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List of Contributors ix Introduction 1 1 Managing Knowledge in Health Visiting 9 Kate Robinson Introduction 9 Defining health visiting practice 11 What do health visitors do ??? and where do they do it? 12 Evidence–based medicine 16 The current landscape of evidence–based practice 22 Refuting evidence–based practice 22 So does it work ??? and if not, why not? 24 Redefining evidence–based practice 25 Managing knowledge and evidence in practice 27 Case study 1.1: National policy–making in relation to inequalities in health 27 Case study 1.2: Introducing new technology 28 Case study 1.3: Creating guidelines in primary care 30 Case study 1.4: Protocol–based decision–making in nursing 31 Case study 1.5: Knowledge management in primary care 32 Lessons from the case studies 33 Communities of practice 35 Reflective practice 37 Clients: what do they know and how do they know it? 40 Social networking sites 41 The debate 44 Summary 46 References 46 Appendix 1: Activities for Chapter 1 49 2 Health Visiting: Context and Public Health Practice 52 Martin Smith and Maria Horne Introduction 52 Public health 55 Defining public 55 Defining health 56 Defining public health 58 Human rights and public health 62 The principles of health visiting 66 The search for health needs 66 The stimulation of an awareness of health needs 67 The influence on policies affecting health 68 The facilitation of health enhancing activities 69 Health inequalities 71 Summary 78 References 79 Appendix 2: Activities for Chapter 2 83 3 The Community Dimension 85 Rosamund Bryar and Jean Orr Introduction 85 Defining community 86 Impact of communities on health 89 The role of health visitors with communities 94 Gaining an understanding of the health of your local community 101 Windshield survey 102 Public health walk 102 Health needs assessment 103 Using health promotion models to support community working 110 Summary 113 References 113 Appendix 3: Activities for Chapter 3 117 4 Approaches to Supporting Families 120 Karen I. Chalmers Introduction 120 Models of intervention in family life 121 Three models relevant to health visiting practice in families with young children 122 Application of models in practice 125 Policies 126 Evidence for interventions to support families 128 Characteristics of programmes to support families with young children 129 Early home visiting programmes 130 Current home visiting programmes 132 Family Nurse Partnership Programme 132 Flying Start ??? Wales 136 Starting Well ??? Scotland 137 The Triple ??? P Programme ??? Positive Parenting Programme 139 Sure Start Programmes 140 Working with families 145 Empirical evidence on relationship development 147 Challenges 149 Public health agenda 149 Level of evidence 150 Adhering to the programme criteria 150 High needs families 151 Practice specialisation 151 Concerns about child safety 152 Adequate resources 152 Summary 153 References 153 Appendix 4: Activities for Chapter 4 160 5 Safeguarding Children: Debates and Dilemmas for Health Visitors 163 Julianne Harlow and Martin Smith Introduction 163 The key concepts 165 Defining child 165 Defining childhood 167 Defining safeguarding 168 Defining child abuse 173 Defining significant harm 179 Incidence and prevalence of child abuse 182 Assessment of vulnerable children 186 The Framework for the Assessment of Children in Need and Their Families 186 Common Assessment Framework (CAF) 188 Graded Care Profile 190 Working together 190 Confidentiality and information sharing 192 Supervision 193 Summary 197 References 198 Appendix 5: Activities for Chapter 5 202 6 Evaluating Practice 205 Karen A. Luker and Gretl A. McHugh Introduction 205 Sources of evidence 206 Evaluation ??? the problem of definition 209 Conceptualising evaluation 210 The care planning process 214 Actual and potential problems 215 Evaluation and evaluative research 217 Evaluation of healthcare 218 Structure, process and outcome evaluation 219 Additional issues in evaluating the practice of health visiting 227 Record–keeping 231 Problem–orientated recording 232 Summary 235 References 236 Appendix 6: Activities for Chapter 6 239 Bibliography 243 Index 266