80 Outcomes Evaluation of an Inter-Disciplinary Hospital-Based School Program for Elementary School Children with Tertiary Complex Learning Difficulties: A Pilot Study

Children with learning problems use significant amounts of health resources, and care is complicated by its interface with the education system. There are few published outcome studies of effective treatment programs for young children with complex learning problems requiring interdisciplinary care. This pilot study examined two standardised questionnaires for assessing family-centred behaviours of health care providers: Measure of Processes of Care-20 (MPOC-20) for families, and Measure of Processes of Care for Service Providers (MPOC-SP) for staff. Program-specific outcome measures were also evaluated.

All children, aged 4.5 to 8 years (n=44) with complex learning difficulties were recruited on admission during the first term of an inter-disciplinary, hospital-based day school program which had been recently redesigned to increase access. Parent outcomes, including MPOC-20 and a parent program-specific questionnaire (PPSQ), were obtained 8 weeks after transition back to the community school. PPSQ addressed self-rated advocacy, knowledge of child's needs, ability to use child-specific strategies, and satisfaction with transition. Responses were rated on a 1–5 point scale (5=satisfaction, eg high level of confidence or perceived success). Staff outcomes, including MPOC-SP and staff program-specific questionnaire (SPSQ) based on a similar 5 point scale were obtained at the end of the first program year.

Parent response rate for both measures was 18.2%. Mean total MPOC-20 score was 4.97±2.07SD (1–7 point scale, where 7=exemplary care). Mean PPSQ score was 4.17+/–1.21 SD with advocacy 4.13±1.15 SD, knowledge 4.06±1.48 SD, strategies 4.45±0.81 SD, and transition satisfaction 3.92±1.50 SD. Staff response on the MPOC-SP was 70.0% with a mean score of 5.34±1.43 SD. Mean staff score on the SPSQ was 3.49±0.97 SD.

Both parent and staff MPOC scores indicated that the redesigned program was meeting needs for family-centred care from a “moderate” to a “fairly great” extent. Although response rate was low, parent MPOC scores were in keeping with reports in the literature (range 4–6) for children with other disabilities, suggesting that MPOC-20 may be a valid assessment tool in this population. Parent satisfaction was highest for ability to use strategies and lowest for transition process. Staff MPOC scores were similar to parent scores, although satisfaction on SPSQ was lower. Results serve as a baseline against which outcomes of future program redesign can be assessed. Further study of these measures in this patient population with a larger, more complete sample is indicated, particularly for the parent group. Follow-up over time will determine if short-term improvements are maintained.