Phoenix M, Rosenbaum P
CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada; KidsAbility Centre for Child Development, Waterloo, ON, Canada.
Child Care Health Dev. 2015 May;41(3):494-9. doi: 10.1111/cch.12194. Epub 2014 Sep 24.
Service providers, policy makers and researchers are increasingly concerned with service provisions for hard-to-reach families. These are defined as families who are eligible for a service, but are difficult for service providers to identify or engage. In our setting, hard-to-reach families were those who missed appointments without prior notice, a problem that was inefficient for the organization, frustrating for clinicians and did not meet child or family needs. This case report describes the development of a care path to promote engagement with hard-to-reach families (MATCH: Making Alternative Therapy Choices Happen) and its adoption among clinicians within a community-based paediatric rehabilitation centre in Ontario, Canada. The care path was developed and implemented at a pilot site at KidsAbility Centre for Child Development (KidsAbility), which allowed us to tailor the care path using clinician input via questionnaires, and to monitor use of the care path. Following pilot implementation clinicians reported being satisfied with the approach and perceived improved child and family outcomes. The care path was expanded to four service sites using a Knowledge Brokering model. After training, clinicians reported a good understanding of the care path: 87% felt that they would have an opportunity to use it within six months, however only 68% felt ready to use it. Challenges to offering MATCH and continuing training preferences were investigated. The MATCH care path illustrates a practical application of the principles of best-practice for engaging hard-to-reach families, tailored for a specific paediatric rehabilitation setting. Continued research is planned to further define the hard-to-reach families within paediatric rehabilitation, determine how hard-to-reach families view engagement in services, and evaluate the effectiveness of MATCH implementation in reducing missed appointments and promoting family engagement in paediatric rehabilitation services.
服务提供者、政策制定者和研究人员越来越关注难以接触到的家庭的服务提供情况。这些家庭被定义为有资格获得某项服务，但服务提供者难以识别或接触到的家庭。在我们的环境中，难以接触到的家庭是指那些未事先通知就错过预约的家庭，这个问题对机构来说效率低下，让临床医生感到沮丧，并且无法满足儿童或家庭的需求。本病例报告描述了一种护理路径的开发，以促进与难以接触到的家庭的接触（MATCH：使替代疗法选择成为现实）及其在加拿大安大略省一个社区儿科康复中心的临床医生中的采用情况。该护理路径是在儿童能力儿童发展中心（KidsAbility）的一个试点地点开发和实施的，这使我们能够通过问卷调查利用临床医生的意见来定制护理路径，并监测护理路径的使用情况。试点实施后，临床医生报告对该方法感到满意，并认为儿童和家庭的结果有所改善。该护理路径通过知识中介模式扩展到了四个服务地点。培训后，临床医生报告对护理路径有很好的理解：87%的人认为他们将有机会在六个月内使用它，然而只有68%的人觉得准备好使用它。对提供MATCH和持续培训偏好的挑战进行了调查。MATCH护理路径说明了针对难以接触到的家庭的最佳实践原则的实际应用，是为特定的儿科康复环境量身定制的。计划继续进行研究，以进一步界定儿科康复中难以接触到的家庭，确定难以接触到的家庭如何看待参与服务，并评估MATCH实施在减少错过预约和促进家庭参与儿科康复服务方面的有效性。
