HARTI HAUORA TAMARIKI A Randomised Controlled Trial of an Opportunistic, Holistic and Family Centred Approach to Improving Outcomes for Hospitalised Children and their Families

BRIEF NAME: The Harti Hauora Tamariki Tool. The intervention consists of the application of the Harti Hauora Tamariki Tool (HHT) to children admitted acutely to a paediatric medical ward at Waikato Hospital New Zealand.. The Harti Hauora Tamariki tool (HHTt) is based on a Whanau Ora approach and weaves Kaupapa Maori methodology into the provision of hospital-based health care. It consists of a checklist of 22 components of importance to holistic child and whanau health. These are: 1. Registration with a general practitioner. This is assessed by specific questions incorporated in the HHT. 2. Enrolment with a Well Child/Tamariki Ora provider. The Well Child Tamariki Ora programme is a series of health visits and support that are free to all families for children from around 6 weeks up to 5 years of age. The service is provided by Plunket and other accredited providers. Enrolment is assessed by specific questions incorporated in the HHT. 3. Completion of a "Before School Check". This is the last Well Child Tamariki Ora checkup which takes place when the child is 4 years of age. It is funded by the Ministry of Health. It is performed by a nurse who checks the child's height and weight, their teeth, and his/her general health and learning development. It also provides caregivers with an opportunity to get professional advice and support about their child's health and development. 4. Enrolment in an early childhood education facility. This is assessed by specific questions incorporated in the HHT. 5. Oral health assessment consisting of (a) determining whether an oral health check has been conducted in the preceding 12 months and (b) recording the "Lift the Lip Score", referring to an oral health provider as appropriate. This assessment is conducted as an integral part of the HHT. 6. Immunisation status check and update as required for the index child, any pregnant women in the household, and any other members of the household (for flu vaccination). This is done by checking the child's immunisation status on the National Immunisation Register and by asking about the immunisation status of other members of the household. 7. Housing and safety to check whether the house is adequately insulated and to perform a home safety checklist. This is assessed by specific questions incorporated in the HHT. A referral is made to the Whare Ora programmes if eligible and agreed by the care-giver. The Whare Ora programme can offer families products and services such as heating devices, thermal curtains, draught stoppers, mould kits, blankets, pillows and subsidised insulation referrals. 8. Smoking by the parent / caregiver or other members of the household, offering advice and support to quit. This is assessed by specific questions incorporated in the HHT. Referrals to smoking cessation services are made on the spot where agreed and appropriate. 9. Drug and alcohol use screen with referral as appropriate. If the screening question (part of HHT is positive) then the research assistant proceeds to conduct an Audit C assessment, and depending on the result, a Full Audit. Based on the score the interventions delivered might include no action, brief advice, referral to the Family Start service (see https://www.health.govt.nz/our-work/life-stages/child-health/well-child-tamariki-ora-services/family-start) for details, referral to other community service providers or referral to the patients' GP. 10. Family violence assessment with four screening questions incorporated in the HHT. Interventions include women's refuge information, referral to a DHB social worker, referral to or information about Family Start, and if appropriate completing the Intimate Partner Violence Health Assessment process (details available at https://www.health.govt.nz/system/files/documents/pages/intimate-partner-violence-intervention-policy-mar17.doc) 11. Problem gambling. Assessed by specific questions within the HHT. Where appropriate additional information (e.g. the Problem Gambling Foundation brochure) or a referral to the Salvation Army Oasis Centre for Problem Gambling is provided. 12. Eligibility and registration with support services (Community Services Card; National Travel Assistance, Work and Income NZ subsidies etc.). An assessment of eligibility is conducted within the HHT with interventions ranging from providing information to assisting with applications for National Travel Assistance prescription subsidies, Work and Income New Zealand subsidies and benefits, DHB social worker assistance, Family Start, Spark JUMP package information, Te Whare Kokanga, Salvation Army, accommodation at Te Whare Taurima. 13. Breastfeeding. The HHT ascertains if there is current breastfeeding and if there are problems with this, then a referral to a lactation consultant is offered or other resources such as the Ministry of Health "Breastfeeding for your baby" brochure, the Mama Aroha App and the Midlands Breastfeeding App BreastfedNZ. 14. Car restraints. The HHT checks whether the family has adequate car seats and restraints for the children and where this is not the case it may refer to whanau ora booklet, to ‘In loving arms’ if under 1 years, to health shuttle services or K’aute for use of car restrains/travel for health appointments, or provide ‘Car restraints save lives’ NZTA pamphlet 15. Safe sleep check for those aged 6 months or less. If no safe place to sleep the baby then the research assistant plays the Safe Sleep DVD or offers to provide a Pepi Pod. 16. Power to protect (shaken baby) DVD viewing for parents of children under the age of 2 years if accepted. 17. Sore throat check for index child and other household members. Whether or not the screening question is positive the Sore Throats Matter message is promoted and if positive then a referral to Pharmacy on Meade for community throat swabbing services if eligible. 18. Body mass index and intervention as required. The interventions may include referral to the GP, growth charting, "Be Smarter" messages, and referrals to Sport Waikato or Bodywise for older children in the Whanau. 19. Developmental assessment. If the caregiver has concerns about the child's development then a milestones checklist is performed. If the criteria are met then the child is referred to the Waikato DHB Child Development Centre (if the caregiver is in agreement). 20. Skin condition check. If there are concerns about the index child's skin or the skin of other children in the whanau, then the hospital medical team is informed (or the GP referred to for other children). Resources such as "Stop Skin Infections" brochures, eczema or head lice information is provided. 21. Vision and hearing check. If the caregive has concerns about the child's hearing or that of other children in the whanau then the Research Assistant may inform the medical team, refer to the GP, make and appointment with a private optometrist, or (for those aged 4-17) make an appointment with the vision and hearing screening clinic. 22. Review of past admission frequency. This is done by consulting the iPM (electronic hospital admissions database) to determine whether the child has had 5 or more admissions in the preceding 6 months. If so, the medical team is alerted to this. The time taken to complete the HHT is recorded. It is expected that this will vary from 30 minutes to over 2 hours, depending on the number of interventions required. The HHT and its associated interventions are delivered by one of three Research Assistants during a face to face consultation with the child's parent or caregiver while the child is admitted to hospital. If the child is discharged home before the HHT can be administered, then it will be performed by appointment. The tool is applied just once with most activity undertaken on the spot, but sometime follow-up actions may be required which are performed after the consultation has ended.