yblive Summer 2009, Ready, Steady, Grow
Mainstreaming an evidence-based programme:
Learning from the Public Health Nurse team in Ballymun
Mary Kelly, Assistant Director of Public Health Nursing, in conversation with yblive
Ready, Steady, Grow is available to all infants and toddlers Ballymun because of a groundbreaking decision by the public health nurse team in the area to train in the delivery of Professor Angeles Cerezo’s rigorously evaluated Parent and Child Psychological Support Programme and to reorganise and restructure their child health clinic service to make this programme part of their work with newborns and parents. yblive caught up with one of the Assistant Directors of Public Health Nursing in Dublin North Central , Mary Kelly, during a break in the intensive PCPSP training, to find out more about why public health nurses in Ballymun are spearheading this initiative.
yblive: The reorganisation and restructuring of the PHN child health clinics is a huge undertaking for you and all your team – why did you go down this road with youngballymun in Ready, Steady, Grow?
Mary: Obviously there is no one reason – a number of aspects came together to make this both possible and practical. Some are to do with the way youngballymun works and some are to do with other factors within our own team and within the HSE here at local level.
yblive: Where would you like to start?
Mary: When I was asked by my Director of Nursing Mary Byrne to represent the Ballymun nursing team at the service design meetings my initial apprehension that this might be another initiative that would go nowhere was replaced by a belief that this project was researched and grounded in best practice, that the service design was a creative planning process that had a broad cross-section of people involved and that the service that came out of the process would meet local needs and would be evidence-based. I felt a new optimism and could see a way to integrating Ready Steady Grow into our Child Health Services .
yblive: But even with that confidence it is still a big step to reorganise the PHN child health clinics service around what came out of the process. What factors influenced your decision?
Mary: Quality and focus - our decision was based on the quality of the service that emerged from service design and the focus on outcomes for children and families. I had heard Professor Cerezo present on her work at a conference in Trinity College – back then an initiative was being taken in Tallaght to implement the programme there. We were not in a position at that point to make the move ourselves to take it on, even though a number of PHNs in this area would have wanted to back then. However, the time is now right for a number of reasons to take that step. Along with the partnership with youngballymun and the new context which it provides for service development there are other factors that make the move possible. Being able to visit the service in Tallaght and talk with people there for example makes change more tangible, more possible.
Timing
Another factor is simply timing – the PHN team is positioned just now to take on this kind of major change. We have a full team so we have the capacity to cover the extra stretch involved… even last year for a number of reasons we would have been too over-stretched to contemplate a step like this. Another aspect is the mix on our team. We have a great blend of experienced and established public health nurses together with newer members of the team who bring their training and practice experience in hospitals to inform the work moving forward. Timing comes into something like this – the move has to be made when the time is right; it is vital not to miss the window of opportunity.
Motivational factors
Ready, Steady, Grow has significant motivational factors to support our team as they move evidence-based practice forward. We are gaining hugely from Professor’s Cerezo’s input into the delivery of the programme. The work is now team-based rather than the traditional PHN role of delivering the child health clinic service as a sole professional. We will have an in-built evaluation process built into the work for the first time and we will know what the outcomes for children and parents are from our work.
Leadership
We could not have taken the steps forward that we are taking without collective leadership and support locally within the HSE. youngballymun has played its part in building that through communicating and engaging with the HSE at different levels. However, key people in the HSE locally have also really played their part – the LHO Manager, the General Manager and the Director of Public Health Nursing,– and for systems change like this the key leadership roles are vital.
yblive: What are the main challenges we have to be aware of moving forward?
Mary: I think there are two – one is resourcing the service and the second is broadening it out further into other aspects of our child health services and then across the country. Resourcing the service becomes a challenge if the HSE community services, such as the public health nurse service, are reduced in the current climate. The evaluation however helps us make the case for effective and cost-effective preventative services available at the start of the child’s life.
The second challenge is sustainability – embedding this work in the training and professional development for nurses, psychologists and others so that we have the capacity to deliver the programme on a much wider scale if the evaluation finds that there are measurable outcomes for children from this work.
The partnership between ourselves and youngballymun widens the networks of contacts and the spread of influence that we have so whilst both these matters are challenges, neither of them is in any way an insurmountable obstacle – indeed on the contrary I am more optimistic than I would be were we not delivering Ready, Steady, Grow.
