From knowledge translation theory to practice: developing an evidence to care hub in a pediatric rehabilitation setting.

Purpose: Ensuring evidence-informed care happens systematically and consistently is not easy in complex health facilities. This paper describes the evolution of knowledge translation infrastructure (Evidence to Care) within a pediatric rehabilitation hospital to address barriers to evidence-informed decision-making and accelerate research uptake to influence clinical care.Methods: Development of Evidence to Care involved a series of steps integrating knowledge translation principles, best evidence and stakeholder needs. Key aspects included: recognizing health system drivers and organizational enablers; establishing organizational structures and processes; building and operationalizing a strategic vision through activities and demonstration projects; and evaluating impact.Results: By way of a fully realized working model, two large-scale demonstration projects aligned with the Knowledge-to-Action Cycle have been completed. Audit findings demonstrate tangible examples of improving healthcare quality through investment in knowledge translation resources, processes and tailored evidence products. Critical enablers of this infrastructure include strong leadership commitment and ongoing direction, a dedicated expert team, alignment with strategic priorities and situated within organizational structures to link research, clinical care and education.Conclusions: With a replicable model, Evidence to Care addresses established health system barriers related to time, resources, skill and knowledge through dedicated knowledge translation specialists and knowledge brokers to facilitate knowledge translation practice.Implications for rehabilitationDeveloping dedicated knowledge translation infrastructure is both novel and relatively new in healthcare.Sharing step by step processes helps other organizations learn from field-tested experiences of what works and what doesn't in a particular setting.Involving stakeholders at all levels of an organization is key to valuing knowledge translation and fostering an evidence-friendly culture.Co-creating tailored knowledge products and planning for dissemination and uptake fosters inter-disciplinary collaboration and joint problem-solving among clients, families and providers.

An Environmental Scan of Parent-focused Transition Practices between Neonatal Follow-up and Children's Rehabilitation Services.

Purpose: Identify parent-focused transition practices for parents of children born preterm/acutely ill when transitioning from Neonatal Follow-Up Programs (NFUP) to Children's Treatment Centers or Networks (CTCN).Methods: NFUP and CTCN health-care providers participated in an online survey and qualitative interviews. Quantitative data were analyzed using descriptive statistics and qualitative data underwent conventional content analysis.Results: 60 participants (17 sites) from diverse health disciplines completed the survey, and 14 (from 11 of 17 sites) participated in a follow-up interview. Enablers to transition included knowledgeable practitioners, shared services, and family engagement; although not present across all sites. Barriers commonly reported were a lack of time, understanding of roles, and parent engagement.Conclusion: Research study findings highlight the need to improve and bridge NFUP to CTCN parent-focused transition practices. Recommendations for next actions steps include improved cross-sector communication, bridging sectors through enhanced service provision, and moving from information provision to family engagement.

Exploring Student Food Behaviour in Relation to Food Retail over the Time of Implementing Ontario's School Food and Beverage Policy.

BACKGROUND: Canadian provincial policies, like Ontario's School Food and Beverage Policy (P/PM 150), increasingly mandate standards for food and beverages offered for sale at school. Given concerns regarding students leaving school to purchase less healthy foods, we examined student behaviours and competitive food retail around schools in a large urban region of Southern Ontario. METHODS: Using a geographic information system (GIS), we enumerated food outlets (convenience stores, fast-food restaurants, full-service restaurants) within 500, 1000 and 1500 m of all 389 regional schools spanning years of policy implementation. Consenting grade 6-10 students within 31 randomly selected schools completed a web-based 24-h diet recall (WEB-Q) and questionnaire. RESULTS: Food outlet numbers increased over time (p < 0.01); post-policy, within 1000 m, they averaged 27.31 outlets, with a maximum of 65 fast-food restaurants around one school. Of WEB-Q respondents (n = 2075, mean age = 13.4 ± 1.6 years), those who ate lunch at a restaurant/take-out (n = 84, 4%) consumed significantly more energy (978 vs. 760 kcal), sodium (1556 vs. 1173 mg), and sugar (44.3 vs. 40.1 g). Of elementary and secondary school respondents, 22.1% and 52.4% reported ever eating at fast food outlets during school days. CONCLUSIONS: Students have easy access to food retail in school neighbourhoods. The higher energy, sodium and sugar of these options present a health risk.

A whole new world: a qualitative investigation of parents' experiences in transitioning their preterm child with cerebral palsy to developmental/rehabilitation services.

BACKGROUND: Parents' experiences transitioning their children from neonatal to developmental/rehabilitation services (DRS) are unknown. METHODS: A qualitative descriptive approach was used, including interviews with 18 parents (13 mothers and 5 fathers) of children born preterm and diagnosed with cerebral palsy (CP), located in a large urban center in Canada. Interview data underwent thematic analysis. RESULTS: Parents' experiences with transition to DRS were a whole new world with three key themes: Wanting to know what to expect, feeling supported in their transition, and getting there emotionally and physically. Transition broke an emotional bond with neonatal services while parents were simultaneously entering DRS, experiencing their child's CP diagnosis, and reliving prior emotional trauma. CONCLUSIONS: The findings reveal a cumulative emotional burden for parents in the first 3 years of life; a known critical period for parenting and early childhood development. Early transition interventions should consider including enhanced supports and services for parents.

