The Nurture Programme

What was involved?

The Nurture Programme: Infant Health and Wellbeing began in 2014 as an initiative to improve universal child health and wellbeing services. Nurture was a unique collaboration between the HSE, the Katharine Howard Foundation (KHF), and CES, with support from the Atlantic Philanthropies. The programme set out to strengthen the supports offered to every child born in Ireland from pregnancy up until the child’s third birthday.

Over a five-year period the work of the programme produced new resources, training and approaches. The website MyChild.ie and a suite of books now provide evidence based, accessible information for parents. New antenatal standards were developed, to improve the quality of antenatal education classes. A Child Health Training Programme was developed for health professionals. Professionals are now using standardised tools and approaches, to help identify children’s needs early, and work on a national, standardised record is underway.

Engaging with staff across health services and consulting parents were important features of how the programme was designed and implemented.

The Nurture Programme won the ‘Improving Our Children’s Health’ category at the 2020 Health Service Excellence Awards. Feedback about the programme from parents and professionals is positive.The work of Nurture will continue to be implemented and further developed as part of the HSE’s National Healthy Childhood Programme.

CES’s role

CES has been involved with the programme from the outset and was engaged to provide implementation expertise and support. Programme design drew on the use of evidence, and implementation science methodology, both of which are fundamental to our work.

We supported six national implementation teams, which brought together over 100 professionals from across the child health workforce. Implementation teams can lead and provide guidance within organisations when introducing change, especially in large complex organisations. Nurture Implementation Teams brought together experience and expertise in everything from public health nursing and midwifery, through to communications and training.

We helped to plan, conduct and analyse consultations with service providers, professionals and parents. The programme consulted with over 4,000 parents and used focus groups to engage with a diverse range of parents and families and to take account of factors such as culture, language and literacy.

We supported staff engagement, consultation and usability testing, all of which were critical to introducing new standardised approaches and tools and making them sustainable.

What changed

The Nurture Programme was evaluated by Quality Matters in partnership with Dublin City University. The evaluation found that the programme had made a positive impact in the following areas:

· Better information for parents When asked, 80% of parents said they were more confident and knowledgeable after visiting the website.

· A consistent approach Parents now get the same information from all of the health professionals they meet.

· The use of standardised tools and approaches which helps parents and professionals to track child development

· The quality of antenatal education has improved through the development of training and national antenatal standards.

Learning

In addition to the evaluation report, the organisations involved were keen to capture learning from the experience of implementing the programme and share it with others.

The Delivering Systems Change report highlights sixteen different lessons for leaders in health and related services. Highlights from these lessons include:

· Implementation teams can help lead and guide change and should reflect diverse skills. A variety of factors influenced composition of the team, including knowledge and skills, but also belief in the initiative and ability to collaborate. Being able to navigate hierarchical structures was recognised as an important skill in implementing change.

· Engaging with service users benefited the end product and also helped unite teams around a single goal. Consultation should take place early, and continue at key points of the work, for example when finalising products. Focusing on the benefits for service users was particularly useful in multidisciplinary settings, and uniting diverse perspectives around a single goal.

· Consistent, purposeful communication supports staff engagement. Leaders have to convince staff that the change has credibility and is achievable. They need to communicate regularly, highlighting progress incrementally no matter how small. Experience of the programme showed the importance of peer networks, where staff were more receptive to messages delivered by those in similar roles. This approach is even more effective when staff are briefed and supported to take on this role with their peers.

Resources and publications