Qualitative study exploring whether emotion work conducted by health visitors has an influence on their assessment and identification of children in need of care and protection?

Abstract

There is an increased understanding that experiencing adversity in childhood can have a significantly negative impact on the long-term developmental wellbeing of children and young people, as well as their families and communities. Political and societal ambition is that such adverse experiences and their consequences are eradicated through preventative and early intervention measures taken by health, education, and social care practitioners on the identification of a child(ren) who requires support.

Professionals working with children have become increasingly proficient in this type of work however no professional is infallible. As a result, many children and young people living with adverse circumstances can go unnoticed. For some this includes experiencing harm which often only comes to light when they have been significantly or fatally injured.

Every child living in the United Kingdom is aligned with the universal health visiting service following birth to school entry. Health visitors play an essential role in “searching for health needs” through the “surveillance and assessment of the population’s health and wellbeing” (Nursing & Midwifery Council [NMC] 2004, page 11) . Such universal contact based on these core principles mean that health visitors are ideally positioned to identify children living in challenging situations but, like others, they can find this difficult on occasions. The purpose of this study is to explore whether health visitors view the emotion work they carry out as part of their role has an influence on their ability to assess, identify, and respond to children in need of care and protection.

STUDY – METHOD: The study has been progressed qualitatively, using a reflexive ethnographic approach to interviews as the main data collection and analytic method with short periods of office-based observation. 16 health visitors who managed caseloads of between 100-450 pre-school children were observed and interviewed to understand their experiences, values, and beliefs. Gee’s (2014) toolkit was used to critically analyse the discourse shared during the interviews.

FINDINGS: The emergent findings demonstrate that health visitors can be conceptualised as ‘applied clinical anthropologists’ in the way they develop relationships with families to gain access to their home environments. The approach taken is to gather information to the depth required for a social, bioecological assessment (Bronfenbrenner 2005) of a child in the context of their family and community system. Health visitors are welcomed by most families and are often successful in assessing and responding to child need. However, at times, the level of engagement necessary can be overwhelming for both the health visitor and parent/carer. This influences the level of child centred assessment obtained.

The study has demonstrated that the influences on the work of the health visitor can be interpreted through a complex interplay of theoretical concepts. Firstly, Bourdieu’s “theory of practice” (Bourdieu & Wacquant 1992, page 4) provides the basis on which to understand why challenges and barriers arise during the relational work of the health visitor with the child and family. Secondly, Gross’ (2014) Emotion Regulation Framework and Hochschild’s (1983) theory of Emotional Labour, are utilised to consider how health visitors and families respond emotionally to these challenges. The study then goes on to demonstrate what impact these responses can have on the assessment of children.

RECOMMENDATIONS: Implications for practice are that health visitors require increased rates of supervision. This should include an observational element. Educational programmes for health visitors, require a focus on promoting professional wellbeing with learning sessions on unconscious bias. Research and learning developments are suggested to influence assessment and decision-making practice. Research with other professional groups and children & families is recommended to build on the findings of this study in order to influence future safeguarding policy and practice to protect children.