Mental Health Care in Pediatric Rehabilitation Hospitals: A Biopsychosocial, Collaborative, and Agency-based Service Integration Approach.

Background: Canadian hospitals are not currently prepared to meet the psychosocial needs of children with disabilities as services are rooted in a biomedical care model. Objective: To describe a practical and holistic framework for pediatric rehabilitation hospitals to meet the health care needs of children and their families. Method: An environmental scan was conducted of best practice guidelines, policy documents, and models of integrated mental health care. Recommendations from clinical guidelines and national strategy documents were incorporated to develop a service integration approach. Results: An agency-based approach was used to develop a two-phase biopsychosocial framework. In framework Phase I, reactive care is provided to mental health concerns. In Phase II, there is a shift to proactive care and mental health wellbeing. Conclusions: Emphasis is placed on capacity building of clinical staff into best practices for mental health care. Implementation needs and consideration for uptake of the framework are also discussed.

Caring for the healthcare professional.

Purpose Hospitals must systematically support employees in innovative ways to uphold a culture of care that strengthens the system. At a leading Canadian academic pediatric rehabilitation hospital, over 90 percent of clinicians viewed Schwartz Rounds™ (SR) as a hospital priority, resulting in its formal implementation as a quality improvement initiative. The purpose of this paper is to describe how the hospital implemented SR to support the socio-emotional impact of providing care. Design/methodology/approach This quantitative descriptive study provides a snapshot of the impact of each SR through online surveys at four assessment points (SR1-SR4). A total of 571 responses were collected. Findings All four SR addressed needs of staff as 92.9-97.6 percent of attendees reported it had a positive impact, and 96.4-100 percent of attendees reported each SR was relevant. Attendees reported significantly greater communication with co-workers after each SR ( p<0.001) and more personal conversations with supervisors after SR2 and SR4 ( p<0.05) compared to non-attendees. Attending SR also increased their perspective-taking capacity across the four SR. Practical implications As evidenced in this quality improvement initiative, SR addresses staff's need for time to process the socio-emotional impacts of care and to help reduce those at risk for compassion fatigue. SR supports and manages the emotional healthcare culture, which has important implications for quality patient care. Originality/value This research details an organization's process to implement SR and highlights the importance of taking care of the care provider.

Developing a Compassionate Culture Within Pediatric Rehabilitation: Does the Schwartz Rounds™ Support Both Clinical and Nonclinical Hospital Workers in Managing Their Work Experiences?

Schwartz Rounds™ offers an interprofessional forum for staff to openly engage in discussions about social-emotional aspects of care. We aimed to assess the perceived impact of Rounds in the health care context of pediatric rehabilitation, as well as a comparative analysis of how Rounds affected clinical versus nonclinical staff. Does effect on perceived outcomes was also investigated. Data were collected from 29 hospital staff (15 clinicians, 14 nonclinicians) who attended one, two, or three+ Rounds via semistructured interviews. Thematic analysis indicated impacts at the personal and social levels (e.g., reduced stress, increased level of approaching behaviors, normalizing and validating emotional experiences, and building bridges within the hospital). Data also revealed the novel finding of Rounds affecting professional knowledge and skills (e.g., interprofessional practice, reflective practice, clinical imagination). These findings elucidate how Schwartz Rounds™ is beneficial in a pediatric rehabilitation setting, albeit somewhat differentially for clinical and nonclinical staff.