The improved survival of neonates with increasingly complex needs is one marker of the success of current neonatal care. This success does, however, bring with it an ongoing requirement for support for babies and their families, particularly following discharge from the neonatal unit (NNU). Parents supported by staff become highly skilled in providing for their baby’s needs during their journey through the NNU; however, many find the transition to home difficult even when comprehensive discharge planning has been undertaken. There are no longer staff available to immediately address concerns or questions and many parents turn to the primary healthcare team and, in particular, the family health visitor.

As nurses or midwives with additional training in specialist community public health, health visitors are in a unique position to provide support for families of babies who have spent time on NNUs, but consistent health visitor support is not universally available. We decided to investigate this with the aim of developing materials to support health visitors and parents through the initial transition period from the NNU to home.

The project is a collaboration between staff from the NNU at the Royal Victoria Infirmary (RVI), Newcastle upon Tyne, the Institute of Health Visiting (iHV, a national charity that aims to support health visitors’ practice) and the Tiny Lives Trust (an independent charity supporting the unit at the RVI).

In 2019 Tiny Lives undertook a survey of parents whose babies had received neonatal care at the RVI, to explore the levels of health visiting support they had received. This highlighted a lack of consistent support and advice from health visiting, with some families experiencing high levels of support and others feeling unsupported. We aimed to gain a deeper understanding of the health visitor’s role and how to support this in the future.

The project

The iHV was awarded a grant by the Tiny Lives Trust to support the scoping, co-design and delivery of a training package and resources for health visitors who support families accessing the NNU at the RVI to meet their babies’ needs.

The overall aim of the project is to ensure all families are supported with universal care from their health visiting team that meets their individual needs. Through supporting this workforce development, the mental health and wellbeing of families and their babies should be improved. Families will have access to best practice and evidence-based advice to support their babies to have the best start in life. Healthcare professionals will feel confident and capable to support them effectively.

Scoping for the project included a survey of health visitors alongside a focus group with parents. This provided insights to support the development of the resources. A large percentage of health visitors reported a lack of confidence to work with the families of babies who had undergone neonatal care; the need for further training was highlighted. The parents were able to clarify areas that they felt would help health visitors to work in partnership with them. These included:

• an understanding of the family’s journey to help develop the health visitor’s empathy
• the importance of listening to the family
• working with the team supporting the family to reduce the burden of care.

From these insights we have worked with both the parents and subject experts to design and develop an e-learning module on the health visitor’s role with these families. This was made available in October 2020 through Health Education England’s e-Learning for Healthcare website (https://portal.e-lfh.org.uk/Component/Details/665064) with free access for all health visitors in the UK. Key topics include: understanding the needs of families; supporting the transition to home; infant growth and develop-ment, and family wellbeing (FIGURE 1).

FIGURE 1 Screen grabs from the e-learning module Working with Families to Transition from Neonatal Units to Home.

At the same time, a local ‘train the trainer’ programme began in the north east of England for health visitors to become ‘neonatal family ambassadors’. This aims to raise the profile of the needs of these families and to equip health visitors with the evidence to support and guide their practice. They will have access to training resources and good practice guides to share with their colleagues. These include insights from parents about their journey through neonatal care, supporting the emotional wellbeing of families, growth and growth monitoring, development and the role of the neonatal family ambassador. The project will be evaluated later this year with a view to sharing the learning nationally to inform future training and development opportunities.