Key contacts
Hannah Zhu (hannah.zhu@nhs.net) – Kingston
Kingston team: Isabel Ng (SHO), Joanna Morris (Consultant), Sarah Bidgood (ANNP), Phoebe Cotterill (ANNP), Nicola Vaughan (Nurse in charge), Hind Thomas (Senior Nurse in charge), Jamie Patel (Nurse Educator), David Mummery (GP)
Guddi Singh (guddi.singh@nhs.net), Kiran Rahim – Newham
Emma Sunderland (emma.v.sunderland@gmail.com) – Hackney
Akudo Okereafor (aokereafor1@gmail.com) – North Middlesex
This project was piloted in Kingston Hospital with data pending from multiple centres listed above.
Introduction
Poverty is the most important determinant of child health in the UK, associated with adverse health, developmental, educational and long-term social outcomes. Paediatric nurses and doctors feel powerless when faced with child poverty, with training gaps and underdeveloped pathways leading to missed opportunities to help poor families. To meet this need, we used QI methodology to develop clinical screening tools and resources for addressing poverty in clinical practice.
SMART objectives
AIM:
By June 2019, >80% of paediatricians in the paediatric assessment unit (PAU) to screen for child poverty and offer local resources when appropriate.
MEASURES:
- Percentage of paediatricians per shift who screened for child poverty for the last patient they assessed on PAU.
2. Percentage of paediatricians per shift who were aware of local poverty resources
3. Resources given and patient feedback
Progress made: What have you learned from doing this?
Stakeholders co-designed tailored screening questions, in addition to identifying established poverty risk factors including: single parent, unemployment, >3 children, chronic health conditions and social worker involvement. Our bespoke, local child poverty leaflet (with resources that increase income, provide essentials and increase participation) was offered when appropriate.
Screening questions:
Nurses: “How did you get to hospital/how will you get home?”
Doctors: “Have you been on holiday in the last year, UK or abroad?”
At baseline, no doctors or nurses screened for child poverty or signposted to relevant local resources. Plan-do-study-act (PDSA) cycles tested screening questions and resource leaflets while improving stakeholder buy-in. Screening for child poverty increased from 0% to 89% in 2 months (March-May 2019), with resource awareness increasing from 0% to 100% in the same period. Qualitative patient feedback has been positive e.g.“Thank you for being to thoughtful, you really helped me”. Further work will include capturing the resources are accessed by families, adapting this to different sites and ongoing sustainability.
| Test # |
PLAN |
Do |
STUDY |
ACT |
|
1 |
Brainstorm screening questions for child poverty |
Practise asking questions and reflect on how this felt |
Most questions too direct, need more context |
Refine with senior colleagues and patients |
|
2 |
Focus group of senior nurses who know local area well |
Screening developed to be used with family and social history |
Non-intrusive, high yield questions |
Implement screening questions |
|
3 |
Design, teach and display local MDT resources |
Screening and knowing resources 0% to 50% |
Doctors feel that it’s stimatising giving “poverty” resources, 3 leaflets given |
Disseminate in clinical and waiting areas, review leaflet phrasing and design |
|
4 |
Increase awareness and compliance |
Email, texts, removed “poverty” from leaflet 50 to 89% |
Screening better, 100% resource awareness, 15 leaflets given |
Improve confidence in offering resources |
EXAMPLE CASE:
Dad brought a 5 month old baby to A&E at 3am with an URTI. Dad was very stressed about getting home since he would have to take 2 buses. Family history: mum has postnatal depression, has not touched baby for 1 week, 2 other young children at home. Social history: dad gave up work (in a factory) to look after mum and baby, no income or family support nearby, no holidays in the last year. Dad is very worried he will not be able to support his family when their money runs out.
Signposted to: Citizen’s Advice, HomeStart, Welcare, Relate
Additional referrals: health visitor, social services, GP
What’s your take home message?
Our project shows a dramatic improvement, from zero to almost 89%, in screening and 100% in resource awareness for child poverty amongst paediatricians in 2 months. This is an example of how we can all use quality improvement to play a role in helping families fight poverty in our clinical practice.
Resources?
- RCPCH Health Policy Team, State of Child Health Report 2017: www.rcpch.ac.uk/resources/state-child-health-2017-full-report
- RCPCH and Child Poverty Action Group, Poverty and Child Health: Views from the Frontline 2017: www.rcpch.ac.uk/resources/poverty-child-health-views-frontline
- http://www.4in10.org.uk/
- https://www.bacaph.org.uk/advocacy/child-poverty-introduction