Population Child Health Research

SC4C offers an integrated model of care, in which paediatricians work directly with GPs in their practices to bring the best possible close-to-home care to children and their families. Evaluation from the UK showed the model resulted in a 39% reduction in new patient hospital appointments, a 19% reduction in speciality referrals, and a 22% reduction in ED attendances 12 months after implementation of a similar model. Pilot data from Victoria has shown a 5% decrease in OP referrals and most importantly a 16% increase in parental confidence in GP care and satisfaction in the care they received. Through an NHMRC grant we have taken this model to 23 GP practices in Sydney and Melbourne, and the model will be expanded to rural areas with our successful Medical Research Future Fund (MRFF) Primary Health Care Research Grant: Strengthening Care for Rural Children (SC4RC), which aims to deliver and rigorously evaluate a primary health care strengthening program for rural children. 

If families are asked about their social and emotional needs, they are up to 40 times more likely to have these needs met. EPIC-CP asks families what they need from services and then uses a co-designed social care navigation pathway to meet the needs of the children and young people with cerebral palsy and their families. Funded by the Cerebral Palsy Alliance Research Foundation and Sydney Children’s Hospitals Foundation the EPIC CP team, led by A.Prof Sue Woolfenden, will deliver and evaluate their EPIC-CP pathway in 2023. Sue is also leading the psychosocial pillar of the Luminesce Alliance Developing Brain Study proposal with SCHN, UNSW, and University of Sydney collaborators extending this concept to children with other neurological and developmental needs.  

RuralKidsGPS is an innovative, integrated model of care. Care coordinators will work closely with care teams and families to meet the needs of children with complex health conditions through shared care plans, technology-enabled healthcare, and capacity building for families and local healthcare providers. RuralKidsGPS builds on a successful model of care—KidsGPS—developed by SCHN. Evaluation of this model within urban Sydney showed a 40% reduction in Emergency Department (ED) presentations and a 42% reduction in day-only admissions over two years, saving the health system $2.5million/annum and families >50,000km of travel. RuralKidsGPS will extend and evaluate the model across four rural LHDs: Murrumbidgee, Southern, Western, and Northern New South Wales. If proven acceptable and cost effective, RuralKidsGPS could be delivered to the nearly 100,000 children across rural NSW who live with a chronic medical condition. RuralKidsGPS received NSW health Translational Research Grant Scheme (TRGS) funding starting in July 2021.

The CYPHP is the largest paediatric health systems transformation program in the UK involving 120,000 children across two London boroughs. The trial is co-led by Prof. Lingam (UNSW) and Dr Ingrid Wolfe (Kings). Children receiving the CYPHP integrated model of care had a 13% lower non-elective admission rates compared to those receiving enhanced usual care. In addition, children in the CYPHP group had improved quality of life and improvements in clinical symptoms after the intervention. Importantly we found children registered with intervention practices were 50% more likely to be prescribed a spacer for their asthma compared with children registered in enhanced usual care practices. Children with severe asthma seen by the CHILDS service compared with those seen in primary care, were significantly more likely to have asthma action plans 76% versus 37%, and asthma control monitored 89% versus 53%. The program has been adopted across South Thames, presented in parliament, and informed the NHS plan for 2025.

Our work studying the myriad innovations created through COVID-19 was a unique opportunity to understand the healthcare system and select the best innovations e.g., telehealth for rural communities to upscale and mainstream in the future. We co-designed the Resilient Healthcare for Children framework that informed the NSW Covid-19 research response plan. Our work on Covid health services trends for respiratory illness was used by the US CDC and the UK winter planning initiatives; our work documenting the 55% increase in mental health presentations for children has led to increased NSW children’s community mental health funding.

