnerships makes successful delivery to the requisite level of fidelity for intervention effectiveness a complex task. Quality improvement, especially across complex, multi-professional, multi-agency systems, is rarely easy. Innovation, such as the development of the ELIM-I is only the first step. For successful implementation of this innovation to be achieved, further development and scientific evaluation are required, and clearly, further studies to pilot it in a range of contexts and evaluate its efficacy are essential [ 60 , 84 ].

Embedding health care and educational innovations into routine practice is not straightforward and requires explicit planning [ 61 ]. Applying NPT, our work identified that SLC training for HVs has and is supporting practitioners to do the work of coherence/sense-making and participation/engagement which is required to embed SLC interventions into practices at the 2–2½-year-old review. That is practitioners have ‘bought in’ to delivering interventions to support child language development. However, the next NPT step required for successful and sustainable implementation, that is enacting the intervention, remains difficult. Whilst the ELIM-I protocol provides further guidance, it is yet to be tested in practice, and, in its current form, as guidance rather than as material objects and/or local policy, there are risks with respect to its potential for successful implementation [ 84 , 85 ]. Efforts must focus on the NPT stages of enacting and appraisal if the innovation is to be sustained and delivered across contexts with the required level of fidelity to the original protocol for the potential benefits to be realised [ 60 , 61 ]. Practitioners are likely to require additional support and resources to enable the ELIM-I to be implemented successfully and in a manner which will narrow rather than widen inequalities through offering truly proportionate and tailored support appropriate to each family. This would include intervention materials, including preparatory letters, shared decision-making tools, video modelling resources, aide-memoires, etc., for use with a range of families and communities; training resources to ensure HV teams have the appropriate skills to model contingent responsive interaction and can make appropriate judgements regarding tailoring; and audit and reflection tools to enable ongoing appraisal and hence maintenance of the innovation in practice.

Further work is also needed for ELIM-I to be accessible to families from a range of linguistic and cultural backgrounds. We recommend further work to develop and pilot a manualised program with standardised intervention resources and guidance for local implementation and policy development. Strategies to support successful implementation with proven efficacy include the development of simple, evidence-based, accessible and visually clear and appealing resources; the use of decision support systems, checklists and digital tools, and context-specific standardised protocols [ 86 ]. Furthermore, multi-professional collaboration and the development of local consensus groups have been shown to improve implementation [ 87 , 88 ].

The response of services to the COVID-19 pandemic have underlined the diversity in service provision which exists across the country for children in the first 1001 days and the benefits which can be realised when early years settings and HV services collaborate to support vulnerable families [ 89 ]. Furthermore, the DfE is ambitious to leverage the skills, knowledge, and capacity of the whole children’s workforce to give children the ‘Best start in Speech Language and Communication’. To date the ELIM-I development has focussed, in the main, on HV teams. Whilst the key principles of the ELIM-I are likely to readily translate to early years settings its implementation must be contextualised. Further work is needed to adapt the ELIM-I for use in early years settings to facilitate inter-agency collaboration.

A fundamental shift for services during the pandemic has been the move to remote support using digital tools. There is an acknowledgement amongst professionals and families of both benefits and harms from this shift. For some families, remote services are welcomed as convenient, lower cost and accessible whilst for others, the ‘digital divide’ makes them completely inaccessible. Importantly, for families with the highest level of need, remote services do not support the necessary development of professional and parent–caregiver trust and alliance for successful support to be delivered [ 89 ].

Digital remote delivery therefore will never be a panacea for service delivery to support families of children in the early years. However, within a matrix of differing tailored support, digital delivery offers the potential for convenient and economical delivery for some families, potentially freeing up resource for face-to-face support for those with the greatest need for specialist practitioner support. Development of methods to deliver ELIM-I digitally therefore could bring potential benefits with respect to further tailoring and personalised care, and possible cost savings. In addition, they ensure services are robust to future pandemic or other ‘shocks’ to services for children and families and have the potential to enable multi-disciplinary collaboration.

Conclusions

It is possible to develop a universal intervention for use by HVs at the 2–2½-year review to promote children’s language development which parents and practitioners judge would be acceptable and feasible in practice. For such an intervention to be equitable and to promote engagement and partnership, it must be proportionate, varying in intensity of support, tailored, such that goals and intervention approaches address the specific barriers and enablers in each family, and must address power relationships through shared decision-making, patient activation and strength-based approaches.

Acknowledgements

First, we would like to acknowledge the leadership, mentorship and unparalleled contribution to the field of child language interventions of Professor James Law, OBE, who led the wider project of which this intervention study was a part. Professor Law passed away in October 2021 prior to submission of the revision of this paper.

