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Strong Application Example.

The first 1,000 days of life are a critical window in which the brain’s ability to change is highest, and the possibility of reducing severity and impact of disability is maximized, especially in children with Targeted Disease (TD).

TD is the most common cause of childhood physical disability (1 in 700 Australians). Access to early diagnosis of TD enables early evidence-based intervention and improved outcomes. In Western Australia (WA), the early diagnosis of TD is now possible for babies from 12 weeks of age, and with support from the PCHF our team have established a world-leading early intervention service for high-risk babies, ensuring early diagnosis of TD and improved outcomes. However, early detection of TD does not exist beyond the inner-metropolitan area, meaning babies at-risk are falling through the gaps in our health system.  

TD is the third most costly health condition in Australia (3) and costs increase with severity of TD (4). For children with TD in Australia socio-economic disadvantage at birth has recently been shown to be associated with more severe and complex TD (5). Of concern we also know the rate of post-natal TD in indigenous people is three times the rate of caucasians (6). This confirms that many children with TD particularly those with the greatest need for early diagnosis and intervention services are most likely to have the least financial resources available and to live in neighbourhoods with fewer services.  

Unfortunately, children with TD in rural and remote areas, those with the greatest need for early diagnosis and intervention are most likely to have the least financial resources available and live in areas with fewer services. It is vital that we build systems that detect children with TD and other common impairments early, promote early responsive parenting and support parent mental health at this very difficult time. We propose the development of a sustainable state-wide teaching and training model of care (MOC) for the early detection of TD, activity which is not funded by the Department of Health or the NDIS. 

Comment: This response while abbreviated provides details on the cohort, the urgency of proposed intervention, any inequalities for access to intervention/healthcare and current funding constraints. Words in bold are particularly relevant. 

Improvement is required when a response which does not include or is not clear on the following points and add needs further information to clarify relevant issues:

  • The issue you are addressing is described in a manner so that an educated non-clinical person could be expected to understand it. If the issue is related to a particular health condition, then a brief explanation of the condition and the impact on children would be helpful, such as morbidity and mortality rates, loss of function e.g.
  • Details on cohort including the number of children in WA currently affected by this issue. Is it getting worse and why? Any co-morbidities? Is the prevalence higher in some groups compared to others? Difference in prevalence depending on age, gender etc
  • Where is the current gaps in healthcare, are some groups of children not accessing treatment for this condition, are clinicians not able to offer the highest standard of care without this funding e.g.
  • Highlight any issues relating to accessibility and equality of healthcare, this may be relevant for rural and remote areas
  • Include statistics or links to supporting evidence
  • The gap in what the Government funds to help address this problem

The importance and urgency of this particular project obtaining funding so it can be implemented.

How will your proposed solution effectively address the paediatric health issue(s) identified in your project in lay terms? 

There is an urgent need to implement change within our health system in response to the evidence. The solution to addressing the issues of inequity for regional and remote families in WA and building resources for families is the establishment of a state-wide at-risk TD network Model of Care (MOC). This will enable all children and parents in WA access to early detection and diagnosis of TD to ensure evidence-based early intervention and maximised outcomes for children and their families. The proposed TD MOC network will be multi-directorate and state-wide, encompassing key clinical partners across CAHS (Neonatology, Child and Adolescent Community Health) and beyond (Western Australia Country Health Services). We are seeking funding to pilot the roll out of this network in one WACHS region to establish proof of concept and ensure the MOC can be implemented in full as efficiently as possible. The scaled-up network is designed to be self-sustainable after 3 years.  

Objective: Establishing the TD MOC. To implement education and training in early diagnosis tools for clinicians in one pilot region of Western Australia. 

