G23(P) Improving annual reviews for children with complex needs in community paediatrics

2019 ◽  
Author(s):  
H Zhu ◽  
S Williams ◽  
D Pore ◽  
S Kenyon ◽  
A Pearce
Keyword(s):  
Complex Needs ◽  
Community Paediatrics

Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?

2019 ◽  
Vol 28 (3) ◽  
pp. 1356-1362
Author(s):  
Laurence Tan Lean Chin ◽  
Yu Jun Lim ◽  
Wan Ling Choo
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Multidisciplinary Team ◽  
Biopsychosocial Model ◽  
Family Members ◽  
Clinical Decisions ◽  
Goals Of Care ◽  
Complex Needs ◽  
Aspiration Risk ◽  
Patient Centric

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.

Understanding homeless complex needs

2009 ◽  
Author(s):  
Alessandro Morandi ◽  
Nicola Paulesu ◽  
Patrizia Meringolo
Keyword(s):  
Complex Needs

Access to Justice for Ethno-Racial Psychiatric Consumer/Survivors in Ontario

2011 ◽  
Vol 29 ◽  
pp. 127 ◽  
Author(s):  
Ruby Dhand
Keyword(s):  
Mental Health ◽  
Institutional Racism ◽  
Access To Justice ◽  
Complex Needs ◽  
Troubles Mentaux ◽  
Inappropriate Care ◽  
Race Ethnicity ◽  
Complex Forms ◽  
Face Complex ◽  
Legal Barriers

Ethno-racial psychiatric consumer/survivors face complex forms of discrimination as a result of the culture specific stigmatization of mental health disabilities, institutional racism and culturally inappropriate care. In an effort to achieve better access to justice for ethno-racial communities, we must strive to understand their complex needs, perspectives and conceptions of mental health. Thus, I identify and critique the legal barriers, which are perceived to differentially affect ethno-racial psychiatric consumer/survivors in Ontario, through an analysis of the Consent and Capacity Board [CCB]. I propose the hypothesis that factors such as race, ethnicity, culture, poverty and social exclusion are not fully addressed by the CCB. I use data collected from interviews with stakeholders to reveal the procedural, structural/systemic and discretionary barriers faced by ethno-racial psychiatric consumer/survivors within the CCB’s pre-hearing, hearing and post-hearing processes, along with recommendations to address these barriers.Les consommateurs/survivants de la psychiatrie ethnoraciale doivent surmonter des formes complexes de discrimination en raison de la stigmatisation culturelle des troubles mentaux, du racisme institutionnel et des soins culturellement inappropriés. Pour améliorer l’accès à la justice des collectivités ethnoraciales, nous devons nous efforcer de comprendre leurs besoins complexes, leurs perspectives et leurs conceptions de la santé mentale. Dans le présent travail, je relève et critique les obstacles juridiques, qui sont perçus comme touchant différemment les consommateurs/survivants de la psychiatrie ethnoraciale en Ontario, en effectuant une analyse des travaux de la Commission du consentement et de la capacité (la « CCC »). J’émets l’hypothèse que la CCC ne prend pas pleinement en compte des facteurs comme la race, l’ethnicité, la culture, la pauvreté et l’exclusion sociale. J’utilise des données provenant d’entrevues avec des parties prenantes pour illustrer les obstacles procéduraux, structurels/systémiques et discrétionnaires auxquels font face les consommateurs/survivants de la psychiatrie ethnoraciale lors des audiences préparatoires et des audiences de la CCC et dans le cadre des processus suivis par la CCC après les audiences, et je formule des recommandations visant à surmonter ces obstacles.

scholarly journals What makes palliative care needs “complex”? A multisite sequential explanatory mixed methods study of patients referred for specialist palliative care

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anne M. Finucane ◽  
Connie Swenson ◽  
John I. MacArtney ◽  
Rachel Perry ◽  
Hazel Lamberton ◽  
...  
Keyword(s):  
Palliative Care ◽  
Focus Groups ◽  
Healthcare Professionals ◽  
Psychological Needs ◽  
Care Providers ◽  
Specialist Palliative Care ◽  
Care Needs ◽  
Complex Needs ◽  
Sequential Explanatory ◽  
Palliative Care Needs

Abstract Background Specialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC. However, little is known about complex needs on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on referral to a hospice service. Methods Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived to be influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly. Conclusions Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed SPC knowledge or support to meet their needs. Hospices need to provide greater clarity regarding who should be referred, when and for what purpose. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of SPC input.

scholarly journals Communicative Interaction with and without Eye-Gaze Technology between Children and Youths with Complex Needs and Their Communication Partners

2021 ◽  
Vol 18 (10) ◽  
pp. 5134
Author(s):  
Yu-Hsin Hsieh ◽  
Maria Borgestig ◽  
Deepika Gopalarao ◽  
Joy McGowan ◽  
Mats Granlund ◽  
...  
Keyword(s):  
Eye Gaze ◽  
Dyadic Interaction ◽  
Communicative Interaction ◽  
Communication Interface ◽  
Complex Needs ◽  
Dyadic Communication ◽  
Communication Partners ◽  
Severe Motor ◽  
Communication Needs ◽  
Symmetrical Communication

Use of eye-gaze assistive technology (EGAT) provides children/youths with severe motor and speech impairments communication opportunities by using eyes to control a communication interface on a computer. However, knowledge about how using EGAT contributes to communication and influences dyadic interaction remains limited. Aim: By video-coding dyadic interaction sequences, this study investigates the impacts of employing EGAT, compared to the Non-EGAT condition on the dyadic communicative interaction. Method: Participants were six dyads with children/youths aged 4–19 years having severe physical disabilities and complex communication needs. A total of 12 film clips of dyadic communication activities with and without EGAT in natural contexts were included. Based on a systematic coding scheme, dyadic communication behaviors were coded to determine the interactional structure and communicative functions. Data were analyzed using a three-tiered method combining group and individual analysis. Results: When using EGAT, children/youths increased initiations in communicative interactions and tended to provide more information, while communication partners made fewer communicative turns, initiations, and requests compared to the Non-EGAT condition. Communication activities, eye-control skills, and communication abilities could influence dyadic interaction. Conclusion: Use of EGAT shows potential to support communicative interaction by increasing children’s initiations and intelligibility, and facilitating symmetrical communication between dyads.