Screening and assessment of chronic pain among children with cerebral palsy: a process evaluation of a pain toolbox.

Purpose: Though high numbers of children with cerebral palsy experience chronic pain, it remains under-recognized. This paper describes an evaluation of implementation supports and adoption of the Chronic Pain Assessment Toolbox for Children with Disabilities (the Toolbox) to enhance pain screening and assessment practices within a pediatric rehabilitation and complex continuing care hospital. Methods: A multicomponent knowledge translation strategy facilitated Toolbox adoption, inclusive of a clinical practice guideline, cerebral palsy practice points and assessment tools. Across the hospital, seven ambulatory care clinics with cerebral palsy caseloads participated in a staggered roll-out (Group 1: exclusive CP caseloads, March-December; Group 2: mixed diagnostic caseloads, August-December). Evaluation measures included client electronic medical record audit, document review and healthcare provider survey and interviews. Results: A significant change in documentation of pain screening and assessment practice from pre-Toolbox (<2%) to post-Toolbox adoption (53%) was found. Uptake in Group 2 clinics lagged behind Group 1. Opportunities to use the Toolbox consistently (based on diagnostic caseload) and frequently (based on client appointments) were noted among contextual factors identified. Overall, the Toolbox was positively received and clinically useful. Conclusion: Findings affirm that the Toolbox, in conjunction with the application of integrated knowledge translation principles and an established knowledge translation framework, has potential to be a useful resource to enrich and standardize chronic pain screening and assessment practices among children with cerebral palsy. Implications for Rehabilitation It is important to engage healthcare providers in the conceptualization, development, implementation and evaluation of a knowledge-to-action best practice product. The Chronic Pain Toolbox for Children with Disabilities provides rehabilitation staff with guidance on pain screening and assessment best practice and offers a range of validated tools that can be incorporated in ambulatory clinic settings to meet varied client needs. Considering unique clinical contexts (i.e., opportunities for use, provider engagement, staffing absences/turnover) is required to optimize and sustain chronic pain screening and assessment practices in rehabilitation outpatient settings.

Support for healthy eating at schools according to the comprehensive school health framework: evaluation during the early years of the Ontario School Food and Beverage Policy implementation. / Soutien en faveur de l'alimentation saine dans les écoles conformément à l'approche globale de la santé en milieu scolaire : évaluation au cours des premières années de la mise en oeuvre de la Politique de l'Ontario concernant les aliments et les boissons dans les écoles.

INTRODUCTION: Provincial, national and international public health agencies recognize the importance of school nutrition policies that help create healthful environments aligned with healthy eating recommendations for youth. School-wide support for healthy living within the pillars of the comprehensive school health (CSH) framework (social and physical environments; teaching and learning; healthy school policy; and partnerships and services) has been positively associated with fostering improvements to student health behaviours. This study used the CSH framework to classify, compare and describe school support for healthy eating during the implementation of the Ontario School Food and Beverage Policy (P/PM 150). METHODS: We collected data from consenting elementary and secondary schools in a populous region of Ontario in Time I (2012/13) and Time II (2014). Representatives from the schools completed the Healthy School Planner survey and a food environmental scan (FES), which underwent scoring and content analyses. Each school's support for healthy eating was classified as either "initiation," "action" or "maintenance" along the Healthy School Continuum in both time periods, and as "high/increased," "moderate" or "low/decreased" within individual CSH pillars from Time I to Time II. RESULTS: Twenty-five school representatives (8 elementary, 17 secondary) participated. Most schools remained in the "action" category (n = 20) across both time periods, with varying levels of support in the CSH pillars. The physical environment was best supported (100% high/increased support) and the social environment was the least (68% low/decreased support). Only two schools achieved the highest rating (maintenance) in Time II. Supports aligned with P/PM 150 were reportedly influenced by administration buy-in, stakeholder support and relevancy to local context. CONCLUSION: Further assistance is required to sustain comprehensive support for healthy eating in Ontario school food environments.