We would like to express sincere thanks to all the practitioners and parents who gave their time, expertise, and insights in the workshop and co-design activities. The team also wish to acknowledge the role of Sheena Carr and Renvia Mason and colleagues at Public Health England and The Department for Education for their feedback on the original report.

Abbreviations

Authors’ contributions.

CM led the study, designed the methodology and data collection materials and conducted all aspects of the data collection and analysis. She wrote the first draft of the paper and created the final version for submission after revisions and suggestions from co-authors. RW coordinated data collection processes and conducted data collection processes, acted as facilitator or observer on a number of the data collection events, and participated in interpretive reflections that informed the analyses. She also contributed to the writing of the paper. CH acted as a facilitator for data collection and participated in interpretive reflections that informed the analyses. She also contributed to the writing of the paper. JC coordinated ethical approval processes, conducted PPI workshops, which informed data collection and interpretation, and participant recruitment. She participated in interpretive reflections that informed the analyses. She also contributed to the writing of the paper. VG conducted PPI workshops, which informed data collection and interpretation, and participant recruitment. She participated in interpretive reflections that informed the analyses. She also contributed to the writing of the paper. JL was PI on the broader project of which the intervention development component described here was a part. He was involved in the conception and design of the study and data interpretation. He also contributed to the writing of the paper. SR was a co-applicant on the research programme, acted as facilitator or observer on a number of the data collection events and participated in interpretive reflections that informed the analyses. She also contributed to the writing of the paper. The author(s) read and approved the final manuscript.

The project was funded by the UK’s Department for Education in conjunction with Public Health England.

Availability of data and materials

Declarations.

All relevant details about the project were submitted to the West Midlands—Black Country NHS Research Ethics Committee (REC), and a favourable ethical opinion was received on 7th of May 2019 (REC reference 19/WM/0114 project # 261205). R&D management approvals were then received from the five sites involved in the study. Participants gave fully informed consent before each workshop/data collection episode.

Not applicable.

The authors declare that they have no competing interests.

1 All names in quotes are pseudonyms.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Facts.net

Turn Your Curiosity Into Discovery

Latest facts.

5 Detailed Facts About Medical Cannabis

5 Detailed Facts About Medical Cannabis

14 Facts About Art And Music Scene In Downey California

14 Facts About Art And Music Scene In Downey California

40 facts about elektrostal.

Lanette Mayes

Written by Lanette Mayes

Modified & Updated: 02 Mar 2024

Jessica Corbett

Reviewed by Jessica Corbett

40-facts-about-elektrostal

Elektrostal is a vibrant city located in the Moscow Oblast region of Russia. With a rich history, stunning architecture, and a thriving community, Elektrostal is a city that has much to offer. Whether you are a history buff, nature enthusiast, or simply curious about different cultures, Elektrostal is sure to captivate you.

This article will provide you with 40 fascinating facts about Elektrostal, giving you a better understanding of why this city is worth exploring. From its origins as an industrial hub to its modern-day charm, we will delve into the various aspects that make Elektrostal a unique and must-visit destination.

So, join us as we uncover the hidden treasures of Elektrostal and discover what makes this city a true gem in the heart of Russia.

Key Takeaways:

  • Elektrostal, known as the “Motor City of Russia,” is a vibrant and growing city with a rich industrial history, offering diverse cultural experiences and a strong commitment to environmental sustainability.
  • With its convenient location near Moscow, Elektrostal provides a picturesque landscape, vibrant nightlife, and a range of recreational activities, making it an ideal destination for residents and visitors alike.

Known as the “Motor City of Russia.”

Elektrostal, a city located in the Moscow Oblast region of Russia, earned the nickname “Motor City” due to its significant involvement in the automotive industry.

Home to the Elektrostal Metallurgical Plant.

Elektrostal is renowned for its metallurgical plant, which has been producing high-quality steel and alloys since its establishment in 1916.

Boasts a rich industrial heritage.

Elektrostal has a long history of industrial development, contributing to the growth and progress of the region.

Founded in 1916.

The city of Elektrostal was founded in 1916 as a result of the construction of the Elektrostal Metallurgical Plant.

Located approximately 50 kilometers east of Moscow.

Elektrostal is situated in close proximity to the Russian capital, making it easily accessible for both residents and visitors.

Known for its vibrant cultural scene.

Elektrostal is home to several cultural institutions, including museums, theaters, and art galleries that showcase the city’s rich artistic heritage.

A popular destination for nature lovers.

Surrounded by picturesque landscapes and forests, Elektrostal offers ample opportunities for outdoor activities such as hiking, camping, and birdwatching.

Hosts the annual Elektrostal City Day celebrations.

Every year, Elektrostal organizes festive events and activities to celebrate its founding, bringing together residents and visitors in a spirit of unity and joy.

Has a population of approximately 160,000 people.

Elektrostal is home to a diverse and vibrant community of around 160,000 residents, contributing to its dynamic atmosphere.

