Healthy Child Wales Programme: for school aged children - Part 2: school entry health review

Purpose and aims

The purpose of the school entry health review is to:

• assess the child’s health needs
• promote public health and wellbeing
• support and enable children to achieve their full potential
• transfer care from health visiting to school nursing services

All school aged children will have access to a named specialist community public health nurse (school nursing) who can be contacted for advice and support.

All children at 5 years of age with an identified outstanding health need, such as outstanding immunisations, will have their care formally transferred over to the named nurse in school nursing services by the health visitor.

All parents/carers of children aged 5 years old will receive a digital school entry information welcome pack during their first term. The school will be asked to distribute the digital packs to all children attending schools.

Any child electively home educated will receive the welcome pack from the school nursing service, introducing the service and providing the digital welcome pack through an appropriate method.

The digital pack will include:

• an overview of the school nursing services
• a welcome letter for the parent/carer including:
  • a school nursing services leaflet, including link a to welcome videos
  • information of who the named specialist community public health nurse (SCPHN SN) will be and how contact can be made
  • information of who the nurse in special schools will be and contact details
  • details about how families can access the school nursing services websites
  • useful links and digital leaflets
• information on:
  • 10 steps to a healthy weight
  • height, weight and vision screening including how results will be shared and can be accessed
  • healthy lunch box, importance of hydration/nutrition
  • school aged immunisation programme including consent process
  • child measurement programme
  • how parents can opt out of height, weight and vision screening and child measurement programme

Information will be shared between the health visiting and school nursing services to ensure a smooth transition into education, regardless of setting.

All children are assessed by the health visitor and have a level of care assigned to them. Any children with an enhanced or intensive level will have their care formally transferred over to the named specialist community public health school nurse at the age of 5.

For children in special schools, the nurse in special schools will be responsible for the care co-ordination. Where there is not a nurse based in a special school, the care co-ordination role will be transferred to the child disability team.

The health visitor will inform the family that care is being transferred to school nursing services when their child reaches 5 years of age. The health visitor will also provide details to parents/carers of how they can access and contact school nursing services.

Children and young people educated other than at school or electively home educated should be transferred to the appropriate named nurse within school nursing services.

Children entering special schools may start school before 5 years of age. Health visiting services will remain the caseload holder for these children until they reach 5 years of age, when care will be transferred to school nursing services. The nurse in special schools will work in partnership with the health visitor and community children’s nursing services to ensure their care is co-ordinated.

Children and young people with complex healthcare needs will be supported by a care co-ordinator within school nursing services. Care co-ordination will be offered to all school aged children and young people with complex healthcare needs and with an identified level of care of enhanced or intensive.

The aim of care co-ordination is to proactively identify and work with other professionals to make the right connections leading to providing the most appropriate care at the right time. This includes supporting the child / young person and parents/carers to navigate the health and care system, so they become more active in managing their own healthcare needs where possible. The care co-ordinator is skilled in assessing and responding to changing healthcare needs and again co-ordinating support to manage changes.

All children will have their immunisation status reviewed to ensure they have accessed the full pre-school childhood immunisation programme. School nursing services will ensure families are made aware of how they can access any outstanding immunisations.

All parents will be provided with information on the growth screening programme and the national vision programme for all children aged 4 to 5 years of aged (reception year) including their height, weight and vision.

All children attending a reception class in any school in Wales, including maintained and independent schools, are eligible for screening.

Children who miss the screening in reception for any reason will be offered "catch-up" sessions in year 1 by school nursing services.

Children who are educated other than at school or electively home educated will be signposted to GP services and opticians by school nursing services through the welcome pack.

In most cases in Wales, hearing screening (also referred to as audiology) is not managed by school nursing services and therefore is outside the scope of the new operating model.

Universal

School nursing services will assess risk, based on the information they have obtained from transfer of care by health visiting services.

School nursing services will review any documentation transferred by the health visitor relating to the child and act upon any outstanding public health needs (for example outstanding childhood immunisations).

Advice and support will be offered if concerns are reported or identified.

Information will be provided to parents on the growth and vision screening programmes, including how to access measurements taken or opt out. 

Advice and support will be offered to all families in line with pathways.

Children and young people in special schools assessed as needing a universal level of support will require low intensity care co-ordination. This will focus on the nurse in special schools working in partnership with the specialist community public health nurse (school nursing) to ensure delivery of the operating model.

Enhanced

Children identified with a body mass index (BMI) equal to or above the 91st centile will be followed up by school nursing services in line with the weight management pathway and will be offered further support, signposting and referrals made where appropriate.

A health assessment may be undertaken if appropriate with parental consent.

Parents will be invited to discuss their child’s health and wellbeing needs during his process.

If the health board has a weight management service, details of how a referral can be made to them will be shared with parents or alternatively made by professionals.

Targeted public health sessions to schools/communities will be offered where health needs are identified from results and trends.

Children and young people requiring additional intervention will receive individualised additional support, early intervention following identification of additional needs, and/or episodic management of needs.

Intensive

School nursing services will work alongside other agencies in line with the Wales safeguarding procedures when outstanding health needs are handed over from the health visitor or new concerns are identified.

A health assessment will be carried out if safeguarding concerns are highlighted.

Referrals to appropriate specialist services will be made according to need, for example to a dietician.

School nursing services will support children, young people and their families who have more complex health needs and those with additional health needs identified during screening. This will include a health care co-ordination role to ensure the health needs are met in line with the relevant height, weight, vision pathway.

Children and young people requiring an intensive level of support will often have multiple complex health needs and psychosocial risk factors, for which they require specialist support. They will often have multiple services involved in their care and care co-ordination will have a higher level of intensity.

The care co-ordinator will be critical to leading on a shared plan of care to meet the child’s health promotion and protection needs in addition to their chronic condition management.

In addition to the screening for height, weight and vision at school entry, school nursing services also support the work led by Public Health Wales to monitor the longer-term trajectory of children’s growth development (height and weight).

Through the child measurement programme, all children that attend reception class, including maintained and independent schools, will have their height and weight measurements taken in line with the national standards for the national programme.