Asthma is the most common cause of unscheduled hospital presentation in Australian children. Most of these hospital presentations can be prevented by comprehensive ongoing and planned care. However, our fragmented health system is failing to provide comprehensive asthma care which is further complicated by inequitable access to health care in vulnerable, marginalised populations like culturally and linguistically diverse (CALD) communities. Using “asthma” as an exemplar, CoMPAs is an Asthma Australia funded two arm randomised controlled trial and implementation evaluation, led by Dr Nusrat Homaira, that aims to evaluate the feasibility and efficacy of a comprehensive model of care to improve quality of life and reduce preventable paediatric hospital presentations within the largest CALD community of NSW. Facilitated by an embedded care-coordinator, the model of care connects all key stakeholders involved in a child’s asthma management and provides a personalised approach to asthma care. It builds upon our previous work at Sydney Children’s Hospital, Randwick in the Asthma Follow-Up Initiative, which utilised an integrated co-developed suite of interventions and resulted in a 60% reduction in number of asthmatic children presenting with acute asthma exacerbations to the emergency room. 

Asthma Care from Home is an NSW Health Translational Research Grant Scheme (TRGS) funded project, led by Dr Nusrat Homaira and Mrs Melinda Gray, focusing on 5-12 years olds discharged from hospital in Northern NSW LHD, Illawarra Shoalhaven LHD, Southern NSW LHD and Western NSW LHD following an asthma exacerbation. Based on our preliminary data, and leveraging our enhanced capacity for technology due to COVID-19, Asthma Care from Home aims to evaluate the impact, implementation and cost effectiveness of a comprehensive integrated technology enabled model of asthma care that a. supports families, communities and healthcare providers, b. is flexible and locally acceptable, and c. adopts innovations such as digital technologies so that asthma care can be provided ‘from home’ when necessary, thereby not only reducing the significant burden of potentially preventable asthma hospital presentations but also ensuring patients’ and families satisfaction with healthcare delivery. We hypothesize that our model of care will reduce asthma hospital presentations, improve asthma quality of life for children in rural NSW and be cost-effective.

The Growing Healthy Kids study delivers a comprehensive integrated weight management service to children in South West-Sydney where 98% of children in the service have severe psychological and social needs.

Alpha NSW aimed to create a health intelligence system that responds to the changing needs of the population. The project also aims to determine how frontline workers could benefit from a data analytic platform that informs service development and delivery. The final report has been submitted to the Ministry of Health.  

In partnership with the Murdoch Children’s Research Institute (MCRI), we led the project Evaluation of the Proof of Concept Child Digital Health Record (CDHR). The CDHR is an electronic version of the information captured in hardcopy baby books, such as the Blue Book in NSW. We have evaluated the process of developing a CDHR, which will store a child’s milestones, health, growth, development, and immunisations throughout early childhood (0-4 years). Our report considers the challenges encountered and the implications for product delivery with a view to informing future state and national rollouts.  

More than one million young Australians experience mental illness each year, and half of all young people experience at least one period of mental ill-health before the age of 25 Given the global burden of disease of youth mental disorders, there remains a need to examine how to improve care for this population. Integrated care has been posited as a potential solution, but there is limited evidence on how best to design, staff, and evaluate different models of integrated care for youth mental health. Through our systematic review of the literature on integrated youth mental healthcare we developed a framework that can form a basis for the development of well-articulated models of youth integrated mental health pathways, assisting services identify what operational changes are needed to best implement and sustain integrated care in their own context. Planned future work involving this framework includes using it to map the integration of primary, secondary, tertiary, public, and private youth mental health services within the Australian health system.

More than 2 million Australians will require transition from child to adult services over the next 20 years. Our pilot RCT evidence showed that structured transition interventions can increase adherence to care and use of adult health services. However, there are no national guidelines or standardised models of care for transition across Australia. Parents and young people have told us, through our ongoing consultation, that they need more structured help through the transition process. We aim to conduct an individual randomised controlled trial, across three states, to evaluate the effectiveness and cost-effectiveness of a structured paediatric-adult transition intervention (Transition Compass) for young people with chronic health conditions. Transition compass consists of in person transition coordination (up to 1-year pre-transfer to adult services and 1 year post transfer), behaviour change self-management training and long-term use of Perx, a digital care platform for condition self-management and behaviour change.