Boasts excellent education facilities.

The city is known for its well-established educational institutions, providing quality education to students of all ages.

A center for scientific research and innovation.

Elektrostal serves as an important hub for scientific research, particularly in the fields of metallurgy, materials science, and engineering.

Surrounded by picturesque lakes.

The city is blessed with numerous beautiful lakes, offering scenic views and recreational opportunities for locals and visitors alike.

Well-connected transportation system.

Elektrostal benefits from an efficient transportation network, including highways, railways, and public transportation options, ensuring convenient travel within and beyond the city.

Famous for its traditional Russian cuisine.

Food enthusiasts can indulge in authentic Russian dishes at numerous restaurants and cafes scattered throughout Elektrostal.

Home to notable architectural landmarks.

Elektrostal boasts impressive architecture, including the Church of the Transfiguration of the Lord and the Elektrostal Palace of Culture.

Offers a wide range of recreational facilities.

Residents and visitors can enjoy various recreational activities, such as sports complexes, swimming pools, and fitness centers, enhancing the overall quality of life.

Provides a high standard of healthcare.

Elektrostal is equipped with modern medical facilities, ensuring residents have access to quality healthcare services.

Home to the Elektrostal History Museum.

The Elektrostal History Museum showcases the city’s fascinating past through exhibitions and displays.

A hub for sports enthusiasts.

Elektrostal is passionate about sports, with numerous stadiums, arenas, and sports clubs offering opportunities for athletes and spectators.

Celebrates diverse cultural festivals.

Throughout the year, Elektrostal hosts a variety of cultural festivals, celebrating different ethnicities, traditions, and art forms.

Electric power played a significant role in its early development.

Elektrostal owes its name and initial growth to the establishment of electric power stations and the utilization of electricity in the industrial sector.

Boasts a thriving economy.

The city’s strong industrial base, coupled with its strategic location near Moscow, has contributed to Elektrostal’s prosperous economic status.

Houses the Elektrostal Drama Theater.

The Elektrostal Drama Theater is a cultural centerpiece, attracting theater enthusiasts from far and wide.

Popular destination for winter sports.

Elektrostal’s proximity to ski resorts and winter sport facilities makes it a favorite destination for skiing, snowboarding, and other winter activities.

Promotes environmental sustainability.

Elektrostal prioritizes environmental protection and sustainability, implementing initiatives to reduce pollution and preserve natural resources.

Home to renowned educational institutions.

Elektrostal is known for its prestigious schools and universities, offering a wide range of academic programs to students.

Committed to cultural preservation.

The city values its cultural heritage and takes active steps to preserve and promote traditional customs, crafts, and arts.

Hosts an annual International Film Festival.

The Elektrostal International Film Festival attracts filmmakers and cinema enthusiasts from around the world, showcasing a diverse range of films.

Encourages entrepreneurship and innovation.

Elektrostal supports aspiring entrepreneurs and fosters a culture of innovation, providing opportunities for startups and business development.

Offers a range of housing options.

Elektrostal provides diverse housing options, including apartments, houses, and residential complexes, catering to different lifestyles and budgets.

Home to notable sports teams.

Elektrostal is proud of its sports legacy, with several successful sports teams competing at regional and national levels.

Boasts a vibrant nightlife scene.

Residents and visitors can enjoy a lively nightlife in Elektrostal, with numerous bars, clubs, and entertainment venues.

Promotes cultural exchange and international relations.

Elektrostal actively engages in international partnerships, cultural exchanges, and diplomatic collaborations to foster global connections.

Surrounded by beautiful nature reserves.

Nearby nature reserves, such as the Barybino Forest and Luchinskoye Lake, offer opportunities for nature enthusiasts to explore and appreciate the region’s biodiversity.

Commemorates historical events.

The city pays tribute to significant historical events through memorials, monuments, and exhibitions, ensuring the preservation of collective memory.

Promotes sports and youth development.

Elektrostal invests in sports infrastructure and programs to encourage youth participation, health, and physical fitness.

Hosts annual cultural and artistic festivals.

Throughout the year, Elektrostal celebrates its cultural diversity through festivals dedicated to music, dance, art, and theater.

Provides a picturesque landscape for photography enthusiasts.

The city’s scenic beauty, architectural landmarks, and natural surroundings make it a paradise for photographers.

Connects to Moscow via a direct train line.

The convenient train connection between Elektrostal and Moscow makes commuting between the two cities effortless.

A city with a bright future.

Elektrostal continues to grow and develop, aiming to become a model city in terms of infrastructure, sustainability, and quality of life for its residents.

