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Child Health Guideline Identifier

Pain and functional disorders - inpatient rehabilitation

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Inpatient assessment and treatment service for children/young people with chronic, debilitating symptoms including pain and functional symptoms, and their families/whanau/caregivers

Overview

The Starship inpatient rehabilitation programme for pain and functional disorders provides diagnostic and management support to children/young people who have severely limited normal activity due to chronic pain or other functional symptoms. Admission for those who live outside the ADHB catchment area depends on resources being available within ADHB and a clear agreement with the patient's DHB of domicile about continuity of care before and after admission.

Model of care

Our model of care involves a multi-disciplinary, rehabilitation approach following assessment and treatment planning. This involves collaboration between services such as the Complex Pain Team, Psychiatric Consult Liaison Team, Allied Health, and other medical and surgical specialities as needed.

Treatment goals

Our goal is to help return children/young people to normal activity (physical, functional, social, and academic) over a prescribed period of time using a graduated, rehabilitation approach. This starts with admission and continues after discharge. The duration of admission will usually be 2 weeks but may be longer. Patients are admitted under the General Paediatric team.

Example of a typical admission (usually 2 weeks)

PHASE 1 - INITIAL ASSESSMENT & PLANNING
  • Review previous assessments and investigations
  • Undertake a period of assessment by Starship services including medical, functional, and psychological assessment
  • Soon after admission, start a daily timetable (link) to support mobilisation and develop a daily routine. This will be reviewed as part of developing a longer term treatment plan
  • If further investigation indicated, this may be done at Starship or on return to home DHB as appropriate
  • Meet with child/young person and their family/whanau/caregivers near the end of assessment phase and discuss the findings, and agree on a treatment plan
  • The treatment plan will include goals for daily activities, use of indicated medications, and defining expectations with regard to sleep patterns, use of screens/devices/phones, visiting by family and friends, and anything else relevant
  • The treatment duration and plan will be documented and signed as an agreement between the Combined Starship Services and the child/young person (if appropriate) and their parents/caregivers 
PHASE 2 - TREATMENT & DISCHARGE PLANNING
  • Commence the treatment plan with the child/young person as in inpatient at Starship
  • Support from the allied health team (psychology, physiotherapy, occupational therapy) will be dependent on availability. Involvement will vary as determined by individual needs and available resources
  • Discuss the treatment plan with the child/young person (if appropriate) and their parents/caregivers at weekly intervals
  • Timing of discharge will also be discussed at this stage
  • On discharge a treatment plan will be provided for the child/young person to continue at home or other venue seen as the most appropriate 

Requirements prior to acceptance for admission

  • Agreement from the child/young person's DHB of domicile to fund the admission
  • A named paediatrician at the child/young person's DHB of domicile to be responsible for the child/young person including care after discharge
  • Copies of previous assessments, investigations and opinions from other health professionals
  • Copy of recent school report(s)
  • An indication of the level of daily activity the child/young person is currently managing so that Starship clinicians have a starting point to establish a rehabilitation plan
  • Encourage child/young person and their family/whanau/caregivers to consider their goals for admission so these can be discussed early and used to develop the rehabilitation plan
  • To access this program, commitment from family/whanau/caregivers to the model of care outlined above is essential. This means family/whanau/caregivers must agree to involvement of all members of the multi-disciplinary team, and support the structured rehabilitation plan (including the daily & weekly plan).
  • Accommodation for family/whanau/caregivers off the ward will need to be arranged for those not domiciled in Auckland, or domiciled in distant areas of Auckland
  • Potential admissions under this program are discussed with the multi-disciplinary team prior to acceptance

Daily activity plan

At the core of our treatment program is a daily activity plan tailored to the needs and level of function of the patient. This starts as soon as possible after admission. An example of a typical daily plan follows.

Example daily plan

Referral information

Please see attached pdf for referral details.

PROCESS after contact from referring clinician

  • Explain process, and refer to this guideline
  • Do not commit to admission until discussed with MDT. Admissions are regularly discussed at the weekly MDT meeting on Wed at 2pm.
  • Work out capacity/availability/timing with charge nurse, CLT, Allied Health, Pain Team, other teams as appropriate
  • Ensure agreement from referring clinician - they can talk through the program and requirements in this guideline with family/whanau/caregivers, and confirm agreement with model of care
  • Determine who is going to be Starship primary paediatrician
  • Fill out referral details
  • Admissions are co-ordinated via Ward 25 Charge Nurse

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Document Control

  • Date last published: 02 August 2018
  • Document type: Clinical Guideline
  • Services responsible: Consult Liaison Psychiatry, General Paediatrics, Paediatric Pain Service
  • Owner: Greg Williams
  • Editor: Greg Williams
  • Review frequency: 2 years

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