The Health Visiting service of Scotland in the context of the Getting it Right for Every Child (GIRFEC) policy approach: Finding the balance among its tensions

Abstract

The Getting it Right for Every Child (GIRFEC) policy approach has been developed in Scotland aiming to enhance the wellbeing of all children and young people by encouraging the provision of additional service input when needed, early intervention and prevention practices and partnership working among services and families. However, this policy approach has been relatively new both in the Scottish context and worldwide. Very little is known about the potential tensions of this policy for professionals and families identified at the ground level. These tensions relate to the thresholds between the provision of universal and targeted health visiting service to families, the balance between support and intrusion as well as the facilitators and barriers to partnership working. This research critically explores how the relevant policy documentation describes these tensions and how health visitors, parents and young children perceive and navigate them. A qualitative case study design was used involving one Scottish NHS Health Board. Relevant Scottish Government national and local documents were analysed to better understand how GIRFEC was expected to translate into practice. Semi-structured interviews with twenty health visitors and two focus groups of twenty parents altogether were also undertaken to collect their views on the provision of the current health visiting service. Interviews with two young children using participatory techniques were conducted to examine the feasibility of obtaining their views on the services they receive. The data were analysed using thematic analysis. Some of the key findings indicated that GIRFEC, despite its intentions, was not fully implemented due to various challenges in its design. As a result, the health visiting service was found to not have fully promoted the GIRFEC principles of early intervention, prevention and partnership working. Health visitors and parents reported to value the service but did not find it supportive enough due to these challenges. Study findings also indicated that, to make the service supportive, changes needed to be made on the way the state intervened into families’ lives in light of child protection and wellbeing concerns, particularly in relation to parental consent. A direction towards the establishment of more collaborative relationships between professionals and parents in such cases was found to be imperative. Areas for improvements in policy and practice are identified in the thesis.