In conclusion, Elektrostal is a fascinating city with a rich history and a vibrant present. From its origins as a center of steel production to its modern-day status as a hub for education and industry, Elektrostal has plenty to offer both residents and visitors. With its beautiful parks, cultural attractions, and proximity to Moscow, there is no shortage of things to see and do in this dynamic city. Whether you’re interested in exploring its historical landmarks, enjoying outdoor activities, or immersing yourself in the local culture, Elektrostal has something for everyone. So, next time you find yourself in the Moscow region, don’t miss the opportunity to discover the hidden gems of Elektrostal.

Q: What is the population of Elektrostal?

A: As of the latest data, the population of Elektrostal is approximately XXXX.

Q: How far is Elektrostal from Moscow?

A: Elektrostal is located approximately XX kilometers away from Moscow.

Q: Are there any famous landmarks in Elektrostal?

A: Yes, Elektrostal is home to several notable landmarks, including XXXX and XXXX.

Q: What industries are prominent in Elektrostal?

A: Elektrostal is known for its steel production industry and is also a center for engineering and manufacturing.

Q: Are there any universities or educational institutions in Elektrostal?

A: Yes, Elektrostal is home to XXXX University and several other educational institutions.

Q: What are some popular outdoor activities in Elektrostal?

A: Elektrostal offers several outdoor activities, such as hiking, cycling, and picnicking in its beautiful parks.

Q: Is Elektrostal well-connected in terms of transportation?

A: Yes, Elektrostal has good transportation links, including trains and buses, making it easily accessible from nearby cities.

Q: Are there any annual events or festivals in Elektrostal?

A: Yes, Elektrostal hosts various events and festivals throughout the year, including XXXX and XXXX.

Was this page helpful?

Our commitment to delivering trustworthy and engaging content is at the heart of what we do. Each fact on our site is contributed by real users like you, bringing a wealth of diverse insights and information. To ensure the highest standards of accuracy and reliability, our dedicated editors meticulously review each submission. This process guarantees that the facts we share are not only fascinating but also credible. Trust in our commitment to quality and authenticity as you explore and learn with us.

Share this Fact:

2025 LB and visitor Josh Veldman is Northwestern's second Saturday commit

Josh Veldman committed to Northwestern on his Saturday visit to Northwestern.

Northwestern's big visit weekend paid immediate dividends on Saturday when two-star linebacker Josh Veldman became the second player to commit to the Wildcats.

Veldman announced his decision on X, formerly Twitter.

MORE: Northwestern in Top 2 for LB Josh Veldman l Cats set to host top 2025 targets l Northwestern's Class of 2025

Veldman followed in the footsteps of quarterback Marcus Romain , who announced his commitment about an hour before Veldman did. Both players were among the 13 high-profile targets on campus this weekend.

Veldman chose the Wildcats over nine other offers, including Iowa State from the Power Four. He told WildcatReport last month that the Wildcats and Cyclones were his top two schools.

There have been several Wildcats over the years from Illinois powerhouse Lincoln Way East High School, including current wide receiver AJ Henning and 2025 commitment Caleb O'Rourke. But Veldman is the first in recent years from nearby New Lenox Lincoln Way West.

The 6-foot-2, 210-pounder was named the SWSC defensive player of the year in 2023 after racking up 110 tackles, 12 TFL, six PBU, four forced fumbles and two sacks. Veldman's coach at LWW is Luke Lokanc, a former teammate of Northwestern head coach David Braun's at Winona State.

Veldman is the fifth member of the Wildcats' Class of 2025.

More to come from WildcatReport...

  • International edition
  • Australia edition
  • Europe edition

Russia could begin full mobilisation after 2024 presidential election, Kyiv official says – as it happened

Secretary of Ukraine’s national security and defence council says Russia has increasingly put its economy onto war footing. This live blog is now closed

  • Russia-Ukraine war at a glance: what we know on day 635
  • 20 Nov 2023 Closing summary
  • 20 Nov 2023 At least 11,000 Ukrainian children are reportedly being detained at 43 re-education camps across Russia, says MoD
  • 20 Nov 2023 Russia may begin full mobilisation after 2024 presidential election, says senior security official
  • 20 Nov 2023 Fox CEO Lachlan Murdoch meets Zelenskiy in Kyiv
  • 20 Nov 2023 Ukraine sacks two high-ranking cyber defence officials, says government official
  • 20 Nov 2023 US defense secretary vows support to Ukraine 'for the long haul' on surprise trip to Kyiv
  • 20 Nov 2023 Morning summary
  • 20 Nov 2023 Two killed by Russian shelling in Kherson, Ukrainian authorities say
  • 20 Nov 2023 US defence secretary visits Kyiv
  • 20 Nov 2023 Opening summary

Vladimir Putin.

Nato supports Bosnia’s territorial integrity and is concerned by “malign foreign interference,” including by Russia , in the volatile Balkans region that went through a devastating war in the 1990s, Nato’s secretary general, Jens Stoltenberg , has said.

