Child Health
Child Health Systems Programme - Pre-School
All NHS Boards in Scotland provide a Child Health Surveillance Programme where children are offered routine reviews at various stages of their life. The aim is to help all children achieve their full potential by offering a planned programme of assessment and screening activities in order to identify and treat at the earliest possible time those who have or may have specific issues/concerns. The majority of boards record these reviews using the Child Health Systems Programme - Pre-School system (CHSP-PS). CHSP-PS is a call/recall system, which facilitates the process of Child Health Surveillance and records the results of surveillance examinations from shortly after birth until school entry.
Background
The Child Health Systems Programme - Pre-School (CHSP-PS) was established in 1991 with Argyll and Clyde being the first NHS Board to adopt the system. There are now 12 participating NHS Boards:
|
NHS Board |
CHSP-PS Implementation Date |
| Ayrshire & Arran | 1993 |
| Borders | 1995 |
| Dumfries & Galloway | Dec 2000 |
| Fife | 1994 |
| Forth Valley | Dec 1997 |
| Grampian | not implemented |
| Greater Glasgow & Clyde Argyll & Clyde* Greater Glasgow |
1991 1995 |
| Highland Argyll & Clyde* Highland |
1991 May 2007 |
| Lanarkshire | 1992 |
| Lothian | 1994 |
| Orkney | not implemented |
| Shetland | May 2008 |
| Tayside | 1995 |
| Western Isles | May 2006 |
* Argyll and Clyde ceased to exist on 31st March 2006 and the administration area was split into two sub-areas that now fall under the administration of NHS Greater Glasgow and Clyde and NHS Highland respectively.
The participating NHS Boards account for approximately 89% of Scotland's pre-school population. The NHS Scotland National Strategic Programmes for IM&T 2001-2005 recommended that the pre-school system be rolled out to all NHS Boards by 2003.
Who uses CHSP - Pre-School?
The two principal groups of users are pre-school health professionals (such as public health nurses, GPs, and community paediatricians) and staff responsible for pre-school health administration within an NHS Board.
Through discussion with the parent/guardian, the pre-school health professional records information on the relevant age related paper examination form. A copy is then given to the parent/guardian and held by the GP/public health nurse. After the clinical contact has taken place the examination details are keyed into the system by administrative staff. Identified problems are also Read coded at this stage. This allows any problems to be followed up and further reviews scheduled if necessary.
CHSP - Pre-School Reviews
As part of the Child Health Surveillance Pre-School programme every child is offered routine reviews at various stages of their life. Through these reviews data can be recorded for local, NHS Board and national use.
The review forms are designed to lead the public health nurse/GP through the age appropriate assessment and examination of the child. They give the public health nurse/GP a complete record of their discussion as well as findings and actions required, and the opportunity to recall the child before their next routine examination if required. After the clinical contact has taken place the information is keyed in to the CHSP-PS system by administrative staff. Any health problems identified are Read coded.
Under the Hall4 core programme, every child is reviewed by a public health nurse at 10 days old (known as the public health nurse first visit) and then most commonly by a public health nurse and a GP at 6-8 weeks old. Information gathered in this early period should provide the basis for establishing the nature and frequency of further contacts. This should assign the family to one of the models of continuing contact and support:
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CORE - The universal programme.
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ADDITIONAL - The universal programme + structured additional support
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INTENSIVE - The universal programme + intensive inter-agency support
The health professional records which model of continuing contact and support the family has been assigned to i.e. Core, Additional or Intensive. This is known as the Health Plan Indicator (HPI). Health professionals can amend a child's HPI as necessary in line with changes in the child's health/family circumstances. Beyond the universal programme of contacts the public health nurse uses their professional judgement to decide on the nature and frequency of further contacts with the family for review of child development. For detailed information on the Hall4 programme of child health screening and surveillance see: 
Annex 1 Health for all Children 4: Guidance on Implementation in Scotland .
Universal Programme of Reviews and Screening Activities
Neonatal hearing screening
Public Health Nurse First Visit
6-8 Week Review
Orthoptist vision screening (4-5 years)
Non-Universal Reviews
Birth Details
2-Year Review
Recall Review
Unscheduled Review
Universal Programme of Reviews and Screening Activities
Neonatal hearing screening
From 2005 all newborn babies are tested for hearing impairment problems, normally prior to hospital discharge. The results are recorded on a screening form .
Public Health Nurse First Visit
This form is generally completed at around 10 days after the birth of the child. This begins the child's electronic surveillance record and gathers basic identification, family and social data. Examples of information collected include: mother's age; smokers in household and infant feeding (at birth, hospital discharge and current method). The health professional can use this initial assessment to assign a health plan indicator (HPI) to the child. Identification data such as name, address, GP etc are also checked and updated.
6-8 Week Review
This form is generally completed at around 6-8 weeks after the birth of the child and is often a Public Health Nurse and GP combined review. Examples of information collected include: feeding of baby (breast, bottle or both); parental concerns (feeding, appearance; behaviour; hearing; eyes; sleeping; movement; illness; crying; weight gain and other); development (gross motor, hearing & communication, vision & social awareness); physical (length, weight, heart, hips, testes, genitalia, femoral pulses and eyes); diagnoses/concerns (Read coded); sleeping position (prone, supine and side). The health professional can assign/update the child's health plan indicator (HPI). Identification data such as name, address, GP etc are also checked and updated.
Orthoptist vision screening (4-5 years)
Vision screening is carried out by an orthoptist prior to school entry at 4-5 years of age. The results are recorded on a screening form . In some areas pre-school orthoptist vision screening has not been implemented as yet and children are screened on school entry.
Non-Universal Reviews
Birth Details
This form is completed in the maternity unit before postnatal discharge. This form gathers information about the birth which may effect a child's subsequent health and development. Examples of information collected include: name; address; date of birth; sex; apgar score; problems during birth; method of delivery; birth weight and height. The birth details form is only used in some NHS Boards.
2-Year Review
This form is completed at around 2 years of age for children with a health plan indicator (HPI) of Additional or Intensive. This can include a full developmental examination where appropriate. The health professional can update the child's health plan indicator (HPI). Families of children on the Core programme receive written information about child development at this age. They are invited to contact a designated person in the primary care team if they have any concerns about the child.
Recall Review
This form is generated by the system when a recall has been requested by a health care professional at a previous examination. A child may be recalled for an additional review if the examiner has any concerns regarding the child. For example, if the examiner has concerns about the child at 6-8 weeks they can request an additional review at a later date, which they specify.
Unscheduled Review
This form can be used when a child is outwith the normal age range as indicated at each age-related review. A child may receive an unscheduled review if they missed the routine scheduled examination or if a parent has any concerns/issues they may wish to discuss.
Analyses available
A variety of routine outputs are available to users of CHSP-PS which can be used for local purposes. Data recorded on the pre-school system have also been used in a range of different analyses and have been published on the ISD Scotland website. These include: breastfeeding; maternal smoking and childhood obesity statistics.
Analyses are available at various levels, for example by NHS Board (residence or examination), Council Area and Community Health Partnership.
Please note that in some NHS Boards a phased implementation occurred after the system was adopted. Therefore, caution should be taken when interpreting data around the implementation period. In addition many data items are not mandatory and recording practices vary between NHS Boards and individual health professionals. Therefore not all data items on the review forms can be used for analysis.
If you would like to request specific analyses please refer to the contacts page within this section for details.
Information is also available from child health surveillance reviews prior to hall4 implementation.
Child Health
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