Study protocol: a mixed-methods study to evaluate which health visiting models in England are most promising for mitigating the harms of adverse childhood experiences

Jenny Woodman; Louise Mc Grath-Lone; Amanda Clery; Helen Weatherly; Dina Jankovic; Jane V Appleton; Jennifer Kirman; Jane Barlow; Sally Kendall; Samantha Bennett; Ruth Gilbert; Katie Harron

doi:10.1136/bmjopen-2022-066880

Study protocol: a mixed-methods study to evaluate which health visiting models in England are most promising for mitigating the harms of adverse childhood experiences

BMJ Open. 2022 Sep 29;12(9):e066880. doi: 10.1136/bmjopen-2022-066880.

Authors

Affiliations

¹ Social Research Institute, UCL-Faculty of Education and Society (IOE), London, UK j.woodman@ucl.ac.uk.
² Social Research Institute, UCL-Faculty of Education and Society (IOE), London, UK.
³ Population, Policy and Practice, UCL Great Ormond Street Institute of Child, London, UK.
⁴ Centre for Health Economics, University of York, York, UK.
⁵ OxINMAHR (Oxford Institute of Nursing, Midwifery and Allied Health Research), Oxford Brookes University, Oxford, UK (Please note JVA is formerly of OxINMAHR but now retired).
⁶ Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK.
⁷ Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
⁸ Centre for Health Services Studies, University of Kent, Canterbury, UK.
⁹ Strategic Commissioning, Kent County Council, Maidstone, UK.

Abstract

Introduction: Exposure to adverse childhood experiences (ACEs) is associated with poorer health outcomes throughout life. In England, health visiting is a long-standing, nationally implemented service that aims to prevent and mitigate the impact of adversity in early childhood, including for children exposed to ACEs. A range of health visiting service delivery practices exist across England (from the minimum five recommended contacts to tailored intensive interventions), but there is a lack of evidence on who receives what services, how this varies across local authorities (LAs) and the associated outcomes.

Methods and analysis: This study will integrate findings from analysis of individual-level, deidentified administrative data related to hospital admissions (Hospital Episode Statistics (HES)) and health visiting contacts (Community Services Data Set (CSDS)), aggregate LA-level data, in-depth case studies in up to six LAs (including interviews with mothers), a national survey of health visiting services, and workshops with stakeholders and experts by experience. We will use an empirical-to-conceptual approach to develop a typology of health visiting service delivery in England, starting with a data-driven classification generated from latent class analysis of CSDS-HES data, which will be refined based on all other available qualitative and quantitative data. We will then evaluate which models of health visiting are most promising for mitigating the impact of ACEs on child and maternal outcomes using CSDS-HES data for a cohort of children born on 1 April 2015 to 31 March 2019.

Ethics and dissemination: The University College London Institute of Education Research Ethics Committee approved this study. Results will be submitted for publication in a peer-reviewed journal and summaries will be provided to key stakeholders including the funders, policy-makers, local commissioners and families.

Keywords: Child protection; Community child health; EPIDEMIOLOGY; Health policy; PUBLIC HEALTH; QUALITATIVE RESEARCH.

MeSH terms

Adverse Childhood Experiences*
Child
Child, Preschool
England
Female
Humans
London
Mothers

Grants and funding

DH_/Department of Health/United Kingdom