Supporting the case for “progressive universalism” in health visiting: Scottish mothers and health visitors’ perspectives on targeting and rationing health visiting services, with a focus on the Lothian Child Concern Model.

Aims. To explore parents and professionals’ experience of family assessment in health visiting (public health nursing), with a focus on the Lothian Child Concern Model (LCCM). Background. Health visitors (HVs) currently assess families as requiring core, additional or intensive support, and offer support at a corresponding level. The majority of families are assessed as core and receive no pro-active support beyond the early days. Previous assessment tools, consisting of checklists, have been criticised as being ineffective in identifying a range of health needs and unacceptable to parents and HVs. The LCCM model was developed and introduced in the study area to promote a partnership approach with parents and assess strengths as well as difficulties in parents’ capacity to care for their child. Methods. Qualitative methods were used. Ten mothers and twelve HVs took part in individual semi-structured interviews. Results. Most mothers were aware of the assessment process but some felt that they were not involved in the decision making process. Explaining the assessment process to parents is problematic and not all HVs do so. The assessment process was stressful for some mothers. HVs find the model useful for structuring and documenting the assessment process. Many believe that most families benefit from some support, using public health approaches. Families are often assessed as core because there are insufficient resources to support all those who meet the criteria of the additional category, and managers assess caseloads in terms of families with child protection concerns. Conclusions. The study findings support the concept of “progressive universalism” which provides a continuum of intensity of support to families, depending on need. Mothers would like better partnership working with HVs. Relevance to clinical practice. The study endorses proposed policy changes to re-establish the public health role of HVs and to lower the threshold for families to qualify for support.

Public feedback - but personal feedforward?

Academic feedback is taken here as the reporting to student writers of the strengths and weaknesses of their submitted draft work, while academic feedforward refers to constructive advice regarding possible strengthening of students’ next work. Both originate from a tutor’s initial judgement of a student’s work. Feedback and feedforward on work showing need for improvement are problematic in a Confucian Heritage Culture. Even gently constructive advice within a programme seeking evidence for assessment of critical thinking may lead to perception of hurtful criticism by Taiwanese students. Some could withdraw from class activity accordingly. So the writers adjusted their response style. They now choose between different approaches featuring tutorial feedback or feedforward, depending on the standard of work being judged. When individual postings feature poor critical thinking, the writers opt for private messages concentrating on constructive feedforward. For better postings, they provide positive feedback with reasons for their judgements, and summarise to the class these exemplars of generic strengths in critical thinking. They also offer private prompting when they see scope for further enrichment of an able student’s critical thinking. This might also be a useful practice when tutoring solely in the West. (192 words) Keywords: Confucian Heritage Culture, public feedback, private feedforward, assessment