Study protocol: a mixed-methods study to evaluate which health visiting models in England are most promising for mitigating the harms of adverse childhood experiences

Can administrative data be used to research health visiting in England? A completeness assessment of the Community Services Dataset

Introduction

Health visiting is a community service provided to families with children under five in England and is a key focus of early years policy. Individual-level data on health visiting is captured in the Community Services Data Set (CSDS), an administrative dataset of publicly funded community services across England. Analyses of CSDS are considered experimental as the dataset matures.

Objectives

In this study, we aimed to identify health visiting contacts in the CSDS and assess the completeness of these data from 2016/17 to 2019/20 compared to external reference data.

Methods

We identified the number of the four mandated postnatal health visiting contacts delivered, excluding those scheduled but not attended, between April 2016 and March 2020. We compared counts by local authority (LA) and financial quarter against the Office for Health Improvement and Disparities' Health Visitor Service Delivery Metrics (HVSDM) to identify a subnational subset of complete CSDS data. We explored the representativeness of this subset.

Results

During the study period, 10.2 million health visiting contacts were delivered to 2.4 million children in England. Of these, we identified 3.9 million mandated contacts based on CSDS codes and age at time of contact, which represented 44.7% of all mandated contacts reported in the HVSDM for the same period. There were 63 LAs with complete CSDS data in at least one quarter, which were broadly representative of English LAs overall. Variables related to staff characteristics were highly missing and only 13 LAs had four or more successive quarters of complete data needed for longitudinal, child-level analyses.

Conclusions

We identified a subnational subset of complete CSDS data, compared to external reference data, which can be used for health visiting research. Until improvements are made to its completeness, analyses (particularly those requiring longitudinal data) may not be generalisable to the whole child population.

Study protocol: evaluation of the 0-5 public health investment in England - a mixed-methods study integrating analyses of national linked administrative data with in-depth case studies

INTRODUCTION

Health visiting is a long-established, nationally implemented programme that works with other services at a local level to improve the health and well-being of children and families. To maximise the impact and efficiency of the health visiting programme, policy-makers and commissioners need robust evidence on the costs and benefits of different levels and types of health visiting, for different families, in different local contexts.

METHODS AND ANALYSIS

This mixed-methods study will analyse individual-level health visiting data for 2018/2019 and 2019/2020 linked with longitudinal data from children's social care, hospitals and schools to estimate the association of number and type of health visiting contacts with a range of children and maternal outcomes. We will also use aggregate local authority data to estimate the association between local models of health visiting and area-level outcomes. Outcomes will include hospitalisations, breast feeding, vaccination, childhood obesity and maternal mental health. Where possible, outcomes will be valued in monetary terms, and we will compare total costs to total benefits of different health visiting service delivery models. Qualitative case studies and extensive stakeholder input will help explain the quantitative analyses and interpret the results in the context of local policy, practice and circumstance.

ETHICS AND DISSEMINATION

The University College London Research Ethics Committee approved this study (ref 20561/002). Results will be submitted for publication in a peer-reviewed journal and findings will be shared and debated with national policy-makers, commissioners and managers of health visiting services, health visitors and parents.