The results of my study have some important implications for how children’s services are delivered within the Merseyside area. I will discuss some of these implications and how they might be changed in order to truly meet the needs of the parents they aim to serve.
Local Authorities
In October 2015 funding will be moved into the hands of local authorities. At this stage, I hope that my results will be disseminated and will be taken into consideration by the local authority when they decide how best to run services for parents of
children under the age of 2. With financial cuts likely, commissioners should be aware of what support parents in Merseyside value and cater services accordingly to meet these needs. From my study, it is clear that services which promote positive longer term relationships between provider and client will be important.
Furthermore, those services which promote professionalism in their staff will be important. Finally, it will be crucial that the local authority considers how it could utilise the experience and expertise of other parents when planning new or making changes to services available to support parents.
Health Visitors
The results of my study identified the importance of a good, trusting relationship with a sense of continuity and confidence between parents and health care professionals. This was particularly important between parents and their Health Visitor. A poor relationship acted as a major barrier to parents seeking advice and support from their assigned Health Visitor. Many of the common parenting problems identified in my study such as difficulties with sleep routine and child illness, are areas which are promoted by the government as being supported by Health Visitors supported by Health Visitors. Due to a breakdown in relationship due to lack of trust or continuity between some health visitors and parents, parents may not always be utilising this support effectively. My study suggests that where possible parents are given more of an opportunity to build up a positive relationship with a Health Visitor through continuity, regular visits and an interactive and more partnered relationship. This should improve with the government’s new recommendation that Health Visitors visit all parents in the home before their child is born.(51) However this could be improved upon further by ensuring the same Health Visitor was attending the ‘weigh-in’ clinic at the same children’s centre each week. If the same Health Visitor attended the clinics weekly and parents knew that each time they attended they would see the same person. This could help form a better relationship and parents would be more likely to utilise the expert knowledge of the Health Visitors, particularly as results showed most parents preferred professional advice to say that of the internet.
Many parents did however struggle to attend these drop-in sessions due to the specific time of day in which they were held in most children’s centres. Sessions were over-subscribed and many parents missed out on this opportunity to meet with the Health Visitor and discuss problems. In some cases it prevented parents attending as some parents felt they would not be seen. If sessions could be extended or
repeated throughout the week this would provide a greater opportunity for parents to meet with the Health Visitor and discuss any problems. In Kirkby parents valued the evening drop in sessions that were held as they could attend after work. In contrast parents reported a positive relationship with children’s centre staff and in many cases this was because they had regular contact with the staff at the centres and had built a trusting relationship over time. This relationship allowed parents to open up about
their concerns and problems as they felt they were in a safe environment. If Health Visitors had the opportunities to further build upon their relationship with parents then parents would be more likely to discuss their concerns with them, as they did with children’s centre staff.
Sleep routine was a common concern for many parents interviewed and some felt that the way in which information was delivered by Health Visitors regarding co- sleeping lead to a break down in the relationship. Like that of the MMR vaccine, co- sleeping is an important message Health Visitors must deliver to parents but there are many parental concerns regarding the evidence-base of this information. If Health Visitors do not actively engage in conversations, dismissing concerns and not
discussing the evidence upon which their advice is founded this can, as my study has shown, lead to a break down in the Health Visitor – parent relationship and parents will not discuss their concerns further. Health Visitors may not feel qualified enough to discuss the evidence surrounding co-sleeping or are unable to devote the time needed to address all the parents’ concerns in one short visit but it is an important issue for many parents and my study has shown that most parents valued and trust the advice from professional sources. I hope that the results of my study will make Health Visitors more aware that they must ensure parents are engaged in active discussions when delivering advice, so that the relationship between them can be maintained.
The sleep routine itself was a concern of most parents interviewed. Health Visitors should be mindful that they are delivering parents with enough information about a child’s sleep patterns during the first 2 years of life.
It would be interesting to consider whether Health Visitors could take on some of the approaches used by BAMBIS, who provide information to parents quickly when contacted at any time of the day or night through texting and phoning. This immediate response is valued highly by parents and may save Health Visitors visiting the home when the problems or concerns are minor.
Many parents discussed how they valued the professional advice they received from Health Visitors and for those parents who had children with long term illness the additional support they received was invaluable. Although to summarise there are some areas where the service could be improved upon to ensure there is not a break
down in the Health Visitor – parent relationship. Ensuring that, where possible, the same Health Visitor attends the same children’s centre for the weigh-in sessions each week. Furthermore that drop-in, weigh-in clinics are held at more accessible times by extending the sessions or holding them at alternative times throughout the week. This might provide more opportunities for parents to build upon their relationships with a Health Visitor. Engaging parents in active conversations about co-sleeping will help parents feel they can continue to approach their health visitor for advice regarding other concerns they have. If the relationship between Health Visitors and parents can be improved, parents are more likely to use this service to support them with their responsive, sensitive and reflective parenting.
Children’s Centres
My study has shown how important and valued children’s centres in Merseyside are for the parents interviewed. There are many reasons for this. Children’s centres are provided parents with a place to seek professional advice and a place to meet other parents who have experienced parenthood. They provide the chance for parents and children to form important relationships with other parents and professionals. All these factors are important in supporting parents with their responsive, sensitive and reflective caregiving and consequently childhood development. It is vital that the local authorities are aware of the importance of the centres to parents in Merseyside when deciding upon their future.
Peer Support
Peer support was seen by parents in my study as vital in supporting them with their sensitive, responsive and reflective care their child’s development. Commissioners should note that parents valued the support of other parents who have knowledge and experience. This is important when designing, evaluating or introducing further parenting programmes in Merseyside. BAMBIS breastfeeding support is a key example of how valued a peer support programme can be for parents of Merseyside. Knowing that other mothers have been through the same experiences and faced the same challenges with regards to breastfeeding is valued by mothers. This service is
unique to the Liverpool region and should be considered by other local authorities as it is clearly benefiting those mothers who require additional support with their breast feeding.
Single Mothers
There are many single parent families in Merseyside and we know that single parent families, in some circumstances can have a negative impact upon childhood
development. Results from my study show that single parent families would benefit from more support, if possible. It may be useful if commissioners and those
managing children’s centres and health care in the community could consider which type of support might be most effective and suitable to the needs of these single parents.
Childhood Rashes;
One interesting result from my study appeared whilst parents discussed where they would go to for support and advice. When discussing this, many parents explained their concerns over childhood rashes. My results indicate that many parents of Merseyside may feel ill-informed of common childhood rashes such as eczema, nappy rash, and cradle cap amongst others and could be provided with more information. It is suggested that more time could be taken by Midwives and Health Visitors during the early weeks of life to better inform parents of common or
concerning rashes. A simple leaflet or link to a good website with information which was given as part of the initial parenting information pack following birth could provide an easy to access solution to this issue faced by parents. This may be an issue which could also be addressed in the training of Health Visitors and Midwives who may not feel that confident in providing the information.