Sarajevo is the first stop on Stoltenberg’s tour of western Balkan countries that will also include Kosovo, Serbia and North Macedonia, the Associated Press reports.

“The Allies strongly support the sovereignty and territorial integrity of Bosnia-Herzegovina,” Stoltenberg told reporters. “We are concerned by the secessionist and divisive rhetoric as well as malign foreign interference, including Russia.”

There are widespread fears that Russia is trying to destabilise Bosnia and the rest of the region and shift at least some world attention from its war in Ukraine .

Jens Stoltenberg speaks during a joint press conference after a meeting in Sarajevo, Bosnia and Herzegovina.

Morning summary

The US secretary of defence, Lloyd Austin, arrived in Kyiv on Monday for a visit. “I’m here today to deliver an important message: the United States will continue to stand with Ukraine in their fight for freedom against Russia’s aggression, both now and into the future.”

Two people were killed early on Monday after Russian forces shelled a parking lot in the southern Ukrainian city of Kherson, authorities said. Regional prosecutors opened a war crimes investigation into the artillery strike, which occurred at about 9am (7am GMT) and injured one other person, the regional prosecutor’s office reported.

A Ukrainian soldier and a woman have died after a grenade exploded in a Kyiv apartment, police in the Ukrainian capital have said, but the cause of the blast, which injured a second man, was not immediately clear. Explosives technicians and investigators were working at the scene of Sunday’s explosion in the Dniprovskiy district, Kyiv police said in a statement.

The Ukrainian army said it had pushed back Russian forces “three to eight kilometres” from the banks of the Dnipro River, which if confirmed would be the first meaningful advance by Kyiv’s forces months into a disappointing counteroffensive . Ukrainian and Russian forces have been entrenched on opposite sides of the vast waterway in the southern Kherson region for more than a year, after Russia withdrew its troops from the western bank last November.

A Ukrainian teenager who was taken to Russia from the occupied city of Mariupol during the war and prevented from leaving earlier this year has returned to Ukraine . Bohdan Yermokhin, who turned 18 on Sunday, appealed to Zelenskiy this month to help bring him back to Ukraine. “I believed I would be in Ukraine, but not on this day,” Yermokhin told Reuters while eating at a petrol station after crossing the border.

About 3,000 mostly Ukrainian trucks, including those carrying fuel and humanitarian aid, were stuck on the Polish side of the border on Sunday due to a more than 10-day blockade by Polish truckers, Ukrainian authorities said . Polish truckers earlier this month blocked roads to three border crossings with Ukraine to protest against what they see as government inaction over a loss of business to foreign competitors since Russia’s invasion of Ukraine in February 2022.

Air defence units in Moscow intercepted a drone targeting the city late Sunday, mayor Sergei Sobyanin said . Sobyanin, writing on the Telegram messaging app, said units in the Elektrostal district in the capital’s east had intercepted the drone. No casualties or damage were initially reported. Air defences had also thwarted a drone attack on the Russian capital overnight to Sunday, authorities said earlier.

Russia launched 20 Iranian-made Shahed drones targeting Kyiv and the Cherkasy and Poltava regions overnight into Sunday, the Ukrainian military said, of which 15 were shot down . The overnight strikes on Kyiv were the second attack on the Ukrainian capital in 48 hours, said the city’s military administration spokesperson, Serhii Popko.

Five people including a three-year-old girl were injured in Russian artillery shelling of Kherson on Sunday morning, the Ukrainian interior minister, Ihor Klymenko , said . “All of them sustained shrapnel wounds. The child and the grandmother were walking in the yard. Enemy artillery hit them near the entrance,” Klymenko said on the Telegram messaging app.

The pro-war Russian nationalist Igor Girkin , who is in custody awaiting trial for inciting extremism, said he wanted to run for president even though he understood the March election would be a “sham” with the winner already clear . Girkin, who is also known by the alias Igor Strelkov, has repeatedly said Russia faces revolution and even civil war unless President Vladimir Putin’s military top brass fight the war in Ukraine more effectively. A former Federal Security Service (FSB) officer who helped Russia to annex Crimea in 2014 and then to organise pro-Russian militias in eastern Ukraine, Girkin said before his arrest that he and his supporters were entering politics.

The Kremlin, facing the prospect of a European Union ban on imports of Russian diamonds, said on Monday that EU sanctions tended to have a “boomerang effect” on those who applied them, Reuters reports.

Kremlin spokesperson Dmitry Peskov was commenting on a proposed EU ban on diamond imports from Russia as part of a new sanctions package against Moscow over the conflict in Ukraine .

Russia is the world’s biggest producer of rough diamonds by volume. Peskov told reporters such a move had been anticipated for a long time, but was likely to backfire.