  • What will we teach? The Clinical Practice Guidelines summarising best-available evidence for making an accurate early diagnosis (9) 
  • To whom will we educate and train? Consumers and practicing health professionals involved in the diagnosis of TD in rural and remote areas of WA, including neurologists, paediatricians, neonatologists, paediatric rehabilitation specialists, general practitioners, psychiatrists, physiotherapists, psychologists, occupational therapists, speech pathologists, nurses and early educators. 
  • By whom? A specialised PCH team, with clinical expertise in implementing the Clinical Practice Guideline will be responsible for delivering education and training. 

Comment: This response while abbreviated restates the importance of the proposed project and provides an outline of the solution with clear objectives. It also links the solution (establishment of MOC) directly to the problem (access to treatment). 

Improvement is required when a response which does not include or is not clear on:

  • Intro summary of the problem introduced above
  • A description of what you are asking PCHF to fund, how long it will take to implement and how it will be sustainable after (and how long it will take to reach sustainability)
  • Objectives (what are you planning to do, how long will it take?)
  • How many children (specify cohort) will benefit from this project 
  • How will you measure success? In what timeframe?
  • For a research project provide clear research question/s, methodology and protocol

The establishment of the WA MOC of teaching and training in the selected region will generate outcomes for babies and their families, the local health workforce and Perth Children’s Hospital. Details on the specific outcomes of the project are listed in Table 1, attached

  • For babies and families, we will increase the number of babies at-risk of TD who are identified early and referred to early intervention services early. This will ensure that they are benefitting from early intervention at a critical time in their development.
  • Families will benefit from increased support by fast-tracking referrals to other appropriate services. This will give caregivers access to mental health support and access to a network of other families in a similar situation. This will help them manage the burden of disease better.

Improvement is required when a response which does not include or is not clear on: 

  • Who will benefit and how
  • Linking the proposed solution to the outcome
  • Outcomes without clear timelines and KPIs
  • How the outcomes will be tracked
  • Capacity building will be measured by the number of health professionals trained in early detection of TD with the expectation that an additional 50 staff will be trained within 12 months.
  • Direct impact on children will be measured by:
    • the number of children diagnosed with TD expected to be 30 within 6 months of the project start 
    • the mean age of diagnosis, which is expected to be reduced from 36 to 12 months by the end of the 12-month project
    • Expected increase in well-being on a long-term basis
  • Impact on families will be measured by the percentage being referred to and using appropriate support services with the expectation that 60% more families will be referred to and use appropriate support services.

Comment: This response while abbreviated states clear expected outcomes. Additional details can be included in a table attached to the application.

Improvement is required when a response which does not include or is not clear on: 

  • The specific outcomes you are measuring
  • The expected outcomes (number, percentage e.g.)
  • Clear timelines

The planned intervention will provide positive changes for paediatric health in WA with the support of external funding. There are two main ways in which this intervention has a positive impact:  

  1. The intervention is patient-centred and patient-focused. It is expected to help minimise distress and minimise the likelihood of the patient developing paediatric medical traumatic stress. The clinician providing services will be responsive to patient need and impart knowledge and education to families and staff regarding the use of this intervention.
  2. The intervention is process-focused and strategies such as the development of a clinical register and continuous improvement through the implementation of evidence-based techniques and equipment will increase efficiency and identify key areas for improvement. This will ensure that the patients will always receive the best treatment available at any time.

Comment: This response while abbreviated states clear planned impact in specific areas.  

Improvement is required when a response which does not include or is not clear on: 

  • The specific areas of impact you expect
  • The expected impact, such as improved mental health, reduced length of stay etc

This model of care is innovative, as this is the first time this treatment method and patient care model has been implemented in an Australian hospital. 

Or 

This equipment has never been used for this purpose in an Australian public hospital before. 

Or 

This research will investigate the effectiveness of a new intervention never before used for this condition for this cohort worldwide. 

Improvement is required when a response which does not include or is not clear on: 

  • Project not a WA, Australia or World-first
  • This study has been undertaken elsewhere
  • This has been funded by the Government before
  • The equipment has already been purchased by CAHS before.

Please refer to the Hints & Tips for timeline and budget information. 

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