AI Support of Teamwork for Coordinated Care of Children with Complex Conditions

Children with complex health conditions require care from a large, diverse set of caregivers that includes parents and community support organizations as well as multiple types of medical professionals. Coordination of their care is essential for good outcomes, and extensive research has shown that the use of integrated, team -based care plans improves care coordination. Care plans, however, are rarely deployed in practice. This paper describes barriers to effective implementation of care plans in complex care revealed by a study of care providers treating such children. It draws on teamwork theories, identifying ways AI capabilities could enhance care plan use; describes the design of GoalKeeper, a system to support providers use of care plans; and describes initial work toward information sharing algorithms for such systems.Engineering and Applied Science

Information Sharing for Care Coordination

Teamwork and care coordination are of increasing importance to health care delivery and patient safety and health. This paper describes our initial work on developing agents that are able to make intelligent information sharing decisions to support a diverse, evolving team of care providers in constructing and maintaining a shared plan that operates in uncertain environments and over a long time horizon.Engineering and Applied Science

Patient and family experiences with peri-operative care for spinal fusion surgery

Children with medical complexity (CMC) require increased number and length of hospitalizations, and increased need for care coordination.1-3 Many complex children with neuromuscular diseases have scoliosis, or a deformity of the spine. Often, scoliosis in these patients affects multiple organ systems and requires spinal fusion surgery to repair the deformity and decrease the likelihood of further organ damage.4,5 While it is well-known that spinal fusion surgery is costly and a high-risk procedure, little research has evaluated the perioperative process of spinal fusion patients. Furthermore, few care pathways exist for medically complex patients undergoing spinal fusions.6 This study examines the pre-, peri-, and post-operative experiences of families of patients undergoing spinal fusion surgery at Boston Children’s Hospital. Providers, organization, leadership and teamwork, and overall outcomes are assessed by this qualitative study. Initial data suggest that a pathway improving coordination and communication, especially among interactions with the surgical coordinator, should be implemented to improve scheduling of surgery and appointments throughout the perioperative proces

"It's all about relationships": the place of boarding schools in promoting and managing health and wellbeing of Aboriginal and Torres Strait Islander secondary school students

Introduction: In recent years, Australian government policies have promoted access to secondary education through boarding schools for Aboriginal and Torres Strait Islander (hereafter respectfully termed Indigenous) students from remote communities. These students experience the poorest health of any Australian adolescent group. This exploratory study examines how boarding schools across Queensland promote and manage healthcare and wellbeing support for Indigenous students. Methods: Qualitative grounded theory methods were used to sample and collect data from the healthcare and wellbeing support staff of eight Queensland boarding schools using semi-structured interviews. Data were coded using NVIVO software and compared to identify the context, conditions, core process, strategies and outcomes of boarding schools' healthcare and wellbeing support. Preliminary findings were fed back to school staff and students' family members for discussion and response at an annual Schools and Communities meeting. Results: Boarding school health staff support Indigenous student-centred healthcare and wellbeing by weaving a relational network with students, families, school staff and external healthcare providers. Either through on-site or school-linked centres, they provide students with access to healthcare services, support wellbeing, and offer health education. Through these strategies, they enable students' participation in education and learning, receive quality healthcare improvement, "move to a better head space", and become responsible for their own healthcare. Enabling conditions are the professional and cultural capabilities of school staff, school leadership and commitment, compatibility of intersectoral systems and resourcing of healthcare and wellbeing support. Conclusions: Boarding schools are doing considerable work to improve the promotion and management of healthcare and wellbeing support for Indigenous students, but there is considerable variation across schools, impacts are not formally monitored or reported, and there are many opportunities for improvement. Working towards a best practice framework, school staff identified a need for a multi-levelled relational model of healthcare and wellbeing support to be iteratively embedded at each stage of the school cycle: at intake; enrolment; term one; and throughout the school year (including in emergencies/crises)

An Appreciative Inquiry of an Exemplary Hospice Interdisciplinary Group Caring for Individuals With Alzheimer’s Disease

