Health visitors care for mothers and children aged 0-5, working in partnership with families, communities and other agencies to promote, protect and safeguard family health.

Families need to be resilient in order to give their children the best start in life. However, health visitors did not have a suitable tool to assess family resilience. As a result, there were concerns that some families were not getting the support they needed.

Assessing family resilience

The research team worked with health visitors to identify what family resilience is. They found it has many elements related to health, engagement, money, parenting and support.

The team used these elements to develop an evidence-based assessment tool: Family Resilience Assessment Instrument and Tool (FRAIT). They then put the tool through several development phases where it was trialled with health visitors. It was reduced in size and made easier for health visitors to use. The team also added a training package, guidance notes and prompts.

During this last year, the team have been working with the National Centre for Population Health & Wellbeing Research (NCPHWR) and Cwm Taf University Health Board exploring the FRAIT data. They found that when Health Visitors use the FRAIT at a birth assessment it helpsthem identify whether a child will be ready for school.  Finally, the team worked with the Wales Institute for Digital Information (WIDI)  to develop eFRAIT, an electronic version of the tool.

FRAIT helps health visitors assess family resilience and identify the support they need. It is available online in English and Welsh and is free to NHS Wales and Welsh higher education institutes.

Changing policy and practice

The team’s research has helped to influence Welsh Government (WG) policy.

FRAIT was included in the WG’s Healthy Child Wales Programme  and the WG require health visitors to use FRAIT with every child under five years of age.

It has also had an impact on how health visitors work. Since its creation, more than 1,086 health visitors and students have had training in how to use FRAIT, and all Welsh education establishments that teach student health visitors include standardised FRAIT training as part of the course.

FRAIT helps health visitors identify which services are needed to support a family  and work with local communities and agencies to meet families’ needs. Thanks to the tool, health visitors are able to focus on how to support and maintain family resilience.

The idea of assessing family resilience has been acknowledged as a valuable approach by public health practitioners in India. The team, in collaboration with colleagues at the All India Institute of Medical Sciences (AIIMS) Rishikesh, have developed a culturally sensitive concept of family resilience. They are now developing the FRAIT India for use in practice.

Research team

Professor Carolyn Wallace, Professor David Pontin, Michelle Thomas, Dr Dean Whitcombe, Dr Paul Jarvis, Kevin McDonald and Megan Elliot – Health, Care and Wellbeing Research and Innovation Group, University of South Wales

Research partners

Hywel Dda University Health Board,

Cwm Taf Morganwg University Health Board

All India Institute of Medical Sciences (AIIMS), Rishikesh.

Read the full REF impact case study