“As a rule, it turns out that a boomerang effect is partially triggered: the interests of the Europeans themselves suffer. So far, we have been able to find ways to minimise the negative consequences of sanctions,” he said.

EU diplomatic sources said last week the proposal under discussion was to ban direct diamond imports from Russia from 1 January and from March to implement a traceability mechanism that would prevent imports of Russian gems processed in third countries.

The Kremlin said on Monday that president Vladimir Putin will set out Russia’s view of what it sees as the “deeply unstable world situation” when he addresses an upcoming virtual G20 summit.

Russian state TV presenter Pavel Zarubin said on his Telegram channel on Sunday that it would be the “first event in a long time” including both Putin and western leaders.

According to the state RIA news agency, the G20 virtual summit will be held on Wednesday.

The Kremlin said on Monday it regretted Finland’s decision to shut crossings on its border with Russia , saying it reflected Helsinki’s adoption of an anti-Russian stance, Reuters reports.

Kremlin spokesperson Dmitry Peskov , speaking at a regular news briefing, also rejected Finland’s accusation that Russia is deliberately pushing illegal migrants towards the border and said that Russian border guards were following all instructions.

Finland, a member of the European Union and – from this year – also of the Nato military alliance, closed four crossings on its border with Russia on Saturday as Helsinki seeks to halt a flow of asylum seekers it says was instigated by Moscow.

The US secretary of defence, Lloyd Austin, arrives in Kyiv on Monday morning.

The US secretary of defence, Lloyd Austin, arrives in Kyiv

Two killed by Russian shelling in Kherson, Ukrainian authorities say

Reuters reports that two people were killed early on Monday after Russian forces shelled a parking lot in the southern Ukrainian city of Kherson, authorities said.

Regional prosecutors opened a war crimes investigation into the artillery strike, which occurred at about 9am (7am GMT) and injured one other person, the regional prosecutor’s office reported.

The Kherson governor, Oleksandr Prokudin, said the two dead were drivers for a private transport business.

Images posted on Telegram showed firefighters dousing cars that had been blasted apart, one day after a separate strike on the city wounded five people, including a three-year-old girl.

Russian forces have regularly shelled Kherson from across the Dnipro River since the regional capital was reoccupied by Ukrainian troops last November.

Ukraine said last week it had secured a foothold on the eastern bank of the Dnipro and that its troops were trying to push Russian forces further back.

US defence secretary visits Kyiv

The US secretary of defence, Lloyd Austin, arrived in Kyiv on Monday for a visit, he said on the X social media platform, Reuters reports.

“I’m here today to deliver an important message: the United States will continue to stand with Ukraine in their fight for freedom against Russia’s aggression, both now and into the future.”

The visit comes amid increasing division over Ukraine aid in the US legislature. A joint Ukraine-US military industry conference in Washington is due to take place next month.

That event, due to be held on 6-7 December, is intended to boost Ukraine’s domestic arms production as its fight against a full-scale Russian invasion nears the two-year mark.

Reuters reports that a Japanese delegation led by senior industry and foreign ministry officials and including business representatives is visiting Ukraine on Monday for talks ahead of a reconstruction conference that Japan will host, the industry ministry said.

Japan, which has been supporting Ukraine with funds and by accepting refugees since Russia invaded in February 2022, has also been promoting support for Ukraine at the level of the G7, which Japan chairs this year.

Kazuchika Iwata , the state minister of economy, trade and industry (METI), and the state minister for foreign affairs Kiyoto Tsuji , are visiting together with representatives of Japan companies, METI said in a statement.

In Kyiv, the delegation, which includes members of Keidanren, Japan’s biggest business lobby, in charge of a committee on Ukraine’s reconstruction, plans talks with the prime minister, Denys Shmyhal , government officials and companies.

Shmyhal said this month Ukraine would need budget support of about $42bn this year and next year to plug a massive deficit and aid reconstruction from the devastation caused by Russia’s invasion.

METI said the visit was an opportunity to hear about Ukraine’s needs and to discuss specific projects and accelerate public and private efforts to help.

The Ukrainian president, Volodymyr Zelenskiy – who visited Japan in May during a G7 summit – and the Japanese prime minister, Fumio Kishida, agreed this month to hold a Japan-Ukraine Conference for promotion of Economic Reconstruction in Tokyo on 19 February.

Opening summary

Hello and welcome to the Guardian’s live coverage of the war in Ukraine .

A Ukrainian soldier and a woman have died after a grenade exploded in a Kyiv apartment, police in the Ukrainian capital have said, but the cause of the blast, which injured a second man, was not immediately clear.

Explosives technicians and investigators were working at the scene of Sunday’s explosion in the Dniprovskiy district, Kyiv police said in a statement.