INTRODUCTION: Les agences provinciales, nationales et internationales de santé publique reconnaissent l'importance des politiques en matière de nutrition en milieu scolaire, qui contribuent à instaurer des environnements sains respectant les recommandations en matière d'alimentation saine à l'intention des jeunes. Le soutien à l'échelle de l'école d'un mode de vie sain reposant sur les piliers de l'approche globale de la santé en milieu scolaire (milieux social et physique; enseignement et apprentissage; politique de santé en milieu scolaire; partenariats et services) a été positivement associé à des améliorations encourageantes des comportements des élèves en matière de santé. Notre étude a utilisé l'approche globale de la santé en milieu scolaire pour classifier, comparer et décrire le soutien à une alimentation saine lors de la mise en oeuvre de la Politique de l'Ontario concernant les aliments et les boissons dans les écoles (N P/P 150). MÉTHODOLOGIE: Nous avons recueilli des données provenant d'écoles élémentaires et secondaires consentantes d'une zone peuplée de l'Ontario à deux reprises, en 2012-2013 (période I) et en 2014 (période II). Des représentants des écoles ont rempli l'enquête Planificateur des écoles en santé ainsi qu'un document d'analyse environnementale de l'alimentation, qui ont fait l'objet d'une attribution de scores et d'analyses de contenu. Le soutien de chaque école en faveur d'une alimentation saine a été classé comme relevant de la phase « lancement ¼, « prise de mesures ¼ ou « maintenance ¼ du continuum des écoles en santé pour les deux périodes, et comme étant « élevé/en hausse ¼, « modéré ¼, « faible/en baisse ¼ entre la période I et la période II par rapport aux piliers de l'approche globale de la santé en milieu scolaire. RÉSULTATS: Ont pris part à l'enquête 25 représentants scolaires (8 écoles élémentaires et 17 écoles secondaires). La plupart des écoles sont demeurées dans la catégorie « prise de mesures ¼ (n = 20) au cours des deux périodes, avec des niveaux divers de soutien aux piliers de la santé en milieu scolaire. Le milieu physique a fait l'objet du soutien le plus élevé (100% de soutien « élevé/en hausse ¼), le milieu social a fait l'objet du soutien le plus faible (68 % de soutien « faible/en baisse ¼). Seules deux écoles ont atteint la plus haute note (maintenance) au cours de la période II. Les soutiens respectant la N P/P 150 semblent avoir été influencés par l'adhésion de l'administration, le soutien des intervenants et la pertinence du contexte local. CONCLUSION: Une aide supplémentaire est nécessaire pour maintenir une alimentation saine dans les environnements alimentaires des écoles ontariennes.

Beverages and snacks available in vending machines from a subset of Ontario secondary schools: Do offerings align with provincial nutrition standards?

OBJECTIVES: As part of an evaluation of Ontario's School Food and Beverage Policy (P/PM 150) in a populous Ontario region, this research aimed to: 1) identify, describe and categorize beverages and snacks available for purchase in secondary school vending machines according to P/PM 150 standards; and 2) compare the number and percentage of beverages and snacks within P/PM 150 categories (Sell Most, Sell Less, Not Permitted) from Time I (2012/2013) to Time II (2014). METHODS: Representatives from consenting secondary schools assisted researchers in completing a Food Environmental Scan checklist in Times I and II. Sourced nutritional content information (calories, fats, sodium, sugars, ingredients and % daily values) was used to categorize products. The number and percentage of products in P/PM 150 categories were compared between Times by paired t-tests. RESULTS: Of 26 secondary schools participating in total, 19 participated in both Time periods and were included in the study. There were 75 beverages identified (59 Time I, 45 Time II), mostly water, juices and milk-based beverages; and 132 types of snacks (87 Time I, 103 Time II), mostly grain-based snacks, vegetable/fruit chips, and baked goods. A majority of schools offered one or more Not Permitted beverages (47% Time I, 58% Time II) or snacks (74% Time I, 53% Time II). Significantly more schools met P/PM 150 standards for snacks (p = 0.02) but not beverages in Time II. CONCLUSION: Full P/PM 150 compliance was achieved by few schools, indicating that schools, school boards, public health, and food services need to continue to collaborate to ensure nutrient-poor products are not sold to students in school settings.

Chronic Pain Assessment Tools for Cerebral Palsy: A Systematic Review.

BACKGROUND AND OBJECTIVE: Chronic pain in children with cerebral palsy (CP) is underrecognized, leading to detriments in their physical, social, and mental well-being. Our objective was to identify, describe, and critique pediatric chronic pain assessment tools and make recommendations for clinical use for children with CP. Secondly, develop an evidence-informed toolbox to support clinicians in the assessment of chronic pain in children with disabilities. METHODS: Ovid Medline, Cumulative Index to Nursing and Allied Health Literature, and Embase databases were systematically searched by using key terms "chronic pain" and "clinical assessment tool" between January 2012 and July 2014. Tools from multiple pediatric health conditions were explored contingent on inclusion criteria: (1) children 1 to 18 years; (2) assessment focus on chronic pain; (3) psychometric properties reported; (4) written in English between 1980 and 2014. Pediatric chronic pain assessment tools were extracted and corresponding validation articles were sought for review. Detailed tool descriptions were composed and each tool underwent a formal critique of psychometric properties and clinical utility. RESULTS: Of the retrieved 2652 articles, 250 articles met eligibility, from which 52 chronic pain assessment tools were retrieved. A consensus among interprofessional working group members determined 7 chronic pain interference tools to be of importance. Not all tools have been validated with children with CP nor is there 1 tool to meet the needs of all children experiencing chronic pain. CONCLUSIONS: This study has systematically reviewed and recommended, through expert consensus, valid and reliable chronic pain interference assessment tools for children with disabilities.