Connection and Kinship: Co-design of a Culturally Safe and Responsive Care for Aboriginal and Torres Strait Islander Children and Families in a Public Paediatric Service

Pre-implementation activities Baseline Standard Care data will be collected from the patient record for consumers attending the Paediatric service for one year prior to the service change and until completion of the project. This will include patient and family demographic information such as age, sex, gender identity, postcode, family composition and patient presenting complaint/s will be obtained from the medical record. Standard patient reported experience measures (PREMS) and patient reported outcome measures (PROMS) are currently collected as standard will be collated. Service level data such as failure to provide care rates and long wait data will be collected from relevant Information Management Systems. Consumer Questionnaire A questionnaire and yarning circles with consumers (carers) will be undertaken to determine barriers to care and to design the model of care. The questionnaire will be sent to all consumers of the Paediatric outpatient service with Aboriginal and/or Torres Strait Islander origin identified in the clinical record who attended the service from January 2024 to the conclusion of the project. Consenting consumers will then be directed to an online questionnaire, or the paper version, exploring their barriers to care, along with background demographic information will be collected for each participant including age, sex, gender identity, postcode, family composition and reason for attending the service, and paediatric team members engaged with. At the end of the questionnaire, all participants will be given the opportunity to participate in the pre-implementation yarning circles. Consumers will have the option to complete the questionnaire only, the yarning circle only, both, or neither. Consumer Yarning Circles Participants who indicate an interest to participate in yarning circles will be contacted by a member of the research team to participate in this project activity. In addition, an Expression of Interest (EOI) will be developed with support from the Cultural Capability team and the hospital Safety and Quality Unit and will be disseminated via the Safety and Quality and Cultural Capability team consumer networks as well as Aboriginal and Torres Strait Islander Leadership Communications and Planning Team. At the beginning of the yarning circle, non-identifying background demographic information will be collected for each participant including patient and family demographic information such as age, sex, gender identity, postcode, family composition, reason for attending the service, and paediatric team members engaged with. The yarning circle will then commence. The yarning circles will be conducted either in-person (preferred method), or via MS Teams. The yarning circles will be facilitated by the hospital Cultural Capability Officer with support from other members of the project team as needed. They will be recorded and transcribed verbatim. Yarning circle participants will be asked open questions about the barriers to care and their needs in order to co-design the new model of care. Yarning circles will last for approximately 90 minutes. At the conclusion of the yarning circle, consumers will complete three brief four item questionnaires asking about their perception about the acceptability of this service change, and the appropriateness of the service change, and the feasibility of the service change. Community Elders Yarning Circles An Expression of Interest (EOI) will be developed and disseminated in the same way described for Consumer yarning. At the beginning of the yarning circle, non-identifying background demographic information will be collected for each participant including patient and family demographic information such as age, sex, gender identity, postcode, engagement with the service (if any), and Paediatric Services team members engaged with. The yarning circles will be facilitated in the same way as that describe for consumers. Staff questionnaire All interdisciplinary team members of the Paediatric Service along with hospital Executive team will be approached to complete the staff questionnaire. The staff questionnaire which will explore barriers to care and satisfaction with the service, perception of acceptability, appropriateness and feasibility of the service change, and basic non-identifiable demographic information including sex, profession, and time working in the TPCH paediatrics service. At the end of the questionnaire, participants will be asked if they would like to be contacted to participate in staff semi-structured interviews. Staff semi-structured interviews Semi-structured interviews will be undertaken with staff who have indicated that they would consent to a follow-up interview. Staff will be selected by the investigators to ensure a purposeful sample is achieved (e.g. across individual professions) to ensure a breadth of data that is representative of the broader population. Interviews will be conducted either 1:1 or as a focus group (maximum n=6 per group), based on the suitability/availability of eligible staff. It is expected that 1:1 interviews will take approximately 20 minutes, while focus groups may take upwards of 1 hour. Participants will be asked open questions about the barriers to care for Aboriginal and/or Torres Strait Islander children and families, and will seek ideas on strategies to overcome these barriers through a new model of care. Aboriginal and/or Torres Strait Islander staff will have the option also to complete the interview/focus group in a yarning format if they prefer. Basic non-identifiable demographic information will be collected from respondents including sex, profession, and time working in the hospital’s paediatrics service. Refinement and endorsement of the new model of care will follow from the pre-implementation activities, led by the research team with ongoing consultation with community via the Cultural Capability team with a view to long term sustainability. The developed model of care will be endorsed by the Aboriginal and Torres Strait Islander Leadership oversight committee and presented to community for final consultation before implementation. Implementation activities Implementation of the model of care will occur following recruitment to the role with an approximately 12-month trial period. The impact of the service change will be measured via ongoing collection of patient reported experience and outcomes data and service level data, a post-implementation consumer questionnaire and yarning circles to elicit feedback on the model of care and further suggestions for refinements needed, and to strengthen the sustainability plan. As per the pre-implementation phase, the consent and contact measures will follow the same processes. Similarly, Elder groups yarning circles will be undertaken. A staff questionnaire and semi-structured interviews with staff to elicit feedback on the model of care. The aim of these implementation activities is to demonstrate the acceptability, sustainability, and appropriateness of the model. Evaluation Activities The impact of the service change will be assessed with reference to Ngaa-bi-nya Aboriginal and Torres Strait Islander program evaluation framework across domains of landscape, resources, ways of working and learnings as well as Implementation and Evaluation Outcomes which will allow evaluation across implementation, service and consumer outcomes. A full service evaluation will be undertaken including economic analysis using a cost utility approach to determine whether the model of care is cost-effective, taking into consideration costs and QALYs.