Public health programmes are essential in promoting and protecting the health of school-aged children. Delivery of these programmes, which includes the National Child Measurement Programme, immunisations, screenings, mental health services and relationship education, has been impacted by the coronavirus (COVID-19) pandemic.
This blog sets out the principles to consider when supporting the restart of programmes safely and effectively and are applicable to the delivery of all public health programmes in school settings. As always, delivery will require local agreements and partnership working.
Ensuring required access to schools
Some staff may feel cautious about the delivery of programmes in their schools. It is important that national and local messages outline the value of each programme in ensuring the health and wellbeing of our children. Local public health providers may need to work with individual schools to understand any concerns to ensure schools are aware that support is available from local teams to support the recommencement of public health programmes.
Where access to schools is limited, local and regional teams should work together to understand and consider alternative methods of delivery. For example, increasing the delivery of routine immunisation in general practice or community centres.
Schools and public health care delivery teams should revisit what risk assessments are in place for visitors to school (including those delivering public health programmes) and whether they need to be updated to reflect COVID-19 requirements.
Consideration should also be given to how public health delivery teams can deliver programmes in a way that reduces contacts and maintains social distancing. How contacts are reduced will depend on the school’s circumstances and will include: grouping children together, avoiding contact between these groups, and staff maintaining distance from pupils and other staff as much as possible.
Those planning and delivering services should also be aware of local context (e.g. COVID-19 prevalence and transmission), agreements and guidance. They should consider other opportunities to minimise the number of staff attending schools or travelling between sites. For example, local or regional oversight could help ensure the delivery of public health programmes do not clash and consider the extent to which multiple programmes could be delivered by the same staff as part of one visit.
We know remote methods – for example teams delivering health promotion messages to classrooms via video – have been enormously valuable. Those planning programmes should consider how digital mechanisms can help address some of the delivery challenges.
Schools and healthcare teams should consider the most appropriate space to deliver any programmes in schools. This may mean delivering programmes in different spaces to those used previously. Consideration must also be given to any travel children may need to do from classrooms and where they will wait. Social distancing and any class or year group “bubbles” need to be maintained.
The availability of facilities for handwashing is of increased importance and will need to be considered. Schools and health care teams should also consider any changes to how they might approach cleaning and disposal of consumables, for example toothbrushes.
Schools and health care teams should minimise the handling of paper-based information. For example, promotion of programmes should be electronic. Where consent is required (e.g. for immunisation), this should be electronic rather than paper.
Health inequalities and vulnerabilities
The delivery of public health programmes in schools are vitally important to help address health inequalities. As efforts are made to re-establish public health programmes, public health providers and schools should consider any changes that may be required. For example, if delivery needs to be adapted to account for differences in understanding of social distancing (e.g. children with special educational needs and disabilities), or the extent to which teams focus their efforts on disadvantaged populations in schools.
It is important to consider the broader factors and social determinants of health that increase the likelihood of vulnerability and adversity for children, their families and communities.
Public Health England’s No Child Left Behind: A Public Health Informed Approach report and the UK Government narrative report for each upper-tier local authority on improving health outcomes for vulnerable children and young people may assist in implementing a targeted place-based approach.
School closures have impacted upon immunisation programme delivery. The re-opening of schools provides an opportunity to re-establish high quality immunisation programmes and achieve high vaccine uptake, thus protecting children and staff. The priorities in the year ahead will be:
- achieving the highest possible uptake of influenza immunisation in primary schools
- working in secondary schools to deliver tetanus, diphtheria, polio, meningitis and cancers that cause the human papilloma virus (HPV).
A range of guidance has been published on infection prevention and control in context of COVID-19, including use of personal protective equipment.
National Child Measurement Programme
It is important that the National Child Measurement Programme (NCMP) recommences from January 2021 onwards because it will provide population level data to help understand how COVID-19 has impacted child obesity prevalence and inequalities. It will also enable local authorities to engage with parents and families who may need support to achieve and maintain a healthier weight by providing advice and information about services and programmes in their area. The NCMP Operational Guidance will be published in Autumn 2020 and will include an addendum on NCMP and COVID-19.
Mental health support
An integral part of the Healthy Child Programme remains the provision of support and advice for children and young people regarding mental health and wellbeing. School nursing services have adapted their service model throughout the COVID-19 pandemic to offer virtual contacts via telephone or video call, as well as providing face to face contacts especially in targeting more vulnerable populations.
Wellbeing for Education Return is being rolled out to help as many schools and Further Education providers as possible to provide wellbeing support for children and young people, preventing as many as possible from developing mental health difficulties and ensuring those with pre-existing or emerging difficulties access the right support.
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Contributor: Wendy Nicholson