Key Standards for Implementing Child Measurement Programme for Wales (2011/12)
Authors:
Dr Ciaran Humphreys, Consultant in Public Health/Health Intelligence
Dr Khesh Sidhu, Consultant for Child Measurement Programme
Mrs Rosalind Causey, Programme Manager, Child Measurement Programme
Date: 6 March 2012 / Version: 1.0 FINAL
Publication/Distribution:
· Public (Internet)
· NHS Wales (Intranet)
· Public Health Wales (Intranet)
Review Date: Valid until 31st August 2012
Purpose and Summary of Document:
Key Standards for Implementing Child Measurement Programme for Wales during its transition year (2011-12). These standards are intended for all involved in delivering or supporting the Child Measurement Programme including nursing, child health and managerial staff.
Date: 06/03/2012 / Version:1.0 / Page: 5 of 8
Child Measurement Programme for Wales / Key Standards 2011/12
Table of Contents
Programme Implementation 3
Making the Arrangements 3
Timing of Measurement 4
Participation and Withdrawal from the Programme 4
Communication with Children 4
Communication with Local Education Authorities and Head Teachers 4
Equipment and Calibration 5
Measuring Process 5
Recording the Results 5
Data Entry 5
Reporting 6
Feedback of Results and Follow Up Actions 7
Training and Supervision of Staff 8
Quality , Equality and Audit 8
References 8
Abbreviations 9
Key standards for implementing Child Measurement Programme for Wales in 2011/12 in accordance with the Regulations [1]
This document needs to be read in conjunction with the Regulations [1] and Guidelines. This is the first year of implementation of the Child Measurement Programme (CMP) and so is considered a ‘transitional year’. It is recognised that it may not be possible for all standards to be fully met during this year.
Programme Implementation
- Each Local Health Board will implement the Child Measurement Programme (CMP) as of September 2011. To support this there is:
· Local Health Board Director level agreement for roll out the CMP in their area, with the expectation that this will become part of the routine service provision.
· A named person to lead the local implementation team, which will be supported by the PHW CMP programme team.
· A written local implementation plan to monitor progress that feeds in to the overall Wales wide CMP programme plan.
· Multidisciplinary engagement in the development and implementation of the local implementation plan, ensuring that local processes and procedures meet the national CMP standards and guidelines.
Making the Arrangements
2. All children attending a reception class in a school in Wales, including maintained and independent schools, are included in the Child Measurement Programme (CMP).
3. For 2011/12 Reception class is taken to be the cohort of children born between 01/09/2006 and 31/08/2007 inclusive.
4. Arrangements for measuring for children in all relevant schools are managed by a relevant healthcare professional (see regulations for details). The relevant person in most cases will be the school nurse team lead.
Timing of Measurement
- Children are measured between September and July of the year they attend reception. For 2011/12, all measurements should have been taken by the last day of the summer term (July 2012)
Participation and Withdrawal from the Programme
- All parents are offered the opportunity to opt out of the programme in advance of measurement, preferably at least two weeks before the measurements are taken, through provision of bilingual written material (e.g. leaflets, letters and a bilingual form) allowing withdrawal of the child from the programme.
7. Children are not included in the CMP weighing and measuring exercise if the parent withdraws them from the programme or if the child is unwilling or unable to participate. Children who have been withdrawn from the CMP may have their heights and weights measured for other purposes, as long as appropriate consent arrangements for those purposes (e.g. routine health assessment) are in place. In such cases withdrawal from the CMP should be indicated through the height consent field as outlined in standard 22. Unless there is a specific reason, such as withdrawal, eligible children are included in the programme.
- If a parent or child requests the presence of a familiar person[1] during the measuring process, then arrangements are made for this.
Communication with Children
9. Children are enabled to feel at ease about being measured and a clear explanation is given about what is going to happen. Weight and height measures can be shared with the child.
- Concerns raised by children should be handled sensitively; if it is not possible to measure the child due to resistance, another opportunity for measurement is provided at a later date.
Communication with Local Education Authorities and Head Teachers
11. School Nurse Leads negotiate a mutually convenient time and in-school location for the measurement exercise to be completed, as well as for any return for ‘catch up’ of any outstanding measurements.
Equipment and Calibration
- Weighing scales comply with EU directive 90/384/EEC and are calibrated annually.
13. Stadiometers used are a portable stand-on height measure that shows height in centimetres and millimetres, (for example the Leicester Height Measure or equivalent). These are in good working order, correctly assembled, and annually inspected for wear and tear. Wall-mounted, sonic or digital height measures should not be used.
Measuring Process
14. The arrangement for measuring should be managed by a relevant healthcare professional in line with the regulations.
15. The weighing and measuring exercise should be conducted in a room or screened area where information on the measurements is secure and cannot be seen or heard by anyone who is not assisting in the conduct of the exercise . Any familiar person accompanying a child (see standard 8) is considered to be assisting the exercise.
16. Where possible, children should be taken to a private weighing or measuring room directly from the class and not kept in a holding area before or after measuring.
17. Measuring is undertaken by a member of staff trained in height and weight measurement in line with good practice and national and local guidelines.
Recording the Results
18. The results of height and weight measuring and any withdrawals from the programme (opt outs) are recorded at the time of the measuring exercise.
