A city-wide commitment to children: Hull’s active START learning

Innovative new features include drawing on lessons from previous pilots to find sensitive approaches that engage children and their families with services to address excess weight. 

This includes using direct telephone calls, ahead of formal letters, to discuss children’s weight status with their parents as part of the NCMP. This approach has been found to better engage parents than just sending the letter and led to a reduction in the number of complaints associated with reporting NCMP results. 

The highly personalised engagement strategy is part of a whole-system approach across the city incorporating services, physical activity and planning to promote a healthier environment. It utilises systems thinking to identify the causes of unhealthy weight and the levers that can be used to address them. 

The challenge

Historically, Hull only provided support to families with underweight or very overweight (categorised by NCMP as obese) children (as a Tier 3 Service). A whole system approach that incorporates services, physical activity and even planning decisions has enabled Hull to use resources effectively in the context of financial challenges for local government. 

As a system, Hull responded to these challenges by redesigning support pathways to introduce and maintain a Tier 2 Weight Management Service for Children and Young People by extending the eligibility criteria for their local Healthy Lifestyle Service.

Another challenge, both locally and nationally, is engaging those parents of children identified via the NCMP as overweight and encouraging them to take up services offered. Before this new approach, Hull would often receive complaints from parents about the NCMP results, mostly from those whose child has been identified as overweight. 

The solution

During April 2021, Hull City Council Public Health were successful in a Government funding application to pilot a Tier 2 Weight Management Service for children and young people and join up the pathway with the NCMP. This was called the Active Start Programme. 

• A small working group was established including representatives from Public Health, the Healthy Lifestyle Team, and the School Nursing Leads for the NCMP. A data sharing agreement was approved so data could be shared between the services and 

• The NCMP permission letters for parents were amended to inform parents about the data sharing arrangement. 

• The Healthy Lifestyle Team, whose focus previously was on preschool children, extended their brief to work with primary aged children and their families. The staff were trained to deliver the HENRY Healthy Families Growing Up Programme, and this became a key element of the Tier 2 Service.

• A pathway was established referring children identified as overweight via the NCMP into the new Tier 2 Weight Management Services for children and young people. This filled the gap that was missing on the pathway and provided support to children and their families based on parenting for weight management. This includes understanding real world scenarios such as shopping with children to purchase healthy foods, portion control and physical activity.

A new approach was taken to deliver the NCMP results to parents whose children had been identified as overweight by the NCMP. 

Previously the results of the overweight children were delivered solely by a formal letter. The new approach involves initiating engagement with families via a phone call before sending the formal NCMP results letter with an invitation to access services. 

The staff making the calls received motivational interview training so they could support families receiving sensitive news about their child’s weight and encourage them to access services. The language and tone used in these phone calls are supportive and non-judgemental.

The impact

Establishing a Tier 2 Weight Management Service for Children and Young People has provided support to children and their families identified via the NCMP. This service is continuing to receive referrals from the NCMP and has increased its reach by also receiving referrals from other sources such as Family Hubs. The service has found that introducing shorter taster sessions such as Eat Well for Less sessions has helped to engage families into services.

By introducing an initial phone call to parents, as part of the NCMP, Hull have managed to improve both referrals and uptake of services slightly but recognises that more needs to be done to engage more families. 

Research is soon to be undertaken to find out what the barriers are to participating in these services and if changes can to be made to make them more acceptable. Following the introduction of an initial phone call fewer complaints have been received from families receiving the NCMP results. This more sensitive approach, staff trained in motivational interviewing techniques and using non-judgemental language appears to have boosted engagement. 

How is the new approach being sustained?

The approach has been adopted as good practice, the Healthy Lifestyle Team have extended their brief to work with primary age range children and their families. Taster sessions have been continued to encourage families to access services. The service has been extended to take referrals from other services, not just the NCMP to increase the reach of participants.

The initial phone call to parents as part of the NCMP feedback process has also been adopted as good practice and the staff have attended training about the Tier 2 Weight Management Service so they can better describe the service to parents to help with engagement. A good working relationship has been established between the two services and there is a plan for joint delivery of some programmes going forward.

Lessons learned

Delivery of the NCMP results have been more positively received by parents in Hull via a more personalised phone call, from staff trained in motivational interviewing techniques, followed by a results letter. This has resulted in better engagement and fewer complaints from parents. There is still work to be done to help to engage parents and families to take part in services to support them. 

Providing a Children and Young People’s Weight Management Service has allowed more families to be supported and developing a pathway to include referrals from the NCMP leads to a targeted approach. Extending the referrals out to other routes helps to provide a wider offer.

Recognising that there is no one quick fix to addressing excess weight it needs to be a whole system, multifaceted approach using the tools and levers within our control both locally and nationally. 

Contact

Joanne Arro, Public Health Commissioning and Service Development Manager

[email protected]

Adhel Cadle, Public Health Nurse at City Health Care Partnership

[email protected]

Andy McKee, Early Help Health Co-ordinator, Healthy Lifestyle Team Manager

[email protected]