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.

A mixed logit model for predicting exit choice during building evacuations.

Knowledge on human behaviour in emergency is crucial to increase the safety of buildings and transportation systems. Decision making during evacuations implies different choices, of which one of the most important concerns the escape route. The choice of a route may involve local decisions between alternative exits from an enclosed environment. This work investigates the influence of environmental (presence of smoke, emergency lighting and distance of exit) and social factors (interaction with evacuees close to the exits and with those near the decision-maker) on local exit choice. This goal is pursued using an online stated preference survey carried out making use of non-immersive virtual reality. A sample of 1,503 participants is obtained and a Mixed Logit Model is calibrated using these data. The model shows that presence of smoke, emergency lighting, distance of exit, number of evacuees near the exits and the decision-maker, and flow of evacuees through the exits significantly affect local exit choice. Moreover, the model points out that decision making is affected by a high degree of behavioural uncertainty. Our findings support the improvement of evacuation models and the accuracy of their results, which can assist in designing and managing building and transportation systems. The main contribution of this work is to enrich the understanding of how local exit choices are made and how behavioural uncertainty affects these choices.