Impact case study database

FRAIT gives HVs an evidence-based tool to support their family resilience assessment, judgement making and family access to services. It is available online in English and Welsh, free to NHS Wales and welsh HEIs. A business model has been developed to commercialise elsewhere. Since 2017, FRAIT has been disseminated through meetings/presentations to COPs, HEI staff, WG Head of Women and Children’s Health, Chief Medical Office and Chief Nursing Office, international conferences, publications in peer reviewed journals, training materials and social media.

Impact on Welsh Government policy and practice

The FRAIT team have worked with Welsh Government (WG) since 2014 [S1]. FRAIT was included in WG ‘Healthy Child Wales Programme’ (HCWP) 2016 and has been mandatory since October 2017 for every child under 5yrs [S2]. The FRAIT team meet bi-monthly with WG members to discuss FRAIT feedback [S1, S3]. FRAIT allows UHBs to meet WG mandated policy requirement to implement HCWP [S2].

Public Health Wales/WG presented FRAIT at European Public Health Conference Milan, 2015, the largest public health event in Europe. Delegates (n=2700) [S1] included researchers, educators, policy makers, community representatives and health managers from 71 countries. USW team have received enquiries from India, Ireland, Northern Ireland, England, Scotland, Spain, USA, Singapore, South Africa and Namibia [S4].

NWIS planned development of eFRAIT for digital HV records and digital data return for service monitoring and planning in March 2020 [S5, S7]. COVID-19 delayed eFRAIT completion and is now planned for completion in January 2021. This will improve data collection and data quality across Wales.

Impact on Health Visitor (HV) practice:

Since 2017 every welsh HV has used FRAIT on seven occasions with every caseload family (min. 250 families/caseload) from pre-birth to 5yrs. ‘I find it useful particularly at the 6-8 week review to consider and bring together information gained during the assessment’ - Lynda Robbins, Health Visitor, Cwm Taf University Health Board *[ S11].* USW research has changed how HVs think about working with families. HVs focus on resilience and how to support/maintain it rather than risk and vulnerability [S8]. All 1086 welsh HVs use FRAIT to support professional judgment when working with families. HV practice has changed by standardising family resilience assessment across Wales [S1,S2, S3, S4, S5, S6], increasing low resilience families’ chances of accessing support/resources. HVs can identify unavailable/insufficient services/interventions and lobby relevant agencies/providers [S8]. This has changed the style of daily HV practice and welsh HVs have identified family resilience as a quality indicator [ R6].

A retired HV who is now a Patient and Public Involvement (PPI) representative said:

“As a health visitor in the 80s, I was acutely aware of the need for a working tool which identifies the needs and vulnerabilities of children and their families in a manner which was both recognised and comprehended by other service deliverers(…) In HV records it is imperative to be able to provide evidence for the actions/decisions/interventions made at and after an assessment. This is a key part of generic HV practice as it provides proof of the pathway options discussed and shared with the family. Although in the Common Assessment Framework (CAF) it emphasises the fact that we work in partnership with families, it is well recognized that this partnership is an unequal one. Nevertheless, practitioners have a duty of care to work in collaboration with families to endeavour to reach an agreed optimum outcome. It seems, therefore, appropriate to consider that the FRAIT becomes an integral element of the CAF/TAC or whatever each LA (local authority) is calling their comprehensive assessment process”. [S11]

HVs work closely with statutory local authority services (e.g. social workers, police, courts) and third sector agencies (e.g. NSPCC Cymru) to safeguard children and family members. FRAIT supports HV professional judgment when safeguarding [S8].

The other FRAIT PPI representative is a young mum and human resources manager. She says the tool helps HVs to not miss anything out and help all families as their children grow up:

*“For health visitors I could see this being a tool that would ensure that key areas and questions relating to family health were not missed or overlooked. I think this could be a beneficial tool to communicate with my health visitor if I felt unable to communicate key information verbally’” [S11]

Since 2017, over 1086 welsh HVs and students have had FRAIT training via a cascade train-the-trainer model [S9] (see www.frait.wales for training materials). All Welsh HEIs teaching student HVs have changed their curricula to deliver standardised FRAIT training provided by the FRAIT team [S8, S9, S10]. USW researchers meet quarterly with welsh HEI HV lecturers to co-ordinate FRAIT delivery. Due to COVID-19 restrictions, a FRAIT Online Universities Package Quiz/Knowledge Checker was developed in October 2020 for all welsh HEI student HVs to complete https://360.articulate.com/review/content/749d94ae-5fbe-4849-b817-d7de628d66bc/review. An Associate Professor at Swansea University commented ‘ *I think the e- learning FRAIT package has been great for my SCPHN students this year. Unfortunately, the situation with COVID has meant that it has been very difficult for all students to experience how to use the FRAIT in clinical practice. It has also been tricky for practitioners to dedicate time to virtually deliver a ‘live’ presentation for the students, so the e-learning package has been useful to enable them to learn the ‘nuts and bolts’ of the tool at their own pace.’ [S11]

Since July 2017, the active FRAIT twitter account (@HVFRAIT), with 80 followers, has recorded engagement ranging from 169-2013 impressions and 20,100 total engagements. FRAIT website www.frait.wales is viewed internationally [S10] and FAQs frequently updated in response to HVs/ CoP questions.

Impact on families

HVs make 1.8 million family contacts every 5 years. Standardising family resilience assessment across Wales and increases low resilience families’ chances of accessing support and interventions. Every Family with children age 5 years and under has a personalised child health record (known as ‘red book’) which includes information on FRAIT [S2, S6]. At COP meetings HVs confirm that FRAIT helps them identify insufficient services in specific locations and work with local communities and agencies to rectify this [S8].