Every Child Journal Every Child Journal

Health Health

Research and development Evaluation and clinical governance

Through our clinical IT experience, we were surprised
how few online health options were available to
parents. Before starting the project, I spent a lot of
time researching the web support available. There are
numerous parenting and child care advice websites - but
only two that have trained health visitors involved.
Netmums.com is an excellent website, where parents
can share advice in forums. Netmums has many visitors.
However, users can’t directly ask a health visitor a
question - health visitors only comment on long forum
threads.
Many other parenting forums and websites exist – but
their advice is not research-based and can be detrimental.
Often advice in magazines presented by (self-professed)
untrained parenting experts is biased and unsafe - for
example, advising early weaning.
As part of the evaluation and clinical governance process,
the service regularly surveys site users. Every two months,
the service sends out a questionnaire to 30 parents
who have used the ‘Ask a health visitor’ service. It asks
questions like:
n How quickly did you receive an answer?
n Did you find the answer useful? If not, how could it
have been more helpful?
n How do you think the service could be improved?
n Why did you use our service?

Online
There is one other health visiting website - but
parents have to pay £5 for every question they ask, and
the question may not be answered for a week.
We decided the only ethical option was to provide a
free service. This free service is available to all parents,

health
and helps children irrespective of financial situation or
socio economic group. The aim is to answer all questions
within 24 hours - because clinical experience and research
showed that parents want a speedy response. The service
meets the needs of client groups known not to access

visitors
A new website gives parents 24-hour access to Health Visitors. The
website’s founders, Chamaine Lovett and Liz Costagliola, explain
why their service is so effective.
traditional health care services.
Social networking is a new and innovative way of
engaging parents. Dads and younger mums are using
social networking groups to link to and find information
from Health Visitor Direct.
As not all parents are experienced in internet use,
the website is simple to use. Parents can read numerous
parenting books and search the internet, but still need
to ask a question. Because of this, the website focuses on
parents asking direct questions with some articles as extra
information. For example, there is an article about fussy We have a response rate of about 40%. So far, feedback
eaters - but the site still gets questions on this issue. has been 100% positive - with comments like: “It’s such
a relief to be able to talk to someone at a weekend” and
The aims of the service are: “I’ve already noticed some positive changes”. As new
n To provide 24-hour internet access to a qualified government initiatives are introduced, the service will
health visitor to all parents. develop and grow - ensuring all practice is current and

O
ur internet-culture expects innovative and
technology-led options in health. Modern
parents are often expected to work long hours.
That’s why we started Healthvisitordirect.com - an online
parenting service - to improve the health outcomes of UK
children.
Over recent years, there have been far fewer Health
Visitors. They struggle with increased caseloads. As
resources are focused in the most deprived areas, many
parents have little contact with their family health visitor.
A report from the CPHVA (Community Practitioners
50 and Health Visitors Association) said: “Health visitors now
have a far higher number of families to care for. There
has been an 85% rise in case loads in the past year
alone. In the latest health visitor report, 60% of health
visitors had over 500 children to look after (the maximum
recommended is 400). About 70% of health visitors said
they don’t have the time to help even the families most
in need.”
Healthvisitordirect.com offers 24-hour access to a
health visitor. Parents can email questions about their
children anonymously and receive an answer/support
from a qualified health visitor without feeling judged.
Health visitor direct aims to reach all parents.
n To make the service accessible to client groups
who don’t access traditional health visitor services
- particularly dads, parents of disabled children,
parents from lower socio-economic groups and young
parents.
n To work towards the Every Child Matters outcomes - in
particular ‘Be Healthy and Stay Safe’.
n To work alongside other government initiatives like
‘Change4Life’ and the ‘Five a Day’ campaign.
n To support parents in all aspects of parenting.
n To support and advise mothers and fathers on the
prevention and management of post-natal depression.
evidence-based.
One of our biggest start-up problems was finding
money. The project was self financed - with a very limited
budget to set the service up and promote it. Through
sponsorship, the service has recouped the financial outlay
and grown within its first year.
In the first year, we visited parliament and the DCSF
and had discussions with NHS Direct. Meetings with the
health visitor union (CPHVA) were very productive. The
service is working with external partners to offer support
on other websites and in the media and ensuring research
and evidence based advice is distributed to parents. 51

