The pediatric nurse: link between pediatrics and youth health care

Dutch pediatricians are confronted with several problems in which (psycho)social factors are involved. Because of these problems pediatricians feel the need to a close cooperation with the Dutch Youth healthcare.
The Amphia hospital in Breda in the Netherlands has started with an integral model of cooperation concerning the care for children with these types of problems. Two pediatric nurses are present at the outpatient clinic of the Amphia hospital. They form the linking pin between pediatrics and the social domain.

Purpose: Is this model of cooperation effective and is it of added value compared to usual care?

Study design: Randomized Controlled Trial.

Study population: The study population concerns of children aged 0-18 years, in which (psycho)social factors are involved.

Intervention: The intervention is the new cooperation model at the outpatient clinic of the Amphia hospital.
Whenever the anamneses of the pediatrician shows that the child suffers from (psycho)social
problems, the study will be explained to the child and its parents and the research information as
well as an informed consent form will be hand over by the pediatrician. Once the informed consent
form is signed, the child is included in the study and allocated by randomization to the intervention
group, the child is referred to the pediatric nurse for (psycho)social problems. If the child is suffering
from somatic problems for which specialist help is necessary, these problems will be treated by the
pediatrician. The children (and parents) in the intervention group will be contacted by the pediatric
nurse. Together with the children and parents she considers what is necessary for the child. If
necessary she transfers the children to other professional authorities. Children in the control group
receive ‘care as usual’, which implies that the parents/child follow the advice from the pediatrician,
given by the research nurse, for the follow-up care.

Primary study parameters: The primary study parameters are parental and children’s satisfaction with the care provided (Exit questionnaire) and the throughput from the first consultation to fitting care. Other study parameters are parenting stress and taxation of problem severity from the professional’s point of view.

Secondary study parameters:

The secondary study parameters are problem severity from a parental- (VAS: for children 0-2 years,
SDQ: for children 2-18 years) and professional (VAS) perspective as well as costs involved in the new
working method.

The deployment of the pediatric nurse as linking pin between pediatrics and the social domain, shortens the throughput to appropriate support for children with (psycho)social problems and it enlarges the satisfaction of parents and children with the care provided.

Throughput

Intervention group: first consultation with the pediatrician, first consultation with the pediatric nurse, last consultation with the pediatric nurse.

Control group: first consultation with the pediatrician, first consultation with youth healthcare or
general practitioner, last consultation with youth healthcare or general practitioner.



Parental and children’s satisfaction (Exit-questionnaire)

First measurement

Intervention group: immediately upon ending the intervention

Control group: Three months after the first consultation with the pediatrician

Second measurement

Intervention group: Three months upon ending the intervention

Control group: Six months after the first consultation with the pediatrician



Parenting stress

First measurement: immediately after inclusion

Second measurement: at the end of the intervention (intervention group)/ three months after the
first consultation with the pediatrician (control group)



Problemseverity

Parental perspective JIVES scoring-form:

0-2 years: the JIVES scoring-form will be completed immediately after inclusion and end of the
intervention (intervention group)/three months after the first consultation with the pediatrician
(control group).

2-18 years: The SDQ will be completed immediately after inclusion and at the end of the intervention
(intervention group)/three months after the first consultation with the pediatrician (control group).

Both parents and children aged 11 and over will complete this questionnaire.



Professional perspective JIVES scoring-form:

At the end of the first and control consultation with the child the JIVES scoring-form will be
completed by the pediatrician.



Evaluation new working method

At months 8, 11 and 14 a focus group interview will be held with professionals to evaluate the
program integrity, the efficiency and effectivity of the new working method, the collaboration
process and the total approach.



Intervention costs and structural funding

At the end of 2017/beginning of 2018 information concerning the costs will be collected and
interviews with experts concerning structural funding of the new working method will be planned.

Intervention

The intervention comprises the procedure that started in 2015 at the Amphia hospital, Breda, The Netherlands. In this procedure, pediatric nurses are the linking pin between pediatrics, Dutch Youth healthcare and social domain.

Two pediatric nurses are present at the outpatient clinic of the Amphia hospital during one shift/week for the execution of the intervention. In addition as part of the intervention, they have the availability to pay visits to other locations (i.e. the clients home) during 1.5 day/week.

The procedure starts at the moment a child (and its parents) consults a pediatrician. If it appears from the anamnesis by the pediatrician that the child suffers from problems in which (psycho)social factors are involved, the child can be considered for inclusion in the study. If so, the pediatrician explains the study to the child and its parents, hands them over the research information as well as an informed consent form. In addition the pediatrician refers the child to the pediatric nurse for (psycho)social problems. The pediatric nurse contacts the family by telephone within two weeks after the consultation with the pediatrician. In consultation with the child and the parents an appointment is made at the parents’ house or at the outpatient clinic. During this consultation the pediatric nurse clarifies the problem and together with the parents and the child she considers which care fits best to the child. This procedure can take several consultations. When necessary, the pediatric nurse connects the child to other professional authorities in the field as for example the infant welfare center (i.e. teaching in upbringing) or specialized youth assistance. When it becomes clear that the family is able to go on by itself or when they are transferred to another professional authority the pediatric nurse closes the contact after a written feedback toe the family, the pediatrician and (with parental consent) the general practitioner and other professional parties involved. Three months after closing down the contact with the pediatric nurse there is a control consultation with the pediatrician.
If the child suffers from somatic problems which need attention of a pediatrician, the pediatrician takes care of this.

‘Care as usual’

For the control group, the procedure starts with a consultation to the pediatrician as well. If it appears from the anamnesis by the pediatrician that the child suffers from problems in which (psycho)social factors are involved, the child can be considered for inclusion in the study. If so, the pediatrician explains the study to the child and its parents, hands them over the research information as well as an informed consent form. Once the informed consent form is signed, the child is included in the study and allocated by randomization to the control group, the child is offered ‘care as usual’. In this study ‘care as usual’ implies that the parents/child follow the advice from the pediatrician, given by the research nurse, for the follow-up care. Whenever the child suffers from somatic problems which need attention of the pediatrician, the pediatrician takes care of this. Six months after the consultation with the pediatrician there is a control consultation with the pediatrician.