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The UK will have a much higher rate of “invisible children” when the country finally emerges from the coronavirus lockdown, health visitors have warned.
In line with social-distancing guidelines, health visitors – who usually support families with babies and young children in their homes – have been forced to move most of their vital work online and over the phone.
As well as doing child development checks and helping new parents with things like breastfeeding, the specially-trained nurses and midwives also help to identify children and families who might need additional support because of social, health or educational vulnerabilities.
They are now only able to hold face-to-face appointments with families deemed the most at risk.
But Alison Morton – director of policy and quality at the Institute of Health Visiting – said shortcomings in the new system meant that early signs of some children’s vulnerabilities could be missed during lockdown.
“The virtual contact is the best we can offer in most cases at the moment,” Morton said.
“But they do have their limitations and we do know that there is going to be a much higher rate of what the Children’s Commissioner calls ‘invisible children’.”
These are children who health visitors would have had a better chance of finding if they were able to go into people’s homes and “build up a relationship” with the parents, Morton said.
“If you pick up a phone, it can feel a bit like you’re going through a checklist,” she continued. “It isn’t going to work quite as well, we know that. But people are working to do that better and I’m sure it’s better than nothing.
“But we want to be monitoring the impact of using that kind of a method and how it affects outcomes and the number of children being identified.”
Among the issues Morton worries could be missed are mental health problems, childhood illnesses and domestic violence.
“Domestic violence and abuse and vulnerabilities are much easier to pick up on in person,” she said. “It’s that interpersonal relationship you build – someone starts to trust you. And over the course of a visit, people will say: ‘While you’re here, would it be okay…’ Those casual ‘testing the water’ questions.
She added: “We know it takes many many times for parents who are experiencing domestic violence to actually ask for help – it’s quite a long journey before people feel confident or safe to talk about the things that are worrying them the most.”
In response to these issues, the Children’s Commissioner has published a series of local about child vulnerability in the local area.
The hope is that these profiles will help councils to understand which children are likely to be at risk in their area and how many.
“Local authorities should be factoring this information into their decision making when it comes to Covid-19 responses,” the Commissioner said.
“For example if 26% of the children in your area live in crowded homes – as is the case in Newham – making sure there is space for them to play outdoors, or getting them into schools, should be a priority.”
Last Saturday, the government announced an extra £76m in emergency funding to support survivors of domestic abuse, sexual violence and modern slavery during the pandemic.
How are health visitors working under lockdown?
The comments from the Institute of Health Visiting come after health visitors were forced to completely transform the services they offer to adhere to social-distancing rules.
Health visitors are now offering their sessions on Skype and over the phone, while in some areas parent groups that usually meet in person are being held virtually.
Sophie Jones, area manager for Public Health Nursing in south Somerset, said she was “really proud” about how the health visitors she manages have stepped up to the mark during lockdown.
“They have pulled things out of the bag I didn’t even know was possible,” she said, describing how teams managed to transfer most of their services online in a matter of days.
While some appointments would have taken 45 minutes in person, they are now taking 90 minutes on the phone as health visitors try to offer extra support.
“As a professional, you always worry you have missed something,” Jones said. “That’s a normal feeling. This situation has made people more conscious to ask more questions and make sure that any families we are concerned about, we’re raising with other services.”
But she – like Morton – is worried about how the impacts of lockdown are hitting the families health visitors care for.
“We know that we’re going to have to put a big recovery plan in place,” Jones said.
“We know there’s going to be issues that arise out of this – including a decline in mental health because of isolation and this permanent high level of cortisol stress.
“That’s within our ‘universal’ families now too – it’s within everybody.”
It’s a worry echoed by Eileen O’Sullivan, a specialist health visitor in parent and infant mental health, who works in south Warwickshire.
The impact of Covid-19 and the subsequent lockdown is likely to have a “far-reaching and lasting impact”, she said.
“The families we have been speaking to anecdotally are struggling with their mental health,” O’Sullivan said. “Specialists are seeing an increase in referrals. It’s just a massive impact.
“A lot of the mums that I have been speaking to are also talking about ‘lost maternity leave’ in the sense that it’s just not what they anticipated it was going to be and they’re almost mourning the loss of that,” O’Sullivan said.
“They can’t go out, they can’t meet other mums, they can’t go to baby groups. They’re possibly home-schooling other children when they thought they would have that special bonding time with their baby.
“That, among with many other factors – such as finances – are testing people’s mental health when having a baby is already a huge challenge in normal climates. This is really adding a lot of additional layers of challenge.”