Case Study 1
Using the Child Health System Map as a tool for strategic service and intervention planners

Our interviews suggested that the map could support strategic service and intervention planners to:

• aid discussion between different stakeholders working together on an initiative

• bring people together to support a shared understanding of ‘systems approaches’

• support intervention planners to specify which factors are/are not being targeted

• identify potential unintended consequences of planned interventions

• identify factors to evaluate within interventions

• support visualisation of local data & identify local data gaps

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The following materials describe our experience of using the Child Health System map to aid discussion between different stakeholders working together on an initiative

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1. What was the practice challenge?

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Designing services and activities to deliver a nutrition and healthy weight action plan.

The newly formed Children & Young People’s Nutrition and Healthy Weight Group within Wakefield District Council developed an action plan for 2023-2024 with 14 priority actions for the region. Some example actions were:

• exploring HENRY as an evidence-based programme for Wakefield;

• providing parents/cares with trusted information on healthy eating;

• providing the early years workforce with appropriate training to feel confident to cascade key public health messages in relation to diet, nutrition, exercise and health  

The newly formed team comprised:

• A service manager for Children’s Public Health

• A project manager for strategy and observations

• 0-19 Service Team members

• A Health Improvement Team Leader

• Early Intervention and Prevention Partnership Manager

• Specialist Health Improvement Officer

• Public Health Project Co-ordinator

• CEO of a local young person’s charity

• A representative from a local medical centre

• Chair of the voluntary and community sector networking group in Wakefield

• Professional advisor for nutrition and dietetics

• Wakefield CAMHS and Eating Disorder Team

• A children’s matron 

• Project Officer for Strategy & Transformation

• Associate Director Population Health: Personalisation & Engagement

• Health Improvement Manager

• A Public Health Registrar

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The Children and Young People’s Nutrition and Healthy Weight Group identified that as a newly formed group, that they needed to define, collectively, a shared understanding of:

• What’s the problem that we are trying to address?

• What’s the scale of the problem?

• Where does this issue fit?

• Where’s the governance for the issue?

• Is the governance in place?

• Who does what in relation to this issue?

• How can we make sure that any intervention or service development that we produce does not fail?

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2. How did people use the map when working on this challenge?

At an early meeting of the Children & Young People’s Nutrition and Healthy Weight Group, two researchers delivered, via an online meeting, a short presentation [embed PowerPoint slides] on how the Child Health System Map had been produced and what it shows. Group members were given a PDF image of the map, with capacity to zoom in and out on the image.

The researchers gave members of the group three minutes to look at a sub section of the map  showing all factors that are related to ‘diet’ at two degrees of separation. The researchers asked people to reflect individually on:

• Which factors does your work currently influence?

• Is there anything that surprises you on the map?

The Chair of the Children & Young People’s Nutrition and Healthy Weight Group then facilitated a discussion among members of the group about what ideas were prompted by reviewing the factors and connections on the map.

3. How did using the map influence work on the challenge?

The discussion revealed the following issues for group members:

• The breadth of issues connected to diet was considered surprising. Group members perceived that the map shows the range of issues with the potential to influence diet.

• The team identified a need to get more people ‘around the table’ on the issue of Children & Young People’s Nutrition and Healthy Weight, to effect change across different parts of the systems for example, planning, education and housing.

• The team also identified that the map shows how many issues are connected to the adult world and reflected that addressing factors directly affecting children and young people alone is not enough.

• The team recognised that, as a small team with low capacity, a whole system approach is likely to be more impactful than focusing scant resources on treating small numbers of individuals.

• The map highlighted to the team the  need to link with families as an important component of the system.

• The group reflected that the map could enable the group to identify, (using domain areas), areas of work where they are confident. For example, they could reflect on where governance fits and assess provision across a range of domains in local areas

• The group reflected that the map enabled them to see issues as connected in a system rather than in operating silos, and could help them work in a more co=ordinated way to tackle issues.

• The team identified that they might want to develop their own map to reflect local issues of concern that did not feature on the map.  

  • For example, the team considered that the factor ‘school meals’ should be changed to ‘whole school environment’ and policies to support wider action across schools.

  • The team wanted to develop stronger links between sleep  and children and young people’s nutrition and healthy weight.

  • The team wanted to consider the impact of advertising on diet.  

• The team reflected that services in the area have perhaps been treatment focused and perceived that the map helps to illustrate the need to be prevention focused.

• The team noted that the factors and their relevance will vary on age of the child, for example, some are much less relevant when young people get more independence.

• The team perceived that the map shows the importance of the lifecycle, but noted that prenatal experiences are missing.

The following changes were made:

• The group decided to review the group membership

• The group updated its terms of reference

• The group decided to develop an offer for young people from 5 – 11 years, concentrating on three themes - on line, group work and 1-2-1 services

• The group is reviewing local National Child Measurement Programme data to analyse which schools to approach to pilot some group work activity

Other ways the map might be used in practice

For evaluating current provision

• The Wakefield team found it helpful to look at the youth justice issue of reducing first time entrants to the criminal justice system and evaluate the work that the council is currently doing.

  • The map helped team members to identify who needs to be ‘round the table’ in evaluating this provision.

  • The map helped team members to communicate their perceptions on the issues when building relationships with colleagues to work on the issue.

• The Wakefield Child Health team proposed that the Child Health Systems Map could be used to review the family service hub provision in the District. The team asked themselves:

  • What data, knowledge or information do you have about relationships of interest?

  • What more data, knowledge or information would you like to have?