The Experiences and Perspectives of African-Australian Community Service Providers Who Work with At-Risk and Justice-Involved Youth

2021 ◽  
pp. 0306624X2110226
Author(s):  
Stephane Shepherd ◽  
Aisling Bailey ◽  
Godwin Masuka
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Young People ◽  
Service Delivery ◽  
Community Service ◽  
Service Providers ◽  
Professional Staff ◽  
Youth Justice ◽  
Complex Needs ◽  
Australian Community

African-Australian young people are over-represented in custody in the state of Victoria. It has been recognized in recent government and stakeholder strategic plans that African-Australian community service providers are well placed to help address the increasing complex needs of at-risk African-Australian youth. However little is known about the capacities of such providers to effectively contend with this growing social concern. In response, this study aimed to explore the perspectives and operational (service delivery and governance) experiences of African-Australian community organizations which provide services to at-risk young people in Victoria. Through a series of in-depth interviews with the leadership of eight key African-Australian service providers, we aimed to identify their perceived strengths, obstacles faced and proposed strategies to realize key objectives. Perspectives on key risk factors for young African-Australian justice system contact were also gathered. Several themes were extracted from the interviews, specifically (i) Risk factors for African-Australian youth justice-involvement (school disengagement, peer delinquency, family breakdown, intergenerational discord, perceived social rejection), (ii) The limitations of mainstream institutions to reduce African-Australian youth justice-involvement (too compliance focused, inflexible, business rather than human-centered, disconnected from communities and families), (iii) The advantages of African-Australian community service providers when working with African-Australian youth (community credibility, client trust, flexibility, culturally responsive), (iv) The challenges faced by African-Australian service providers (lack of funding/resources, professional staff shortages, infrastructural/governance limitations), and (v) “What works” in service provision for at-risk African-Australians (client involvement in program design, African staff representation, extensive structured programming matched with client aspirations, prioritizing relationship building, persistent outreach, mental health and legal literacy for clients and families). Implications for service delivery and social policy are discussed within.

scholarly journals Healthcare Providers’ Perceptions of Challenges with Frequent Users of Emergency Department Care in Switzerland: A Qualitative Study

2021 ◽  
Vol 58 ◽  
pp. 004695802110281
Author(s):  
Patrick Bodenmann ◽  
Miriam Kasztura ◽  
Madison Graells ◽  
Elodie Schmutz ◽  
Oriane Chastonay ◽  
...  
Keyword(s):  
Online Survey ◽  
Emergency Services ◽  
Healthcare Providers ◽  
Negative Consequences ◽  
Emergency Department Care ◽  
Frequent Users ◽  
Complex Needs ◽  
Wide Range ◽  
Ed Overcrowding ◽  
Ed Visits

Frequent users of emergency departments (FUED; ≥ 5 ED visits/year) commonly cumulate medical, social, and substance use problems requiring complex and sustained care coordination often unavailable in ED. This study aimed to explore ED healthcare providers’ challenges related to FUED care to gain insight into the support and resources required to address FUED complex needs. An online survey was sent to all general adult emergency services within Switzerland (N = 106). Participants were asked to indicate the extent to which they perceived that FUED represented a problem and to describe the main challenges encountered. In total, 208 physicians and nurses from 75 EDs (70.7%) completed the survey. Among the 208 participants, 134 (64%) reported that FUED represented a challenge and 133 described 1 to 5 challenges encountered. A conventional content analysis yielded 4 main categories of perceived challenges. Negative consequences in the ED secondary to FUED’s presence (eg, ED overcrowding, staff helplessness, and fatigue) was the most frequently reported challenge, followed by challenges related to FUEDs’ characteristics (eg, mental health and social problems) leading to healthcare complexity. The third most frequently encountered challenge was related to the ED inappropriateness and inefficiency to address FUEDs’ needs. Finally, challenges related to the lack of FUED healthcare network were the least often mentioned. ED healthcare providers experience a wide range of challenges related to FUED care. These findings suggest that currently EDs nor their staff are equipped to address FUEDs’ complex needs.

A problem-solving approach to criminalised women in the Australian context

2021 ◽  
pp. 1037969X2098510
Author(s):  
Megan Beatrice
Keyword(s):  
Criminal Justice ◽  
Problem Solving ◽  
Procedural Justice ◽  
Criminal Justice System ◽  
Justice System ◽  
Therapeutic Jurisprudence ◽  
Upward Trend ◽  
Complex Needs ◽  
Australian Context

The upward trend of incarceration rates persists among women in Victoria, with increasingly punitive sentencing and onerous new bail laws. At the same time, the complex needs of women in the criminal justice system are becoming the focus of greater study and documentation. This article presents the case for a specialist women’s list under the Magistrates’ Court of Victoria jurisdiction, based in principles of therapeutic jurisprudence and procedural justice. While the list aims to reduce offending by addressing criminogenic factors unique to women, the picture is far bigger; the Victorian Women’s Court ultimately promotes justice for women who commit crimes.

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