HealthLit4Kids: Supporting schools to be health literacy responsive organisations.

ISSUE ADDRESSED: To reduce inequity, services and community organisations must respond to the health literacy needs and strengths of each individual accessing their services. As a social determinant, health literacy is compounded by interactions between the service provider, the individual, and their wider community. Schools provide a critical nexus between the teacher (as service provider), the student (as learner) and their family (carers and wider community) to support the development of children's health literacy. METHODS: Five Tasmanian primary schools (84 teachers) completed an assessment of their school in relation to the domains of a health literate organisation using the HeLLOTas! (HEalth Literacy Learning Organisations Tasmania) Self-Assessment Checklist, before and after taking part in the HealthLit4Kids program. RESULTS: While the differences between pre- and post-intervention ratings were not large, they moved in a positive direction for all six domains. There was a significant main effect of time, F (1, 4) = 83.9, P < .001, ƞ2  = 0.99, showing that overall ratings increased from before to after the intervention. Teacher-recommended actions across all schools were grouped for insight into their interpretation and application of the tool in the school context. CONCLUSION: Using the HeLLOTas! Self-Assessment Checklist served a dual purpose. Teachers developed a shared understanding of the characteristics of a health-literate organisation to produce a schoolwide action plan. Simultaneously, we gained valuable insights into the processes required to support the development of organisational health literacy in schools, and we share ten propositions applicable to other schools locally, nationally and internationally. SO WHAT?: To the best of our knowledge, this is the first time that a school's health literacy responsiveness has been measured. Our key propositions will support future efforts by policy makers, researchers and school principals.

Help is just a phone call away: after-hours support for palliative care patients wishing to die at home.

The 24-hour support for palliative patients is the gold standard of health care in Australia. However, in the state of Tasmania after-hours telephone support was spatially fragmented and inequitable. In 2014, hospice@HOME, a pilot programme introduced in Tasmania in that year, implemented a state-wide after-hours palliative care support service--1800HOSPICE--offering 24-hour support, 7 days a week for palliative patients, caregivers and the public. Six months of after-hours call logs in combination with additional patient data, were analysed to evaluate the use and wider implications of a state-wide after-hours palliative care support number. Family and caregivers mainly used the after-hours support to request changes to support services (25.1%), report changes in patients' overall condition (23.6%) and request acute medical assistance (16.2%). Through the use of the after-hours services by all individuals involved in the care, end-of-life patients were able to reduce ambulance contact and emergency department admission, and thereby increase their likelihood of dying at home (for patients whose preference was to die at home). Overall, 24-hour palliative care telephone support was found to be a valuable tool for all individuals involved in the care of end-of-life patients.

Social cognition in children with epilepsy in mainstream education.

AIM: To establish whether deficits in social cognition are present in children with generalized or focal epilepsy in mainstream education, and whether any relation exists between social cognition, communication, and behaviour measures. METHOD: In a cross-sectional study, children with an epilepsy-only diagnoses in mainstream education (n=20 with generalized epilepsy; eight males, 12 females; mean age 11y 6mo, SD 2y 6mo; and n=27 with focal epilepsy; 12 males, 15 females; mean age 11y 8mo, SD 2y 2mo) and comparison participants (n=57; 28 males, 29 females; mean age 11y 2mo, SD 2y 4mo) were administered the Strange Stories task and the Mind in the Eyes task, as well as an IQ assessment. Parents completed the Children's Communication Checklist-2 and the Child Behavior Checklist (CBCL). RESULTS: Both groups of children with epilepsy performed more poorly than control children on the Mental Stories component of the Strange Stories task, F(2,101)=3.2, p<0.001. Performance on Mental Stories was related to pragmatic communication, but only in the generalized epilepsy group (r=0.51, p=0.03, 95% CI=0.2-0.8). There were no differences between epilepsy groups or control participants in the Mind in the Eyes task, F(2,101)=0.4, p=0.4. INTERPRETATION: Children with 'epilepsy only' are at risk of deficits in social cognition and may require appropriate support.

Rehabilitation in severe head injury in children: outcome and provision of care.

Functional outcome and provision of care to 82 children (males:females 2.7:1; age range 0 to 16 years) with severe head injury were investigated. The children were admitted to the intensive care units of the Regional Neuroscience Units of the Greater Manchester and Lancashire districts of the North West Region of the UK between 1994 and 1996. A questionnaire was devised based on 12 areas of recovery and data were collected at discharge and 6 weeks, 6 months and 12 months from discharge. Data were collected during home visits and at joint assessment at 12 months with the district consultant community paediatrician (CCP). Early involvement of the CCP enhanced the provision of needs at discharge and 6 weeks after discharge, as did a period of stay in district-level care before discharge home. CCPs received formal notification of the injured child in only 32% of cases by discharge, and 54% of cases by 6 months. Sixty-five per cent of children required early educational support but structured help reached only 55% of these children by the end of the study. Integrated planning between health and education was achieved in about half of the study population. Good physical recovery was achieved by the majority of children but parents said they did not feel prepared for the degree of help which their child still required 12 months after discharge. Children who required anticonvulsants at 12 months' follow-up scored significantly lower on cognitive potential. Psychosocial family functioning deteriorated in a substantial number of families according to parental perception. Prevalence of this perception did not diminish over the study period. Aspects of caregivers' understanding and the child's language deficits, self-care skills, fine and gross motor performance, as well as family, social, and financial consequences were assessed. A dedicated and integrated approach to assessment and provision of care across the domains of hospital, education, and community is discussed.