Complexity and service provision in the Royal Children's Hospital's Family Choice Program
Document TypeMasters Research thesis
Access StatusOpen Access
© 2017 Katherine Maughan
Due to continued advancement in medical care and technology, the number of children living with complex medical care needs is increasing. Despite this, understandings of this group of children and the programs that support them are limited. This research aimed to understand the medical and psychosocial complexity of the children and families access the Royal Children’s Hospital, Family Choice Program (FCP) and how this complexity impacts on service provision, including respite and case management services. In doing this, the thesis uses an exploratory approach to understand the documented medical complexity of the children and the documented psychosocial complexity of their families. The thesis explores the service provided within the FCP, specifically the respite and case management services. The thesis considers the relationships between these variables to explore the relationship between medical and psychosocial complexity and the provision of service within the FCP. The study reviews the files of 65 children accessing the program over a six-month period (October 2014 – March 2015). A clinical data mining approach was used to collect the data, which involved collecting quantitative data from three program-based sources: The Family Choice Program Plan (FCPP), psychosocial assessment, and The Care Manager (TCM) a documentation system used by the program. The descriptive data were explored initially in three categories; medical complexity, psychosocial complexity, and service provision (incorporating respite and case management involvement). This descriptive data was then analysed further through a one-way repeated measures of analysis of variance (ANOVA) test to explore the differences between multiple variables to understand their impact on the dependent variable. Doing this meant it was possible to understand the impact of medical and psychosocial complexity of the provision of service within the FCP. The thesis provides new understandings and knowledge from an exploratory program-based perspective on the medical complexity of children; reviewing the type and frequency of the medical interventional care needs of the children accessing the FCP. It also provided information about the medical ‘vulnerability’ and/or ‘intensity’ of the child’s care needs in line with the program definitions. A review of the documented psychosocial complexity of the families of children with complex medical care needs found 27 documented stressors over ten psychosocial themes. The study also found how frequently these psychosocial stressors were documented for the group. Additionally, the study provides understanding of the service provision within the program; including respite and case management involvement. Respite was reviewed by considering the number of children accessing respite and the hours of respite allocated each week. Further, it explored the level of case management involvement provided to the families accessing the program. This study found a relationship between the documented medical complexity of the children, the psychosocial complexity of their families, the presence of respite and the level of case management involvement provided. This knowledge provided an understanding of how medical and psychosocial complexity impact on service provision within the program, also providing further understanding on children with complex medical care need internationally. The implication of these findings for program research and practice are considered.
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