Embedding Relational Practice in Paediatric Care: Translating the PAIR (Phased Approach to Including a Relational Focus) Model into Action at Queensland Children's Hospital (PAIR Infant: working collaboratively with parents at QCH Infant Clinic)

Intervention name: PAIR Model (Phased Approach to Including a Relational Focus) Description of intervention: The intervention involves implementation of the PAIR Model within routine Early Childhood Intervention (ECI) services at the Queensland Children’s Hospital Infant Clinic. The PAIR Model is a structured, relationship-focused framework that integrates parent–child interaction coaching, values-based goal setting, and reflective practice into standard allied health therapy for infants at high risk of neurodevelopmental delay. The model aims to strengthen caregiver–infant relationships, support parent wellbeing, and enhance practitioner relational competence during a critical neurodevelopmental window. Recruitment of participants will occur over a five month period. Each enrolled family will then participate in the intervention from the time of baseline (T0) assessment through to final follow-up (T2). During this period, families will receive PAIR-informed care embedded within their usual Infant Clinic appointments, along with 1–2 additional targeted sessions focused on collaborative goal setting and parent–child interaction. Who delivers the intervention: The intervention includes 1-2 additional sessions offered to families attending the Tuesday Infant Clinic. These sessions will be offered by an occupational therapist face to face or via telehealth (family preference) and will focus on collaborative goal setting and strengthening parent attunement. The occupational therapists, physiotherapists, and speech pathologists working in the Tuesday Infant Clinic at QCH will extend on parent-child interactions as part of their role in this clinic and incorporate PAIR principles into routine care. The intervention is delivered by allied health clinicians (occupational therapists, physiotherapists, and speech pathologists) working in the Queensland Children’s Hospital Infant Clinic. These clinicians are trained in the PAIR Model by the model developer, an experienced paediatric occupational therapist and researcher, and receive ongoing reflective supervision. All clinicians have professional qualifications and experience in early childhood intervention and acute paediatric care. Mode of delivery: The intervention is delivered face to face or via telehealth and embedded within routine individual therapy sessions between clinicians and families. Practitioners apply PAIR Model principles during standard clinical appointments rather than providing separate or additional sessions. Intervention frequency and duration: Practitioners receive a 2-day face-to-face training workshops (4 hours total) prior to implementation and monthly 1 hour reflective supervision sessions. Families are exposed to PAIR-informed care across their usual Infant Clinic appointments. Recruitment of families will occur progressively. Once enrolled, each family will participate in the intervention for approximately 3 months. During this time, families receive PAIR Model treatment along with 1-2 additional 30-60 minute sessions (delivered face to face or via Telehealth) scheduled on a Tuesday, prior to and in addition to routine appointments. Setting: The intervention is delivered at the Queensland Children’s Hospital, within the Infant Clinic (inclusive of inpatient, outpatient and day-hospital). Strategies to improve adherence or fidelity: Adherence and fidelity are supported through monthly reflective supervision for practitioners, use of a standardised relational competency fidelity measure (Therapist Relational Competency Scale), and ongoing feedback from the research team. The intervention is embedded into routine clinical workflows to support sustained implementation. No additional physical materials will be used. PAIR informed visual tools and QCH information sheets will be provided as relevant to family priorities (eg. GAS goal setting tool). In the additional PAIR informed sessions in the intervention group, the activities will focus on collaborative goal setting (using GAS) and observing parent-child interactions. The duration of the additional telehealth sessions and when they are administered relative to the routine appointments - 1-2 30-60 minute Telehealth or face to face sessions will be offered to families. These will occur on a Tuesday and will occur prior and in addition to the regular sessions these families receive. For the monthly reflective supervision sessions the supervision will be provided face to face to PAIR trained practitioners. The supervision will be provided by CIA, Jacqui Barfoot.