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 Every Child Journal
Health
Case study one
Sam is 2–year-old Joseph’s mum. Over the last three months,
Joseph has become a fussy eater. He has a small appetite
and refuses many foods.
Sam was advised by her mum to make him sit at the
table until he had cleared his plate. This was a nightmare for
the family and Sam was dreading each mealtime. Joseph
became very distressed, and became reluctant to even sit at
the table.
Sam had suffered postnatal depression and was helped
by a health visitor. However, she didn’t want to ask her
health visitor because she already felt a failure as a mum for
having postnatal depression. She didn’t want to admit that
she: “Couldn’t even feed her own child”.
Case study two
(Some details have been changed to preserve anonymity.)
Lisa, from the West Midlands, is a young single mum of
a 9-month-old baby. She has low self esteem. She has a long
history of depression and self-harm.
She told us she currently had no thoughts of self harm,
but had the classic symptoms of post natal depression. She
felt like she had to drag herself out of bed every morning
- and only did so because of the demands of her baby. She
was very tearful, was taking no pleasure in everyday life and
felt she had nothing to look forward to.
Lisa contacted Health visitor direct in January 2009 and
was allocated an online health visitor. The health visitor
responded by acknowledging her feelings and by giving
advice on self-help. However, the health visitor saw that she
needed much more support than could be offered in an
email.
The health visitor advised her to see her GP and to ask
her health visitor for a home visit. Lisa replied that she didn’t
The future
Our aim is to get healthvisitordirect.com in the personal child
held record. We want to run free ‘well baby’ clinics in easily
accessible community locations, like supermarkets. We aim
to work in partnership with other agencies, like the NHS, and
to continue to expand the service according to user’s needs.
This could include advisory services by phone and other
forms of media.
Liz Costagliola and Chamaine Lovett are the founders
of Healthvistordirect.com. Liz Costagliola is an NHS
health visitor. She has a Bsc in Community Health and
specialises in paediatric eczema and breast feeding
52 advice. Chamaine Lovett works in clinical IT at the NHS.
Vol 1.3 n www.teachingtimes.com
By the time Sam contacted Health visitor direct, she
was desperate. The service gave her the correct advice for
managing a fussy eater. They kept in weekly contact for
about two months, giving her ongoing support and advice.
By the end, mealtimes were much more relaxed. The family
was eating together and Joseph was eating a more varied
diet. He still isn’t eating as much as Sam wants - but he is
healthy, growing normally and she is no longer worried.
How a parent reacts to a child’s refusal of food is crucial.
It plays an important role in whether the child can overcome
the fear of trying new foods. It is important that fussy eating
is treated appropriately - as left unresolved it can continue
into adolescence and cause social avoidance and anxiety.
feel able to talk to anyone face to face about her feelings
- but was comfortable using email with strangers. She
said she felt able to discuss things she hadn’t been able to
discuss with other professionals - or even friends. Emails
went back and forth for several weeks, sometimes three
times a day. The emails offered encouragement and self
help.
The Health Visitor persisted in encouraging Lisa to
see her GP and health visitor. After four weeks, she felt
confident enough to see her health visitor and the online
contact finished.
A study has shown that post natal depression can affect
mother and baby bonding and affect the child’s social skills.
The study also shows that babies whose mothers recovered
quickly from post natal depression had reduced effects. It
could be argued that, without intervention from Health
visitor direct, Lisa’s depression would have deteriorated
with a detrimental effect on her baby.
She worked as a nurse in baby and immunisation clinics,
family planning clinics and weight management clinics.
References
n A Stein, DH Gath, J Bucher, A Bond, A Day and PJ Cooper: The relationship
between post-natal depression and mother-child interaction (1991). The
British Journal of Psychiatry 158: 46-52 (1991) The Royal College of
Psychiatrists
n Irene Chatoor: Children’s Medical centre (2009). Pg 44-48 - sensory food
adversions in infant and toddlers.
n Clinical Child psychology and psycharity, vol 6, no 2 257-270 (2001).
Selective eating: symptom, disorder or normal variant
n netmums.com/support/Fending_for_Ourselves_Families_Need_Health_
Visitors.547/