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Healthy Start Implementation Process

The Healthy Start Implementation Process aims to reduce vitamin D deficiency and associated health issues among children and pregnant women in Ealing. Initiated in 2009 due to alarming seizure rates linked to low vitamin D levels, the project provides essential nutritional support through education and community engagement. Key milestones include stakeholder interviews, health staff training, and public awareness campaigns. The future plans emphasize family support using vouchers and improving the integration of health services to ensure all children receive adequate nutritional resources from a young age.

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Healthy Start Implementation Process

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  1. Healthy StartImplementation Process Eulalee Green Health Development Manager Registered Dietitian eulalee.green@nhs.net 07939 831 821

  2. Overview • Background • The Project Plan • Future Plans Healthy StartImplementation Process

  3. Background • 2005-2008: 35 children with rickets • 2007-2009: 20/22 children with tuberculosis had vit D deficiency • 2004-2007: 17 hypocalcaemic seizures at 1-2 months old • 2 required PICU, • 1 long term complications • 2008: 2 infant: cardiac failure due to vit D deficiency • 20% of paediatric fracture patients are vit D deficient Source: Dr Michie, Consultant Senior Lecturer in Paediatrics, Ealing Hospital Healthy StartImplementation Process

  4. Background • Rates over 5 years (2003 – 2008) • 23 electoral wards Healthy StartImplementation Process

  5. Healthy Start Project • Early 2009: DoH identified high seizure rates in Ealing • June 2009: HS project started • Aim: • Reduce neonatal hypocalcaemic seizures (vitamin D) • Reduce congenital malformation rates (folic acid) Healthy StartImplementation Process

  6. Milestones • Baseline data • Stakeholder Interviews • Map current processes • System redesign • Implement and monitor • Health Staff training • Community Publicity • Monitoring • Outcome evaluation • Roll-out to non-PCT sites Healthy StartImplementation Process

  7. Baseline Data • 8 sites over 3 neighbourhoods • 20,750 Children: 0-4 yrs • 11,000 women: pregnant or with a child <12mths old Healthy StartImplementation Process

  8. Stakeholder Interviews • Public Health – Strategic Lead • Universal Children Services – client advice • Maternity Services – client advice • Family Nurse Partnership • GP Services & Paediatricians – client advice • Health Centres – supplement sales & budget • Children Centres – client advice • Supplies Department – distribution to centres • Accounts Department- reporting to DoH & reclaim funds Healthy StartImplementation Process

  9. The Process (July 2009) • Account Department had unwritten process • Centres had different processes • Quarterly returns not submitted • Monies banked incorrectly • Wrong account and supply codes used • Staff confused about recommendations • GP & MW not involved Healthy StartImplementation Process

  10. System Redesign (Aug 2009) • Draft: Flow Chart, FAQ, Leaflet • Key stakeholders meeting • Prepare final documents • Pilot at one site • Roll-out to other PCT sites • Deliver training for Reception Staff • Implement system and monitoring Healthy StartImplementation Process

  11. Health Staff Training (Sept 2009) • Practice Managers – 25 managers • Pharmacists – 2 sessions, about 40 pharmacists • Health Visiting Team – 4 neighbourhood meetings – 40 staff • Midwives –Queen Charlottes & Ealing Hospital – about 30 staff • Ealing Hospital – 45 minute presentation hour from 9:00 am to 6:00 pm - up to 135 staff • Clinic administrators – 10 staff • Children Centre Staff (delivered by the Children Centre Dietitians) • Corum outreach team – 30 staff Healthy StartImplementation Process

  12. Community Publicity (Sept 2009) • Baby TV film • Poster • Two articles a year, in Ealing Matters, Team Talk Core Brief, and Nutrition Today • Weaning Groups 6x a week – CCD • Breastfeeding Peer Supports – CCD • Switch-Script on GP system Healthy StartImplementation Process

  13. Monitoring(2009 – 2010) • PH collates HS uptake • Vouchers held by the centre for 12 months • Every month figures and copies of banking slip • Compile quarterly sheets • Quarterly figures sent to Accounts Healthy StartImplementation Process

  14. Uptake Data Healthy StartImplementation Process

  15. Outcome Evaluation • Difficult to obtain and time consuming • Hospital coding errors, so need to hand search patient records • Hypocalcaemic seizures – only 2 between 1 Sept 2010 to 28 Feb 2011 Healthy StartImplementation Process

  16. Process in 2010 • Written Process (FAQ & Flow Charts) • Distribution sites submitting correct information • HV, CNN & MW understand vitamin recommendations • Accounts Department – some problems • GP – some problems • Not distributing from non-PCT sites Healthy StartImplementation Process

  17. Problems • Process monitoring • Outcome monitoring • Accounts department not including HS as one of its priority • Distribution of refund • HS vouchers – infant vitamin voucher not from 1 mth Healthy StartImplementation Process

  18. Future Plans • Investigate how families are using vouchers • Access GP training programme • Re-look at non-PCT sites • Write in to the SOP for: • GP antenatal booking • 1st Antenatal appointment • New birth visit • Training staff at birth registration offices • Children Information Services website • Local library services Healthy StartImplementation Process

  19. Plea to the DoH • Children vitamin vouchers from 1 mth • Constant messages on HS sites and leaflets to include drops from 1 month for African, Afro-Caribbean, Middle Eastern and Asian babies • Request hospitals to remove ‘paediatric’ as diagnostic code • Request GP, midwifery and health visitor IT systems, include auditable fields for vitamin D, folic acid, and breastfeeding Healthy StartImplementation Process

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