Alzheimer’s disease is a debilitating illness that is the 6th leading cause of death among the elderly. The treatment of Alzheimer’s requires multiple interventions due to the complexity of the disease. The interdisciplinary group (IDG) model of care is considered a best practice for patients’ medical management (Molyneux, 2001). The IDG focuses on a holistic approach, which includes both patients and their caregivers. The IDG in hospice consists of professionals from different clinical disciplines whose collaborative knowledge and skills assist in caring for patients and their families. This study focused on what works well in an exemplary IDG, using appreciative inquiry as to the method of inquiry. Data were collected from 6 participants of an exemplary IDG caring for patients diagnosed with Alzheimer’s disease. The data were analyzed using the appreciative inquiry 4-D cycle: Discovery, Dream, Design, and Destiny. In the Discovery phase, 10 themes emerged, showing the connection to the Dream phase. The Dream phase led into the Design phase, focusing on provocative propositions, which bridge the best of what is with what might be. This then connected with the Destiny phase, bringing the dreams of the future to the present. I found that what works well with this exemplary IDG is the connection to other members of the team and the larger system; dedication; commitment; and valuing of team members, their patients, and patients’ families. The findings suggested the need for increased training of marriage and family therapists for IDG settings as the systemic thinking of marriage and family therapy appears to be a good fit for the IDG

From Care Plans to Care Coordination: Opportunities for Computer Support of Teamwork in Complex Healthcare

Children with complex health conditions require care from a large, diverse team of caregivers that includes multiple types of medical professionals, parents and community support organizations. Coordination of their outpatient care, essential for good outcomes, presents major challenges. Extensive healthcare research has shown that the use of integrated, team-based care plans improves care coordination, but such plans are rarely deployed in practice. This paper reports on a study of care teams treating children with complex conditions at a major university tertiary care center. This study investigated barriers to plan implementation and resultant care coordination problems. It revealed the complex nature of teamwork in complex care, which poses challenges to team coordination that extend beyond those identified in prior work and handled by existing coordination systems. The paper builds on a computational teamwork theory to identify opportunities for technology to support increased plan-based complex-care coordination and to propose design approaches for systems that enable and enhance such coordination.Engineering and Applied Science

THE REALIZED AND EXPECTED EARLY CHILDHOOD INTERVENTION PRACTICES IN LITHUANIA

Inclusive early childhood practices are at the forefront of the research and practice efforts in many European countries. Inclusion in early childhood programs can set a trajectory for inclusion across the life course, making it critical that we include individuals with special educational needs in all facets of society from birth. In many European countries, including Lithuania, children with special educational needs and their families continue  facing significant barriers to accessing inclusive high-quality early childhood practices and too many pre-school children with special educational needs and disabilities continue  receiving special education services in separate settings, as opposed to the least restrictive environment. The aim of the research was to assess the realized and expected early childhood intervention practices while educating children with diverse needs in inclusive pre-school settings. The study was based on a survey using the instruments of Recommended Practices in Early Intervention/Early Childhood Special Education. The instrument includes the following topic areas: leadership, assessment, environment, family, instruction, interaction, collaboration, and transition

System upgrade: realising the vision for UK education

A report summarising the findings of the TEL programme in the wider context of technology-enhanced learning and offering recommendations for future strategy in the area was launched on 13th June at the House of Lords to a group of policymakers, technologists and practitioners chaired by Lord Knight. The report – a major outcome of the programme – is written by TEL director Professor Richard Noss and a team of experts in various fields of technology-enhanced learning. The report features the programme’s 12 recommendations for using technology-enhanced learning to upgrade UK education

Teacher Leadership to Enhance Day Treatment Services

Day treatment classrooms offer alternative educational programming for students who cannot attend regular classrooms due to their need for mental health care and treatment. The unique design of day treatment classrooms combines individualized educational programming provided by publicly funded teachers and mental health treatment provided by workers from a children’s mental health agency. The Problem of Practice (PoP) aims to increase the leadership capacity for an elementary teaching team providing day treatment services within a children’s mental health organization. The special education teacher and the academic programming of the student receives limited attention within the wider multidisciplinary team as the mental health treatment goals are prioritized, unintentionally overriding the educational goals. Too little is known about the current conditions under which this elementary teaching team in day treatment classrooms provide effective special education programming to its students. Emergent and authentic leadership approaches are examined within the existing distributed and team leadership style of the organization and critically analyzed through Nadler-Tushman’s Congruence Model. This Organizational Improvement Plan (OIP) utilizes Appreciative Inquiry (AI) as its guiding organizational change framework to communicate the need for change and implement the change plan to enhance networking, collaboration, and communication with both school-based and non-school based stakeholders