Evaluations
New methods have been devised and tested since 2014 in order to develop an evidence-based approach to a new visit to the BVC at three and four years of age which focuses on the child’s behaviour, mental health and parental support. The BVC Elvis project was initiated by researchers at CHESS [Centre for Health Equity Studies], Karolinska Institutet and Stockholm University, in cooperation with the County of Stockholm Child Health Care Unit. A political decision was made in 2017 to introduce the new types of visits throughout the county.
A report evaluating the visit at three years of age was published in 2017 and a report evaluating the visit at four years of age was published in 2018.
Evaluation of A new visit to BVC at three years of age in the BVC Elvis project
Summary
The BVC Elvis project aims to improve the BVC’s work with three and four year-olds. This first report describes the good experiences from the evaluation of the new visit at three years of age. More than 100 BHV nurses have been testing the new methods for a year based on an IT tool with a parental questionnaire that is completed before the visit and new contents for the meeting with the child.
The evaluations of the new visit at three years of age are positive without exception. Parents are satisfied with the on-line questionnaire that 84% completed before the visit to the BVC. They feel that the questions in the on-line questionnaire are relevant and that the questionnaire takes the right amount of time to complete. The on-line questionnaire makes individualised discussions possible, which is something parents appreciate.
The BVC needs to get better at communicating information digitally. The BVC Elvis project provides digital information for parents on parenting, development and health promotion for three year-olds. Just under a third of the parents stated that they had read the on-line information. Those who read it had, without exception, a positive view of its contents. This part of the project needs to be developed further to reach more parents and thus make the nurses’ work easier.
Many nurses commented in interviews and responses to questionnaires that the work has become more enjoyable and more meaningful! In particular, they pointed to the new approach to note the child’s communication in the meeting with the child. And they also pointed to the greater scope for playing with the child and how, in the individualised discussion with parents, it was possible to quickly identify what was important for the specific family they were meeting.
The new aim relating to parenting support is also perceived as challenging and the nurses stress the importance of access to training and supervision. They also highlight the importance of the additional funding that has been made available, which has made it possible for them to devote more time to the visit and training and more detailed study.
The new visit at three years of age takes 30–45 minutes, which is around 15 minutes more per child than previously. With administration and reading through the responses to the questionnaire prior to the visit, it is therefore reasonable for every family with a three year-old to be offered a total of one hour of the nurse’s time. For a nurse who has approximately 70 to 80 children per age group, it means around half a week’s additional working time per year. The conclusion is that the funding per three year-old needs to be increased slightly if implementation of the new contents of the visit at three years of age is to be possible at BVCs in every county.
Evaluation of A new visit to BVC at four years of age in the BVC Elvis project
Summary
This report describes the evaluation of a new visit to BVC at four years of age which was tested by around 130 BHV nurses in the county of Stockholm for one year. The BVC Elvis project aims to improve the BVC’s work with children and parents at three and four years of age. The new visits are based on an IT tool with a parental questionnaire that is completed before the visit and new material in the meeting with the child.
The evaluations of the new visit at four years of age are positive without exception. The parents are happy with both types of visit at four years of age, but the parents in the project have several questions and concerns relating to their children and parenting during the visit and have a greater opportunity to raise concerns relating to their parenting with the nurse, compared to parents who had the usual visit at four years of age.
Parents are also happy with the on-line questionnaire that was completed prior to approximately 83 per cent of the visits. They consider the questions to be relevant with an appropriate scope and they appreciate the preparations and the individualised discussion with the nurse. A quarter of parents read the BVC Elvis information texts on parenting, development and promoting health before the visits and have a favourable view of the contents. During one randomly selected week, the five most-read texts on the website had more than a hundred individual visits each.
The BHV nurses were more likely to consider the new visit to be very positive compared to the ordinary visit and are often satisfied or very satisfied with their own input. After a year, they all state that they wish to continue with the new way of working; 90 per cent feel comfortable with the new type of parental discussion; and 95 per cent consider this way of working to be positive or very positive. The parental discussion is considered to be more meaningful since it can be based on the parental questionnaire and the discussion guide makes it easier to lead the discussion. The preparations that the parental questionnaire entails for both parents and nurses, are therefore positive.
The new material, train pictures with the elements of the visit as wagons and a memory game, are considered positive by 88 and 87 per cent of the nurses. Compared to the ordinary visit, in which most of the time is used for interaction with the child, the time is allocated more evenly in the new visit between a parental discussion and interaction with the child. The outcomes and follow-up of the two types of visit are similar, but a lower proportion of referrals is sent to the speech therapist in the new type of visit.
Many nurses commented in interviews and responses to questionnaires that the work has become more enjoyable and more meaningful!
Interviews with nurses show that it took longer to assimilate the new way of working during the visit at four years of age than in the new visit at three years of age. The nurses were generally more satisfied with the “old” visit at four years of age than with the “old” visit at three years of age. The aim of the new visit with regard to greater support for parenting is also perceived as challenging and the nurses appreciated the seminars and the guidance linked to the project. The new visit at four years of age generally takes longer than the usual visit.
Through a political decision by the county management, the BVC in the county of Stockholm has therefore received additional funding to implement the working method. During the project period, the parental questionnaire and the parenting information was only available in Swedish. This has meant that fewer foreign-born parents were able to complete the parental questionnaire and read the information for parents.
Around 20 per cent of the parents in the visits during the project had native languages other than Swedish. The fact that the material is only available in Swedish prevents equal care being provided for the residents of the county and translations of the system are currently being planned.