19. Weight is recorded to the nearest 0.100 kg and height to the nearest 0.1 cm.
- Results of measurement and information on opt out consent is sent to child health clerks for entry onto the system within two weeks of the measuring exercise.
Data Entry
- Results are entered into the Community Child Health 2000 System as soon as possible, ideally no later than one month after measures are taken. All results to be entered by the 31st of August in the academic year of measurement.
22. Withdrawal from the CMP is recorded on the Community Child Health 2000 System. During the transition year 2011/12 only, if a parent [or child] has withdrawn from the CMP, this is recorded on the Community Child Health 2000 System by going to the to the individual child’s school record screen, then for children who have been withdrawn from the CMP, selecting the drop down option for height consent field> to <Withdrawn>.
4 The above method of recording consent is to be used until the new CMP Specific data capture forms and screens have been completed. These and are expected to be released for use from September2012.
All mandatory fields for the 2011/12 are completed for each child included in the programme, these are:
i. Name
ii. DOB
iii. NHS number
iv. Ethnicity
v. Postcode
vi. Person completing the measurement
vii. School code[2]
viii. Date measured
ix. Weight
x. Height[3]
23. It is expected that all children in reception year in each school will have the relevant school recorded against their records in keeping with professional standards on record keeping. This is essential for accurate record keeping as well as for clinical reasons, and is required in order to produce denominator data for the CMP.
24. Data entry is in line with specified guidance produced by the programme.
Reporting
25. Gathering, further processing and reporting of height and weight information is in accordance with the Regulations. Use of information specified by the regulation includes:
a. Releasing the information, together with advisory material relating to children's weight, to a parent of the relevant child to whom it relates;
b. Providing advice to a parent of the relevant child in relation to such information;
c. Releasing the information to a relevant health professional for use in accordance with good practice for the provision of care and treatment of a particular child;
d. Releasing the information in a form in which the child cannot be identified for use, in accordance with good practice, for surveillance, research, monitoring or audit and the planning of health services.
Information for the CMP will be stored in the CCH2000 to facilitate (a-c) and released into the NCCHD in accordance with point d above. National level reporting is via the NCCHD. This is refreshed quarterly via uploads from each of the 13 local HSC2000 Child Health Databases.
26. Annual reports for CMP are published during the spring of the following year. The results for the interim year, 2011/12, will be published in spring 2013.
Note: The epidemiological BMI classifications for overweight and obesity are used for national level reporting. These differ from the clinical classifications which should be considered in relation to clinical contacts with children.
Feedback of Results and Further Actions
- The CMP is a population surveillance programme; it is not a screening programme. Concerns health professionals have relating to the health of individual children should be addressed in line with good clinical practice. Such concerns may relate to any aspect of health including child protection concerns or concerns about weight issues. Responding to concerns about weight should be in line with the local obesity pathway guidance, other local pathways and good clinical practice.
- Parents who request the results of measurement for their own child will receive them. There is no expectation that results from the CMP should be given automatically to all parents. However parents who request the results of measurement for their own child will receive them
Note: For any clinical situation, including providing BMI centile results to parents, the clinical, as opposed to the epidemiological, classification for overweight or obesity is used. In line with NICE clinical guidelines UK 1990 children’s BMI centile thresholds is standard in the clinical assessment of overweight and underweight. The raw BMI alone should NEVER be used in the assessment of whether a child is overweight or obese. BMI is not a direct measure of body fat, so care needs to be taken when interpreting the results. Rapid changes of BMI may occur in normal childhood growth, so this as well as additional factors such as girth measurement and stature should be taken into account before intervention is considered.
Training and Supervision of Staff
- School nursing and child health staff administering the programme should be trained using the CMP training guidelines before 01/09/2012.
30. Local mentoring is recommended, with development needs regularly assessed via the personal development plan process.
31. There should be appropriate clinical supervision and delegation should be in keeping with the all Wales Guidelines for Delegation [2].
- CMP training should be provided to new staff, with update training:
· When there are any significant changes
· Refresher training at least every 5 years
Quality, Equality and Audit
33. An annual local audit of processes, measurements and data entry is undertaken to confirm accuracy of data entry, consistency and adherence to these standards.
34. Quality and safety, clinical governance or equivalent committees are made aware of relevant issues arising from annual audits of the CMP relating to the standards raised above and in keeping with local clinical and information governance policies and guidelines
References
[1] Regulations; 2011 No. 985 (W. 142) NATIONAL HEALTH SERVICE, WALES The Child Measurement Programme (Wales) Regulations 2011, available at
http://www.legislation.gov.uk/wsi/2011/985/regulation/1/made
[2] All Wales Guidelines for Delegation September 2010 available at
http://www.wales.nhs.uk/sitesplus/documents/829/All%20Wales%20Guidelines%20for%20Delegation.pdf
Abbreviations
CMP – Child Measurement programme for Wales
NCCHD –National Community Child Health Database
Date: 06/03/2012 / Version:1.0 / Page: 5 of 8[1] See ‘authorised person’ in the Regulations for details
[2] Local code in use in relevant child health system.
[3] Height and weight centile and raw BMI data are calculated by the system. System changes are planned to update the centile reference data and to enable the system calculation of BMI Centiles.
4 It is anticipated that developments in the Child Health 2000 System will lead to alternative mechanisms in future years.