Healthy Child Wales Programme: for school aged children - Part 4: public health interventions

Who is most at risk

High impact areas are those where the biggest difference can be made to children and young people’s health through the delivery of the operating model. This can be wide ranging and dynamic as public health issues change and new challenges emerge.

Children and young people with complex health needs are at risk of poorer health and wellbeing outcomes, although this risk will be influenced by multiple protective factors such as a supportive family dynamic. This includes children and young people with:

• physical disability
• learning disability, autistic spectrum disorder and neurodiversity
• emotional distress
• other vulnerabilities
• looked after children

Compiling a health needs assessment is a tool for school nursing services to gain a more in-depth understanding of their population and the needs that exist, with the goal of enabling more effective planning, prioritisation, and subsequent delivery of services to improve outcomes for children and young people. These high impact areas can include:

• health behaviours and lifestyle
• smoking and vaping
• sexual health
• building resilience
• reducing risk behaviours
• children and young people with complex health needs

Children and young people with more complex health needs will require an individual health assessment. This will be completed if unmet health needs are identified at school entry, or thereafter, and reviewed annually. The health assessment will be nurse-led but involve close engagement with the parent/carer utilising the wider team around the child approach. Every child and young person in Wales identified with enhanced or intensive level of care will have a care co-ordinator assigned to them by NHS Wales.

Within the implementation period, an all Wales standardised health assessment for children and young people with complex healthcare needs will be developed. This individualised assessment will cover a chronology of health events, family relationships, identified health needs, including public health needs and focus on the child or young person’s strengths and vulnerabilities.

The completed assessment undertaken in collaboration with parents/carers, along with reports from other professionals, will enable school nursing services and the team around the child to develop a healthcare plan for the child / young person with complex needs. This should include establishing what is important to the child and parents/carers and understanding their goals. Training, guidance and support for children and families with complex and long-term health conditions will be planned and facilitated by the team around the child, with school nursing services leading on care co-ordination.

The operating model is the national evidenced-based universal provision for school aged children, as part of the Healthy Child Wales Programme. The level of intervention, whether universal, enhanced, or intensive, will be defined by the population, community and individual needs assessments carried out by school nursing services. All school aged children are offered universal services. Children and young people with enhanced or intensive levels of health need are offered additional support to meet those needs.

Universal

Core components of the operating model available to all families with children / young people between the age of 5 and 16 years of age will include:

• health and development
• school entry health review
• screening and surveillance

Immunisations will include:

• specialist community public health nurses (school nursing) can offer information on key public health messages including immunisations
• school aged immunisation programme

High impact areas, guided by the population health needs assessment, include:

• hydration
• nutrition
• smoking/vaping cessation
• infectious diseases
• healthy lifestyle choices

Safeguarding includes:

• early detection / awareness of adverse childhood experiences

Emotional health and wellbeing includes:

• healthy relationships
• puberty and growing up / hygiene / body changes including periods and pelvic floor
• transition support at key points including:
  • nursery to reception
  • year 6 into secondary school
  • transition into adulthood
• school based drop-in sessions
• emotional health and wellbeing support

Relationship and sexuality education includes:

• sexually transmitted infections
• contraception
• condom distribution scheme

The universal offer will continue to be offered and provided with adjustments made as appropriate based on individual health assessments for children with complex health needs.

Enhanced

The enhanced level of support will include a more predicted, assessed and expressed needs-based approach with early interventions to promote positive outcomes. The targeted public health support is provided throughout the compulsory school age for children / young people aged 5 to 16 years old (years 1 to 11).

It also provides targeted, evidence-based support for children and young people in the following areas.

Under health and development, the enhanced level of support will provide:

• health assessments (to identify unmet health needs)
• follow up from school entry health review/screening and surveillance/referral to specialist services

Regarding immunisations, the enhanced level of support will:

• assist in school aged outbreaks/pandemics, for example, polio or measles outbreaks, working with partner agencies

Public health includes:

• nutrition and weight management
• bladder and bowel health
• dental health
• substance misuse
• referral to specialist services

Emotional health and wellbeing includes:

• emotional health and wellbeing one to one support
• referral to specialist services

Safeguarding concerns includes:

• health assessment to identify unmet health needs
• referral to specialist services

Regarding sexual health, the enhanced level of support will:

• signpost for further support or refer to specialist services

Children and young people with complex needs can experience anxiety and low mood due to feeling different from others and their emotional mental health can be further negatively affected due to their physical health needs being the focus for professionals. They may have learning and/or communication difficulties. It is also evidenced that children and young people with complex health needs and disability are at a higher risk of abuse. Therefore, in recognition of the additional healthcare needs and risk, face to face drop-in sessions in special schools will be offered. Where required, school nursing services will seek advice from learning disability nurses, to support necessary adjustments in delivery of these sessions.

School nursing services will work in partnership with parents/carers and the team around the child, to support the high impact areas and individual health needs identified. This may include liaison with learning disability nurses and wider services. The child may be able to be stepped down to the universal pathway once needs are supported.

Intensive

The decision to provide this highest level of support is guided by the individual healthcare assessment and overall complexity/intensity of health need. As a result, identification of intensive need may include:

• referral to specialist services
• safeguarding concerns
• wrap around support for the child and family with the school nursing services undertaking higher intensity care co-ordination within the wider team around the child
• family centred holistic care and support may be required to support resilience of the whole family, with multi-agency input and specialist referral