“A citizen contacted the police with a report that an explosion rang out in a neighbouring apartment,” they added.

The news came as Volodymyr Zelenskiy dismissed the commander of the military’s medical forces , Maj Gen Tetiana Ostashchenko, and said “new priorities had been set” in the operations of Ukraine’s military after a meeting with the defence minister, Rustem Umerov.

“There is little time left to wait for results. Quick action is needed for forthcoming changes,” the Ukrainian president said in his evening video address.

In other key developments:

Russia launched 20 Iranian-made Sha hed drones targeting Kyiv and the Cherkasy and Poltava regions overnight into Sunday, the Ukrainian military said, of which 15 were shot down . The overnight strikes on Kyiv were the second attack on the Ukrainian capital in 48 hours, said the city’s military administration spokesperson, Serhii Popko.

Five people including a three-year-old girl were injured in Russian artillery shelling of Kherson on Sunday morning, the Ukrainian interior minister, Ihor Klymenko, said . “All of them sustained shrapnel wounds. The child and the grandmother were walking in the yard. Enemy artillery hit them near the entrance,” Klymenko said on the Telegram messaging app.

The pro-war Russian nationalist Igor Girkin, who is in custody awaiting trial for inciting extremism, said he wanted to run for president even though he understood the March election would be a “sham” with the winner already clear . Girkin, who is also known by the alias Igor Strelkov, has repeatedly said Russia faces revolution and even civil war unless President Vladimir Putin’s military top brass fight the war in Ukraine more effectively. A former Federal Security Service (FSB) officer who helped Russia to annex Crimea in 2014 and then to organise pro-Russian militias in eastern Ukraine, Girkin said before his arrest that he and his supporters were entering politics.

  • Ukraine war live

Most viewed

IMAGES

  1. How to Become a Health Visitor

    health visitor second visit

  2. How to Become a Health Visitor

    health visitor second visit

  3. How to Become a Health Visitor

    health visitor second visit

  4. Health visitor

    health visitor second visit

  5. Health Visitor

    health visitor second visit

  6. What does a health visitor do?

    health visitor second visit

COMMENTS

  1. Health visitor prescribing during the Covid-19 pandemic

    As health visitors have continued to visit families in their own homes throughout the Covid-19 global pandemic, health visitor prescribing has prevented families from having to attend GP surgeries to seek medication, thus saving GP time, and reducing the risk of infection for GPs and families by reducing face-to-face contact. ...

  2. Your Antenatal Appointment Schedule

    After your booking appointment at about 10 weeks, you will usually have these appointments: in your second trimester, in weeks 14-16, 25 and 28. in your third trimester in weeks 31, 34, 36, 38, 40 and 41 (if you haven't given birth before 40 weeks) If you have already had a healthy pregnancy and baby, you will have 7 appointments. As well as ...

  3. Health visitor

    Health visitors are mainly concerned with helping to ensure that people's domestic behaviour is sanitary, hygienic, and beneficial to the welfare of themselves and their families, particularly to their children. As their name suggests, they fulfill their role in the community, by visiting family homes, to give advice and support to all age groups.

  4. Structuring health needs assessments: the medicalisation of health visiting

    Health visitors from Site A structured the interaction so that there was a clear demarcation between the assessment process and the rest of the visit where, on the whole, the health visitor focused on what might be considered routine aspects of health visiting practice about maternal and child health, as shown in Extracts 1 and 2:

  5. The importance of the antenatal home visit by the health visitor

    Research has shown that the antecedents of many lifelong conditions and illnesses in the middle and later years of life have their roots in the antenatal period, and health visiting is the only universal service that can provide health promotion, early intervention and primary prevention in the antenatal period that continues into the early years.

  6. Services and support for parents

    How your health visitor can help. A health visitor will usually visit you at home for the first time around 10 days after your baby is born. Until then you'll be cared for by local midwives. A health visitor is a qualified nurse or midwife who has had extra training. They're there to help you, your family and your new baby stay healthy.

  7. What is a Health Visitor

    Health Visiting is… Health visitors are registered nurses/midwives who have additional training in community public health nursing. They provide a professional public health service based on best evidence of what works for individuals, families, groups and communities; enhancing health and reducing health inequalities through a proactive, universal service for all children 0-5 years and for ...

  8. Health visiting teams and children's oral health: a scoping review

    A limitation of this review relates to terminology. This review included the term health visiting teams acknowledging the practice of health visiting as a team approach. The majority of the included studies of the peer-reviewed search mainly used the term health visitor and occasionally specified whether it was a community nurse or school nurse.

  9. Home visits

    The programme includes home visits from a family nurse while you're pregnant, and after your baby's born. These visits help: to have a healthy pregnancy. you and your baby grow and develop together. you to be the best parent you can be. Your health visitor will take over from your family nurse when your baby is two until they go to school.

