Research and the organisation of complex provision : conceptualising health visiting services and early years programmes

This paper developed from discussions about the possible implementation and trial of an Australian maternal and early childhood sustained home visiting programme (MECSH), into a United Kingdom (UK) context. There are many similarities in services in the two countries, but some differences. To summarise and illustrate the complex and interconnected way that early years and preventive health services are specified, a diagram was developed, which provides a framework for this paper. The paper describes a health visiting service that encompasses universal, indicated and selective forms of prevention, with some embedded evidence-based programmes, forming part of a proactive and preventive service that is, itself, embedded within a wider resource system. Policy-driven terms derived from the English Health Visitor Implementation Plan have been used, but translated into the generic language of prevention (universal, indicated and selective), as a basis for future research. The place for different types of practitioner and needs of families with different levels of personal capacity or resource are also considered.