  10. The role of the health visitor

    Abstract. The role of the health visitor has evolved over time, but their work remains vital to ensuring the health and wellbeing of families with infants and pre-school children. Every child in the United Kingdom should have a health visitor from as early as the antenatal period and have several planned contacts during the first five years of ...

  11. Timing of first postnatal contact by health visitor

    The Department of Health and Social Care's Healthy Child Programme currently mandates 1 health visitor visit in the antenatal period and 2 health visitor visits in the early postnatal period. ... that an early health visitor contact would be scheduled. For this reason, the committee added a caveat, making a second recommendation on the basis ...

  12. Women's views on contact with a health visitor during pregnancy: an

    Introduction. The antenatal contact by health visitors has been recommended in England since 2009. This was when the Healthy Child Programme supported the contact between 28- and 36-week gestation by health visitors to women and their partners (Department of Health, 2009).With the transfer of commissioning of health visiting to local government in England in 2015, five contacts by health ...

  13. Make the Most of Your Baby's Visit to the Doctor (Ages 0 ...

    By age 4 months, most babies: Bring their hands to their mouth. Make cooing sounds. Hold toys that you put in their hand. Turn their head to the sound of your voice. Make sounds when you talk to them. See a complete list of milestones for kids age 4 months.

  14. Unintended consequences of restrictive visitation policies during the

    In this issue, Van Driest et al. 4 explored the consent rate for an observational study conducted in the early months of the COVID-19 pandemic after the implementation of a one-parent/visitor ...

  15. PDF Procedure for action with regards to no access visits, failed contact

    5.1.4 If there is no access the health visitor must leave a calling card stating the date and time of next visit, health visitor's name and contact details. 5.1.5 Where there is no access at a second visit, the health visitor will send a letter outlining the services available, giving the name and contact telephone number of the health visitor.

  16. After a Night 'on Fire,' Biden Hits the Road to Make the Case for a

    Pumped up by the reaction to his forceful address to Congress the evening before, the president sought to build on the momentum by opening his general election campaign with a trip to Pennsylvania.

  17. PDF Universal health visitor reviews toolkit

    The health visitor service delivery metrics were developed by NHS England in order to provide assurance on service transformation in England. They cover: the antenatal check; new born visit; the 6 to 8 week review; the 12 month assessment; and the 2 to 21⁄2 year assessments, and report on the following indicators:

  18. Double-blind, Placebo-controlled, Randomized Study of the Tolerability

    Recruitment of volunteers will be competitive. A maximum of 450 children aged 12 to 17 years inclusive will be screened in the study, of which it is planned to include and randomize 300 children who meet the criteria for inclusion in the study and do not have non-inclusion criteria, data on which will be used for subsequent safety and immunogenicity analysis.

  19. Health Visitor Information Pack

    The health visitor information pack describes the evidence-based approach of the work of health visitors and information on the transition of the service over the next 2 years and beyond.

  20. 'Making the most of together time': development of a Health Visitor-led

    In the UK, the Healthy Child Programme provides support from 0 to 19 years of age and is led by Public Health England (PHE) aiming to 'improve the health of babies, children and their families to enable a happy healthy childhood and provide the foundations of good health into adult life' [24-26]. In the 0-5-year period, this programme ...

  21. Viktor Orbán meeting offers preview of Trump's 2nd-term ...

    Orbán supports Trump's vow to end the war in Ukraine if he's elected within 24 hours - a process that could happen only on Putin's terms and reward his illegal invasion. Their ...

  22. 40 Facts About Elektrostal

    Residents and visitors can enjoy a lively nightlife in Elektrostal, with numerous bars, clubs, and entertainment venues. Promotes cultural exchange and international relations. Elektrostal actively engages in international partnerships, cultural exchanges, and diplomatic collaborations to foster global connections.

  23. 2025 Lb And Visitor Josh Veldman Is Northwestern's Second Saturday

    Josh Veldman committed to Northwestern on his Saturday visit to Northwestern. became the second player to commit to the Wildcats. Veldman announced his decision on X, formerly Twitter. , who announced his commitment about an hour before Veldman did. Both players were among the 13 high-profile targets on campus this weekend.

  24. Russia could begin full mobilisation after 2024 presidential election

    A Ukrainian soldier and a woman have died after a grenade exploded in a Kyiv apartment, police in the Ukrainian capital have said, but the cause of the blast, which injured a second man, was not ...

  25. Moscow Metro

    Russia - Moscow Metro - 2 different maps showing different stations !! - Hi Folks, I took a moscow metro map from the reception of the hotel ( Moscow Street by Street Visitors Guide -Map 1). In the room there was another map in a brochure named Cultural map of Moscow from Capital Tours.. The funny part is the following.